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Background: An unusual case involving a middle-aged male with a 9-year history of presumptive chronic regional pain syndrome (CRPS) and ulnar neuropathy was referred for failure in treatment. Methods: On presentation, the patient was requesting an amputation of his arm. However, work-up uncovered a periosteal extra-digital glomus tumor on the base of the small finger metacarpal. Results: Surgical excision of the lesion resulted in rapid resolution of his pain and normal hand function was ultimately restored. Conclusions: Glomus tumors account for up to 5% of all soft tissue tumors of the upper extremity, occurring most frequently within or adjacent to the nail bed. Time from onset of symptoms to correct diagnosis may not be established for many years, especially with atypical tumor locations. Although glomus tumors have been widely reported, atypical locations of these tumors should be included in the differential diagnosis for patients with unusual chronic pain or neuropathy. Furthermore, when evaluating a chronic pain patient, our findings support the opinion that assignment of the diagnosis of CRPS should only be a diagnosis of exclusion.

A cluster of cases of pneumonia of unknown etiology emerged in Wuhan, China, at the end of December 2019. The cluster was largely associated with a seafood and animal market. A novel Betacoronavirus was quickly identified as the causative agent, and it is shown to be related genetically to SARS-CoV and other bat-borne SARS-related Betacoronaviruses . The number of cases increased rapidly and spread to other provinces in China, as well as to another four countries. To help control the spread of the virus, a "cordon sanitaire " was instituted for Wuhan on January 23, 2020, and subsequently extended to other cities in Hubei Province, and the outbreak declared a Public Health Emergency of International Concern by the Director General of the World Health Organization on January 30, 2020. The virus was named SARS-CoV-2 by the International Committee for the Taxonomy of Viruses, and the disease it causes was named COVID-19 by the World Health Organization. This article described the evolution of the outbreak, and the known properties of the novel virus, SARS-CoV-2 and the clinical disease it causes, and the major public health measures being used to help control it's spread. These measures include social distancing, intensive surveillance and quarantining of cases, contact tracing and isolation, cancellation of mass gatherings, and community containment. The virus is the third zoonotic coronavirus, after SARS-CoV and MERS-CoV, but appears to be the only one with pandemic potential. However, a number of important properties of the virus are still not well understood, and there is an urgent need to learn more about its transmission dynamics, its spectrum of clinical severity, its wildlife origin, and its genetic stability. In addition, more research is needed on possible interventions, particularly therapeutic and vaccines.

Background: Racial/ethnic minority groups remain underrepresented in clinical trials. Many strategies to increase minority recruitment focus on minority communities and emphasize common diseases such as hypertension. Scant literature focuses on minority recruitment to trials of less common conditions, often conducted in specialty clinics and dependent on physician referrals. We identified trust/mistrust of specialist physician investigators and institutions conducting medical research and consequent participant reluctance to participate in clinical trials as key-shared barriers across racial/ethnic groups. We developed a trust-based continuous quality improvement intervention to build trust between specialist physician investigators and community minority-serving physicians and ultimately potential trial participants. To avoid the inherent biases of non-randomized studies, we evaluated the intervention in the national Randomized Recruitment Intervention Trial (RECRUIT). This report presents the design of RECRUIT. Specialty clinic follow-up continues through April 2017., Methods: We hypothesized that specialist physician investigators and coordinators trained in the trust-based continuous quality improvement intervention would enroll a greater proportion of minority participants in their specialty clinics than specialist physician investigators in control specialty clinics. Specialty clinic was the unit of randomization. Using continuous quality improvement, the specialist physician investigators and coordinators tailored recruitment approaches to their specialty clinic characteristics and populations. Primary analyses were adjusted for clustering by specialty clinic within parent trial and matching covariates., Results: RECRUIT was implemented in four multi-site clinical trials (parent trials) supported by three National Institutes of Health institutes and included 50 associated specialty clinics from these parent trials. Using current data, we have 88% power or greater to detect a 0.15 or greater difference from the currently observed control proportion adjusting for clustering. We detected no differences in baseline matching criteria between intervention and control specialty clinics (all p values > 0.17)., Conclusion: RECRUIT was the first multi-site randomized control trial to examine the effectiveness of a trust-based continuous quality improvement intervention to increase minority recruitment into clinical trials. RECRUIT's innovations included its focus on building trust between specialist investigators and minority-serving physicians, the use of continuous quality improvement to tailor the intervention to each specialty clinic's specific racial/ethnic populations and barriers to minority recruitment, and the use of specialty clinics from more than one parent multi-site trial to increase generalizability. The effectiveness of the RECRUIT intervention will be determined after the completion of trial data collection and planned analyses.

