THE DECLINE OF ISCHEMIC HEART DISEASE MORTALITY IN TEXAS: HEALTH PLANNING IMPLICATIONS

This is a report on an empirical study of the decline of ischemic heart disease mortality in the State of Texas. The study period was from 1970 to 1977. The data was collected and analyzed at three different levels of analysis: state, health service area (HSA), and county. The study was designed to test five main hypotheses. They serve to test the role of the medical care system as a possible factor associated with the changing ischemic heart disease mortality trends.^ The principal findings of the study were that a reasonable relationship could be found between the number of emergency medical care personnel, the number of icu-ccu beds, the number of medical specialists and the percent of hospitals with icu-ccu and the decline in ischemic heart disease mortality for the State of Texas. However, non significant relationships were found between variables in the medical care system and ischemic heart disease mortality trends, at the health service area level of analysis. More specifically, the number of coronary care unit beds was found to be negatively correlated with the decline in ischemic heart disease mortality at the county level.^ While being limited in its scope, the study suggests that certain factors (emergency medical service, icu-ccu beds, percent of icu-ccu units, and medical specialists) have been shown to be associated with the observed decline in ischemic heart disease mortality. The study also suggests many avenues of future research that need to be explored. ^

SERIOUS MORBIDITY DUE TO ACUTE RESPIRATORY DISEASE ASSOCIATED WITH EPIDEMIC INFLUENZA

Current measures of the health impact of epidemic influenza are focused on analyses of death certificate data which may underestimate the true health effect. Previous investigations of influenza-related morbidity have either lacked virologic confirmation of influenza activity in the community or were not population-based. Community virologic surveillance in Houston has demonstrated that influenza viruses have produced epidemics each year since 1974. This study examined the relation of hospitalized for Acute Respiratory Disease (ARD) to the occurrence of influenza epidemics. Considering only Harris County residents, a total of 13,297 ARD hospital discharge records from hospitals representing 48.4% of Harris County hospital beds were compiled for the period July 1978 through June 1981. Variables collected from each discharge included: age, sex, race, dates of admission and discharge, length of stay, discharge disposition and a maximum of five diagnoses. This three year period included epidemics caused by Influenza A/Brazil (H1N1), Influenza B/Singapore, Influenza A/England (H1N1) and Influenza A/Bangkok (H3N2).^ Correlations of both ARD and pneumonia or influenza hospitalizations with indices of community morbidity (specifically, the weekly frequency of virologically-confirmed influenza virus infections) are consistently strong and suggest that hospitalization data reflect the pattern of influenza activity derived from virologic surveillance.^ While 65 percent of the epidemic period hospital deaths occurred in patients who were 65 years of age or older, fewer than 25 percent of epidemic period ARD hospitalizations occurred in persons of that age group. Over 97 percent of epidemic period hospital deaths were accompanied by a chronic underlying illness, however, 45 percent of ARD hospitalizations during epidemics had no mention of underlying illness. Over 2500 persons, approximately 35 percent of all persons hospitalized during the three epidemics, would have been excluded in an analysis for high risk candidates for influenza prophylaxis.^ These results suggest that examination of hospitalizations for ARD may better define the population-at-risk for serious morbidity associated with epidemic influenza. ^

