[Regulation of erythropoiesis].

Following a brief review of the factors regulating erythropoiesis, which have enhancing influence only, an inhibiting factor with low molecular weight is presented. This non-toxic factor derived from normal human erythrocytes is inhibitory to the 59Fe incorporation into mouse erythrocytes in vivo and also to the 3H-TdR uptake into fetal mouse erythroblasts in vitro.


[Serum ferritin and its diagnostic significance in iron metabolism disorders].

Aim of the study was the evaluation of the diagnostic value of the parameters of iron metabolism in normal adults and also in patients suffering from uncomplicated iron deficiency, iron overload due to repeated blood transfusions, malignant lymphoma and Crohn's disease. In these patients, the determination of serum ferritin increased the diagnostic efficiency only in poly-transfused patients with iron overload.


[Serum ferritin and cytochemical storage iron in erythropoiesis and the R.E.S. in iron deficiency and faulty iron metabolism].

In 60 patients with iron deficiency anemia of chronic disorders serum iron, an iron absorption test, serum transferrin, serumferritin and stainable non-heme iron in erythropoiesis and reticuloendothelial system, were evaluated. Intercorrelations of these parameters were studied in different diagnostic groups. Pathogenetic principles and the clinical value of the applied diagnostic methods are discussed.


[Heme synthesis and iron status in pregnancy].

In 130 pregnant women (41 without complications, 40 with prematurity, 49 with EPH-Gestosis) Serumferritin, ferrochelatase (FCH), delta-aminolaevulinic-aciddehydratase (D-ALA-D), porphobilinogendeaminase (PBG-D) as well as hematologic routine parameters were measured. Regarding serumferritin, both uncomplicated and cases with pathologic conditions revealed a significant decrease in group II (28th week of pregnancy) as compared to group I (12th to 28th week of pregnancy). Women with EPH-Gestosis showed the lowest values. Activities of hemesynthesizing enzymes did not show any significant differences, neither between the two groups nor between uncomplicated and pathologic cases. Compared to healthy, non pregnant women; in pregnant women we found a significant increase in D-ALA-D and PBG-D, but a significant decrease in FCH. Enzyme pattern in pregnancy reveals an increased synthesis of porphobilinogen and an increased conversion of porphobilinogen to porphyrin. The low activity of FCH we measured in our study could be a reason for the elevation of free protoporphyrin in the erythrocytes.


[Indication and value of erythrokinetic examinations in anemia].

As erythrokinetic studies are time consuming and costly, this technique should only be done to provide information which is unavailable through simpler tests. By means of discussion concerning the methodological procedure and obtainable information, the indications for erythrokinetic investigations with Cr 51 and Fe 59 are derived. Since the results should be interpreted together with the clinical and haematological findings, a close cooperation of the departments of nuclear medicine and haematology would be essential.


[Cytochemical aspects in bone marrow cells in macrocytic anemias].

Cytochemical investigations are useful for the characterization of different kinds of macrocytic anemias. Vitamin B12 and folate defects or chronic alcoholic myelopathy, induce in the erythroblasts cytochemical patterns which can be distinguished from those seen in preleukemia, erythroleukemia, or in drug induced toxic anemia. Tests for alpha-naphthol-acetate-esterase, for acid phosphatase, for iron, and for polysaccharides (PAS-stain), are especially valuable for these diagnostic procedures.


[New aspects in the pathogenesis of anemia in chronic polyarthritis].

In 44 patients with rheumatoid arthritis and 30 control persons, the activities of the following three hemesynthesizing enzymes were determined: delta-aminolevulinic acid dehydratase (D-ALA-D), porphobilinogen deaminase (PBG-D), and ferrochelatase (FCH). Compared with the control persons in patients with rheumatoid arthritis, statistically significant decreased activities of FCH were determined, whereas no differences between the two groups tested occurred with D-ALA-D and PBG-D.


[Anemia in patients with malignant testicular tumors].

Changes in erythropoiesis were studied in 94 patients with testicular germ cell tumours (24 seminoma, 70 nonseminomatous tumours). Additionally ferrokinetic studies with 59Fe were performed in 29 patients with proven metastases. Only 2 of 37 tumour-free patients sustained moderate anemia after recess of primary therapy (2 seminoma, after X-ray-irradiation). In patients with disseminated tumour disease the anemia and the reduction of 59Fe-utilisation correlated positively with the elevation of serum estradiol concentrations, whereas no correlation could be established with testosterone serum levels.


[Hypotrypsinemia in diabetes mellitus].

Plasma concentrations of immune-reactive trypsin (IRT) were determined in 212 patients with juvenile-onset, insulin-dependent diabetes (Type I) and in 158 patients with maturity onset diabetes (Type II) in comparison to 121 healthy individuals. Significantly increased IRT levels were obtained in the type I diabetics, whereas IRT concentrations were normal or increased in the type II diabetic patients. Hypotrypsinemia occurred predominantly in type I diabetics with high IgG-insulin antibodies or islet-cell antibodies. No correlation was noted between the IRT-levels and the beta-cell residual capacity in the type-I diabetics.


[Clinical significance of cholesterol excretion in the urine].

Determination of urinary cholesterol has been suggested to be of possible value in the diagnosis of urogenital carcinomas especially of prostate, kidney and bladder. However, it has not been proven whether this method could be used as a screening test in large numbers of patients. 430 males and 545 females with an age above 50 years were selected for the study. Total urinary cholesterol values exceeding 5.1 mg/24 hours (regarded as positive results) were present in 13 males (3%) and 9 females (1.6%). In addition to benign diseases of the kidney and the urogenital tract, 2 carcinomas of the bladder and 1 carcinoma of the kidney were detected in the male group with elevated urinary cholesterol excretion. In view of the low prevalence of urological carcinomas and the cost of urinary cholesterol determination by GLC, this method cannot be recommended as a primary screening test, but could be of practical value in populations with microscopic haematuria and increased prevalence of urological carcinomas.


Anterior segment ischemia: classification and description in chronic myelogenous leukemia.

A patient with chronic myelogenous leukemia is described who developed anterior segment ischemia after extreme leukocytosis with a resultant increase in the blood viscosity. The patient's signs and symptoms resolved after therapy which normalized the white blood cell count. It is thought that the anterior segment ischemia was a result of sludging of white blood cells in the ciliary arteries. It is important to recognize that anterior segment ischemia can occur as a complication of chronic myelogenous leukemia associated with extreme leukocytosis. A new classification of anterior segment ischemia is given.


Myelogenous leukemia and bilateral exudative retinal detachment.

A 47-year-old woman with a diagnosis of myelogenous leukemia presented with poor vision secondary to bilateral exudative retinal detachments. Chemotherapy improved her leukemia status and her vision improved but her retinal pigment epithelium became diffusely mottled and irregular, presumably because of a toxic effect from the exudative subretinal fluid. Clinical and fluorescein findings are presented.


[Acute leukemia in infants].

Acute leukemias in infants, including the congenital and neonatal leukemia, present a number of unfavourable features. Age of the infant, hyperleukocytosis, outstanding organomegaly, early onset of the CNS leukemia are some of the factors causing this group of acute leukemias of childhood to be those with highest risk. The poor prognosis of the illness is further worsened by frequent rejection of cytotoxic therapy, often failure in inducing remission and its shortness. Two patients with acute lymphoblastic leukemia, aged 4 months, are presented. Clinical the hematologic remission was achieved in both by the application of the current therapeutic methods. Recurrence and CNS leukemia appearing 5 months after the remission resulted in death of one patient. The second patient also developed CNS leukemia 5 months after remission. It was treated and another remission was achieved, but the child died due to interstitial pneumonia.


Port Moresby or the bush?

85% of the population of Papua New Guinea lives in rural areas. Most death in Papua New Guinea occur in rural areas - from diseases that can easily be cured or prevented. We know how to treat them. We have the drugs. But we do not deliver the goods. We do not deliver health services to rural villages. This is the central problem of health care in Papua New Guinea, all else is secondary to it. It is just as important to train Papua New Guinea doctors to tackle the problem of delivering health services to rural areas (public health) as it is to train them in what to deliver (clinical medicine). If we do not deliver rural services, but persist in concentrating on urban curative services, then we will go on being largely irrelevant to the health needs of Papua New Guinea.


Where have all the doctors gone? An analysis of national medical officers.

Criticisms of deployment of national doctors have ranged from their lack in rural areas to their lack as clinical specialists. It has been charged that after 27 years of producing doctors there is not one national doctor working anywhere in the highlands. An analysis of all the Papua New Guinea medical graduates from Fiji School of Medicine, medical graduates from Papuan Medical College and medical graduates from University of Papua New Guinea has been done. There were 124 doctors trained during the past 27 years. Of these only 66 (59 national and 7 non-national) are currently available. These 66 doctors are evenly divided up as general duties medical officers throughout the country except in the highlands provinces, medical administrators including provincial health officers, specialists or trainee specialists and other categories including 9% in private practice. These 66 doctors comprise 28% of the total doctors in the country. They make up 82% of the medical administrators, 40% of provincial health officers, 20% of medically qualified lecturers, 17% of general duties medical officers, 12% of doctors staffing rural health centres and 9% of Health Department specialists. 38% of national Health Department or Church doctors available for service are rural-based compared to 49% of non-national Health Department or Church doctors. The basic problem is the small pool of national doctors available. Only 4 highlands doctors are available, the first two graduating as recently as 1975. The proportion of highlands medical students is increasing each year. Many national doctors worked in highland provinces in the past and the killing of Dr. Luke Rovin in 1972 has probably been a factor in the absence of national doctors from the highlands in recent years. When more highlands doctors become available there will be national doctors working in the highlands.


Comparison of the Sahli and grey wedge haemoglobinometers.

