The eyes speak when the mouth cannot: Using eye movements to interpret omissions in primary progressive aphasia.

Though it may seem simple, object naming is a complex multistage process that can be impaired by lesions at various sites of the language network. Individuals with neurodegenerative disorders of language, known as primary progressive aphasias (PPA), have difficulty with naming objects, and instead frequently say "I don't know" or fail to give a vocal response at all, known as an omission. Whereas other types of naming errors (paraphasias) give clues as to which aspects of the language network have been compromised, the mechanisms underlying omissions remain largely unknown. In this study, we used a novel eye tracking approach to probe the cognitive mechanisms of omissions in the logopenic and semantic variants of PPA (PPA-L and PPA-S). For each participant, we identified pictures of common objects (e.g., animals, tools) that they could name aloud correctly, as well as pictures that elicited an omission. In a separate word-to-picture matching task, those pictures appeared as targets embedded among an array with 15 foils. Participants were given a verbal cue and tasked with pointing to the target, while eye movements were monitored. On trials with correctly-named targets, controls and both PPA groups ceased visual search soon after foveating the target. On omission trials, however, the PPA-S group failed to stop searching, and went on to view many foils "post-target". As further indication of impaired word knowledge, gaze of the PPA-S group was subject to excessive "taxonomic capture", such that they spent less time viewing the target and more time viewing related foils on omission trials. In contrast, viewing behavior of the PPA-L group was similar to controls on both correctly-named and omission trials. These results indicate that the mechanisms of omission in PPA differ by variant. In PPA-S, anterior temporal lobe degeneration causes taxonomic blurring, such that words from the same category can no longer be reliably distinguished. In PPA-L, word knowledge remains relatively intact, and omissions instead appear to be caused by downstream factors (e.g., lexical access, phonological encoding). These findings demonstrate that when words fail, eye movements can be particularly informative.

Taxonomic Interference Associated with Phonemic Paraphasias in Agrammatic Primary Progressive Aphasia.

Phonemic paraphasias are thought to reflect phonological (post-semantic) deficits in language production. Here we present evidence that phonemic paraphasias in non-semantic primary progressive aphasia (PPA) may be associated with taxonomic interference. Agrammatic and logopenic PPA patients and control participants performed a word-to-picture visual search task where they matched a stimulus noun to 1 of 16 object pictures as their eye movements were recorded. Participants were subsequently asked to name the same items. We measured taxonomic interference (ratio of time spent viewing related vs. unrelated foils) during the search task for each item. Target items that elicited a phonemic paraphasia during object naming elicited increased taxonomic interference during the search task in agrammatic but not logopenic PPA patients. These results could reflect either very subtle sub-clinical semantic distortions of word representations or partial degradation of specific phonological word forms in agrammatic PPA during both word-to-picture matching (input stage) and picture naming (output stage). The mechanism for phonemic paraphasias in logopenic patients seems to be different and to be operative at the pre-articulatory stage of phonological retrieval. Glucose metabolic imaging suggests that degeneration in the left posterior frontal lobe and left temporo-parietal junction, respectively, might underlie these different patterns of phonemic paraphasia.

Biomechanical changes and recovery of gait function after total hip arthroplasty for osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: To determine the change in walking gait biomechanics after total hip arthroplasty (THA) for osteoarthritis (OA) compared to the pre-operative gait status, and to compare the recovery of gait following THA with healthy individuals. METHODS: Systematic review with meta-analysis of studies investigating changes in gait biomechanics after THA compared to (1) preoperative levels and (2) healthy individuals. Data were pooled at commonly reported time points and standardised mean differences (SMDs) were calculated in meta-analyses for spatiotemporal, kinematic and kinetic parameters. RESULTS: Seventy-four studies with a total of 2,477 patients were included. At 6 weeks postoperative, increases were evident for walking speed (SMD: 0.32, 95% confidence intervals (CI) 0.14, 0.50), stride length (SMD: 0.40, 95% CI 0.19, 0.61), step length (SMD: 0.41, 95% CI 0.23, 0.59), and transverse plane hip range of motion (ROM) (SMD: 0.36, 95% CI 0.05, 0.67) compared to pre-operative gait. Sagittal, coronal and transverse hip ROM was significantly increased at 3 months (SMDs: 0.50 to 1.07). At 12 months postoperative, patients demonstrated deficits compared with healthy individuals for walking speed (SMD: -0.59, 95% CI -1.08 to -0.11), stride length (SMD: -1.27, 95% CI -1.63, -0.91), single limb support time (SMD: -0.82, 95% CI -1.23, -0.41) and sagittal plane hip ROM (SMD: -1.16, 95% CI -1.83, -0.49). Risk of bias scores ranged from seven to 24 out of 26. CONCLUSIONS: Following THA for OA, early improvements were demonstrated for spatiotemporal and kinematic gait patterns compared to the pre-operative levels. Deficits were still observed in THA patients compared to healthy individuals at 12 months.