The Hospital Study of the City of Houston and Harris County

In 1941 the Texas Legislature appropriated $500,000 to the Board of Regents of the University of Texas to establish a cancer research hospital. The M. D. Anderson Foundation offered to match the appropriation with a grant of an equal sum and to provide a permanent site in Houston. In August, 1942 the Board of Regent of the University and the Trustees of the Foundation signed an agreement to embark on this project. This institution was to be the first one in the medical center, which was incorporated in October, 1945. The Board of Trustees of the Texas Medical Center commissioned a hospital survey to: - Define the needed hospital facilities in the area - Outline an integrated program to meet these needs - Define the facilities to be constructed - Prepare general recommendations for efficient progress The Hospital Study included information about population, hospitals, and other health care and education facilities in Houston and Harris County at that time. It included projected health care needs for future populations, education needs, and facility needs. It also included detailed information on needs for chronic illnesses, a school of public health, and nursing education. This study provides valuable information about the general population and the state of medicine in Houston and Harris County in the 1940s. It gives a unique perspective on the anticipated future as civic leaders looked forward in building the city and region. This document is critical to an understanding of the Texas Medical Center, Houston and medicine as they are today. SECTIONS INCLUDE: Abstract The Abstract was a summary of the 400 page document including general information about the survey area, community medical assets, and current and projected medical needs which the Texas Medical Center should meet. The 123 recommendations were both general (e.g., 12. “That in future planning, the present auxiliary department of the larger hospitals be considered inadequate to carry an added teaching research program of any sizable scope.”) and specific (e.g., 22. That 14.3% of the total acute bed requirement be allotted for obstetric care, reflecting a bed requirement of 522 by 1950, increasing to 1,173 by 1970.”) Section I: Survey Area This section basically addressed the first objective of the survey: “define the needed hospital facilities in the area.” Based on the admission statistics of hospitals, Harris County was included in the survey, with the recognition that growth from out-lying regional areas could occur. Population characteristics and vital statistics were included, with future trends discussed. Each of the hospitals in the area and government and private health organizations, such as the City-County Welfare Board, were documented. Statistics on the facilities use and capacity were given. Eighteen recommendations and observations on the survey area were given. Section II: Community Program This section basically addressed the second objective of the survey: “outline an integrated program to meet these needs.” The information from the Survey Area section formed the basis of the plans for development of the Texas Medical Center. In this section, specific needs, such as what medical specialties were needed, the location and general organization of a medical center, and the academic aspects were outlined. Seventy-four recommendations for these plans were provided. Section III: The Texas Medical Center The third and fourth objectives are addressed. The specific facilities were listed and recommendations were made. Section IV: Special Studies: Chronic Illness The five leading causes of death (heart disease, cancer, “apoplexy”, nephritis, and tuberculosis) were identified and statistics for morbidity and mortality provided. Diagnostic, prevention and care needs were discussed. Recommendations on facilities and other solutions were made. Section IV: Special Studies: School of Public Health An overview of the state of schools of public health in the US was provided. Information on the direction and need of this special school was also provided. Recommendations on development and organization of the proposed school were made. Section IV: Special Studies: Needs and Education Facilities for Nurses Nursing education was connected with hospitals, but the changes to academic nursing programs were discussed. The needs for well-trained nurses in an expanded medical environment were anticipated to result in significant increased demands of these professionals. An overview of the current situation in the survey area and recommendations were provided. Appendix A Maps, tables and charts provide background and statistical information for the previous sections. Appendix B Detailed census data for specific areas of the survey area in the report were included. Sketches of each of the fifteen hospitals and five other health institutions showed historical information, accreditations, staff, available facilities (beds, x-ray, etc.), academic capabilities and financial information.

Cary's Illustrated and Priced Catalogue: Surgical Instruments, Physicians, Hospital Supplies, and Furnishings, Druggist Sundries, Etc.

Second Edition. Pp.5-61 General Surgical Necessities, Gauze, Antiseptic Sundries, Surgical Sundries, Rubber Bandages, Catheters, Bougies, Splints, Tents, Emergency Bags, Surgeon's Needles, Operating Instruments, Amputating, Forceps, Aspiration, Cases, Catheters and Directors, Pocket Case Instruments, Dissecting and Post-Mortem Pp.62-118 General Operating - Osteotomy, Mastoid, Trephining, Eye Instruments, Aural, Nasal, Mouth and Throat, Tooth Forceps, Laryngoscopic Sets, Hydraulic Air Compressor, Variocele, Genito Urinary Pp. 119-167 Genito Urinary-Lithotrity, Alimentary, Anal and Rectal, Gynaecological, Pessaries, Microscopes, Syringes Pp.168-205 Chemical Apparatus and Glassware, Physician's Cabinets, Office Furniture, Operating Chairs and Tables, Hospital Beds, Cautery, Electrolytic, Batteries Pp.206-246 Cases, Varicose, Braces, Abdominal Supporters, Trusses, Invalid Chairs and Supplies, Sterilizers, Saddle-Bags, Deformity Apparatus Advertisements: Bandages, Abdominal Supporters, Rubber Supplies, Bags, Batteries, Cotton, Microscopes, Hypodermic Tablets, Atomizers, Furniture, Sterilizers, Syringes