Experiment confirms that the MRC grey wedge photometer is better for haemoglobinometry than the Sahli haemoglobinometer. However, there is considerable observer variation and the precision of those who undertake haemoglobinometry should be studied by analysis of duplicates. Only in this way can the significance of any measurements obtained be assessed.


Clinical and roentgenographic manifestations of pulmonary tuberculosis in adults in Papua New Guinea.

The clinical and roentgenographic manifestations of newly confirmed cases of pulmonary tuberculosis at Port Moresby General Hospital during a one year period, starting May 1st, 1977, were reviewed. Of 402 adult patients who were commenced on anti-tuberculosis drugs during this period 101 had bacteriologically confirmed pulmonary tuberculosis. A history of chronic productive cough was the most common clinical finding. Extrapulmonary involvement was found in one third of the patients. Family history of tuberculosis was positive in 20%. There were 50 patients with one or both upper lobes involved, 20 with miliary, 9 with pleural effusion, 5 with generalized by non-miliary pattern, 5 with lower lobes, and one with primary tuberculosis. No tuberculoma was found and the chest x-ray was normal in 2 patients. The most common pattern was involvement of both upper lobes (31 patients). One or more cavities were present in more that half of the patients. In 13% of the patients, roentgenographic findings were considered atypical for adult pulmonary tuberculosis. Cases of lower lung field tuberculosis were the most difficult to diagnose. Comparing the result of this study with that of similar series from countries with a low prevalence of tuberculosis shows that there is a higher frequency of miliary pattern and a lower frequency of tuberculoma and primary tuberculosis in papua New Guinea adults.


Severe anaemia in Port Moresby. A review of 101 adult Melanesian patients with haemoglobin level of 4G/100 ml or less.

Causes of anaemia in 101 adult Melanesian patients admitted to Port Moresby General Hospital over a 3-year period with haemoglobin levels of 4.0 gms per 100 ml or less were studied retrospectively. Cases of anaemia due to acute haemmorrage were excluded. Iron deficiency was found in 80, haemolysis in 39, megloblastosis in 26 and anaemia of chronic diseases in 5 patients. Anaemia was secondary to multiple causes in 56 and to a single cause in 45 patients. In the group with multiple causes, a combination of iron deficiency and haemolysis was found in 28, iron deficiency and megaloblastosis in 18, iron deficiency, haemolysis and megaloblastosis in 6 and haemolysis and megaloblastosis in 5 patients. In the group with a single cause, iron deficiency was found in 34, anaemia of chronic diseases in 5, haemolysis in 4 and megaloblastosis in 2 patients. Hookworm infestation and malaria appeared to be the major underlying causes of anaemia in the majority of these patients. Three of 45 patients who had received blood transfusions shortly after admission to the hospital died, while there was only one death in the nontransfused group. It is concluded that: i) severe anaemia in Papua New Guinea is commonly secondary to multiple causes; ii) administration of iron and folic acid as well as treatment for malaria and hookworm is a responsible approach when these patients can not be investigated; and iii) blood transfusion does not appear to be necessary in this group of patients despite a very low haemoglobin level.


Haemoglobinometry in Papua New Guinea.

In 1978, doctors in Papua New Guinea were questioned about their practice of haemoglobinometry. Forty one doctors carried out blood haemoblobin measurements themselves, 26 used the Sahli method, 26 used a photoelectric absorptiometer method and 9 used the AO/Spencer haemometer. Thirty doctors had no occasion to ever need a haemoglobin estimation and 58 referred blood elsewhere, mostly to a hospital laboratory. The relative advantages of the methods presently available in Papua New Guinea are discussed and the value of quality control emphasized.


Status of granuloma inguinale in Papua New Guinea.

Granuloma inguinale has been endemic in Papua New Guinea for at least eighty years and recently appears to be increasing, particularly in the urban centres. Most patients were found to be recent migrants to the Port Moresby area with low socioeconomic status and poor personal hygiene. The disease was found more frequently in males. A possible association between carcinoma of the penis and granuloma inguinale was observed. Lesions were chronic, progressive and located mainly in the genital region. Attempts to culture the causative agent were unsuccessful.


Leukaemoid reaction in Eastern Highlands children.

In the five year period 1973-77, 278 children in Goroka Hospital paediatric ward were found to have a white cell count (W.C.C.) over 30,000/mm3. Of those with a W.C.C. over 40,000/mm3 in 1977 where the outcome was known, 13 of the 17 (76%) died. It is suggested that "leukaemoid reaction" in Highlands children be defined as a total W.C. over 40,000/mm3 that is not due to leukaemia. A leukaemoid reaction is a useful, but grave, prognostic sign. Such children comprise a quarter of all deaths in the Goroka paediatric ward.


What some Eastern Highlands mothers believe about malnutrition.

The beliefs of a sample of 41 mothers, from the Benabena region of the Eastern Highlands of Papua New Guinea, about malnutrition were studied. Information was obtained, by using an open-ended questionnaire, about recognition of malnutrition and beliefs associated with aetiology, sequelae, prevention and treatment. All mothers recognised a malnourished child as being sick and more than 80% believed a general or specific lack of food to be a cause of malnutrition and that giving food was an important aspect of prevention. Diarrhoea, fever and vomiting were the most commonly named associated symptoms. The only significant difference between mothers who attended maternal and child health clinics regularly and those who did not occurred when they were asked what they would do for a malnourished child. A significantly higher proportion of regular clinic attenders replied that they would give food. The possible implications of the results for nutrition education are discussed.


Childhood pneumonia at Goroka Hospital.

We have reviewed the clinical presentation of pneumonia to the Goroka paediatric ward. In comparison to survivors, children dying from pneumonia more often (p less than 0.05) had malnutrition (weight-for-age under 80%), anaemia (haemoglobin under 9g%), and a marked leucocytosis (total white cell count over 30,000 cells per c.m.m.). Children dying from pneumonia had been ill for longer and had been given more antibiotics prior to admission. There was no significant difference between children dying from pneumonia and survivors in age distribution, pulse rate, incidence of cardiac failure or duration of stay in hospital. 70% of the children dying from pneumonia at Goroka Hospital are infants under 12 months of age. Pneumococcal vaccine gives a poor antibody response in infants, and overseas studies using lung aspiration suggest that Haemophilus influenzae and Staphylococcus aureus might be causative organisms as well as Streptococcus pneumoniae. A study to determine the aetiology of pneumonia in Highlands children is required to enable a rational choice of routine antibiotic therapy and to plan further research on vaccination against pneumonia.


Renal syndromes of malaria.

Malaria is a disease of the erythron, but as would be expected with involvement of so vital an organ, serious secondary dysfunction of other organs such as the brain or kidneys commonly occurs. The body ultimately acquires defences against red cell parasitism, but when these do not culminate in effective phagocytic clearance of plasmodial antigens, injury to such organs as the liver and kidneys may result. All of the renal syndromes here described may occur in such close correspondence with malarial parasitism that a causative role in some cases is justifiably assumed. However, since all may occur in contexts other than malaria, in malarial as well as non-malarial countries, none is pathognomonic and none constitutes independent evidence of malarial infection. Indeed, though experimental malaria has had but a limited role in delineating the scope of possible malarial injuries to the kidney, the experiments of nature here described reveal natural malaria to be a versatile model system simulating most of the spectrum of known renal responses. The first three syndromes described are more or less direct consequences of unmodified malarial infection; the latter three reflect the intervention of immunity.


Patterns of use of Madang Hospital.

The patterns of inpatient use of Madang Hospital were examined. A highly disproportionate use of the hospital by the neighbouring population was demonstrated. The implications of this for health care planning are discussed and some methods of alleviating the inequalities in health care provision to urban as opposed to rural communities are suggested.


Chromobacterium violaceum infections. Report of a fatal case.

A case of systemic Chromobacterium violaceum infection, believed to be the first reported in a Papua New Guinean, is described. Autopsy disclosed multiple liver abscesses and the diagnosis was made by recovery of the organism from one of the abscesses. Aspects of management of this uncommon infection are discussed.


Physiological and chemical characterization of invertebrate metallothionein-like proteins.

Metallothionein-like proteins have been isolated from marine invertebrates. Three crustaceans, Scyllus serratus, Cancer magister and Acetes sibogae together with a mollusc, Cryptochiton stelleri, have been investigated. S. serratus hepatopancreas was shown to contain cadmium and zinc inducible metallothionein-like proteins with an amino acid analysis very similar to vertebrate metallothioneins. The molecular weight, ultra-violet spectrum and isoelectric points of S. serratus metallothioneins are also comparable to the vertebrate proteins, suggesting a fundamental biological function conserved throughout evolution.


Nutritional and environmental factors affecting metallothionein levels.

A number of elements including zinc, cadmium, mercury and copper will enhance the synthesis of MT, but only zinc and cadmium are deposited with this protein at higher levels than with other proteins in the liver when these are given orally. However, mercury and copper are deposited with MT in the kidney regardless of whether given orally or by injection. As the level of zinc is increased in the diet a corresponding increase of zinc concentration occurs only in the MT fraction of tissue cytosols. Zinc disappears from the MT fraction to the supplementation levels within 3 to 4 days when rats which have been fed a high zinc diet are changed to a zinc deficient diet. The evidence indicates that MT is involved with zinc metabolism. The half-life of MT is longer when cadmium is used to induce its synthesis than when zinc is used. Dietary sulfur deficiency limits the synthesis of MT. Various stresses, in which strenuous exercise, cold environment, and CC14 injection were most effective, and infections were found to enhance MT synthesis, suggesting a role for it in the defense mechanism.


Lidocaine treatment following baboon endotoxin shock improves survival.

