Significance of chest pain during treadmill exercise: correlation with coronary events. A follow-up study of 1,402 patients with a positive maximal treadmill stress test was made to evaluate the significance of angina during the test. Life tables were constructed and evaluated for significance of age, sex and work load at onset of angina. Coronary events (myocardial infarction, progression of angina and coronary death) were twice as frequent in subjects with angina and S-T segment depression as in those without angina. The increased incidence in 4 years held for all coronary events and was still doubled at 7 years for progression of angina and coronary death. The incidence of coronary events was more than twice as great when the angina was induced by a light work load (4 metabolic equivalents = METS) as when it was induced by a heavy work load (8 to 9 METS). Men aged 41 to 50 years having angina during exercise testing had a 3-fold greater incidence of coronary events and a 4-fold greater incidence of myocardial infarction compared with their counterparts who had S-T segment depression alone. In this study, angina during exercise testing identified 85% of true positive tests for coronary artery disease, whereas S-T depression alone identified only 64% of such tests. Thus, angina during exercise testing increases the sensitivity of the test and identifies cohorts of subjects at high risk for subsequent coronary events.


Electrophysiologic studies on atrioventricular nodal Wenckebach cycles. Wenckebach cycles with a 4:3 ratio, produced by rapid atrial pacing, were studied in 27 anesthetized denervated dogs using programmed stimulation. A test stimulus (S') could be inserted after any preselected beat of the Wenckebach cycle. An on-line computer measured the atrial (A) to His bundle (H) intervals. In all dogs a progressive increase in atrioventricular (A-V) nodal refractoriness was seen in the effective refractory period for each beat and a rightward shift of the A'-H' relative to the A-A' refractory curves. Atypical Wenckebach cycles could be produced by small changes in the basic cycle length. No evidence for reentry was found from the refractory curves of Wenckebach cycles and by interruption of stimulation after the third stimulus of a 4:3 Wenckebach cycle. Analysis of the A'-H' relative to the H-A' refractory curves did not confirm a positive feedback mechanism. In order to mimic a Wenckebach cycle, a blocked premature beat was inserted during stressed 1:1 conduction. The changes in the refractory curves for successive beats after the premature beat were rate-dependent and similar to those in Wenckebach cycles but smaller in magnitude. In Wenckebach cycles there is a progressive increase in refractoriness, caused by cumulative effect similar to that seen after a blocked beat during stressed 1:1 conduction, until block occurs and the cycle resets.


Atrial pacing for cardioversion of atrial flutter in digitalized patients. To test the safety and reliability of atrial pacing as a conversion technique in patients with atrial flutter who are receiving digitalis therapy, atrial pacing conversion was attempted for 49 episodes of atrial flutter in 32 consecutive patients. All patients except one were receiving digitalis. To control ventricular rates most patients had received larger than usual therapeutic doses of digitalis glycoside before pacing. Fourteen of the 25 patients whose serum levels were measured had glycoside concentrations greater than 2 ng/ml. Before atrial pacing the mean atrial and ventricular rates were, respectively, 290 +/- 20.6 and 134 +/- 27.9/min (mean +/- standard deviation). Successful rhythm conversion was achieved on 48 occasions (98%) in 31 patients. One patient required transthoracic direct current synchronized countershock cardioversion. With atrial pacing, the atrial flutter rhythm reverted immediately to sinus mechanism in 23 instances, and there were 25 episodes of atrial fibrillation. Among those who experienced atrial fibrillation, the rhythm spontaneously reverted to sinus mechanism within 24 hours on 14 occasions; on 11 occasions; the rhythm reverted to atrial flutter and repeat pacing was required. Sinus mechanism was eventually established in all 31 patients.


Effects of digitalis on sinus nodal function in patients with sick sinus syndrome. The effect on sinus rhythmicity and automaticity of complete digitalization in a 24 hour period was observed in 14 patients with sick sinus syndrome. Sinus nodal function was evaluated in these patients by assessing sinus nodal recovery time and by treadmill exercise testing and 24 hour Holter monitoring, before and after digoxin administration. Corrected sinus nodal recovery times ranged from 240 to 2,065 msec (average 714) before digoxin and were shortened to 250 to 1,260 msec (average 565) after the glycoside. Further, digoxin induced accelerated infra sinus escape pacemaker activity in five patients: junctional and ventricular in one and atrial in four. Spontaneous sinus rate evaluated with Holter monitoring revealed an average of 56 beats/min (range 43 to 69) before digitalis that was unchanged (average 58 beats/min; range 48 to 74) after digoxin therapy. Similarly, the sinus nodal response to exercise was unaffected after digitalization (average 118 beats/min both before and during digitalis therapy). It is concluded that digoxin does not exert adverse effects on sinus nodal function in patients with sick sinus syndrome. The glycoside can be used safely in these patients when indicated for cardiac pump dysfunction or for control of tachyarrhythmia.


Effects of morphine sulfate on human coronary blood flow. Because morphine causes coronary vasoconstriction in conscious dogs, human coronary blood flow was measured with the thermodilution technique before and after administration of morphine sulfate, 0.2 mg/kg body weight (maximum 15 mg) intravenously, in 10 patients to determine if the canine experience is clinically applicable. Coronary blood flow increased from a baseline value of 104.4 +/- 13.4 (mean +/- standard error of the mean) to 113.0 +/- 17.4 ml/min (difference not significant) 15 minutes after the administration of morphine. Baseline coronary vascular resistance was 1.14 +/- 0.19 mm Hg/ml/min; 15 minutes after morphine administration the resistance value was 1.02 +/- 0.17 (P less than 0.025). There was no significant change between baseline values and values 15 minutes after morphine administration in systemic mean arterial pressure (98.2 +/- 5.3 to 92.8 +/- 4.7 mm Hg); heart rate (69.5 +/- 3.5 to 72.6 +/- 3.4 beats/min), left ventricular ejection time (0.345 +/- 0.009 to 0.342 +/- 0.007 second) or tension-time index (2,324 +/- 128 to 2,291 +/- 149 mm Hg/sec per min). The slight coronary vasodilation noted after morphine administration in this study is in marked contrast to the significant coronary vasoconstriction demonstrated in the unanesthetized dog.


Successful treatment of drug-resistant atrial tachycardia and intractable congestive heart failure with permanent coupled atrial pacing. Temporary coupled atrial stimulation slowed the ventricular rate by nearly 50% in an adolescent patient with intractable congestive heart failure and focal repetitive atrial tachycardia that was resistant to drug treatment. Because of the success with the temporary pacemaker, a specially designed permanent pacemaker was implanted to provide coupled atrial stimulation. The necessary electrophysiologic conditions for ventricular slowing by coupled atrial pacing are: (1) an atrial effective refractory period shorter than that of the atrioventricular junction, and (2) depolarization of the ectopic atrial pacemaker by the responses to coupled atrial stimulation. During a 4 year follow-up period the treatment resulted in elimination of the tachycardia, followed by return of the heart size to normal and complete clinical recovery. Coupled atrial stimulation can provide effective treatment in selected patients with disabling drug-resistant atrial tachycardia in whom this mode of therapy is shown to be effective by careful electrophysiologic studies.


Studies of the mechanism of spleen cell cure for osteopetrosis in ia rats: appearance of osteoclasts with ruffled borders. After ia (osteopetrotic) rats receive whole body radiation and an injection of spleen cells from a normal littermate, the dense, sclerotic skeleton characteristic of osteopetrosis is rapidly remodeled and becomes normal in appearance radiographically and histologically within three weeks. The mechanism of this skeletal transformation has been explored in cured ia rats by light and electron microscopic examination of osteoclasts. In ia rats less than 25 days of age, osteoclasts viewed by electron microscopy lack a ruffled border - the extensive elaboration of plasma membrane next to the bone surface. Cured ia rats have osteoclasts with ruffled borders indistinguishable from those of normal littermates. In ia rats that receive only 600 rads whole body radiation, osteoclasts are still present three weeks later, but appear abnormal by light microscopy, with dense nuclei and lacking cytoplasmic vacuoles next to the bone surface. Cured ia rats have two types of osteoclasts, one type indistinguishable from osteoclasts of normal littermates by light microscopy, the other resembling osteoclasts of ia rats that received radiation only. These data indicate that the mechanism of the spleen cell cure for osteopetrosis in ia rats is rapid remodeling of the skeleton produced by osteoclasts with ruffled borders. Whether normal spleen cells produce these osteoclasts directly by cell division or indirectly by elaboration of some unknown local factor required for formations of ruffled borders by ia osteoclasts is not known.


Endothelial cell membrane: differences in the density of intramembranous particles between tissue- and blood-fronts revealed by freeze-fracture. Significantly higher density of intramembranous particles (IMP) was noted in the endothelial plasma membrane facing the blood-front compared to the tissue-front. The difference may be related to the function of the vascular endothelium as an active barrier between the blood and the tissue.


Ultrastructure of Octodon degus spermatozoon with special reference to the acrosome. The ultrastructure of spermatozoa from the cauda epididymidis and vas deferens of Octodon degus-a Chilean hystricomorph rodent-is presented. The head of spermatozoa measured 7.7 micrometer long by 5.9 micrometer wide and the tail was 41 micrometer long. The head was flattened dorso-ventrally and ovate in outline. The acrosome was the most distinctive feature of O. degus spermatozoa. In a frontal view of the head, the rim of the acrosome surrounding the nucleus had the shape of an inverted U. The acrosomal region covering the plane of the flattened head exhibited dome-shaped protrusions. Transverse or sagittal sections of acrosomal protrusions showed that the plasma membrane and outer acrosomal membrane were evaginated, while the inner acrosomal membrane followed the contour of the nucleus. The protrusions were not distributed at random and they were absent in the equatorial segment and in the rim of the acrosome. In frontal views, near the boundary between the acrosome and post-acrosomal region, fine rods about 170 nm long ran obliquely on the caudal part of the equatorial segment. Behind the same boundary, the post-acrosomal region showed a serrated border. Phosphotungstic acid treatment at pH 0.3 produced staining at the surface of the sperm as well as within a superficial layer of the marginal thickening of the acrosome and on the acrosomal protuberances.


