Causes of death in patients with rheumatoid arthritis over a 40-year period : with special emphasis on autopsy

Rheumatoid arthritis (RA) patients have premature mortality. Contrary to the general population, mortality in RA has not declined over time. This study aimed to evaluate determinants of mortality in RA by examining causes of death (CoDs) over time, accuracy of CoD diagnoses, and contribution of RA medication to CoDs. This study further evaluated detection rate of reactive systemic amyloid A amyloidosis, which is an important contributor to RA mortality. CoDs were examined in 960 RA patients between 1971 and 1991 (Study population A) and in 369 RA patients autopsied from 1952 to 1991, with non-RA patients serving as the reference cases (Study population B). In Study population B, CoDs by the clinician before autopsy were compared to those by the pathologist at autopsy to study accuracy of CoD diagnoses. In Study population B, autopsy tissue samples were re-examined systematically for amyloidosis (90% of patients) and clinical data for RA patients was studied from 1973. RA patients died most frequently of cardiovascular diseases (CVDs), infections, and RA. RA deaths declined over time. Coronary deaths showed no major change in Study population A, but, in Study population B, coronary deaths in RA patients increased from 1952 to 1991, while non-RA cases had a decrease in coronary deaths starting in the 1970s. Between CoD diagnoses by the clinician and those by the pathologist, RA patients had lower agreement than non-RA cases regarding cardiovascular (Kappa reliability measure: 0.31 vs. 0.51) and coronary deaths (0.33 vs. 0.46). Use of disease modifying anti-rheumatic drugs was not associated with any CoD. In RA patients, re-examination of autopsy tissue samples doubled the prevalence of amyloid compared with the original autopsy: from 18% to 30%. In the amyloid-positive RA patients, amyloidosis was diagnosed before autopsy in only 37%; and they had higher inflammatory levels and longer duration of RA than amyloid-negative RA patients. Of the RA patients with amyloid, only half had renal failure or proteinuria during lifetime. In RA, most important determinants of mortality were CVDs, RA, and infections. In RA patients, RA deaths decreased over time, but this was not true for coronary deaths. Coronary death being less accurately diagnosed in RA may indicate that coronary heart disease (CHD) often goes unrecognized during lifetime. Thus, active search for CHD and its effective treatment is important to reduce cardiovascular mortality. Reactive amyloidosis may often go undetected. In RA patients with proteinuria or renal failure, as well as with active and long-lasting RA, a systematic search for amyloid is important to enable early diagnosis and early enhancement of therapy. This is essential to prevent clinical manifestations of amyloidosis such as renal failure, which has a poor prognosis.

Relationship between annual rainfall and tree mortality in a tropical dry forest: Results of a 19-year study at Mudumalai, southern India

Variability in rainfall is known to be a major influence on the dynamics of tropical forests, especially rates and patterns of tree mortality. In tropical dry forests a number of contributing factors to tree mortality, including dry season fire and herbivory by large herbivorous mammals, could be related to rainfall patterns, while loss of water potential in trees during the dry season or a wet season drought could also result in enhanced rates of death. While tree mortality as influenced by severe drought has been examined in tropical wet forests there is insufficient understanding of this process in tropical dry forests. We examined these causal factors in relation to inter-annual differences in rainfall in causing tree mortality within a 50-ha Forest Dynamics Plot located in the tropical dry deciduous forests of Mudumalai, southern India, that has been monitored annually since 1988. Over a 19-year period (1988-2007) mean annual mortality rate of all stems >1 cm dbh was 6.9 +/- 4.6% (range = 1.5-17.5%); mortality rates broadly declined from the smaller to the larger size classes with the rates in stems >30 cm dbh being among the lowest recorded in tropical forest globally. Fire was the main agent of mortality in stems 1-5 cm dbh, elephant-herbivory in stems 5-10 cm dbh, and other natural causes in stems > 10 cm dbh. Elephant-related mortality did not show any relationship to rainfall. On the other hand, fire-related mortality was significantly negatively correlated to quantity of rainfall during the preceding year. Mortality due to other causes in the larger stem sizes was significantly negatively correlated to rainfall with a 2-3-year lag, suggesting that water deficit from mild or prolonged drought enhanced the risk of death but only with a time lag that was greater than similar lags in tree mortality observed in other forest types. In this respect, tropical dry forests growing in regions of high rainfall variability may have evolved greater resistance to rainfall deficit as compared to tropical moist or temperate forests but are still vulnerable to drought-related mortality.