State rate -setting in conjunction with Medicare prospective payment: The effects of the Maine program

Maine implemented a hospital rate-setting program in 1984 at approximately the same time as Medicare started the Prospective Payment System (PPS). This study examines the effectiveness of the program in controlling cost over the period 1984-1989. Hospital costs in Maine are compared to costs in 36 non rate-setting states and 11 other rate-setting states. Changes in cost per equivalent admission, adjusted patient day, per capita, admissions, and length of stay are described and analyzed using multivariate techniques. A number of supply and demand variables which were expected to influence costs independently of rate-setting were controlled for in the study. Results indicate the program was effective in containing costs measured in terms of cost per adjusted patient day. However, this was not true for the other two cost variables. The average length of stay increased during the period in Maine hospitals indicating an association with rate-setting. Several supply variables, especially the number of beds per 1,000 population were strongly associated with the cost and use of hospitals. ^

Proceedings of the Twentieth Annual Biochemical Engineering Symposium

The 20th Annual Biochemical Engineering Symposium was held at Kansas State University on April 21,1990. The objectives of the symposium were to provide: (i) a forum for informal discussion of biochemical engineering research being conducted at the participating institutions and (ii) an opportunity for students to present and publish their work. Twenty-eight papers presented at the symposium are included in this proceedings. Some of the papers describe the progress of ongoing projects, and others contain the results of completed projects. Only brief summaries are given of the papers that will be published in full elsewhere. The program of the symposium and a list of the participants are included in the proceedings. ContentsCell Separations and Recycle Using an Inclined Settler, Ching-Yuan Lee, Robert H. Davis and Robert A. Sclafani Micromixing and Metabolism in Bioreactors: Characterization of a 14 L Fermenter, K.S. Wenger and E.H. Dunlop Production, Purification, and Hydrolysis Kinetics of Wild-Type and Mutant Glucoamylases from Aspergillus Awamori, Ufuk Bakir, Paul D. Oates, Hsiu-Mei Chen and Peter J. Reilly Dynamic Modeling of the Immune System, Barry Vant-Hull and Dhinakar S. Kompala Dynamic Modeling of Active Transport Across a Biological Cell: A Stochastic Approach, B.C. Shen, S.T. Chou, Y.Y. Chiu and L.T. Fan Electrokinetic Isolation of Bacterial Vesicles and Ribosomes, Debra T.L. Hawker, Robert H. Davis, Paul W. Todd, and Robert Lawson Application of Dynamic Programming for Fermentative Ethanol Production by Zymomonas mobilis, Sheyla L. Rivera and M. Nazmul Karim Biodegradation of PCP by Pseudomonas cepacia, R. Rayavarapu, S.K. Banerji, and R.K. Bajpai Modeling the Bioremediation of Contaminated Soil Aggregates: a Phenomenological Approach, S. Dhawan, L.E. Erickson and L.T. Fan Biospecific Adsorption of Glucoamylase-I from Aspergillus niger on Raw Starch, Bipin K. Dalmia and Zivko L. Nikolov Overexpression in Recombinant Mammalian Cells: Effect on Growth Rate and Genetic Instability, Jeffrey A. Kern and Dhinakar S. Kompala Structured Mathematical Modeling of Xylose Fermentation, A.K. Hilaly, M.N. Karim, I. C. Linden and S. Lastick A New Culture Medium for Carbon-limited Growth of Bacillus thuringiensis, W. -M. Liu and R.K. Bajpai Determination of Sugars and Sugar Alcohols by High Performance Ion Chromatography, T. J. Paskach, H.-P. Lieker, P.J. Reilly, and K. Thielecke Characterization of Poly-Asp Tailed B-Galactosidase, M.Q. Niederauer, C.E. Glatz, l.A. Suominen, C.F. Ford, and M.A. Rougvie Computation of Conformations and Energies of cr-Glucosyl Disaccharides, Jing Zepg, Michael K. Dowd, and Peter J. Reilly Pentachlorophenol Interactions with Soil, Shein-Ming Wei, Shankha K. Banerji, and Rakesh K. Bajpai Oxygen Transfer to Viscous Liquid Media in Three-Phase Fluidized Beds of Floating Bubble Freakers, Y. Kang, L.T. Fan, B.T. Min and S.D. Kim Studies on the Invitro Development of Chick Embryo, A. Venkatraman and T. Panda The Evolution of a Silicone Based Phase-Separated Gravity-Independent Bioreactor, Peter E. Villeneuve and Eric H. Dunlop Biodegradation of Diethyl Phthalate, Guorong Zhang, Kenneth F. Reardon and Vincent G. Murphy Microcosm Treatability of Soil Contaminated with Petroleum Hydrocarbons, P. Tuitemwong, S. Dhawan, B.M. Sly, L.E. Erickson and J.R. Schlup

