An internally referenced test strip immunoassay for morphine

We describe an internally referenced immunochemical test-strip for use in the rapid detection of morphine. The method is based on the "enzyme-channelling" immunoassay technique, and a glucose oxidase-horseradish peroxidase enzyme pair is used to immunospecifically generate an insoluble, colored reaction product on the test-strip surface. Test strips are composed of two active surfaces, each of which contain co-immobilized glucose oxidase and antibody. The indicator pad contains antibody directed against the drug, and the color that develops on its surface is inhibited by the presence of drug in the sample. The reference pad contains anti-peroxidase and is used to set the assay detection limit and normalize for variations in temperature, timing, and sample interference. The 10-min assay protocol involves incubating the strip in sample, then incubating it in a developer solution containing glucose, a peroxidase chromogenic substrate, and a peroxidase conjugate of the analyte. The ratio of the color formed on the indicator pad to that formed on the reference pad is used to score the test as positive or negative for drug at a predetermined concentration.

A comparison of the predictions made by orthopaedic surgeons, nurses and physiotherapists about the rehabilitation problems of fracture patients

Health service staff sometimes are not aware of the psychological and social aspects of patients' rehabilitation problems. This paper compares the accuracy of predictions made by orthopaedic surgeons, nurses and physiotherapists about the rehabilitation problems of a series of fracture patients. Predictions were obtained in the acute orthopaedic trauma wards of one hospital, from members of all three professions, about 26 patients selected as likely to have rehabilitation problems. Follow-up data were obtained from interviews with the patients during the six months after their injury and from the orthopaedic case notes. The orthopaedic surgeons accurately predicted 48 per cent of the problems that occurred, the nurses 26 per cent and the physiotherapists 20 per cent. In their predictions the surgeons discriminated more accurately than the nurses or physiotherapists between the occasions on which problems did and did not occur in the follow-up period. The surgeons were better predictors than the other professions about medical and orthopaedic, work and personal and social problems. Fifty-five per cent of the problems that occurred were predicted by members of one or more professions. If it is desired to base early decisions about treatment or referral in rehabilitation on predictions about patients' likely problems, there is a need to increase the proportion of problems that are accurately predicted, and to increase the ability of predictors to discriminate between the occasions on which problems are and are not likely to occur.

Biopsy and definitive radiation therapy in stages I and II carcinoma of the female breast

One hundred-twenty patients with Stages I and II carcinoma of the female breast were treated by biopsy followed by definitive radiation therapy without mastectomy. The breast received 4500-5000 cGy (rad) using a 6 MV linear accelerator followed by a supplement to the area of the primary tumor of 2000 cGy (rad) using electrons in 99 patients (83%) and interstitial implantation in 21 patients (17%). Local recurrence was not recorded in the 43 patients with Stage I disease, while three of 77 patients (4%) with Stage II disease suffered a local recurrence. The actuarial five-year relapse-free survival was 91% and 60% in Stages I and II respectively. Cosmetic results were considered excellent by both physician and patient in the majority of cases. Axillary dissection was the recommended method of staging the axilla but was noted to be more morbid than axillary sampling. Electrons may be as effective as interstitial implantation as a means of supplementation following external beam therapy if specific guidelines are followed.

Length of sickness absence from work after minor fractures

Rehabilitation professionals sometimes believe that sickness absence from work is unduly prolonged. This paper examines the implications of factors that influence the timing of return to work, among patients with minor fractures, for the appropriateness of the time at which they should return to work. Data about a consecutive series of 85 employed hospital outpatients with fractures of the wrist, hand or foot bones were collected by means of interviews with the patients and from the orthopaedic case notes. The mean length of sickness absence from work was 3 weeks. Variations were related to the site and severity of the injury. Patients with physically heavy jobs, and patients with a husband or wife at home while they were off work, were off work for longer than average (6 and 5 weeks respectively). 76 per cent of the patients said they returned to work at the right time, and 23 per cent too early. Comparable findings relating to fracture patients, appear not to have been reported in the research literature previously. The patients in the series were away from work longer than advocates of aggressive rehabilitation might consider necessary, although the patients themselves felt they had returned to work at the right time or too early. The development of explicit criteria, based on the nature of the patient's injuries, recovery and job, might enable doctors to give patients more helpful advice about the time at which they should appropriately return to work.

