Starting volumes from 50mL upwards are applicable, and again high

Starting volumes from 50mL upwards are applicable, and again high pressures are used for disruption of multilamellar systems. The system

works in a pressure range of 0–200 bar and is equipped with this website heating and cooling systems to control sample temperature during processing [43]. The liposome suspension passes the exchangeable orifices several times (up to thousands of passes). Liposomes are formed in the size range from 50 to 100nm by this process. This technique is suitable for large-scale production and sterile liposome preparation. In contrast to the microfluidizer, where the fluid stream is split and mixed by collision in a mixing chamber, homogenizers work on a different principle. In a homogenizer, the fluid Inhibitors,research,lifescience,medical beam is pressed

with high pressure through an orifice, and this beam collides with a stainless steel wall. The liposome suspension is continuously pumped through the homogenizer system, where high pressures are generated to downsize lipid vesicles [44]. The most prominent scalable downsizing method is Inhibitors,research,lifescience,medical the extrusion. Size reduction is managed under mild and more reproducible conditions compared to those discussed above. In this method, preformed vesicles are forced through defined membranes by a much lower pressure as described in the French press method. Extrusion through polycarbonate filters was first published by Olson et al. in 1979 [45]. Mayer et al. Inhibitors,research,lifescience,medical [19] performed extensive studies on varying lipid compositions and the influence on extrusion behavior and membrane properties. Depending on the apparatus and scale, the diameters of these membranes range from 25 to 142mm. Lipex Biomembranes Inc., now Northern Lipids Inc., invented a vessel system for extrusion which is marketed Inhibitors,research,lifescience,medical from the mL scale to several liters. As suggested for all downsizing methods, liposomes should be extruded above the Tc of the lipid composition; this system can be tempered. The Lipex extruder system is available in a jacketed mode to allow extrusion at higher temperatures. An alternative is the Maximator device, established Inhibitors,research,lifescience,medical by Schneider et al. [46]. It is a continuous extrusion

device 4-Aminobutyrate aminotransferase working with a pumping system. The Maximator consists of a thermostable glass supply vessel directly connected to a pneumatic high pressure piston pump. The latter is driven by either oxygen or nitrogen at pressures below 0.5MPa (5 bar or 75psi). The propellant gas does not come into contact with the liposome suspension. The resulting operating (extrusion) pressure—which can be adjusted via the reduction valve in the control device for the propellant gas (3)—can be as high as 12MPa (120 bar or 1800psi) with the current equipment. All the presented extrusion methods have in common that the reproducibility of downsizing is extremely high. Systems with a heating device can either be used with saturated and unsaturated lipids and are; therefore, all purpose systems.


addition it has been recently proven to exert synergis


buy SCR7 addition it has been recently proven to exert synergistic effects with prednisolone in the mdx mouse (69). A more detailed assessment of its mechanism of action in dystrophic is currently ongoing in our laboratory. The possibility to sustain muscle metabolism via drugs able to mimic the beneficial effects of exercise, without the mechanical stress, are also providing interesting results (70, 71). However, a possible pathology-related Inhibitors,research,lifescience,medical alteration of these pathways can in fact contribute to the damaging action of exercise in dystrophic muscle; this needs to be clarified for validating these pathways as drug targets. As anticipated in previous paragraph, stimulation of regeneration is another important mechanism, Inhibitors,research,lifescience,medical although must be paralleled by reduction of degeneration to avoid rapid exhaustion of satellite cells. Evaluation of regeneration efficiency requires a detailed evaluation

of the proportion of centronucleated fibers and the detection of specific markers of myogenesis. Due to the cross-talk between damage and regenerative pathways, such an estimation in muscle of mdx mice that already Inhibitors,research,lifescience,medical have a high level of regeneration is not always a simple task (6). Conclusion The mdx mouse is extensively used for pre-clinical evaluation of therapeutics in dystrophinopathies. The great efforts devoted to standardize the approaches may help to enhance translation of data from mouse to humans, which remains however a delicate task. Preclinical Inhibitors,research,lifescience,medical scientists should be aware of the great expectation of novel therapeutic for these severe diseases and caution should be used when concluding about potential efficacy in mdx mice as a proof of therapeutic