Tab. 1: Semi-quantitative estimations of mineral composition

Paleontological and petrological studies of clay beds in the Basilika Formation (Tertiary age) are the subject of this paper. The petrology of the beds indicates that their main constituents were derived from volcanic activity and represent bentonites. Differing composition of the beds may suggest several spatially separated eruptions. The volcanic source area probably lay towards the north of the present Tertiary outcrops of Svalbard. Two foraminiferal assemblages are found in the bentonites: the lower is dominated by arenaceous forms while the upper consists of calcareous species.

(Table 1) Occurrences of volcanic ash at DSDP Leg 78A Holes

Air-fall volcanic ash recovered at Deep Sea Drilling Project Sites 541, 542, and 543 on and east of the toe of the Barbados Ridge delineate middle and late Miocene, early Pliocene, and Pleistocene-Quaternary pulses of explosive volcanism in the Lesser Antilles arc. The ash beds at Site 541 allow precise correlation of intervals repeated by a probable reverse fault at this convergent margin.

Description and chemical composition of the fossil manganese nodules of the Cambrian manganese deposits of Conception and Trinity bays, Newfoundland

This paper is based upon data collected during the summers of 1912 and 1913. Mr. A. O. Hayes and Prof. van Ingen of Princeton University, while making a study of the general geology, stratigraphy, and palaeontology of the shores of Conception Bay, Newfoundland, came upon the manganiferous rocks of the Lower Cambrian exposed at Manuels, Topsail, Brigus, and other places. The following summer, of 1913, the writer as a member of the Princeton Newfoundland Expedition undertook a more detailed study of these deposits. In this paper therefore there has been an attempt to present as comprehensive a study of the manganese of southeastern Newfoundland. It is primarily chemical in its nature and the analyses herewith presented are from samples taken from the principal manganese-bearing beds.

Geo-referenced photo-mosaics of the Menez Gwen Hydrothermal Vent (Mid-Atlantic Ridge)

The Menez Gwen hydrothermal vents, located on the flanks of a small young volcanic structure in the axial valley of the Menez Gwen seamount, are the shallowest known vent systems on the Mid-Atlantic Ridge that host chemosynthetic communities. Although visited several times by research cruises, very few images have been published of the active sites, and their spatial dimensions and morphologies remain difficult to comprehend. We visited the vents on the eastern flank of the small Menez Gwen volcano during cruises with RV Poseidon (POS402, 2010) and RV Meteor (M82/3, 2010), and used new bathymetry and imagery data to provide first detailed information on the extents, surface morphologies, spatial patterns of the hydrothermal discharge and the distribution of dominant megafauna of five active sites. The investigated sites were mostly covered by soft sediments and abundant white precipitates, and bordered by basaltic pillows. The hydrothermally-influenced areas of the sites ranged from 59 to 200 m**2. Geo-referenced photomosaics and video data revealed that the symbiotic mussel Bathymodiolus azoricus was the dominant species and present at all sites. Using literature data on average body sizes and biomasses of Menez Gwen B. azoricus, we estimated that the B. azoricus populations inhabiting the eastern flank sites of the small volcano range between 28,640 and 50,120 individuals with a total biomass of 50 to 380 kg wet weight. Based on modeled rates of chemical consumption by the symbionts, the annual methane and sulfide consumption by B. azoricus could reach 1760 mol CH4 yr**-1 and 11,060 mol H2S yr**-1. We propose that the chemical consumption by B. azoricus over at the Menez Gwen sites is low compared to the natural release of methane and sulfide via venting fluids.

