Causes Of Patterns Research Articles

Changing Pattern of Acute Renal Failure

During the four-year period 1981-1984, 250 patients with severe acute renal failure were treated at one centre. There were seven obstetric cases (2.8 per cent) 118 'surgical' cases (47.2 per cent) and 125 medical cases (50 per cent). This is a different pattern from that seen in the majority of earlier reports. In 60 of the 125 medical patients the aetiology of the acute renal failure could only be determined by renal biopsy. This series suggests that with changing medical practice (particularly the improvement in resuscitation) and an ageing population, the pattern of causes of acute renal failure is altering. It also highlights the value of renal histology as a guide to diagnosis and treatment in patients with unexplained acute renal failure.

Changing patterns in the causes of scalds in young Dutch children

The causes of burns in children who were treated as inpatients and outpatients were examined at a burn centre and a university hospital during the period 1972-85. In particular young children, from 0–5 years, were the victims of hot fluid burns caused mainly by coffee and tea. Over the years a change has taken place in the pattern of causes in spite of an increase in the consumption of tea and coffee. The number of coffee scalds has decreased markedly, probably as a result of the increasing use of electric coffee machines.

Mortality in lung and gastrointestinal cancer among shipyard workers.

The risk of shipyard workers acquiring lung cancer and gastrointestinal cancer was investigated retrospectively by analysing the mortality pattern of 365 deceased shipyard workers. Instead of using the proportional mortality ratio (PMR), the odds ratio (OR) was determined according to a method proposed by Axelson, Miettinen and Der Wang. The pattern of causes of death among Swedish males was used as a reference. The OR was 2.3 for lung cancer and 1.4 for gastrointestinal cancer, using death in cancers of other sites (ICD 170-209) as reference diseases. There was a heavy exposure to asbestos, which is the probable cause of the increased risk of lung cancer in this population.

Mortality studies in psychiatry. Should they stop or proceed?

Psychiatry as a medical discipline has a special concern for preventing premature deaths in psychiatric patients. Such patients continue to be at excess mortality risk despite changing patterns of causes of death and improvements in the treatment of some diagnostic groups. In this overview of current findings and research trends, we find a continuing need for mortality studies and increased opportunities for integrating these investigations with other longitudinal studies of psychiatric populations.

Safety of roof-bolting operations in underground coal mines

Helander, M.G., Krohn, G.S. and Curtin, R., 1983. Safety of roof-bolting operations in underground coal mines. Journal of Occupational Accidents, 5: 161–175. Roof bolting is generally considered as being the most dangerous job in underground coal mines in the United States. In addition to the ever present danger of roof falls, the roof-bolting machines have many design features that seem to further increase the hazards of the job. The following were the main findings of the study: (1) Fatalities are mostly caused by roof falls (85% of the cases), whereas less serious accidents are mostly caused by the machine (about 50%) and to a lesser degree by roof falls (25%). (2) Roof-bolter operators with less than one year of work experience incur approximately five times the number of accidents and three times the number of fatalities as compared to more experienced operators. (3) Several work activities are involved in accidents; drilling accidents are the most frequent (18%), followed by inserting bolts (14%) and tramming (13%). (4) All machine parts of the roof bolter are involved in accidents: the drill steel, the boom, and the frame being the most frequent. Even safety features, such as the canopy and the automatic temporary roof support are involved. (5) Accident causation patterns are different for machines made by different manufacturers.

Epibenthic megafauna of a bathyal basin off southern California: patterns of abundance, biomass, and dispersion

A total of 50 species was recorded in a survey of near-bottom megafauna at a depth of 1300 m in the Santa Catalina Basin using the submersibles Alvin and Sea Cliff, and bottom trawls. The nine most common epibenthic types were counted in Alvin photographic surveys, yielding a total density of 16.7 individuals per m 2. Biomass of the four most abundant species (an ophiuroid, gastropod, holothurian, and rockfish) totaled 67.9 g m −2. The ophiuroid Ophiophthalmus normani comprised 99% of the community in terms of abundance and standing crop. All four dominant epibenthic species showed nonrandom dispersion patterns on the studied scales of one-half to hundreds of meters. Ophiophthalmus normani showed weak tendencies toward evenness on the smallest scale (0.5 m) and also formed randomly located patches 1 to 4 m in diameter. Both the gastropod Bathybembix bairdii and the holothurian Scotoplanes globosa aggregated in clumps from 25 to 96 m in diameter, but they showed no significant between-species correlation in patch location. The rockfish Sebastolobus altivelis was in most cases evenly distributed on scales of 6 to 158 m. Potential causes of patterns included attraction to detrital kelp parcels, avoidance of disturbed areas, breeding aggregation, and other social interactions. We conclude that the megafauna comprises a major fraction of the bathyal benthic biomass and that it, particularly the ophiuroids, significantly impacts the energetics and ecology of bathyal communities.

