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The objective of this study was to evaluate the use of sHLA in a solid-phase EIA as a rapid and sensitive way to identify potential IgG HLA class-I-typing reagents. To evaluate the efficacy of the sHLA EIA, we used the assay to screen 259 HLA-A, -B, and -C antisera that our laboratory had procured using the standard NIH LCA. A positive result obtained by the sHLA EIA, which was defined as an EIA ratio of 3 SD above the mean of 91 anti-HLA-negative sera, revealed that 91% (79 of 87) of the A-locus-typing reagents were positive, 96% (150 of 156) of the B-locus antisera were positive, and only 75% (12 of 16) of the C-locus reagents were positive. The typing reagents that were negative by EIA (n = 18) fell into two categories. First, 38% (7 of 18) were negative by sHLA EIA, as they were IgM-typing reagents (NIH LCA reactivity ameliorated by DTT). The second group of the 11 remaining typing reagents had a mean EIA ratio of 1.0 +/- 0.246 (mean +/- 1 SD), which was significantly (P < 0.001) higher than the mean of the 91 negative controls that were used to establish the negative cutoff. The overall sensitivity of the sHLA EIA to detect HLA class-I-directed IgG was 97.2%.

"The Captain of all these men of death," wrote John Bunyan in 1680, "that came against him to take him away, was the Consumption, for it was that that brought him down to the grave." Until the twentieth century tuberculosis, or the Consumption, was the foremost cause of death among adults. It had not been recognized as a specific infectious process until 1882. The sanatorium movement for segregation and treatment of tuberculous patients originated in the late nineteenth century. Locations in the mountains were thought to be especially favorable, for the sake of fresh air, sunshine, and the aromas of pine and spruce. Long before the epidemic of lung cancer, or the possibilities of correction for cardiac disease, development of thoracic surgery was closely intertwined with the history of the sanatoriums. All of them had disappeared, however, soon after the middle of the twentieth century.

Emulsifiable concentrate and microencapsulated formulations of permethrin were evaluated for residual activity against stable flies on lactating dairy cows. Cows were treated in the field with each formulation and hair was clipped from the leg and shoulder area, and bioassayed at 1, 2, 3, 4, 7 and 14 days after treatment. Significantly more stable flies died when exposed to hair sampled 3, 4 and 7 days after treatment from the shoulder than from the lower leg. Analysis with gas chromatography of hair samples showed no detectable permethrin residues on shoulder or leg hair 72 h after treatment with the emulsifiable concentrate formulation. Microencapsulated permethrin was still detectable on hair sampled from both locations 7 days after treatment. The permethrin concentration on the leg hair was approximately 50% of the shoulder hair concentration after 3 days, with the leg hair residue dropping to 31% of shoulder level after 7 days.

More than 30 million Americans lack health insurance, and millions more are "underinsured." Meanwhile, the cost of health care in the United States is escalating, and some of our care is of questionable value. This article presents a health care reform strategy that addresses these three fundamental problems in the US health care system. The strategy, designed to empower consumers to make cost-conscious health care choices, combines a universal tax credit that enables all Americans to purchase basic health coverage; insurance reforms including pooling and reinsurance mechanisms; requirements that all employers make insurance available to their employees and that all consumers purchase coverage; and efforts to measure and improve the quality and efficiency of health care services. This strategy would help us to achieve universal health insurance coverage, while creating the proper incentives for cost control. In addition, it can be largely internally financed through savings automatically triggered by its implementation.

Quinlan's ID3 algorithm has been used to induce, from behavioral sequences observed on mice in day and night conditions, rules linking each activity to the three preceding ones in a given sequence. These rules were then input into two expert systems so that they might be validated on other behavioral sequences. It is shown that the succession of various activities exhibited by the mouse is by no means random, but rather displays a Markovian determinism of the first order during the night and of the second order during the day. Among the seven activities singled out in this study, the method applied here has proven very effective in predicting the occurence of rest, locomotion, and grooming in the nest. It is only moderately effective in the cases of feeding and nest-building and fails with respect to drinking and to grooming out of the nest. These results are discussed in the light of current knowledge about the physiological determinants of these various activities. Lastly, the method employed here is compared with other methods having similar uses., (Copyright © 1990. Published by Elsevier B.V.)

