General practitioners in partnership with management: an organisational model for debate.

The role of general practitioners is changing and expanding. Doctors have more control over the treatment received by their patients but remain largely unaccountable to the public and management. This article proposes an organisational model for integrating primary and secondary care which retains the advantages of fund-holding while giving management control over overall strategy. It proposes that general practitioners control funds for all primary and secondary care. Secondary care will be contracted through a joint team of managers and an elected general practice executive committee. A new health care purchasing authority will contract for primary services with individual practices or primary care provider units. General practitioners will have local contracts reflecting their desire to provide an expanded range of services and the needs of the community.     

Morphological indices and otolith microstructure of Atlantic croaker,Micropogonias undulatus,as indicators of habitat quality along an estuarine pollution gradient

Synopsis Atlantic croaker, Micropogonias undulatus, sampled from a transect along a pollution gradient show a trend of declining growth and physical condition. This trend is apparent in the mean size of 0-group croaker, in their recent growth rate measured by marginal otolith increment widths, in longer term growth rate as indicated by relative otolith weights, and in general physical condition as measured by an index of condition of the caudal fin. We suggest that these measures are indicators of stress associated with environmental conditions. Because croaker from different positions along the pollution gradient were distinguishable, it appears that they remain for extended periods within areas of degraded environmental quality.     

An early Holocene reef in the western Atlantic: submersible investigations of a deep relict reef off the west coast of Barbados,W.I.

Submersible observations and collections reveal that a probable relict reef off the west coast of Barbados has a rich cover of sponges, along with algae and scattered corals, on a substrate of algal nodules in a muddy-sand matrix. The collections provide new data on the distributions of these fauna. This relict reef is about 20 km long, has a relief of up to 10 m, and is established at a depth of 80 m. Relict shallow-water features in other areas at similar depths along with data from core holes drilled off the south coast of Barbados suggest that this reef was probably established about 12,000 years ago and existed for no more than 2,000 years, during the Holocene sea-level transgression.     

Evaluation of a radioreceptor assay to assess exogenous estrogen activity in serum of patients with breast cancer.

A radioreceptor assay (RRA) for the determination of total estrogen activity, was set up and used to assess the possible presence of exogenous molecules with estrogen activity in serum; a comparison was made with the specific radioimmunoassay (RIA) for the endogenous estrogen 17-B estradiol (17-B-E2). The assay was first performed on sera from healthy people taking estrogens in the form of oral contraceptives or lotions for local application whose total estrogenic activity in the blood was assumed to be abnormal. The assay was then performed on serum from 98 patients with early breast cancer and 20 patients with metastasis, not undergoing hormone therapy. A higher estrogen activity was found in 2.5% of sera compared to the activity found using the RIA method which is specific for endogenous estrogen 17-B-E2, the RRA/17-B-E2 ratio being higher than 3. Increased estrogen activity was found in 10% serum samples from digoxin treated cardiopathic patients, with an RRA/17-B-E2 ratio ranging from 4.4 to 20. The RRA assay could prove useful for showing up exogenous estrogen activity from various sources (drugs, food) in sera of people in whom estrogen stimulation could be potentially dangerous (i.e. in patients with hormone-sensitive tumors). This exogenous activity could support a certain degree of neoplastic stimulation and, therefore, unfavourably condition the patients' therapeutic response.