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The alarming increase in hospital emergency room (ER) usage, especially by inner city populations, is an important indicator of the current health care crisis. If neighborhood health centers (HC) are effective in reaching their target population, they should have sufficient impact to stop or reverse this trend. This study tried to measure the impact of the dental HC services on ER usage for dental emergencies. The ER logs of the main hospitals were studied covering a four-year period. The patient's address was coded by census tract to compare ER usage from various areas, especially the HC target area and a second poverty district as comparison area. Dental ER usage from all areas continued to grow with the largest increase occurring from 1969 to 1970. Revised hypotheses were tested in two follow-up studies, one using personal interviews of ER patients and the other using Medicaid payment files. A change in Medicaid payment regulations (20% fee cut) in 1969 had led many dentists to withdraw from the program, but some in the second poverty district had responded by expanding their services to the poor. The HC had an impact, but this was clouded by other powerful changes in the dental health care system for the poor.

Few case histories of “unsuccessful” mental health planning consultation have been reported in the literature. Two case histories are herein presented, one considered “successful” (by criteria described in the paper) and one considered not. Examination of these two cases underscores the importance of (1) explicit definition of task, (2) access of the consultant to policy makers, (3) access to the target population, (4) consultant control over his own schedule, and (5) adequate logistic support. Practical recommendations are included for achieving these steps.

Maps are used primarily as inventories or to evaluate spatial variability as a means of testing hypotheses. Sequential steps involved in evaluating relevant variables and in testing hypotheses about specified target populations are outlined. Identification of component subproblems and attempts to use the formalism necessary iteratively to test deterministic differential equations (or the corresponding probabilistic equations) could enhance the understanding of many earth-science problems.

IN THIS paper we consider the problem of estimating the total size of a target population from which a study sample has been obtained by merging names from several routinely collected lists. Previously, we obtained an estimate of this size and showed its relation to traditional capture-recapture models [l, 21. Section 2 of this paper summarizes the notation and assumptions, reviews the method, and corrects our previous expression for the variance of that estimate. In Section 3, we discuss some of the cases in which the underlying assumptions may fail and demonstrate that this may lead to an estimate of population size with a distressingly large bias. Section 4 proposes some methods for dealing with failures of the assumptions and Section 5 presents an example of the use of these methods. Finally, Section 6 is a critical discussion of the techniques.

Dietary intakes of specified nutrients can be estimated easily and relatively accurately by using techniques proposed in this paper. Foods that contain these nutrients and that are most frequently consumed by a target population group can be used as the basis for development of a quantified food record form. Placing foods of similar nutrient content into groups, evaluating the variance of the foods within each group in respect to nutrient standards used, and estimating nutritional adequacy of diets by using mean nutrient contributions from each group result in a reasonably accurate assessment of nutrient adequacy of diets of groups of people. A simple computer program was written to process the data and to provide nutrient profiles that could be used to develop and monitor nutrition education programs.

This article explores some central issues in congruence between family needs and welfare-service provisions. A set of concepts and a methodology are presented on the basis of which 267 welfare-service organizations exercising some discretionary power and operating in Jerusalem in the economic-social, health, and socialization spheres were censused. The following five key variables guided the collection of data: goals, resources, structural determinants, service provisions, and target population. According to the data thus collected, eighteen distinct profiles of welfare-service organizations crystallized; these might be viewed as an empirically derived typology of social welfare service agencies. The findings from Jerusalem 1965-66 revealed the dominance of voluntarily sponsored welfare operations in which the government subsidizes the operation without participating in policymaking. In contradistinction to welfare-service operations in the economic-social and socialization spheres of welfare, service ope...

IUD acceptance at the Albert Schweitzer Hospital Deschapelles Haiti was studied. Nurse-midwives performed the Lippes loop insertions under medical supervision. Patients paid $.40 for the clinic services and participated in a 20-min educational session a personal medical and reproductive history and routine hemoglobin determination. A pelvic examination was performed before the IUD was inserted. Records of insertions were kept from January 1 1966 to April 1969 of both well and ill patients. There was a 63% cumulative continuation rate at the end of 2-yr followup for the ill patients and a 71% rate for the well patients. The ill patients had 61 expulsions 66% of whom had reinsertions. Of the 32 expulsions of the well patients 80% had reinsertions. Pregnancy rates were similar for both groups. Less than 5% of the target population accepted the device. It is hoped that this will change as infant and child mortality rates continue to fall.