No satisfactory mechanical respirator existed before 1929, when Philip Drinker and Louis Shaw described an apparatus of their own design. This machine was in the form of a cylindrical tank enclosing the patient's body and chest, leaving the head outside the chamber under atmospheric pressure. Air pumps, later a bellows, raised and lowered pressure within the tank to assume the entire work of breathing. Popularly named the iron lung, the Drinker respirator supported thousands of patients afflicted with respiratory paralysis during the polio era. It was being superseded by positive-pressure airway ventilators just as the polio era came to a close. Today the Drinker respirator has disappeared virtually without a trace. Although its disadvantage was its cumbersome size, we must concede that it supported patients over the long term with fewer complications than do the respirators of today.

A surgical approach to embolectomy from the pulmonary artery had been worked out in laboratory animals prior to 1908 by Friedrich Trendelenburg, professor of surgery and director of the University Surgical Clinic at Leipzig, Germany. His technique was based on limited opening of the left side of the chest directly over the common or undivided pulmonary artery and encircling the proximal aorta and pulmonary artery together through the transverse sinus of the pericardium. Both vessels were to be occluded by traction on the encircling band. Emboli were to be extracted through a small pulmonary arteriotomy, which then was to be controlled by a tangentially applied clamp, while occlusion of the great blood vessels was released. Unfortunately, during the first clinical trial of the technique, the patient died because of technical difficulties. Not until 1924 was a surviving patient described, by Trendelenburg's former trainee, Martin Kirschner.

Filth fly parasites reared by commercial insectaries were released on two dairies (MO, DG) in southern California to determine their effect on populations of house flies, Musca domestica L., and stable flies, Stomoxys calcitrans (L.). Spalangia endius Walker, Muscidifurax raptorellus Kogan and Legner, and Muscidifurax zaraptor Kogan and Legner were released on the MO dairy from 1985 to 1987 in varying quantities. Parasitism by Muscidifurax zaraptor on the MO dairy was significantly higher (P less than 0.05) from the field-collected stable fly (4.4%) and house fly (12.5%) pupae, compared with a control dairy (0.1%, stable fly; 1.3%, house fly). Muscidifurax zaraptor, released from April through October during 1987 on the DG dairy (350,000 per month), was not recovered in a significantly higher proportion from either fly species relative to the corresponding control dairy. No specimens of Muscidifurax raptorellus were recovered from the MO dairy. Parasite treatments had no apparent effect on adult populations of either fly species or on overall parasitism rate of field-collected stable fly (16.8%, MO; 17.2%, DG) and house fly (23.3%, MO; 20.9%, DG) pupae. Spalangia spp. were the predominant parasites recovered from field-collected stable fly and house fly pupae on all four dairies. Sentinel house fly pupae placed in fly-breeding sites on both release dairies were parasitized at a significantly higher rate, as compared with sentinel pupae on control dairies. The generic composition of parasites emerging from sentinel house fly pupae was 20.6% Spalangia spp. and 73.2% Muscidifurax spp., whereas in field-collected house fly pupae, Spalangia spp. and Muscidifurax spp. constituted 74.3 and 19.6% of the parasites, respectively.

Resistance to pyrethrins plus piperonyl butoxide (PB) in a population of Fannia canicularis (L.) (BR strain) at a broiler-breeder facility was determined (in F2 laboratory generation) to be 109.1-fold the median lethal dose (LD50), apparently having been influenced by twice-daily treatments with automatic spray equipment during the previous 2 years. By contrast, resistance was only 12-fold the normal LD50 in a population of Musca domestica L. (DH strain) at an egg-production facility that was subjected during a comparable period to treatments twice per week with synergized pyrethrins with the identical automatic pyrethrin-spray system. The automated application of a nonpersistent chemical at frequent intervals, obviously, provides continuity of selection pressure leading to high levels of resistance. Other factors such as enclosed poultry housing and the elimination of refugia have also contributed to the enhancement of resistance. The resistance level in Strain BR regressed to 31.7-fold after remaining unselected for an additional generation in the laboratory. Other bioassays on the F2 generation revealed limited resistance toward permethrin of 3.7-fold the normal LD50.