outcome in patients, especially when related to drugs of easy access. Assessment of interest to move a potential candidate towards clinical trials requires strictly controlled studies, dedicated head-to-head evaluation of similar Inhibitors,research,lifescience,medical drugs, and the multi-disciplinary evaluation of data package by expert panels, such as of the TREAT-NMD Advisory Committee for Therapeutics. Nonetheless, the mdx mouse is a valuable tool, when properly used, and largely contributed to enhance our understanding and approach to this rare pathology. Acknowledgements Related research in the author’s laboratories was made possible by funding from Italian Telethon and Dutch Parent Project. The author wishes to thank all colleagues contributing to research in this field, and especially Dr. Anna Cozzoli, Dr. Roberta Francesca Capogrosso and Dr. Valeriana Sblendorio for dedicated and timeless efforts during the last years.
DMD certainly has a remarkable position amongst all hereditary muscle disorders.

The centrocyte-like lymphocytes are CD20 positive, and both atyp

The centrocyte-like lymphocytes are CD20 positive, and both atypical lymphocytic and plasmacytic populations will stain strongly with IgA heavy chain, with absence of light chain staining (7). Molecular abnormality Much like H. pylori associated MALT lymphoma, IPSID appears to arise from monoclonal overgrowth secondary to chronic immune stimulation by an infectious organism in this case by C. jejuni (7). Deletions of alpha

heavy chain gene are observed which lead to expression of a faulty heavy chain that precludes binding of light chain to form an intact immunoglobulin molecule (7,41). Prognosis In the early phases, the disease may completely resolve following antibiotic therapy; Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical however, transformation to DLBCL is not uncommon (7). Diffuse large B cell lymphoma (DLBCL) DLBCL of the gastrointestinal tract is an aggressive lymphoma which may

arise de novo or from transformation of another lymphoma, commonly MALT lymphoma. It constitutes 40% to70% of all gastric lymphomas, more commonly Inhibitors,research,lifescience,medical affecting males with a median age range of 50 to 60 years (1,2). Pathogenesis No definite risk factors have been identified, although some evidences suggest that this neoplasm may arise in a background of atrophic gastritis, particularly in the setting of immunodeficiency. Foci of DLBCL may be found in MALT lymphomas, ranging from small number of transformed cells to predominant large cell population with minimal residual MALT lymphoma (2). Distinction of the latter from DLBCL can be difficult, and may require correlation of identical rearranged immunoglobulin (Ig) genes with co-existent low-grade MALT Inhibitors,research,lifescience,medical lymphoma (1). Morphology and immunophenotype DLBCL is characterized by large lymphoid cells, with nuclei greater than twice the size of a small lymphocyte, and frequently larger than nuclei of tissue macrophage. The tumor cells are medium to large Inhibitors,research,lifescience,medical sized cells and contain round, oval, or slightly irregular nuclei with vesicular nuclear chromatin, prominent nucleoli, and ample Megestrol Acetate amount of basophilic

cytoplasm (Selleck Syk inhibitor Figure 3, left), and show a moderate to high proliferation index as evident by tumor cell nuclear positivity for Ki-67 immunostain. In most cases, the predominant cells resemble either large centroblasts or immunoblasts; nonetheless, a mixture of these two cell types is also commonly encountered. Histologically, there is an intense cellular infiltration of the lamina propria. Figure 3 DLBCL (left), large tumor cells with vesicular chromatin, prominent nucleoli and moderate to abundant amount of cytoplasm (H&E, 400×). The image on the right shows a Burkitt lymphoma with the characteristic “starry sky” … Transformed MALT lymphomas may be distinguished from de novo germinal center DLBCL by immunophenotype.

However, the protein complex was mainly excreted after two hours

However, the protein complex was mainly excreted after two hours in contrast to IGF-1/NP which accumulation in liver was over 17%ID/g at the same time point. It has been shown that intravenously administered mesoporous silicon microparticles loaded with siRNA encapsulated into nanoliposomes accumulate into the liver and spleen, but remain in the sinusoidal space, enabling sustained release of siRNA-loaded nanoliposomes [52]. Inhibitors,research,lifescience,medical In our other studies we have analyzed behavior of I-125 labeled thermally hydrocarbonized mesoporous

