The "clean break" revisited: is U.S. population again deconcentrating?

"The Hoover index, calculated across counties and larger spatial units, is again declining--signalling a renewal of population deconcentration in the United States. After increasing for several decades, the index declined in the 1970s when nonmetropolitan population growth surged past metropolitan-area growth, but the index rose in the 1980s as metropolitan population growth recovered and surpassed nonmetropolitan growth. We update these trends, introducing careful controls for changes in metropolitan-area boundaries, and we incorporate a ¿functional urban region' approach. Although the nonmetropolitan population growth rate is still below the metropolitan rate, we conclude that in the 1990s some features of the ¿turnaround' of the 1970s have returned."

[Studies on purification and some properties of nisin from Lactococcus lactis subsp. lactis Al2]

Nisin from Lactococcus lactis subsp. lactis AL2 was extracted with n-propanol from NaCl-saturated culture and purified by ion-exchange chromotography on CM-Sephadex C-25. Nisin was purified 1.63 fold with a yield of 41.7%. The molecular weight of nisin was determined by SDS-PAGE to be about 3500. Nisin activity was stable at low pH and sensitive to digestion by a-chymotrypsin. Nisin is capable of inhibiting a broad range of gram-positive bacteria. In contrast, the gram-negative bacteria, yeasts, molds and Nip+ L. lactis subsp. lactis ATCC11454 were not inhibited.

Epilepsy: a review of seizure types, etiologies, diagnosis, treatment, and nursing implications

Critical care nurses must be able to adequately identify and document seizure activity, perform appropriate interventions, and recognize signs of AED toxicity. Critical care nurses not only share the responsibility of taking care of epilepsy patients, but also must help in valuable patient and family education as it relates to long-term management. Becoming better informed of the plan of care for epilepsy patients helps optimize expected outcomes and enables patients and families to manage this illness better.

Epilepsy: a review of seizure types, etiologies, diagnosis, treatment, and nursing implications

Critical care nurses must be able to adequately identify and document seizure activity, perform appropriate interventions, and recognize signs of AED toxicity. Critical care nurses not only share the responsibility of taking care of epilepsy patients, but also must help in valuable patient and family education as it relates to long-term management. Becoming better informed of the plan of care for epilepsy patients helps optimize expected outcomes and enables patients and families to manage this illness better.

Localization and physical mapping of genes encoding the A+U-rich element RNA-binding protein AUF1 to human chromosomes 4 and X

Messenger RNAs encoding many oncoproteins and cytokines are relatively unstable. Their instability, which ensures appropriate levels and timing of expression, is controlled in part by proteins that bind to A+U-rich instability elements (AREs) present in the 3'-untranslated regions of the mRNAs. cDNAs encoding the AUF1 family of ARE-binding proteins were cloned from human and murine cDNA libraries. In the present study monochromosomal somatic cell hybrids were used to localize two AUF1 loci to human chromosomes 4 and X. In situ hybridization analyses using P1 clones as probes identified the 4q21.1-q21.2 and Xq12 regions as the locations of the AUF1 genes.

Self-concept and behavior in adolescent girls with Turner syndrome: potential estrogen effects

Data on self-concept and behavior were gathered from 31 girls with Turner syndrome (TS) followed longitudinally between the ages of 12 and 16 and from 89 normal control girls recruited from public schools and assessed cross-sectionally. The two groups of girls were similar in age and racial composition. The girls with TS were treated with estrogen replacement therapy in increasing doses between the ages of 12 and 16 (100-400 ng/kg-day ethinyl estradiol). Their self-reported self-esteem and psychological well-being (Piers-Harris Self-Concept Scale) revealed significant improvement over time for most scales as well as the total score (P < 0.001). Parents reported improvement in problem behaviors, as reflected in the Child Behavior Checklist (CBCL) scales: Behavior Total, Externalizing Behavior, Aggressive Behavior, and Social Problems Behavior scales (all P < 0.001). Analysis of covariance comparing normal controls to the TS subjects revealed that at age 12 yr, TS and normal subjects differed significantly for the School Social Competency sub-scale and the Social Problems Behavior subscale (all P < 0.001). Girls with TS resembled the normal controls on all CBCL scales by ages 14-15 yr. Thus, we found improved self-concept both by self- and parental report in estrogen-treated girls with TS followed longitudinally through adolescence. An analogous correlation with age was not seen in the cross-sectional normal control sample. These findings support positive effects of estrogen on psychological well-being in girls with TS and underscores the need to initiate estrogen replacement therapy by ages 12-14 yr in this population.