Apoenzyme activities of erythrocyte transketolase, glutathione reductase, and glutamic-pyruvic transaminase during pregnancy. The erythrocyte apoenzyme activities of transketolase, glutathione reductase, and glutamic-pyruvic transaminase were determined in 236 pregnant women during the first or second trimester and again during the third trimester. There were no differences in erythrocyte glutathione reductase and erythrocyte glutamic-pyruvic transaminase activities during these two periods. In contrast, erythrocyte transketolase decreased significantly in the third trimester. No statistically significant correlations were found between levels of activity for the various enzymes and dietary intakes of protein, vitamins or calories. The percent of subjects with low erythrocyte transketolase activity (a value one standard deviation or more below the mean initial value) increased significantly during the third trimester. The percent of subjects with low erythrocyte glutamic-pyruvic transaminase activity was significantly reduced during the third trimester although the mean apoenzyme level did not change. Vitamin deficiencies as measured by enzyme stimulation tests tended to occur less frequently among subjects with low enzyme activities but in no instance was there a statistically significant difference. Hence, no association could be found between apoenzyme activity and the incidence of vitamin deficiencies.


The effect of dietary carbohydrate:fat ratio on energy intake by adult women. The effect of the dietary carbohydrate:fat (C:F) ratio on the spontaneous energy intake by healthy adults was investigated by comparing a high-carbohydrate diet (fat 24%, carbohydrate 58%, protein 18% of energy) and a high-fat diet (fat 47%, carbohydrate 35%, protein 18% of energy) in a 2 X 2 week cross-over design. Subjects were 22 healthy nuns in a Trappist convent with very regular activities. The diets consisted of combinations of liquid formula (75%) and standardized snacks (25%). The difference in C:F ratio was concealed: energy density, taste and appearance were similar. Energy consumption was recorded continuously. The mean daily energy intakes remained constant: 8276 kJ (1978 kcal). The difference in mean daily energy intake between diets was 73 kJ +/- 180 (SEM). Small changes in body weight were observed, but these are argued not to indicate definitive effects. It is concluded that changing the C:F ratio within commonly occurring ranges does not influence the spontaneous energy intake of healthy adults. The composition of the dietary fat was kept constant. Under practical conditions a change in the C:F ratio will also induce a change in the fatty acid composition of the diet, which might affect the energy intake regulation. Other experiments are required to see whether the C:F ratio can affect body composition or other physiological parameters in the long run.


Blood glucose rise after lactose tolerance testing in infants. Lactose tolerance tests are used clinically to screen children and infants. It is assumed that absorption of a lactose challenge in infants would occur in a predictable pattern prior to weaning. Twenty-one infants from 3 to 12 months of age were studied. The maximum blood glucose rise over fasting levels ranged from 11.0 to 62.0 mg/100 ml; the mean was 32.6 mg/100 ml. Six infants had a maximum rise of less than 20 mg/100 ml. Eleven infants (52%) had a maximum rise of greater than 30 mg/100 ml. Signs of intolerance were not noted in any subject. Weight and length were normally disturbed. Results indicate the variance in glucose rise existing within a population of infants growing normally and consuming milk. Gastric emptying, digestion, and absorption may influence the blood glucose rise after a lactose test. Established glucose levels used as an index to lactose absorption in older children and adults may not accurately reflect lactase activity in infants.


A comparison of administering protein alone and protein plus glucose on nitrogen balance. It has been suggested previously that in the fasting state the administration of amino acids alone would be more effective in sparing protein than the administration of amino acids plus small amounts of glucose. In the present study we have examined the effect of administration of amino acids alone (1 g/kg per day) and of the same regimen supplemented with 100 g glucose daily, on the nitrogen balance in 10 subjects, six of whom were obese and four undernourished. Mean cumulative nitrogen balance over a 5-day study period was -12.4 g on amino acids alone and +0.5 g when glucose was added (P less than 0.01). It thus appears that the addition of glucose may be beneficial rather than harmful in subjects receiving amino acid therapy.


Hair root diameter measurement as an indicator of protein deficiency in nonhospitalized alcoholics. Protein status of alcoholics admitted to a detoxification center was investigated with a view to adapting a hair root test for use in screening for protein deficiency. Hair root volume and hair root diameter had previously been shown to correlate well with hair root protein and to be sensitive indicators of protein deficiency. Hair root volumes in this study correlated well with mean maximum hair root diameters (n = 35, r = 0.9), which were simpler to measure, so diameter measurements were used. Mean maximum hair root diameters (range 0.02 to 0.19 mm) correlated with plasma RNase concentrations (range 6000 to 14,000 units/ml; n = 17, r = -0.7). Mean hair diameters of 84 alcoholics averaged 0.0864 +/- 0.0366 mm; those of 25 nonalcoholics were significantly greater: 0.100 +/- 0.0254 mm (P less than 0.05). Frequency of occurrence of hair root diameters of 0.06 mm or less was significantly higher in 71 alcoholics (29.5%) than in 23 nonalcoholics (8.6%) matched by age. Mean hair root diameters of 0.06 mm or less therefore can be used to signify protein deficiency where more expensive or technically demanding tests are not feasible. Protein deficiency occurs extensively in non hospitalized alcoholics. This method enables staff to single out those clients most likely to be in need of nutritional counseling and therapy.


Physical and neuromotor development of progeny of pyridoxine-restricted rats cross-fostered with control or isonutritional dams. Female rats were fed diets containing graded levels of pyridoxine throughout gestation. At parturition, the pups were cross-fostered with a dam which had been fed the same diet as the biological mother throughout gestation (an isonutritional foster mother), or with one which had received a control diet containing 400% of the National Research Council recommendations for B6 throughout gestation (a control foster mother), or were left to suckle the biological mother. Physical, neuromotor, and reflexological development of the pups was assessed throughout the 3 week lactation period. There were no significant differences between pups nursed by their biological mothers and by isonutritional foster mothers. Growth, reflex acquisition, and neuromotor activities were impaired in pups subjected to pyridoxine restriction during gestation. Acquisition of a number of reflexes and time spent in neuromotor activities were responsive to cross-fostering with a control foster mother but the deficits were not completely eliminated. Growth was only slightly affected by cross-fostering and acquisition of audicular startle and negative geotaxis was not affected by the nature of the foster mother. The latter reflexes are apparently determined directly by the gestational nutrition of the fetus whereas other reflexes and neuromotor activities are influenced by long-term effects of pyridoxine restriction on the postnatal performance of the dam as a mother, in addition to being directly influenced by maternal diet during gestation.


Riboflavin deficiency in women taking oral contraceptive agents. The effect of oral contraceptive agents (OCA) on riboflavin nutritional status of women of child-bearing age in a low socioeconomic population was studied. For a control group, 100 women in the same age and socioeconomic group using alternate forms of contraception were selected. Riboflavin deficiency was determined by measuring erythrocyte glutathione reductase activity, a reliable index of the deficiency. None of the women was on vitamin supplements or had clinical conditions effecting dietary intake or utilization. Eleven of 100 women in the control group had biochemical evidence of deficiency. This compared to 24 of 56 OCA users who were deficient. The frequency of deficiency increased among those on OCA for longer periods of time. Thirteen of 17 OCA users for 3 years or more, compared to 11 of 39 users under 3 years were deficient. There were no discernable dietary differences between the groups. These studies demonstrate that riboflavin deficiency is a problem of women in the lower socioeconomic level in the child-bearing age. The use of OCA aggravates the prevalence of deficiency.


Thiamin deficiency effects on rat leukocyte pyruvate decarboxylation rates. Thiamin status usually is assessed by urinary excretion of thiamin or by exogenous thiamin pyrophosphate (TPP) stimulation of erythrocyte transketolase activity. Because of the possible great utility of a biologically and chemically sensitive alternative method for thiamin status assessment, studies were made of rat leukocyte pyruvate decarboxylation activity in thiamin deficiency. Pyruvate decarboxylation rates were determined by assaying 14CO2 produced by leukocytes from 1-14C-pyruvic acid in vitro. Reaction conditions were 5 mumoles pyruvic acid, 2.2 X 10(4) DPM 1-14C-pyruvic acid, leukocytes from 5 ml whole blood, 50 mumoles NaH2PO4, 5 mumoles MgSO4, and 1 mumole MnSO4 at pH 7.4 in 1 ml reaction volume at 25 C. Four weeks of thiamin deficiency decreased leukocyte pyruvate decarboxylation rates and markedly increased the TPP effect on this reaction. Dual weekly assays in the same rats showed that 21 days of thiamin deficiency significantly increased the TPP effect on leukocyte pyruvate decarboxylation rates. In contrast, the TPP effect on erythrocyte transketolase activity was significantly increased after only 7 days of thiamin deficiency. Erythrocyte transketolase is more sensitive than leukocyte pyruvate decarboxylation rate to early thiamin deficiency in rats.


Relationship between tocopherols and serum lipid levels in children with beta-thalassemia major. Serum tocopherol levels were found to be below normal (less than 0.5 mg/100 ml) in nine (50%) of 18 children with beta-thalassemia major receiving inadequate treatment with blood transfusions. The mean tocopherol levels were significantly lower in the children with beta-thalassemia (0.57 mg/100/ml +/- 0.20) than in the controls (1.08 mg/100 ml +/- 0.24). Serum total lipid levels were found to be low in children with beta-thalassemia. The difference between the mean total lipid level in the beta-thalassemic patients (365 mg/100 ml +/- 75) as compared to that of the controls (581 mg/100 ml +/- 94) was highly significant (P less than 0.01). The ratio of serum tocopherol to 1 g total lipids was lower in children with beta-thalassemia (1.41 mg/100 ml +/- 0.43) than in the controls (1.88 mg/100 ml +/- 0.46) and the difference was significant. Yet, only three out of the 18 children with beta-thalassemia showed a ratio of less than 0.8 mg/100 ml tocopherol per 1 g total lipid which may be considered indicative of tocopherol deficiency.


