Causes Of Patterns Research Articles

Changing Pattern of Intestinal Obstruction in Northern Jordan

Obstructed abdominal wall hernias have been reported to be the leading cause of mechanical intestinal obstruction (MIO) among adults in developing countries. In the developed countries, postoperative adhesions are the commonest cause. With the worldwide improvements in health services and education, especially in developing countries, we aimed to determine the effects of these improvements on the patterns and outcomes of management of MIO in Jordan The records of all patients who were treated for MIO between the years 2005 and 2010 were reviewed retrospectively. Causes of MIO, presenting symptoms, the main imaging study performed, and the results of management are described. The pattern was compared with that in a previous 1993 report from Jordan. A total of 88 patients were treated for MIO. Postoperative adhesions in 52.5%, gastrointestinal tumors in 21.0%, and obstructed abdominal wall hernias in 9.5% were the three major causes of MIO. Three patients developed surgical-site infections (3.3%), and one developed a minor anastomotic leak that was treated accordingly (1.1%). There were no mortalities. In 1993, obstructed hernias accounted for 30% of the MIOs followed by postoperative adhesions and tumors (27 and 14%, respectively). There was a 7% mortality rate. Our data confirmed that improved health education programs and services changed the pattern of causes improved the outcomes of management of MIO in Jordan.

Injury patterns of South African provincial cricket players over a two season period

Introduction: To determine the incidence and nature of injury patterns for elite cricketers over two seasons. Methods: The physiotherapists and/or doctors working with four provincial teams completed a questionnaire for each cricketer that presented with an injury during the 2004-2005 (S1) and 2005-2006 (S2) cricket seasons. This was in order to determine (i) the anatomical site of injury, (ii) the month of injury during the season, (iii) the diagnosis using the OSCIS injury classification system,6 (iv) the mechanism of injury, (v) whether it was a recurrence of a previous injury, (vi) whether the injury had recurred again during the season, and (vii) biographical data. Results: The results showed that 180 injuries (S1 - 84; S2 – 96) were sustained. The teams spent, on average, 2 472 hours on matches, 4 148 on practices and 1 612 hours on fitness during the two season period. The injury prevalence was 7.5% per match, while the incidence of injury was 29.6 injuries per 10 000 hours of match, practice and training time, with the match incidence being 73.5 injuries per 10 000 hours and the training incidence being 15.4 injuries per 10 000 hours. Bowling (29.4%), fielding and wicket-keeping (26.7%) and batting (18.9%) accounted for the majority of the injuries. The occurrence of injuries were predominately to the lower limbs (S1 45.3%; S2 – 41.7%), back and trunk (S1 – 19.0%; S2 – 18.9%), upper limbs (S1 – 19.0%; S2 – 22.2%), head and neck (S1 - 6.0%; S2 – 2.8%) and illnesses (S1 – 10.7%; S2 – 14.4%). The injuries occurred primarily during first-class matches (38.9%), limited-overs matches (21.6%), practices (16.7%) and as a result of gradual onset (19.5%). Acute injuries made up 77.8% of the injuries. The majority of the injuries were first-time injuries (75.6%), with 10.5% and 13.9% recurrent injuries from the previous and the present season, respectively. The major injuries during S1 were haematomas (19.0%), muscle strains (16.7%) and other trauma (14.3%), while during S2 the injuries were primarily muscle strains (15.6%), other trauma (19.8%), tendinopathy (15.6%) and acute sprains (14.6%). The primary mechanisms of injury occurred in the delivery stride when bowling (18.9 %) and over-bowling (7.2 %), impact by the ball when batting (11.1 %) and sliding to field the ball (6.1 %). Conclusion: The results indicate a pattern of cause of injury, with the fast bowler most likely to sustain an acute injury to the soft tissues of the lower limb while participating in matches and practices during the early part of the season.

