Medical Audit,Continuing Medical Education and Quality Assurance

Medical audit and continuing medical education (CME) are now the mainstays of quality assurance in hospitals. Audits should address problems that have serious consequences for patients if proper treatment is not given. The single most important step is the selection of essential or scientific criteria that relate process to outcomes. CME does less than commonly believed to improve care. Today, quality assurance increasingly means a near-guarantee to every patient of appropriate treatment and fewest possible complications. Maintenance of the public trust rests on a firm commitment of the medical staff and board to this principle, implemented through an organized program of quality assurance. Under these conditions, medical audit and CME can effectively improve care by improving physician performance.     

New species and new combinations in Briquetia and Hochreutinera,and a discussion of the Briquetia generic alliance (Malvaceae)

Two new species ofBriquetia,B. sonorae andB. inermis, are described from northern Mexico, and another species that ranges from Mexico to Bolivia is transferred into the genus asB. spicata. The genus (previously known as monotypic, Paraguayan-Brazilian) is thereby enlarged from one species to four, and its geographical and morphological limits are greatly expanded. Also, a Mexican species ofAbutilon is transferred toHochreutinera, asH. amplexifolia, enlarging that genus from one to two species. On the basis of this new information, the limits of the informalBriquetia alliance are reconsidered; it is considered to include onlyBriquetia, Dirhamphis, andBatesimalva.     

The pineal gland of the mole-rat (Spalax ehrenbergi,Nehring)

Summary A comparative investigation of the distribution of monoaminergic neurons in non-malacostracan crustaceans was performed with the histochemical fluorescence method of Falck-Hillarp.Two fluorophores were found: the more widespread of the two emits a green fluorescence; and the more sparsely distributed emits a yellow to brown-yellow fluorescence.Specific green fluorescent areas were shown to exist in the protocerebrum. The central body and the optic ganglia of the compound eye (where present) are always fluorescent. Moreover, the centre of the nauplius eye may have a green fluorophore, as in ostracods, and a neuropile area, here called the frontal area. These neuropile centres are known from ordinary histological studies of the nervous system. In addition, there are specific monoaminergic centres, such as the so-called dorsal area of phyllopods and anostracans as well as the copepod specific areas. Specific monoaminergic areas appear in the deutocerebrum and the suboesophageal ganglion where they are particularly well developed.Presumed sensory neurons in the cavity receptor organ of Artemia salina are shown to be monoaminergic. Monoaminergic sensory neurons have not been described previously in Arthropods.Presumed motor innervation of hind-gut and trunk muscles is also found, and it is concluded that in crustaceans neurons of every type (sensory, internuncial, motor) may be monoaminergic.We have enjoyed unrestricted laboratory facilities at the Department of Histology, Faculty of Medicine, and with great pleasure express our sincere thanks to Prof. Bengt Falck. — Grants from the Swedish Natural Science Research Council (2760-007), the Swedish Medical Research Council (04X-712), the Royal Swedish Academy of Science (Hierta-Retzius), the Royal Physiographic Society of Lund, and the University of Lund supported the work.     

A simple dichromatic densitometer for repeated measurements of cardiac output in small animals.

The construction of a simple device for continuous monitoring and recording of plasma indocyanine green concentration in small animals is described. The apparatus is designed to hold a vascular bed such as the ear or the omentum and to transilluminate it with white light from a fiber optic bundle. The transmitted light is divided by a dichroic mirror. Appropriate filters select a narrow band of frequencies from each segment. There are two photovoltaic cells, one sensitive to the dye and the other insensitive to it. Both are approximately equally reactive to changes in transilluminence caused by changes in blood content or hematocrit and are relatively insensitive to changes in oxygen saturation of the transilluminated blood. Reproducible estimates of cardiac output have been obtained with the injection of 300 mug indocyanine green in a volume of 20 mul with the densitometer applied to the small intestine or to the ear of the animal. The device responds linearly to increasing plasma indocyanine green concentrations and can be calibrated with less than 0.1 ml of blood.     

NITRATE UPTAKE IN MARINE PHYTOPLANKTON: (NITRATE,CHILORIDE)-ACTIVATED ADENOSINE TRIPHOSPHATASE FROM SKELETONEMA COSTATUM (BACILLARIOPHYCEAE)1,2

A membrane-bound (nitrate, chloride)-activated AT Pase was found in the neritie diatom, Skeletonema costatum (Grev.) Cleve. The enzyme is suggested to translocate NO₃⁻ across the plasmalemma, against a concentration gradient. The K_m of the enzyme with respect to NO₃⁻ is ca. 0.9 × 10⁻⁶ M, and is in close agreement with the reported K₈ for NO₃⁻ uptake by the whole cell.     

Partial purification of active delta and epsilon subunits of the membrane ATPase from escherichia coli

We have partially purified active delta and epsilon subunits of the E. coli membranebound Mg²⁺ -ATPase (ECF₁). Treating purified ECF₁ with 50% pyridine precipitates the major subunits (α, β, and γ) of the enzyme, but the two minor subunits (δ and ϵ), which are present in relatively small amounts, remain in solution. The delta and epsilon subunits were then resolved from one another by anion exchange chromatography. The partially purified epsilon strongly inhibits the hydrolytic activity of ECF₁. The epsilon fraction inhibits both the highly purified five-subunit ATPase and the enzyme deficient in the δ subunit. The latter result indicates that the delta subunit is not required for inhibition by epsilon. By contrast, two-subunit enzyme, consisting chiefly of the α and β subunits, was insensitive to the ATPase inhibitor, suggesting that the γ subunit may be required for inhibition by epsilon. The partially purified delta subunit restored the capacity of ATPase deficient in delta to recombine with ATPase-depleted membranes and to reconstitute ATP-dependent transhydrogenase. Previously we reported (Biochem. Biophys. Res. Commun. 62:764 [1975]) that a fraction containing both the delta and epsilon subunits of ECF₁ restored the capacity of ATPase missing delta to recombine with depleted membranes and to function as a coupling factor in oxidative phosphorylation and for the energized transhydrogenase. These reconstitution experiments using isolated subunits provide rather substantial evidence that the delta subunit is essential for attaching the ATPase to the membrane and that the epsilon subunit has a regulatory function as an inhibitor of the ATPase activity of ECF₁.