Nutritional status of adolescent girls in regard to zinc, copper, and iron. Adolescent girls in the sixth through eight grades were surveyed for dietary intake and nutritional status in regard to zinc, copper, and iron in both the fall of 1975 and the spring of 1976. The adolescents (183 girls in the fall and 184 girls in the spring) consumed on the average 60 and 75% of the Recommended Dietary Allowances for iron and zinc, respectively. The mean concentration of zinc in hair samples was 216 +/- 64 microgram/g in the fall and 191 +/- 36 microgram/g in the spring. The mean concentration of copper in hair samples was 31 +/- 23 microgram/g. None of the girls had a concentration of zinc in their hair samples of less than 100 microgram/g. Hair concentrations of zinc anc copper were significantly correlated, but serum and hair concentrations of zinc were inversely correlated. However, in subsample of 102 girls, 3% has serum zinc levels below 70 microgram/100 ml and 4% had serum copper levels below 70 microgram/100 ml. Only 1% of the subjects had a hematocrit below 36%. No significant difference in any of these parameters was noted between girls who had experienced menarche and those who had not.


Zinc deficiency: a cause of abnormal dark adaptation in cirrhotics. Six stable alcoholic cirrhotics with serum zinc less than 70 microgram/100 ml had abnormal dark adaptation responses (mean dark adapted final threshold 3.2 +/- 0.6 versus 2.1 +/- 0.2 log lux in 21 age matched controls, P less than 0.01). Serum vitamin A ranged from 15 to 37 microgram/100 ml. Zinc sulfate (220 mg/day) was fed to three patients for 1 to 2 weeks and dark adapted final thresholds fell 0.9, 0.4, and 1.2 log lux without concurrent rises in serum vitamin A. Two patients were treated initially with oral vitamin A (10,000 IU/day) for 2 to 4 weeks, but their final thresholds fell to normal (2.1, 2.2 log lux) only after the addition of zinc for 1 to 2 weeks. The sixth patient, treated with vitamin A and zinc together, attained a normal final threshold in 2 weeks. The improvement in dark adaptation by zinc may be due to enhanced activity of previously depressed retinol dehydrogenase.


Dietary studies and the relationship of diet to cardiovascular disease risk factor variables in 10-year-old children--The Bogalusa Heart Study. A dietary study of 10-year-old children was incorporated into a larger epidemiological survey investigating the distributions, interrelationships, and course-over-time of arteriosclerosis risk factor variables in children. Food intakes, eating patterns, and diet-risk factor interrelationships are described for 185 children (35% black, 65% white) using an improved 24-hr dietary recall method. Protein intakes were high. The polyunsaturated-to-saturated fatty acid ratio averaged 0.4 and a sucrose-to-starch proportion of 1.1 was noted. Eggs were the main food source of cholesterol and milk was the prime source of saturated fatty acids and protein. Black girls had a significantly greater mean sodium intake than the three other sex-race groups. Intermittent snacks provided the most calories; breakfast and dinner contributed most of the day's cholesterol, and lunch was the prime source of lactose and calcium. Longer eating spans reflected significantly greater intakes of calories, protein, fat, carbohydrate, and sodium, and greater levels of total serum cholesterol. A lack of correlations was noted in large matrices of dietary components and risk factor variables, but results of the comparison of mean intakes of dietary components for children grouped according to serum cholesterol showed significant differences in the intakes of various forms of fat and carbohydrate.


Lactation and pregnancy in Iran. II. Diet and nutritional status. Dietary intake in the third month postpartum and nutritional status during pregnancy close to term were assessed in Iranian urban uomen of low and middle socioeconomic status as part of a study investigating nutrition, hormonal status, and lactation in a population where lactation failure is a serious problem. Dietary intake was assessed by the 24-hr-recall method. The greatest differential in food groups consumed was in animal products, fruit, and vegetables. Intake of nutrients equal to or less than 80% of recommendations in both socioeconomic groups were energy, vitamin B6, folacin, calcium, iron, and zinc. In the low socio-economic group, only average intakes of vitamin C, thiamin and protein met the standards. Significant differences were found between the socioeconomic groups in hemoglobin, hematocrit, serum total protein, and protein fractions, but not in weight and height. The only parameters of nutritional status significantly correlated with adequacy of lactation were postpartum weight and percent of standard weight for height in the low socioeconomic group, and hematocrit values in the middle socioeconomic group. Differences between pregnant and postpartum individual values of the blood parameters were in general greater in the middle socioeconomic group than the low socioeconomic group.


Assessment of a short dietary method for prospective study on cancer. This study was a trial to develop a short dietary questionnaire for estimating individual calorie and nutrient intakes among Japanese-American women in Hawaii participating in a prospective cancer study. One hundred five women recorded 4-day measured food records, and their average individual daily intakes of calories, protein, fat, carbohydrate, saturated fat, and cholesterol were computed. Individual food items of the 105 records were grouped according to common food categories and types of usage. The amount and frequency of use, and the average serving weights of the food groups were then calculated. Fifty food groups were selected for stepwise regression analyses of the individual nutrient intakes on the daily frequencies of the recorded items. Regression equations for each nutrient were computed from the 4-day records of 53 women and validated against the known intakes of the remaining 52 participants. The equations yielded high multiple R's and, except for protein and carbohydrate, there was resonable agreement between the mean observed and predicted intakes of the 52 women. However, the coefficients of determination of the observed and predicted intakes of the 52 women revealed considerable unexplained variation. Before designing a questionnaire, further studies are needed to develop and validate a precise short method for estimating individual nutrient intakes in large prospective studies.


Vitamin A deficiency in the Philippines: a study of xerophthalmia in Cebu. An investigation of xerophthalmia was undertaken in four ecological zones in Cebu in the Philippines. One thousand seven hundred fifteen children aged 1 to 16 years were examined in 12 barrios. Clinical, biochemical and anthropometric data were collected from the children. Dietary and socioeconomic information was obtained from the households. Multivariate statistical techniques were used to examine factors possibly associated with xerophthalmia. Of children 47% had deficient or low serum vitamin A levels and 4.5% had clinical signs of xerophthalmia. Approximately 2% had both low serum vitamin A levels and clinical eye signs and were then defined as having active xerophthalmia. Vitamin A deficiency was more prevalent in males than females. Xerophthalmia was most common in the 4 to 6 year old age group. Diarrhea, roundworm infestation and measles were not positively correlated with xerophthalmia but whooping cough and tuberculosis were. Low intakes of carotene and vitamin A were associated with xerophthalmia but protein and fat intakes were not. A higher incidence of xerophthalmia occurred in children of working than nonworking mothers. Data on home production and use of vegetables and fruits are presented. The results of this study are being used to introduce three alternate intervention strategies to control xerophthalmia.


Assessment of the cardiovascular system in conjoined thoracopagus twins. The thoracoomphalopagus conjoined twins comprise 75% of all conjoined twins. In the assessment of the organ systems of the twins, the cardiovascular system is important since union of this system in the twins has occurred in 75% of the cases. Of the five cases reported here, two had separate hearts and vessels with a common pericardium only. Two twins were joined at the right atrial level. The fifth pair were connected at both atrial and ventricular levels. It has been suggested that the presence of two separate QRS complexes in the ECG indicates complete separation of the two hearts. Case 4 shows that even in the presence of atrial union, the existence of an atrioventricular block in one twin may produce a very slow heart rate, while the other twin may have a normal rate that will not influence the ventricular rate of the other. In our experience, angiocardiography has been the most useful diagnostic procedure.


Trisomy for the distal end of the short arm of chromosome 3: a syndrome. We report a patient with a chromosomal syndrome involving trisomy for the distal three-fifths of the short arm of chromosome 3. The major clinical featues include bilateral temporal indentation, prominent cheeks, a long and prominent philtrum, protruding middle portion of the upper lip, penile hypoplasia, and an increased number of whorls on digits.


Type A2 influenza viral infections in children. We retrospectively reviewed the manifestations of influenza A2 in 83 hospitalized young children. Our purpose was to define the spectrum of clinical illness in this age group. Findings included fever (91%), vomiting or diarrhea (49%), pharyngitis (34%), pneumonitis (29%), otitis media (24%), conjunctivitis (13%), croup (13%), and bronchiolitis (6%). Neuromuscular manifestations occurred in 16 patients (19%) and included seizures, apnea, opisthotonos, and myositis. Three children had cerebrospinal fluid pleocytosis. Children younger than 3 months of age had fever less often and gastrointestinal symptoms more often than older children. Threee children died of progressive pneumonitis. We conclude that influenza A2 may cause a wide range of respiratory and neurologic findings in infancy and early childhood.


Toxic encephalopathy related to antihistamine-barbiturate antiemetic medication. A toxic encephalopathy characterized by depressed level of consciousness, marked irritability, and ataxia developed in seven children, 5 years of age and younger, following administration of an antiemetic combination of pentobarbital and pyrilamine maleate. Three of the seven patients were given a dosage of medication and exceeding the manufacture's recommendation. All seven patients recovered without sequelae.


Tick-borne relapsing fever in the Eastern United States. Tick-borne relapsing fever is endemic in the western part of the United States, but it has not been reported east of the Mississippi River. Sporadic cases have been reported in the eastern part of the United States, but travel to the West during the incubation period appeared to provide the source of infection. In the fall of 1975, a case of relapsing fever was diagnosed in Cincinnati in a child who had not traveled outside of Ohio, indicating the presence of Borrelia in this area. Serial serological studies indicated that B turicatae was the species involved. The occurrence of this case suggests that relapsing fever may exist in the eastern part of the United States, but its presence may not be appreciated because of the rarity of the disease and the difficulty in confirming the diagnosis.


A patient with a partial deletion of the short arm of chromosome 3. The case of a patient with a monosomy 3p25, due to a deletion of the distal part of chromosome 3, is presented. To our knowledge this is the first patient described with this anomaly. Severe psychomotor retardation, an asymmetric skull, the facial appearance, and ear anomalies were the most striking features on examination. The parental karyotypes were normal. The localization of the breakpoint, and the possibility of roentgenographic influence in the etiology of this case are discussed.


Home-testing for recurrent bacteriuria, using nitrite strips. Follow-up of children with recurrent urinary infections would be simplified by an accurate home-testing program for detection of infection. We provided nitrite test strips to the parents of 30 girls with recurrent urinary infection to determine if twice weekly home testing of first-voided urine could reliably detect infection. Infections were documented by dip slides or colony counts indicating more than 10(5) bacteria per milliliter of urine. Twenty-four families (80%) complied over a mean study period of 11 months, detecting 28 of 30 episodes of bacteriuria (93%). No false-positive tests occurred. Urinary nitrate, the substrate for nitrite production by bacteria, was universally present (greater than 100 microgram/ml) in 80 children. The nitrite test is useful for home follow-up observation of children at high risk of bacteriuria if applied repeatedly by motivated parents.