Baboons treated with lidocaine (2 mg/kg/hr) after shock from endotoxin were compared to untreated controls in an LD70 E coli endotoxin (4 mg/kg) model. Survival, systemic and pulmonary arterial pressures, cardiac output, white blood cell and platelet counts, blood gases and arterial and mixed venous PGE and PGF 2 alpha levels were determined. Baboons receiving lidocaine had a better (P less than 0.05) survival at 72 hours than the controls. Circulatory function was improved with lidocaine; however, white blood cell and platelet counts, blood gases, and the prostaglandin release were similar in both groups. The mechanism by which lidocaine improves survival in baboon endotoxin shock appears to be unrelated to its effects on white blood cells, platelets, or the prostaglandin release.


[The catabolic patient].

Trauma and stress can cause characteristic changes in metabolism: raised lipolysis and reduced glucose tolerance as well as major renal nitrogen losses are manifestations of a postoperative or posttraumatic excess of catabolism over anabolism. Excess catabolism is caused by immobilisation and inadequate oral or parenteral nutrition. Wasting in seriously ill patients for intensive treatment. Priority must be given to the prevention of insufficiencies of organs and systems, and to the elimination of stress factors. It is only then that mobilisation and the administration of calories and nitrogen will restore a normal anabolism-catabolism balance.


[The cardiocirculatory state of the catabolic patient].

The patient in the state of catabolism shows, at least at the beginning, a hyperdynamic cardiovascular system which is characterized by an increased cardiac output and a high oxygen consumption. The following factors intervene in the regulation of the cardiac output: autoregulation of tissue perfusion, preload and afterload of the heart, contractility of the myocardium and heart frequency. All these elements are influenced by neurohormonal factors during stress or in the state of catabolism. Clinical observation of the functional signs at the level of the peripheral organs allows to evaluate the circulatory function. In patients in a critical or unstable state, monitoring by invasive techniques may become necessary in order to evaluate the situation and to adapt the treatment.


[Metabolic regulation in surgical patients].

The concentration of circulating hormones and substrates was determined in 7 patients before, during and after major elective surgery. On the basis of these and other of our studies, as well as data in the literature, a tentative scheme of postoperative and post-traumatic metabolism has been drawn up. It is based on the classical division into a "shock phase", a catabolic healing phase and an anabolic healing phase. The adjustment of intravenous feeding to these metabolic phases is discussed.


Testosterone metabolism in vitro by male sexual accessory glands from normal and autoimmunized rabbits.

In vitro metabolism of (3H)-testosterone from male accessory gland homogenates from autoimmunized and normal rabbits was studied at different times of incubation. Results indicated that 5 alpha - androstane-3 alpha, 17 beta-diol was the main metabolite formed in both cases, though the presence of the 3 beta-isomer cannot be excluded. On autoimmunized rabbits with small histological alteration, transformation of the precursor (3H)-testosterone was significantly greater (40 min: P less than 0.01; 60 min: P less than 0.05). This led to a higher yield of 5 alpha-androstane-3 alpha, 17 beta-diol at both incubation times, being significant only at 40 min (P less than 0.02). The 4-androstene-3,17-dione also increased as compared with the normal group. In autoimmunized rabbits with a greater histological alteration, the bioconversion of (3H)-testosterone decreased for both incubation times, being significant only for the 40 min (P less than 0.05). A decreased interconversion to 4-androstene-3,17-dione was also observed, being significant only for 40 min (P less than 0.05). These results suggest that in an early stage of autoimmunization there might be a transient stimulation of enzyme activities in the sexual accessory glands. In another moment of the phenomena a more severe histological lesion with infiltration of male accessory glands was present. At the same time, decrease in the enzymatic activities could be noticed.


Autografting cryopreserved buffy coat cells for chronic granulocytic leukaemia in transformation.

Seven patients with chronic granulocytic leukaemia in transformation were treated with combination cytotoxic drugs only or cytotoxic drugs plus total body irradiation followed by transfusion of reconstituted cryopreserved autologous buffy coat cells. Four of the patients were restored to second chronic phase disease which lasted 74, 32, 26 and 12 weeks respectively. Three other patients derived little benefit from the procedure. Buffy coat cells from patients with CGL apparently contain enough pluripotential stem cells to provide effective autografts in most cases. Lymphoid as well as myeloid reconstitution can usually be achieved. Buffy coat cells may thereby be superior to bone marrow cells for this purpose. Aggressive cytoreductive treatment followed by autografting appears to be a promising approach to the palliative management of patients with CGL in transformation.


Induction of abortion by intra-amniotic administration of prostaglandin F2 alpha in patients with intrauterine fetal death and missed abortion.

The use of intra-amniotic administration of Prostaglandin (PG) F2 alpha in the management of intrauterine fetal death and missed abortion is evaluated in a series of 30 patients. The patients were from 17 to 38 years of age with a median of 25 years. Parity ranged from 0 to three, and duration of gestation ranged from 16 to 37 weeks, with a median of 24 weeks. A single intra-amniotic dose of 40 mg PGF2 alpha was used under direct ultrasound vision. Induction was achieved in all cases. There were 28 complete, and two incomplete terminations. The mean treatment to completion interval for all patients was 5.3 hours. Side effects were minimal: we believe that PGF2 alpha can be safely administered intra-amniotically even with a dead fetus in the uterus and that it can lead to abortion with a minimum of discomfort and danger to the mother.


Abnormalities in the erythroid progenitor compartments in patients with chronic myelogenous leukemia (CML).

Peripheral blood and bone marrow specimens from 6 patients with Ph1-positive CML were evaluated for their content of erythropoietic and granulopoietic colony-forming progenitor cells. Specimens obtained from untreated patients showed marked increases in all compartments the most dramatic of which were for CFU-E and circulating CFU-C. This increased cell flow down the early stages of the red cell pathway in CML suggests that heightened proliferation and differentiation of primitive hemopoietic cells may be a more general phenomenon than previously suspected in this disease. In 5 of 6 patients, abnormal erythroid progenitors capable of proliferation and differentiation into hemoglobinized erythroblasts in cultures containing less than 0.002 units of erythropoietin/ml were regularly detected. In the 6th patient abnormal growth was not seen in cultures of the initial marrow obtained but was detected in cultures set up with peripheral blood taken 7 months later. The unexplained amplification of the erythropoietic compartment and the ability of some of these cells to mature in vitro in the virtual absence of erythropoietin is at variance with the anemia characteristic of untreated patients. This suggests the possibility of a major differentiation block at the level of CFU-E. Further studies of the properties of erythroid progenitors in these patients should help to provide new insights into the pathogenesis of CML and may provide useful markers for monitoring engrafted cell function after autotransplantation of patients in blast crisis.


Splenectomy in early chronic myeloid leukemia.

The authors report their experience with 25 patients suffering from C.M.L. who underwent splenectomy in an early phase of the disease. There were no operative deaths; seven patients had postoperative complications, three of which required re-operation for intra-abdominal hemorrhage. The follow-up is still too short to permit definite conclusions, but the results so far obtained suggest that splenectomy is useful in reducing leukemic tissue, improving the quality of life, and potentially efficacious in delaying the onset of blastic transformation.


A comparison of analgesic effectiveness of oral butorphanol/acetaminophen, oxycodone/acetaminophen and placebo in hospitalized postsurgical patients.

One hundred four patients with moderate to severe postoperative pain participated in a double-blind study comparing butorphanol/acetaminophen with oxycodone/acetaminophen and placebo with respect to analgesic effectiveness and incidence of side effects. Pain was rated by the patients and an observer; sums of these data were calculated. Side effects, their severity and their relationship to the drug were recorded. Both active medications provided statistically significant levels of analgesia as compared with placebo. Analgesia produced by both combinations of drugs was statistically similar until 4 hours postdrug. From 4 to 6 hours postdrug, butorphanol/acetaminophen was significantly more analgesic. Both active medications produced analgesia within 0.5 hours, showing a peak effect at 1 to 2 hours and lasting for 6 hours. The incidence of side effects was minimal and statistically equivalent for each treatment group.


Amelioration of blood viscosity in sickle cell anemia by pentoxifylline. A case report.

An 18 year old female patient with homozygous sickle cell anemia (HbSS: HbS 65% and HbF 4.9%) has been suffering from painful hemolytic crises about once a week since her childhood. Under treatment with pentoxifylline (2.4 gm daily in three divided doses), the blood viscosity decreased from 6.7 to 4.9 cP (normal: 4.3 to 5.3 cP at shear rate 46/sec) and the erythrocyte filtration accelerated from 127 to 77 sec (normal: 30 to 49 sec). Though hemolysis could not be prevented by pentoxifylline, there was no further demand for analgesic medication even in the hemolytic state. By decreasing blood viscosity and improving microcirculation, pentoxifylline may prevent the vasoocclusive complications of sickle cell anemia.


Studies on vasoocclusive crisis of sickle cell disease. I. Effect of pentoxifylline.

A method was developed to induce and continuously monitor vasoocclusive crisis of sickle cell disease in non-human primates. Pentoxifylline, a phosphodiesterase inhibitory agent, showed significant preventive effect. This may be based on its ability to increase intracellular cAMP levels and consequently to decrease platelet aggregation and to increase red cell deformability.


Small marker chromosome mosaicism confirmed in two cases ascertained prenatally.

Two cases of chromosomal mosaicism were prenatally diagnosed and confirmed in tissues cultured from subsequently aborted fetuses. In both cases a small marker chromosome was observed which proved de novo in origin, since parental chromosomes were normal. The implications and interpretation of such findings in counselling families undergoing amniocenteses is discussed. Mosaicism for small marker chromosomes may be more frequent than hitherto suggested.


Acute leukemia associated with trisomy 8 mosaicism and a familial translocation 46,XY,t(7;20)(p13;p12).

A patient is shown to have acute granulocytic leukemia, bone marrow mosaicism, and cutaneous fibroblast mosaicism for trisomy 8, an inherited reciprocal translocation involving the short arms of chromosomes 7 and 20, and a family history of cancer. A normal sister who had the same balanced chromosome translocation was evaluated for a preleukemic state; the results were unremarkable. The inherited translocation and postzygotically derived trisomy 8 are thought to represent additive factors contributing to the development of leukemia in the patient.