silicon nanoparticles in liver using combined data of autoradiography and electron microscopy [53]. Similar nanoparticles as used in this study were seen in hepatic veins and sinusoids but not internalized into macrophages or hepatocytes. In addition, Bimbo et al. reported that THCPSi nanoparticles are not phagocytes in extent by CaCo-2 or RAW 264.7 macrophages Inhibitors,research,lifescience,medical in vitro. Instead they showed a strong cellular association as majority of the nanoparticles remained attached to cell membranes [54]. We suggest that IGF-1/NP is intact in the liver and IGF-1 may be released during the 240min studied, whereas IGF-1/IGFBP-3 is cleared trough

hepatic system. This can be seen as steadier IGF-1 release in blood compared IGF-1/NP to IGF-1/IGFBP-3 and is also in accordance with our Inhibitors,research,lifescience,medical in vitro results. More stable release of IGF-1 conjugated to NPs can be achieved as compared to protein complexes. The doses used in our study have been the same as in experimental autoimmune encephalomyelitis Inhibitors,research,lifescience,medical mice where positive effects on inflammatory, demyelinating, and demyelinated lesions have been seen when using IGF-1 [55]. Relatively low levels of IGF-1 with or without IGFBP-3 or nanoparticles accumulated to the brains in all studied time points. The amount

crossing the BBB might, however, be sufficient to affect the physiological functions and modulate neuroendocrine and behavioural responses. The sustained release to blood and low tissue concentrations of IFG-1 delivered with nanoparticles may decrease the side effects like hypoglycemia without Inhibitors,research,lifescience,medical losing the therapeutic effect. Low blood and tissue concentrations together with constant and sustained release may be beneficial for the continuous Etomidate IGF-1 therapy for INCL. In summary, we have studied the biodistribution and pharmacokinetics of human IGF-1 administrated free or VEGFR inhibition complexed to its natural binding protein IGFBP-3 or nanoparticles in infantile neuronal ceroid lipofuscinosis (INCL) mouse model. IGF-1 conjugated to nanoparticles accumulated and also remained in liver probably in the hepatic veins and sinusoids at high concentration in contrast to IGF-1/IGFPB-3 complex which dissociated and was actively excreted via kidneys and liver during studied time points. Since IGF-1/NP level also in blood decreased moderately compared to IGF-1/IGFBP-3 this data demonstrates steadier release of IGF-1 in to the circulation and longer bioavailability of IGF-1.

In the long term, after adequate treatment, of medical conditions

In the long term, after adequate treatment, of medical conditions enhancing somatic risks, no absolute contraindications are acknowledged (conditions including higher somatic risks are

described in Table II). In addition, every other untreated severe medical and life-threatening anesthesiological risk has to be taken into account. If treated insufficiently, these conditions become relative contraindications, Inhibitors,research,lifescience,medical and an individual and interdisciplinary benefit/risk analysis has to be performed for each learn more patient. In general, each factor enhancing the risk for ECT or anesthesia should be taken into consideration. In case of the described specific risks interdisciplinary counseling may be necessary. Afterwards the higher somatic risk has to be compared with the

risk of an insufficiently treated or prolonged psychiatric illness. Patients and relatives or responsible legal guardians have to be informed about rislcbcnefit ratios Inhibitors,research,lifescience,medical to contribute to a shared decision. Conclusion ECT is a nonpharmacologic biological treatment which has been proven to be a. highly effective treatment option predominantly for depression, but also for schizophrenia in a variety of controlled investigations. This is not. onlytrue in acute treatments; ECT can also be used for relapse prevention during maintenance therapies. In addition, the safety and tolerability Inhibitors,research,lifescience,medical of electroconvulsive treatment have been enhanced by using modified stimulation

techniques and by progress in modern anesthesia. During recent Inhibitors,research,lifescience,medical years, clinical conditions considered as absolute contraindications for EXT in former times became relative contraindications. Thus, today a. safe treatment can also be offered to patients with higher somatic risks. Recent research has contributed to an enhancement of the knowledge of possible mechanisms of action of ECT and to a. safe and well tolerated treatment, Inhibitors,research,lifescience,medical but unfortunately the final clarification of the underlying crucial mechanisms still remains unresolved. Nevertheless, this highly effective therapeutic option should L-NAME HCl not. kept, back, especially from patients suffering from psychiatric illnesses which arc unresponsive to other treatments. ECT still represents an important option in the therapy of treatment-resistant depression. Thorough information provision in hospitals, and also the growing objective and unbiased information in the press and other media, could contribute to fighting the prejudice and stigma of psychiatric disorders and specific therapies such as ECT. Select abbreviations and acronyms C-ECT continuation ECS electroconvulsive shocks ECT electroconvulsive therapy GABA γ-aminobutyric acid Contributor Information Thomas C. Baghai, Dept of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany. Hans-Jürgen Möller, Dept of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany.

