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TRULY comparative studies of residential health care systems for mentally retarded are virtually nonexistent. This situation exists despite the fact that all mentally retarded comprise perhaps 5 per cent of the national population, and in the face of the fact that over 200,000 mentally retarded are in public residential facilities, cared for by nearly 100,000 staff members at a cost of over $500,000,000. The research from which this paper is drawn addressed this research lacuna, and was perhaps the first to collect comparative data on a broad range of health care system components in residential centers for mentally retarded and the technological bases influencing them. The present paper presents findings on certain indexes of comprehensiveness of health care in these institutions and their technological influences at five public facilities in widely different locations in this country. It need only be mentioned that care to the youth and adults in these institutions influences the pattern of services for mentally retarded children and youth in the community, and for those who will be admitted to these facilities in the future.

CANADA Geese (Branta canadentsis) are highly traditional in their use of circumscribed nesting, migration, and winter localities (Hanson and Smith, 1950; Martin, 1964; Sherwood, 1966), patterns of movement and roosting in local areas (Raveling, 1969a), and timing of daily activities (Raveling, 1967: 135-157). This regularity is accompanied by facilitation behaviors (Crawford, 1939) serving mood transference and induction of reaction by contagion. Particularly prominent in Anserini are movements of the head and often the neck, which have been previously described as social signals communicating the intention to fly (Heinroth, 1911; and many subsequent papers). Purposes of this paper are to document the variation of preflight intention movements of Canada Geese as related to social status (i.e. family, single, age, sex) and thereby to discuss more fully the probable functions of behavioral and morphological patterns associated with coordination of flight. Results are based on observations of a large winter flock and from quantification of the activities of radioand color-marked individuals and families of known social status.

How little we realize the complexities attendant upon the lives of wild animals until we have undertaken to investigate and reveal them. So it was in connection with the gathering of material for this paper, when observations were undertaken to determine the active life movements of the Columbian ground squirrel (Citellus columbianus columbianus) in regard to seasonal and daily activities, aside from its normal periods of aestivation and hibernation. To gain the information recorded here, field observations were made, supplemented by studies of the animals in the very liberal confinement provided for those under control and study (Shaw, '25a). Binoculars were used for more certain identification in the field, while temperatures were taken in degrees Fahrenheit. The elevation at Pullman is 2536 feet at the Campus of the State College of Washington. The hours of each day of observation were continuous throughout as to time and made by one person, the writer. The time involved extended across four years, 1910 to 1914, with the chief investigations of these problems pursued in 1910 and 1911. For the sake of economy and brevity, wherever the term "squirrel" is used through the text, it will be understood to refer to the Columbian ground squirrel. In studying the activities of this squirrel and to some extent its related forms, it was necessary to regard them especially from two view points, seasonal and daily. Such investigations showed that these movements were subject to and modified by many influences such as season, sun, wind, rain and snow, drought, slope of the land and altitude. It was also noticed that the species was influenced both seasonally and daily by such complexities as the warmth and brightness of the sun's rays and their ability to reach all parts of the earth's surface equally; bringing the animals from their winter nests later in spring on the north slopes of hilly territory, where the snow remains piled deep and also later of a morning, on a sunless slope (Shaw, '25c). Of course the action of the sun on the vegetation and the relation of the animal to surounding food so produced, is of intimate association (Dice, '19, pp. 17-18).