Pesticide appliers with mixed pesticide exposure: G-banded analysis and possible relationship to non-Hodgkin's lymphoma

To further investigate the possible relationships between agricultural pesticide exposure and the increased risk of non-Hodgkin's Lymphoma among farm workers in the north central United States, we performed G-banded chromosome analyses of peripheral blood from workers classified according to primary types of pesticide exposure: herbicides (n = 20), insecticides (n = 18), fumigants (n = 23), and occupationally unexposed controls (n = 33). Significantly increased rearrangement frequencies were demonstrated in fumigant and insecticide appliers compared to control subjects. At certain chromosome bands there were significant excesses of breaks observed in pesticide appliers, but no breaks were observed in controls. Some of these bands contained genes with potential implications for cancer risk, including oncogenes and genes involved in tumor suppression and apoptosis. Of particular interest with regard to lymphoma risk were the excess rearrangement and breaks involving band 14q32 in fumigant appliers and the excess breaks involving band 18q21 in herbicide appliers; translocations linking 14q32 and 18q21 are the most common rearrangements observed in non-Hodgkin's lymphoma patients. The potential pathobiological relevance of these cytogenetic events warrants additional investigation at the molecular level.

An instrument to assess the oral health status of nursing home residents

This article presents data from the development and testing of an instrument to evaluate the oral health of nursing home residents by nursing personnel (RNs, LVNs, and CNAs). After the instrument was developed, nursing staff were taught to do a brief oral health status examination (BOHSE). Using the instrument, a dentist examined 100 residents; the examination was repeated on the same residents by each category of nurse examiners. Correlation coefficients indicate that statistically significant interrater reliability between the three categories of nursing personnel and the dentist was established, suggesting that nursing staff can be taught to evaluate the oral health of residents. Replication of the study in multiple sites is recommended.

[Experimental study of internal radiation with yttrium-90 microspheres in the treatment of mouse transplanted hepatoma]

The effect of yttrium-90 microspheres in the treatment of mouse transplanted hepatoma H22 was studied. Seventy BALB/C mice with hepatoma H22 were randomly divided into 7 groups (A, B, C, D, E, F, G) and treated respectively with 37, 18.5, 14.8, 11.1, 7.4, 3.7 and 0 MBq/cm3 internal radiation by intratumoral injection of Y-90 microspheres. Dose-dependent therapeutic effects were observed. In group A and B, the tumor growth was markedly retarded and eventually un-palpable. Histological examinations showed complete necrosis of the tumor. In groups C,D, E,F, the tumor growth was also inhibited. However, patchy necrosis could be seen amid apparently normal tumor cells. Only isolated, spotty foci of necrosis were present in the untreated control tumors. The results indicate that a tumor of 1 cm diameter can be effectively treated by internal radiation with 18.5MBq Y-90 microspheres injected into the tumor.