) Mixed-effects models can include all data from participants, ev

) Mixed-effects models can include all data from participants, even those who terminate the study prematurely.7,8 Analyses of the sensitivity of results to the assumptions

of the analytic model are useful components of a data analysis plan. These can include use of pattern-mixture models26,27 and the assessment and application of predictors of attrition such as the two-item Intent to Attend questionnaire.28 A second observational component of an RCT is the flexible-dose study, in which those who l’ail to respond to a low dose are then offered a greater dose of the intervention. Such a design is inappropriate for dose finding because “self-selection” Inhibitors,research,lifescience,medical determines dose. Fortunately, the use of clinical trial flexible dose RCTs is more limited today than two or three decades ago. The problem of flexible dosing can be obviated by conducting a fixeddose study that allows Inhibitors,research,lifescience,medical lor a brief period of titration.29 In summary if conditions allow, a RCT is preferable for intervention evaluation. However, there are clinical contexts and patient types that do not lend themselves

to randomized treatment assignment (eg, suicidal patients). In such a case, an observational study can inform treatment choice if an appropriate adjustment, such as the propensity score adjustment, is implemented. Regardless of the design, the generalizability of the results is restricted to the type of participants Inhibitors,research,lifescience,medical included in the study. Acknowledgments Dr Leon has received Inhibitors,research,lifescience,medical research support from the National Institute of Mental Health (MH060447, MH068638 and MH092606). In the past 12 months he has served on independent Data and Safety Monitoring Boards for AstraZeneca, Pfizer and Sunovion and has been a consultant to FDA, NIMH, MedAvante and Roche. He has equity in MedAvante.
Depression occurs commonly, but not inevitably, in patients with cancer at the end of life. Although there are over 7 million cancer deaths Inhibitors,research,lifescience,medical around the world each year,1 estimates of the prevalence of depression in terminally ill cancer patients are imprecise. Most studies of comorbid cancer and depression either make no

distinction between cancer phases (eg, newly diagnosed, active treatment, survivorship, stable metastatic disease, end-stage) or fail to operationally define “end-of-life” care. Consequently, reported prevalence rates SB-3CT for depression in patients with cancer span a broad range. Best estimates are that between 15% and 50% of cancer patients experience depressive symptoms, and 5% to 20% will meet various diagnostic criteria for major depressive disorder.2-7 Similarly, few data are available with respect to the frequency with which cancer patients are appropriately treated for depression at the end of life.8,9 Only a small number of controlled clinical trials have been conducted with depressed cancer patients, whether or not they are in a terminal phase of their illness.

coli-specific The annotation and validation of all the implie

coli-specific … The annotation and validation of all the implied prokaryotic interaction data and protein complexes is nontrivial. One important way to achieve this is to make them accessible by a Wiki, for instance, the “SubtiWiki” or the “WikiPathways”. These Wikis

provide a knowledgebase for the Gram-positive model bacterium Bacillus subtilis [19], Inhibitors,research,lifescience,medical or pathways in general [20]. The SubtiWiki includes the companion databases SubtiPathways [21] and SubtInteract with graphical presentations of metabolism, its regulation, as well as protein–protein interactions and complexes, and is highly recommended as an exemplary resource to study systems biology of protein complexes in bacteria. Moreover, protein modifications have to be charted. They influence protein complex formation, and removing or adding a protein modification allows corresponding protein complexes to change with time. An important mechanism is phosphorylation. Interacting proteins may specifically bind to these protein

