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Serological tests for Rocky Mountain spotted fever were performed on single serum specimens from sixth graders from Forsyth County, North Carolina, an area highly endemic for this disease. Five of 508 *.098%) sera were positive (titer greater than or equal to 1:64) using the indirect fluorescent antibody method. Elevated Proteus agglutination antibody titers (greater than 1:160) to OX-19, but not ot OX-2, were common (19.6%) in these children. No correlation of those with positive OX-19 titers could be made with the cases demonstrating elevated indirect fluorescent antibody titers or with a history of urinary tract infection. These data suggest that the increased prevalence of elevated Proteus OX-19 antibody levels makes a single high titer unreliable in the diagnosis of Rocky Mountain spotted fever and that naturally acquired mild or asymptomatic subclinical cases of Rickettsia rickttsii infection occur.

Experimental glaucoma was produced in one eye of five cynomolgus monkeys with the argon laser delivering 100-200 50-mu spots at 1200-1500 mW power and 0.5 sec to 360 degrees of the mid-trabecular meshwork. Monocular electroretinograms (ERGs) were recorded prior to and 2, 3, and 4 mo following the laser treatment. In the laser-treated (glaucoma) eyes, normal flash ERGs were observed using 1-Hz stimulation; however, pattern ERGs (PERGs) elicited using steady-state counterphase modulation of a 0.51 cpd square wave grating showed statistically significant reductions of amplitude. Only small reductions of PERG amplitude were seen with a 1.25 cpd grating. In three animals, abnormalities of the PERG occurred prior to clinically significant cupping of the optic nervehead. Moreover, reductions of PERG amplitude were progressive and associated with the magnitude of cupping of the optic nervehead and elevation of intraocular pressure. PERG amplitude did not change following acute reductions in intraocular pressure in the glaucoma eyes. Several control experiments were conducted to insure that results were not due to alterations in pupil size, refractive state, or accommodation in the glaucoma eyes. The authors believe they now have a monkey model for the electrophysiologic study of glaucoma.

Experimental glaucoma was created in one eye of three cynomolgus monkeys by argon laser application to the mid-trabecular meshwork. Simultaneous pattern electroretinograms (PERG) and pattern visual evoked potentials (PVEP) were measured in both control and glaucoma eyes to spatial frequencies of 0.5, 1.25, 2.5, and 3.5 cpd which were counterphase modulated at 6 Hz. The transient flash electroretinogram was also measured. While normal flash electroretinograms were recorded in all eyes both before and after the unilateral production of elevated intraocular pressure (IOP), reductions in PERG and PVEP amplitude were seen in the eyes with glaucoma as early as two weeks following a sustained increase of IOP, despite the absence of cupping of the optic nervehead judged by ophthalmoscopic examination and analysis of photograph by two observers. Optic nervehead abnormalities occurred subsequently. In glaucomatous monkey eyes, the earliest PERG and PVEP changes were most evident with lower spatial frequencies of stimulation. Our data suggest that the optimal stimulus parameters for the detection of early glaucoma are low spatial frequency patterns presented at a rapid rate of temporal modulation.

Videotape offers an inexpensive method for off-line viewing of dynamic radionuclide cardiac studies. Two approaches to videotaping have been explored and demonstrated to be feasible. In the first, a video camera in conjunction with a cassette-type recorder is used to record from the computer display scope. Alternatively, for computer systems already linked to video display units, the video signal can be routed directly to the recorder. Acceptance and use of tracer cardiology studies will be enhanced by increased availability of the studies for clinical review. Videotape offers an inexpensive flexible means of achieving this.