Perioperative assessment of older surgical patients using a frailty index-feasibility and association with adverse post-operative outcomes.

This study aimed to examine the feasibility of using a frailty index (FI) based on comprehensive geriatric assessment (CGA), to assess the level of frailty in older surgical patients preoperatively and to evaluate the association of FI-CGA with poorer postoperative outcomes. Two hundred and forty-six patients aged ≥70 years undergoing intermediate- to high-risk surgery in a tertiary hospital were recruited. Frailty was assessed using a 57-item FI-CGA form, with fit, intermediate frail, and frail patients defined as FI ≤0.25, >0.25 to 0.4, and >0.4, respectively. Adverse outcomes were ascertained at 30 days and 12 months post-surgery. Logistic regression models assessed the relationship between FI and adverse outcomes, adjusting for age, gender and acuity of surgery. The mean age of the participants was 79 years (standard deviation [SD] 6.5%), 52% were female, 91% were admitted from the community, 43% underwent acute surgery, and 19% were assessed as frail. The FI-CGA form was reported as being easy to apply, with a low patient refusal rate (2.2%). The majority of items were easy to rate, although inter-rater reliability was not tested. In relation to outcomes, greater frailty was associated with increased 12-month mortality (6.4%, 15.6%, and 23% for fit, intermediate frail, and frail patients respectively, P=0.01) and 12-month hospital readmissions (33.9%, 48.9%, and 60% respectively, P=0.004). There were no statistically significant differences between fit, intermediate frail, and frail groups in perioperative adverse events (17.4%, 23.3%, and 19.1% respectively, P=0.577) or 30-day postoperative complications (35.8%, 47.8%, and 46.8% respectively, P=0.183). Our findings suggest that it is feasible to use the FI-CGA to assess frailty preoperatively, and that using the FI-CGA may identify patients at high risk of adverse long-term outcomes.

A cryogenic optical feedthrough using polarization maintaining fibers.

Polarization maintaining optical fibers can be used to transmit linearly polarized light over long distances but their use in cryogenic environments has been limited by their sensitivity to temperature changes and associated mechanical stress. We investigate experimentally how thermal stresses affect the polarization maintaining fibers and model the observations with Jones matrices. We describe the design, construction, and testing of a feedthrough and fiber termination assembly that uses polarization maintaining fiber to transmit light from a 633 nm HeNe laser at room temperature to a homodyne polarization-based interferometer in a cryogenic vacuum. We report on the efficiency of the polarization maintaining properties of the feedthrough assembly. We also report that, at cryogenic temperatures, the interferometer can achieve a sensitivity of 8 × 10(-10) rad/√Hz at 0.05 Hz using this feedthrough.

Mössbauer and EPR studies of the photoactivation of nitrile hydratase.

The alphabeta dimer of active nitrile hydratase from Rhodococcus sp. R312 contains one low-spin ferric ion that is coordinated by three Cys residues, two N-amide groups from the protein backbone, and one OH(-). The enzyme isolated from bacteria grown in the dark is inactive and contains the iron site as a six-coordinate diamagnetic Fe-nitrosyl complex, called NH(dark). The active state can be obtained from the dark state by photolysis of the Fe-NO bond at room temperature. Activation is accompanied by the conversion of NH(dark) to a low-spin ferric complex, NH(light), exhibiting an S = (1)/(2) EPR signal with g values of 2.27, 2.13, and 1.97. We have characterized both NH(dark) and NH(light) with Mössbauer spectroscopy. The z-axis of the 57Fe magnetic hyperfine tensor, A, of NH(light) was found to be rotated by approximately 45 degrees relative to the z-axis of the g tensor (g(z) = 1.97). Comparison of the A tensor of NH(light) with the A tensors of low-spin ferric hemes indicates a substantially larger degree of covalency for nitrile hydratase. We have also performed photolysis experiments between 2 and 20 K and characterized the photolyzed products by EPR and Mössbauer spectroscopy. Photolysis at 4.2 K in the Mössbauer spectrometer yielded a five-coordinate low-spin ferric species, NH(A), which converted back into NH(dark) when the sample was briefly warmed to 77 K. We also describe preliminary EPR photolysis studies that have yielded new intermediates.