Autophosphorylation of rhodopsin kinase from retinal rod outer segments

Rhodopsin kinase has been identified as a 68K protein that is more readily extracted from dark-adapted rod outer segments (dark-extract) than from illuminated rod outer segments (light-extract). We observed that a 68K protein is phosphorylated by endogenous protein kinase of dark- or light-extract of bovine rod outer segments and that the amount of incorporated radioactivity (32P) was greater in the dark-than in the light-extract. Phosphorylation of the 68K protein is neither stimulated by cyclic nucleotides nor affected by the light or dark conditions of the phosphorylation reaction. Light-and dark-extracts were centrifuged simultaneously on individual sucrose density gradients revealing that the 68K phosphoprotein cosediments with endogenous rhodopsin kinase activity and that both greater 32P incorporation and higher rhodopsin kinase activity are found in dark-extract as compared to light-extract. These findings suggest strongly that the 68K phosphoprotein and rhodopsin kinase are identical and that rhodopsin kinase undergoes autophosphorylation.

Protein kinases of retinal rod outer segments: identification and partial characterization of cyclic nucleotide dependent protein kinase and rhodopsin kinase

Protein kinase activity of dark-adapted bovine rod outer segments is partitioned by centrifugation into soluble and membrane-bound fractions. The soluble kinases are separated by DEAE-cellulose chromatography into three peaks of activity, which can be classified by substrate specificity and cyclic nucleotide dependence into two categories. One peak of protein kinase activity has the characteristics reported for rhodopsin kinase (category one); it phosphorylates only bleached rhodopsin, and its activity is not affected by light, exogenous adenosine cyclic 3',5'--monophosphate (cAMP), guanosine cyclic 3',5'-monophosphate (cGMP), or a protein kinase inhibitor from skeletal muscle. Rhodopsin kinase has an apparent molecular weight of 68 000. The second category of kinase includes two peaks of activity which are stimulated severalfold by cAMP or cGMP but not by light. These protein kinases phosphorylate soluble proteins including histones and a protein kinase substrate prepared from rat intestine but not rhodopsin. The two peaks elute from DEAE-cellulose with 0.09 and 0.20 M KCl, suggesting that they are similar respectively to type I and type II cyclic nucleotide dependent protein kinases that have been characterized in other tissues. The activity of type I kinase is variable and much less than that of the type II enzyme; its molecular weight was not determined. The type II protein kinase has an apparent molecular weight of 165 000. This study confirms that different protein kinase enzymes catalyze selectively the phosphorylation of bleached rhodopsin and soluble proteins, and it repudiates the speculation in a previous publication [Farber, D. B., Brown, B. M., & Lolley, R. N. (1979) Biochemistry 18, 370-378] that a single protein kinase might catalyze both phosphorylation reactions.

New Mauna Loa coronagraph systems

A new set of instruments, consisting of two coronagraph systems, has been installed and is operating at the Mauna Loa Observing Station, Hawaii, operated by the High Altitude Observatory of Boulder, Colorado. The instruments are the 23-cm objective Mark III K-coronameter (K-III) system, a photoelectric instrument used to observe the inner solar corona from 1.2 R(0) to 2.2 R(0) and the 12.5-cm objective Prominence Monitor system used for the detection of H(alpha) limb activity. New features of the K-coronameter system include the use of achromatic wave plates for wide bandpass operation and linear diode array detectors. Raster scans of the coronal image are obtained in 1.5 min for a critical sampling scheme of 20-sec of arc resolution (10 x 10-sec of arc pixels) in the coronal p(B) image. This represents a 350 information gain factor for each detection channel when compared with the previous Mauna Loa K-coronameters.