The pattern electroretinogram (PERG) and visual evoked potential (PVEP) were recorded simultaneously using a 1.1 cpd pattern which was counterphase modulated at 1 Hz. The responses of ocular hypertensive (OHT) eyes (with normal visual fields) and eyes with early glaucoma (with early visual field defects and/or early cupping of the optic nervehead) were compared to age-matched normal observers. All patients (26 eyes) and normal observers (14 eyes) had normal transient flash electroretinograms. Delays were seen in mean PERG latency in both OHT and early glaucoma eyes, while mean PERG amplitude was significantly reduced only in the early glaucoma eyes. The PVEP responses were ‘unmeasurable’ in 11/26 patient eyes because the waveforms were grossly abnormal in shape, making it impossible to identify the N- and P-components. The data were categorized in this manner: a patient response was considered abnormal if latency or amplitude exceeded normal limits (PERG or PVEP) or if the waveform was ‘unmeasurable’ due to its shape (PVEP only). Of the 26 patient eyes, we found that 8 eyes had normal PERG and PVEP, 11 eyes had abnormal PERG and PVEP, one eye had an abnormal PERG and a normal PVEP, and 6 eyes (3 patients) had a normal PERG and an abnormal PVEP. These data support the proposition that foveal vision (as assessed by the PVEP) may be affected by early glaucomatous damage. The relationship between the PERG and PVEP also was evaluated using a new measurement which we call the ‘latency window’. Using this measurement, 15/26 patient eyes were abnormal - 9 of these had ‘unmeasurable’ PVEPs. This measurement could be useful in classifying ‘W’-shaped PVEPs as normal or abnormal.

Previous studies have suggested that the focal accumulation of phagocytic leukocytes is an important feature of the host response in mucormycosis. To ascertain the basis for this influx of inflammatory cells, we evaluated the effect of members of the order Mucorales, including species from the genera Rhizopus, Absidia, and Mucor, on the chemotactic activity of normal human serum for neutrophils and monocytes. Both hyphae and spores produced concentration-dependent chemotaxigenesis in serum to a maximum level equivalent to that produced by zymosan activation of serum. Chemotactic activity was similar for live and heat-killed hyphae. No leukotactic activity was demonstrated in the absence of serum. The pretreatment of serum with anti-C3 antibody, heating at 56 degrees C, or 0.01 M EDTA abolished the activity. The pretreatment of serum with 0.01 M ethylene glycol-bis(beta-aminoethyl ether)-N,N-tetraacetic acid did not abolish the activity. These data provide evidence that the leukotactic activity of Mucorales species is generated through the alternative complement pathway.

We measured the persistence for gratings of three different spatial frequencies after they had been equated for visibility by manipulating: (1) the contrast of the stimulus, (2) the duration of the stimulus, or (3) both contrast and duration. When we presented gratings of equal apparent contrast and equal duration, persistence increased with increasing spatial frequency. This effect occurred when apparent contrast was equated in terms of extended-duration or brief duration contrast sensitivity. However, when we examined persistence using gratings equated for temporal integration (i.e. equal apparent contrast but unequal durations), no differences in persistence as a function of spatial frequency were observed. Thus, the increase in persistence which is typically found with higher spatial frequencies can be accounted for by knowledge of the spatio-temporal characteristics of the visual system. Our findings are discussed in terms of the notion of different filter time-constants for different spatial channels.

Homozygosity for simple recessive gene c in axolotl embryos results in the absence of a heartbeat. Gene c alters the morphology of the mutant anterior endoderm - the primary heart inductor.

Congenital malformations now represent the largest single cause of mortality in the infant of the diabetic mother. The mechanism by which diabetes exerts its teratogenic effects is not known. This study evaluated whether arachidonic acid might be involved, a possibility raised by the role of arachidonic acid in palatal elevation and fusion, processes analogous to neural tube folding and fusion. This hypothesis was tested in two animal models of diabetic embryopathy, the in vivo pregnant diabetic rat and the in vitro hyperglycemic mouse embryo culture. The subcutaneous injection of arachidonic acid (200-400 mg/kg per day) into pregnant diabetic rats during the period of organ differentiation (days 6-12) did not alter the maternal glucose concentration, the maternal weight gain, or the weight of the embryos. However, the incidence of neural tube fusion defects was reduced from 11% to 3.8% (P less than 0.005), the frequency of cleft palate was reduced from 11% to 4% (P less than 0.005), and the incidence of micrognathia was reduced from 7% to 0.8% (P less than 0.001). The addition of arachidonic acid to B10.A mouse embryos in culture also resulted in a reversal of hyperglycemia-induced teratogenesis. The teratogenic effect of D-glucose (8 mg/ml) in the medium resulted in normal neural tube fusion in only 32% of the embryos (P less than 0.006 when compared to controls). Arachidonic acid supplementation (1 or 10 micrograms/ml) produced a rate of neural tube fusion (67%) that was not significantly different from that observed in controls. The evidence presented indicates that arachidonic acid supplementation exerts a significant protective effect against the teratogenic action of hyperglycemia in both in vivo (rat) and in vitro (mouse) animal models. These data therefore suggest that the mechanism mediating the teratogenic effect of an increased glucose concentration involves a functional deficiency of arachidonic acid at a critical stage of organogenesis.