In the present paper the aged are defined for convenience sake as those who are over 60 years old. In the authors' hospital 2, 614 in-patients have undergone the orthopedic functional training, and the aged patients among them are 84 in number (3.2%), 61 cases (73%) of which had fractures. Among fractures in the aged those of the femur predominate, and then come the vertebral and the fibula and tibia fractures. The patients at the age of 65 make up the largest number, and the number of male-patients is twice as large as that of female. As the cause of fractures tumbling predominates, then, falling and blow. After they sustained fractures 23% of the patients retired from their jobs, and 7% changed their jobs. In comparison with the younger patients of fracture the aged patients are naturally slower to develop bony union and consequently the period of plaster fixation, hospitalization, and training is likely to be prolonged. Besides, because of the atrophy of soft tissues during this period the adjacent joints tend to develop contractures easily.Since the aged are generally lacking in active motivation for the functional recovery return to the society and very prone to accidents, it is of importance to watch them closely during the orthopedic functional training, and to give them a positive psychological support, while taking the above tendencies into consideration. At the same time it is necessary to direct them with sympathy and kindness to continue the functional training by themselves regularly without undue overstrains. This should also be taken into consideration in cases of the aged patients. Besides, the treatment of the aged patients who suffer from complications requires the utmost caution. However, through above mentioned cautious treatment and training it is possible for the aged patients to recover their function to a level as high as that of the ordinary patients, though it must be admitted that the level of recovery of the aged is slightly lower as expected. But the question remains in the case that the knee joint contracture is apt to stay on even after the treatment of lower limb fracture, as in the cases of general fractures.The questionaire on pain was sent to 37 patients who had undergone the hospital training. Answers were obtained from 77% of them. Generally speaking, among pains numbness predominates, but the incidence of numbness among the aged patients is lower than that among the ordinary patients. And pain occurs most frequently in cold environment and then at the time of fatigue. The cause of pain is the impediment of blood circulation at the affected part. The incidence of pain caused by the impediment of blood circulation is rather high among the aged. And the means of treatment given by the patients are hot spring bath, massage, and hot compress in order. The questionaire indicates that such heat treatments as hot spring bath and others relax muscle tones at the affected part, relieve nervous excitability and improve circulation, and at the sametime, psychologically give them a peaceful rest. The fact acupuncture and moxacautery are resorted to by some patients is considered co be characteristic of the aged.The questionaire on activities of daily living was sent to 23 patients who had undergone the hospital training (16 of them were judged physically handicapped according to the National Annuity Law), and to 6 patients who had received the indoor training. All these patients suffered from fractures of the lower limb and trunk. It is important to notice that the patients of lower limb fracture comlain-ed mainly of difficulty in walking and kneel sitting. By the examination according to the National Annuity Law quite many patients of fractures are judged physically handicapped, because of their inability to do kneel or crosse legged sitting. in sitting upright or cross legged. This kind of impediment becomes serious for the Japanese who spend their home life on tatami matts.

The ideas expressed in this paper were developed in the course of a year spent exploring the life philosophies and religious outlooks of suicidal patients. Certain conclusions about the part played by the pa tient's and therapist's values in the suicidal situation seemed to force themselves on me as a result of observing and talking with patients and participating in the daily activities of a center devoted entirely to suicide prevention and research. I have interpreted the values and attitudes that patients and therapists communicated?explicitly and implicitly?in the light of my own conceptual framework regarding the role of values and beliefs in personality development and integration, taken together with my general experience as a psychotherapist. I shall present these conclusions, and then outline some of the general premises regarding the nature of values on which they are based. I might add that I take complete responsibility for these notions. Nothing I say should be construed as representing the policy of the Suicide Pre vention Center.

The need to demonstrate that health care has an influence on health status is increasingly pressing. Such demonstrations require tools of measurement which are unfortunately not available. Development of instruments has been hampered by a lack of consensus on appropriate frames of reference, and there appears to be little agreement on what should be measured and what relative importance should be ascribed to different dimensions of health status. An approach that does not require the assignment of numerical values or weights to various aspects of health status and is applicable to all age groups within the population and to the whole spectrum of health problems rather than to specific medical diagnoses would seem desirable. A scheme that is based upon the development of a “profile” rather than a single “index” for describing health status is proposed in this paper. The model is a conceptual framework whose usefulness will depend upon efforts of a large number of researchers from many disciplines to develop instruments which can be incorporated in it.

“România curat?” represents a complex system of activities and actions judiciously correlated in order to improve the environmental conditions and population health, and implies the developing of an adequate mentality of community, a realistic evaluation of environmental problems. In this respect, the present paper approaches to one of the most important local community problems, namely collecting and cleaning of the waste waters resulted from daily activities. We attempted to create a model, which might be applicable in practice, of collecting and cleaning the waste waters resulted from daily activities of a village. This work also describes the impact that the exploitation of the sewage network-waste water treatment station system will have upon environmental factors.

