Distribution of quality adjusted life expectancy: A systems approach

Statistical methods are developed which assess survival data for two attributes; (1) prolongation of life, (2) quality of life. Health state transition probabilities correspond to prolongation of life and are modeled as a discrete-time semi-Markov process. Imbedded within the sojourn time of a particular health state are the quality of life transitions. They reflect events which differentiate perceptions of pain and suffering over a fixed time period. Quality of life transition probabilities are derived from the assumptions of a simple Markov process. These probabilities depend on the health state currently occupied and the next health state to which a transition is made. Utilizing the two forms of attributes the model has the capability to estimate the distribution of expected quality adjusted life years (in addition to the distribution of expected survival times). The expected quality of life can also be estimated within the health state sojourn time making more flexible the assessment of utility preferences. The methods are demonstrated on a subset of follow-up data from the Beta Blocker Heart Attack Trial (BHAT). This model contains the structure necessary to make inferences when assessing a general survival problem with a two dimensional outcome. ^

Joint effects of pulmonary function and aerobic power on survival in a cohort of healthy adults

Objective measurements of physical fitness and pulmonary function are related individually to long-term survival, both in healthy people and in those who are ill. These factors are furthermore known to be related to one another physiologically in people with pulmonary disease, because advanced pulmonary disease causes ventilatory limitation to exercise. Healthy people do not have ventilatory limitation to exercise, but rather have ventilatory reserve. The relationship between pulmonary function and exercise performance in healthy people is minimal. Exercise performance has been shown to modify the effect of pulmonary function on mortality in people with chronic obstructive pulmonary disease, but the relationship between these factors in healthy people has not been studied and is not known. The purpose of this study is to quantify the joint effects of pulmonary function and exercise performance as these bear on mortality in a cohort of healthy adults. This investigation is an historical cohort study over 20 years of follow-up of 29,624 adults who had complete preventive medicine, spirometry and treadmill stress examinations at the Cooper Clinic in Dallas, Texas.^ In 20 years of follow-up, there were 738 evaluable deaths. Forced expiratory volume in one second (FEV$\sb1$) percent of predicted, treadmill time in minutes percent of predicted, age, gender, body mass index, baseline smoking status, serum glucose and serum total cholesterol were all significant, independent predictors of mortality risk. There were no frank interactions, although age had an important increasing effect on the risk associated with smoking when other covariates were controlled for in a proportional-hazards model. There was no confounding effect of exercise performance on pulmonary function. In agreement with the pertinent literature on independent effects, each unit increase in FEV$\sb1$ percent predicted was associated with about eight tenths of a percent reduction in adjusted mortality rate. The concept of physiologic reserve is useful in interpretation of the findings. Since pulmonary function does not limit exercise tolerance in healthy adults, it is reasonable to expect that exercise tolerance would not modify the effect of pulmonary function on mortality. Epidemiologic techniques are useful for elucidating physiological correlates of mortality risk. ^

Neogene benthic foraminiferal faunas of a southwest Pacific bathyal depth transect

Temporal changes in benthic foraminiferal assemblages were quantitatively examined (> 63 µm fraction) in four southwest Pacific deep-sea Neogene sequences in a depth transect between approximately 1300 and 3200 m to assist in evaluating paleoeeanographic history. The most conspicuous changes in benthic foraminiferal assemblages occurred in association with paleoclimatic changes defined at least in part by oxygen isotopic changes. The largest, centered at ~15 Ma (early Middle Miocene), is represented by an increase in the relative frequencies of Epistominella exigua, which underwent a major upward depth migration at that time. This was contemporaneous with the well-known positive oxygen isotopic shift in the early Middle Miocene. In Sites 588 and 590, most of the increase in relative abundances of E. exigua occurred during the middle to later part of the ~80 shift, following major growth of the east Antarctic ice sheet. Later assemblage changes occurred at 8.5 and 6.5 Ma. These associations indicate that the benthic foraminiferal assemblages in this depth transect largely adjusted to changes in deep waters related to Antarctic cryospheric evolution. In general, the Neogene benthic foraminiferal assemblages in this region underwent little change during the last 23 million years. This faunal conservatism suggests that deep-sea environments underwent relatively little change in the southwest Pacific during much of the Neogene. Although paleoceanographic changes did occur, partly in response to highlatitude cryospheric evolution, these were not of sufficient magnitude to create major deep-sea faunal changes in this part of the ocean. The benthic foraminiferal assemblages are dominated by individuals smaller than 150 µm. Most taxonomic turnover occurred in the larger (> 150 µm) size fractions.

Tie points and log-adjusted depth scales for ODP Leg 207 Sites

Multiple copies of Cretaceous black shales extending from the early Cenomanian to the end of the Santonian were recovered at five sites on Demerara Rise during Leg 207 of the Ocean Drilling Program. These sediments are primarily composed of laminated organic-rich claystones interbedded with coarser, lightly laminated foraminferal-bearing packstones and wackestones. The black shales represent the local expression of widespread organic-rich sedimentation in the Atlantic during the mid-Cretaceous. However, incomplete recovery prevented construction of continuous composite sections, resulting in uncertainties concerning the correct stratigraphic placement of individual cores. By combining high-resolution measurements of bulk density collected shipboard on the multisensor track with continuous downhole measurements of formation resistivity using the Formation MicroScanner, an equivalent logging depth scale was constructed for black shales recovered from Sites 1258, 1260, and 1261. The integrated depths approach centimeter-scale resolution and are supported by comparisons of coarser resolution natural gamma ray emissions collected on cores and through downhole logging operations. The new depths highlight the extent of both intra- and intercore gaps and provide an opportunity to further constrain temporal and spatial paleoceanographic changes captured in proxy records from these sediments.