Critical Incidents Associated with Intraoperative Exchanges of Anesthesia Personnel

It is a common practice for anesthesia to substitute for one another, especially for short breaks during long surgical procedures. The assets and liabilities of this practice of relief have not been examined previously. In the course of gathering 1,089 reports of preventable errors and failures associated with anesthesia management, we identified 96 which involved a relief anesthetist. This subset was examined in search of common characteristics and patterns of cause and discovery of errors. In 28 incidents, the relief anesthetist discovered an error or the cause of an error. In 10 incidents, the process of relief was identified as having contributed to the commission of an error. Although 70 of the 1,089 incidents were associated with substantive negative outcomes, e.g., death, cardiac arrest, or extended ICU stay, none of those incidents was caused by a relieving anesthetist. There is a strong implication that relief is beneficial more often than not even aside from the presumed beneficial effect on the vigilance of the primary anesthetist (the latter effect was outside the scope of this study). From the descriptions of the causes and discoveries of errors in these relief-related incidents, guidance can be drawn for the safe and effective conduct of the intraoperative exchange of anesthesia personnel.

Critical incidents associated with intraoperative exchanges of anesthesia personnel.

It is a common practice for anesthesia to substitute for one another, especially for short breaks during long surgical procedures. The assets and liabilities of this practice of relief have not been examined previously. In the course of gathering 1,089 reports of preventable errors and failures associated with anesthesia management, we identified 96 which involved a relief anesthetist. This subset was examined in search of common characteristics and patterns of cause and discovery of errors. In 28 incidents, the relief anesthetist discovered an error or the cause of an error. In 10 incidents, the process of relief was identified as having contributed to the commission of an error. Although 70 of the 1,089 incidents were associated with substantive negative outcomes, e.g., death, cardiac arrest, or extended ICU stay, none of those incidents was caused by a relieving anesthetist. There is a strong implication that relief is beneficial more often than not even aside from the presumed beneficial effect on the vigilance of the primary anesthetist (the latter effect was outside the scope of this study). From the descriptions of the causes and discoveries of errors in these relief-related incidents, guidance can be drawn for the safe and effective conduct of the intraoperative exchange of anesthesia personnel.

Selection in cohorts and pattern of causes of death.

Selection in cohorts and pattern of causes of death.

A changing pattern of causes of death in Japanese diabetics. Observations over fifteen years

Changes in causes of death in Japanese diabetics over the past 15 yr were presented. The subjects studied were 8908 death certificates with mention of diabetes, which were found by the review of some 570,000 certificates reported between 1960–1974 in Osaka, Japan. In 4974 (55.8%), diabetes was identified as the underlying cause and in the remaining 3934 (44.2% ) as a contributory condition. Increase of the deaths from disease of the circulatory system both in contributory and underlying cause was noted. In this category, disease of heart, which was much less frequent than cerebrovascular disease in the period 1960–1964, revealed a rapid increase approaching the level of the latter in underlying cause. However, death due to diseases of the circulatory system were not significantly higher in diabetics than in the general population except the latest period, 1970–1974, indicating that the increase was largely dependent on that in the general population. The outstanding features in comparison of the underlying cause in diabetics between U.S.A. and Osaka were predominance of disease of heart in the former, whereas that of cerebrovascular disease in the latter.

