Terminal Situation Research Articles

Changes in smoking, serum cholesterol and blood pressure levels during a community-based cardiovascular disease prevention program--the North Karelia Project.

A comprehensive community-based program to control cardiovascular disease was carried out in North Karelia, Finland, in 1972--1977. Reductions in smoking, serum cholesterol and blood pressure (BP) levels were among the central intermediate objectives. The effect was evaluated by examining independent population samples at the outset and at the end, both in the program area and in a matched reference area. More than 10,000 subjects were studied each time (participation rate about 90%). This paper presents the analyses of the estimated effect of the program on the risk factor means by comparing the baseline and terminal situations among the population aged 30--59 years. The effect of the program among men was estimated to be a reduction of 13% in smoking, 4% in serum cholesterol and 3% in systolic and diastolic BP means. Among women, there was a net reduction of 5% in systolic BP and 4% in diastolic BP means. The net reductions in smoking (8%) and serum cholesterol (1%) among women were within sampling variation. It is concluded that the population means of the major coronary heart disease risk factors were reduced during the program more in the intervention area than in the reference area, and it seems likely that most of this difference was due to the program.

The presentation and management of oral lesions in leukaemia

Oral symptoms constitute one of the greatest sources of discomfort and potential danger in leukaemia; a painful and infected mouth often leads to interference with the intake of nutrients or even fluids, and further compromises an already difficult situation. Even in terminal situations where no further hope exists, the comfort of patients is greatly enhanced by an equally energetic approach to oral problems; there can be few more distressing deaths than that of a leukaemic patient with a neglected mouth and throat. In this paper the benefits of routine close liaison between clinical haematologists and dental surgeons are emphasized; frequent attendance in the ward of a trained dental hygienist is of great value, and assists in the education of the attendant nursing staff.

Single-crystal Raman spectrum of strontium dichloride hexahydrate and some related materials

Single-crystal Raman spectra at liquid nitrogen temperature are reported for SrCl2·6H2O, SrCl2·6D2O and SrBr2·6H2O. The crystals are trigonal and have a unimolecular primitive cell in which water is coordinated to strontium in both terminal and bridging situations. There are two features of particular note in the assignment. (a) It is shown that although all E modes can in principle show LO–TO splitting, the splitting is likely to be small for those modes originating as Raman-active only in the line group of the chain; this is confirmed by observation. (b) The effect of disorder among the set of terminal water molecules is to relax the selection rules governing Sr—O bond stretching in the plane normal to the chain axis. A complete assignment is offered for all three crystals, except in the ν(OH) region.

Atrial Augmentation of Surface Electrocardiographic Leads in Study of Complex Arrhythmias

A relatively simple and safe technique for augmenting atrial potentials while continuous surface electrocardiographic leads are being recorded on a single channel direct-writing electrocardiograph machine is described. In addition to obviating the need for special multichannel recorders, this technique permits recording of a single lead in which both atrial and ventricular depolarizations are clearly recognizable. The technique is particularlv suitable in coronary care units where it may be desirable to conserve floor space, and in physicians' offices and other areas not equipped with a multitude of recording apparatus. The use of the needle technique is extremely fast and particularly useful in severe shock and near terminal situations.

Kaprekar's Routine with Five-Digit Integers

Kaprekars routine consists of rearranging the digits (not all alike) of an integer, N0, to form the largest and the smallest possible integers, finding their difference, Nj, and repeating the operation on N4 and on the subsequent differences until a terminal situation is reached. He found p.] that when the routine is applied to any four-digit (not all alike) integer in the decimal system, the self-producing 6174 is eventually reached. The routine has been expanded to other number bases [2] , [3] , and to three-digit [4] and five-digit [5] integers. When applied to two-digit integers, an integer and its reverse are involved, the smaller being subtracted from the larger in each step of the routine. In the system with base r , all differences are multiples of r 1. Each step may be called a reversal-subtraction-operation (RSQ). There are three possible terminal situations which may result when the routine is applied to a two-digit integer, namely: A. If at any step of the repetitious routine, an integer with two like digits is produced, its Nj will be 00. B. A self-producing integer is formed. That i s , the integer is reproduced when subjected to an RSO. For example: 37 in the scale of eleven, where 73 37 = 37. C. A regenerative loop is formed, in which an RSO on one member produces the next member. For example: in the scale of nine, 53 35 = 17, 71 17 = 53, and so on. In each of these categories, if all two-digit integers in a particular system lead to the same result, it is said to be unanimous. The two-digit ordered integers ab and a + k b + k have the same NA, Hence, to investigate the entire field in the scale of r , it will be sufficient to examine only the r 1 integers with the form r 1 b, where b < r 1. Each of these is the representative (rep) of all two-digit integers from which an RSO produces the same NA. Any two-digit integer can be converted into its rep by addition of an appropriate multiple of 11, ThuSj 52 + 44 = 96 in

Coalition Formation in Continuous, Episodic and Terminal Situations

An attempt was made to test Caplow's predictions concerning behavior of triad members in three different group contexts. The hypotheses received partial support, but examination of other data led to suggestions for criterion revision applicable to all studies of coalition formation.

Radiation management of otherwise hopeless thoracic neoplasms.

Every physician should be aware of his responsibility if he declares a cancer patient and leaves him to his fate. The term hopeless implies the death sentence of the individual patient. In medical use this term can mean either incurability or no possibility of a favorable influence on the patient's condition, even of a palliative nature. In our interpretation, the term hopeless should be reserved for the very few patients whose suffering might be increased or whose fate might be speeded by any method of attacking the cancer. These are obviously terminal situations. Hopeless is usually applied when a thoracic neoplasm is inoperable, although we often see patients with lesions considered operable who have no chance of cure by surgery, owing to spread of the neoplasm. Further, we know that some surgically patients can be cured by radiation, and that good palliation can be obtained in excess of

Terminals

The speaker will confine his remarks largely to the duties respecting terminals as impose d by law on the War Department and on the Corps of Engineers, and in explaining that attitude toward the port and terminal situation in general.