Commentary: Non-communicable diseases in sub-Saharan Africa: a new global health priority and opportunity

As part of the updated assessment of the Global Burden of Disease (GBD) study, the World Health Organization (WHO) has provided an overview of the global and regional levels and patterns of causes of death. Based on this assessment, it is estimated that nearly 59 million people died in the world during 2004. Of these deaths, 60% were due to noncommunicable diseases (NCDs) (i.e. Group II conditions), such as cardiovascular disease, diabetes, cancer and metabolic disorders. With only about one-third of the deaths due to communicable diseases, maternal and prenatal conditions and nutritional deficiencies (Group I conditions), there is increasing recognition of the importance of NCDs as a growing contributor of the GBD. Within sub-Saharan Africa, Group I conditions remain an important cause of deaths, although the contribution of NCDs is also increasing. In 2004, Group I conditions accounted for 62% of all deaths among adults aged 15–59 years in this region, whereas cardiovascular diseases, cancer and other Group II conditions contributed for about one-third of the deaths in this age group among both males and females. Within Group I conditions, HIV/AIDS was the main contributor of mortality, accounting for 35% of the overall adult deaths. Thus, if we exclude HIV/ AIDS, the contribution of remaining Group I conditions to the burden of diseases in sub-Saharan Africa is comparable with that of NCDs, which are becoming a significant public health problem in the region. Similar trends have been observed in other lowas well as middle-income countries which, when taken together, are projected to account for 80% of all global deaths due to NCDs by the year 2030. The increasing burden of NCDs in lowand middle-income countries previously dominated by infectious and other Group I conditions suggests that a major epidemiological transition is taking place in these settings. However, the precise burden of NCDs and other chronic conditions, as well as the rate of occurrence of associated morbidity and mortality in most countries remains unknown. This is particularly true in sub-Saharan Africa where health facilities are under-resourced and accurate information about chronic diseases is lacking. In addition, only few patients with NCDs seek medical services, and limited research has been conducted to determine the burden of NCDs and the distribution of potential risk factors in various geographical locations. To help fill this gap in our knowledge, Dalal et al. report in this issue of the IJE a comprehensive review of literature on the burden of NCDs as contributors of morbidity and mortality, as well as the prevalence of associated risk factors. As part of this publication, they searched the PubMed database and included community-based studies conducted in any subSaharan African country, published in English, and reported on the burden or risk factors for four main NCDs: heart diseases, stroke, diabetes mellitus type 2 and cancer. They also analysed publicly available data sets on estimated and projected causes of death from the WHO GBD and the International Agency for Research on Cancer (IARC). The findings of this report provide important insights on the epidemiology of NCDs in Africa and associated risk factors. Overall, NCDs were relatively common in the studies reported, indicating that they are a major public health priority in sub-Saharan Africa. These results confirm that Africa is facing an emerging epidemic of NCDs, which is overlapping with the ongoing burden of infectious diseases. The prevalence of specific conditions and associated risk factors varied from one country to another and also within the same country, indicating that the burden Published by Oxford University Press on behalf of the International Epidemiological Association

Sensitivity of the Causality in Variance Test to the Garch (1,1) Parameters

In this paper we discuss the sensitivity of causality of variance tests to the GARCH\((1,1)\) parameters. The idea of study is to investigate the impact of a number of volatile data sets on volatility spillover tests. We investigate a type of data generating process, AR(1)-GARCH(1,1), with an extensive set of Monte Carlo simulations. It is found that causation pattern, due to causality between two series, is influenced by the intensity of volatility clustering. Two testing procedures are applied for testing causality in the variance. We notice a severe size and power distortion when the clustering parameter is high and when the process is near integration. Furthermore, whenever there is a severe size distortion, there is a serial autocorrelation in the standardized residuals. This is seen when the asymptotic distribution of the statistics is used to define a critical region. So, instead of relying on the asymptotic distribution, we calculate the percentiles of the test statistic with the null hypothesis of no spillover effect and use them as a critical region for both size and power. We observe a significant improvement in the results. (Less)

Causes and 3-year-incidence of blindness in Jing-An District, Shanghai, China 2001-2009