Coral Remote Sensing Workshop: Proceedings and Recommendations, 17-18 September, Sheraton, Brickell Ave, Miami FL

Coral reefs exist in warm, clear, and relatively shallow marine waters worldwide. These complex assemblages of marine organisms are unique, in that they support highly diverse, luxuriant, and essentially self-sustaining ecosystems in otherwise nutrient-poor and unproductive waters. Coral reefs are highly valued for their great beauty and for their contribution to marine productivity. Coral reefs are favorite destinations for recreational diving and snorkeling, as well as commercial and recreational fishing activities. The Florida Keys reef tract draws an estimated 2 million tourists each year, contributing nearly $800 million to the economy. However, these reef systems represent a very delicate ecological balance, and can be easily damaged and degraded by direct or indirect human contact. Indirect impacts from human activity occurs in a number of different forms, including runoff of sediments, nutrients, and other pollutants associated with forest harvesting, agricultural practices, urbanization, coastal construction, and industrial activities. Direct impacts occur through overfishing and other destructive fishing practices, mining of corals, and overuse of many reef areas, including damage from souvenir collection, boat anchoring, and diver contact. In order to protect and manage coral reefs within U.S. territorial waters, the National Oceanic and Atmospheric Administration (NOAA) of the U.S. Department of Commerce has been directed to establish and maintain a system of national marine sanctuaries and reserves, and to monitor the condition of corals and other marine organisms within these areas. To help carry out this mandate the NOAA Coastal Services Center convened a workshop in September, 1996, to identify current and emerging sensor technologies, including satellite, airborne, and underwater systems with potential application for detecting and monitoring corals. For reef systems occurring within depths of 10 meters or less (Figure 1), mapping location and monitoring the condition of corals can be accomplished through use of aerial photography combined with diver surveys. However, corals can exist in depths greater than 90 meters (Figure 2), well below the limits of traditional optical imaging systems such as aerial or surface photography or videography. Although specialized scuba systems can allow diving to these depths, the thousands of square kilometers included within these management areas make diver surveys for deeper coral monitoring impractical. For these reasons, NOAA is investigating satellite and airborne sensor systems, as well as technologies which can facilitate the location, mapping, and monitoring of corals in deeper waters. The following systems were discussed as having potential application for detecting, mapping, and assessing the condition of corals. However, no single system is capable of accomplishing all three of these objectives under all depths and conditions within which corals exist. Systems were evaluated for their capabilities, including advantages and disadvantages, relative to their ability to detect and discriminate corals under a variety of conditions. (PDF contains 55 pages)

Report of the Inter-American Tropical Tuna Commission for the year 1975

ENGLISH: The Inter-American Tropical Tuna Commission operates under the authority and direction of a convention originally entered into by the Republic of Costa Rica and the United States of America. The convention, which came into force in 1950, is open to adherence by other governments whose nationals fish for tropical tunas in the eastern Pacific Ocean. Under this provision the Republic of Panama adhered in 1953, the Republic of Ecuador in 1961, the United Mexican States in 1964, Canada in 1968 and Japan in 1970. In 1967, Ecuador gave notice of her intent to withdraw from the Commission, and her withdrawal became effective on August 21,1968. The Commission held two meetings in 1975, its 31st n1eeting in San Diego, California, U.S.A., March 3 and 5, and its 32nd meeting in Paris, France, October 13, 14 and 17, and in Washington D.C., U.S.A., December 18. SPANISH: La Comisión Interamericana del Atún Tropical está bajo la autoridad y dirección de una convención la cual fue originalmente formada por la República de Costa Rica y los Estados Unidos de América. La Convención, vigente desde 1950, está abierta a la afiliación de otros gobiernos cuyos nacionales pesquen atún en el Pacífico oriental tropical. Bajo esta medida la República de Panamá se afilió en 1953, la República del Ecuador en 1961, los Estados Unidos Mexicanos en 1964, Canadá en 1968 y el Japón en 1970. En 1967, el Ecuador anunció su intención de retirarse de la Comisión y la renuncia se hizo efectiva el 21 de agosto de 1968. La Comisión celebró dos reuniones en 1975, la XXXI reunión en San Diego, California (E.U.A.) del 3 al 5 de marzo, y la XXXII reunión en París, Francia el 13, 14 Y 17 de octubre (primera parte) y en Washington D.C. (E.U.A.) el 18 de diciembre (segunda parte). (PDF contains 176 pages.)

