Cent Decline Research Articles

Did early detection and treatment contribute to the decline in ischemic heart disease mortality? Prospective evidence from the Alameda County Study.

In a previous study, the authors reported a 45 per cent decline in ischemic heart disease mortality between cohorts selected to be representative of Alameda County, California, in 1965 and 1974. The decline could not be explained by baseline differences in the distribution of many of the known ischemic heart disease risk factors available for analysis in this cohort. This study reports the results of further analyses which evaluated the hypothesis that early detection and improved treatment contributed to the decline. In multiple logistic analyses adjusted for age, sex, and race, those who reported heart trouble at baseline had an ischemic heart disease mortality decline 2.5 times greater than those who did not (p = 0.01). Those who used preventive health services had an ischemic heart disease mortality decline 2.2 times greater than those who did not (p = 0.03). These interactions were independent of each other and were not explained by adjustment for physical activity, smoking, social connections, or body mass index. There was an increase in the prevalence of self-reported heart trouble between 1965 and 1974, especially among younger age groups. These results are consistent with the hypothesis that early detection and treatment contributed to the decline in ischemic heart disease mortality observed in the Alameda County Study.

The dynamic relationship between the dollar and US prices: An intensive empirical investigation

The empirical, bivariate relationships between the dollar and US prices during the recent floating rate period are analyzed using time series methodology. Results indicate a long distributed lag from the dollar to the CPI, but no relationship in the opposite direction, and that a permanent 10 per cent decline in the dollar was ultimately followed by a CPI rise of 4.85 per cent. Similar results are obtained for various components of the CPI, including services, while substantially smaller price responses are reported in other studies that typically employ shorter lag structures in the context of structural econometric models.

THE CURRENT ACCOUNT, MONETARY POLICY, MARKET SENTIMENT AND THE REAL EXCHANGE RATE: SOME IMPLICATIONS FOR THE FARM SECTOR

The real effective value of the Australian dollar declined sharply between early 1985 and September 1986. 'Market fundamentals' associated with the deterioration in Australia's terms of trade and current account, and rising foreign debt levels are the commonly cited explanation for the decline. However, several other shorter term influences may have also contributed. Theoretical and empirical analysis indicates that market fundamentals might explain, at most, 20 percentage points of the 37 per cent decline in the rate over this period. Thus, a significant real appreciation would be expected over the medium term prior to, and quite independently of, any recovery in Australia's terms of trade in general or in world farm commodity prices in particular.

The Market Economies Of Southeast Asia In 1986

The weighted average growth in the ASEAN countries as a whole fell from 4.6 per cent in 1984 to 0.5 per cent in 1985. In the course of 1985, expectations were that growth would pick up in 1986 but this did not materialize, and the Nomura Research Institute estimates 1986 growth to be in the order of 0.6 per cent (report in the Business Times [Singapore], 19 December 1986). Commodity prices continued to fall and the failure of the indus trialized countries to show strong growth adversely affected the performance of the Southeast Asian market economies. Real output in the industrialized countries grew by only 2.7 per cent in 1986 as compared to 3.0 per cent in 1985. While ASEAN countries used to grow faster than the industrialized countries, only Thailand and Brunei recorded a higher rate of growth than the industrialized countries in 1986. However there are signs that this poor performance ? poor relative to earlier years ? can be reversed in 1987 with overall growth averaging a modest 2 per cent. The world economy is in a transition phase, adapting to major changes such as a large shift in the pattern of exchange rates, sharp reductions in interest rates and energy prices, and the planned strengthening in the U.S. fiscal position. For the industrial countries the key policy issue is how to sustain a satisfactory rate of demand growth while working toward the elimination of the financial imbalances between countries that have threatened the sustainability of expansion (International Monetary Fund, World Economic Outlook, October 1986). The year 1986 saw the beginnings of profound changes to Asian economies brought about by the 22 September 1985 summit of Finance Ministers from the five major industrial nations. This summit agreed on concerted steps to weaken the dollar, particularly against the yen. The yen has since then strengthened by about 40 per cent against the dollar. Japan's exports have become more expensive and its overseas sales have dropped in yen terms, driving down the country's growth rate which in fact turned negative in real terms in the first quarter of 1986. Consequently the Asian nations that compete with Japan for export markets, particularly those which are linked to the dollar, are enjoying a boom such as South Korea, Taiwan and Hongkong. Cheap oil and low interest rates have added to the windfall. However only Thailand among the market Southeast Asian economies has shown growth, comparable to 1985, of about 4 per cent for 1986. Singapore is expected to grow by about 1.9 per cent in real terms for 1986, itself a significant reversal from the minus 1.8 per cent in 1985 while Malaysia is expected to grow by about 1.0 per cent, also an improvement over the minus 1.0 per cent growth of 1985. Brunei's expected growth for 1986 is estimated by the Nomura Research Institute to be 4 per cent. According to that same source, the Philippines is expected to decline by 0.1 per cent and Indonesia by 1.1 per cent in 1986, the Philippine figure a significant improvement over the 3.8 per cent decline in 1985. Of all the market Southeast Asian countries, Indonesia has worsened most in its 1986 economic position as it had a positive 1.3 per