Loss of the metastatic phenotype in murine carcinoma cells expressing an antisense RNA to the insulin-like growth factor receptor

The ability of malignant cells to form metastases in secondary sites remains a major obstacle to the curative treatment of cancer. Previously, we identified type 1 insulin-like growth factor (IGF-1) as a paracrine mitogen for highly metastatic murine carcinoma, H-59 cells. Here the role of IGF-1 and its receptor (IGF-1R) in metastasis was further investigated using H-59 cells transfected with a plasmid vector expressing IGF-1R cDNA in the antisense orientation. The transfectants had a markedly reduced expression of IGF-1R and lost the ability to respond to IGF-1 in vitro. When injected in vivo, either directly into the microvasculature of the liver or lung (experimental metastasis) or s.c. to allow the growth of primary local tumors (spontaneous metastasis), these cells did not give rise to any metastases under conditions which allowed wild-type or control transfectants to form multiple hepatic and pulmonary metastases. The results demonstrate that the IGF-1R can play a critical role in the regulation of carcinoma metastasis.

Usher syndrome: increasing awareness in Scotland

In July 1993, professionals from a number of European countries met at the 7th European Usher Syndrome Study Group. The purpose of the Study Group (which meets on a biannual basis) is to give professionals working in this specialized field the opportunity to share ideas and examples of their work. People attending included medical practitioners, social service workers, representatives from voluntary bodies and individuals with Usher. The following article is an expanded version of a paper presented at the Study Group. It describes the development of a 3 hour workshop for the wide range of practitioners a child or young person with Usher syndrome may meet. Through group work, positive approaches to working through the personal and practical implications of Usher syndrome are explored.

Characterization of cDNAs encoding the murine A+U-rich RNA-binding protein AUF1

A+U-rich elements (ARE) serve to control the degradation of some proto-oncogene and lymphokine mRNAs. The protein, AUF1, which consists of two polypeptides of 37 and 40 kDa (p37 and p40, respectively) when purified from cytosol, has been implicated in ARE-directed mRNA turnover due to its binding to ARE. Molecular cloning of a cDNA (p37AUF1) corresponding to human p37 predicted a polypeptide containing two non-identical RNA recognition motifs (RRM) and a C-terminal Gln-rich domain [Zhang et al. Mol. Cell. Biol. 13 (1993) 7652-7665]. Two cDNAs, designated muAUF1-3 and muAUF1-7, were isolated from a murine fetal cDNA library, using as a probe, a fragment of the p37AUF1 cDNA encoding RRM1 and approximately half of RRM2. The muAUF1-3 open reading frame (ORF) was very homologous to human p37AUF1 with the greatest homology between the corresponding RRMs and the C-terminal Gln-rich motif. Clone muAUF1-7 was highly homologous to muAUF1-3, but was truncated within the region encoding the RNP-1 box in RRM2. Clone muAUF1-3 encoded 19 amino acids in RRM1 not encoded by either muAUF1-7 or human p37AUF1. Such alterations in sequence could modify the RNA-binding properties of these proteins and have concomitant effects on ARE-directed posttranscriptional processes.

Paracrine growth stimulation by hepatocyte-derived insulin-like growth factor-1: a regulatory mechanism for carcinoma cells metastatic to the liver

Tumor H-59 is a subline of the Lewis lung carcinoma which is highly and preferentially metastatic to the liver. We used this carcinoma model to investigate the role of paracrine growth regulation by liver-derived factors in this organ-selective pattern of metastasis. We observed that serum-free medium conditioned by primary cultures of mouse hepatocytes was highly and specifically mitogenic for H-59 cells but had little effect on the proliferation of a second subline, i.e., carcinoma M-27, which is metastatic only to the lung. This mitogenic activity was hepatocyte-specific and could be blocked or depleted by a monoclonal antibody to insulin-like growth factor 1 (IGF-1). IGF-1 could in turn be detected in hepatocyte conditioned medium by the Western blot assay, and when added to serum-deprived cells, IGF-1 could stimulate the proliferation of H-59 but not M-27 cells. Furthermore, when expression of the IGF-1 receptor was analyzed by the Northern blot assay, we found that H-59 cells expressed significantly higher levels of mRNA transcripts encoding IGF-1 receptor. A ligand binding assay revealed that the number of IGF-1 binding sites on H-59 cells was 3.4-fold higher than that on M-27 cells. The results identify IGF-1 as the growth factor mediating the proliferative effect of hepatocyte conditioned medium and suggest that paracrine growth stimulation by hepatocyte-derived IGF-1 is a potential mechanism of selection in the process of liver colonization by these carcinoma cells.