BackgroundRegistered data can provide valuable information regarding blindness. The purpose of this study was to evaluate the main causes and 3-year incidence of registered blindness in Jing-An district in Shanghai, China.MethodsData from the blindness registry (age, gender and cause of visual disability) were collected and analyzed. The prevalence of blindness for 2003, 2007, 2009 and the 3-year incidence of blindness were calculated.ResultsThe reported blindness increased significantly from 113.7 per 100,000 in 2003 to 145.8 per 100,000 in 2006 to 165.9 per 100,000 in 2009 (P < 0.05, P < 0.05, respectively). Age significantly affects prevalence; the odd ratios (OR) were 2.57 in the 30 y - 49 y range (P < 0.001), 7.27 in the 50 y - 69 y range (P < 0.001) and 21.2 in the ≥ 70 y (P < 0.001). The 3-year incidence increased from 32.3 per 100,000 in 2001-2003 to 34.2 per 100,000 in 2004-2006 to 40.8 per 100,000 in 2007-2009. The causes of new blindness registered in 2001-2009 were myopic macular degeneration (19.4%), followed by glaucoma (17.7%), age-related macular degeneration (11.8%), optical nerve atrophy (9.4%), retinitis pigmentosa (8.6%), diabetic retinopathy (7.8%) and corneal opacity (5.8%).ConclusionsThe 3-year incidence and prevalence of registered blindness increased in the past 9 years. The leading causes of new blindness were myopic macular degeneration, glaucoma and age-related macular degeneration. The pattern of causes has changed little in the past 9 years and is different from other locations in China. The pattern is similar to that of Taiwan, Hongkong, and Western countries.

Insight from hindsight: A practitioner’s perspective on a causal approach to performance improvement

The petrochemical industry works relentlessly on many fronts to improve performance and to create desired performance outcomes. Companies’ approaches vary widely; yet despite best efforts, the industry continues to experience periods of undesirable performance outcomes in product quality, reliability, process safety, environmental, and personal injury. The industry continues to search for better methods, techniques, and technology that are assumed to be missing, but the causes of incidents illustrate that what is in the way of improving performance may not be what is missing but rather what already exists. This paper provides an alternative perspective of performance problems viewed from underlying causes and patterns of causes of incidents in these so-called “high hazard industries” ( Carroll, 2004) across several years and geographic regions. The perspective includes two distinct insights. The conclusion is that when these repeating patterns are combined with a limited ability to effectively find, learn, and eliminate the causes, organizations are left with repeating periods of performance problems despite well-intended efforts to improve.

Cost-Effectiveness of Preparticipation Screening for Prevention of Sudden Cardiac Death in Young Athletes

Inclusion of 12-lead electrocardiography (ECG) in preparticipation screening of young athletes is controversial because of concerns about cost-effectiveness. To evaluate the cost-effectiveness of ECG plus cardiovascular-focused history and physical examination compared with cardiovascular-focused history and physical examination alone for preparticipation screening. Decision-analysis, cost-effectiveness model. Published epidemiologic and preparticipation screening data, vital statistics, and other publicly available data. Competitive athletes in high school and college aged 14 to 22 years. Lifetime. Societal. Nonparticipation in competitive athletic activity and disease-specific treatment for identified athletes with heart disease. Incremental health care cost per life-year gained. Addition of ECG to preparticipation screening saves 2.06 life-years per 1000 athletes at an incremental total cost of $89 per athlete and yields a cost-effectiveness ratio of $42 900 per life-year saved (95% CI, $21 200 to $71 300 per life-year saved) compared with cardiovascular-focused history and physical examination alone. Compared with no screening, ECG plus cardiovascular-focused history and physical examination saves 2.6 life-years per 1000 athletes screened and costs $199 per athlete, yielding a cost-effectiveness ratio of $76 100 per life-year saved ($62 400 to $130 000). Results are sensitive to the relative risk reduction associated with nonparticipation and the cost of initial screening. Effectiveness data are derived from 1 major European study. Patterns of causes of sudden death may vary among countries. Screening young athletes with 12-lead ECG plus cardiovascular-focused history and physical examination may be cost-effective. Stanford Cardiovascular Institute and the Breetwor Foundation.

