Carbon flow in four lake ecosystems: a structural approach.

Direct and indirect carbon fluxes in lakes Marion (British Columbia), Findley (Washington), Wingra (Wisconsin), and Mirror (New Hampshire) are compared, using budgets and input-output analysis. Overall differences in carbon flow between the lakes are shown with cycling indices of .031, .108, .572, and .661, respectively. The results suggest that lake ecosystems may be considered unique aggregatins of similar components.

A yeast model reveals biochemical severity associated with each of three variant alleles of galactose-1P uridylyltransferase segregating in a single family.

Classic galactosaemia is a potentially lethal inborn error of metabolism that results from profound impairment of galactose-1P uridylyltransferase (GALT). Like many autosomal recessive disorders, classic galactosaemia demonstrates marked allelic heterogeneity; many if not most patients are compound heterozygotes. Owing in part to the fact that most GALT mutations are never observed in patients in the homozygous state, in part to concerns of possible allelic interaction, and in part to the broad range of GALT activity levels associated with the affected, carrier, and control states, definition of the specific functional consequence of individual variant GALT alleles from studies of clinical samples alone can be a challenging task. To overcome this problem we previously developed and applied a null-background yeast system to enable functional analyses of human GALT alleles expressed individually or in defined pairs. We report here the application of this system to characterize three distinct variant alleles of GALT identified within a single family. Of these alleles, one carried a missense mutation (K285N) that has previously been reported and characterized, one carried a nonsense mutation (R204X) that has previously been reported but not characterized, and the third carried a missense substitution (T268N) that was novel. Our studies reported here reconfirm the profound nature of the K285N mutation, demonstrate that the R204X mutation severely compromises both expression and function of human GALT, and finally implicate T268N as one of a very small number of naturally occurring rare but neutral missense polymorphisms in human GALT.

Academic psychiatry in the political marketplace.

There is pressure for all medicine to be publicly accountable and for there to be public manifestations of professional responsibility. The expectation of an immediate return on the public's investment in education is matched by cries for"relevence" in research. The generation and transmission of psychiatric knowledge is not compatible with such a direct telelogic approach. Yet, public accountability is necessary, considering the public monies involved. Academic psychiatry should become familiar with the political marketplace--a high-pressure environment where fiercely competing interests vie for the politician's attention through votes and contributions, and where the "squeaky wheel gets the grease". Psychiatry can ill afford to adopt a passive posture in this political marketplace. Psychiatrists bear responsibility for informing the public about the relevance of psychiatric research and education. The profession must accept--even embrace--the concept of public accountability as a synchronous extension of our professional responsibilities.

Medical students' attitudes about psychiatry. Implications for psychiatric recruitment.

A questionnaire study of 204 senior medical students at two East Coast schools revealed that most were favorable about psychiatry and psychiatrists. When queried concerning criticisms, many stated doubts about the scientific rigor, therapeutic efficacy, and appropriate roles of psychiatrists. Psychiatric clerkships strongly influences student attitudes. Students were especially pleased with opportunities to work directly with patients and to observe psychiatrists doing so. Students were negatively influenced by the antipsychiatry views of nonpsychiatric faculty, house staff, and peers. The findings are discussed with reference to various explanations for the recent decline in psychiatric recruitment and a connection with the rise of family practice is proposed. Direct confrontation of student criticisms, questions, and misconceptions about psychiatry and advocacy of the special expertise and practice opportunities may improve both students' attitudes and psychiatric recruitment.

The development of criteria for evaluating psychiatric education programs.

During the last year, the Psychiatry Education Branch of the National Institute of Mental Health undertook an exhaustive review of 530 training proposals from 205 institutions. The scope of such an endeavor, as well as the desire to maintain peer review, necessitated the recruitment of 90 outside consultants. The need for consistency of judgment among a large group of site visitors gave rise to a document that detailed points of concern in the evaluation of psychiatric training programs. Broader dissemination of this document might be useful in a program's self-evaluation, and might further its understanding of the site-visit process. The result of many such evaluations should be the improvement of psychiatric education throughout the country.