Serum samples from 13 newly diagnosed type I diabetics were tested for their ability to mediate antibody-dependent cellular immune reactions against pancreatic islets prepared from Wistar/Jena K rats. Nine of these serum samples proved able to mediate islet cell damage when the islets were preincubated with sera and then cultivated with leukocytes of healthy subjects for 20 h. Damage to islets was demonstrated both by the trypan-blue exclusion test and by measurement of insulin leakage during incubation. The data presented point to a possible pathogenetic role of antibodies mediating cellular immune reactions in type I diabetes.

Incubation of the chemotactic agent N-formyl-methionyl-leucyl-phenylalanine with human neutrophils produced a rapid elevation of the intracellular level of cyclic adenosine monophosphate (cAMP). This cAMP spike occurred within 30 s after exposure and returned to normal by 5 min.

Isolated pancreatic islets from 7-10 days old Wistar rats were incubated in freshly prepared human serum. The cytotoxic insulin leakage from the islets was correlated with the presence in the sera of islet cell surface antibodies (ICSA) determined by indirect immunofluorescence. Such cytotoxic ICSA were found to be common in Type-I diabetics as well as in nondiabetic subjects who had contact with laboratory rats.

We attempted to confirm the results of a previous study in which patients with hypogonadotropic hypogonadism (HH) could be readily distinguished from normal adolescents with constitutional delay of growth and development (CDGD) by their lower serum PRL responses to TRH. We compared the PRL responses to TRH of 13 teenaged males with HH to those of 14 teenaged males with CDGD. Although the mean maximum serum PRL concentration after TRH in HH patients (29.5 ng/ml) was significantly less (P less than 0.05) than that in the CDGD subjects (41.1 ng/ml), there was considerable overlap between the 2 groups. Seven of the 13 HH patients had peak serum PRL concentrations in response to TRH that were greater than 25 ng/ml, the lowest value in the CDGD subjects. These results suggest that a normal PRL response to TRH in a male who has delayed puberty does not exclude the diagnosis of HH, but that a subnormal response probably does support that diagnosis.

Flicker sensitivity and spatial contrast sensitivity (CS) were examined in a total of 99 patients with Parkinson's disease (PD). All patients were undergoing treatment with dopaminergic agents. Specific losses in sensitivity observed in PD were (1) a loss in flicker sensitivity which was most pronounced around the peak of the function (8 Hz) and (2) a loss near the peak of the spatial CS curve, often with no noticeable low frequency attenuation. Several PD patients affected by the ‘on-off ’ syndrome were tested in both ‘on’ and ‘off’ phases, and the results show that the CS function switches in parallel with motor symptoms of the disease. These data suggest that not only is the visual system affected in PD, but that dopamine may have an essential role in receptive field organization in human vision.

Nursing staff and social workers independently rated the manifestations of agitation and depression in 408 nursing home residents. The role of dementia was also investigated. The relationship between agitation (3 factors: aggressive, physically nonaggressive, and verbally agitated) and depression (2 factors: social functioning and depressed affect) was examined. While residents who manifested either aggressive behavior (e.g., hitting, cursing) or physically nonaggressive behaviors (e.g., general restlessness, pacing) tended to be more cognitively impaired, aggressive behaviors were negatively related to the social functioning aspect of depression, and physically nonaggressive behaviors were not related to either aspect of depression. Verbally agitated individuals were more cognitively intact and displayed depressed affects. It is conceivable that depressed affect was perceived only in verbally agitated residents since these persons were able to communicate their depression to caregivers. This result raises questions concerning the meaningfulness of depression measurements in noncommunicative residents.