Background: Failure to include participants of diverse race and ethnicity (i.e. those other than European Caucasian, non-Hispanic) in clinical trials impedes the safe development of new therapies given the potential for racial/ethnicity-related variations in treatment response. Increasing diversity is problematic for low prevalence diseases, where most community-based approaches do not reach those with the disease., Purpose: Increase racial/ethnic diversity of participants in a Parkinson's disease therapeutic trial., Methods: We incorporated a randomized Ancillary Trial into the multisite National Institute of Neurologic Disorders and Stroke Exploratory Trials in Parkinson's Disease Long-Term Study 1. Movement disorders clinics already participating in long-term trial 1 were eligible and were the unit of randomization and analysis. At least 14% of adult residents over age 55 and living within 30 miles of the eligible site were from a diverse population, or there was a near-by zip code with a highly diverse population. Eligible sites also agreed to be randomized. The intervention was designed to increase community physicians' trust in long-term trial 1 investigators and address recruitment barriers in diverse populations. Primary outcomes included percentage of participants from diverse racial/ethnic groups enrolled in long-term trial 1, and qualitative findings from key informant interviews of the Ancillary Trial investigators and coordinators at the end of the trial., Results: The Ancillary Trial stopped early for lack of efficacy, conditional power less than 1%. The 17 intervention sites had 12.6% diverse participants compared to 15.6% in 15 control clinics; odds ratio 0.82 (95% confidence interval = 0.32-2.16). In key informant interviews, high enrollers of diverse participants reported more use of existing physician relationships, untargeted community outreach, and extensive efforts to overcome participants' barriers. Low enrollers reported more use of patients in their practices and placed more responsibility for low enrollment on prospective participants., Limitations: The Ancillary Trial included only those with Parkinson's disease. Whether our findings generalize to trials in other low prevalence diseases is unknown., Conclusions: Increasing diversity in Parkinson's disease clinical trials requires new paradigms for trial investigator and coordinator interactions with community physicians and prospective trial participants.

Objective: To examine the relationship between a general measure of chronic life stress and atherosclerosis among middle aged adults without clinical cardiovascular disease via pathways through unhealthy lifestyle characteristics., Methods: We conducted an analysis of The Multi-Ethnic Study of Atherosclerosis (MESA). The MESA collected in 2000 includes 5,773 participants, aged 45-84. We computed standard regression techniques to examine the relationship between life stress and atherosclerosis as well as path analysis with hypothesized paths from stress to atherosclerosis through unhealthy lifestyle. Our outcome was sub-clinical atherosclerosis measured as presence of coronary artery calcification (CAC)., Results: A logistic regression adjusted for potential confounding variables along with the unhealthy lifestyle characteristics of smoking, excessive alcohol use, high caloric intake, sedentary lifestyle, and obesity yielded no significant relationship between chronic life stress (OR 0.93, 95% CI 0.80-1.08) and CAC. However, significant indirect pathways between chronic life stress and CAC through smoking (p = .007), and sedentary lifestyle (p = .03) and caloric intake (.002) through obesity were found., Conclusions: These results suggest that life stress is related to atherosclerosis once paths of unhealthy coping behaviors are considered.

Objectives: We obtained population estimates of the prevalence of lack of diagnostic follow-up after an abnormal prostate-specific antigen (PSA) result and assessed the role of sociodemographic, access, and risk perception factors on follow-up of abnormal tests., Methods: We used data from the 2000 National Health Interview Survey cancer control supplement. For 3,310 men aged 40 or older with a PSA test, 463 men reported an abnormal PSA test. Outcomes were abnormal PSA and lack of diagnostic follow-up in the latter group. Covariates for logistic regression included sociodemographic variables (age, race/ethnicity, and education), access to care (health insurance and usual source), and risk of cancer (family history and perceived risk). Survey analysis procedures accounted for the complex survey design., Results: Abnormal PSA results were associated with age, family history, and perceived risk of cancer. Approximately 15% of men with abnormal PSA tests reported no follow-up. The estimated number was 423,549 (95% confidence interval [CI] 317,755, 529,343). No follow-up was more likely in Hispanic men (odds ratio [OR] = 2.21, 95% CI 1.04, 4.70) and men without insurance (OR=6.56, 95% CI 2.02, 21.29), but less likely in men with a family history of prostate cancer or higher perceived risk of cancer., Conclusions: Substantial numbers of men had no follow-up of abnormal PSA tests. Primary care physicians should assess continuity of care following abnormal PSA results. Data about prostate cancer screening and follow-up are needed to support clinical and policy decisions.