Left lower quadrant pain of unusual cause.

The differential diagnosis of left lower quadrant abdominal pain in an adult man includes, among others, sigmoid diverticulitis; leaking abdominal aortic aneurysm; renal colic; epididymitis; incarcerated hernia; bowel obstruction; regional enteritis; psoas abscess; and in this rare instance, situs inversus with acute appendicitis. We report a case of situs inversus totalis with left-sided appendicitis and a brief review of the literature. There were several subtle indicators of total situs inversus present that were missed by the physicians and surgeons who initially evaluated the patient prior to surgery. Computed tomography scan with contrast, however, revealed the diagnosis immediately, and treatment was successfully initiated.

The normal difference in bilateral indirect blood pressure recordings in normotensive individuals.

If there is a significant dichotomy between bilateral blood pressure determinations in both arms, it is often taken as a sign of some type of underlying pathology. We wished to evaluate what the normal variation might be for significant differences between blood pressures in both arms. Significant difference was arbitrarily chosen as a systolic blood pressure value greater than 10 mm Hg. Bilateral indirect blood pressure determinations were obtained in 100 subjects with no known history of hypertension in the sitting position. The blood pressure was obtained by 2 observers, one who recorded the systolic and diastolic blood pressure as announced by the person taking the blood pressures who was blinded to the actual values taken. The coefficient of variation in obtaining the blood pressures in each arm was determined in 5 of the 100 subjects. The age, sex, and handedness of each individual were recorded as demographic variables. The average left and right systolic blood pressures were 112.1 +/- 16.5 and 112.7 +/- 16.3 mm Hg, respectively. The average left and right diastolic pressures were 64.4 +/- 11.6 and 63.5 +/- 9.9 mm Hg, respectively. There was no significant difference between left minus right systolic or diastolic differences (Student's paired t-test). There were no significant differences in systolic or diastolic blood pressure between gender or between right and left handed individuals (non-paired t-test). The average coefficients of variation for right and left arm systolic blood pressures were 5.41% and 5.81%, respectively. Fifteen subjects had differences in systolic blood pressure between both arms exceeding 10 mm Hg (7% to 22%, 95% confidence interval). Differences of more than 10 mm Hg in indirect bilateral blood pressure recordings are frequent in normotensive individuals and probably do not per se indicate any abnormal pathology. In the right clinical situation, differences that are noted should probably be repeated and should be added to the total clinical picture when used to determine whether a pathologic condition is present.

Incremental analysis of diagnostic peritoneal lavage fluid in adult abdominal trauma.

It is uncertain how much diagnostic peritoneal lavage (DPL) fluid must be recovered from abdominal trauma patients to avoid falsely low red blood cell (RBC) counts. A study was carried out to investigate this controversy. A convenience sample of adult abdominal trauma patients in a Level 1 university trauma center who were undergoing DPL with 1 L crystalloid was enrolled. Subjects with grossly positive or colorless effluent were excluded. A blinded prospective experimental design was used. Differences were evaluated among RBC counts collected at 200, 400, 600, and 800 mL of returned fluid using repeated-measures analysis of variance. In 11 patients, mean RBC counts collected at 200 and 400 mL were 24,600 (95% confidence interval [CI], 20,700 to 29,100) and 39,700 (95% CI, 33,200 to 47,100) cells/microL. These were substantially lower than the final mean count of 95,800 (95% CI, 80,000 to 115,800), measured at 800 mL (F = 23.7, P < .0001). Mean counts at 600 mL were less than those obtained at 800 mL but were not statistically different (P = .08). Two of the 11 subjects would have been misclassified (as not requiring surgery) had "early" sampling been used. In abdominal trauma patients, the RBC count of DPL fluid regularly increases as more fluid is recovered. It is important to collect >600 mL of effluent to avoid misleading, low RBC counts and misclassification of patients.

A stereoselective cobalt-containing nitrile hydratase.

