Policy implications of the national study of the content of family practice.
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Biomedical subjects
Publications and source records attributed to R Graham.
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Using direct imunofluorescence, lesions from 266 human breast specimens were studied for the presence of IgA, IgM, or IgG localization. The lesions included benign elements from 66 subcutaneous mastectomy specimens in which the absence of simultaneous breast malignancy was documented, primary breast carcinomas from 153 mastectomy specimens, and 47 biopsies containing metastatic breast cancer. A statistically significant association of IgA and IgM with benign lesions was contrasted to the association of IgG with malignant lesions. In both primary and metastatic lesions, IgG localization was associated with estrogen-receptor-poor primary cancers as compared with estrogen-receptor-rich primary cancers. Among primary breast cancer patients, IgG localization in the tumor correlated with relative lymphopenia. A shorter disease-free interval was noted in association with IgG localization among the metastatic breast lesions. No statistically significant association between stage of disease and immunoglobulin presence was demonstrable. Moderate-to-severe intraductal epithelial hyperplasias were more often associated with immunoglobulin G localization that were other benign lesions.
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Concentration of factor VIII from fresh plasma by cryoprecipitation remains the basis for preparation of products used to treat haemophilia A. This paper describes the preparation of a factor VIII concentrate from small plasma pools in transfusion centres with drying facilities. The dried concentrate from one litre of plasma dissolves very well in 50 or 100 ml of distilled water and contains around 500 IU per bottle. The specific activity per mg protein is 0.19 IU and the fibrinogen concentration is half that in frozen cryoprecipitate. This method of drying causes no appreciable loss in the factor VIIIC activity and little denaturation as shown by the factor-VIII-related antigen/factor VIIIC ratio of 1.7.
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It is the purpose of this paper to review and illustrate recent, pertinent, advances in detection methods for those food particle contaminants that have potential as hazards to human health or that elevate the risk for product liability disputes. Sources for the contamination of the human food supply include extraneous particulates associated with raw materials, food handling and packaging processes, as well as extraneous filth from insects and rodents. Likewise, environmental particulates, either airborne or in liquid suspension, can be considered as potential food contaminants. Concern for the quality of human foods relates to the type and quantity of suspected contaminants. To reduce the risk of particle contaminations of all types in human food supplies and to insure high yields of safe, high quality products, industry safeguards include monitoring and identification of foreign matter. Supportive methodology has been developed to detect, separate and identify particle contaminants of many types. Microscopic contaminants are characterized using light microscopy, electron microscopy and allied techniques. Specific applications of these techniques are described in brief detail.
An assessment of the progress of family practice over the last ten years, from the point of view of public policy analysis, finds that family practice has adequately and successfully addressed the majority of the policy issues of concern to its major constituencies in the early 1970s. The decade of the 1980s finds family practice as a vigorous, thriving specialty, which has met many of the early expectations of its supporters. Now, however, because of its own growth and the changing environment of medical practice in the United States, family practice faces a broad range of expectations and policy challenges from a wider, and in some cases more hostile, constituency.
An iron-binding compound was isolated from ethyl acetate extracts of culture supernatant fluids of Pseudomonas aeruginosa and was purified by successive paper and thin-layer chromatographic procedures. The purified compound was characterized by UV, visible, infrared, and fluorescence spectroscopy. The compound possesses phenolic characteristics, with little or no similarity to dihydroxybenzoates and no indication of a hydroxamate group. P. aeruginosa synthesized the compound during active growth in culture media containing less than 5 X 10(-6) M added FeCl3. When added to iron-poor cultures of P. aeruginosa, the compound promoted the growth of the bacterium and also reversed growth inhibition by the iron chelator ethylenediamine-di-(o-hydroxyphenylacetic acid).
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The normal flora of cockroaches (Periplaneta americana) was determined over a period of 24 days prior to substituting water with 1% Formalin for drinking water. During the first 4 days of treatment the normal flora was significantly reduced and by the fifth day, when the cockroaches became diarrhoeic, no bacteria, fungi, or viruses could be detected by the methods used.
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Human peripheral blood lymphocytes incubated in culture for 1 to 3 days at 37 degree C, but not at 4 degree C, release a soluble factor which can stimulate, up to 400-fold, collagenase production by isolated, adherent, rheumatoid synovial cells. Production of lymphocyte factor is enhanced by phytohemagglutinin or concanavalin A. By gel filtration the factor has an apparent molecular weight of about 12,000.