The hemolytic-uremic syndrome: spectrum of severity and significance of prodrome. A review of our experience with the hemolytic-uremic syndrome (HUS) illustrates a broad spectrum of severity. Comparison of this experience with that in other parts of the world leads to the following conclusions: (1) Nondiarrheal HUS may be sufficiently different from postdiarrheal HUS to warrant separate consideration in clinical studies. (2) The Netherlands more closely resembles California than Argentina in having patients with less severe acute renal disease and a more favorable outcome. (3) In California, with no specific therapy aimed at combating intravascular coagulation, even oliguric or anuric postdiarrheal disease has a good prognosis for survival (96%); the prognosis for recovery of normal renal function is good in the large majority of patients oliguric or anuric for two weeks or less (94%), but it is guarded in those with a longer period of renal shutdown (57%). (4) Patients with nonoliguric disease have an excellent prognosis for complete recovery. (5) Very mild and even clinically inapparent cases exist and appear to be part of the spectrum of the same process responsible for severe HUS.


The hemolytic-uremic syndrome: experience at a center in the Midwest. Nineteen children with the hemolytic-uremic syndrome were treated in our hospital from 1968 to 1976. Seven were over 5 years of age. The disease occurred most often in the spring of the year. Lethargy was a prominent symptom in all patients, and seizures occurred in seven. Transfusion and dialysis were the most important treatment modalities. Heparin was used in four children and did not appear to affect the course of disease although three recovered. Thirteen of 15 children who did not receive heparin recovered. Irreversible renal failure occurred in three children, all of whom were in the older age group. Serious sequelae were rare in those who survived.


Continuous phenobarbital treatment after a 'simple febril convulsion'. In only a small proportion of young children with brief, generalized, febrile convulsions do afebrile seizures develop, but this fraction is several times the prevalence of epilepsy in an unselected population. The risk of another febrile convulsion is approximately 30%. Febrile status epilepticus during a subsequent infection is a potential source of serious morbidity and mortality. Intermittent phenobarbital administration during subsequent, febrile illnesses confers little protection against recurrent, febrile convulsions. Continuous phenobarbital administration during the preschool years is indicated for most children who have had a simple febrile convulsion.


Amebic liver abscess: 1966-1976.

Amebic liver abscess: 1966-1976. A 10-year retrospective analysis of 15 patients with amebic liver abscess is reviewed and represents a continuation of the previous 2-decade experience at our institution (37 patients). Records were studied to determine the population affected, presenting symptoms, physical and laboratory findings, type and response to therapy. Most patients were rural males of lower socioeconomic status in the third to fifth decade of life. They presened as a febrile illness with abdominal pain for an average of 2 1/2 months duration. Significanct physical abnormalities were tender hepatomegaly (93%), right-sided pulmonary changes (40%), and fever (66%). All patients had abnormal liver scan, positive amebic serology, and hypoalbuminemia. All patients promptly responded to amebicidal therapy except one whose therapy was delayed. Clinical suspicion, liver scanning, serologic testing, and response to therapy are the keys to diagnosis.


The humoral immune system in inflammatory bowel disease. II. Immunologlobulin levels. As there have been reports of differences in mean levels of serum immunoglobulins between patients with ulcerative colitis and Crohn's disease, serum IgG, IgA, and IgM were estimated in 158 patients with inflammatory bowel disease and the results correlated with the clinical features of the patients. Although a higher mean IgG level in ulcerative colitis compared to Crohn's disease was confirmed, no difference was found when the comparison was limited to patients with colonic Crohn's disease. Patients with either disease had higher mean IgM levels than controls, and the IgM levels were higher on treatment with corticosteroids and showed a tendency to rise in remission. IgG and IgM levels were also higher in both diseases if extraintestinal manifestations were present. It is concluded that if clinical features, particularly disease site, are taken into account, the overall immunoglobulin responses in these two diseases show no differences.


Serial carcinoembryonic antigen (CEA) blood levels in patients with ulcerative colitis. Fifty-seven patients with ulcerative colitis were folloued 1-49 months (mean, 18 months) with serial CEA determinations during periods of remission, mild relapses, and severe relapses. Elevated CEA titers correlated with activity and possibly extent of disease: 12% of patients with proctitis, 47% of patients with left-sided colitis, and 60% of patients with transverse or universal colitis had elevated CEA titers during a flare. Moreover, 24% of patients with mild flares and 86% of patients with severe flares had elevated CEA titers. Ninety-two percent of patients with extensive disease and severe flares had elevated CEA titers. Elevated CEA titers were correlated with histologic findings in three patients. Inflammation of mucosa was demonstrated by colonoscopy and confirmed by biopsy in one patient with persistently elevated CEA titers during clinical remission. In two other patients with active disease whose CEA titers fell prior to colectomy, marked denudation of colonic mucosa was noted. In this study, a transiently elevated CEA titer indicated either clinically active ulcerative colitis or active inflammation of colonic mucosa.


Studies on translocation of immunoglobulins across intestinal epithelium. III. Failure of cholera enterotoxin to stimulate secretion of IgA by rabbit intestine. We tested the hypothesis that the secretion of IgA into intestinal fluids is modulated by increases in epithelial cell cyclic AMP. Cholera enterotoxin instilled into intestinal loops of rabbits did not induce IgA secretion, even though an appropriate fluid response was obtained. The findings, therefore, do not support the hypothesis.


Significance of serum level of 25-hydroxycholecalciferol in gastrointestinal disease. The serum 25-OHCC concentration was measured in 151 patients in order to evaluate the potential use of this determination in the management of gastrointestinal disorders. Patients with functional bowel disease had lower serum mean 25-OHCC levels than normals. The results were divided into normal (greater than 21 ng/ml), low normal (12-21 ng/ml), and low levels (less than 21 ng/ml). Two thirds of patients with malabsorption had low serum 25-OHCC. Most patients following jejunoileal bypass surgery for morbid obesity had low levels despite supplemental oral calciferol therapy. In patients with chronic liver disease, cholestasis more than parenchymal cell disease appeared responsible for low serum 25-OHCC levels. Measurement of serum 25-OHCC may be an ancillary screening test for fat malabsorption and in patients with intraluminal bile salt deficiency. Furthermore, repeated measurements may be useful in monitoring therapy with vitamin D products in patients with chronic malabsorption and cholestasis.


The diagnosis of microscopic carcinoma of the esophagus. Microscopic squamous cell carcinoma of the esophagus with early submucosal spread was diagnosed in two patients with hiatal hernia and evidence of esophageal reflux. The lesions were not suggestive of malignancy on endoscopic examination. Both patients are known to be alive more than one year after resection and presumably without recurrence. More liberal use of endoscopic brush cytology and biopsy or intubation cytology particularly in the cases at high risk, might substantially improve the chances of very early diagnosis and favorably alter the present grim mortality rate.


Antireflux surgery for symptomatic gastroesophageal reflux: mechanism of action. To determine the effects of Nissen fundoplication upon the symptoms of reflux and the diagnostic tests employed to evaluate reflux and to examine the relationship between gastroesophageal reflux and lower esophageal sphincter pressure before and after fundoplication, 10 patients with symptomatic reflux were studied before and after operation. Clinical evaluation, barium esophagography, endoscopy with mucosal biopsy, esophageal manometry, acid-perfusion and acid-reflux testing, and gastroesophageal scintiscaning were performed on each patient before and after surgery. Following fundoplication, marked symptomatic, radiographic, endoscopic, and histologic improvement was observed. Serial acid-reflux tests at increasing gastroesophageal pressure gradients returned to normal after surgery. Lower-esophageal-sphincter (LES) pressure increased from 8.2 +/- 1.3 to 12.0 +/- 1.5 mm Hg (P less than 0.01). In addition, surgery resulted in a significant decrease in the gastroesophageal reflux index from 17.4 +/- 2.4 to 2.7 +/- 1.1% (P less than 0.001). Surprisingly, the pre- and postoperative resting LES pressures did not correlate significantly with corresponding gastroesophageal reflux indices for individual patients. We conclude that increased LES pressure alone does not explain adequately the functional and clinical improvement which follows fundoplication.


Effects of cimetidine on healing of chronic gastric and duodenal ulcers in dogs. The effects of cimetidine on healing of gastric and duodenal ulcers induced in mongrel dogs were studied. Gastric ulcers were produced by subserosal injection of acetic acid solution and duodenal ulcers by topical application of acetic acid on the serosal surface of the duodenum. Oral treatment with cimetidine, 450 mg/dog/day in three divided doses for 14 days, produced a remarkable acceleration of healing of duodenal ulcers but exerted little influence on gastric ulcers.


Sweat electrolytes in chronic pancreatitis. Sweat electrolytes were carried out in 84 adult patients with calcific pancreatitis, 51 with noncalcific pancreatitis, and the results compared to 37 adult controls. Of the patients with calcific pancreatitis, 33.5% had sweat sodium levels greater than 90 mEq/liter and 14.4% a level greater that 120 mEq/liter. Patients with noncalcific pancreatitis also had a high incidence of elevated sweat sodium levels. Sweat potassium levels were less discriminating, and there appeared to be high sweat calcium levels in a few patients so tested. The reasons for the elevated sweat sodium levels in pancreatitis is not readily apparent, and the possible relationship to heterozygous forms of cystic fibrosis is discussed.


Studies on the ascites fluid of acute pancreatitis in man. Total protein, alpha1-antitrypsin, alpha2-macroglobulin, amylase, methemalbumin, tryptic amidase activity, radioimmunoassayable elastase 2, and three lysosomal hydrolases were determined in the ascites fluid from patients with acute pancreatitis. In eight patients methemalbumin was detected in ascites and serum, supporting the diagnosis of hemorrhagic pancreatitis. Significant levels (4-45 microgram/ml) of tryptic amidase activity were detected in ascites samples from all patients. Evidence is presented which demonstrates that the tryptic amidase activity is due to alpha2-macroglobulin-bound trypsin. Pancreatic elastase 2, determined with a new sensitive and specific radioimmunoassay, ranged from 400 to 2100 ng/ml in serum and from 650 to 4460 ng/ml in ascites fluid. Substantial amounts of alpha2-macroglobulin-bound trypsin and elastase 2, entering the circulation from the peritoneal cavity, might be responsible for certain serious complications seen in acute pancreatitis. However, with the exception of serum calcium and methemalbumin and the ascites fluid methemalbumin and total protein, none of the biochemical parameters studied showed a distinct correlation with the patient's outcome.