Report of the Inter-American Tropical Tuna Commission for the year 1977

ENGLISH: The Inter-American Tropical Tuna Commission operates under the authority and direction of a convention originally entered into by the Republic of Costa Rica and the United States of America. The convention, which came into force in 1950, is open to adherence by other governments whose nationals fish for tropical tunas in the eastern Pacific Ocean. Under this provision the Republic of Panama adhered in 1953, the Republic of Ecuador in 1961, the United Mexican States in 1964, Canada in 1968 and Japan in 1970. In 1967, Ecuador gave notice of her intent to withdraw from the Commission, and her withdrawal became effective on August 21,1968. The Commission held two meetings in 1977, the 34th from June 27 to 29 in San Diego, California, and the 35th on October 17 and 18 in Mexico City. SPANISH: La Comisión Interamericana del Atún Tropical está bajo la autoridad y dirección de una convención la cual fue originalmente formada por la República de Costa Rica y los Estados Unidos de América. La Convención, vigente desde 1950, está abierta a la afiliación de otros gobiernos cuyos nacionales pesquen atún en el Pacífico oriental tropical. Bajo esta medida la República de Panamá se afilió en 1953, la República del Ecuador en 1961, los Estados Unidos Mexicanos en 1964, Canadá en 1968 y el Japón en 1970. En 1967, el Ecuador anunció su intención de retirarse de la Comisión y la renuncia se hizo efectiva el 21 de agosto de 1968. La Comisión celebró dos reuniones en 1977, la XXXIV del 27 al 29 de junio en San Diego (California) y la XXXV del 17 al 18 de octubre en ciudad de México. (PDF contains 156 pages).

Report of the Inter-American Tropical Tuna Commission for the year 1978

ENGLISH: The Inter-American Tropical Tuna Commission operates under the authority and direction of a convention originally entered into by the Republic of Costa Rica and the United States of America. The convention, which came into force in 1950, is open to adherence by other governments whose nationals fish for tropical tunas in the eastern Pacific Ocean. Under this provision the Republic of Panama adhered in 1953, the Republic of Ecuador in 1961, the United Mexican States in 1964, Canada in 1968 and Japan in 1970. In 1967, Ecuador gave notice of her intent to withdraw from the Commission, and her withdrawal became effective on August 21,1968. The Commission held two meetings in 1977, the 34th from June 27 to 29 in San Diego, California, and the 35th on October 17 and 18 in Mexico City. The Commission adjourned its 35th meeting, held in Mexico City on October 17, and 18, 1977, without agreeing to a resolution for the conservation of yellowfin during 1978. SPANISH: La Comisión Interamericana del Atún Tropical está bajo la autoridad y dirección de una convención la cual fue originalmente formada por la República de Costa Rica y los Estados Unidos de América. La Convención, vigente desde 1950, está abierta a la afiliación de otros gobiernos cuyos nacionales pesquen atún en el Pacífico oriental tropical. Bajo esta medida la República de Panamá se afilió en 1953, la República del Ecuador en 1961, los Estados Unidos Mexicanos en 1964, Canadá en 1968 y el Japón en 1970. En 1967, el Ecuador anunció su intención de retirarse de la Comisión y la renuncia se hizo efectiva el 21 de agosto de 1968. La Comisión celebró dos reuniones en 1977, la XXXIV del 27 al 29 de junio en San Diego (California) y la XXXV del 17 al 18 de octubre en ciudad de México. La Comisión clausuró su XXXV reunión, celebrada en ciudad de México del 17 al 18 de octubre de 1977, sin acordar una resolución para la conservación del atún aleta amarilla en 1978. (PDF contains 164 pages.)

Report of the Inter-American Tropical Tuna Commission for the year 1984

ENGLISH: The Inter-American Tropical Tuna Commission operates under the authority and direction of a convention originally entered into by the Republic of Costa Rica and the United States of America. The convention, which came into force in 1950, is open to adherence by other governments whose nationals fish for tropical tunas in the eastern Pacific Ocean. Under this provision Panama adhered in 1953, Ecuador in 1961, the United Mexican States in 1964, Canada in 1968, Japan in 1970, and France and Nicaragua in 1973. Ecuador withdrew from the Commission in 1968, Mexico in 1978, Costa Rica in 1979, and Canada in 1984. On October 16,17, and 18, the Commission held its 42nd meeting in La Jolla, California. SPANISH: La Comisión Interamericana del Atún Tropical funciona bajo la autoridad y dirección de un convenio establecido originalmente por la República de Costa Rica y los Estados Unidos de América. El convenio, vigente desde 1950, está abierto a la afiliación de otros gobiernos cuyos ciudadanos pescan atún en el Pacífico oriental tropical. Bajo esta estipulación, Panamá se afilió en 1953, Ecuador en 1961, los Estados Unidos Mexicanos en 1964, Canadá en 1968, Japón en 1970, Francia y Nicaragua en 1973. Ecuador se retiró de la Comisión en 1968, México en 1978, Costa Rica en 1979 y Canadá en 1984. La XLII reunión de la Comisión fue convocada en La JoBa (California) el 16, 17 Y18 de octubre de 1984. (PDF contains 270 pages.)