Psychiatry in crisis.

Psychiatry today faces sociopolitical, economic, and philosophical pressures that threaten its existence as a valued medical specialty. Recent legislation that decreases the numbers of foreign medical graduates eligible to practice in the United States, increases the numbers of community mental health centers and types of services they offer, and limits federal support of psychiatric education will affect the future of psychiatry as a profession and discipline. Forthcoming legislation and federal health policies will be related to the ability of the profession to demonstrate its unique role in the provision of mental health and health services. The authors offer suggestions for the education of the American public regarding the important role of psychiatry in America's health and mental health care system.

Administrative relationships between community mental health centers and academic psychiatry departments.

The authors reviewed the administrative relationships between academic departments of psychiatry and community mental health centers (CMHCs). By telephone, they surveyed the chairpersons of 110 departments of psychiatry with approved psychiatric residency programs and found that 87 (79%) had some type of administrative relationship with a comprehensive CMHC. Almost two-thirds of the chairpersons of these departments considered the CMHC to be of major importance to their educational programs. Only 8 (7%) of the 110 departments had discontinued their relationship with a CMHC. Most of the chairpersons whose departments were involved with a center were optimistic about the future of their programs in CMHCs.

Psychiatric education: state of the art, 1976.

The authors describe an extraordinary review of 527 programs in 205 institutions conducted by the Psychiatry Education Branch of NIMH. Each institution was evaluated by 2 site visitors, whose findings were reviewed by a group of 12 special consultants. These consultants voted on approval of grant applications and assigned priorities to those which were approved. Direct results of the review included approval of 69% of the programs, increased support of programs in medical student education, consultation-liaison psychiatry, and psychiatric investigation, but a decrease in the total number of institutions supported. Indirect results were the encouragement of self-evaluation in each program reviewed, the valuable exchange of ideas among the educators involved in the review process, and implications for future reviews. The authors, who believe that psychiatric education is in good health, discuss the findings of this review in terms of the future of the field.

Administrative relationships between state hospitals and academic psychiatry departments.

To review administrative relationships between academic departments of psychiatry and state hospitals the authors sent a questionnaire survey to chairmen of the 115 psychiatry departments in the United States with approved residency programs, receiving responses from 98 (85%). They discuss three types of relationships and examine the nature of the training of university residents in state hospitals, providing suggestions for integrating service-oriented settings such as state hospitals into an academic psychiatry program.

Medical students' evaluation of psychiatry: a cross-country comparison.

The authors reviewed studies of attitudes toward psychiatry held by 368 medical students at the University of California, Los Angeles (UCLA), and 204 senior medical students from two schools in Washington, D.C. They found that the attitudes of all these students were remarkably similar: they viewed psychiatry as a worthwhile medical specialty but one of low prestige and low precision and thought that most psychiatric patients could be adequately managed by non-physicians. On the basis of their findings the authors offer recommendations for teaching basic psychiatric skills and for improving psychiatry's image and attractiveness.

The educational challenge of consultation-liaison psychiatry.

The authors examine issues related to quality of psychiatric consultation-liaison education programs on the basis of data from the fiscal year 1975 NIMH review of grant proposals for 71 such programs. This category received the lowest percentage of approval (31 approved, 40 disapproved), which is seen as a reflection of the state of development of the field. Although this is a difficult field in which to teach and practice, the authors feel that the numbers and quality of consultation-liaison programs will grow over the next 10 years and that the proliferation of training programs for primary care physicians and the return of psychiatry to the mainstream of medicine will facilitate this growth.

The VA psychiatry service as a setting for residency education.

The authors report data from a survey of chairmen of academic departments of psychiatry and chiefs of Veterans Administration (VA) psychiatry services concerning administrative relationships between academic psychiatry departments and VA psychiatry services and the education of psychiatry residents in VA settings. The extent and quality of relationships, the interdependence of academic departments and VA psychiatry services, factors important for good VA training, and advantages and disadvantages of using the VA for residency education are documented. The authors present their conclusions and recommendations for improving the quality of relationships between academic departments and VA psychiatry services and for strengthening psychiatric education in the VA setting.