Aprepitant (AP) is a known inhibitor of cytochrome P450 3A4 which may affect tacrolimus metabolism. We retrospectively examined the effect of oral AP on intravenous tacrolimus concentrations in 26 patients undergoing reduced intensity transplantation from 09/2005 to 09/2006. Oral AP 125 mg daily was administered on transplant day +1 and 80 mg on days +2 and +3. Intravenous tacrolimus was administered as a 0.03 mg/kg/day continuous infusion on day -6 through day +1 (pre-AP), during-AP (days +2 to +7), and post-AP starting on day +8. Tacrolimus doses were adjusted to achieve concentrations of 5-20 ng/mL. Dose-corrected tacrolimus concentrations (ng/mL/mg per dose) in the pre-AP, during-AP, and post-AP time periods were: 8.12 (95% CI: 7.3-9.1), 11.63 (95% CI: 9.63-13.63), and 11.42 (95% CI: 8.12-14.7), respectively (P<0.01 between pre-AP and during-AP, P<0.01 between during-AP and post-AP, P = 0.01 between pre-AP and post-AP time periods). Although statistically significant, the observed rise was not clinically significant between during-AP and post-AP time periods. Previous work has shown that AP is not expected to exert an inhibitory effect within 48 h of AP discontinuation. Collectively, these data suggest that AP effect on tacrolimus metabolism is of minor clinical significance. A controlled trial is needed to confirm these findings.

In response to the problem of adolescent smoking and limited appropriate cessation resources, this study examined the pattern and structure of the American Lung Association, Why Do You Smoke? (WDS) to determine its appropriateness for use in youth smoking cessation programs. The WDS is used to help smokers identify primary motivations for using tobacco and is comprised of eight subscales, each with three items representing primary smoking motivations ("Stimulation," "Handling," "Pleasure," "Crutch," "Psychological," "Habit," "Peer," and "Independence"). Study participants were all minors enrolled in a tobacco cessation program (n = 251). The pattern and structure of this self-assessment was examined using a correlated multiple group component factor analysis as a confirmatory approach. Findings show that the level of endorsement (as evidenced by subscale means and standard deviations) was relatively large across the eight subscales. Alpha coefficients ranged from .54 to .85. Results also underlined that the pattern coefficient matrix provided support for the hypothesized subscales through an examination of simultaneously extracted confidence intervals. These subscales should be further examined as to their usefulness in cessation interventions, such as the validity of using this instrument by gender, ethnicity, and age. However, from a measurement perspective, the confirmatory analysis provides excellent credence for the continued use of the WDS in cognitive/behavioral intervention programs targeting adolescents.

Rogers's Science of Unitary Human Beings framed this study of pandimensional pattern changes in healers and healees paired for an 8-week series of Therapeutic Touch (TT) sessions. Comparison of healee patterns before and after 141 TT sessions supported the hypotheses that healees would manifest decreased pulse and blood pressure, and reduced pain and stress (p < .05). Duration of TT sessions was not preset but determined by healers according to energy cues. TT time was not related to pattern changes, consistent with the clinical practice of TT and the atemporal nature of Rogers's conceptual framework. Healers and healees showed parallel changes after the TT series. Participants manifested greater spirituality (p <.05). Although increases in three of the four dimensions of power were significant (p <.05), changes in power measured as a whole were not. Contrary to expectations, manifestations of diversity were decreased in healers and healees.

The "clarification session" has been implicated as an important component of the treatment of families affected by incest. On the basis of information presented in clinical literature, however, the specific nature of this intervention varies widely. This exploratory study examined the practices and attitudes regarding clarification sessions of select members of the Association for the Treatment of Sexual Abusers. Surveys were completed by 483 members. Results indicated that approximately 77% of respondents had experience in conducting clarification sessions. The top two reported reasons for conducting clarification sessions were for the perpetrator to assume all responsibility for the abuse and to decrease the level of self-blame of the victim. The majority of respondents concurred that several activities needed to occur prior to the clarification session, whereas less consensus was indicated for activities that were deemed essential during the clarification session. Respondents' practices, attitudes, and beliefs are discussed in terms of the current state of limited, empirically based knowledge in this area. Directions for future research are suggested.