Government regulation of occupational safety: underground coal mine accidents 1973-75.

The purpose of this paper is to determine the influence of federal mine safety inspections on underground coal mine accidents. An economic incentives model is developed to relate federal enforcement activities to accident rates. The determinants of accident rates are analyzed for 535 coal mines during the period 1973-75. Estimates based on these data when applied to the model indicate that increasing inspections by 25 per cent would have produced a 13 per cent decline in fatal accidents and an 18 per cent decline in disabling accidents.

The effect of laminectomy on spinal cord blood flow, energy metabolism and ATPase activity.

The purpose of these studies was to determine the effects of dorsal laminectomy on spinal cord blood flow (SCBF) energy metabolism, Na +-K +-adenosine triphosphatase (ATPase) activity and release of arachidonate, a polyunsaturated fatty acid. With the laminectomy site open, SCBF was significantly depressed (22% to 45%) along the entire length of the spinal cord at 15 minutes post-laminectomy. Concurrently, there were significant increases in the tissue levels of the adenine nucleotides adenosine diphosphate (ADP) and adenosine mono-phosphate (AMP) and a significant decrease in the tissue energy charge. At one hour after laminectomy, SCBF approached control values if the laminectomy site was closed but remained depressed if the incision was left open. Similarly, at 24 hours postlaminectomy SCBF had normalised if the laminectomy site was closed. However, if within the one hour preceding the 24 hour SCBF measurement, the laminectomy site was reopened, SCBF tended to fall at and caudad to the laminectomy site. Other laminectomy induced changes were: (a) a 66 per cent decline in the activity of the plasma membrane bound enzyme Na+-K+-ATPase between from 2 to 24 hours after laminectomy and (b) a six-fold increase in spinal cord tissue arachidonate levels by 10 minutes after laminectomy. The partial inhibition of Na+-K +-ATPase activity by laminectomy was reversed and actually enhanced 1 -5 to two-fold if the laminectomy site was capped with methyl methacrylate. Postlaminectomy arachidonate values returned to normal levels by 90 minutes of the laminectomy site was continuously covered with 37°C NaCl. These data indicate that laminectomy can cause a significant perturbation in SCBF along with certain tissue biochemical parameters. At the present time, the mechanism(s) for these laminectomy induced changes are unknown although a temperature induced vasoconstriction of spinal cord vessels is suspected. These laminectomy initiated alterations appear to be transient. Cats allowed to recover following laminectomy showed no demonstrable neurological deficit or histologic evidence of tissue damage. Thus, this operative procedure does not appear to permanently affect spinal cord functioning unless, perhaps, there is a pre-existing vascular insufficiency. (Supported by the Veterans Administration, Cincinnati, OH)

The Hormonal Maintenance and Restoration of Guinea Pig Seminal Vesicle Fibromuscular Stroma