Cost implications of improving malaria diagnosis: findings from north-eastern Tanzania.

BackgroundOver diagnosis of malaria contributes to improper treatment, wastage of drugs and resistance to the few available drugs. This paper attempts to estimate the rates of over diagnosis of malaria among children attending dispensaries in rural Tanzania and examines the potential cost implications of improving the quality of diagnosis.Methodology/Principal FindingsThe magnitude of over diagnosis of malaria was estimated by comparing the proportion of outpatient attendees of all ages clinically diagnosed as malaria to the proportion of attendees having a positive malaria rapid diagnostic test over a two month period. Pattern of causes of illness observed in a <2 year old cohort of children over one year was compared to the pattern of causes of illness in <5 year old children recorded in the routine health care system during the same period. Drug and diagnostic costs were modelled using local and international prices. Over diagnosis of malaria by the routine outpatient care system compared to RDT confirmed cases of malaria was highest among <5 year old children in the low transmission site (RR 17.9, 95% CI 5.8–55.3) followed by the ≥5 year age group in the lower transmission site (RR 14.0 95%CI 8.2–24.2). In the low transmission site the proportion of morbidity attributable to malaria was substantially lower in <2 year old cohort compared to children seen at routine care system. (0.08% vs 28.2%; p<0.001). A higher proportion of children were diagnosed with ARI in the <2 year old cohort compared to children seen at the routine care system ( 42% vs 26%; p<0.001). Using a RDT reduced overall drug and diagnostic costs by 10% in the high transmission site and by 15% in the low transmission site compared to total diagnostic and drug costs of treatment based on clinical judgment in routine health care system.ImplicationsThe introduction of RDTs is likely to lead to financial savings. However, improving diagnosis to one disease may lead to over diagnosis of another illness. Quality improvement is complex but introducing RDTs for the diagnosis of malaria is a good start.

Injury patterns of South African provincial cricket players over two seasons

Objective. To determine the incidence and nature of injury patternsin elite cricketers over two seasons.Methods. Physiotherapists and/or doctors working with 4 provincial teams completed a questionnaire for each cricketer who presented with an injury during the 2004 - 2005 (S1) and 2005 - 2006 (S2) cricket seasons. This was done to determine: (i) the anatomical site of injury; (ii) the month of injury during the season; (iii) the diagnosis using the OSCIS injury classification system; (iv) the mechanism of injury; (v) whether it was a recurrence of a previous injury; (vi) whether the injury had recurred again during the season; and (vii) biographical data.Results. The results showed that 180 injuries (S1 – 84; S2 – 96)were sustained. On average the teams spent 2 472 hours on matches, 4 148 on practices and 1 612 on fitness training during the two-season period. The injury prevalence was 8% per match, while the injury incidence was 30/10 000 hours of match, practice and training time, with the match incidence being 74 injuries/ 10 000 hours and the training incidence 15 injuries/10 000 hours. Bowling (29%), fielding and wicket-keeping (27%) and batting (19%) accounted for the majority of injuries. The occurrence of injuries was predominantly to the lower limbs (S1 – 45%; S2 – 42%),back and trunk (S1 – 19%; S2 – 19%), upper limbs (S1 – 19%; S2 – 22%), head and neck (S1 – 6%; S2 – 3%), and related to illnesses (S1 – 11%; S2 – 14%). The injuries occurred primarily during first-class matches (39%), limited-overs matches (22%), and practices (17%), and some were of gradual onset (20%). Acute injuries comprised 78% of injuries. The majority of injuries were first-time injuries (76%), with 11% and 14% recurrent injuries from the previous and current seasons, respectively. The major injuries during S1 were haematomas (19%), muscle strains(17%) and other trauma (14%), while during S2 the injuries were primarily muscle strains (16%), other trauma (20%), tendinopathy (16%) and acute sprains (15%). The primary mechanisms of injury occurred in the delivery stride when bowling (19%) and overbowling (7%), on impact by the ball when batting (11%), and on sliding to field the ball (6%).Conclusion. The results indicate a pattern of cause of injury, withthe fast bowler most likely to sustain an acute injury to the soft tissues of the lower limb while participating in matches and practices during the early part of the season.