While rates of tobacco use on university campuses rose over the past decade, little is known about what institutions are doing to address this rising concern. Health center directors at public institutions of higher education across the state of Texas were surveyed (n = 42) regarding the perceived importance of smoking cessation, prevalence of interventions on their campuses, and perceived success of intervening efforts. While most health center directors regarded smoking cessation as important, over half of the directors indicated that their sites did not offer tobacco cessation services of any kind. Furthermore, of those offering smoking cessation, most believed that their smoking cessation programs were only somewhat or not at all effective. Findings revealed that there is a noticeable gap between perceived importance and actual implementation of smoking cessation programs within university-based health centers. Recommendations include implementing innovative cessation methods, such as those that are Web-based and highly accessible to students.

The purpose of this study was to investigate the effects of offering Therapeutic Touch (TT) as an adjunct to cognitive behavioral therapy (CBT) for people with chronic pain. Patients were randomized to relaxation training (control group) or TT plus relaxation (experimental). Subsequently, all participants attended a CBT program. Preprogram and postprogram data were examined to identify patterns of change in pain intensity, self-efficacy, unitary power, disability, and perceived distress. In addition, patterns of attrition were examined. Patients in this study who were randomized to receive TT fared better in terms of enhanced self-efficacy and unitary power, as well as having lower attrition rates. Trends associated TT with less distress and disability. This pilot study suggests that offering TT as an adjunct to CBT may help to improve clinical outcomes, reduce program attrition, and promote unitary power in those who suffer with chronic pain.

With rates of adolescent tobacco use steadily increasing over the past 20 years, assisting youth to quit, particularly those youth most susceptible to tobacco use, has become a national focus. The purpose of this pilot study was to examine and profile the smoking patterns of a small sample (n = 37) of juvenile offenders in Texas. In contrast to anecdotal reports, the sample group from this study did not differ clinically from the general population of adolescent tobacco users. Importantly, the study participants indicated previous attempts to stop smoking. The authors conclude that delinquent youth may be responsive to cognitive behavioral smoking cessation programs that also address the management of peer networks.

We report a biologic approach to improve medial collateral ligament healing using growth factors normally expressed in healing tissue. Our previous in vitro work demonstrated that platelet-derived growth factor-BB and transforming growth factor-beta 1 promoted fibroblast proliferation and matrix synthesis, respectively. There-fore, these growth factors were used in vivo to determine whether they could improve medial collateral ligament healing, whether this effect was dose-dependent, and if combinations of growth factors could improve healing more than individual growth factors. Thirty-seven rabbits had various doses of growth factors applied to the ruptured right medial collateral ligaments using a fibrin sealant delivery vehicle. The five groups consisted of 1) two groups receiving two doses of platelet-derived growth factor-BB, 2) two groups receiving two doses of this growth factor plus transforming growth factor-beta 1, and 3) one group receiving fibrin sealant only. After sacrifice at 6 weeks, biomechanical and histologic evaluations of the healing ligament were performed. Femur-medial collateral ligament-tibia complexes of the knees given the higher dose of platelet-derived growth factor-BB had ultimate load, energy absorbed to failure, and ultimate elongation values that were 1.6, 2.4, and 1.6 times greater than the same complexes of the control group. Adding transforming growth factor-beta 1 did not lead to any further increase in the structural properties of the complex compared with treatment with platelet-derived growth factor-BB. These encouraging results suggest that use of platelet-derived growth factor-BB may improve the quality of the healing medial collateral ligament, and that it may also have a similar potential for promoting healing of other ligaments.

The nosology of dementing conditions of very old people, as described in the International Classification of Diseases, Ninth Revision (ICD-9) and reported in Vital Statistics of the United States, is examined. Methods included a questionnaire of state officials who oversee death certification that asked chiefly about death certificate entries that denote dementing conditions. Current nosology includes several dementing conditions that are commonly indistinguishable without a postmortem examination. Dementing conditions are grouped with other conditions of unrelated pathogenesis. The words "psychosis" and "dementia" are used interchangeably. The majority of state officials said that some death certificate entries denoting dementing conditions are acceptable as causes of death. The current system of nosology of dementing conditions probably results in the under-reporting of these conditions in vital statistics. The tenth revision of the International Classification of Diseases (ICD-10) classifies dementing conditions similarly to the ninth revision. An alternative system of nosology, based on dementia as a common characteristic, is suggested.