Using the separated epithelium and muscle preparation of the guinea pig seminal vesicle, we designed studies to investigate the hormonal control of epithelial collagen, muscle collagen and muscle cells. All hormone treatment regimens involved a comparison of the effects of hormone maintenance (hormone treatments initiated on the day of castration) versus hormone restoration (hormone treatments initiated after a castration-induced regression) on these 3 components of the fibromuscular stroma.In the epithelium, castration induced a 35 per cent decline in collagen content, which was either returned to normal by androgen restoration or prevented by androgen maintenance. In all androgen treatment regimens, changes in epithelial collagen correlated with changes in epithelial wet weight, cell number, RNA content and cell size. In contrast, growth of the epithelium was not stimulated by estrogen maintenance or restoration.Castration reduced muscle wet and dry weight, as well as cell size and RNA content, but there was no effect on cell number and collagen content. Androgen maintenance or restoration reversed the castration-induced regression in all parameters and also caused collagen content to increase 35 percent above normal. Estrogen maintenance of castrates sustained wet weight, dry weight and RNA content at normal and stimulated supranormal increases in both collagen content and cell number. Similarly, estrogen restoration induced supranormal increases in collagen content and returned RNA content to normal. However, estrogen’s ability to stimulate supranormal increases in cell number and restore wet and dry weight to normal was lost after a castration-induced muscle regression.In summary, components of the guinea pig seminal vesicle fibromuscular stroma have been shown to be sensitive to androgens and/or estrogens. The action of androgen on these tissue components was independent of the state of tissue regression, whereas with the exception of RNA and collagen content, all the effects of estrogen were significantly reduced with castration-induced regression of the tissue.

Cerebral palsy and newborn care. III: Estimated prevalence rates of cerebral palsy under differing rates of mortality and impairment of low-birthweight infants.

To maintain a stable over-all prevalence of handicap, the rate of handicap among survivors must decline in parallel to the decline in mortality among live births. The 24 per cent decline in mortality among low-birthweight infants in New York City between 1962 and 1976 requires a 35 to 39 per cent decline in the rate of neurological impairment among low-birthweight survivors simply to avoid the production of an increased number of handicapped children in the population as a whole. Such evidence as we have suggests that the declining morbidity may not be keeping pace with the recent declines in mortality: thus, although more healthy survivors will result from newborn intensive care, a modest increase in the prevalence of handicap may also ensue.

The recent decline in mortality of the extreme aged: an analysis of statistical data.

Official U.S. statistics reveal a 26 per cent decline in the mortality rate for the extreme aged population (persons 85 years and over) between 1966 and 1977. This reduction was greater than that exhibited by other adult age groups and substantially larger than earlier declines for the extreme aged. This study examines the possible effect of statistical artifacts, such as errors in population estimation, on the changed mortality trend. Data from the Social Security files on Medicare enrollment are utilized to test the accuracy of population estimates for the extreme aged. Mortality rates are decomposed by selected cause of death, sex, and race to determine the influence of demographic, social, and health factors on the shift in the pattern. The results of the analysis indicate that substantial real reduction in mortality has occurred among the elderly population. Reductions among females continue to exceed those among males, but less markedly than in the past. Rates for nonwhites are subject to particularly large margins of error due to incorrect population estimates. A sharp downturn in the age-adjusted rates for the cardiovascular diseases, which are more common among the aged, appears to account for the relatively greater reduction in mortality in this age group.

Liberalized abortion in Oregon: effects on fertility, prematurity, fetal death, and infant death.

An analysis of Oregon Vital Statistics data from 1965 to 1975 was conducted to assess the impact of Oregon's 1969 abortion legislation, which substantially increased the number of reported medically induced abortions. This increase was associated with a slight increase in the age-adjusted 1970 fertility rate and there was no decrease in births to women in the age groups obtaining proportionately the most abortions. A significant and persistent 11 per cent reduction in premature births to women over age 20 (p less than .001) and a 22 per cent reduction in spontaneous fetal deaths (p less than .05) were associated with liberalized abortion. Decreases in neonatal and postneonatal infant mortality were observed, but were indistinguishable from an ongoing trend toward improved infant health. A gradual 25 per cent decline in the age-adjusted fertility rate occurred between 1969 and 1975, but the increase in the number of reported abortions could account for only one-fourth of this decrease. A seven-fold increase in the use of family planning clinics between 1970 and 1973 and more liberalized laws regarding provision of family planning service appeared to account for a much higher proportion of the decreased fertility than did liberalized abortion.