Continuous passive motion in computer assisted auscultation of the knee

A study of physiological patellofemoral crepitus (PPC) signal recorded from adolescent knees has yielded information which suggests that decay time of PPC amplitude due to continuous passive motion (CPM) activity is a consistent and useful signature variable for a given knee. The PPC vibrational signal was induced in each case by 1 min of static load on the patella and postural variables during the examination were carefully controlled. The speed of CPM has been noted as a factor directly influencing the rat of PPC amplitude decay; specifically, a higher CPM speed contributes to an increased decay constant at a cost of increased inter-subject variability. It is proposed that CPM might form an important basis for the ultimate development of a computer-based auscultation technique for diagnosis of patellofemoral joint disorders.

Evaluation of active compression-decompression CPR in victims of out-of-hospital cardiac arrest

OBJECTIVE--Active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) appears to improve ventilation and coronary perfusion when compared with standard CPR. The objective was to evaluate potential benefits of this new CPR technique in patients with out-of-hospital cardiac arrest in St Paul, Minn. DESIGN--Ten-month, prospective, randomized parallel-group design. SETTING--St Paul, Minn, population 270,000. PATIENTS--All normothermic victims of nontraumatic cardiac arrest older than 8 years who received CPR. MAIN OUTCOME MEASURES--Return of spontaneous circulation, admission to the intensive care unit (ICU), return of baseline neurological function (alert and oriented to person, place, and time), survival to hospital discharge, survival to hospital discharge with return of baseline neurological function, and complications. RESULTS--Seventy-seven patients received standard CPR and 53 patients received ACD CPR. The mean emergency medical services call response interval was less than 3.5 minutes. When all patients were considered, a higher percentage of ACD CPR patients had a return of spontaneous circulation and were admitted to the ICU vs standard CPR (45% vs 31%, and 40% vs 26%, respectively), but these trends were not statistically significant (P < .10 and P < .10). No statistically significant differences were found between hospital discharge rates (12 [23%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), return to baseline neurological function (10 [19%] of 53 for ACD CPR vs 13 [17%] of 77 for standard CPR), or return to baseline neurological function at hospital discharge (nine [17%] of 53 for ACD CPR vs 12 [16%] of 77 for standard CPR). Return of spontaneous circulation, ICU admission, and neurological recovery in both CPR groups were highly correlated with downtime (time from collapse to emergency medical system personnel arrival to the scene in witnessed arrests). With less than 10 minutes' downtime, survival to the ICU was 59% (19/32) with ACD CPR and 33% (16/49) with standard CPR (P < .02), return to baseline neurological function was 31% (10/32) with ACD CPR and 20% (10/49) with standard CPR (P = .27), and hospital discharge rate was 38% (12/32) with ACD CPR and 20% (10/49) with standard CPR (P = .17). Complication rates in patients admitted to the hospital were similar in both groups. CONCLUSIONS--This study demonstrates that ACD CPR appears to be more effective than standard CPR in a well-defined subset of victims of out-of-hospital cardiac arrest during the critical early phases of resuscitation. Based on this study, a larger study should be performed to evaluate the potential long-term benefits of ACD CPR.

Purification, characterization, and cDNA cloning of an AU-rich element RNA-binding protein, AUF1