Microbiota and Microsatellite genotypes of Pacific oysters stemming from three oyster bed in the Northern Wadden Sea

Background: Studies of oyster microbiomes have revealed that a limited number of microbes, including pathogens, can dominate microbial communities in host tissues such as gills and gut. Much of the bacterial diversity however remains underexplored and unexplained, although environmental conditions and host genetics have been implicated. We used 454 next generation 16S rRNA amplicon sequencing of individually tagged PCR reactions to explore the diversity of bacterial communities in gill tissue of the invasive Pacific oyster Crassostrea gigas stemming from genetically differentiated beds under ambient outdoor conditions and after a multifaceted disturbance treatment imposing stress on the host. Results: While the gill associated microbial communities in oysters were dominated by few abundant taxa (i.e. Sphingomonas, Mycoplasma) the distribution of rare bacterial groups correlated to relatedness between the hosts under ambient conditions. Exposing the host to disturbance broke apart this relationship by removing rare phylotypes thereby reducing overall microbial diversity. Shifts in the microbiome composition in response to stress did not result in a net increase in genera known to contain potentially pathogenic strains. Conclusion: The decrease in microbial diversity and the disassociation between population genetic structure of the hosts and their associated microbiome suggest that disturbance (i.e. stress) may play a significant role for the assembly of the natural microbiome. Such community shifts may in turn also feed back on the course of disease and the occurrence of mass mortality events in oyster populations.

(Table 1) Stratigraphic position, abundance, shape, color, and refractive indices of glass shards of selected samples from DSDP Leg 60 Holes vitric muds

Precisely determined refractive indices of glass shards from 32 ash-rich, volcaniclastic sediments, mostly turbidites interbedded with nonvolcanic sediments in the Mariana Trough, range from 1.480 to 1.585 (corresponding to SiO2 ca. 75 to 49%), with most in the range 1.500 to 1.540 (SiO2 ca. 70-62%) and a second, smaller mode between ca. 1.560 and 1.585 (57 to 49% SiO2). Shards are almost exclusively colorless from 1.480 to ca. 1.530, light brown with minor colorless and green tones between 1.530 and 1.560, and dominantly brown at higher refractive indices. Tubular pumice shards are more common at higher silica percentages and non- to poorly-vesicular cuniform shards at low SiO2 values, but there is no clear correlation between shape and composition of shards. About half of the samples have bimodal shard populations with silica differences ranging up to 20 percent; unimodal layers have a range of up to about 7 percent SiO2. Of 21 samples in which one type of shard dominates, seven have the main mode in the rhyolitic composition (>69% SiO2), eight in the intermediate range (56 to 69% SiO2), and five in mafic composition (SiO2 <53%). These unusually abundant mafic shards occur mainly in site survey piston cores, SP-IA and 4E, and in Holes 454, 456, 458, and 459B. These are the sites closest to the present arc. Hole 453, containing by far the most vitric tuff turbidites, shows a gradual increase in silica content of ash layers upward to the hole from Cores 36 to 19 (about 4.6 to 3.0 Ma). A drastic decrease in ash-rich beds in the younger (Pleistocene) part of this hole was noted by the shipboard party (see site chapter, Site 453) and was interpreted by them as indicating increasing distance from the arc volcanoes as the trough opened. The increase in silica in ashes from the early to the late Pliocene at Site 453 could be interpreted in the same way and might indicate that the trough started to open in early Pliocene time.