Invasive study of cardiac anatomy and function traces its origin to the work of a 25-year-old surgical trainee in a provincial German town in the pre-Depression years of 1929 and 1930. Only 1 year out of medical school and undeterred by the medical profession's fear of tampering with the heart, Dr Werner Forssmann explored methods for a more direct access to the cardiac chambers, finding it necessary to make the observations on himself. Later he was able to show that the right-sided cardiac chambers could be visualized radiographically after injection of iodinated contrast materials through a catheter into the right atrium, and again he tried the method on himself.

In patients treated nonsurgically for "limited" small cell carcinoma of the lung, the most frequent site of relapse is within the chest. We have treated patients with clinical Stage III M0 disease (T3 and/or N2, M0) by two cycles of chemotherapy, surgical resection of the primary site and mediastinal nodes, and continued chemotherapy thereafter. Since May, 1979, the regimen has consisted of cyclophosphamide, doxorubicin, vincristine, and etoposide on a 3 week cycle. The first 12 patients so treated had partial or complete remission after two cycles. Resection was technically not possible in two. Residual small cell carcinoma was not identifiable in the specimens from two of the 10 patients undergoing resection. Microscopic tumor extended to a resection line in two of the eight with residual tumor. Malignant tissue appearing to have the structure of papillary adenocarcinoma was found in hilar and paratracheal nodes in one patient, but nowhere in the resected lung; some residual small cell carcinoma remained in the lung. Nuclear ballooning and eosinophilic inclusions were noted in cells still identifiable as small cell carcinoma in one case. Marked fibrotic scarring was noted in eight cases, acute and organizing bronchopneumonia in three, and multiple small parenchymal abscesses in one case. Long disease-free survival occurred in one patient, in whom residual tumor could not be found in the specimen; in at least one more in whom residual tumor was present; and even in one patient in whom tumor was present at the bronchial resection line.

Over a period of 12 1/2 years, 476 patients underwent thoracotomy for lung cancer at two affiliated hospitals. Hospital mortality for all patients was 5.25% and for those undergoing pulmonary resection, 5.67%. Hospital mortality is more indicative of true risk than is the 30 day mortality figure, which we regard as arbitrary and misleadingly low. Thirty-seven preoperative risk factors were analyzed for their effects on both morbidity and mortality, and 12 classes of postoperative complications were analyzed for their effect on mortality. All preoperative risk factors together accounted only for 12% of the risk of mortality (R2 by multiple regression analysis). Only three of these factors bore a significant association with mortality: patient age 60 years or over (p less than 0.05), need for pneumonectomy (p less than 0.005), and premature ventricular contractions on the admission electrocardiogram (p less than 0.05). All the listed postoperative complications together accounted for only 28% of the risk of mortality. Of these complications, four showed a significant association with postoperative death: infectious complications (pneumonia and empyema) and cardiovascular accidents (pulmonary embolism and myocardial infarction). In both analyses, the remainder of the risk of death must be attributed either to factors not considered or to purely random factors. It follows that much the greater part of the risk of death from surgical treatment of lung cancer could not be predicted from the preoperative status of the patients.

The prospect of leasing instead of hiring your staff may sound farfetched, even crazy at first, but more and more successful businesses are finding this arrangement best meets the needs of both the organization and the employees. Employee leasing can be a practical remedy for the tremendous financial burden of employee pension costs and bring many other benefits to everyone involved as well. Of course, before such an arrangement is entered, there are important legal, economic, and practical considerations to be made. The innovative idea of employee leasing is explored here in depth, with special focus on the legal angle. Helpful charts are provided which compare the costs of a defined benefit plan and a leasing arrangement.

Prospects for the patient with small cell carcinoma of the lung have been partially turned around during the past decade. This dramatic achievement remains very incomplete, but it continues to gather momentum and seems to carry promise of greater advance in the future. An essential feature of the new approach to treatment is that it depends on cooperative and interdisciplinary effort; in all probability, increasing cooperation will be necessary for future progress. We will attempt to review here the current approaches to the understanding and management of this disease, as they may be of concern to surgeons, and to try to define the areas of failure and controversy.