Studies of sarcoplasmic reticulum function and contraction duration in young adult and aged rat myocardium

Kinetic measurements of Ca +2 uptake in microsomal fractions from rat myocardium demonstrated significantly lower rates of oxalate-facilitated accumulation in preparations from aged (24 to 25 month) hearts as compared to those from young adult (6 to 8 month) hearts. The per cent decline in transport activity in microsomes from aged hearts varied with Ca 2+ concentration decreasing from 57% at 0.33 μ m Ca 2+ to 24% at 1.21 μ m Ca 2+. Double-reciprocal plots of the dependence of the velocity of accumulation on Ca 2+ concentration showed upward curvature in both age groups indicating the presence of multiple Ca 2+ binding sites. Mechanical studies using muscles isolated from the same hearts used to prepare sarcoplasmic reticulum demonstrated prolonged contraction duration in aged myocardium in agreement with previous findings. The lower in vitro rates of Ca 2+ accumulation in aged microsomes suggest a possible biochemical mechanism to account for the observed increase in the time-course of cardiac relaxation.

Inhibition of insulin secretion by exogenous insulin in normal man as demonstrated by C-peptide assay.

To investigate whether insulin exerts feedback regulation of its own secretion, paired studies were performed in normal men in two separate protocols. In the first protocol, four men were studied on two occasions. On one occasion, insulin was infused at 5 μU. per kilogram per minute for 120 minutes, achieving arterial insulin levels of 600 to 700 μU./ml. With use of a variable glucose infusion, the plasma glucose concentration was maintained at fasting levels for 60 minutes and then raised abruptly to 165 mg./dl. and was maintained at that level for the remaining 60 minutes. On a second occasion, the study was repeated except that saline was infused instead of insulin. The plasma glucose concentration remained at fasting levels until the last 60 minutes, when it was similarly raised to 165 mg./dl. and maintained at that level until the end of the study. Connecting peptide reactivity (CPR) was measured as an index of endogenous insulin secretion in the presence of exogenous insulin. During the initial 60 minutes of the study, with euglycemia maintained, there was a significant (46 per cent) decline (p < 0.01) in the levels of CPR in the insulin-treated subjects. At 60 minutes, when hyperglycemia was induced, CPR rose in both groups. The rise of CPR in the insulin-treated group, however, was significantlyless (p < 0.01) than in the saline control group. To investigate whether insulin inhibition of insulin secretion during hyperglycemia would occur without prolonged insulin pretreatment, paired studies were performed in three additional men. In this protocol, insulin (5 mU. per kilogram per minute) or saline was infused for 70 minutes. Euglycemia was maintained for just 10 minutes. Thereafter, the plasma glucose concentration was. raised to 170 mg./dl. in both groups. This acute induction of hyperglycemia without prolonged insulin pretreatment resulted in similar increases in CPR in both insulin- and saline-treated groups. From these data we conclude that (1) exogenous insulin administration, with maintenance of euglycemia, results in significant inhibition of basal insulin secretion; (2) the administration of exogenous insulin for 60 minutes before and for 60 minutes after the acute induction of hyperglycemia results in significant inhibition of glucose-stimulated insulin secretion; and (3) exogenous insulin administered for just 10 minutes before and during the acute induction of hyperglycemia, however, does not result in inhibition of the insulin response to the hyperglycemic stimulus.

Cardiovascular haemodynamics during enflurane-pancuronium anaesthesia in patients with valvular heart disease.

The effects of enflurane-pancuronium anaesthesia on cardiovascular haemodynamics were studied before operation in six patients with valvular heart disease. A ten per cent decline in cardiac index and a 20 per cent decline in stroke volume were the only changes observed. Mean arterial, pulmonary arterial, contral venous, and pulmonary capillary wedge pressures were unaffected, as were systemic vascular resistance and pulmonary vascular resistance. The authors therefore conclude that enflurane-pancuronium anaesthesia causes only minimal cardiovascular depression in patients with valvular heart disease.

Analysis of United States neonatal mortality statistics from 1968 to 1974, with specific reference to changing trends in major causalities