Genetic analysis of Azotobacter vinelandii mutant strains unable to fix nitrogen.

Transformation was used to perform ratio test crosses with mutant strains of Azotobacter vinelandii unable to fix N2. Mutations that simultaneously eliminated both components of nitrogenase (nif-1 and nif-2) were tightly linked. The nif-45 mutation that resulted in the absence of an active molybdenum cofactor was closer to nif-1 and nif-2 than to any of the other nif mutations. Strains that lacked component I carried mutations that were closely linked to each other. Mutations that probably were located in the structural genes for components I and II appeared to be relatively close to each other on the A. vinelandii genome.


Paternity testing by using erythrocyte enzyme esterase D.

A total of 206 paternity cases were tested for the erythrocyte enzyme esterase D (EsD) along with the 15 genetic marker systems routinely phenotyped. Of 39 observed exclusions of falsely accused males, 5 were exonerated by EsD. Reliability and ease of testing indicates that EsD is a useful exclusion determinant.


Elective induction of labor conducted under lumbar epidural block. II. Labor induction by amniotomy and intravenous prostaglandin.

Labor was electively induced at term in 117 clinically normal nulliparae and parous women by combining low amniotomy with intravenous administration of prostaglandin F2 alpha (n = 64) or prostaglandin E2 (n = 53). Analgesia was obtained by continuous lumbar epidural block with bupivacaine. The procedure was very effective in producing vaginal delivery within 24 h after prostaglandin infusion (n = 115), but it was accompanied by an extremely high incidence of uterine hypertonus. Tentative explanations for the transient uterine hyperstimulation are a direct stimulatory effect of the local anesthetic on the contractility of the myometrial fiber and/or a temporarily higher amount of circulating oxytocic compound reaching the myometrium due to local vasodilatation as a result of sympathetic nerve blockade. In some cases uterine hypertonus was associated with slowing of the basal fetal heart rate and, when severe, with the appearance of late deceleration patterns and fetal acidosis. In other cases the fetal heart rate deceleration is explained by the toxic effect of bupivacaine on the myocard. Since both the myometrial hyperactivity and the FHR alterations were temporary, fetal biochemical parameters were unaffected at completion of the first stage of labor. Because with intravenous prostaglandin uterine hyperstimulation is more difficult to avoid and regional analgesia further increases the hazard of both hypertonus and fetal heart rate deceleration, the combined application of an intravenous prostaglandin and continuous epidural analgesia should not be introduced into obstetrical practice.


Extraamniotic prostaglandin F2 alpha for intrauterine death and fetal abnormality.

Prostaglandin F2 alpha was administered extraamniotically for termination of pregnancy in 15 cases of intrauterine fetal death between 18 and 39 wk gestation and in 10 cases of fetal abnormality or hydatidiform mole between 16 and 28 wk gestation. Although delivery was achieved with minimal side effects in all cases, the best results were obtained in patients with intrauterine fetal death. It is concluded that discontinuous extraamniotic prostaglandin therapy constitutes a safe and effective approach for the active management of intrauterine fetal death.


Fetal and maternal metabolism of prostaglandin F2 alpha in the guinea pig.

Metabolism of prostaglandin F2 alpha (PGF2 alpha) was studied with both qualitative and quantitative techniques in liver, kidney and lung of fetal and maternal guinea pigs at term. In the pregnant guinea pigs 15-hydroxyprostaglandin dehydrogenase (PGDH) activities were highest in the kidney, followed by the lung and then by the liver. In fetuses PGDH activity was highest in the liver, followed in decreasing order by kidney and lung. The kidneys and lungs of the mothers showed a 6- to 10-fold higher PGDH activity than those of the litter (P less than 0.005), but the mean PGDH activity of liver was lower in the mothers than in the fetuses. It is suggested that the liver may play a major role in prostaglandin metabolism during fetal life, and may fulfil part of the function reserved to the lung during adult life. Maternal and fetal lungs differed greatly in their handling of PGF2 alpha. This was not due to a difference in aeration, for the differences in the metabolism of PGF2 alpha between mother and litter increased when well-aerated neonatal lungs were considered instead of non-aerated fetal lungs. The observed differences in enzyme activity between fetal and neonatal lungs add yet another dimension to the role of prostaglandins in the establishment of neonatal respiration.


Use of prostaglandin, hypertonic saline and oxytocin for second-trimester abortion.

The management of second-trimester abortion is still not satisfactory with respect to safety and side-effects; it is considered to be in a state of evolution. The goal of this investigation has been to combine, in reduced quantity, prostaglandin and hypertonic saline in order to minimize the complications and side-effects associated with the separate administration of each component. This study documents the results of a random sample of 385 abortions performed in the second trimester, induced by intra-amniotic instillation of prostaglandin (20 mg) and NaCl 5 and 10 g in different volumes and concentrations augmented with oxytocin. In a series of 20 patients, the coagulation profile is presented and the clinical characteristics of 4 groups are compared. This study demonstrated no coagulation defects. The gastrointestinal side-effects were reduced. In spite of the reduced dosage of each component, the instillation abortion interval still remained 17.08 h on the average. Incomplete abortion ranged from 32% to 48.78%. The data presented in this report suggests that combination of prostaglandin, hypertonic saline and oxytocin is feasible for midtrimester abortion.


Comparison of intrauterine prostaglandin metabolism during pregnancy in man, sheep and guinea pig.

Metabolism of prostaglandin F2 alpha (PGF2 alpha) was studied in uterine tissues from pregnant women (n = 10), sheep (n = 6) and guinea pigs (n = 6). Two maternal tissues, myometrium and decidua or maternal placenta, and two fetal tissues, fetal placenta and membranes, were studied in each species. PGF2 alpha was metabolized via the well-known pathway into 15-keto-PGF2 alpha and 13,14-dihydro-15-keto-PGF2 alpha, while 13,14-dihydro-PGF2 alpha was tentatively identified in some tissues. The presence of 15-hydroxyprostaglandin dehydrogenase (PGDH) and 13,14-prostaglandin reductase was demonstrated in all tissues from each of the three species studied, but the quantitative intrauterine distribution of these enzymes differed from one species to another. In man, PGDH activities were highest in fetal membranes followed by fetal placenta and then by decidua and myometrium. In sheep, PGDH activities were highest in the maternal placenta followed in decreasing order by myometrium, fetal placenta and membranes. In the guinea pig, PGDH activity was highest in the fetal membranes followed in decreasing order by maternal placenta, fetal placenta and myometrium. Quantitative assay of PGDH showed that PGDH activity in the pregnant uterus is higher in women than in sheep and guinea pig. The results are discussed in relation to the involvement of prostaglandins in parturition.


Personal results, trial of classification and standardization in clinical impedancemetry.

The author analyzes the results obtained in clinical impedance testing of 2,799 ears by tympanometry and study of the acoustico-facial reflex. Impedance terminology is discussed and classified in an attempt to bring order to the results. Important findings include the high incidence of negative middle ear pressure in older, profoundly hard-of-hearing children.


Cancer of the thyroid: its management.

Four types of cancer of the thyroid gland occur, each different in biological behaviour and in associated factors affecting prognosis. Knowledge of these differences makes it possible to determine appropriate treatment for each case and reduces the chance of undertreatment or overtreatment. Fortunately, most cancers of the thyroid gland are well differentiated and can be treated by conservative surgical measures; the results are low mortality, minimal morbidity, and good prognosis.


The management of squamous cell cancer of the mouth and throat.

Until chemotherapy is proved more effective in the initial management of squamous cell cancer of the mouth and throat, radiation and surgery will remain the principal treatment modalities. This paper documents a treatment selection process which is used in the Head and Neck Clinic of the Peter MacCallum Hospital. Anatomical resectability, potential of control by radiation, disability and deformity produced by surgery, presence of metastases, psychological factors, and concurrent disease, as well as tumour behaviour, are all factors which influence the choice of radiation or surgery, alone, or in combination, in the treatment of each patient.


Results of the surgical treatment of selected patients with squamous cell cancer of the mouth and throat.

The five year results of excision of cancer of the oral cavity and oropharynx in 172 patients selected for surgical treatment are reported. The overall survival rate was 48.8%, with 39.5% of patients dying with persistent or recurrent disease. An unexpectedly high survival rate of 42.2% was achieved in 45 patients with residual or recurrent tumour resected after failed initial radiation therapy.


Current trends in the treatment of cancer of the larynx.

The case histories of 250 patients with cancer of the larynx presenting to the Peter MacCallum Hospital, the Alfred Hospital and the Royal Melbourne Hospital in the ten-year period 1966 to 1975 have been reviewed to determine: The results of primary irradiation treatment of T1N0 and T2N0 glottic cancer; The comparative results of primary irradiation plus salvage surgery as compared with primary radical surgery for T3N0 glottic and supraglottic cancer; and The surgical morbidity of secondary salvage laryngectomy following irradiation as compared with that of primary total laryngectomy. These findings are compared with those of a previous study of cancer of the larynx for the period 1956 to 1965.


Carcinoma of the larynx: experience at St Vincent's Hospital, Sydney.

Two hundred and twenty-nine patients with carcinoma of the larynx were treated at St Vincent's Hospital, Sydney, during the years 1958 to 1973. A crude cumulative five-year survival of 76% in Stage I and 62% in Stage II was obtained using radiotherapy as the first treatment in these stages, reserving surgery, consisting of laryngectomy, for radiotherapy failures. A 63%, five-year survival was achieved in Stage III by using laryngectomy as the first definitive treatment.


Temporal bone resection for cancer.