Concern for equity of financing among the elderly must not ignore questions of equity between the needs of Medicare beneficiaries and those of the nonelderly . Modest income-related cost-sharing, combined with the merger advocated, might improve fairness , efficiency, and coverage. But fundamental reform must involve new tax policies.

An artisanal static process for protein enrichment of cassava by solid-state fermentation, developed in laboratory and tested on pilot units in Burundi (Central Africa), provides enriched cassava containing 10.7% of dry matter protein versus 1% before fermentation. Cassava chips, processed into granules of 2-4-mm diameter, are moistened (40% water content) and steamed. After cooling to 40 degrees C, cassava is mixed with a nutritive solution containing the inoculum (Rhizopus oryzae, strain MUCL 28627) and providing the following per 100 g dry matter: 3.4 g urea, 1.5 g KH(2)PO(4), 0.8 g MgSO(4).7H(2)O, and 22.7 g citric acid. For the fermentation, cassava, with ca. 60% moisture content, is spread in a thin layer (2-3 cm thick) on perforated trays and slid into an aerated humidified enclosure. The incubation lasts +/- 65 h. The production of protein enriched cassava is 3.26 kg dry matter/m(2) tray. The effects of the variation of the nutritive solution composition and the inoculum conservation period on the protein production are equally discussed.

We reviewed survival of patients with clinically localized small cell carcinoma of the lung treated by surgical resection, combination chemotherapy, and prophylactic cranial irradiation. Long-term survival was defined as continuing complete remission 30 months after the start of treatment. Initial TNM staging determined the course of treatment. Ten patients with disease in Stages I and II were treated over 30 months ago by initial resection followed by the full course of chemotherapy. Only one has had a relapse, whereas 80% remained disease-free at 30 months. Five of these patients have passed 5 years. Four patients with T3 N1 disease were treated by two cycles of chemotherapy, surgical resection, and cranial irradiation plus resumption of chemotherapy thereafter; two remained in remission at 30 months. Sixteen patients initially with N2 disease were treated according to the same schedule; 10 of the 16 underwent successful resection. All 16 patients have had a relapse, but the relapse occurred very late in three--at 27, 30, and 37 months. The reasons for the apparently poor prognosis of N2 disease are not clear. Considerations of tumor response kinetics and somatic mutation suggest that these biologic factors are fundamentally responsible. Other studies may find disease control achieved in a very few patients with N2 disease.

Surgical resection offers distinct theoretical advantages as the "local" modality in treatment of Stage I and II small cell carcinoma of the lung. We have treated 10 such patients by initial resection since 1975; all survivors but one received adjuvant chemotherapy for the full course thereafter. One patient died of a pulmonary embolus; the other nine remain without evidence of disease from 7 to 69 months after resection. A trial was undertaken of extended indications for resection in selected patients with Stage III-M0 disease. Criteria for patient selection have been developed gradually; these exclude patients for reasons of refusal, physiological inadequacy, disease unsuited to gross total eradication, or lack of adequate initial response to chemotherapy. Of six patients who survived the exclusion criteria and underwent resection, one has had a relapse at 26 months. All others remain without evidence of disease, 5 to 25 months after the start of treatment. We believe that systematic patient selection on the basis of defined criteria will identify a subset of patients having markedly improved chances for disease control. This group may represent as many as half of the patients first presenting with localized or MO disease. Patients excluded as candidates for resection have continued to receive standard nonsurgical combined-modality therapy.

Pretreatment classification of patients with small cell carcinoma of the lung into categories of "limited" and "extensive" disease is inadequate; it does not identify the few having a good prognosis for disease control. Available reports from the literature were analyzed for (1) histologically verified TNM stage; (2) adequate treatment by current standards; and (3) number and percent of patients remaining in complete remission at 30 months after the start of treatment. Long-surviving patients by histologically verified stage were as follows: Stage I, 5 of 6 patients (83%); Stage II, 3 of 4 (75%); T3 without N2 or M1, 2 of 4 (50%); and N2 with any T value but without M1, 1 of 16 (6.2%). Long survivors with most distant involvement in the supraclavicular nodes were the following: ipsilateral, 3 of 22 (13.6%); contralateral, 2 of 40 (5%). Histologically verified M1 elsewhere allowed less than 1% long survivors. Indirect evidence of M1 by abnormal bone scan allowed less than 5%. Contrary to general usage, TNM staging of patients with small cell carcinoma of the lung promises to correlate closely with the probability of long disease-free survival.