Hypogastrinemia in hypothyroidism.

Hypogastrinemia in hypothyroidism. Fasting plasma gastrin levels measured by radoimmunoassay were found to be low in patients with hypothyroidism. The intravenous infection of arginine caused an increase of plasma gastrin in hypothyroid patients but was significantly lower than those in normal subjects. The decreased gastrin level in patients with hypothyroidism was significantly improved after the thyroid function was normalized by treatment.


The interactive effects of induced abortion, inter-pregnancy interval and contraceptive use on subsequent pregnancy outcome. Prior induced abortion and outcome of the next pregnancy are investigated, allowing for two intervening and potentially confounding variables: 1) length of interval between the termination of the first pregnancy and the conception of the next (inter-pregnancy interval) and 2) the utilization of contraception during this interval. Results show that non-contracepting (susceptibility) intervals which immediately precede a subsequent pregnancy are significantly shorter following an induced abortion than those following a spontaneous abortion or delivery. A life table analysis of all susceptibility intervals confirmed this finding. To investigate outcome of subsequent pregnancy as influenced by preceding pregnancy outcome, inter-pregnancy interval and contraceptive use in the interval, a categorical linear model has been developed. Among non-contraceptors, the model indicates no differences in proportions of succeeding adverse outcomes (spontaneous abortion or low birth weight) regardless of inter-pregnancy interval and whether or not the preceding pregnancy had been terminated by an induced abortion. For the contraceptive users, however, proportions of adverse outcomes increased with length of inter-pregnancy interval, and, within each interval category, proportion of adverse outcomes was higher when the preceding pregnancy had terminated in an induced abortion.


Cadmium exposure in a community near a smelter. In June, 1976, the authors conducted a cross-sectional survey of a community near a cadmium smelter in Denver, Colorado, to evaluate human cadmium absorption and its possible health effects. In 1975 the mean annual airborne cadmium concentration in an area about 1 km from the smelter was 0.023 microgram/m3; the mean concentration in a comparison area 13 km distant was 0.003 microgram/m3. Whole blood and urine specimens were collected from 250 individuals residing within 2 km of the smelter and from a control population of 105 residents in the comparison area. There were no significant differences (p greater than .05) in whole blood or urine cadmium concentrations, as determined by flameless atomic absorption spectrophotometry, between persons in the two areas. The median blood and urine cadmium concentrations of residents within 1 km of the smelter were 0.05 and 0.09 microgram/100 ml, compared with 0.07 and 0.08 microgram/100 ml for control area residents. However, the difference between blood cadmium levels for smokers and nonsmokers was statistically significant (p less than .01). The median blood cadmium concentration for smokers was 0.21 microgram/100 ml compared with 0.04 microgram/100 ml for nonsmokers. Other laboratory determinations of blood and urine showed no evidence of a cadmium effect on hematopoietic or renal function.


Raw hamburger: an interstate common source of human salmonellosis. An interstate common-source outbreak of salmonellosis was first detected in the United States in September and October, 1975, when a tenfold increase in Salmonella newport isolates was noted through routine salmonella surveillance by the Colorado Department of Health. Eighteen primary cases with a distinctive antibiotic resistance pattern (tetracycline, streptomycin, and sulfonamides) were evaluated in a case-control study, and illness was found to be associated with eating raw hamburger (p less than .001) from any store of one grocery chain (p less than .001). A Dallas, Texas, processing plant that supplied the Colorado markets also supplied other states, and these other states were alerted. Maryland discovered nine S. newport isolates with the same antibiogram and, as in the Colorado outbreak, illness was associated with eating raw or very rare ground beef from the same grocery chain (p less than .03). A third outbreak of S. newport with the same antibiogram occurred on a Florida military base. S. newport with the same antibiogram and a phage lysis pattern identical to those of the human epidemic isolates was cultured from frozen hamburger recovered in Colorado and Florida. The associated hamburger originated at the same Dallas, Texas, processing plant. A source of the epidemic strain was not identified, but the organism probably originated before delivery to the plant.


A novel pattern of treponemal antibody distribution in isolated South American Indian populations. Serologic surveys for treponemal disease were carried out in 1970-1976 among three linguistically distinct and isolated population groups in the Brazilian Amazon Region and among the Mapuche Indians of southern Chile. Three patterns were found: 1) no evidence for treponemal infection in two very recently contacted groups; 2) sporadic positive individuals in groups with long periods of contact with non-Indian populations; and 3) a high prevalence of positive tests in one cultural group with limited exposure to non-Indians. The seroepidemiology and clinical manifestations of a possible treponemal infection in those villages with a high prevalence of positive tests were unlike those of the classically described human treponematoses.


The Tecumseh study of respiratory illness. X. Relation of acute infections to smoking, lung function and chronic symptoms. The relationship of acute respiratory illness and infection to chronic bronchitis was investigated in the community of Tecumseh, Michigan. Families were randomly selected for study from among all those in the community and they were followed for periods of one year. Occurrence of acute respiratory illnesses was identified on a weekly basis. Frequency of chronic symptoms of cough and sputum production was separately ascertained. Lung function studies were performed three times during the course of the surveillance year and blood specimens were collected at those times. The blood specimens were tested for rise in antibody titer with antigens of type A and B influenza, respiratory syncytial virus and Mycoplasma pneumoniae. Adults with mild or intermittent chronic symptoms of cough and sputum production experienced more acute respiratory illness than those without these symptoms. This finding was present at different levels of smoking frequency. A similar relationship was present when serologic infection rates were used in the analysis instead of acute illness incidence. When the population was dichotomized on the basis of lung function data, the segment of the population with more depressed values was found to have experienced higher infection rates. The results suggest that acute infection may play an independent role in the pathogenesis of chronic respiratory disease.


Estimating prevalence from the results of a screening test. This paper deals with some basis properties of screening tests. Such tests purport to separate people with disease from people without. Minimal criteria for such a process to be a test are discussed. Various ways of judging the goodness of a test are examined. A common use of tests is to estimate prevalence of disease; frequency of positive tests is shown to be a bad estimate, and the necessary adjustmants are given.


Risk factors and angiographically determined coronary occlusion. An association of coronary artery occlusion, as determined by coronary arteriography with age, prevalence of risk factors and alcohol intake was studied in 1635 male and 371 female heart patients. The degree of coronary artery occlusion was positively related to elevated cholesterol, elevated triglycerides, diabetes, age and history of smoking for both male and female patients. Hypertension was related to the degree of occlusion only for female patients. Male and female patients who had a higher alcohol intake tended to have less extensive occlusion. No positive association was found between obesity and the degree of occlusion. When the patients were divided on the basis of age (less than 50 and greater than or equal to 50 years) the findings did not differ. The lack of finding a relation between obesity and occlusion or between hypertension and occlusion for males differs from the general findings of epidemiologic studies on the relation between these risk factors and coronary heart disease. The authors believe that this discrepancy may either be explained by the way they selected patients (i.e., they selected patients who underwent a diagnostic angiographic examination), or that obesity and hypertension are not directly related to coronary occlusion but influence occlusive disease through some secondary mechanism.


Trends in urban mortality in relation to fluoridation status. Mortality trends from 1950 to 1970 were studied for 473 cities in the United States with populations of 25,000 or more in 1950, according to fluoridation status of their water supplies. Findings showed no relationship between fluoridation and observed changes in general mortality over the 20-year period. Also, no relationship was found between fluoridation and heart or cancer death rate trends.


Improving trend in hypertension control in a black inner city community. Throughout the 1960's repeated findings indicated a poor state of management for hypertension in widely diverse communities across the United States. In the early years of the 1970's similarly derived findings showed a substantial improvement in hypertension management. These trends are confirmed in two random samples of a black urban population studied in 1971 and in 1973 indicating more than a twofold improvement in blood pressure control over that period. This improvement was noticeable in all subgroups of the population at risk although young black males continue to have a less favorable status of detection and control of hypertension.


Tuberculosis: generation effects and chemotherapy. Mortality from pulmonary tuberculosis in the United States was analyzed by cohort. The introduction of effective chemotherapy necessarily renders models based on generation differences alone inappropriate in this disease. However, such models continue to be used. The data show major departures from the prediction of a generation based model during the 1950's. Projection of the 1941 rates and cohort slopes to 1970 using a generation model predicts 358,000 more deaths than were actually certified. The departure was smaller for blacks than for whites, and differences in delivery of treatment probably account for this. Projections of mortality need to be made for the planning of control measures. However, such projections must be done with the understanding that inter-cohort differences can be altered during adult life.


Psittacosis outbreak in employees of a turkey-processing plant. In June 1976, 28 employees of a Nebraska poultry processing plant had clinical onset of an illness compatible with psittacosis. The diagnosis was serologically confirmed in 22 patients by fourfold or greater changes in their complement fixation antibody titers, using a Chlamydia group antigen. Lack of serologic response in the remaining patients could not be readily explained by therapy differences, timing of serologic evaluation, or severity of clinical illness. The comparable attack rates in the various processing departments were consistent with an airborne infection. However, results of the investigation also suggested that workers having both frequent contact with turkey tissues and skin injuries were more likely to be infected than other processing workers. The cost of the outbreak for reimbursed medical costs, workmen's compensation, and lost wages was $19,000. A single turkey flock was implicated as the source of infection. This flock had been screened on a voluntary basis for evidence of infection prior to slaughter, using criteria developed by the United States Department of Agriculture. Although the preslaughter screening failed to detect psittacosis infection, two turkeys from the same flock which inadvertently had not been sent to slaught were subsequently found to be infected.