modifications or only bind if these modifications are absent. Thus, Van Noort et al. [22] Inhibitors,research,lifescience,medical compared this mechanism with other posttranscriptional regulatory mechanisms in M. pneumoniae. This organism is particularly suited for such studies because it encodes only two protein kinases and one protein phosphatase. This fact allows an elegant identification of the protein-specific Inhibitors,research,lifescience,medical effects on the phosphorylation network using specific deletion mutants. Van Noort and co-workers also considered changes in protein abundance and lysine acetylation [22]. Introduction of the mutations did not alter the transcriptional response, but deletion of the two putative N-acetyltransferases affected protein phosphorylation, which demonstrates Inhibitors,research,lifescience,medical the cross-talk between the two posttranslational modification systems. Phosphoproteome studies were also reported for B. subtilis. Jers et al. [23] identified nine previously unknown tyrosine-phosphorylated proteins in B. subtilis, and the majority of these were at least in vitro PtkA substrates. 2.2. Metabolic Adaptation and Protein Complexes For growth, intracellular model pathogens

rely on different metabolic Inhibitors,research,lifescience,medical resources and exploit suitable protein complexes for Digestive enzyme their utilization and thus regulate metabolism accordingly. Therefore, comparing the wild-type S. aureus strain 8325 and the isogenic deletion mutants (either lacking the eukaryotic-like protein serine/threonine kinase PknB or the phosphatase Stp, [24]) remarkable differences were found. Those differences were in nucleotide metabolism and cell wall precursor metabolites, such as peptidoglycan and cell wall teichoic acid biosynthesis in S. aureus. This phosphatase and the kinase are also antagonistic players in central metabolism, affecting enolase, triose phosphate isomerase, fructose biphosphate aldolase, Tyrphostin B42 order pyruvate dehydrogenase, phosphate acetyl transferase, and others. Similarly, S. aureus pathogenicity potential depends on the iron status of the host [25].

Timing of Bone Marrow Transplantation in Leukemia Allogeneic tran

Timing of Bone Marrow Transplantation in Leukemia Allogeneic transplantation in first remission, in general, is recommended as the standard approach for patients at high risk for relapse with conventional therapy. Without doubt, allogeneic transplantation provides the most efficacious anti-leukemic therapy due to the potent graft-versus-leukemia (GVL) effect, and data have confirmed that allogeneic transplantation

confers the lowest relapse rate for every subtype of AML. The high transplant-related Inhibitors,research,lifescience,medical morbidity and mortality is the only reason for not offering this to every patient with ALL or AML. In essence, this is a delicate balance between JAK phosphorylation efficacy and toxicity.16 One of the most important issues relates to the timing of transplant. The foremost question among practitioners and patients is, given the high procedural mortality, should such a procedure be preferably reserved for patients in second complete remission or at relapse? Such considerations are Inhibitors,research,lifescience,medical bolstered by data demonstrating reasonable survival if transplant is performed in second remission (Figure 12). Given the high non-relapse mortality in allogeneic transplantation, such transplantation may sway patients Inhibitors,research,lifescience,medical away from transplant in first remission. While there is no doubt that allogeneic transplantation can be performed successfully in second

complete remission, such reports are highly selective and confined to a small group of patients who have survived the relapse, achieved a second complete remission and were fit enough to undergo a trasnsplant, and for whom a donor was available. This represents a small minority of patients. If one considers the overall survival for all relapsed patients, this is no more than about 10%.17,18 Inhibitors,research,lifescience,medical Thus, presenting the optimistic data of second complete remission (CR2) to patients at diagnosis is thoroughly misleading and clearly needs to be avoided. Inhibitors,research,lifescience,medical Figure 12 Acute leukemia overall survival following second remission transplant. INTENTION-TO-TREAT ANALYSES Phase

III studies, representing prospective randomized trials, are the gold standard, especially when analyzed by intention to treat. However, it is crucial to understand the limitations of such analyses. For example, phase III studies of transplantation usually underestimate the toxicity of the procedure because the donor arm is diluted by the number of patients who do Phosphatidylinositol diacylglycerol-lyase not receive the transplant. They may also underestimate or overestimate efficacy depending on whether transplant is better than the comparator group. Furthermore, intention-to-treat analyses from diagnosis do not provide information for individual patients, as specified time points. Importantly, a generic issue of transplant studies relates to the large number of patients who do not undergo the assigned or randomized procedure. Any intention-to-treat analysis can only be reliably assessed if patients actually receive the treatment specified in their assignment or randomization.