Fifteen patients with cancer involving the temporal bone have been considered for radical surgical treatment by partial resection of the temporal bone during the past 12 years. All but one had undergone previous treatment by local surgery and/or irradiation. Two patients proved to be inoperable at surgical exploration. Three types of partial resection of the temporal bone and described to encompass disease involving the concha, the mastoid and squamous areas of the temporal bone, the ear canal, the middle ear, and the parotid gland. Closure of the surgical defect has been achieved in five cases using the residual pinna, in four cases with scalp flaps, and in five cases with a deltopectoral flap. Complications have been surprisingly few, with only one postoperative death. In one case communicating hydrocephalus persisted until death from residual disease many months later. Minor repair failure occurred in two patients. No attempt has been made to restore facial nerve function by grafting procedures. Long-term survival has been disappointing; however, it is considered that such radical surgery remains justified in selected cases for relief of the pain and disfigurement caused by chronic ulcerating neoplastic disease.


Uniform data recording for head and neck cancer.

A uniform method of recording data on head and neck cancer patients is presented. This has been shown to work well in the clinical field. The records are always completely up to date and immediately available at any time for data analysis.


Endometriosis of the sigmoid colon and rectum.

Endometriosis is a common disease of women which occasionally causes serious symptoms in virtue of involvement of the distal large intestine. Two cases are reported, illustrating opposite ends of the spectrum of this disorder, one presenting with a complete large-bowel obstruction, and the other with periodical per-rectal bleeding. Endometriosis in these locations can closely mimic carcinoma, and from a consideration of our cases and the literature, those features which might help to distinguish one from the other are discussed. The treatment of endometriosis itself is briefly outlined. Either to avoid unnecessarily radical surgery, or to plan appropriate specific treatment at the time of surgery for the colorectal lesion, a preoperative diagnosis is desirable, but it is unlikely unless the clinician is aware of this unusual form of endometriosis.


Calculi in a Meckel's diverticulum: a case report and a review.

A case is reported of multiple calculi occurring in a Meckel's diverticulum which caused chronic abdominal pain in a 48-year-old man. The problem was diagnosed before operation by radiological studies. The features of this condition are well illustrated in this patient. The published literature is reviewed.


Giant fibrous polyp of the lower end of the ureter: case report and review of the literature.

Primary benign mesodermal tumours of the ureter mostly occur in the proximal part of the ureter. A case of a large fibrous polyp of the lower end of the ureter is described. The clinical presentation, radiological findings and treatment are discussed.


Double rotation skin closure: an alternative to elliptical closure.

A simple method of closure of circular skin defects is presented. Even for small defects it is often appropriate on occasions when elliptical excision is either not possible or inferior.


De-epithelialization and over-flapping in plastic surgery.

Contour defects resulting from trauma, from the excision of a neoplasm, or present at birth, may be restored in a number of ways, and the material used may be autogenous, homogenous, heterogenous, or synthetic in nature. The use of Silastic implants is currently fashionable, but despite the manufacturer's claims, there is no foreign material which the body will accept permanently as its own. Implants are easy to procure and to shape, and their use can sometimes simplify a surgical procedure, but there is no doubt that where autogenous material is available, it will almost always give the best and most permanent result. This paper illustrates the versatility of simple de-epithelialization and over-flapping procedures in restoring contour defects, and is also a plea for the use of living tissue where it is readily available.


Laser surgery for malignant melanoma and superficial malignancies.

This study describes 18 months' experience with the CO2 laser in the treatment of malignant melanoma and other superficial malignancies. In 110 patients, a general assessment was made of the advantages commonly claimed for the laser. In addition, a comparison between laser and scalpel surgery was made by means of a small retrospective study. Results from 39 patients undergoing wide excision and graft for primary malignant melanoma in association with axillary lymph node dissection indicated that the laser offered no specific advantages over the scalpel for this particular type of operation. The laser was shown to have specific advantages in the treatment of extensive superficial malignancy, in locally recurrent tumours, and in malignancy of soft tissues. In these situations it did minimize blood loss and achieve satisfactory extirpation of the lesion.


Successful reconstruction of the upper urinary tract by a combined Boari flap ureteroplasty and transureteroureterostomy.

Acute obstructive uropathy, following an abdominal hysterectomy in a 45-year-old woman, had been temporarily circumvented by bilateral nephrostomy. Reconstruction of the upper urinary tracts, in the face of a small, defunctionalized bladder, was successfully accomplished by a Boari flap ureteroplasty and transureteroureterostomy.


Surgical manpower in New South Wales.

A series of surveys of general surgeons in the State of New South Wales is reported. Each five years the number of general surgeons entering practice has been proportionately greater than population growth, and has also been proportionally greater than that of other surgical specialities. The speciality is not growing and is so saturated that almost half the general surgeons are engaged in general practice. It is suggested that the number of training posts be reduced to a level near that required to satisfy the requirement of our community for replacement of those leaving practice.


Herzberg revisited: factors in job dissatisfaction.

A study of nursing personnel in a private general hospital suggests that the high rate of turnover results as much from dissatisfaction with intrinsic job factors as from dissatisfaction with extrinsic factors. These findings contradict the Herzberg two-factor theory, and suggest alternative means of improving management of nurses.


Motivating and rewarding the staff nurse.

In meeting the economic and professional need for staff nurses to stay at the bedside, a system established at one medical center uses four methods to motivate and reward the staff nurse. They are: recognition and monetary reward, rural nursing experience, cross-training, and inservice participation.


An incentive program designed to develop and reward clinical competence.

A conceptual model is presented for establishing a salary and classification plan which structures a separate career pathway for staff nurses and provides an economic incentive for incrementally achieving higher excellence as a staff practitioner. The plan establishes standard or behavioral norms for four discrete practice levels and systematically measures the content of both line and staff positions to determine their relative difficulty. Consequently equitable salary relationships are made available for all nursing activity, while simultaneously assuring a congruent and competitive posture in the health care community.


On erythrocyte morphology.

The significance of the distinctive morphological difference between mammalian and non-mammalian vertebrate erythrocytes (disc versus ellipse) is discussed in the light of mammalian erythrocyte rheology.


Age-related changes in the nigrostriatum: a behavioral and biochemical analysis.

Rotational behavior was examined prior to (Exp. 1) and following unilateral lesions (Exp. 2) in the substantia nigra of young and old rats. Before lesioning no preferences for turning to the left or right were seen in either age group following graded doses of amphetamine. However, after radiofrequency lesions of the left substantia nigra both young and old rats turned predominantly to the left, and the ratio of left to right turns increased as a function of amphetamine dose. However, there were significant differences between young and old rats in the effect of amphetamine on rotational behavior, with old rats showing decided decrements in response strength. Direct dopaminergic stimulation under apomorphine or dopaminergic receptor blockade with haloperidol produced no such age related deficits. The results are discussed in terms of possible presynaptic alterations in dopaminergic functioning with aging.


The relationship of age and level of physical activity with the fractionated components of patellar reflex time.

Sixty male subjects were placed into four equal groups based upon age and level of physical activity: Old Active, Old Inactive, Young Active, and Young Inactive. The criterion measure of total patellar reflex time was fractionated into a central component, reflex latency, and a peripheral component, reflex motor time. Subjects were tested on 2 separate days and on each day, two blocks of ten patellar reflex trials were taken alternating trials between normal and Jendrassik conditions. A split plot analysis of variance showed that no statistically significant differences were found between any group for either of the fractionated components. Also, the amount of Jendrassik facilitation was similar for all four groups. The results suggested that the entire patellar stretch reflex apparatus and the system of alpha-gamma linkage may be unaffected by age and level of activity.


Nutritional status of the elderly: anthropometric and clinical findings.

Relationships between adiposity indices based on weight and skinfold measurements were examined in 75 women and 25 men, aged 63-96 years. For both men and women, relative weight, weight/height, and body mass index (weight/height2) were positively correlated (p less than 0.001) with the triceps and the subscapular skinfold thicknesses. Correlations with the suprailiac skinfold also were significant but of lesser magnitude. Weights of 42% of the subjects exceeded the ideal weight for height by 20% or more; triceps fatfolds of 18% were in the obesity range. One-third of the group was judged to be hypertensive. Relative weight was positively associated with systolic (p less than 0.05) and diastolic (p less than 0.01) blood pressures. Relative weight was correlated with fasting serum glucose of women (p less than 0.01), but unrelated to serum cholesterol concentrations. None of the anthropometric or clinical findings were associated with current level of dietary kilocalories.


The changing pattern of whole body protein metabolism in aging humans.

Dynamic aspects of whole body protein (nitrogen) metabolism were explored in healthy young adults and elderly men and women. Measurements were made of the rate of whole body protein breakdown, with the aid of 15N-glycine, and the rate of muscle protein breakdown, as estimated from urinary N tau-methylhistidine excretion. The results also were evaluated in relation to obligatory (endogenous) urinary nitrogen losses, previously determined in this laboratory for the two age groups. Rates of whole body and muscle protein breakdown, per unit body weight, were lower in elderly subjects than in young adults. Muscle accounted for a mean of 27% of whole body protein breakdown in young adults and 20% or less (p less than 0.01) in elderly subjects. Daily obligatory N loss was positively correlated (p less than 0.01) with whole body protein breakdown. It was calculated that muscle contributed less to the obligatory N output in elderly subjects than in young adults. These results indicate a change in the distribution of whole body protein metabolism during aging in human subjects, with muscle making a lower contribution to total body protein metabolism in elderly subjects compared with young adults.


Valvular calcification in the elderly: possible pathogenic factors.

Calcification of the mitral ring and of the aortic valve cusps was studied in an unselected autopsy series of 219 patients over 60, dying in a department of geriatric medicine. Possible correlations with age, sex, heart size, systolic and diastolic blood pressures, bone density and serum calcium, phosphate and alkaline phosphatase were examined. There were no significant findings for aortic valve calcification though there was a weak association with advanced age. Mitral ring calcification was significantly associated with higher age, female sex and with increased heart weight after correction for body size. These findings suggest that mechanical factors, rather than changes in mineral metabolism, are implicated in the development of mitral ring calcification.