This article introduces the educational services of the BBC as integrated media for learning. Television is considered as one of the component parts of a complex learning system. Reference is made to the role of television in the Open University, and to the problems of adult education in an open society. Instances are given of the difficulties of specifying objectives and identifying a target population.

The United States has not had a consistent, comprehensive youth employment policy. Program objectives are not clear and are often in conflict with the objectives of other programs aimed at the same target population. The primary needs at this juncture are a clearly specified policy objective and a method for identifying the ways in which potential interventions can help attain that objective. The authors argue that the genesis of public concern with youth employment problems lies in the general acceptance of greater equality of opportunity as a national goal. The appropriate objective of youth employment policy is conceptualized as the reduction of certain inequalities in economic opportunity that confront the young. Equality of economic opportunity is a long-run concept. The relations between actions at a point in time and opportunity over time are developed within a model of youth behavior. The analysis focuses on the notions of career paths, employment success, and economic oportunity.

Field tests demonstrated that 1.25% lindane emulsion, with or without a penetrant, remained effective against the western pine beetle, Dendroctonus brevicomis Leconte, for 6 months after application to infested logs of ponderosa pine, Pinus ponderosa Lawson. Greater than 98% reduction of the target population was achieved. Smaller tests indicated these sprays are effective also against the Jeffrey pine beetle, D. jeffreyi Hopkins; the fir engraver scolytus ventralis Leconte; and California flatheaded borer, Melanophila californica Van Dyke.

The basic assumption here is that laws that op erate in attitude organization and change are universal and least susceptible to contamination by language or culture. Some of the major theories relevant to persuasion are, there fore, presented to provide a universal frame of reference ac cording to which the act of persuasion can be examined, ana lyzed, and discussed. On the other hand, latent criteria used in making evaluative judgments may vary from one individual to another and, to a greater extent, from one culture to another. Hence there are basic difficulties in cross-cultural communica tion. To overcome these difficulties, a three-step strategy of cross-cultural communication is proposed, which involves (1) a comprehensive—that is, both quantitative and qualitative— analysis of attitude components present in a target population, (2) systematic use of a multi-channel, multi-step flow of com munication, and (3) an application of C. E. Osgood's "GRIT" strategy for intercultural persuasion, in which communication is more by deeds than by words.

Based on the training needs of the 1963 intake of craft apprentices at Baker Perkins, an experimental self‐correcting adaptive teaching system was constructed and given preliminary trials with a section of the target population. From the limited data obtained decisions were taken to alter the branching rules slightly but otherwise continue operating the system as originally designed. Various devices for collecting and interpreting information were apparently working well enough to be confident that the system is potentially self‐correcting.

An urgent need is for some overall unit of educational benefit, and it is here proposed that such be established by certain scaling techniques. Groups of judges are asked to render overall evaluations on “students” of specified characteristics. Their evaluations are studied for correlation with the student traits, and the resultant coefficients, loaded with latent and applied values, become defensible weights to describe other students' overall educational advancement. The general unit so developed, when normalized for the target population, may be termed a “benefit T-score”, or more simply “bentee”. Recursive features of the scaling process, applicable at different levels of generality, should provide for a shift from value-space to test-space, and from societal to expert opinion. Discovered weightings should illuminate differing values of lay and professional groups within society. And the bentee could provide an objective function suitable for optimizing in management-science techniques, now largely neglected in curriculum and administration.

producing microorganisms, their toxins, or the poisons produced by higher animals or plants to cause illness, death, or panic in a target population. Microorganisms that might be used as BW ^gents may include pathogenic bacteria, fungi, rickettsiae, viruses, and protozoa. An enemy would probably try to disseminate BW materials in air, water, food, or drink. He might conceivably consider other routes that would permit the BW agent to reach the oral or respiratory tracts, or to penetrate the skin. The purpose of this presentation is to discuss whether drinking-water systems may be vulnerable to biological warfare and to evaluate measures that may prevent or control this type of attack.