Pontiac fever. An epidemic of unknown etiology in a health department: I. Clinical and epidemiologic aspects. In July 1968, an explosive epidemic of acute febrile illness occurred at a county health department facility in Pontiac, Michigan. Illness characterized principally by fever, headache, myalgia, and malaise affected at least 144 persons, including 95 of 100 persons employed in the health department building. The mean incubation period was approximately 36 hours. Illness was self-limited, generally lasting from two to five days. Secondary cases did not occur in family contacts and second attacks did not consistently follow re-exposure in the building. A defective air-conditioning system was implicated as the source and mechanism of spread of the causative factor. However, extensive laboratory and environmental investigations failed to identify the etiologic agent. Since these investigations a bacterium similar to or identical with the agent responsible for Legionnaires' Disease has been isolated from guinea pigs exposed to the Pontiac health department building in 1968 as well as from guinea pigs exposed to water from the evaporative condenser. Paired sera from 32 cases of Pontiac Fever showed seroconversion or diagnostic rises in antibody titers to this bacterium.


Racial variation in the incidence of ovarian cancer in the United States. The incidence of ovarian cancer was determined in four US populations of heterogeneous racial-ethnic composition. Japanese, Chinese, Hispano, and black women had rates of epithelial tumors that were 19-42% lower than those of white women. Though these differences were due primarily to lower rates of serious and papillary tumors, all but Chinese women also had a decreased incidence of mucinous tumors, and Hispano and black women had low rates of endometrioid-clear cell malignancy. The incidence of nonepithelial ovarian tumors in the four populations showed little relationship to race.


An investigation of the use of asbestos cement pipe for public water supply and the incidence of gastrointestinal cancer in Connecticut, 1935-1973. The age adjusted sex specific incidence data for stomach, colon, and rectal cancer for Connecticut townships for the period 1935 to 1973 were used to investigate whether asbestos cement pipe usage for domestic drinking water is associated with gastrointestinal cancer. The townships were grouped according to the Assessment of Exposure (AOE) and Risk Factor (RF) for asbestos. These are composite indices of asbestos exposure including factors relating to the age of the pipe, the ability of water to leach asbestos from the pipe, and the length of pipes used by the population. No association was noted between these asbestos risk scores and gastrointestinal tumor incidence.


Purification and substrate specificity of polymorphic forms of esterase D from human erythrocytes. Esterase D (EsD), purified from human erythrocytes and tested with a variety of substrates, hydrolyzed only triacetin, tributyrin, and certain soluble aryl esters of aliphatic acids. Esters of 4-methylumbelliferone were easily the best substrates. When the three genetically different isozymes were compared, the less common forms, EsD 2 and EsD 2-1, were less stable than EsD 1. With some substrates, the Michaelis constant of the EsD 2 form differed from that of the EsD 1 form. The EsD 2-1 hybrid form was usually, but not invariably, intermediate in properties. The physiologic significance of the genetic variability of this enzyme is unknown.


Efficiency and robustness of pedigree segregation analysis. Different pedigree structures and likelihoods are examined to determine their efficiency for parameter estimation under one-locus models. For the cases simulated, family size has little effect; estimates based on unconditional likelihoods are generally more efficient than those based on conditional likelihoods. The proposed method of pedigree analysis under a one-locus model is found to be robust in the analysis of nuclear families: skewness of the data and polygenic inheritance will not lead to the spurious detection of major loci unless they occur simultaneously, and together with a moderate amount of environmental correlation among sibs.


A genetic study of immunoglobulin E.

A genetic study of immunoglobulin E. Path analysis gives evidence of genetic heritability (.425) for serum IgE levels. Complex segregation analysis indicates, in addition to significant polygenic heritability, a major regulatory locus RE, with homozygotes re/re maintaining persistently high levels of IgE. The gene frequency of re is .489, and the displacement is 1.67 standard deviations.


The genetics of Otosclerosis. I. Distorted sex ratio. The offspring of 214 otosclerotic x normal couples were investigated, and within these sibships, the segregation of otosclerosis is compatible with autosomal dominant inheritance. However, the overall sex ratio is approximately 0.73, with otosclerosis being approximately 1.8 times more frequent in female offspring. These observations are interpreted as the consequence of selection against males carrying the otosclerosis gene. Elimination of such males occurs only in certain sibships. The remaining families demonstrate a sex ratio approximating unity with similar rates of otosclerosis in both sexes. This selection operates mainly, and possibly only, prenatally.


Probability of paternity exclusion when relatives are involved. In diagnosis of paternity by means of polymorphic markers, the proportion of men excluded on the basis of the phenotypes of the mother and child is the best index for controlling information. Its expected value, the probability of exclusion of a male chosen at random with respect to a random child-mother couple, calculated from gene frequencies of every genetic system, may be modified by a close relationship between the mother, the real father, and the presumptive father. The father and even more the brother of the mother, if he is the father of the child, diminishes the probability of exclusion of an individual chosen at random in the population, and if he is falsely accused, he has a higher probability of being excluded. On the other hand, the brother of the real father chosen at random in the population has the least chance of being excluded. The two different rules of exclusion are involved in the calculations, the first one being the more reliable.


Prenatal diagnosis by linkage: hemophilia A and polymorphic glucose-6-phosphate deydrogenase. Close linkage between the loci for G6PD and hemophilia A allows prenatal diagnosis of hemophilia in the fetuses of certain women who are heterozygous for two electrophoretic types of G6PD. A pregnant woman, whose mother was an obligate heterozygote for hemophilia, had factor VIII levels and a G6PD phenotype that failed to indicate clearly whether or not she was heterozygous for hemophilia. The G6PD phenotype of her male fetus revealed that the fetus was unlikely to have hemophilia.


Polymorphism of chromosome 9 in 600 Greek subjects. The morphologic variations of C-band heterochromatin of chromosome 9 were studied in 600 Greek subjects referred for cytogenetic investigation. There was great variability in the location and length of the heterochromatic bands. The location and length of the heterochromatic band were equal in 177 individuals and unequal in 423. Twenty-five subjects (4%) carried a pericentric inversion on one of the homologs, and 12 individuals (2%) had an extremely elongated C-band in one homolog 9. Our findings are compared with those reported in the literature, and the ethnic variation is discussed and evaluated.


Compatibility and stability of electrolytes, vitamins and antibiotics in combination with 8% amino acids solution. The compatibility and stability of the following additives in an 8% amino acids and 50% dextrose solution intended for total parenteral nutrition were studied: potassium phosphate, calcium gluconate, magnesium sulfate, multiple vitamine mixtures, folic acid, cyanocobalamin, phytonadione, insulin, ampicillin, cephalothin, kanamycin and gentamicin. In addition to physical examination, techniques of ultraviolet spectroscopy, thin-layer chromatography and microbiologic assay were used to delineate compatibility characteristics. The principle compatibility problems are generated by elevated concentrations of calcium and phosphate. The efficacy of ampicillin, cephalothin and kanamycin in the amino acids/dextrose solution, with or without additives, did not appear to be significantly different from control samples prepared in sterile water. It appeared that gentamicin might be significantly more effective in the test solutions than in sterile water, but further investigation is needed to verify this. A comprehensive study of the stability of vitamins in parenteral nutrient solutions must be made before a final judgment can be made.


Concentration-time profile of phenytoin after admixture with small volumes of intravenous fluids. A study was designed to determine if admixtures with small volumes of four intravenous fluids (0.45% sodium chloride, 0.9% sodium chloride, 5% dextrose in water and lactated Ringer's) maintain their phenytoin concentrations over a suitable period of time to allow intravenous infusion of the drug. Three phenytoin concentrations (4.6 mg/ml, 9.2 mg/ml and 18.4 mg/ml) were prepared by adding a sufficient volume of an i.v. fluid to the appropriate volume (10.0, 20.0 and 40.0 ml) of phenytoin sodium injection (46 mg of phenytoin acid/ml) to produce a total volume of 100 ml. Each admixture was visually inspected for crystallization, the pH of each solution was determined, and the solutions were filtered through a 0.22-micrometer micropore filter. Unfiltered and filtered aliquots of all solutions were collected at 0, 0.25, 0.5, 1, 4, 8 and 24 hours following admixture. Phenytoin concentrations did not decline systematically during this period nor was there a significant difference (p greater than 0.05) between unfiltered and filtered aliquots in any of the solutions studied, except for the 9.2 mg/ml concentration of 5% dextrose in water. The phenytoin concentrations in the 5% dextrose in water and lactated Ringer's solutions showed the greatest variability over the 24-hour period. The pH for all solutions ranged from 10.15 to 11.50. One-half normal saline and normal saline in small volumes appear to be suitable vehicles for intravenous infusion of phenytoin.


Recommendations for the labeling of large volume parenterals. National Coordinating Committee on Large Volume Parenterals. Recommendations for a uniform standard for all labeling of large volume parenterals are presented. Operational definitions are given, and current FDA and compendial requirements for labels of large volume parenterals are reviewed. Specific recommendations for the USP, the FDA, manufacturers and hospitals are made.


Aluminum hydroxide: evaluation of two dosage forms and two dosing schedules in reducing intestinal phosphate absorption. A crossover, randomized, eight-week trial using eight adult volunteers was undertaken to (1) determine the efficacy of aluminum hydroxide in decreasing gastrointestinal phosphate absorption, (2) compare the effectiveness of "with meal" and "between meal" dosing schedules, and (3) compare the effectiveness of the capsule and liquid dosage forms. Four treatments, each with a daily dose of approximately 6 g, were taken on a three-times-a-day regimen. The effectiveness of the treatment regimens was measured by using two variables: the decrease in total urinary phosphorus excretion, and the increase in the percent tubular reabsorption of phosphorus (TRP). Aluminum hydroxide treatment produced a significant change in urinary phosphorus excretion (p less than 0.0005) and in percent TRP (p less than 0.0005). For the study population, total urinary phosphorus excretion was the determining factor in changing the percent TRP. The increase in TRP and the decrease in total urinary phosphorus excretion was of the same degree regardless of dosage form or dosage schedule. Aluminum hydroxide was effective in decreasing phosphorus absorption as measured in this study. It appears that aluminum hydroxide capsules could be used with equal efficacy as the liquid dosage form in controlling hyperphosphatemia in patients with chronic renal failure who will not comply with a treatment program using the liquid.