Medical problems of the elderly in nonmetropolitan Illinois.

Are the medical problems of the ambulatory elderly in a nonmetropolitan area different from the problems of the metropolitan elderly? What relation does the availability of physician resources in a nonmetropolitan area have to the care delivered to the elderly? The study involved an analysis of 965 patient records sampled from the office practices of 16 family practitioners and 12 general surgeons. Data were extracted using the survey instrument developed for the National Ambulatory Medical Care Survey (DHEW, 1974). Results were obtained describing patient status, presenting problems, principal diagnoses, reasons for visit, and disposition. Comparisons of the medical problems managed by the family practitioners were made with those managed by the general surgeons. Problems managed by the nonmetropolitan physicians were compared with the data on the elderly obtained from the National Ambulatory Medical Care Survey. The data suggest that nonmetropolitan physicians, regardless of specialty, manage a broad range of chronic and acute problems. The survey of office records, however, does not provide information about how the elderly obtain access to other services essential to a coordinated, comprehensive system of health care.


Age at menopause in relation to reproductive history in Japanese, Caucasian, Chinese and Hawaiian women living in Hawaii.

A multiple regression analysis was undertaken to examine the relationship between age at menopause and selected biological and sociological variables in the reproductive history of Caucasian, Japanese, Chinese and part-Hawaiian post-menopausal women living in Hawaii. The analysis was conducted using the medical history records of 196 Caucasian, 181 Japanese, 72 Chinese and 60 Hawaiian women. Age at menarche, parity and months spent breast-feeding were found to have no significant effect on age at menopause. Regression models were not found to be heterogeneous among ethnic groups and no substantial interaction of ethnic group was found with age at menarche, parity or months spent breast-feeding.


Age-related differences in binocular backward masking with visual noise.

Peripheral processing, as defined by Turvey (1973), was investigated in a study of binocular backward masking involving random visual noise. For young (mean age 20.3 years) and old (mean age 55.4 years) adults, processing time (represented by stimulus onset asynchrony, SOA) was characterized as a power function of target energy (TE) (i.e., TEb x SOA = K). Over a wide range of target energy levels, processing time showed a similar rate of decline (similar exponent, b) for both age groups with increasing target energy. However, old subjects processed targets more slowly at all target energy levels (different constant, K), and this age difference was constant across all target energy levels. Results were independent of variables such as sex, education, response criterion, unmasked threshold, and method of determining stimulus onset asynchrony.


Speed of retrieval from long-term memory in relation to age, familiarity, and datedness of information.

The time required to name four groups of pictures was measured in 83 community dwelling males (18-70 years of age). One group consisted of objects used 50 to 70 years ago (unique dated exemplars), and another consisted of objects unique to contemporary times (unique contemporary exemplars). For comparison, other pictures of contemporary and dated objects commonly used in both periods were employed. There were three major findings. One, the familiarity of the pictured object is the major determinant of the time required to retrieve its name. Older subjects named the dated unique objects that were relatively more familiar to them more rapidly than did younger adults, while the reverse was true for contemporary unique objects. No age difference in the speed of naming common contemporary objects was found. Two, the overall age-related difference in naming latency was attributed to perceptual-motor aspects of the task. Three, the physical features as well as the familiarity of the object contributed to the speed of retrieval of the object's name.


Retrieval time from different memory stores.

Two experiments were carried out to measure age-related differences in speed of error-free recall by normal adults. The major results were that: (a) the time taken to read a word aloud (retrieval from lexical memory) does not increase appreciably until subjects reach their 60s; (b) the time taken to recall a verbal item just attended to (retrieval from primary memory) increases steadily throughout the adult years, and most markedly between the sixth and seventh decades; and, (c) the time taken to recall recent verbal information outside the span of attention (retrieval from secondary memory) also increases as a function of chronological age, at a relatively rapid rate and most markedly between the fifth and sixth decades. The effects are independent of the number of stimulus-response alternatives.


Recall of prose as a function of age and input modality.

Three short paragraphs were presented to 18 young (means = 27.6 years) and 18 old (means = 67.2 years) female volunteers to evaluate the effects of three types of input conditions on recall. In the Aloud (combined auditory-visual) condition subjects read the paragraphs aloud, without review, four times (trials), and, after each reading, verbally recalled as much as possible. In the Silent (visual) condition the task was identical except that the paragraph was read silently. In the Review condition subjects also read silently, but were allowed to review the material. The results indicated that, for both age groups, opportunity for review required more reading time and led to significantly better recall than either the silent or aloud conditions, which did not differ. There were no age-related differences in the time used for reading the paragraphs. Further, an Age X Trial interaction indicated that age-related differences in recall were not significant until Trial 3, with the young subjects showing greater increases across trials than the old.


Binaural analysis in the aging auditory system.

In a simulation of the "cocktail party" problem, subjects listened to recordings of a target voice, obscured by four background voices from adjacent locations in space. Listening conditions were either dichotic (with interaural directional cues preserved) or diotic (same input to both ears, directional cues removed). Elderly subjects were unable to use binaural directional cues as effectively as young subjects to improve intelligibility of the target voice. The results suggest that there is an age related deficit in the ability to perform the binaural signal analysis necessary to effectively separate speech signals from noise.


Age changes, cohort differences, and cultural change on the Guilford-Zimmerman Temperament Survey.

The relation between adult age and temperament was investigated using the Guilford-Zimmerman Temperament Survey. Between the years 1958 and 1974, the GZTS was administered to 915 men from 17 to 98 years of age in the Baltimore Longitudinal Study. Repeated measures were obtained for 336 men approximately 7 years after initial testing. Each GZTS scale was analyzed cross-sectionally and longitudinally. Sequential analyses of independent samples were also carried out in an attempt to separate the effects of maturation from those of generational and cultural change. Results showed that Masculinity declined at all ages, but General Activity declined only after age 50. Thoughtfulness and Personal Relations showed cultural declines during the time period studied, whereas Friendliness showed a long-term cultural decline. Later-born cohorts were lower in Restraint and higher in Ascendance than early-born cohorts.


Denial of aging: age identification and reference group orientations.

A 10-year longitudinal study of the age-identities of persons 70 and older revealed that many rejected the possibility that they were, in fact, "old." Although there was increased acknowledgment in the restudy of being old, a majority of respondents continued to define themselves in other ways (i.e., as middle-aged or elderly). The importance of comparative reference groups for aging denial was tested. As hypothesized, favorable self-evaluations versus age peers were positively correlated with younger self-images. These comparative evaluations were shown to be as useful as "positional" variables in explaining age-identity. The findings demonstrate the utility of a reference-group perspective in explaining diverse psychological adaptations to late-life role changes.


Predicting death from behavioral test performance.

This study described several brief behavioral measures which, with further validation, could be useful in predicting the deaths of older adults within a five-year period following testing. Such tests can be used in routine biomedical examinations, alerting the physician to possible problems in the future. The study was based on a battery of 18 tasks as well as 8 measures of health, social activity, and demographic characteristics administered to 380 healthy men and women aged 60 to 89 years. Five years later, the scores of those who had subsequently died (N = 83) were compared with a matched sample of those still living. Thirteen of the 18 task performances significantly distinguished between those still living and those who died. Discriminative analyses were carried out, and the discriminative score cut-offs correctly classified 66% of the subjects as to survival status.


Changes in aged white male suicide: 1948-1972.

Recent changes in the suicide rate of aged white males in America are considered in this study. It is shown that the trend in aged male suicide is closely similar, in the negative direction, to trends in aged income status. A multivariate model, incorporating social and economic variables in a dynamic manner, is formulated. The analysis of rates based upon the dynamic multivariate formulation shows that income status has exerted a significant, negative impact upon aged white male suicide over the period of the analysis. The social variables considered apparently have little or no significance with respect to the course of suicide over the period analyzed.


Performance and acquisition of serial position sequences by pigeons as measures of behavioral toxicity.

A procedure has been developed to measure the repeated acquisition of serial position sequences and to study the effects of drugs and toxic chemicals on the behavior generated by the procedure. Thus far experiments using the procedure have shown: (1) Performance schedules generate lower error rates than corresponding acquisition schedules: (2) Addition of a reset contingency further decreases errors under both performance and acquisition schedules: (3) Chained acquisition and performance schedules generate lower error rates than corresponding tandem acquisition and performance schedules: (4) Chained acquisition and performance schedules produce behavior that usually is more sensitive to drugs than corresponding tandem acquisition and performance schedules: (5) Acquisition schedules produce behavior that usually is more sensitive to drugs than corresponding performance schedules: and (6) Lead is an exception in that it produced clearer effects under a chained performance schedule with a reset contingency than under a corresponding acquisition schedule. The greater sensitivity to drug effects of behavior under acquisition schedules than behavior under performance schedules and of behavior under chained schedules may be a function of the baseline error rates, rather than the behavioral processes of acquisition, performance, and stimulus control.


Effects of solvents on schedule-controlled behavior.

Operant conditioning techniques have been shown to be sensitive to the acute effects of industrial solvents. In the first experiment, five rats trained in a multiple schedule with a fixed-ratio (FR) 10 component and a differential reinforcement of low rates (DRL) 20-sec component, with a time out 60-sec between reinforcement periods, were exposed to 0.25, 0.50, 1 and 2 ml of toluene in the experimental chamber. The effects were dose-dependent, with an increase in rate in the DRL component and a decrease in FR responding. A second experiment assessing the effects of chronic exposure to thinner in the acquisition of a timing behavior in rats showed an impairment in DRL learning after 4, 8 or 16 weeks of exposure to the solvent: however, rats having a resting period did not differ from control animals. Whereas this finding suggests a reversible impairment in the acquisition of a complex behavior, further research is needed to achieve more definitive conclusions.


Testing for behavioral effects of agents.