The probable conditions in Washington following widespread thermonuclear attack are assessed with respect to (1) radiation conditions in the city itself and in the surrounding areas, and (2) deaths and debris conditions in the Nation's Capital Mock attacks with thermonuclear-size bombs were made on all targets designated as critical by the FCDA within a 300-mile radius of Washington. Appropriate fallout contours were selected and oriented as to wind speed and bearing for each target. The attacks were repeated 36 times using a random sample of actual 60,000-ft wind readings. Radiation levels for the area were then compiled in terms of the per cent of time a given two-day accumulated dose would be exceeded. An attack day was selected at random and the effects of blast heat and local (close-in) fallout in Washington were added to indirect radiation effects. A comparison of the amount of time a rescue worker would have to wait (impeded by debris and radiation) to enter an area with the amount of time left to a survivor in shelter attenuating 0.9 of radiation effects was made. An area exists, in Virginia, where less than 200 r can be expected a large per cent of the time. A very small percentage of the target population will survive to be cared for in this area. It was found that present shelter is not adequate to prevent intolerable numbers of deaths Present “evacuation areas” should be re-evaluated in terms of likely radiation conditions.

To assess smoking trends of junior and senior high school youth, a prospective study was conducted over a two year period. A total of 10,565 subjects comprised the study population. The resultant data were analyzed by smoking behavior classification, grade level, and sex. Comparisons of smoking rates by matched and unmatched samples were also included. The findings supported the contention that behavioral patterns with respect to smoking and nonsmoking behavior are well established by the junior high school years. The authors maintain that from an educational point of view, smoking education programs must begin before the junior high school years. Educators need to recognize the characteristics of the target population to maximize the effect and efficiency of their educational programs.

"Educational objectives must be appropriate to individual circumstances; what is relevant to a suburban middle-class youngster may be entirely inappropriate to an inner-city youth. To evalu ate civic behavior, then, we must not only state objectives in terms of desired behaviors, but we also must make sure that they are appropriate objectives for the target population."

The problem of environmental pollution and the advent of insecticidal resistance among mosquitoes and other pest insects have stimulated considerable interest in the possibility of mosquito control with genetic techniques. The goal of these methods is suppression or eradication of the pest population by introduction of genetic factors which would impose a load on the target population. However, aside from the preliminary work of a few workers (Craig and VandeHey 1962, Kitzmiller et al. 1967, Sakai and Baker 1972) little is known of the genetic variability present in wild populations. Thus it would appear desirable to assess the variability within wild populations before any attempt at genetic control is undertaken.

STOCK MARKET RESEARCHERS frequently face the problem of selecting a sample of stocks to test their theory. A random sample in which each company in a target population has some predetermined probability of selection insures that the usual statistical procedures for establishing the variability of the results may be employed. But random samples are difficult to execute because of the frequency of name changes, new listings, deletions, and miscellaneous difficulties in securing accurate information for the small companies

This paper examines theoretical and administrative aspects of mental health planning for persons who do not require hospitalization but who do need placement in special living arrangements in the community. The desirability of developing nonhospital affiliated group-placement facilities is highlighted and the necessity for cooperation with a number of agencies to establish standards and programs of rehabilitation is stressed. Selected issues centering on the question of continuity of care are discussed and beginning guidelines for defining a target population for possible placement are offered. A number of administrative alternatives currently in operation are presented with special focus on obstacles to sound planning.

The costs to identify a clinically important test by an automated multiphasic screening program provide useful information in planning for a specified target population. When 44,663 multip...

When a statistician or a researcher in any field designs a study, there are many concepts which he must clarify in his own mind before the study is started. He must define his problem, his target population, and his statistical unit, decide on how he is going to take a sample and what he is going to do with it when he gets it, realize what problems can arise because of the manner in which the sample is selected, and he must decide how to collect, tabulate, and analyze the data, and what kinds of conclusions he could draw. When a statistician evaluates a study done by someone else, he obviously must look at the same concepts to see whether the conclusions drawn follow logically from what was done in terms of the manner in which these concepts were defined. I would like to take the University Group Diabetes Program