Improved emergency room medication distribution. A system developed to improve drug distributions, safety and control in the emergency room of a 400-bed hospital is described. The system centers around the use of a special cabinet containing medication bins which store selected and limited quantities of medications packaged in single-unit containers. A dditionally, intravenous solutions, irrigating solutions, eye tray medications, medications for cardiopulmonary resuscitation and refrigated drugs are kept in areas of ready access. Punched cards containing information on the drug are stored with the medication and are used for billing and reordering purposes. A 24-hour supply of medications that may be dispensed after the pharmacy closes are packaged in prelabeled, zipper-locked plastic bags. The system results in improved safety as well as long-term cost savings.


Pharmacy and therapeutics committee review of the parenteral cephalosporins. The process by which a 530-bed university hospital reduced, from three to one, the number of parenteral cephalosporins in its formulary is discussed. In January 1975, cephapirin sodium was added to the formulary which already included cefazolin sodium and cephalothin sodium. Nine months later, the pharmacy and therapeutics committee decided to delete cephapirin and cephalothin from the formulary. The pharmacy department had supplied background information to the committee, and infectious disease specialists advised the committee. The decision was ratified by the executive committee of the medical staff. The rationale for the decision and its implementation, including staff communications, are discussed.


Drug use review: operational definitions. A distinction is made between drug use review (DUR) studies and programs. DUR studies can be quantitative or qualitative. Quantitative studies involve the collection, organization and display of estimates or measurements of amounts of drug use. Qaulitative studies are multidisciplinary operations which collect, organize, analyze and report information on the rationality of the drug use base. A DUR program is an ongoing method of assuring the quality of drug use through the employment of standards and efforts to correct drug use not consistent with these standards; the effectiveness of corrective actions is measured.


Using pharmacokinetics in drug therapy. 1: Learning objectives for practitioners, subject outline and suggested readings. Pharmacokinetic learning objectives for pharmacists are presented. Included is a basic self-assessment test. Suggested readings in pharmacokinetics are listed.


The effect of 1alpha(OH)D3 and 1alpha,25(OH)2D3 on the bone in patients with renal osteodystrophy. Six patients with chronic renal disease and variable degrees of renal osteodystrophy were treated for three weeks with either 1alpha,25-dihydroxyvitamin D3 (1alpha25(OH)D3) or 1alpha,hydroxyvitamin D3 (1alpha(OH)D3) and both the biochemical and osseous responses measured. The most consistent changes seen were an increase in serum calcium concentration to normal, a decrease in immunoreactive parathyroid hormone toward normal, an increase in the extent of the calcification front and a decrease in the extent of fibrous dysplasia in the marrow cavity. Two important parameters which did not change significantly were serum alkaline phosphatase activity and the osteoid volume. These data, in conjunction with that from previous studies, indicate that therapy with 1alpha,25(OH)2D3 or 1alpha(OH)D3 does not heal the osteomalacia of renal osteodystrophy, but that it does suppress the secondary hyperparathyroidism, and ameliorate the osteitis fibrosa seen in patients with chronic renal disease. They raise the likelihood that additional factors, such as metabolites of vitamin D other than 1alpha,25(OH)2D3, play a role in regulating bone formation and/or mineralization.


Coronary angiography and left ventriculography in survivors of transmural and nontransmural myocardial infarction. Recent studies have suggested a similar prognosis for patients with transmural myocardial infarction and nontransmural myocardial infarction despite a smaller infarct size in the latter patients estimated by creatine phosphokinase (CPK). Thirty-one patients with transmural myocardial infarction and 17 patients with nontransmural myocardial infarction as defined by electrocardiographic criteria underwent coronary angiography and left ventriculography from 10 to 24 days after they had an acute myocardial infarction. Forty-three of these 48 patients were asymptomatic following their myocardial infarction. When compared to patients with nontransmural myocardial infarction, those with transmural myocardial infarction had greater peak CPK levels, 1,090 +/- 210 versus 290 +/- 60 IU (p less than 0.01). There was no difference in prevalence of single, double or triple vessel coronary artery disease, mean number of coronary arteries 50 per cent narrowed (2.0 +/- 0.2 versus 2.0 +/- 0.2), near total or total occlusions, coronary score (Friesinger) (7.9 +/- 0.6 versus 8.2 +/- 0.7), left ventricular ejection fraction (48 +/- 2 versus 53 +/- 4), or per cent of akinetic-dyskinetic myocardial segments (66 of 242 [27 per cent] versus 32 of 132 [24 per cent]) between two groups. The similar extent of coronary artery narrowing and degree of left ventricular dysfunction may explain the similar prognosis for patients with transmural myocardial infarction and those with nontransmural myocardial infarction despite differences in enzymatically estimated acute infarct size.


Toxicity of D-penicillamine in rheumatoid arthritis. A report of 63 patients including two with aplastic anemia and one with the nephrotic syndrome. To assess toxicity of D-penicillamine a retrospective chart review was performed on 63 patients with rheumatoid arthritis receiving penicillamine. These patients had a total of 83 courses of therapy. The mean age of patients was 52 years and the mean duration of disease was 10.07 years. Laboratory data showed an increase in hematocrit values from 36 per cent to 40 per cent and a decrease in the erythrocyte sedimentation rate from an average of 50 to 29 mm/hour. The platelet count also decreased with treatment from 394,000 to 267,000/mm3. The over-all complication rate was 53 per cent. Life-threatening complications occurred in two patients including one case of aplastic anemia and one case of nephrotic syndrome. One additional patient was referred with aplastic anemia. Minor complications include rash in 18 per cent, loss of taste in 6 per cent, dyspepsia in 11 per cent, oral ulceration in 7 per cent and proteinuria of less than 3 g/day in 8 per cent. In summary, 53 per cent of the courses of penicillamine were associated with toxicity including one episode of aplastic anemia and one case of nephrotic syndrome. Therapy was stopped due to complications in 39 per cent of the patients in this series.


Granulocytopenia in hospitalized patients: I. Prognostic factors and etiology of fever. The clinical course of 126 hospitalized patients during 192 episodes of granulocytopenia and fever was studied. Fever was a regular accompaniment of granulocytopenia, occurring in 94 per cent of granulocytopenic episodes. The mean duration of granulocytopenia (less than 1,000/mm3) was 18 days, with fever (temperature greater than 38 degrees C) being present during 44 per cent of those days. Fever was present during 69 per cent of days with a granulocyte count less than 10/mm3. A presumed infection was present in 86 of 128 febrile granulocytopenic episodes in adults and in 19 of 64 febrile granulocytopenic episodes in children. A fungal infection was found in 11 patients; a viral infection in 23 patients. Bacteremia occurred during 44 granulocytopenic episodes with 16.8 bacteremias/1,000 days of granulocytopenia in adults and 12.7 bacteremias/1,000 days in children. The mortality was 33 per cent per granulocytopenic episode in adults and only 8 per cent per episode in children.


Granulocytopenia in hospitalized patients. II. A prospective comparison of two antibiotic regimens in the empiric therapy of febrile patients. The results of empiric antibiotic therapy in 126 hospitalized patients with fever during 192 episodes of granulocytopenia were studied. Febrile granulocytopenic patients were randomly allocated to receive either carbenicillin, methicillin and gentamicin, or carbenicillin and cephalothin. The response rate for the two antibiotic regimens was similar, 49 (60 per cent) of 81 responded to the former and 42 (54 per cent) of 78 to the latter. The response rate in patients receiving other antibiotics because of specific indications or counterindications was 19 (58 per cent) of 33. Thirty-nine (35 per cent) of 110 patients who responded to initial antibiotic therapy had an increase in circulating granulocytes of one log10 or more compared to only 10 (12 per cent) of 79 nonresponders with such an increase. The mortality rate in adult patients receiving carbenicillin, methicillin and gentamicin was eight (16 per cent) of 51, compared to 18 (37 per cent) of 49 in those receiving cephalothin and carbenicillin (P less than 0.05). The significance of this difference in the initial response rate or mortality rate between patients treated with the two antibiotic regimens when only patients with documented bacterial infection were considered. Patients who responded to their initial antibiotic regimen, and patients for whose fever no explanation was found, had the best prognosis.


Reversal of myelofibrosis in advanced breast cancer. Reversal of myelofibrosis and splenomegaly is described in a 41 year old woman with metastatic breast cancer. After intensive chemotherapy and hormonal therapy, the tumor regressed, the splenomegaly receded, the hemogram showed no abnormalities, and the dense collagen and reticulin fibers in the marrow disappeared. The severe thrombocytopenia and leukoerythroblastosis noted before therapy were not obstacles to clinical management. In our report we document that myelofibrosis associated with breast cancer is not an ominous sign. Patients may benefit from an intensive, but well titrated, therapeutic program.


Pituitary hyperthyroidism. Case report and review of the literature. A 58 year old woman with an enlarged sella turcica was found to have hyperthyroidism with a supranormal concentration of serum thyrotropin. Transsphenoidal microsurgery resulted in the removal of a chromophobe adenoma comprised mainly of thyrotropes. Postoperatively, serum thyrotropin, thyroxine and triiodothyronine levels fell within normal limits, and the patient maintained normal thyroid and pituitary function.


Thallium-201 myocardial perfusion studies in patients with the mitral valve prolapse syndrome. To determine whether regional myocardial ischemia plays a role in patients with the mitral valve prolapse syndrome, we examined myocardial perfusion with exercise stress testing and thallium-201 myocardial scintigraphy. Twelve patients were studied, 11 women and one man aged 18 to 56 years, mean age 30 years. In all patients, mitral valve prolapse was documented by echocardiography or phonocardiography. Patients over 35 years of age underwent cardiac catheterization. Electrocardograms disclosed abnormalities during maximal exercise in eight of the 12 patients. In two patients, angina developed during exercise. Thallium-201 (201Tl) scintigrams were normal in the 11 patients with presumed or documented normal coronary arteries. One patient, in whom an apical defect was demonstrated on scintigraphy, had significant disease of the left main and left anterior descending coronary artery. Repeat testing after successful aortocoronary bypass grafting revealed improved exercise capacity and a normal 201Tl myocardial scintigram. The data indicate that patients with mitral valve prolapse alone do not have regional myocardial ischemia and that the presence of a defect on 201Tl myocardial scintigraphy following maximal stress testing would suggest the existence of concomitant coronary artery disease.