The relationships between the three syndromes of agitated behavior aggressive, physically nonaggressive, and verbally agitated) and three aspects of past personality (exposure to stress, history of a mental disorder, and leisure habits) were examined in 408 nursing home residents. Results showed that residents who had experienced the following stressful events during their lives — a life-threatening experience, separation from spouse, retirement, financial problems, and immigration — exhibited more physically nonaggressive behaviors (such as, pacing). Residents who had not experienced the stressful event of relocation manifested more aggressive (e.g., hitting) and physically nonaggressive behaviors. Neither history of a mental disorder nor past preferences for leisure activities were found to be related to agitated behaviors manifested by nursing home residents. Possible explanations for these results are discussed.

During the renal functional diagnostics at the narcotized rat in various forms of anaesthesia (Pentobarbital and Velonarcon/Faustan) the behaviour of the blood pressure was continuously registered. In contrast to the Velonarcon/Faustan anaesthesia, in which a distinct hypertonic reaction was observed which normalized itself only after 100 minutes with the Pentobarbital anaesthesia an approximately invariable constant blood pressure level lying in the renal autoregulative region could be achieved during the whole period of investigation.

Yersinia enterocolitica, a gram negative aerobic non-haemolytic bacillus, has been identified as a cause of meningitis only once before and the neuropathological features of Y. enterocolitica meningitis have not been reported in the literature. We describe the pathological features of a case of acute fatal meningitis caused by Y. enterocolitica, serotype 0:18, in a 47-year-old male alcoholic with cirrhosis. The organism presumably reached the meninges via the blood stream from the abdominal cavity. Intravascular fibrin thrombi, both recent and organising, were associated with multiple foci of necrosis in the brain. In spite of vigorous antibiotic therapy for three weeks the organism was cultured from the brain at autopsy. Among the various infections caused by Y. enterocolitica, meningitis appears to be the most difficult to eradicate.

Agitation is a significant problem for elderly persons, their families, and their caregivers. This study describes the agitated behaviors of 408 nursing home residents. Nurses who were familiar with the residents used a 7-point scale to rate how often each resident manifested 29 agitated behaviors. Each resident was rated independently by three nurses, one from each of the three nursing shifts. Results showed that agitated behaviors occurred most often during the day shift (i.e., when residents were most active), and least often during the night shift. The most frequently exhibited agitated behaviors were general restlessness, pacing, repetitious sentences, requests for attention, complaining, negativism, and cursing. Most agitated behaviors correlated significantly across shifts, suggesting that such behaviors occur and reoccur throughout the 24-hour day. Factor analysis yielded three syndromes of agitation: aggressive behavior, physically nonaggressive behavior, and verbally agitated behavior. These results provide a foundation for further studies of agitation in elderly persons.

In previous studies, we showed that in the monkey, systemically administered N-methyl, 4-phenyl, 1-2-3-6 tetrahydropyridine (MPTP) produces a chronic parkinsonian syndrome accompanied by spatial frequency-dependent abnormalities in both the pattern electroretinogram and visual evoked potential. We describe the effect of intravitreally administered 6-hydroxydopamine (6-OH-DA) on the pattern electroretinogram and pattern visual evoked potential of 3 aphakic monkeys. Because of the aphake condition, several complexities of intravitreal injection of 6-OH-DA could be avoided. Nevertheless, following 6-OH-DA treatment, both the phase and the amplitude of pattern electroretinogram and pattern visual evoked potential became abnormal. This abnormality was most pronounced for the higher spatial frequencies (2.5 and 3.5 cycles per degree), whereas lower spatial frequencies (0.5 and 1.2 cycles per degree) were less impaired. The effects of systemically administered MPTP on pattern electroretinogram and pattern visual evoked potential are similar to the effects of intravitreal injections of 6-OH-DA, suggesting that a retinal catecholaminergic system plays an important role in pattern vision of primates.

Direct observations of 24 highly agitated, cognitively impaired nursing home residents were performed during each hour of the 24-hour day for 2–3 months. Results showed that agitated behaviors (in particular, strange noises, requests for attention, repetitious mannerisms, picking at things, strange movements, and pacing) were manifested at very high frequencies. The data also showed that daytime agitation was positively related to nighttime agitation. Patterns of agitation were specific to each resident, an important finding for future research and intervention.