Re-Presenting the Past: A Note on Narrative Historiography and Historical Drama

It has often been noted how eagerly playwrights go to historical events for their plots. One reason for this is suggested in the ninth chapter of Aristotle's Poetics: dramatic works need an air of plausibility, and what better indication that a series of events is possible than the fact that it actually occurred? A no less valid reason for dramatizing history might be proposed from the historiographer's point of view: historical works need an air of authenticity, and what better indication that a series of events actually occurred than the fact that it can be re-enacted without the palpable presence of a narrator's mediating consciousness? Speaking in terms of literary genres, the tales of historiography are based on the plays of history. Yet historians seldom presume to imitate the Supreme Producer by merely presenting the show. Rather, they will mingle with the actors on the plain stage of printed pages and minister to the needs of their audience the readers of history books more or less directly. This apparent modesty is motivated, of course, by the historian's ambition to do better than simply reproduce the past. He wants to re-present it with hindsight, disclosing patterns of cause and purpose of which the participants in the original events could not have been fully aware. But the skillful historian does not turn enacted drama into narrated tale by standing in front of the closed curtain, so to speak, with his back turned on the dramatis personae whose own sense of identity relies on their relationship to each other. He knows that we expect him to make us see the past from within and from without at the same time as evolving drama and as the fixed target of distanced retrospection. I hope to contribute to the exploration of that dual mode of vision by contrasting, in the first part of this essay, the historian's use of verbal signs to the scientist's and the novelist's, and by focusing, in the second and third parts, on differences and similarities between narrative historiography and historical drama.

Cancer in humans: exposures and responses in a real world.

Cancer causation in humans is at least a three-dimensional problem too often viewed from only two dimensions, especially as far as the two-dimensional results (dose versus response) of cancer induction tests in animals are viewed. The expression of a cancer represents a critical convergence of additional factors in the third dimension which include metabolic variables, many of which may involve secondary mechanisms. Many of these mechanisms are involved in the causation pattern of cancer in humans and can be expected to operate within the dose-response considerations observed in the fields of toxicology and pharmacology. The expression of critical reactions of cells in relatively unprotected tissues may occur more readily after exposures involving fewer molecules of one "carcinogen" as compared to another "carcinogen". Results from animal tests may have limited human relevance in some instances and detract us from consideration of the more fundamental factors involved in the etiology of human cancer. A precipitous rush to "zero tolerances" for all animal carcinogens may impair our efforts to prevent the worst "causes" of cancer induction in humans.

Black‐White Economic Participation in Large U.S. Cities: Some Determinants of Their Differentials

Abstract. In this study some of the causes of the differentials in Black‐White economic participation in large U.S. cities are examined. Specific concern is with unemployment and withdrawal from the labor force. The underlying hypothesis is that these differentials are a response to compositional differences between the two populations. The effects of region, economic structure, and segregation are also examined. A causal model is explicated in which these variables are inter related and their direct and indirect effects upon the dependent variables analyzed. The data suggest that, while having similar patterns of causes, labor force withdrawal and unemployment differentials are distinct phenomena. It also appears that a major portion of the variance in these variables is not accounted for by compositional differences between Blacks and Whites on socio‐economic variables. However, educational and occupational differentiation have theoretically significant effects. It is argued that a major portion of the residual variance is due to discrimination, although there is no way of directly testing this hypothesis. An important negative finding is the apparently minor impact of residential segregation, suggesting that the physical isolation of Blacks is not a key factor in their limited economic participation. Finally, the data suggest that it is meaningful to regard assimilation as a multidimensional phenomenon whose dimensions are causally interrelated.

BIOLOGICAL MALIGNANCY AND SOCIAL MALIGNANCY

Analogies between biological and social processes can be interesting; analogical thinking can suggest cause-and-effect relationships but does not prove their existence. When social evils follow an ingravescent course, they can be characterized as malignant. Both forms, biological and social, are parasitic, self-perpetuating, and invasive. Both malignancies arise from the normal and in some cases can be normalized again, but frequently there is an irreversible tendency to escape control. There are varieties of each, patterns of causes are complex, some having an important genetic component, and all influenced importantly by nongenetic factors. Each tends to recur following suppression by treatment, and in many instances the response is like that of a wounded hydra. Both social and biological malignancies tend to drain the substance and energy of the host and, kamikaze-like, threaten its life. There is a parellel between views of an earlier day that cancer is caused by the sins of

Quantitative community analysis and bryophyte ecology on Signy Island

Longton & Holdgate and Longton, in earlier papers of this Discussion (pp. 237, 213), have outlined the general features of the vegetation of Signy Island, drawing comparisons with other Antarctic island groups and with the Peninsula. Signy Island is characterized by a relatively extensive cover of bryophyte and lichen communities, which exhibit considerable diversity in composition. This presents a situation well suited for the investigation of some of the principles of community construction and the causes of patterns of plant distribution, under the conditions of an Antarctic environment. This paper, the outcome of work carried out on Signy Island between 12 January and 7 March 1966, first describes an approach to the recognition of the main ecological categories within the vegetation, and secondly singles out for more detailed consideration the water relations of certain of the dominant species, as one of their attributes affecting distribution.