The value of the electrocardiogram in the differential diagnosis of a tachycardia with a widened QRS complex. To determine the value of the electrocardiogram for differentiating aberrant conduction from ventricular ectopy, findings were retrospectively reviewed from patients with a widened QRS complex during tachycardia in whom the site of origin of tachycardia was determined by His bundle electrography. Seventy episodes of sustained ventricular tachycardia from 62 patients and 70 episodes of aberrant conduction during supraventricular tachycardia from 60 patients were available for study. Findings suggesting a ventricular origin of tachycardia were (1) QRS width over 0.14 sec, (2) left axis deviation, (3) certain configurational characteristics of QRS and (4) atrioventricular (A-V) dissociation. Capture or fusion beats resulting from A-V conduction of dissociated atrial complexes during ventricular tachycardia were seen during only four of 33 episodes of sustained tachycardia.


Serum triglycerides and serum uric acid in untreated and thiazide-treated patients with mild hypertension. The Oslo study. Levels of serum lipids, uric acid and body weight are reported from a controlled trial of drug treatment of middle-aged men with uncomplicated mild hypertension. The results come from 300 men after three years of follow up; 150 men in the treatment group and 150 men in the control group. The treatment has been standardized starting with hydrochlorothiazide alone and adding alpha methyldopa when necessary. In case of side effects, alpha methyldopa was replaced with propranolol. Pretreatment results demonstrated a strong covariation among body weight, uric acid and triglycerides. In the entire treatment group, there was no significant change in triglycerides after three years (increase from 1.85 to 2.02 mM/liter, P greater than 0.05). Cholesterol was also unchanged. Further analysis showed that certain patients reacted with an increase in triglycerides during treatment: those prone to a distinct increase in uric acid and those gaining weight. Those who needed combination therapy (having the highest pretreatment blood pressure) showed most of the increase in triglyceride and uric acid. In the group treated with hydrochlorothiazide alone, the triglycerides were unchanged. However, those selected from this group with a distinct increase in uric acid also showed an increase in triglycerides. The treatment increased the pretreatment positive correlation between uric acid and triglycerides.


Use of cerebrospinal fluid lactate levels in the diagnosis of bacterial meningitis. Ninety-two cerebrospinal fluids were analyzed by a simple gas-liquid chromatography method for lactic acid. The presence of greater than 30 mg/dl of lactic acid correlated with proven bacterial or cryptococcal meningitis. Elevated lactate levels were also found in two patients with suspected but not proven bacterial meningitis. In 78 patients who did not have bacterial meningitis the cerebrospinal fluid contained less than 30 mg/dl of lactic acid.


A protocol for the adoption of analytical methods in the clinical chemistry laboratory. The demand on the clinical chemistry service laboratory to continually adopt more precise and accurate methodologies makes it mandatory for the service laboratory to have a systematic protocol for evaluating and adopting new assay methods. A protocol is presented for adopting clinical chemistry methods in the service laboratory, with emphasis on spectrophotometric determinations. The recommended protocol may be used to evaluate alternate procedures to those currently in use as well as procedures for additional analytes. We present those critical points to be considered in method adoption and instruction for the resolution of each point.


Effect of evaporation from sample cups on urea nitrogen assay. The effects of evaporation from sample cups for urea nitrogen assays were determined. Thirty replicate analyses were performed on each of five groups of pooled human serum subjected to controlled evaporation in our laboratory. We found a mean increase in urea nitrogen concentration of one percent per hour due to evaporation. We urge laboratory personnel to take the action necessary to minimize errors due to evaporation. Specimens should always be capped while awaiting analysis in the laboratory.


Use of case histories in teaching clinical microbiology. In the Winter Quarter, 1977, case histories were introduced into the Diagnostic Microbiology course of the Medical Technology curriculum at the University of Minnesota. The primary goal was to increase the students' exposure to patients and patients' illnesses and to emphasize the role and responsibilities of technologists and clinical laboratories to these patients. This goal seems to have been met as indicated by an evaluation received from the students, since 58.3 percent believed they better understood the role of the technologist and clinical laboratory in patient care. Other side benefits we hoped to achieve seem to have been partially met. These included: 1) association of infectious processes with other laboratory results; 2) a feeling of integration with the patient and health care team; and 3) the introduction of medical terminology.


Medical technologist supervisors: are they prepared to manage? A group of 330 supervisory technologists in California was surveyed to determine their level of responsibility for each of 21 tasks and the type of education they had received for each task. Their perceived effectiveness as managers was determined using the responses from five questions to construct an Effectiveness Perceived Index (EPI). Two groups were analyzed--those with high task responsibility and low education and those with high task responsibility and high education. For 17 of the 21 tasks, the correlation between low education and low perceived effectiveness was significant, using a .05 significance level. Promotion systems were also explored, and it was found that promotion into supervisory positions is still based mainly on technical competence, not managerial ability. The great need for management development and more enlightened promotion policies in California's laboratories is very much supported by this survey.


Learning theory, intelligence, and mental development. The current state of experimental research on mental retardation was considered from a historical perspective. The early position that defined intelligence as the ability to learn was presented. Subsequent refinements were traced as intelligence was related first to stages and, subsequently, to subprocesses of learning. Research on learning in retarded persons, which mainly dates from the late 1950s, took little account of this history. The methodological errors that flawed much modern mental retardation research were made explicit. Attempts to isolate the roles of MA and of intelligence were reviewed. It was shown that with growing understanding sophisticated designs emerged. Kappauf's three-dimensional model relating performance to IQ and CA was discussed and some models of retardation presented. Research on the development of intelligence was related to these models and to the design of intervention strategies.


Patterns of cognitive ability in retarded children: a reexamination. A previous study of patterns of cognitive abilities in mentally retarded and nonretarded children was reexamined for the retarded group. Sixty-seven EMR children were given a set of cognitive tasks shown in previous research to measure simultaneous and successive synthesis. The data were factor analyzed and revealed a pattern of cognitive processes similar to patterns found for nonretarded children in other research. The results were discussed in terms of implications for research on strategic behavior in mentally retarded children.


Careers of mentally retarded young persons: services, jobs, and interpersonal relations. Life histories and follow-up data at age 22 were obtained for a total city population of children classified as mentally retarded (index cases). Histories were also obtained at age 22 from matched comparisons who at no time had been classified as retarded. Matching was on age, sex, and social background. Placement at school-leaving age and major occupation at age 22 were reported for the index population. Those 22-year-old index cases not receiving mental retardation services and their matched comparisons were examined on objective and subjective measures of the jobs they held and selected indicators of interpersonal relationships.


Visual recognition in mentally retarded adolescents: cue value and instruction effects. Recognition scores for positive and negative discriminative stimuli tested after a single trial through a discrimination problem list indicated that the frequency theory shown by Ekstrand, Wallace, and Underwood (1966) to account for the verbal discrimination learning of nonretarded adults may also hold for the visual-discrimination learning of mentally retarded persons (MA 5 to 8 and MA 8 to 11 years). In addition, retarded subjects correctly recognized the stimuli the stimuli more often after a simple inspection trial than after a standard discrimination-learning trial, indicating that they encoded the stimuli differently depending on the instructional set. The encoding difference was mediated by looking patterns. Both MA and serial position of stimuli on presentation and on test affected recognition.


Behavior rating inventory for moderately, severely, and profoundly retarded persons. The reliability and validity of the behavior of a sample of institutionalized mentally retarded children, with total IQs between 2 and 53, were assessed by a new scale measuring the following areas; communication, self-help, physical skills, self-control, and social behavior. Clinically and statistically acceptable levels of interrater agreement were found. With respect to validity: (a) several factors loaded very highly on items consistent with the a priori labeling of subscales; (b) two of the factors (cognitive and psychomotor development) could account for about 75% of the explained variance in ward placement levels (multiple R = .86); and (c) individual items on the Behavior Rating Inventory for the Retarded correlated highly with independently derived measures of the actual behavior these items represented. The major advantages of this scale over existing ones include its clearly demonstrated validity and relative ease of administration and scoring.


Congenital and neurological abnormalities in infants with phenylketonuria. We reported the occurrence of congenital and neurological abnormalities in 150 children with phenylketonuria (PKU) age 1 year or older, who have been treated with a restricted phenylalanine diet, according to the protocol used in a nation-wide longitudinal collaborative study of children treated for PKU. The overall occurrence (9.3%) of congenital anomalies was not significantly different from that of a general population, except for an apparent increased incidence of pyloric stenosis. None of the subjects had a persistent major neurological defect.


Retinal locus and the identification of tachistoscopically presented letters by retarded and nonretarded individuals. Two-letter stimulus displays, differing in the magnitude of the horizontal spatial separation between the letters, were presented tachistoscopically to retarded and nonretarded persons. Assuming that the spatial separations are linearly related to retinal location, I derived an estimate of the stimulus-recognition threshold for each group by employing the method of constant stimuli. The data indicated a similar stimulus-recognition threshold and a similar decrement in the accuracy of responding as the stimulus separations increased. These findings suggested that reported differences in iconic memory between retarded and nonretarded individuals are most likely related to a postretinal stage of cognitive processing. Studies of iconic memory must take into account not only the influence of retinal locus but also the finding that, as the task becomes more difficult, retarded individuals may be less willing to respond.


Relationship between dimensions of adaptive behavior and sheltered workshop productivity. A factor analysis was performed on the 24 domains of the AAMD Adaptive Behavior Scale using a sample of 217 adult retarded workshop clients. Of the seven dimensions found to describe adaptive behavior, Personal Independence, Social Maladaptation, and Personal Maladaptation accounted for the majority of variance in the factor matrix. Scores on each of the seven factors were obtained for all clients and used to predict productivity in a workshop setting as defined by average hourly salary for the time period in which the scale was administered. A stepwise regression analysis yielded a highly significant regression effect in which the factors of Personal Independence and Social Maladaptation accounted for 25% of the variance in salary and had a multiple correlation coefficient of .50 with the predicted variable. We concluded that adaptive behavior is a multidimensional variable, significantly affecting productivity in sheltered workshop settings.