Booth's dynamic model is a particular realization of a general hypothesis ascribing the start and stop of rat meals to fluctuations in the value of the net energy flow entering into the lean body mass. The Mark 3 version of this model has been adapted to the mouse Mus musculus C3H. Recordings for 11.5 consecutive hours of diurnal and nocturnal sequences of feeding behaviour in six mice have made it possible to compare not only the simulated and observed ingested amounts, but also the corresponding time patterns. The results show the consistency of the energy flow hypothesis with the feeding pattern in mice. The results also show that satiety conditioning does not improve simulated patterns and indicate which modification of the model parameters allow the simulation of the observed differences between day and night patterns. Finally, detailed discrepancies between observed and simulated results suggest that the model would be improved by taking into account other behaviours liable to interact with feeding behaviour.

Optimal treatment of pleural empyema remains controversial to the present day. In the preantibiotic era, surgical thinking favored early and aggressive drainage of closed-space infections, but the dynamics of the pleural space were poorly understood and open pneumothorax generally was considered the necessary price of surgical drainage. Against bitter opposition, revision of the dogma of early open drainage was achieved in 1918 by Evarts Graham and his associates on the US Army's Empyema Commission. Unacceptable mortality rates for early drainage were brought under control through a treatment program of repeated tapping, with surgical drainage only after loculation had occurred. Paradoxically, closed water-seal drainage for empyema had been used by a German internist, Gotthard Bülau, as early as 1875. His technique was published in 1891, 27 years before the report of the Empyema Commission. As a closed system, it would have been suited to empyema drainage in either the early diffuse or the loculated stages. Thoracotomy was not possible at the time, and Bülau probably could not foresee the future importance of his method to surgery.

Actions to reduce the federal deficit in recent years threaten to strand the economically and socially disadvantaged while maintaining generous subsidy programs for populations with little or no financial need. This situation has been brought about in large part because of government's inherent reluctance to scale down programs that are politically popular even if no longer affordable or, in the long run, appropriate. The authors suggest that realistic and responsible social welfare policy reform requires that no sector of the federal budget be exempt from review or change. In the area of health, the importance of reshaping programs such as Medicare and Medicaid and disaggregating trends to focus more on populations with legitimate unmet needs is underscored. The authors make a number of suggestions on how existing social welfare programs can be better targeted.

Small cell carcinoma of the lung is notable for extreme malignancy in clinical behavior, with rapid growth, wide dissemination, and short survival after treatment. It is highly responsive to chemotherapy and radiation therapy, yet seldom cured. Prevalent therapeutic dogma rules out surgical resection as any part of treatment. We find, however, that patients with disease in stages I and II, treated with initial resection followed by the full course of chemotherapy, have a good prognosis for long disease-free survival.

A comprehensive set of electron dosimetry measurements at 7, 10, 12, 15, and 18 MeV was made on a Mevatron 80. Dosimetry measurements presented include percentage depth dose, dose in the buildup region, field size dependence of output, output at extended distances, lead transmission measurements, and isodose curves. These beam measurements are presented to document the electron beam characteristics of this linear accelerator. Three relatively new dosimetry techniques, which have not been standardly used in the past, are illustrated. One technique determines the depth dose of fields too small to measure. A second technique accurately converts depth dose measured in polystyrene to depth dose in water. A third technique calculates the output at extended distances.

In 1983, the Health Care Financing Administration funded a multiyear evaluation of Medicaid demonstrations in six States. The alternative delivery systems represented by the demonstrations contained a number of innovative features, most notably capitation, case management, limitations on provider choice, and provider competition. Implementation and operation issues as well as demonstration effects on utilization and cost of care, administrative costs, rate setting, biased selection, quality of care, and access and satisfaction were evaluated. Both primary and secondary data sources were used in the evaluation. This article contains an overview and summary of evaluation findings on the effects of the demonstrations.