Bridging the gap between community ecology and historical biogeography: niche conservatism and community structure in emydid turtles

Historical (phylogenetic) biogeography and community ecology were once integrated as part of the broader study of organismal diversity, but in recent decades have become largely separate disciplines. This is unfortunate because many patterns studied by community ecologists may originate through processes studied by historical biogeographers and vice versa. In this study, we explore the causes of a geographic pattern of community structure (habitat use) in the emydid turtle assemblages of eastern North America, with more semi-terrestrial species of the subfamily Emydinae in the north and more aquatic species of Deirochelyinae in the south. Specifically, we address the factors that prevent northern emydines from invading southern communities. We test for competitive exclusion by examining patterns of range overlap, and test for the role of niche conservatism using analyses of climatic and physiological data based on a multilocus molecular phylogeny. We find no support for competitive exclusion, whereas several lines of evidence support the idea that niche conservatism has prevented northern emydines from dispersing into southern communities. Our results show how understanding the causes of patterns of historical biogeography may help explain patterns of community structure.

N-Acetylcarnosine Lubricant Eyedrops Possess All-In-One Universal Antioxidant Protective Effects of L-Carnosine in Aqueous and Lipid Membrane Environments, Aldehyde Scavenging, and Transglycation Activities Inherent to Cataracts: A Clinical Study of the New Vision-Saving Drug N-Acetylcarnosine Eyedrop Therapy in a Database Population of Over 50,500 Patients

The antioxidant activity of L-carnosine (beta-alanyl-L-histidine, bioactivated in ocular tissues) versus N-acetylcarnosine (N-acetyl-beta-alanyl-L-histidine, ocular-targeted small dipeptide molecules) was studied in aqueous solution and in a lipid environment, employing liposomes as a model of lipid membranes. Reactive oxygen species (ROS) were generated by an iron/ascorbate promoter system for induction of lipid peroxidation (LPO). L-carnosine, which is stabilized from enzymatic hydrolysis, operates as a universal aldehyde and ROS scavenger in both aqueous and lipid environments and is effective at preventing ROS-induced damage to biomolecules. Second-generation carnosine analogs bearing the histidyl-hydrazide moiety were synthesized and tested versus L-carnosine for their ability to reverse the glycation process, also known as the Maillard reaction, and reverse the stable intermolecular cross-links, monitored in the glucose-ethylamine Schiff base model, ultimately resulting in the formation of the advanced glycation end products (AGEs) from nonenzymatic glycation, accumulating in numerous body tissues and fluids. The obtained data demonstrate the transglycation properties of the ophthalmically stabilized L-carnosine and L-carnosine histidyl-hydrazide derivatives tested and can be used to decrease or predict the occurrence of long-term complications of AGE formation and improve therapeutically the quality of vision and length of life for diabetes mellitus patients and survivors with early aging. Scientists at Innovative Vision Products, Inc. (IVP), developed lubricant eyedrops designed as a sustained-release 1% N-acetylcarnosine prodrug of L-carnosine. The eyedrops contain a mucoadhesive cellulose-based compound combined with corneal absorption promoters and glycerine in a drug-delivery system. Anti-aging therapeutics with the ophthalmic drug eyedrop formula including N-acetylcarnosine showed efficacy in the nonsurgical treatment of age-related cataracts for enrolled participants in the prospective, randomized, double-masked, placebo-controlled crossover clinical trial after controlling for age, gender, and daily activities. In a cohort in excess of 50,500 various patients seeking cutting-edge medical care, the N-acetylcarnosine topical eyedrops target therapy was demonstrated to have significant efficacy, safety, and good tolerability for the prevention and treatment of visual impairment in this older population with relatively stable patterns of causes for blindness and visual impairment. Overall, accumulated study data demonstrate that the IVP-designed new vision-saving drugs, including N-acetylcarnosine eyedrops, promote health vision and prevent vision disability from senile cataracts, primary open-angle glaucoma, age-related macular degeneration, diabetic retinopathy, and aging. N-acetylcarnosine eyedrop therapy is the crown jewel of the anti-aging medical movement and revolutionizes early detection, treatment, and rejuvenation of aging-related eye-disabling disorders. N-acetylcarnosine, as an innovative medical science tool and component of the home medicine and alternative medicine approaches, has the potential to alleviate visual impairment and its associated social, economic, and political woes for an aging population.