LONGEVITY OF DIABETIC PATIENTS IN RECENT YEARS.

A virtually complete follow-up of diabetic patients treated at the Joslin Clinic since 1930 shows a downward trend in the mortality and corresponding improvement in the survivorship record. The mortality rates of diabetics, however, remain higher than those in the general population; the excess is relatively greatest at ages twenty-five to thirty-four and least in older patients. The death rates among diabetic females tend to be lower than among diabetic males, but the difference is less than in the general population. The survivorship rate among cases seen within a year of onset of the disease is better than in the aggregate experience. The pattern of causes of death among diabetics has changed radically. There has been a marked increase in the proportion of deaths caused by vascular disease, with small vessel disease playing a more and more important role. Reductions have been recorded for diabetic coma, diabetic gangrene and infections. Analysis of causes of death by age at onset and duration of diabetes show the effect of these factors on mortality and, in particular, the outstanding importance of diabetic nephropathy in juvenile diabetics with long duration ofdisease. Mortality from all types of vascular disorders is higher in diabetics than in the general population. In this experience the mortality for renal vascular disorders was seventeen times as high as in the general population.

FAMILY PATTERNS OF MORTALITY AND LIFE SPAN.

Although there has long been an idea that heredity plays an important role in the determination of life span, this concept has been "more taken for granted than supported by exact scientific investigation." Since one cannot extrapolate directly from experimental organisms to man nor carry out studies of a similar nature in man, it is necessary to use the direct epidemiological approach, determining first of all whether the observed differences in mortality follow family patterns. Some of the very early, more recently published, and current family studies of life span are summarized and reviewed critically. The results of the genealogy studies, (including both large individual kinships, e.g. the Hyde family, Peirce family, etc., and the collections of genealogies, e.g. Foster's Peerage Burke's Landed Gentry, Society of Friends records, Finnish and Swedish noble and middle class families), as well as studies involving samples from special subgroups of the population (families of workingmen, nonagenarians, senescent twins, insurance applicants, etc.) appear to show various family patterns. However, the suggested positive relationships, as well as any lack of relationships, are all explicable by one bias or another involved in the selection, completeness, source, or validity of the data. The apparent explanation for the paucity of investigations of family patterns of causes of death probably resides in the fact that the same difficulties present in the longevity studies also apply to the investigation of causes of death. In addition, problems arise from the variability in diagnostic criteria and the interpretation of competing causes. Moreover, all except the current studies involve deaths occurring in the pre-antibiotic, even in the pre-public health, era. The influence of sanitary and nutritional factors and epidemic diseases in altering the life span, despite the biological potential, might be considerable. Therefore, although many data are available on family patterns of longevity and a few on causal relationships, any attempt to interpret the findings in terms of a current population is hardly feasible. In view of this situation, two studies of patterns of mortality and aging have been initiated at Johns Hopkins University. The major investigation is a Community-Based Population Study comparing the mortality experience of corresponding relatives of a sample of deaths which occured in Baltimore in 1960 and of living matched controls, in order to determine whether there are family patterns of mortality and, if so, their nature in respect to age at death and causes of death. The second and smaller investigation, designed to identify in living subjects possible indicators of family patterns of mortality, involves a special group of 500 living males who are participating in a longitudinal study of aging. Some preliminary findings of both the Community-Based Population Investigation and the Special Group Study are Presented. It is concluded that at present, despite all the recorded information and presumptive evidence, the problem of the genetic aspects of mortality and life span remains to be resolved. Large, collaborative projects both for retrospective family data analysis and for longitudinal follow-up of subjects are recommended for future study.

The Planning of Land Use

THE development of geographical thought over the past half-century has been marked by the emergence of a logical pattern of cause and effect and by the demonstration of the influence of environmental factors on human life. Prof. L. Dudley Stamp points out in his presidential address to Section E (Geography), that the stage has now been reached when geographical methods of survey and analysis, and further, of synthesis, can be and should be applied and used so as to assist in the solution of the great social problems of the world to-day. In particular, in the field of land-use planning, there is considerable, justification for the assertion that geography is the science of which land planning is the art.