Selecting and evaluating a collection agency.
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Biomedical subjects
Publications and source records attributed to R B Taylor.
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In scarcely more than 30 years, the People's Republic of China has progressed from limited health care available only to a privileged few to a countrywide system providing basic services to one fifth of the world's population. The author gives his impressions of the current situation, based on a recent visit.
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The photosensitive affinity label NAP (4-azido-2-nitrophenyl) was used to make a stable covalent-bonded monomeric immune complex (Ag2Ab) between rabbit anti-NAP antibody and a bihaptenic compound containing NAP linked to fluorescein (NAP-aminocaproyl-lysyl-Fl). This complex injected into mice had marked effects on their subsequent response to fluorescein coupled to a thymus-independent carrier (Fl-ficoll). Depending on the time at which the complex was administered relative to challenge, it was possible to obtain either enhancing or suppressive effects. The enhancing but not the suppressive effect of complex was dependent on immune recognition of the rabbit IgG carrier. While the suppressive effect probably results from complex-mediated inactivation of T-independent B cells, it is suggested that the enhancing effect results from priming of the T-dependent B cells by Fl-Ficoll followed by their triggering into antibody production by rabbit IgG-specific helper cells.
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A high-performance liquid chromatographic separation of proguanil, cycloguanil and 4-chlorophenylbiguanide is reported using a hydrophobic stationary phase and lauryl sulphate as pairing ion. It is suggested, on the basis of the behaviour of phenylbenzoate as an undissociated solute and the variation of retention with lauryl sulphate and sodium ion concentrations that the mechanism of separation is one of ion exchange. The biguanides can be detected in serum at concentrations in the region of 60 ng ml-1 and preliminary results are presented to show the variation of proguanil in serum over a 24-h peroid following ingestion of 200 mg orally.
Abuse of readily available, widely advertised drugs like the salicylates often challenges the family physician. But self-medication by the patient may be only part of the problem. This case dramatizes the hazards of "knee jerk" therapeutics and the critical importance of the three C's of primary care.
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Spleen cells from B6 mice injected with fetal calf serum (FCS) could be kept proliferating as a continuous cell line in vitro provided they were culture in the presence of irradiated syngeneic spleen cells and FCS. Cells in this cell line showed a strong proliferative response when stimulated with concanavalin A (Con A), and they were able to mediate the following functions: (1)they helped the generation of alloantigen-specific cytotoxic T lymphocytes (CTL) from thymocyte-spleen cell mixed lymphocyte cultures (MLC), (2)they induced the generation of CTL from normal syngeneic spleen cells in the absence of allogeneic stimulator cells, and (3)they induced normal spleen cells to differentiate into anti-sheep erythrocyte (SRBC) plaque-forming cells (PFC), in the absence of SRBC in the cultures. The use of this cell line (called line 12) may thus provide an interesting approach for the study of cellular and molecular requirements for cell-cell interactions and for the differentiation of T and B effector functions.
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This study concerned two questions: Why does the patient come to the physician? And, how does patient-physician agreement as to the primary purpose affect the process and outcome of the medical encounter? Separate interviews of patients and physicians following 200 medical encounters revealed a preponderance of visits for continuing care, a paucity of visits for social and emotional problems, and a number of visits in which "concern" as the patient's primary purpose was misperceived by the physician. There was no statistically significant relationship when agreement (or lack of agreement) between patient and physician as to the purpose of the encounter was compared with patient age and sex, number of previous visits of the patient to the physician, and subsequent patient-physician agreement as to the diagnosis, prognosis, therapy, and satisfaction. There was also no statistically significant relationship when patient-physician concordance as to visit purpose was compared with education level of the patient or with physician perception of the patient's intended compliance. In both concordance and non-concordance groups, physicians underestimated both patient satisfaction with the encounters and intended compliance.
The extended family encounter is a planned, prolonged physician-family interaction that allows an in-depth approach to a challenging clinical problem. A protracted and intense interaction may be indicated when organic, emotional or family problems are unresponsive to usual methods of continuing and comprehensive care. It will often provide vital data, afford diagnostic insight, help crystallize the plan of management and enhance the relationship between the patient and his family.
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