IN THE LATE spring and summer of 1962, an intensive program for distribution of Sabin oral poliovaccine was carried out in the Cleveland area. This program was modeled after the "Sabin-on-Sunday" (SOS) method of community immunization developed in Phoenix and Tucson, Arizona. 1 As the campaign progressed, it appeared that community-wide participation had been achieved as evidenced by the crowds of people who came to distribution centers in all socioeconomic areas. Efforts to achieve this goal of community-wide immunization have been stimulated by the occurrence in recent years of severe poliomyelitis epidemics with concentration of high attack rates in the lower socioeconomic areas of cities 2S and the concurrent observation of generally low levels of inactivated poliovaccine immunization levels in the areas with highest rates. 5-8 Although much work has been expended in campaigns to reduce this problem, results frequently have been less successful in reaching the target populations than was

To the Editor.— The editorial by Brickner (225:1645, 1973), entitled "Finding the Unreached Patient," dealt eloquently with a specific issue, "the isolated, homebound, aged," but also raised, by implication, additional generically related problems. In the midst of the current wave of interest in family practice, primary care, ambulatory services, and community medicine—in short, in nonhospitalized persons—have adequate methods been devised to identify target populations for such programs? Resources available for health care and medical care will always be limited. Perfect health for all people of all ages is a fantasy. The right to good health must be realized within finite constraints. Who in the community has highest priority? By what mechanism should specific target groups in need be identified and ranked? To what degree should the identified needs of one sub-group be weighed against the probable but poorly documented needs of another sub-group? Should outreach programs with limited resources be

A study was conducted of married Catholic men in the Chicago area to determine their expectations of the consequences of vasectomy or the values served by vasectomy. It was speculated that these expectations and values influenced the attitude these men held toward vasectomy. Data indicated that the most important expectancy belief was that sexual fulfillment would be heightened by vasectomy. This finding can have potential effects on the design of communication and education programs connected with family planning centers. Careful counseling and screening of all potential vasectomy patients should be conducted to prevent unrealistic expectations for the operation.

To the Editor:— Reading the lead article "Response of Hyperlipoproteinemia to Cholestyramine Resin" by Fallon and Woods (204:1161, 1968) combined with participation on various drug committees compels me to take microphone in hand and dictate a response.This manuscript is an excellent example for elementary biostatistics courses to show beginning students how one can take a set of data which shows practically no drug effect and leave the unsuspecting reader with the implication that the drug was effective. In any study aimed at determining the efficacy of a drug on people with hyperlipoproteinemia the target population (the group of people about which conclusions are to be drawn) should be all people with hyperlipoproteinemia. A random sample is then selected and statistical tests may be used to draw inferences about all hyperlipoproteinemia cases on the basis of those observed in the sample. Thus, if one wishes to know whether there

The author uses admissions data from a federally-sponsored hospital for Blacks in the 1860's as a way of pinpointing change in medical care policy. The changes reflected the conflicts among sponsoring agencies, and had little to do with the actual needs of the target population. It is suggested that resolution was achieved because federal officials and native Whites sought a common end. Finally, attention is drawn to the value of historical analogues for the analysis of contemporary programs, such as the Office of Economic Opportunity.

A personal preliminary guide to the implementation of family planning in developing countries is presented. The initial strategy should be to bring family planning to the people who are initially motivated i.e. already want it and gradually build the momentum to recruit the target population which should not include all people. In many areas euphemistic terms must be substituted for the ideas of planning and control. In most cases the program must be taken to the people using mass media contact field workers and midwives. Informational content of programs should stress the why and the how of family planning. Field workers should be carefully trained not be patronizing and should be acceptable to the public. The medical public should be informed supporters of the program and should be included in the subsidizing of supplies. Aim at a budget of at least $.05us per capita per year for the normal program. Consider 10% of the budget the fist year is success.

Within the past few years special projects and services have proliferated which are designed to increase the academic attainment of students who progress ineffectively in conventional American educational programs. Despite differences in the materials and activities of these innovative programs, and in spite of the fact that the target populations range from pre-school to the college years, almost without exception their proponents subscribe to belief in the vital role that a positive concept of self plays in the development of a fully-functioning personality.' A positive concept of self, it is argued, is essential to the learner's personal, social, and intellectual growth and development. Bibliotherapy is frequently utilized in these compensatory programs as one of the vehicles through which personal and ethnic identification may be effected as a means of enhancing concepts of self.