Global and regional causes of death

Assessing the causes of death across all regions of the world requires a framework for integrating, and analysing, the fragmentary information that is available on numbers of deaths and their cause distributions. This paper provides an overview of the met and methods used by the World Health Organization to develop global-, regional- and country-level estimates of mortality for a comprehensive set of causes, and provides an overview of global and regional levels and patterns of causes of death for the year 2004. The paper also examines some of the data gaps, uncertainties and limitations in the resulting mortality estimates. Deaths for 136 disease and injury causes were estimated from available death registration data (111 countries), sample death registration data (India and China), and for the remaining countries from census and survey information, and cause-of-death models. Population-based epidemiological studies and notifications systems also contributed to estimating mortality for 21 of these causes (representing 28% of deaths globally, 58% in Africa). Ischaemic heart disease and cerebrovascular disease are the leading causes of death, followed by lower respiratory infections, chronic obstructive pulmonary disease and diarrhoeal diseases. AIDS and TB are the sixth and seventh most common causes of death, respectively, lower than in previous estimates. One-half of all child deaths are from four preventable and treatable communicable diseases. Globally, around 6 in 10 deaths are from non-communicable diseases, 3 from communicable diseases and 1 from injuries. Injury mortality is highest in South-East Asia, Latin America and the Eastern Mediterranean region. These results illustrate continuing huge disparities in risks and causes of death across the world. Global mortality analyses of the type reported here have been criticized for making estimates of mortality for regions with limited, incomplete and uncertain data. Estimates presented here use a range of techniques depending on the type and quality of evidence. Better evidence on levels of adult mortality is needed for African countries. Considerable gaps and deficiencies remain in the information available on causes of death. Nine of 10 deaths in 2004 occurred in low- and middle-income countries, reinforcing the fundamental importance of improving mortality statistics as a measure of health status in the developing world. Acknowledging the controversies around use of incomplete and uncertain data, systematic assessments and synthesis of the available evidence will continue to provide important inputs for global health planning. Innovative methods involving sample registration, and the use of verbal autopsy questionnaires in surveys, are needed to address these gaps. Research on strategies to improve comparability of cause-of-death certification and coding practices across countries is also a high priority.

Evolution of mortality amongst the youth of Navarra: 1985-1995

Recent publications show that mortality rates amongst young people and adolescents in some industrialised countries have increased in recent years. The addition of new diseases such as AIDS, which principally affect the young population, to those inevitable deaths brought about through causes such as traffic accidents has increased interest in this public health problem. The number of deaths and the adjusted global mortality rates amongst men and women of 15-34 years did not increase in Navarra in the 1985-1995 period. These are situated around 70 per 100,000. Changes have taken place in the pattern of causes, similar to those observed in other industrialised areas, with an increase of deaths through overdose and AIDS, and a decline in mortality due to traffic accidents in recent years. Traffic accidents were the first cause of death amongst youths until 1993. From this year onwards deaths from AIDS became the first cause amongst women, while amongst men the number of deaths from AIDS is equal to those caused by traffic accidents.

Pattern and outcome of childhood intestinal obstruction at a tertiary hospital in Nigeria.