Nitrile hydratase from Pseudomonas putida NRRL-18668 has been purified and characterized. The purified enzyme catalyzes the hydration of 2(S)-(4'-chlorophenyl)-3-methylbutyronitrile at least fifty times faster than that of 2(R)-(4'-chlorophenyl)-3-methylbutyronitrile. This enzyme is a member of the class of nitrile hydratase that contains cobalt. Visible absorption and CD spectra suggest the cobalt exists as a non-corrin low-spin Co3+ ion in a tetragonally-distorted octahedral ligand field. Chemical reduction of the native enzyme results in a species with the EPR signature of a low-spin Co2+ complex. Like the other cobalt-containing nitrile hydratases, this enzyme is relatively stable, maintaining its activity below 35 degrees C, and it shows a broad activity optimum between pH 7.2 and 7.8. The structural genes for this enzyme have been cloned and sequenced. The deduced amino acid sequences for the alpha and beta subunits show 48-63% and 35-41% homology, respectively, to other sequenced nitrile hydratases. In particular, the cysteine residues in the alpha subunit that have been suggested to coordinate the metal ion in the iron-containing nitrile hydratases [Brennan, B. A., Cummings, J. G., Chase, D. B., Turner, I. M., Jr., & Nelson, M. J. (1996) Biochemistry 35, 10068-10077] are conserved in this enzyme, suggesting that this nitrile hydratase, like the enzyme from Rhodococcus rhodochrous J1, is a member of a newly described class of metalloenzymes with Co3+-thiolate ligation [Brennan, B. A., Alms, G., Nelson, M. J., Durney, L. T., & Scarrow, R. C. (1996) J. Am. Chem. Soc. 118, 9194-9195].

Factors favoring houseplant container infestation with Aedes aegypti larvae in Marília, São Paulo, Brazil.

Since reinvasion of São Paulo State by the Aedes aegypti (L.) mosquito in 1985, flower pots and vases have been important larval habitats despite educational messages focusing on their control. The objectives of this study were to characterize flower pots and vases as larval habitats with respect to the quantities present and infested, the types of plants involved, and the specific locations of the mosquito larvae; to explore local names for houseplants; and to examine factors affecting acceptance of control measures. The results showed an average of more than four potential plant-related larval habitats per premises, of which only 0.4% were occupied by the vector. Plant-related containers represented 31% of all the containers with Aedes aegypti larvae. Although a sample of 126 respondents was able to list 105 different houseplant names, 49% of the positive plants were of two types: ferns and the ornamental plant Dieffenbachia avoena. The public's apparent unwillingness to accept recommended anti-aegypti control measures involving houseplants seems related to the relative rarity of aegypti larvae in the very common houseplant containers, the control program's poor credibility as a source of information about plants, and a perception that the recommended control measures are harmful to plants. An intervention currently being planned for dengue control will use educational material that refers specifically to those plants whose containers are most commonly found to harbor aegypti larvae; it will also utilize information sources such as botanists with greater credibility regarding plants; and it will set out alternative plant care recommendations that are more likely to appeal as beneficial to the plants and that will stand a better chance of being accepted.

Factors favoring houseplant container infestation with Aedes aegypti larve in Marilia, Sao Paulo, Brazil / Factores que favorecen la infestación de recipientes con plantas domésticas por larvas de Aedes aegypti en Marília, São Paulo, Brasil

Desde 1985, después de la reinfestación de mosquitos Aedes aegypti (L.) en el Estado de São Paulo, se encontró que ­a pesar de la diseminación de mensajes educativos destinados a su control­ las macetas y floreros son un hábitat importante de las larvas. Los objetivos de este estudio fueron identificar las macetas y floreros como hábitats de larvas de mosquitos en relación con su número y grado de infestación, los tipos de plantas involucradas y la localización específica de las larvas; investigar los nombres locales de las plantas domésticas y examinar los factores que afectan al cumplimiento de las medidas de control. Los resultados mostraron un promedio de más de cuatro posibles hábitats de larvas relacionados con plantas por cada sitio, de los cuales solo 0,4% tenían el vector. Los recipientes para plantas representaron 31% de todos los receptáculos con larvas de A. aegypti. A pesar de que de una muestra de 126 personas entrevistadas enumeraron 105 nombres de plantas domésticas, 49% de las plantas asociadas con larvas fueron solo de dos tipos: helechos y la planta ornamental Dieffenbachia avoena. La evidente falta de voluntad de la población para aceptar las medidas de control contra A. aegypti en lo que respecta a plantas domésticas parece deberse a la poca frecuencia relativa de A. aegypti en los recipientes domésticos, la falta de confianza en los programas de control como fuente idónea de información sobre plantas y la opinión de que las medidas de control recomendadas son dañinas para las plantas. Actualmente se está planeando una intervención para el control del dengue en la que se usará material educativo que trata específicamente sobre las plantas cuyos recipientes albergan con mayor frecuencia las larvas de A. aegypti. También se hará uso de fuentes de información botánica con mayor credibilidad en materia de plantas. Además, se formulará un plan diferente con un enfoque más atractivo desde el punto de vista de la salud de las plantas para incrementar su posibilidad de aceptación.