The degradation of some proto-oncogene and lymphokine mRNAs is controlled in part by an AU-rich element (ARE) in the 3' untranslated region. It was shown previously (G. Brewer, Mol. Cell. Biol. 11:2460-2466, 1991) that two polypeptides (37 and 40 kDa) copurified with fractions of a 130,000 x g postribosomal supernatant (S130) from K562 cells that selectively accelerated degradation of c-myc mRNA in a cell-free decay system. These polypeptides bound specifically to the c-myc and granulocyte-macrophage colony-stimulating factor 3' UTRs, suggesting they are in part responsible for selective mRNA degradation. In the present work, we have purified the RNA-binding component of this mRNA degradation activity, which we refer to as AUF1. Using antisera specific for these polypeptides, we demonstrate that the 37- and 40-kDa polypeptides are immunologically cross-reactive and that both polypeptides are phosphorylated and can be found in a complex(s) with other polypeptides. Immunologically related polypeptides are found in both the nucleus and the cytoplasm. The antibodies were also used to clone a cDNA for the 37-kDa polypeptide. This cDNA contains an open reading frame predicted to produce a protein with several features, including two RNA recognition motifs and domains that potentially mediate protein-protein interactions. These results provide further support for a role of this protein in mediating ARE-directed mRNA degradation.

[Methotrexate-citrovorum factor individualized reduced dose therapy for ectopic pregnancy: report of 20 cases]

In twenty patients with ectopic pregnancy who received treatment using methotrexate-citrovorum factor in an individualized reduced dose regimen 17 cases were successfully treated, 4 required one course of therapy, 8 required two courses, 4 required three courses, only 1 required four courses, according to the difference in the speed of hCG reduction. The success rate was 85.0%, two cases got intrauterine pregnancy within 6 months after the treatment. Three ruptured cases during treatment were operated upon. The pathologic findings at the ectopic site were chorionic bleeding, necroses, with dissolution of trophoblastic cells.

An immunohistochemical study of neuropeptide Y positive sites in the developing human hippocampal formation

Neuropeptide Y (NPY)-positive sites were evaluated by immunohistochemistry in the hippocampal formation of human fetuses aged from 15 to 41 weeks of gestation. Immunopositive cells and fibers were identified in the hippocampus as early as 15 weeks of gestation. These cells were localized in the polymorphic and pyramidal layers and their numbers increased with the age of the fetuses. NPY-positive cells were observed to be closely apposed to blood vessels and some NPY fibers, present mainly in the polymorphic layer, would infiltrate the alveus.

Treatment of ovarian malignant germ cell tumors with preservation of fertility

Conservative operation and postoperative chemotherapy were given to 15 patients with malignant germ cell tumors of the ovary with the preservation of fertility and ovarian functions. Four patients, one with endodermal sinus tumor and three immature teratoma, had full term deliveries after the operation. The possibility was discussed to preserve young women's fertility and ovarian function in treating their malignant germ cell tumors.

[Diagnostic errors in dysfunctional uterine bleeding. Analysis of 24 cases]

This paper reports 24 cases of genital organic diseases which were misdiagnosed as dysfunctional uterine bleeding during 1984-1990. These include small submucous uterine myoma 5 cases, Granulosa cell tumor of ovary 2 cases, leiomyosarcoma of uterus 1 case, ectopic pregnancy 7 cases, carcinoma of endometrium 4 cases, abortion 3 cases, choriocarcinoma 2 cases, altogether there were 9 patients with malignant tumors in the series. The author point out that it is possible to reduce the misdiagnosis rate by emphasizing history, diagnostic curettage, ultrasonography, hysteroscopy and blood hCG determination.

Immunosuppressive effects of fish oil in normal human volunteers: correlation with the in vitro effects of eicosapentanoic acid on human lymphocytes