Intestinal obstruction is a common cause of pediatric surgical emergency with a high morbidity and mortality in Africa. A retrospective review of cases managed from January 1996 to December 2005 at a teaching hospital in Southwestern, Nigeria was done to examine the pattern of causes of intestinal obstruction in children and the management outcome. One hundred and thirty cases were seen over the study period with an age range of 2 hours to 14 years. Majority (61.24%) were infants, while 18.46% were neonates. Fifty-five cases (42.31%) were due to congenital causes while the rest were of acquired causes. The major causes of intestinal obstruction in the study were intussusception (29.23%), anorectal malformations (22.31%), obstructed inguinoscrotal hernia (16.92%) and Hirschsprung's disease (13.85%). Surgical site infection and sepsis were the commonest complications observed with an overall complication rate of 60.78%. The mortality rate was 3.08% and most (75%) occurred in neonates. While mortality as an outcome of management is low, the morbidity was very high in this study.

Natural course of Fabry disease: changing pattern of causes of death in FOS – Fabry Outcome Survey

Background:Fabry disease is a rare X-linked lysosomal storage disorder characterised by severe multisystemic involvement that leads to major organ failure and premature death in affected men and women. Over the...

Utilization of the Seniors Falls Investigation Methodology to Identify System-Wide Causes of Falls in Community-Dwelling Seniors

As a highly heterogeneous group, seniors live in complex environments influenced by multiple physical and social structures that affect their safety. Until now, the major approach to falls research has been person centered. However, in industrial settings, the individuals involved in an accident are seen as the inheritors of system defects. The objective of the present study was to investigate safety deficiencies that contributed to falls in community-dwelling seniors using a systems approach. The investigations were conducted using the Seniors Falls Investigation Methodology (SFIM), an adapted version of a method used to examine transportation accidents, such as airplane crashes. Fifteen seniors, who experienced a fall or near fall, participated in multiple case studies. A cross-case synthesis was used to summarize findings and identify common patterns of causes and safety deficiencies. Falls and near falls are a result of latent unsafe conditions, and unsafe acts and decisions combined in a diverse set of circumstances. If not identified and removed, these unsafe conditions can cause falls for other seniors. This study provided compelling evidence that causes of falling are systemic and develop over time. It demonstrated that the systems approach is needed to expand the focus from the individual to multilayered organizational and supervisory causes. The SFIM demonstrated capability to identify causes of falls that will allow better prevention and management programs, hence advancing seniors' safety. SFIM shows great potential for implementation in organized settings, such as hospitals and long-term care homes.

Decreased postoperative drift in intermittent exotropia associated with A and V patterns

Few data exist concerning postoperative drift in patients with intermittent exotropia who have coexistent A or V patterns. In addition, the impacts of pattern collapse and surgical method on postoperative drift have not been well addressed. We retrospectively reviewed the records of 132 patients who had surgery for intermittent exotropia and had >or=6 months' follow-up. Mean postoperative drift in 66 patients with pattern exotropia was compared with a nonpattern (comitant) group matched for surgeon, age, surgical method, and initial deviation. Postoperative drift was calculated by subtracting the deviation at postoperative day 1 from that at approximately 6 weeks, 6 months, 9 months, and >1 year. Pattern and comitant groups were similar in mean +/- SD age (15 +/- 17 years), follow-up (2.3 +/- 2 years), preoperative exotropia (23(Delta) +/- 11(Delta)), initial postoperative deviation (1(Delta) +/- 5(Delta) esotropia), and surgical technique. Patients with pattern intermittent exotropia showed significantly (p < 0.02) less exotropic drift postoperatively at all times than did patients without a pattern. In contrast to undercorrected patients, in those who were sufficiently overcorrected, the effect of pattern became statistically insignificant after 6 months. Patients with persisting postoperative patterns had a significantly less postoperative drift (p < 0.01). Postoperative drift in patients with A- or V-pattern intermittent exotropia is consistently less than in comitant exotropia, particularly if the pattern persists postoperatively and if the exotropia is undercorrected. Therefore, surgeons should consider smaller early overcorrections in pattern than comitant intermittent exotropia. Lesser postoperative drift in pattern exotropia may suggest differing underlying causes of pattern vs nonpattern exotropia.