However, no clear etiological model has been defined POCD may li

However, no clear etiological model has been defined. POCD may likely be of multifactorial etiology, with many factors contributing

small effects to the added risk. Future studies will hopefully shed light on these factors and their Interactions.
Dementia is one of the major causes of loss of autonomy, and the main reason for the Institutionalization of the elderly. Epidemiological studies conducted in the last 10 years have shown that the prevalence of dementia is close to 5% in the population over 65 years of age. These studies Inhibitors,research,lifescience,medical have also shown that its prevalence increases sharply with age, and as a result of the expected shift in population demographics, the incidence and prevalence of dementia are expected to increase dramatically over the coming decades. The number of demented patients worldwide is projected to increase from 243 million in 2001 to 81.1 million in 2040.1 Significantly, Inhibitors,research,lifescience,medical the vast majority of new cases are expected to appear in developing countries. For example, the number of demented persons in China and India will increase by 300% during this period.1 Inhibitors,research,lifescience,medical Prevention and management of dementia are therefore a major public health challenge in the majority of countries around the world. As a general rule, the occurrence

of dementia is not a sudden phenomenon. It is the final stage of cognitive Inhibitors,research,lifescience,medical deterioration, the speed of which varies from one individual to the other. However, even in cases where its development is rapid, the process is measured in terms of months. Taking into account the life expectancy of individuals at risk, retarding the development of dementia for a few months may have important consequences on the prevalence of dementia.2 Such expectations have been raised in recent Inhibitors,research,lifescience,medical years with the discovery of a relationship between hypertension and dementia. Overall, published studies suggest that high blood pressure increases the risk

of cognitive decline and dementia, and therefore, that lowering blood pressure might reduce this risk. This paper will review the evidence for this, and will discuss some of the important questions that remain unanswered. Hypertension and cognitive decline: evidence from observational Mephenoxalone studies It has been known for decades that there is a direct, causal relationship between high blood pressure and the risk of stroke, and therefore the risk of dementia (Figure 1). It is common knowledge that large strokes or multiple strokes contribute directly to cognitive decline and to the risk of dementia, consequently called vascular dementia. However, it is only in the past 10 years that studies have reported that hypertension may be related to cognitive decline and dementia without the signaling pathway occurrence of a stroke. Figure 1. Diagrammatic representation of the consequences of hypertension on the brain.

Most patients are unwilling to take depot medications so their

Most patients are unwilling to take depot medications so their

use in outpatient settings is somewhat less than in the West (the most commonly used depot medications are haloperidol decanoate and fluphenazine decanoate). Nonadherence is even more of a problem in China than in the West; very few patients remain on medication for more than 1 year after an initial Inhibitors,research,lifescience,medical admission. As part of the new reform era (that started in 1978), hospitals in China have been forced to become economically self-sufficient; the state is no longer willing to pay for services that arc not profitable. This change has decreased the willingness of hospital administrators to expend personnel and resources to provide cost-effective (but n unprofitable) community services. Prior to the mid-1980s most psychiatric hospitals provided extensive outreach (“home-bed”) services to Inhibitors,research,lifescience,medical help schizophrenic patients avert hospitalization, but the need to become economically self-sufficient has forced hospitals to cut back on services that reduce GSK-3 inhibitor hospitalization rates. Similarly, family therapy for schizophrenia47,48

and group psych oeducati on for relatives of schizophrenic patients49 Inhibitors,research,lifescience,medical are cost-effective ways of reducing rehospitalization in China, but psychiatric hospitals (the only source of the personnel who could provide these services) are reluctant to employ family therapy methods in their outpatient departments because this change would reduce overall hospital revenues. Inhibitors,research,lifescience,medical Community-based services Social welfare services for disabled persons in China experienced a renaissance during the 1980s, largely initiated and sustained

by the efforts of the All China Disabled Persons’ Federation under the direction Inhibitors,research,lifescience,medical of Deng Pufang, Deng Xiaoping’s disabled son. A comprehensive range of legislation during this period recognized the extent of the problem of the disabled in the country, established the rights of the disabled and the responsibility of the state to provide for their care and employment, and set out a plan for their rehabilitation. As part of Megestrol Acetate this movement, psychiatric rehabilitation was transformed from a low-status activity limited to “industrial therapy” for chronically institutionalized patients to a high status activity that provided mental health professionals with access to funding and support that were not previously available.50 In the absence of a culture-specific theory of psychiatric rehabilitation, the indigenous models that evolved over this period were based on vague notions about the benefits of repetitive practice and social support; they involved collective activities rather than individualized assessment and skills-training.