In the present state of science no morphological or chemical changes may be detectable at a time when behavior is profoundly disturbed, as in schizophrenia. Until we are reassured to the contrary, we must assume that exogenetic intoxication can produce changes detectable only as behavioral changes. Therefore behavioral toxicology must be studied. In contrast to toxic manifestations such as lethality or carcinogenicity, which tend to be unequivocal and irreversible, behavioral changes are like physiological changes in that they are quantitative, changing in time, and relate to variables with a considerable range of normal variability. An experiment on behavioral teratology in mice is described and the results used to illustrate the limits of the possible in behavioral toxicology. From reported and observed variability it is surmised that changes that occur in as many as 1 per 100 of the population or average as large as a 10% decrement will still be too small to be detected by direct experiment. Such risks are frequently unacceptable. Reasons are given for hoping that epidemiological studies may be able to supplement experimental toxicological studies to provide a better assessment of risk of small impairments or rare susceptibility.


Some problems in interpreting the behavioral effects of lead and methylmercury.

Two sets of observations are reported as illustrations of problems encountered in behavioral toxicology. First, in an attempt to determine the contribution of methylmercury-induced ataxia to behavioral changes observed on the fixed-consecutive-number schedule, some ancillary control experiments were undertaken. Neither pharmacologically-produced incoordination (ethanol) nor mechanically-produced incoordination (foot taping) led to behavioral changes similar to those seen after exposure to methylmercury. Second, total crop impaction in a pigeon that died during a behavioral experiment on lead suggested some further work. Lead-induced crop stasis in pigeons was measured by x-raying the passage of force-fed stainless steel ball bearings through the crop. This retardation of motility reliably preceded signs of overt toxicity. These results suggest that the behavioral changes in the pigeon noted by us and reported by other investigators cannot be attributed to CNS dysfunction alone, but more likely arise from starvation, or from combined CNS damage and starvation. In addition, these results demonstrate that the appearance of behavioral effects prior to overt toxicity does not necessarily reflect CNS damage.


Behavioral epidemiology of food additives.

Behavioral toxicology in the natural environment can be considered a special branch of epidemiology. Behavioral epidemiology, because it typically relies on complex functional criteria, faces all of the problems of behavior measurement posed by uncontrollable variation, and amplified even further by chemical exposure. Many such issues arose in a study of behavioral responses to artificial food colors in children. Difficulties in employing Applied Behavioral Analysis in such a context run the gamut from selection of retrospective criteria to appropriate statistical models.


Effects of toxicants on visual systems.

The analysis of visual toxicity is complicated by the heterogeneity of visual capacities in different regions of the visual field. Since various toxicants may impair different functions allied to localized portions of the visual field, it is important to explore the relationship of field defects to residual visual abilities. We have begun this exploration by studying methylmercury poisoning in macaque monkeys. Extended exposure to this toxicant produces a marked concentric constriction of visual fields, a result similar to that found in human victims. In addition, visual sensitivity is greatly reduced on those tests in which the periphery of the visual field is more sensitive than the center. Our findings suggest simple but reliable clinical tests for screening suspected victims of substances impairing peripheral vision.


Psychological test methods: sensitivity to long term chemical exposure at work.

Five studies dealing with long term occupational exposure to carbon disulfide, a mixture of organic solvents, toluene, styrene and lead are reviewed. All of the studies were cross-sectional, comprising either a comparison between exposed and nonexposed groups or the determination of exposure-response relationships, or both. The tests for the cognitive functions were known clinical intelligence and memory tests. The perceptual and psychomotor tasks were the Santa Ana test, the Bourdon-Wiersma test for visual-motor speed and accuracy, the Symmetry Drawing test and the Mira test. In four of the five studies the neurotoxic effect involved both cognitive and psychomotor functions. In the carbon disulfide group, psychomotor retardation was the most pronounced effect: in the group exposed to solvent mixtures the main effects were seen in the cognitive functions. The effects of styrene were limited to perceptual and psychomotor disturbances. As the most sensitive methods have varied from study to study, the continued use of broad and diverse psychological methodology in studies dealing with long term neurotoxic effects is proposed.


Quantitative analysis of rat behavior patterns in a residential maze.

A method for monitoring spontaneous locomotor patterns of rats during one day is described. The animals' locomotion is registered in a residential maze by 18 optical gates connected to a computer. Status changes of each optical gate are stored on a disk file and can be retrieved for complete session reconstruction and data analysis. The general features of a rat's behavior in the maze are discussed. Quantitative analyses and statistical comparisons between two sessions spaced two weeks apart and between a group of 4 control animals and 4 rats treated in utero with methylmercury chloride are performed. Following parameters are analysed as functions of time and maze location: locomotor and local activity, occupational duration and time per visit in the maze compartments. Angular dependences of path decisions and regional preferences of crossing at the alley bifurcations are observed. No changes of the measured parameters can be observed between the first and second sessions. Methylmercury treatment results in a consistently lower local activity during the night period and in differences of path preferences.


Comparison of neurobehavioral effects induced by various experimental models of ataxia in the rat.

The purpose of the present study was to design a standard battery of tests capable of quantitatively characterizing ataxia and concomitant neurological signs in the rat. In addition to a systematic analysis of the walking gait of animals, tests for activity, catalepsy, rigidity and various reflexive responses were included in the battery. The standardization of the test system was performed by determining and comparing neurobehavioral effects produced by 3-acetyl pyridine, acrylamide, pyrithiamine and thiamine deficiency, four experimental treatments reported to induce ataxia in animals. Results indicate that profiles of neurobehavioral disturbances accompanying ataxia in animals varied distinctively with each experimental treatment.


Morphological studies of toxic distal axonopathy.

Distal axonopathy is the most common form of toxic injury to the peripheral nervous system. Morphological studies of the experimental distal axonapathies produced by acrylamide monomer and hexacarbons have lead to a reappraisal of the dying-back hypothesis. These studies have also provided a rationale for many of the clinical findings in humans with distal axonopathies, and have been especially helpful in elucidating the effects of axonal neurotoxins on the central nervous system.


Cellular responses to neurotoxic compounds of environmental significance.

Many neurotoxic chemicals of environmental significance can be conveniently classified according to their cellular site of action in the nervous system. This paper considers neurotoxins which damage the nerve cell body (neuronopathy), its axonal process (axonopathy), or the myelin sheath which segmentally enwraps the myelinated axon (myelinopathy). Each of these three conditions can be reproduced in experimental animals for study of the mechanisms and consequences of neurotoxic damage. Detailed morphological examination of toxic distal axonopathies have stimulated biochemical studies which promise to yield a precise explanation of the molecular basis for this common type of neurotoxic disease. It seems possible that a precise description of the molecular basis for toxic distal axonal degeneration is within sight.


Physiological and neurobehavioral alterations during development in lead exposed rats.

Neonatal rats were exposed to lead (Pb) from parturition to weaning via the milk of dams which consumed 0 (tap water), 0.02% or 0.2% PbAc2 solutions. To determine if this regimen altered physiological and neurobehavioral development, responses to a battery of sensory-motor tests were evaluated during maturation and as adults. The tests were: visual evoked responses (VER), temperature regulation, maximal electroshock seizure patterns, reflex patterns, and neuromuscular performance. Overall results revealed that the Pb-exposed group compared to controls exhibited delayed maturation, altered developmental patterns and long-term CNS disturbances. Additionally, low-level strychnine administration during development caused additive interactions with both Pb groups, uncovering subtle effects of toxicant exposure. These sensitive and quantifiable techniques proved useful for assessing CNS functioning following perinatal insult, and except for the VER, are simple to conduct and cost efficient because they require a minimal amount of personnel training, equipment cost and time invested per animal. These screening tests also suggest further areas of study and may indicate the mechanism(s) responsible for the deficit.


A preliminary test battery for the investigation of the behavioral teratology of selected psychotropic drugs.

Pregnant Sprague-Dawley rats received 25 mg/kg of prochlorperazine, 20 mg/kg of fenfluramine, 75 mg/kg of propoxyphene or 200 mg/kg of diazepam daily between the 7th and 20th days of gestation. Vehicle control groups and a positive control group (vitamin A 40,000 IU/kg/day) were similarly prepared. Observations of reproductive performance were made and the offspring examined in a battery of neurobehavioral tests. Fenfluramine and prochlorperazine produced abnormalities in both the reproductive measures and neurobehavioral testing. Propoxyphene produced developmental delays and other signs of "pure" behavioral teratogenesis in that these effects were not anticipated in any of the observations of reproductive performance. Diazepam appeared to have the mildest effect on all the measurements taken. The test methods used in this study appear to be a reasonable initial approach to the development of neurobehavioral screening procedures which are comprehensive, sensitive, and usable.


Assays for behavioral toxicity: a strategy for the Environmental Protection Agency.

Broad agreement on specific approaches or standardized test batteries for assessing behavioral toxicity is unlikely to emerge in the foreseeable future. EPA should reject test standardization in any case, however; standardization stifles progress and, in addition, may bypass unique properties of new types of substances. The optimal strategy is to prescribe a set of functions, such as sensory, motor, and complex performance processes, leaving it to the manufacturer to select adequate tasks. Adequacy would be judged by EPA staff, in consultation with advisory panels, and resolved, in most cases, by a dialogue with the manufacturer.


Comparative behavioral toxicology.

Behavioral conditioning together with conventional sensory testing methods may be used in the evaluation of toxic effects on sensory systems in experimental animal models. Such procedures yield precise quantitative estimates of impairment in absolute and differential acuity and in sensory perception. Additionally, these behavioral changes can be related to the presence of histopathology in peripheral sensory structures; this orderly relation between structure and function may aid in our understanding of the basis for sensory coding in the normal end organ.


Trialwise tracking method for measuring drug-affected sensory threshold changes in animals.

