We outline the implementation of a new method of measuring the quality of medical care that counts cases of unnecessary disease and disability and unnecessary untimely deaths. First of all, conditions are listed in which the occurrence of a single case of disease or disability or a single untimely death would justify asking, "Why did it happen?" Secondly, we have selected conditions in which critical increases in rates of disease, disability, or untimely death could serve as indexes of the quality of care. Finally, broad categories of illness are noted in which redefinition and intensive study might reveal characteristics that could serve as indexes of health. We describe how these inth of the general population and the effects of economic, political, and other environmental factors upon it, and to evaluate the quality of medical care provided both within and without the hospital to maintain health and to prevent and treat disease.

SUMMARY In order to learn more about stretch reflex behaviour of triceps surae, normal human subjects sat in a chair with one foot on a platform attached to a torque motor that produced phasic dorsiflexion displacements of the ankle. EMG activity was recorded from triceps surae and responses were obtained for various conditions. When the subject's foot was relaxed, stretch of triceps surae produced a single EMG component at short-latency which increased in magnitude with increasing velocity of stretch. The response was not altered if the subject was asked to plantarflex or dorsiflex the ankle voluntarily when he felt the perturbation. It was reduced by vibration of the Achilles tendon. If the triceps surae was stretched while the subject plantarflexed his ankle, the short-latency response was followed by one and sometimes two long-latency responses. Like the short-latency reflex when the foot was relaxed, none of these responses was altered by the subject's planned movement after feeling the perturbation. All of the responses were suppressed to a similar degree by vibration. The long-latency reflexes depended on longduration of stretching and relatively slow acceleration of stretch. The reflexes persisted after anaesthesia to the foot suggesting that muscle afferents were responsible. Interactions between H-reflexes and stretch-reflexes revealed that the afferent volley producing a stretch reflex acted like the afferent volley producing a small H-reflex. Responses at an interval of 30 ms to both an electrical stimulus for an H-reflex and a stretch stimulus were possible if the electrical stimulus produced only a small H-reflex and if the subject had been plantarflexing the ankle. The shortlatency reflex when the foot was relaxed or exerting a background force appears to be the monosynaptic, Ia mediated stretch reflex. The physiological properties of the long latency reflexes are similar to those of the short-latency reflex, and they may represent, at least to a certain extent, response of the motor neuron pool to successive Ia bursts.Stretch of contracting muscle produces a series of responses. The first, at "short-latency", has usually been shown to be equivalent to the monosynaptic reflex. If the muscle is active at the time of the stretch then there will be one or more "longlatency" responses following the early response, first seen by Hammond,' which also appear to be reflex in nature. Following these responses are additional events which can be strongly influenced by voluntary intent. The precise role of the short and long-latency responses in control of movement is unclear; speculations include the idea of a mechanism to control

No abstract

No abstract

Biosynthesis of gangliosides, a c r i t i c a l process i n early development of neurological function,was studied in 3 week old r a t s . Analysis of the glycosylation steps in the biosynthetic pathway has been impeded due t o the d i f f i c u l t y i n solubilizing the membrane bound glycosyl transferase enzymes. W e have solubil ized UDP-gal Gm2 ganglioside galactosyltransferase from r a t l i v e r Golgi by detergent extraction. Two isozymes which catalyzed the synthesis of Gml ganglioside were separated by DEAE chromatography. Peak I , the more basic form, and Peak 11, the more acidic form were highly unstable following chromatography but could be stored a t -20°C i n 50% glycerol. pH optima f o r Peaks I and I1 wer 7 and 6. The Ys f o r UDP-gal f o r Peaks I and I1 were 7.9 x M and 4.7 x 10-M; Kms f o r Gm2 were 2.6 x 10-5 M and 1.5 x