Analysis of computer-stored United States natality and mortality records for the years 1968 to 1974 revealed a 10 per cent decline in the number of live births and a fall in the annual newborn mortality rate from 16.1 to 12.3 per 1,000 live births. The mortality rates over the seven years declined approximately 25 per cent for both white and black infants dying before 28 days of age. The annual numbers of neonatal deaths per 1,000 live births in the black population, however, were considerably greater than those recorded for white infants throughout the years analyzed; thus, the (mean ± S.D.) newborn mortality rate in blacks was 21.5 ± 2.19 as compared to 13.0 ± 1.32 in whites (p < 0.001). Male predominance was found to exist in all major underlying causes of death identified, with white infants showing significantly higher average male/female ratios than black infants (1.41 ± 0.02 versus 1.29 ± 0.02 for 1968 to 1974). Specific causalities of death exhibited changing patterns over the seven years. Asphyxia was replaced by hyaline membrane disease/respiratory distress syndrome (HMD/RDS) as the primary etiology after 1970. Approximately 65 per cent of all neonatal deaths due to the three leading causes (HMD/RDS, immaturity, and asphyxia) were found to occur within the first 48 hours of life. It is concluded that although advances in perinatal care have contributed to increasing the survival of newborn infants in the United States, further lowering of mortality statistics will require continued attention to: (1) prematurity and its consequences and (2) improved health care delivery to nonwhite patients.

Metabolic effects of somatostatin in maturity-onset diabetes.

To examine the effects of prolonged infusions of somatostatin in maturity-onset diabetes, we administered five-hour infusions to eight patients. This infusion resulted in a 45 to 55 per cent decline in plasma insulin and glucagon. Plasma glucose initially fell by 20 to 25 mg per 100 ml, but later rose despite continuing hypoglucagonemia. After five hours, plasma glucose concentration was 40 to 50 mg per 100 ml higher than that observed with saline infusion (P less than 0.001). The degree of hyperglycemia and plasma insulin levels correlated inversely at completion of the infusion (P less than 0.01). In addition, somatostatin resulted in a fivefold increase in beta-hydroxybutyrate and a 40 to 45 per cent rise in branched-chain amino acids (P less than 0.005). Our findings suggest that glucagon is not essential for the development and maintenance of fasting hyperglycemia. Furthermore, accentuation by somatostatin of hyperglycemia, hyperketonemia and hyperaminoacidemia in maturity-onset diabetes argues against its use in patients with residual insulin secretion.

Simultaneous left ventricular echocardiography and aortic blood velocity during rapid right ventricular pacing in man

Left ventricular echocardiograms and phasic instantaneous Doppler aortic blood velocities were simultaneously recorded during short paroxysms of rapid right ventricular pacing in 20 conscious subjects. Right ventricular pacing at rates of 100, 120, 140, 160 and 180/min produced stepwise reductions of mean estimates for diastolic (D) and systolic (S) left ventricular internal dimensions (LVID) along with a diminution of aortic blood velocity. Mean (X +/- 1 standard deviation) per cent decline of LVID-D, LVID-S and peak aortic blood velocities for the study group ranged from 8.9 +/- 6.1, 8.5 +/- 5.7 and 13.7 +/- 7.7 at 100 beats/min to 29.3 +/- 10.6, 25.2 +/- 10.5 and 55.2 +/- 13.1 at 180 beats/min, respectively. When LVID-D, LVID-S, and aortic blood velocity X % reductions were plotted for all heart rates there was a high degree of positive correlation (r = 0.99). Two types of abnormal septal motion were observed during rapid pacing: Type I--paradoxical septal motion at all pacing rates (n = 7, 6/7 with left coronary artery disease); Type II--hypokinetic septal motion at lower pacing rates with flat or paradoxical motion at rates greater than 140/min (n = 13, 10/13 with normal coronary arteries). It is concluded that short episodes of rapid right ventricular pacing result in reduced LVID and abnormal septal motion with the latter possibly related to septal ischemia. Such study provides insight into the untoward influence of rapid ventricular rhythms on cardiac performance.

Effect of nitroglycerin and papaverine on coronary flow in man

Blood flow has been measured in 28 aortocoronary saphenous vein bypass grafts performed for chronic angina pectoris using the electromagnetic flowmeter. Nitroglycerin, 0.4 mg. intravenously or 0.1 mg. into the graft, and papaverine 30 mg. intravenously or 15 mg. into the graft, were studied. Intravenous nitroglycerin increased coronary flow a maximum of 4 per cent for 20 seconds followed by 23 per cent decline as mean arterial pressure fell 23 per cent. Intra-arterial nitroglycerin increased coronary flow 74 per cent in 15 seconds with return to control by 90 seconds. Intravenous papaverine elevated coronary flow 76 per cent at 30 seconds with stabilization of flow 15 to 20 per cent above control. Intra-arterial papaverine achieves a maximum flow of 215 per cent at 45 seconds with return to control at five minutes. Although nitroglycerin produces a small but significant rise in coronary flow it is doubtful whether this increase occurs with oral administration in the presence of coronary disease. Thus, the therapeutic effect of nitroglycerin lies in its systemic effects rather than in its coronary effect.