Palinoestratigrafía, paleoambientes y cambios climáticos durante el Cretácico final y Paleógeno de la Cuenca del Grupo Salta, República Argentina

El objetivo principal de la presente tesis es la búsqueda de nuevos registros palinológicos para las formaciones del Grupo Salta, especialmente para aquellas que cuentan con poco o ningún registro de palinomorfos, tales como las Formaciones La Yesera, Las Curtiembres, Yacoraite y Olmedo. Los resultados palinológicos permitieron evaluar algunos aspectos geológicos como las relaciones estratigráficas, edad y ambientes de depósito. El muestreo se centró principalmente en el período comprendido entre el Neocomiano y Daniano, correspondiente a los subgrupos con mayor escasez de datos (Pirgua y Balbuena). 157 muestras palinológicas de la Cuenca del Grupo Salta y áreas relacionadas se trataron en laboratorio, 31 resultaron fértiles. Se brindan los primeros registros palinológicos de la Formación La Yesera (localidad valle de Pucará) que consisten en 35 especies. Las inferencias aleoambientales obtenidas a partir de la palinoflora apoyan las conclusiones que provienen de los datos sedimentológicos: presencia de un lago perenne al momento de la depositación del Miembro Brealito y sequías estacionales cuando se acumuló el Miembro Don Bartolo. La palinoflora indica un clima subtropical con presencia de cierta aridez. A partir de los rangos estratigráficos de algunas especies y de las dataciones radimétricas del Basalto de Isonza, se estima una edad entre el Albiano y el Cenomaniano. Para la Formación Las Curtiembres (Miembro Morales) se describen 19 especies provenientes de la quebrada de Palo Seco, que constituyen la primer asociación palinológica registrada. El predominio de Ephedraceae y Cheirolepidiaceae, junto a la escasa representación de pteridofitas, sugieren condiciones ambientales de aridez a semiaridez, en coincidencia con la sedimentología que indica que la sección superior del Miembro Morales es transicional con las capas rojas de la parte superior de la Formación Las Curtiembres. La asociación palinológica contiene representantes de amplia distribución espacial y temporal. Es relevante la presencia de Peninsulapollis gillii que indica una edad no mayor al Campaniano para la asociación estudiada. Sólo una muestra de la Formación Yacoraite en la localidad de Tres Cruces fue productiva en cuanto al contenido de palinomorfos. La asociación consta solamente de los géneros Leiosphaeridia y Pediastrum que se asocian a condiciones de agua dulce o mixtas. Para la Formación Olmedo se registran 34 especies de palinomorfos y 39 especies para la Formación Tunal (localidades de Garabatal y El Chorro respectivamente). Ambas formaciones comparten un 49 % de taxa. El marcado predominio de algas clorococales indica condiciones lacustres y un ambiente palustre se infiere por la presencia de Pandaniidites texus y Mtchedlishvilia saltenia. El elevado porcentaje de Verrustephanoporites simplex indica que la selva de ulmáceas, era la unidad fitogeográfica más ampliamente distribuida, comparable con la actual Selva de Transición de la Provincia de Yungas. La coincidencia de facies y contenido palinológico indicarían similares condiciones ambientales para las Formaciones Olmedo y Tunal. Mtchedlishvilia saltenia permiten circunscribir las Formaciones al Daniano. Los cambios climáticos acontecidos durante el desarrollo de la Cuenca del Grupo Salta quedaron evidenciados en la palinoflora. Durante el Cretácico Tardío, habrían prevalecido condiciones de aridez y a partir del Maastrichtiano, el clima se torna más húmedo. Las asociaciones del Daniano se caracterizan por una palinoflora de clima subtropical húmedo. Entre el Paleoceno Superior y hasta el Eoceno Inferior, continúa el registro de la flora de clima subtropical pero con una leve disminución en la humedad. Las especies Peninsulapollis gillii, Rhoipites sp. A, Rousea patagonica, Spinitricolpites jennerclarkei, Verrustephanoporites simplex y Azolla sp., pasan el límite Cretácio-Paleógeno registrándose en sedimentos pre- y post-danianos. Se requieren mayores estudios de detalle en aquellos niveles donde está contenido el límite para esclarecer los posibles cambios vegetacionales que hayan ocurrido.