We have studied the effects of dietary supplementation with fish oil on immunological parameters in a group of six normal volunteers, four of whom received a fish oil extract (total EPA dose of 2.4 g/day, which is on the lower range of clinically effective doses) for 6 weeks and two of which received a placebo (olive oil) for an identical period of time. Each volunteer was followed up for a period of 23 weeks after the dietary intervention was ended. All volunteers were boosted with tetanus toxoid (TT) at the onset of the trial. Several immune parameters were followed longitudinally, including NBT reduction and lysozyme release to test neutrophil function; lymphocyte subpopulations; mitogenic responses to phytohemagglutinin (PHA), concanavalin A (Con A) and anti-CD3; IL-2 release after PHA and pokeweed mitogen (PWM) stimulation; immunoglobulin and anti-TT antibody (ATT) synthesis by stimulated lymphocytes; and serum levels of immunoglobulins and of ATT. No consistent changes were observed in neutrophil function tests, mitogenic responses to PHA and Con A, and lymphocyte subsets. The mitogenic response to anti-CD3 and the release of IL-2 after stimulation with PHA and PWM appeared reduced as a consequence of fish oil ingestion, and levels of serum immunoglobulins decreased in three of the volunteers receiving fish oil supplementation. The systemic humoral response after the TT booster appeared not to be influenced by the ingestion of fish oil. However, in those subjects who were given fish oil supplementation, the specific in vitro response of their peripheral blood lymphocytes to TT appeared to be compromised at Week 3. This could reflect the need for progressive accumulation of EPA in lymphocyte membranes for the suppressive effect to be detectable, but it could also reflect a differential sensitivity to the effects of fish oil of circulating B lymphocytes vs. bone marrow B lymphocytes. All the parameters apparently affected by fish oil ingestion were also affected by the incubation of normal lymphocytes with EPA in vitro. In conclusion, low doses of fish oil may have a mild immunosuppressive effect affecting both T and B cell functions. These observations stress the need for more extensive trials designed to determine whether immunosuppressive effects can be consistently elicited and for studies aimed at determining the mechanisms by which omega-3 fatty acids affect the immune system.

Residential mobility differences among developed countries

"Micro-level theories of why households change residence contrast with macro-level approaches that relate the level of spatial mobility to development. This article compares the rate of residential mobility in 16 [developed] countries or other areas and examines both regional variations within countries and changes in rates of local and nonlocal moving. Hypotheses that explain why countries differ in rates of residential mobility are examined."

Poncet's disease: tuberculous rheumatism

Poncet's disease is characterized by a polyarthritis that occurs during acute tuberculosis infection in which no mycobacterial involvement can be found or other known cause of polyarthritis detected. It is a different entity from tuberculous arthritis, which is usually monoarticular and is caused by direct tuberculin infection. Poncet's disease remains a diagnosis of exclusion. Thirteen cases have been reported in the English-language literature since 1974. All patients who received the Mantoux test reacted positively, and 10 of 11 patients treated with antituberculous drugs had resolution of arthritis on therapy. Poncet's disease and erythema nodosum could be differing expressions of a common immunopathogenic response to tuberculin.

Migration distances: an international comparison

Comparing the level or amount of migration within different countries has been a longstanding problem because the local administrative areas commonly used as the basis for measuring migration vary greatly in size and significance within and between countries. Distance moved is a critical aspect of most concepts of migration, and measuring it would facilitate cross-national comparisons. Apparently only the United States, Great Britain, and Sweden have measured migration distances for the country as a whole, and this information is used as the basis for comparative analysis of spatial mobility.

Measuring migration distances: self-reporting and indirect methods

Methods of determining distance covered in migration are discussed. "Two approaches for doing so are simply to ask movers how far they moved or to infer distance from localities of origin and destination. The former has been used in Health Interview Surveys, and the latter is applied to Current Population Surveys; both are national surveys conducted by the U.S. Census Bureau. The two approaches appear to produce consistent results and offer ways of increasing comparability of data and research findings on geographical mobility."

A first-year medical school pilot program for early clinical exposure

A weekly out-patient elective in a medical oncology clinic was established for first- and some second-year medical students. Interviews were carried out immediately after the elective experience and two years later to evaluate the degree of success in achieving specific goals in this elective. Such clinical experience appeared to introduce the medical students to some of the major medical and psychosocial issues involved in the clinical care of patients, to be highly motivating for the students with regard to their standard concurrent basic science curriculum, and to relieve the impatience that first-year medical students have for clinical exposure. The usefulness of the elective, as perceived by the participating students, appeared to increase from the first to the second interview, that is as the students entered the clinical teaching program. The clinical setting was perceived by the students as more useful than either their increased understanding of medicine or observation of physicians as role models. The students' perception and understanding of physician-patient communication, and of the problems facing an oncology patient, appeared to be more favorably influenced than increasing confidence in the ability of the student to deal with patient interaction. Thus, a clinical oncology out-patient experience for first-year medical students appears to be sufficiently rewarding to justify the time and effort to develop such an elective.