Administrative relationships between community mental health centers and academic psychiatry departments: a 12-year update.

OBJECTIVE: The authors investigated the administrative relationships in 1990 between medical school departments of psychiatry and community mental health centers (CMHCs). METHOD: A 20-item questionnaire was sent to the chairpersons of the 110 medical school departments of psychiatry with accredited psychiatric residencies. RESULTS: Sixty-nine percent of the chairpersons responded to the questionnaire. Sixty-eight percent of the responding chairpersons reported that their departments had relationships with CMHCs, and 90% of these relationships involved the education of psychiatric residents. Most responding chairpersons described the quality of their existing CMHC relationships as good to excellent. In the most common type of relationship reported the CMHC was used as a setting for resident education. The vast majority of responding chairpersons stated that quality resident education is possible in a CMHC, and about two-thirds of the responding chairpersons with CMHC relationships involving residency education rated the CMHC rotation as of major importance to their residency programs. CONCLUSIONS: CMHCs continue to be an important and valued component of the educational experience for many psychiatric residents, and many departments of psychiatry have recognized the advantages and benefits of CMHCs for residency training. There are now considerable data on how a relationship between a medical school department and a CMHC should be structured to achieve maximum benefit for both the department and the CMHC.

Financing of child psychiatry pediatric consultation-liaison programs.

Child psychiatrists and pediatricians recognize the importance of providing psychosocial care for children and their families in medical settings. Consultation-liaison and behavioral pediatric programs provide most of the training in this area. Twenty-nine pediatric consultation-liaison program directors participated in an initial and follow-up telephone survey about their programs. In the 5 years between the surveys, there was a drastic reduction in federal funding for these programs. The findings include a change in the number and composition of both staff and trainees. There were major shifts in the financial support of the programs. The programs were involved in fewer activities and in more restricted settings at the time of the follow-up survey. Financing of pediatric consultation-liaison programs plays a major role in shaping the structure and function of the programs.

Psychiatry and the primary care physician.

Psychiatry makes an important contribution to the training and practice of primary care physicians by emphasizing a holistic approach to patient care, by teaching psychiatric skills and by providing knowledge that enables primary care physicians to give basic psychological care to the large numbers of their patients who need it. Consultation-liaison psychiatry and psychiatry education programs for medical students, both of which are given high priority for support by the Psychiatry Education Branch of National Institute of Mental Health (NIMH), are model settings in which to teach the psychiatric aspects of primary care.

The CMHC as a setting for residency education.

The authors review four approaches chairmen of departments of psychiatry have used to attempt to ensure quality resident education in CMHCs they do not control. Several examples are presented of administrative problems that may develop in this type of relationship. Based on this material and the author's experience, a four stage administrative process is presented which emphasized clear identification of goals and objectives, negotiation of a relationship that is beneficial to both the development and the CMHC, development of a written contract, and careful monitoring and evaluation of its progress. Designing a relationship in this fashion offers maximum opportunity for programmatic success.

A ten-year update of administrative relationships between state hospitals and academic psychiatry departments.

OBJECTIVE: In a follow-up to a survey ten years earlier, the authors investigated current administrative relationships between academic departments of psychiatry and state hospitals. METHODS: A 20-item questionnaire was sent to the chairs of the 110 medical school departments of psychiatry with accredited psychiatric residencies. RESULTS: Eighty-two departments, or 75 percent, responded. Seventy-one percent of the respondents reported that their department had a relationship with a state hospital; 79 percent of these relationships involved the education of psychiatric residents. Most respondents rated the quality of the relationship favorably (4 or 5 on a 5-point scale). Almost all respondents believed that residents can obtain a high-quality education in a state hospital. More than half of the departments responding to a question about the importance of a state hospital rotation rated it of major importance in their residency program. CONCLUSIONS: Many medical school departments of psychiatry remain closely involved with state hospitals and recognize the hospital as an important part of residents' education. Administrators have gained much experience about how to develop and implement mutually beneficial relationships.