Effect of x-irradiation of one partner on hybrid frequency in fusions between Chinese hamster cells.

AbstractSublines derived from V79 and B150 Chinese hamster cells lack hypoxanthine‐guanine phosphoribosyltransferase (HGPRT) and thymidine kinase (TK) respectively. When these strains are cultivated together without virus treatment in HAT medium, hybrid colonies with normal enzymic patterns arise in high frequency. The ratio of proliferating hybrid colonies to the minority cell inoculum in mixed cultures is approximately 1/1000. This observation has been used to examine the effect of x‐irradiation pretreatment of one cell type on the frequency of hybrid formation in mixed cultures. B150 cells (TK‐) were irradiated in monolayer cultures at dose levels of 200–4000r (180 KV, 15 ma). After trypsinization, the irradiated cells were mixed with unirradiated V79 cells (subline 129, HGPRT‐) and cultivated in HAT medium. The per cent decline in hybrid frequency as a function of x‐irradiation was compared to the relative decline in viability of x‐irradiated B150 cells when assayed in cultures alone. These curves diverged markedly, with the frequency of proliferating hybrids decreasing much less rapidly with radiation dose than survival of B150 cells. By contrast, when B150 cells were subjected to acute heat shock for graded intervals and subsequently mixed with untreated V79–129 cells, both viability of B150 cells and hybrid formation declined at the same rate. Our results suggest that lethally irradiated cells can still fuse with normal cells, and may contribute functional chromosomes to the hybrid karyotype. At limiting doses of x‐irradiation this technique may be useful as a means for induced segregation of marker chromosomes.

Dental arch depth and width studied longitudinally from 12 years of age to adulthood

This investigation was designed to study dental arch depth and arch width in male and female subjects from the age of 12 years to adulthood. Arch depth and width measurements were taken from dental casts of twenty-six subjects at annual intervals from 12 to 17 years of age and at an additional examination of these subjects after they had reached the age of 23 years. The age range of the subjects at the time of the additional examination was 23.2 years to 30.1 years. The mean age was 26.3 years. All subjects were North American Caucasians with acceptable occlusion. Summarily, selected findings are as follows: 1. 1. Means for both maxillary and mandibular arch depth decrease with age throughout the period studied in each sex, with the rate of change being less after the age of 15 years. The mean decrease in mandibular arch depth from 12 to 26 years of age was 3.2 mm. for male subjects, or approximately a 10 per cent decrease. For female subjects, mean decrease in arch depth was 2.6 mm., or approximately a 9 per cent decline. 2. 2. For female subjects, means for arch width in each arch revealed no significant change during the 14-year span from 12 to 26 years of age. In males there was a small statistically significant increase in arch width from 12 to 15 years of age. 3. 3. Every person in the study showed a decrease in arch depth after the age of 15 years. The range of decrease in the mandibular arch for the period from 15 to 26 years of age was 0.1 mm. to 2.3 mm. For the same age group, 92 per cent of the decreases were in excess of 0.75 mm. and 46 per cent of the decreases were in excess of 1.25 mm. 4. 4. No evidence was found to reject the null hypothesis of no sex difference in mean change in arch depth for any of the age intervals studied. 5. 5. A moderate negative association (r = −0.55) was found between (a) arch depth decrease from 12 to 14 years of age and (b) arch depth decrease from 14 to 26 years of age. 6. 6. Individual comparisons of four subjects were presented, demonstrating the constancy of direction but variability in amount of arch depth decrease from age 12 to early adulthood.

Abstracts: decline and fall.

During 1971, monthly mailings of cards with abstracts of the Journal's Original and Special Articles went to 38,000-odd Journal subscribers. Each of these subscribers had specifically indicated interest in this special service. But for 1972, only 2003 subscribers wanted to receive the booklets containing the abstract cards. Why this 95 per cent decline in enthusiasm? The answer is elementary. In 1971 the booklets were available to any subscriber for the asking. In 1972 an at-cost subscription price of $5 was to be levied. These facts justify the following conclusions: The abstract service in the form of independent monthly mailings is . . .