Antigenic and biological characterization of avian paramyxovirus type 1 isolates from pigeons

21 A/PMV-1 viruses were isolated from pigeons and characterized using polyclonal and monoclonal antisera in hemagglutination inhibition, seroneutralization and immunoprecipitation studies. Polyclonal and monoclonal antibodies directed against the HN and F proteins of Italien virus reacted with all pigeon isolates showing a close relationship between chicken velogenic and pigeon viruses. Differences in the M.W. of F0, P and M proteins were however observed between pigeon and chicken Italien virus. Marked differences in virulence were recorded among pigeon isolates; these were reflected by great variation in the IVPI of the different strains.

Fusion of Newcastle disease virus with liposomes: role of the lipid composition of liposomes

We demonstrate here that fusion occurs between the membrane of the Newcastle disease virus (NDV) and liposomes. Fluorescence dequenching studies (using Rhodamine-bearing viral envelopes) revealed the mixing of the lipids constituting the viral and liposomal membrane. The digestion of internal viral proteins by trypsin-containing liposomes indicated the mixing of the internal aqueous compartments. This last assay is independent of exchange of lipids between liposomal and viral membrane in the absence of fusion. Investigation of the effects of liposomal composition indicated that the presence of phosphatidylethanolamine and gangliosides are essential to optimize fusion. The fact that the Newcastle disease virus membrane can fuse with liposome also confirms that fusion must be determined by the viral proteins and could be mostly independent of the nature or presence of the host proteins.

Repopulating the Countryside: A 1980 Census Trend

Census data confirm that in the 1970's population grew more rapidly outside than inside metropolitan territory, reversing a historic pattern. The new data reveal that the dispersion of population growth beyond metropolitan areas was not so much a movement to small towns as a movement to the open countryside. The trends appear strong enough to suggest a new shift toward rural life-styles.

Cardiomyopathies characterized by evidence of resistance to left ventricular inflow

Restrictive cardiomyopathy characterized by evidence of left ventricular inflow obstruction was studied in four cases--one child and three adults. In three of the cases, including the child, there was pathologic evidence of hypertrophic cardiomyopathy with asymmetric septal hypertrophy. In the fourth case, no cardiac disease was identified as the anatomic basis for the inflow restriction. This latter case broadens the concept of restrictive cardiomyopathies.

Correlation of electrocardiographic and pathologic findings in healed myocardial infarction

A correlative study in 50 cases of healed myocardial infarction compared the 12 lead electrocardiogram with pathologic observations. The electrocardiogram was interpreted according to established Minnesota codes with some modifications. The following conclusions were reached: (1) The electrocardiogram underestimates the extent of myocardial infarction. (2) When a healed myocardial infarct at a specific location is recognized with electrocardiographic criteria, it is likely that there are unrecognized infarcts involving other areas of the left ventricle. (3) Infarctions involving the lateral and inferobasal areas are frequently unrecognized. (4) The electrocardiogram is more likely to miss myocardial infarcts in patients with multiple, than in those with single, electrocardiographically diagnosed infarcts. (5) Apical myocardial infarction does not appear to have specific electrocardiographic findings, other than those related to general infarct localization by electrocardiogram, particularly in patients with anteroseptal or anterolateral infarction. (6) Abnormal Q waves, generally thought to indicate transmural myocardial infarction, are frequently found in subendocardial infarction. (7) The simplified electrocardiographic classification of myocardial infarct site (anteroseptal, inferior, anterolateral) used in this study is preferable to more detailed classifications previously suggested by others.