Elevational zonation of afrotropical forest bird communities along a homogeneous forest gradient

AbstractAim This study analyses the distribution and abundance of birds from a forested tropical gradient in order to determine whether elevationally distinct communities are detectable in this habitat.Location An avifaunal census was carried out on a single transect within the tropical forest of the Udzungwa Mountains in the Eastern Arc, Tanzania, covering a range in elevation from 300 to 1850 m.Methods Two complementary data sets on forest birds were analysed, encompassing (1) data derived from standardized 20‐ha spot‐mapping censuses performed at nine elevations over 175‐m intervals from 400 to 1800 m a.s.l., and (2) all observations of birds binned into 32 data points at 50‐m intervals, from 300 to 1850 m a.s.l. The degree of zonation in the avian community along the elevational gradient was examined using the chronological clustering method, an agglomerative hierarchical clustering method that can be carried out with a range of similarity indices.Results The chronological clustering analysis of the data set based on standardized spot‐mapping revealed a clearly defined boundary at c. 1200 m a.s.l., separating lowland from montane communities. Most bird species could be categorized as belonging to one of these two communities. The data set based on all observations revealed a number of potential secondary boundaries, although these boundaries delimited the entire elevational ranges of individual species in only relatively few cases.Main conclusions In contrast to previously published studies, we find evidence of an elevational zonation of distinct communities within a seemingly homogeneous habitat. Although similar boundaries have been assumed to arise as a result of vegetational ecotones, or because of interspecific competition, these mechanisms are poorly corroborated. We suggest that the causes of patterns of zonation are not well understood, and that the interplay among species distributions, species richness, and environmental factors needs more consideration. The chronological clustering method is proposed as an appropriate tool for studying these specific patterns.

An Empirical Study of Causes of Disability in India

In the field of health related research the pattern of causes provide a clear and in depth idea about the situation of the diseases and injuries prevalence in the population under study. Identifying the causes of disability among sex, place of residence and most importantly among different age groups have a useful contribution in proper health planning. The main focus of the study is to explore the patterns of causes of disability in India. Here, NSS-58th round-2002 disabled persons data has been analyzed using univariate, bivariate and two way ANOVA analysis. Results reveal that locomotor disability is the most prevalent type of disability affecting the population of all ages in India. Mental problems are highest among working age population, and visual and hearing disability are highest among the aged population. Mental disability is occurring mainly due to serious illness during childhood, head injury in childhood and pregnancy and birth related causes. Old age, cataract, glaucoma and other eye disease are the main causes for having visual problems while polio, injury other than burns, other illness, stroke, arthritis, cerebral palsy are the main causes of locomotor disability. The study also shows that injury other than burns is a vital cause of having disability in India.

Cause of death in older men after the diagnosis of prostate cancer.

To compare survival and cause of death in men aged 65 and older diagnosed with prostate cancer and with survival and cause of death in a noncancer control population. Retrospective cohort from a population-based tumor registry linked to Medicare claims data. Eleven regions of the Surveillance, Epidemiology and End Results (SEER) Tumor Registry. Men aged 65 to 84 (N=208,601) diagnosed with prostate cancer from 1988 through 2002 formed the basis for different analytical cohorts. Survival as a function of stage and tumor grade (low, Gleason grade<7; moderate, grade=7; and high, grade=8-10) was compared with survival in men without any cancer using Cox proportional hazards regression. Cause of death according to stage and tumor grade were compared using chi-square statistics. Men with early-stage prostate cancer and with low- to moderate-grade tumors (59.1% of the entire sample) experienced a survival not substantially worse than men without prostate cancer. In those men, cardiovascular disease and other cancers were the leading causes of death. The excellent survival of older men with early-stage, low- to moderate-grade prostate cancer, along with the patterns of causes of death, implies that this population would be well served by an ongoing focus on screening and prevention of cardiovascular disease and other cancers.