Rats and rhesus monkeys were trained under a multiple schedule, the components of which were random ratio schedules for food presentation and for shock presentation. The discriminative stimulus for the shock presentation component was a pure tone for the rats and a light for the rhesus monkeys. In the test session under the extinction condition for the shock presentation component, the intensity of the discriminative stimulus was successively either decreased by fixed units when the conditioned suppression was observed or increased when the conditioned suppression was not observed. The levels finally oscillated within a narrow range around the threshold. The auditory thresholds of rats were increased by intramuscular administration of quinidine at 20 mg/kg and also by repeated intramuscular administration of kanamycin at 250 and 500 mg/kg/day. In rhesus monkeys, visual thresholds were raised by application of pilocarpine at 0.02-0.16 mg/kg to the eyes and also by subcutaneous administration of LSD-25 at 4-8 micrograms/kg in one monkey and at 20-30 micrograms/kg in another. The method used for tracking the animals' sensory thresholds was sensitive enough to test the selective effect of the drugs and was also a relatively easy way to obtain a stable behavioral baseline for experimental purposes.


Behavioral assessment of risk-taking and psychophysical functions in the baboon.

Laboratory procedures have been developed for the experimental analysis of risk-taking and psychophysical functions in dog-faced baboons (Papio anubis). In a procedure analogous to the traffic light situation, animals are rewarded with food pellets for completing a fixed ratio of 100 responses in the presence of a green light. Superimposed upon this baseline performance are 5-second presentations of a yellow warning light terminated by a red light in the presence of which all responses are punished with electric shock. When the yellow light is introduced late in the sequence (e.g., after 93 responses have been completed), response rates increase and the 100-response ratio is completed before the 5-second yellow light times out. When the yellow light appears early in the sequence (e.g., after 73 responses) a marked decrease in response rate is observed with cessation of responding before onset of the red light. The sensitivity of components of this risk-taking performance to pharmacological toxicants is reported and psychophysical assessment of relevant sensory-motor effects described.


Operant conditioning of infant monkeys (Macaca fascicularis) for toxicity testing.

A technique has been developed that allows infant monkeys to perform on an operant schedule as soon as they are able to self-feed. Behavior is shaped in small increments through a series of operants; sensory and motor systems as well as performance on schedules using intermittent reinforcement may be tested as early as 3-4 weeks of age. This is accomplished by exposing the infant to the operant situation almost continuously, and allowing the infant to feed only by operantly responding. Infants exposed to lead post-natally differed from controls in pattern of fixed ratio responding, "activity" as measured by pattern of responding over the course of the session, and on a two-choice form discrimination reversal learning set paradigm. This technique allows rapid accumulation of large amounts of data without experimenter intervention.


Effects of pre- and post-natal lead on affective behavior and learning in the rat.

Literature relevant to the relationship between early ingestion of inorganic lead and subsequent hyperactivity in rodents is discussed. Original research in the area is presented. Rats so exposed were not hyperactive in any of the situations investigated or under any of the dosage regimens employed. They did show hypoactivity in the open field when dosed over a prolonged period. Using a new behavior measure, lead-treated rats were found to be less active than controls in the passive avoidance situation. The possible utility of this new measure for behavioral and developmental toxicology is discussed. It is concluded that the available evidence does not support the contention that a meaningful relationship exists between early lead ingestion and hyperactive behavior. It is suggested that future research may more profitably be directed to assessing the effects of lead ingestion on behavior in stressful or fear provoking situations.


Alcohol and the acoustic reflex: effects of stimulus spectrum, subject variability, and sex.

Acoustic reflex thresholds were measured for eighteen young adults (9 men and 9 women) at four different blood alcohol levels: 0.00%, ascending 0.10%, 0.15% (peak level), and descending 0.10%. Reflex-eliciting stimuli consisted of three narrow-band noises (300 to 600, 600 to 1200, and 1200 to 2400 Hz) and three broad band noises (white noise, recorded rock music, and recorded factory noise). Prealcohol reflex thresholds were found to be significantly more sensitive than all postalcohol reflex thresholds for all stimuli, and broad-band stimuli demonstrated greater threshold shifts than did narrow-band stimuli. Significant sex differences were not observed for any blood alcohol level. Between subject variability was high, with 10 subjects showing little or no reflex threshold change and the other 8 subjects showing dramatic threshold changes.


Understanding continuity effects with complex stimuli.

When a low-intensity stimulus A is alternated in time with a high-intensity stimulus B of relatively short duration, stimulus A is heard as continuous. This "continuity" effect is shown to occur even when the B stimulus is a series of sharp pulses at one rate and the A stimulus is a series of pulses at another rate which must produce a very different neural temporal pattern. Simple substitution models of the continuity effect are thus shown to be inadequate. A model is presented to make various types of continuity effects more understandable.


Consonant perception by normals in conditions of filtering.

Consonant perception was investigated for 120 normal-hearing adults who listened to 16 consonants in a phrase context and made similarity judgements of 256 diadic stimulus pairs on a 9-point equal-appearing interval scale. Stimuli were presented at subjects' most comfortable listening levels in 3 low-pass filtered and one nonfiltered conditions. Subjects' ratings were converted to 16 X 16 full symmetric similarity matrices and submitted to INDSCAL analyses. Results revealed perceptual features common to all groups, as well as group-specific features (i.e., sibilancy, stop/continuancy, and place for nonfiltered; plosive and place for 4000-Hz low-pass; stop/continuancy and place for 2000-Hz low-pass; and voicing and stop/continuancy for 500-Hz low-pass). These results were similar to those found earlier for hearing-impaired subjects having sensorineural losses compatible with these frequency cut-offs.


Users' satisfaction with hearing aids.

Seventy-one hearing aid users were surveyed two years after their initial fitting to determine whether they (1) wore the hearing aid(s) prescribed, (2) were satisfied with their aid(s), (3) had specific complaints about their aid(s), and (4) would recommend that a hearing-impaired friend or relative go through the same hearing aid selection process. Ninety-six percent of the respondents obtained that aid that we recommended. Eighty-eight percent were "very satisfied" or "satisfied" with the help that their aid(s) provided. Eighty-two percent would recommend that a hearing-impaired friend or relative go directly to a "hearing specialist" for assistance when selecting a hearing aid.


The influence of the guess factor on the speech reception threshold.

Thirty normal hearing subjects were utilized in an investigation designed to determine the extent to which guessing on the part of the listener may influence the speech reception threshold. Results suggest that the magnitude of the speech reception threshold may be significantly altered as a result of the degree of guessing which occurs during the administration of the test. Clinical implications of this finding are discussed.


High-frequency consonant word discrimination lists in hearing aid evaluation.

A summary of the results shows that with 5 of the 9 subjects the high-frequency consonant scores indicated the same aid for the patient that the NU-6 scores indicated. In 2 cases the NU-6 indicated amplification was appropriate whereas the high-frequency consonant scores indicated amplification was not appropriate. Obviously, the high-frequency consonant scores should be considered supplemental to the NU-6 scores and not as a replacement for the NU-6. The combination of the NU-6 and the high-frequency consonant results for Subject 1 may indicate that the patient should have received further counseling and should have been taught how to communicate more effectively without an aid. The high-frequency consonant scores obtained by 2 of the subjects indicated different aids than the ones indicated by the NU-6 test and the patient preference. Perhaps the reason the patient chose an aid other than the one that would most benefit him was that he was most comfortable with the aid that allowed him to hear in the manner to which he was accustomed, even if he did not do as well with it. If a person had become accustomed to not hearing the high-frequency sounds, an aid that suddenly allowed him to hear those sounds might disturb him. The addition of high-frequency amplification might have made speech sound foreign to him. It would have been much easier for him to choose the aid that he was most comfortable with.(ABSTRACT TRUNCATED AT 250 WORDS)


Developing service-based teaching in health education for medical students.

In the expanding concern about the social-behavioral aspects of health care in medical education, health education has opportunities for making itself an important part of basic medical training. The need is to actually define a physician's appropriate educational tasks and competencies as a basis for curriculum development in health education which would ideally be integrated into the whole educational program. This case study presents efforts to develop an educational service component at a rural health center which, connected to a major teaching hospital, serves as a learning base for medical students. Through trial and student feedback a program has been developed which includes patient counseling, evaluative home visits, group education sessions, exit interviews, medication counseling, community needs assessment and educational consultation with local school teachers. With this program as a foundation, the goal is to integrate health education learning throughout the rest of the medical curriculum.


Progressive health education through community organization: a case study.

Successful health education programs should be based on well-integrated community systems and networks. A health educator encountering community disintegration assumes a responsibility for taking a community organization effort. A case study of such an effort, based on Rothman's locality development model, is described. Community diagnosis and program development stages are detailed. Community health projects were among the outcomes attributed to this project.


Shaping the future of health education: from behavior change to social change.

The view that individual behavior change is the primary goal of health education presents several serious problems. Although individual behavior does contribute to health and disease, social organization is perhaps a more powerful influence. The use of behavior change as the primary tool for health education raises grave ethical issues. Health education which seeks to change individual behavior has also failed to have a significant impact on public health. An alternative strategy is health education for social change. The goal of this approach is to involve people in collective action to create health promoting environments and life-styles. Several contemporary models for and principles characteristic of health education for social change are described.


Determinants of consumer influence in a health systems agency.

An 18-month study of consumer participation and influence in a Health Systems Agency (HSA) found consumer board members to be less influential than provider board members in agency decision-making. In an effort to investigate causes of the influence deficit experienced by consumer HSA board members three issues were studied: staff attitudes toward consumer participation; board member degree of representative accountability; and board member attitudes concerning commitment to consumer participation, commitment to health planning, health services attitude, and feelings of social powerlessness. Results indicated that staff members were favorable toward the concept of consumer participation. They recognized a lack of low-income minority participation, but they did not provide support or allocate resources to enhance consumers' ability to participate. Providers were less committed to consumer participation, felt more socially powerful, and had greater representative accountability than did consumers. Several strategies for increasing consumer influence in HSA decision-making processes are proposed.