As surveys have extended to wider areas of interest and wider portions of the population, attention has been directed to the nature of the interviewing situation, the "interviewability" of various populations, and the ways in which the social and psychological characteristics of the participants-interviewers and respondents-influence the nature of the social data collected.' An increasingly common target of much social research has been the aged segment of the population. Not only is this portion of the population more numerous and therefore comprises a larger part of all surveys aimed at the general population, but it is increasingly a target population of particular interest to social researchers as it becomes a more significant and more visible part of society. A recent study of an extremely aged population provided an opportunity to direct attention to two critical considerations in the conduct of surveys among the aged-the attainment of cooperation and good rapport with the sampled respondents and the effect upon the interview situation of respondent and interviewer characteristics. The present paper is the first report of our findings in these two areas.

SINCE the publication in 1964 of the Surgeon General's report, Smoking and Health, an increasing number of studies related to the behavior of the public have been reported (1,2). Some of these studies have been economic in orientation, describing fluctuations in the sale of cigarettes and other tobacco products; others have been reports of clinical trials describing the effects of nicotine, tars, and smoke on man and animals; still others have been concerned with the attitudes of the public toward smoking. More recently, physicians have become the target population in studies of smoking behavior (3) and atti

Since conception occurs at a high rate after the first postpartum menstrual period and since women who have recently been pregnant are highly motivated to contraceptive use the Population Council began the International Postpartum Family Planning Program in 1966 in 25 hospitals in 14 countries. The total target population was 2720434 of which about 10% received family planning education and information. In the first 12 months of the program 101725 patients accepted family planning. 51% accepted IUDs 26% oral contraceptives 10% sterilization and 13% other methods. The expulsion rate for the first 3 months of use was 23.4 per 100 insertions for the obstetrical group and 13.1 for the postabortion group but there was a high rate of reinsertion of 60% to 95%. The median age of direct acceptors was 24.9 years and 27.1 for indirect acceptors. The median number of living children was 2.1 and 2.7 respectively. There was a substantial increase in postpartum return rates due to the family planning program. A sample survey of 1930 women showed that after 6 months only 7% were not using any form of contraception. The total cost per prevented virth is estimated at $24.00 assuming 40399 births were prevented by the program.

An experimental group of randomly selected, low-income families receiving comprehensive pediatric care have been compared with respect to their anticipated use of new neighborhood health centers to similarly randomly selected families whose medical care is fragmented and uncoordinated in emergency clinics, well-baby clinics, etc. Families now receiving comprehensive care would continue in that program for both health and illness care despite the greater convenience of the neighborhood clinics. The group now receiving fragmented care say they would use the neighborhood clinic for health care, but only 58% expect to use it for illness care. Thus, it is concluded that only to the extent that neighborhood clinics provide personalized, comprehensive care, can we expect them to replace the present uncoordinated, fragmented pattern of health care prevalent in their target population.

Originally developed to locate environmental conditions conducive to the incubation and spread of communicable disease, the windshield survey technique (1) was successfully adapted for employment by aides in a health education project designed to persuade more women in target populations to have Papanicolaou smear tests annually (2). The Health Education Aide Trainee (HEAT) projeet was conducted in three major California neighborhoods: the Western Addition area of San Francisco (an inner city, predominately black ghetto), sections of Oakland (Fruitvale and East Oakland) with mixed ethnic populations (American Indian, Spanish speaking, oriental, and black), and a rural section of southern Alameda County. The target population in rural Alameda County was primarily Spanish speaking. The Alameda County residents usually had only seasonal employment, primarily in agriculture, either in the fields or in the canning and packing sheds. Employment opportunities in the urban communities were varied. Technique

To the Editor:— On Sunday, May 17, 1970, a total of 190,845 children received rubella vaccine in Allegheny County, Pennsylvania (Pittsburgh and surrounding communities). Since this probably represents the largest one-day rubella immunization program conducted in the United States to date, some observations made during and following the program may be of interest to those contemplating similar campaigns. The target population was all healthy county residents aged 12 months through 12 years. This age group was selected because it was the one most likely to be susceptible to rubella (and therefore to propagate it in future epidemics) but containing few, if any, females who were presently or soon to be pregnant (for whom the vaccine is not yet proved safe). During the planning stages there was concern that (1) only a small proportion of the target population would come for immunization, (2) boys, because their benefits (no future pregnancy) were