Activities of counsellors in a hospice/palliative care environment.

This study examined activities related to the provision of psychosocial care by counsellors in the hospice/palliative care setting. A qualitative design using written reports was used in an urban Canadian hospice/palliative care program. A convenient sample of 13 counsellors indicated the activities they typically performed in their work with patients and families. Thematic analysis of the activities directly related to patient and family care was performed and then validated by presenting these activities back to the counsellors in a group setting. Seven themes resulted: 1) companioning; 2) psychosocial assessment, planning, and evaluation; 3) counselling interventions; 4) facilitation and advocacy; 5) patient and family education; 6) consultation and reporting; and 7) team support. These thematic findings confirmed those of previous studies and also highlighted two additional findings. Team support was seen as an activity that directly affected client care, and there was a strong emphasis on the activity of companioning the dying and their families. Also discussed are implications of these results, as well as suggestions for further research.

The surgical treatment of skeletal anterior open-bite deformities with rigid internal fixation in the mandible.

The rationale for the surgical correction of skeletal anterior open-bite deformities by bilateral mandibular rotation osteotomy is presented. Results of this procedure in which rigid internal fixation is used are reported and show a very high degree of long-term stability. The procedure offers a useful alternative to the more common approach of posterior maxillary intrusion, which does not always address the cosmetic defect.

Biologic and molecular characterization of the IgG serum blocking factor (SBF-IgG) isolated from sera of patients with EBV-induced infectious mononucleosis.

Our laboratory has previously reported the isolation of a serum blocking factor (SBF) from infectious mononucleosis (IM) patients. The SBF has been purified by a combination of Sephadex QAE-50 ion exchange and Sephadex G-200 molecular sieve chromatography. This material was found to be devoid of soluble immune complexes, and immunochemically and biochemically was characterized as IgG and, hence, termed SBF-IgG. The SBF-IgG was shown to significantly (alpha = 0.05) suppress antigen specific (Influenza A-1[H1N1]) in vitro lymphocyte stimulation (LS) as well as leukocyte migration-inhibition (LMI) reactivity. Also, the SBF-IgG significantly suppressed the in vitro.LS response to phytohemagglutinin. In addition, the SBF-IgG when bound to normal donor lymphocytes significantly reduced the high affinity E-rosette (HAR) reactivity at 29 degrees C. A purified T lymphocyte subpopulation of normal donor lymphocytes specifically bound SBF-IgG, and the latter could be r covered using glycine-HCI. It appears that SBF-IgG is a nonspecific antibody; it binds neither lymphokines nor specific antigen, but apparently elicits its in vitro vitro cell-mediated suppressive effect at the level of the T lymphocytes.

Abrogation of cell-mediated immunity by a serum blocking factor isolated from patients with infectious mononucleosis.

Lymphocytes from 80% of patients with infectious mononucleosis in this study failed to produce macrophage migration-inhibition factor in response to partially purified early antigen of Epstein-Barr virus or to tetanus toxoid, whereas lymphocytes from normal subjects did produce this lymphokine. Subsequent analysis of serum from the patients with infectious mononucleosis revealed a serum factor that completely abrogated antigen-specific inhibition of migration by human leukocytes as well as lymphocyte blastogenesis. The serum blocking factor was present in sera from 11 (73%) of 15 patients with infectious mononucleos but only in sera from two (13%) of 15 normal subjects. Samples of serum from five of the patients with infectious mononucleosis and five normal subjects were fractionated with use of Sephadex G-200 gel filtration, and the eluants were assayed for several substances known to inhibit cell-mediated immunity. Serum blocking factor activity could be demonstrated only in fractionated sera from patients with infectious mononucleosis. The serum blocking factor is postulated to be either a soluble immune complex or some as yet unidentified immunoregulatory globulin contained in the IgG fraction of human serum.

Separation of the complement-fixing and early antigens from Epstein-Barr soluble antigen.

The Epstein-Barr virus-associated complement-fixing (soluble) antigen (CFSA) and the early antigen (EA) were isolated by ion-exchange chromatography from the P3HR-1 lymphoblastoid cell line activated with 5-iodo-2'-deoxyuridine for 72 hours. As expected, these two antigens were not immunologically identical. The CFSA, but not the EA, was isolated from the RAJl lymphoblastoid cell line by the same method.

Transfers to a psychiatric emergency room: a fresh look at the dumping symdrome.

There can be considerable interinstitutional distrust regarding transfer of psychiatric patients. In 1970 the directors of all psychiatric hospitals in New York City began to meet regularly in order to define problems and work out amicable resolutions, largely by defining criteria for hospitalization, establishing correct catchment area address, etc. In order to test the success of the program, three medical centers which routinely transfer patients to a receiving hospital were studied in order to see if they misrepresented patients' psychopathology or medical problems prior to transfer. It was found that 90% of the transfers were warranted, but that preselection at the hospital or origin led to the transfer of more males than females and more assaultive, rather than quieter patients, who might have been more amenable to inpatient treatment.

Immunologic identification of Epstein-Barr virus early antigen in a P3HR-1 cell extract.

We extracted the Epstein-Barr soluble antigen (EBSA) from the P3HR-1 human lymphoid cell line, which carries the Epstein-Barr virus (EBV), after P3HR-1 cells were activated with 5-iodo-2'-deoxyuridine. EBSA was identified as the early antigen (EA) complex by immunodiffusion and blocking immunofluorescence tests with high-titered human antiserum to EA. The identity of the EA complex was confirmed with antiserum to EA prepared in rabbits and adsorbed to assure its immunologic specificity. The EA was partially purified on Sephadex G-200. Further characterization by immunoelectrophoresis showed that the EBSA moved rapidly toward the anode. This indicated a highly negative charge. EBSA appeared to be distinct from the previously described complement-fixing S-antigen. It was demonstrable only in EA-producer lymphoid cell lines and reacted specifically with human antiserum to EA, whereas the S-antigen was found in all EBV-carrying lymphoid cell lines and reacted with all EBV antibody-positive human antisera.