St. John, USVI mission report, NOAA/NOS/NCCOS/CCMA/Biogeography Branch, July 6 - July 17, 2009

The intent of this field mission was to continue ongoing efforts: (1) to spatially characterize and monitor the distribution, abundance and size of reef fishes, and the abundance of macroinvertebrates (conch, Diatema, lobster) within and around the waters of the Virgin Islands National Park (VIIS) and newly established Virgin Islands Coral Reef National Monument (VICR), (2) to correlate this information to in-situ data collected on associated habitat parameters, (3) to use this information to establish the knowledge base necessary for enacting management decisions in a spatial setting and (4) to establish the efficacy of those management decisions. An additional focus this year, was to evaluate a new habitat data collection method for RHA sites (MSR and some Coral Bay sites). There are concerns that the cylinder habitat data are not reflective of the fish transect habitat. To address this, we collected habitat data at 5x4 m increments along the transect in addition to data collected using the cylinder method. We are currently assessing the potential differences between these methods and preliminary results indicate that the average difference of coral cover estimates between the two methods was 4.1% (range 0-11%) based on 16 sample sites. In addition, Erinn Muller, a Nancy Foster Fellowship recipient, collaborated with the Biogeography Branch to examine the spatial distribution of coral diseases, to provide baseline information on disease prevalence over varying spatial scales and to establish spatial distributions of coral diseases around St. John.

Objective assessment of cardiopulmonary resuscitation skills of 10-11 year-old schoolchildren using two different external chest compression to ventilation ratios

Study which shows that 10-11 yr olds are capable of effective CPR after a single 2 hour training session using the ABC for Life programme. However they perfrom more effective CPR when using a ratio of 15:2 rather than 30:2 chest compressions : ventilations

AUDIT OF ANTIBIOTIC USAGE IN A MEDIUM-SIZED GENERAL-HOSPITAL OVER AN 11-YEAR PERIOD - THE IMPACT OF ANTIBIOTIC POLICIES

The objective of the present study was to evaluate trends in antibiotic expenditure over an 11-year period (1982-1992) in a 370-bed district general hospital in Northern Ireland and to examine the impact of two separate antibiotic policies on antibiotic usage. A further objective was to examine the attitudes of prescribers to the second policy. Drug utilization review was used to collect information on antibiotic expenditure and usage before and after introduction of separate antibiotic policies in 1985 (not intensively monitored) and 1989 (intensively monitored). A mail questionnaire was used to determine the attitudes of prescribers. The first policy (1985) showed no benefits with regard to the number of antibiotic entities stocked (45 before, 45 after), number of dosage units issued (9.35 increase) or expenditure (33.35 increase). The 1989 policy led to significant reductions in the number of antibiotic entities stocked (28.9%), number of antibiotics issued (11.9%) and expenditure (6.1%). Expenditure began to spiral upwards when active monitoring of the second policy was suspended. The majority of prescribers (87.2%) who responded to the questionnaire (56.5% response rate) felt that the 1989 policy made a positive contribution to antibiotic usage in the hospital.

Open access gastroscopy--3 year experience of a new service

We have audited the first 3 yr of a new open access gastroscopy service in the Royal Victoria Hospital, Belfast to assess service demands, patient demography and diagnostic trends. Over 3 yr there were 1872 referrals (800 from fundholding general practitioners), 8.8 per cent were non attenders and 5.4 per cent cancelled appointments. Endoscopic diagnostic categories showed no significant change over the 3 yr, 39 per cent non ulcer dyspepsia, 35 per cent gastro-oesophageal reflux disease (GORD), 17 per cent peptic ulcer disease (PUD), 6 per cent GORD and PUD, 1 per cent gastric erosions and 0.8 per cent carcinoma.

The cemented custom femoral stem--a 10 year review

We report a series of 706 patients (759 hip implants) with an average follow up of 10.5 years (range, 10-11 years) following total hip replacement (THR) using a cemented custom-made femoral stem and a cemented HDP acetabular component. The fate of every implant is known. One hundred and seventy-four patients (23%) were deceased at the time of their 10-year review all died with a functioning THR in situ. Four hundred and sixty-two patients (61%) were subsequently reviewed. One hundred and twenty three patients (16%) were assessed by telephone review, as they were too ill or unwilling to attend. Kaplan-Meier survival analysis (all components) demonstrated a median survival at 10 years of 96.05% or 95% Confidence Intervals (CI) for median survival of (94.41% to 97.22%). Revision surgery occurred in 30 cases (3.9%). Seventeen had full revisions (2.2%) and 13 (1.7%) socket revisions only. Twenty-one out of 30 revisions were for infection or dislocation. There were 2 cases (0.3%) of revision for aseptic loosening of the stem. The 10-year results of the custom femoral titanium stem are encouraging and compare well with other cemented systems.