Desde 1985, después de la reinfestación de mosquitos Aedes aegypti (L.) en el Estado de São Paulo, se encontró que ­a pesar de la diseminación de mensajes educativos destinados a su control­ las macetas y floreros son un hábitat importante de las larvas. Los objetivos de este estudio fueron identificar las macetas y floreros como hábitats de larvas de mosquitos en relación con su número y grado de infestación, los tipos de plantas involucradas y la localización específica de las larvas; investigar los nombres locales de las plantas domésticas y examinar los factores que afectan al cumplimiento de las medidas de control. Los resultados mostraron un promedio de más de cuatro posibles hábitats de larvas relacionados con plantas por cada sitio, de los cuales solo 0,4% tenían el vector. Los recipientes para plantas representaron 31% de todos los receptáculos con larvas de A. aegypti. A pesar de que de una muestra de 126 personas entrevistadas enumeraron 105 nombres de plantas domésticas, 49% de las plantas asociadas con larvas fueron solo de dos tipos: helechos y la planta ornamental Dieffenbachia avoena. La evidente falta de voluntad de la población para aceptar las medidas de control contra A. aegypti en lo que respecta a plantas domésticas parece deberse a la poca frecuencia relativa de A. aegypti en los recipientes domésticos, la falta de confianza en los programas de control como fuente idónea de información sobre plantas y la opinión de que las medidas de control recomendadas son dañinas para las plantas. Actualmente se está planeando una intervención para el control del dengue en la que se usará material educativo que trata específicamente sobre las plantas cuyos recipientes albergan con mayor frecuencia las larvas de A. aegypti. También se hará uso de fuentes de información botánica con mayor credibilidad en materia de plantas. Además, se formulará un plan diferente con un enfoque más atractivo desde el punto de vista de la salud de las plantas para incrementar su posibilidad de aceptación.

Disposable containers as larval habitats for Aedes aegypti in a city with regular refuse collection: a study in Marília, São Paulo State, Brazil.

In Marília, Brazil, refuse is collected at least every other day, yet non-useful, non-returnable containers such as cans, plastic bottles and tires account for almost half of the container habitats found positive for the Aedes aegypti mosquito. A study was therefore conducted to investigate why these containers exist despite regular refuse collection and a high level of awareness of dengue prevention, and how the control program could most effectively respond. Differing community perceptions as to what constitutes refuse were found to lead people to store a variety of containers in their yard. Other dimensions of the problem include the presence of informal refuse collectors in search of saleable materials, and dumping of refuse in vacant lots and along roads. An intervention based on these data will involve the informal refuse collectors in implementation of a community-based recycling project.

Resonance Raman spectroscopy of nitrile hydratase, a novel iron-sulfur enzyme.

Resonance Raman spectra of Rhodococcus sp. R312 (formerly Brevibacterium sp. R312) nitrile hydratase, a novel non-heme iron enzyme, have a large number of peaks in the 300-500 cm-1 region; observation of shifts in these peaks after labeling with 34S shows that they arise from cysteine coordinated to the ferric ion in the protein. The rich Raman spectra result from coupling of the Fe-S stretch with cysteine side chain deformation modes; the observation of 15N isotope shifts in most of these peaks suggests participation of N-donor metal ligands and peptide backbone amide nitrogens in these modes as well. The aggregate 34S isotope shift is too large to result from a single cysteine ligand, consistent with the analysis of EXAFS data that shows two or three S-donor ligands [Scarrow et al. (1996) Biochemistry 35, 10078-10088]. Widespread 2H isotope shifts seen after exchange of the protein into 2H2O suggest the presence of hydrogen bonds to the coordinated cysteine sulfurs. Comparison of the resonance Raman spectra of nitrile hydratase prepared at pH 7.3 and 9.0 shows a shift of intensity into the higher-energy peaks in the spectra of the latter sample. This is interpreted as resulting from an increase in Fe-S bond strength at the higher pH and is supported by observation of a small decrease in Fe-S bond length in the EXAFS analysis [Scarrow et al. (1996) Biochemistry 35, 10078-10088]. Such a decrease in Fe-S bond length is also consistent with pH dependent changes in EPR spectra and could reflect the loss of one or more hydrogen bonds to sulfur ligands.