The metabolism of a C26 bile alcohol (I, 24-nor-5beta-cho-lestane-3alpha, 7alpha,25-triol) was studied in the isolated perfused rabbit liver. The new bile alcohol and bile acid metabolites secreted into the bile were isolated and identified by a combination of TLC, GLC and GLC-MS. The following bile alcohols were found: II, 24-nor-5beta-cholestane-3alpha,7alpha,12alpha,25-tetrol, III, 24-nor-5beta-cholestane-3alpha,7alpha,12alpha,25,26-pentol; IV, 24-nor-5beta-cholest-23-ene-3alpha,7alpha,12alpha-triol; and V, 24-nor-5beta-cholest-23-ene-3alpha,7alpha-diol. In the bile acid fraction, 24-nor-cholic acid and 3alpha,7alpha,12alpha-trihydroxy-24-nor-5beta-cholest-23-en-26-oic acid were present. The perfused nor-triol was not resistant to 12alpha-hydroxylation.
Clonogenic populations from bone marrow and spleen of nude mice and their normal littermates were enumerated in vitro using a methylcellulose supported culture system. This technique allows for the simultaneous quantitation of progenitors of granulocyte-monocyte pathways (colony forming units in culture, CFU-C) and for progenitors of "mesenchymal" elements (plaque-forming units in culture or PFU-C). These populations were distinguished in culture by their growth, characteristics and morphology. CFU-C gave rise to suspended colonies of granulocyte-monocyte composition while PFU-C formed surface-adherent colonies of mesenchymal morphological features (fibroblastic and reticuloendothelial morphology). Significant elevations in the relative and absolute numbers of CFU-C and PFU-C were observed in the bone marrow and spleen of 6 wk old nu/nu mice relative to heterozygous littermates. The results are discussed in terms of non-T cells components involved in cell-medited immunity against neoplastic development.
The authors present the results of an investigation of the vasogenic type of brain edema using cold injury in cats as a model. Their findings indicate that bulk flow and not diffusion should be considered the main mechanism for the spread of edema through the white matter. This conclusion is based on: 1) comparison of the distances actually traveled by various substances during edema spread with those calculated theoretically for migration of the substances by diffusion; 2) coincidence in the speed of movement by two substances (sucrose and albumin) with widely different diffusion coefficients; 3) measurement of interstitial fluid pressure (IFP) at various distances from the lesion showing the presence of increased IFP in the lesion area and decreasing pressures along the edema pathway toward the normal tissue; and 4) the fact that spreading of edema can be significantly impeded by inducing before the cold lesion an intracellular type of brain edema that reduces the size of the extracellular space (ECS) and increases the resistance to flow of edema fluid. The pressure-volume curve of the brain ECS, as derived from determinations of IFP and tissue water content, indicates that initial steep slope in IFP probably represents the high resistance to fluid mobility through the small diameter extracellular channels and the counteracting resistance of the intermingled structures of brain parenchyma to be separated. Once the IFP exceeds these opposing forces, the ECS dilates, fluid mobility increases, and the edema front advances.
Involvement of the brain, spinal cord, peripheral nerves, meninges, and cerebrospinal pathways in mycosis fungoides manifests itself, clinically, as an obscure neurologic disturbance, occurring in patients with cutaneous manifestations of that disorder. Neurologic expressions of this particular cutaneous lymphoma are infrequently reported, in spite of the fact that many patients dying in the course of mycosis fungoides have pathologically demonstrable central nervous system, peripheral nervous system, and meningeal involvement. We report here a patient who incurred devastating neurologic illness as one of the initial features of the course of systemic dissemination of mycosis fungoides. Death occurred nine years after the onset of cutaneous illness. In this instance, cerebrospinal fluid cytologic studies established the diagnosis of nervous system involvement. Mycosis fungoides cells shed into the cerebrospinal fluid were studied by special techniques of light and electron microscopy. Brain scan abnormalities were present, which were clinically correlative with foci of brain involvement. The initial response of patient's nervous system illness to therapy was gratifying but unsustained, and she went on to fatal brain and multiple organ involvement with disseminated mycosis fungoides. The techniques of spinal fluid cytologic diagnosis, confirmatory of the etiology of disease in this case, may have practical appications in the diagnosis of otherwise obscure neurologic disorders.
Family practice, as a medical specialty, is designed to help fill the void in primary care availability. In order to expose medical students to family practice and provide a basis for choosing a residency in the field, many medical schools have developed undergraduate programs in family practice. This paper reports the results of a survey conducted in March 1975 on the status of undergraduate programs with particular focus on the relationships between administrative status, size of program, faculty size, and type of undergraduate curricula to the number of graduates choosing family practice as a specialty. The data indicate that there is a relationship between the commitment of the school to family practice, the size of the program, and the presence of required courses in the curriculum to the success of the program, as measured by the proportion of students in each school who choose family practice residencies.