Myocardial ischemia may be produced by a wide variety of pathophysiologic scenarios. Currently, long-acting nitrates, beta blockers, and calcium blocking drugs are available to treat ischemia. Each class of therapy poses potential problems for the elderly, and therapy must be individualized. Long-acting nitrates are probably not the best choice of monotherapy since tolerance develops to their use over time. Congestive heart failure, a common sequela to myocardial infarction, is currently best treated by diuretics and vasodilating drugs. These therapies are generally well-tolerated by the elderly. Digitalis, which is not easily given to the elderly due to potential toxicity, is probably best avoided in this patient group unless needed to treat arrhythmia. Careful differential diagnosis of congestive heart failure is a critical pre-condition to starting any therapy for heart failure, particularly in the elderly patient.

The relationship between manifestations of agitated behaviors and interpersonal distance was examined in 24 nursing home residents with high agitation and severe cognitive impairment. Analysis indicated that agitated residents displayed divergent responses to touch: touch was related to an increase in aggressive behaviors and to a decrease in physically nonaggressive behaviors (e.g., strange movements). The positive relationship between aggressiveness and touching suggests that residents may interpret touching as a violation of their personal space. The finding that residents exhibited fewer strange movements when touched suggests that touching can act as a quieting and comforting form of communication. The implications of these findings for caregivers are discussed.

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Epidemiological studies have demonstrated that, using objective performance measures of physical functioning, disability risk can be predicted in nondisabled older adults. This makes it possible to recruit a nondisabled but at-risk population for clinical trials of disability prevention. Successful disability prevention in this population, for example through an exercise program, would have a major public health impact. To enhance the development of exercise interventions in this group it would be valuable to have additional information not available from existing epidemiologic studies. This report examines the evidence that functional limitations preceding disability can be identified in a community-dwelling population and that it is feasible to recruit these people into studies. It introduces a series of articles examining the characteristics of this population: motivators and barriers to exercise, exercise habits and preferences, the impact of positive and negative affect, and the impact of pain and functional limitations on attitudes toward exercise.

This study of the progression of eye pathology in 100 nursing home residents found that the amount of eye pathology (cataracts, macular degeneration, and glaucoma) was high and increased from Time 1 to Time 2 (mean interval = 315 days) and that the increases in cataracts and macular degeneration were statistically significant. Also, the residents’ best-corrected visual acuity dropped significantly from Time 1 to Time 2. These longitudinal data indicate the importance of routine assessments to detect changes in the vision of elderly residents.

Objective. The objective of this study was to examine the efficacy of a systematic algorithm for providing individualized, nonpharmacological interventions for reducing agitated behaviors in nursing home residents with dementia. Methods. This placebo-controlled study combined nomothetic and ideographic methodologies. The study was conducted in 12 nursing home buildings in Maryland; 6 were used as treatment facilities, and 6 as control facilities. Participants were 167 elderly nursing home residents with dementia. Interventions were tailored to the individual profiles of agitated participants using a systematic algorithm that considered type of agitation and unmet needs. Interventions were then designed to fulfill the need in a manner that matched the person’s cognitive, physical, and sensory abilities, and their lifelong habits and roles. Interventions were provided for 10 days during the 4 hours of greatest agitation. Direct observations of agitation were recorded by trained research assistants via the Agitated Behavior Mapping Instrument (ABMI). Evaluation of positive and negative affect was also based on direct observation and assessed via Lawton’s Modified Behavior Stream. Data analysis was performed via SPSS software. Results. The implementation of personalized, nonpharmacological interventions resulted in statistically significant decreases in overall agitation in the intervention group relative to the control group from baseline to treatment (F1,164 ¼ 10.22, p ¼ .002). In addition, implementation of individualized interventions for agitation resulted in statistically significant increases in pleasure and interest (F1,164 ¼ 24.22, p , .001; F1,164 ¼ 20.66, p , .001). Conclusions. The findings support the use of individualized nonpharmacological interventions to treat agitation in persons with dementia and underscore the importance for clinicians of searching for underlying reasons for agitated behaviors.