Over the past two decades epidemiologists interested in chronic illness have tended to concen trate on conditions which are lethal, and they have generally directed more attention to the elucidation of the causes of such diseases than to their social consequences. Although this work has been of great importance, one result is that we know less than we should about the burden on society of many diseases, especially those with a low case fatality rate such as the arthritides, varicosities, and even diabetes. To date one of the few large-scale sources of information of this kind is in the United States where the National Health Examination Survey (1966a and b, 1968) has shown that the prevalence of arthritic conditions is extremely high, although it has not included data on impairment and disability in objectively ascertained cases. In contrast, the US National Health Interview Survey (1960, 1964, 1969, 1971), which has had to depend on the respon dent's word for ascertainment of diagnosis, has collected data on the extent of limitations of activity. Throughout that country arthritis and rheumatism, which are treated in the National Health Survey as a single category, were by far the most serious cause of limited mobility, and in many areas they are also the most important chronic cause of limited activity (US National Health Survey, 1971). If arthritis and rheumatism are taken in combination with impair ments of the spine, hips, and legs, they have con sistently, between 1961 and 1967, accounted for 29% of all cases of limited activity and in this respect far outstrip in importance any other group of chronic diseases. Over the same seven-year period the next most important conditions have been those of the cardiovascular system, yet 'heart conditions' and 'hypertension without heart involve ment' taken together have accounted for only 22% to 23 % of the cases of chronically limited activity (US National Health Survey, 1968). In 1967 some 3,250,000 civilians who were not in hospitals or other institutions suffered limitation of activity because of these two conditions and in well over half of these there was serious loss of time at work (US National Health Survey, 1971). The communal problem of arthritis and rheumatism is accentuated by the fact that the burden imposed by them is heaviest among the poorest members of the com munity. In Britain the General Household Survey is collecting data which are similar to those from the US Interview Survey (1964, 1969, 1971). This paper presents some information about the interrelationship between impairment and disability and arthritic conditions in a group of adults from the general population of New Haven, Connecticut, and combines objective with interview data.

REHABILITATION is that part of medical care which aims primarily to relieve the disability produced by disease and to restore the person to a place in society. The basic defect to be corrected by physical medicine and rehabilitation is disability, which prevents performance of the person's usual functions. However, we have no generally accepted measure of disability. Consequently, rehabilitation workers have been slow to convince other health personnel that their methods are effective (1). Disability usually entails physical, mental, and socioeconomic problems, and for this reason complex measures which assess two or all three aspects have been attempted. Since 1955 the State of Maryland's three chronic disease hospitals have used a scoring method to evaluate the performance of independent movement by long-term patients. This disability score, usually called the Barthel index (2) and occasionally the Maryland disability index (3), assigns 0, 5, 10, or 15 points to performing each of 10 activities of daily living. The sum of these scores is 100 points when all activities are carried out skillfully and independently (table 1). The Barthel index is an empirical score developed by a physical therapist and physiatrist. It provides a simple method for evaluating the physical functioning of a disabled patient at a given time and for assessing change in physical function. The physical therapist and physiatrist discussed with nurses and physicians the physical, mental, and social importance of each activity to the patient and its importance in reducing the need for care. They decided not to refine scores for specific functions to values of less than 5 points. However, instructions were standardized to clarify the criterion of performance for each score and to improve repeatability (2). Patients scoring 100 points could have abilities ranging from barely being able to perform the activities of daily living to being able to earn a salary in skilled employment. Therefore patients can continue to improve after scoring 100 points. Similarly, the patient scoring 0 can emerge from a coma and be conscious though helpless in bed without a change in his score. Although abilities of patients with scores at either end of the scale can vary considerably, the functioning of patients with identical intermediate scores differs less. The lower the patient's score, the more severe is his physical impairment; a rise in score indicates an improvement in his physical functioning. The purpose of the analyses described in this paper is to assess the validity of the Barthel index. (Data for this study were made available by the staff of the Montebello State Hospital, Baltimore, Md.) The 1,223 patients in this study all had at least one cerebrovascular accident before their Dr. Wylie is associate professor of public health administration at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Md.