X-ray spectroscopy of nitrile hydratase at pH 7 and 9.

The iron K-edge X-ray absorption spectrum of Rhodococcus sp. R312 (formerly Brevibacterium sp. R312) nitrile hydratase in frozen solutions at pH 7 and 9 has been analyzed to determine details of the iron coordination. EXAFS analysis implies two or three sulfur ligands per iron and overall six coordination; together with previous EPR and ENDOR results, this implies an N3S2O ligation sphere. The bond lengths from EXAFS analysis [rav(Fe-S) = 2.21 A at pH 7.3; rav(Fe-N/O) = 1.99 A] support cis coordination of two cysteine ligands and conclusively rule out nitric oxide coordination to the iron, a possibility proposed on the basis of an FTIR difference experiment [Noguchi, T., Honda, J., Nagamune, T., Sasabe, H., Inoue, Y., & Endo, I. (1995) FEBS Lett. 358, 9-12]. The higher-frequency EXAFS can be simulated well by inclusion of multiple scattering from two or three imidazole ligands; the fit to the data is improved if first-sphere multiple scattering pathways are also included. A slight shortening (by 0.02 +/- 0.01 A) of one or both Fe-S bonds when the pH is raised from 7.3 to 9.0 is consistent with shifts observed in the Raman spectrum [Brennan et al. (1996) Biochemistry 35, 10068-10077].

Abnormal cerebral glucose metabolism in HIV-1 seropositive subjects with and without dementia.

UNLABELLED: This study was undertaken in order to extend our previous finding of relative basal ganglia hypermetabolism in AIDS dementia complex (ADC) and to develop clinically useful metabolic indices of CNS involvement in HIV-seropositive (HIV+) subjects. METHODS: Twenty-one HIV+ subjects (11 with AIDS) underwent FDG-PET scanning; 12 had a follow-up scan at 6 mo and 4 had a third scan at 12 mo. Forty-three age-matched heterosexual volunteers served as controls. FDG-PET scanning was performed with arterial blood sampling, and scan data were analyzed using the Scaled Subprofile Model (SSM) with principal component analysis. RESULTS: SSM/principal component analysis of the combined (HIV+ and controls) FDG-PET dataset extracted two major disease-related metabolic components: (a) a nonspecific indicator of cerebral dysfunction, which was significantly correlated with age, cerebral atrophy and ADC stage and (b) the striatum, which was heavily weighted (relatively hypermetabolic) and appeared to provide a disease-specific measure of early CNS involvement. CONCLUSION: FDG-PET scans provide quantitative measures of abnormal functional connectivity in HIV-seropositives-with or without AIDS or ADC. These measures, which are robust across centers with respect to instrumentation, scanning technique and disease severity, appear to track the progression of CNS involvement in patients with subclinical neurologic or neuropsychologic dysfunction.

Disposable containers a larval habitats for Aedes aegypti in city with regular refuse collection: a study in Marília, São Paulo State, Brazil

In Marilia, Brazil, refuse ins collected at least every other day, yet non-useful, non- returnable containers such as cans, plastic bottles and tires account for almost half of the container habitats found positive for the Aedes aegypti mosquito. A study was therefore conducted to investigate why these containers exist despite regular refuse collection and a high level of awareness of dengue prevention, and how the control program could most effectively respond. Differing community perceptions as to what constitutes refuse were found to lead people to store a variety of containers in their yard. Other dimensions of the problem include the presence of informal refuse collectors in search of saleable materials, and dumping of refuse in vacant lots and along roads. An intervention based on these data will involve the informal refuse collectors in implementation of a community-base recycling project.