Rogers' model was used to study patterns of power and spirituality in polio survivors (n = 172) and people who have not had polio (n = 80). Participants completed the Power as Knowing Participation in Change Test and the Spiritual Orientation Inventory. Power was positively related to spirituality (r = .34, p < .005). Polio survivors manifested the same power (t = .44, df = 250, p = .33) and greater spirituality than people who had not experienced polio (t = 3.79, df = 250, p < .001), indicating that patterns of human field change are related to surviving polio. Recommendations include replicating this study with other populations and continuing to develop a theory of spirituality within Rogers' framework.

Traditional autoradiographic image analysis has been restricted to the two-dimensional assessment of local cerebral glucose utilization (LCMRglc) or blood flow in individual brains. It is advantageous, however, to generate an entire three-dimensional (3D) data set and to develop the ability to map replicate images derived from multiple studies into the same 3D space, so as to generate average and standard deviation images for the entire series. We have developed a novel method, termed "disparity analysis," for the alignment and mapping of autoradiographic images. We present the theory of this method, which is based upon a linear affine model, to analyze point-to-point disparities in two images. The method is a direct one that estimates scaling, translation, and rotation parameters simultaneously. Disparity analysis is general and flexible and deals well with damaged or asymmetric sections. We applied this method to study LCMRglc in nine awake male Wistar rats by the [14C]2-deoxyglucose method. Brains were physically aligned in the anteroposterior axis and were sectioned subserially at 100-microns intervals. For each brain, coronal sections were aligned by disparity analysis. The nine brains were then registered in the z-axis with respect to a common coronal reference level (bregma + 0.7 mm). Eight of the nine brains were mapped into the remaining brain, which was designated the "template," and aggregate 3D data sets were generated of the mean and standard deviation for the entire series. The averaged images retained the major anatomic features apparent in individual brains but with some defocusing. Internal anatomic features of the averaged brain were smooth, continuous, and readily identifiable on sections through the 3D stack. The fidelity of the internal architecture of the averaged brain was compared with that of individual brains by analysis of line scans at four representative levels. Line scan comparisons between corresponding sections and their template showed a high degree of correlation, as did similar comparisons performed on entire sections. Fourier analysis of line scan data showed retention of low-frequency information with the expected attenuation of high-frequency components produced by averaging. Region-of-interest (ROI) analysis of the averaged brain yielded LCMRglc values virtually identical to those derived from measurements and subsequent averaging of data from individual brains.(ABSTRACT TRUNCATED AT 400 WORDS)

This survey study focuses on stairs in the homes of a substantial number of independently living elderly (60+) residents of a community in which there are mostly multistory houses and apartment buildings with stairs. While the majority could climb their stairs without problems, a substantial minority lived with stairs despite difficulty and even inability in climbing them. Most people were satisfied with their homes, and many were unwilling to admit that stairs were a present or potential problem. Most people, including most with stair problems, had no plans to move from their homes, however, a majority was willing to concede under questioning that stair-free living in a presently unplanned next home would be desirable. There is a plea that stairs be of increased concern in the housing of elderly people, and that there be increased planning for stair-free homes.

Two new issues of pet ownership were considered in a mail questionnaire and an interview survey of a large number of elderly people age sixty and over. First, evidence was obtained that pets are an important determinant of housing choice. Second, many elderly pet owners have made no arrangements for the pet if they predecease it or become unable to care for it. Problems related to these issues are discussed.

The purpose of this study is to report on the extent of, and organization for, tobacco prevention education in North Carolina Public Schools. Moreover, issues for the diffusion of tobacco prevention curricula are discussed. A questionnaire examining tobacco education practices and curriculum within school districts was mailed to health education representatives in each of the North Carolina public school districts. One-hundred twenty-five usable questionnaires were returned for analysis (125/140 = 89.3%). Of the school districts responding to the survey, 101 (80.8%) reported having adopted a system-wide curriculum which includes tobacco-related instruction. Additionally, a large percentage of the school districts with an adopted curriculum were using commercially published materials (85.2%). Large tobacco producing counties in North Carolina were not significantly different than other counties in the adoption or public acceptance of school programs with a tobacco prevention component. However, school systems with an adopted, general tobacco use policy for the district were more likely to have adopted a district-wide tobacco education curriculum. Individual schools were also involved with multiple tobacco prevention curriculum and learning programs. In the sixth, seventh, and eighth grades, the sample reported using a total of twelve different programs. Many of these learning programs lacked necessary elements of effective programs. Key diffusion issues included the impact of multi-tobacco curricula use to the introduction of new and effective material, as well as the association between district-wide tobacco use policies and the adoption of curriculum.