Physicians' fees and public medical care programs

In this article we develop and estimate a model of physicians' pricing that explicitly incorporates the effects of Medicare and Medicaid demand subsidies. Our analysis is based on a multiperiod model in which physicians are monopolistic competitors supplying services to several markets. The implications of the model are tested using data derived from claims submitted by a cohort of 1,200 California physicians during the years 1972-1975. We conclude that the demand for physician's services is relatively elastic; that increases in the local supply of physicians reduce prices somewhat; that physicians respond strategically to attempts to control prices through the customary-prevailing-reasonable system; and that price controls limit the rate of increase in physicians' prices. The analysis identifies a family of policies that recognize the monopsony power of public programs and may change the cost-access trade-off.

Regional physician supply and graduate medical education

This paper examines the relationship between medical students' practice plans and residency plans. The paper concludes that most students surveyed knew where they wanted to practice and that, unless otherwise constrained, students who knew where they wanted to practice tended to apply to programs there. This finding suggests that the Weiskotten literature and its apparent policy implications should be evaluated critically. In particular, the results call into question the rationale for unrestricted subsidies of undergraduate and graduate medical education by the states.

Based on cultural strengths, a school primary prevention program for Asian-American youth

As Asian-American mental health workers in a community mental health center where there is very little being done to provide appropriate services to its Asian-American population, we felt a need to find effective mental health models for the unique cultural and linguistic characteristics of our people. The high-school primary prevention program described in this paper provides Filipino youth with a positive view of their cultural identity and a supportive place to examine how their cultural values and behavior differ from those of mainstream Americans. Recognizing that ethnic minorities need to rely on their own subculture for the kind of psychological and social support required for a positive mental health, the program is aimed at mobilizing the strengths and resources of that particular subculture. In this way, its members can more effectively cope with the larger culture.

Breast reconstruction for malignant or premalignant disease

In ten patients breast reconstruction was done after surgical treatment for a premalignant or malignant breast disease. In six of these, prophylactic subcutaneous mastectomy and implant reconstruction were carried out, and in the remaining four reconstruction was done after simple or modified radical mastectomy. It is suggested that these procedures should be considered by those physicians and surgeons who undertake evaluation and treatment of breast disease in women. Breast reconstruction should be considered and offered to patients who suffer from the severe personal and emotional trauma attendant to surgical operation for breast disease.

Comparison of dantrolene sodium and diazepam in the treatment of spasticity

The effects of dantrolene sodium and diazepam were compared in a double crossover study of 42 patients with spasticity due to stable multiple sclerosis. Both drugs reduced the findings of spasticity, clonus, and hyperreflexia, and the complaints of muscle stiffness and cramping. Each drug had different side effects which suggest indications and contraindications for its use in spastic patients.

A computer-controlled infrared eclipse telescope

An f/8, chopped, dual beam, gyroscopically pointed telescope has been constructed for use in obtaining infrared (7-13 micro) observations of the spectrum of the thermal emission of the solar corona. The instrument employs a scanning Michelson interferometer with germanium beam splitter and a germanium bolometer operated at 2 K. A small general purpose digital computer is used for experiment control and data processing. The computer, using reference signals from the chopper, controls the position of the moving interferometer mirror (through a stepper motor), and the operation of an A/D converter enabling rapid measurements of the bolometer output to be made. Synchronous detection, necessary to minimize sky background radiation, is accomplished within the computer. The resulting interferograms are stored on magnetic tape for future processing and displayed on an x-y recorder. A fourier transformed spectrum may be generated on operator request in nearly real time.

Far infrared airborne spectroscopy

Equipment and techniques employed in an airborne far ir (80-400 micro) spectral measurement of the solar brightness temperature are described, with particular attention paid to the scanning Michelson interferometer and the radiometric calibration. The airborne performance of several telescopic guiding systems, a liquid helium cooled bolometer, and golay cells are discussed, summarizing experience gained on twenty-five jet aircraft flights.