Functional assessment of patients for resource allocation or staffing requires a higher level of interrater reliability than functional assessment in normal clinical settings. Although many functional assessment instruments are available, interrater reliability of these items has frequently not been reported. An assessment instrument based on the Long Term Care Minimum Data Set format was used for 290 patients in six wards in two Veterans Administration nursing homes. Each patient was assessed independently by two nurse caregivers to obtain reliability information. Different reliability measures yielded differing evaluations of the reliability of the instrument. Absolute agreement rates combined with Kendall's tau-b were most useful in deciding on the reliability of items in the instrument.

Temgesic Injection (buprenorphine), a potent analgesic agent, was given to 240 patients under 18 years of age during a year of monitored release. All but four had the product for the management of moderate or severe pain in the immediate post-operative period. Analgesia was reported as adequate or good in 90% of these young patients when it was assessed 2 and 4 hours after infection. There were no reports of side-effects commonly associated with strong analgesics and particularly antagonist-analgesics such as confusion, hallucination, blurred vision, dry mouth and lightheadedness. There were no serious respiratory or cardiovascular effects. The incidences of other events did not differ from those recorded in the much larger adult population of almost 8,000 patients. Buprenorphine is an effective analgesic suitable for use in the young post-operative patient.

Validation studies were undertaken to establish a computer-assisted double-label autoradiographic strategy employing [14C]2-deoxyglucose ([14C]2DG) and [14C]iodoantipyrine ([14C]IAP) to measure local CMRglu (LCMRglu) and CBF (LCBF). An organic solvent was used to extract the majority of IAP between first and second film exposures. In contrast to previously published data, all solvents tested produced partial losses of 2DG from tissue, and all allowed 2-6% of IAP to persist even after 5-day washes. Technical-grade chloroform permitted equal retention of unmetabolized and metabolized 2DG. A linear model was established, which was insensitive to the changes in tissue self-absorption that were shown to occur with chloroform extraction. Propagated error in computing tissue [14C]2DG and [14C]IAP was reduced by maximizing IAP extraction (by longer solvent wash times) and by administering 2.5 times as much IAP as 2DG. Fractional 2DG retention was measured in single-label 2DG sections placed on the films, and fractional IAP retention was evaluated by an optimization procedure. With this strategy, double-label values for LCMRglu and LCBF in anesthetized rats agreed with values obtained in matched single-label series to within 5%. The coefficients of variation for the double- and single-label LCMRglu data were virtually identical, whereas the coefficient of variation for double-label LCBF was 1.8 times that of single-label LCBF. The double-label strategy permitted pixel-by-pixel measurement and video display of the LCMRglu/LCBF ratio; the mean value among structures was 0.472 mumol/ml. With proper attention to methodological detail, this double-label strategy shows great promise for routine laboratory application.

This paper summarizes the major dermatologic and immunologic complications associated with lithium carbonate ingestion. This drug has demonstrated proven efficacy in the treatment of bipolar affective disorder. This fact, the authors believe, outweights its dermatologic complications, and only exacerbation of psoriasis warrants termination of therapy.

The linear growth data of 48 XY individuals, presumed to be androgen-insensitive as a consequence of the testicular feminization syndrome, were found to be similar to normal male standards and tall for normal female standards. These data are interpreted as evidence for one or more Y-linked gene function(s) which augment stature independently of testosterone effects.

The retired musicians of one of America's great symphony orchestras were interviewed. Their careers, which began in the 1930s and 1940s, were long, with retirement sometimes occurring when they were well over seventy years old. Older players were valued for their excellence and experience and were difficult to replace. Obsolescence was not a problem, and the gradual deterioration of playing with age was generally not incompatible with working to an advanced age. Players of string instruments had longer careers than players of woodwind and brass instruments. The players liked their careers and usually cited artistic reasons and the current reputation of the orchestra for their satisfaction. Although the musicians continue to love music and listen to it after retirement, few continue to play seriously.