Triennial Period Research Articles

Warfarin for stroke prevention still underused in atrial fibrillation: patterns of omission.

The value of warfarin in preventing stroke in patients with chronic atrial fibrillation is well established. However, the prevalence of such treatment generally lags behind actual requirements. The aim of this study was to evaluate doctor- and/or patient-related demographic, clinical, and echocardiographic factors that influence decision for warfarin treatment. Between 1990 and 1998, 1027 patients were discharged with chronic or persistent atrial fibrillation. This population was composed of (1) patients with cardiac prosthetic valves (n=48), (2) those with increased bleeding risks (n=152), (3) physically or mentally handicapped patients (n=317), and (4) the remaining 510 patients, the main study group who were subjected to thorough statistical analysis for determining factors influencing warfarin use. The respective rates of warfarin use on discharge in the 4 groups were 93.7%, 30.9%, 17.03%, and 59.4% (P=0.001); of the latter, an additional 28.7% were discharged on aspirin. In the main study group, warfarin treatment rates increased with each consecutive triennial period (29.7%, 53.6%, and 77.1%, respectively; P=0.001). Age >80 years, poor command of Hebrew, and being hospitalized in a given medical department emerged as independent variables negatively influencing warfarin use: P=0.0001, OR 0.30 (95% CI 0.17 to 0.55); P=0.02, OR 0.59 (95% CI 0.36 to 0.94); and P=0.0002, OR 0.26 (95% CI 0.12 to 0.52), respectively. In contrast, past history of stroke and availability of echocardiographic information, regardless of the findings, each increased warfarin use (P=0.03, OR 1.95 [95% CI 1.04 to 3.68], and P=0.0001, OR 3.52 [95% CI 2.16 to 5.72], respectively). Old age, language difficulties, insufficient doctor alertness to warfarin benefit, and patient disability produced reluctance to treat. Warfarin use still lags behind requirements.

Rural Ozone: Trends and Exceedances at CASTNet Sites

Emission reductions were mandated in the Clean Air Act Amendments of 1990 with the expectation that they would result in major reductions in the concentrations of atmospherically transported pollutants. This paper used generalized additive models to characterize the form and magnitude of changes in ground-level ozone concentrations adjusted for concomitant meteorological conditions at 35 rural sites in the eastern US from 1989 to 1995. At all sites and for all three measures, ozone concentrations declined over the period by about 5% for the two daily measures and about 7% for the weekly average. These declines were statistically significant at 18, 17, and 21 sites (for the daily maximum 1-h, daily 8-h maximum, and weekly averages, respectively), and the median percent total change at these sites for all three measures was approximately {minus}9%. All sites were evaluated with respect to the old and new National Ambient Air Quality Standard for ozone. Under the new standard, 23 sites would not have met the standard for at least one triennial evaluation period as compared to seven sites under the old standard.

FROM TRAINING TO TESTING: DETAILS OF AN AGGRESSIVE DRILL AND EXERCISE PROGRAM

ABSTRACT With 1997 comes a second triennial period of exercises following the implementation of the Oil Pollution Act of 1990 (OPA 90). Exercises should now be performed in more of a testing environment than in a training environment. Aggressive exercises seek to test response plans and spill management teams rather than to provide opportunities for training. Aggressive exercises also require that one learn by taking risks and making mistakes. Consequently, for this aggressive style of drills and exercises to succeed, regulatory authorities must acknowledge risk taking when they are evaluating exercises. Though training will always be a focus, at least in some elements of response exercises, it should become more specific and compartmentalized while the remaining bulk of the response is being tested. Because aggressive exercises require full agency representation, joint exercises should be considered a way of reducing the number of industry-led drills while achieving credit for multiple plan holders.

Anaesthesia and maternal mortality

By international agreement obstetric deaths are divided into direct and indirect categories. Direct obstetric deaths are those resulting from obstetric complications of the pregnant state (pregnancy, labour and the puerperium), from interventions, omissions, incorrect treatment, or from a chain of events resulting from any of the above. Indirect obstetric deaths are defined as those resulting from previous existing disease, or disease that developed during pregnancy and which was not due to direct obstetric causes, but which was aggravated by physiological effects of pregnancy. In addition, fortuitous deaths are a category recorded in the Reports on Confidential Enquiries into Maternal Deaths for the triennial periods between 1976 and 1984. They are deaths which occur fortuitously in pregnancy or the puerperium from unrelated causes and these are excluded from maternal mortality as it is internationally defined. Prior to 1976 the Confidential Enquiries had classified maternal deaths as true or associated deaths. True maternal deaths roughly equated with direct deaths, associated deaths were a sum of indirect and fortuitous types. For the purposes of this review the numbers of maternal deaths and the mortality rates will refer to direct obstetric deaths as far as possible.

Incidence of multiple sclerosis in the town of Sassari, Sardinia, 1965 to 1985: evidence for increasing occurrence of the disease.

Prevalence studies carried out in Sardinia from 1975 suggest an increasing occurrence of MS. However, it is questionable whether this increase represents a real change in MS incidence or simply reflects longer survival. Data from 79 patients indicated the average annual incidence for the period 1965 through 1985 was 3.4 per 100,000. On December 31, 1985, the prevalence rate was 69 per 100,000. Evaluation of MS temporal trends showed a significant increase in MS incidence during the study period: values ranged around two per 100,000 in the triennial periods 1965-1967, 1968-1970, and 1971-1973, and around five in each triennium from 1977 onward.

UNITED STATES: Therapeutic Abortions in New York City

This report presents a continuous series of data on the number of therapeutic abortions performed in New York City in the 25-year period 1943-67 excluding the years 1948 1950 and 1963 for which the figures could not be obtained. Detailed data by type of hospital service demographic characteristics of the woman and type of indication are shown for the triennial periods 1960-62 and 1965-67. The data were derived from certificates of fetal deaths which are filed routinely in New York City under a law which requires the reporting of all fetal deaths regardless of the period of gestation. Legislation relating to abortion in New York State was unchanged during the entire period covered by this report. (excerpt)

35. Commission de la Constitution des Étoiles

The Commission has found no opportunity of acting collectively in the last triennial period. Progress in the theoretical study of the constitution of the stars must be mainly a matter of individual effort; and it would be impracticable and undesirable to seek uniformity of views and methods.A brief reference may here be made to some of the problems now especially engaging attention. In this connection I would call attention to a valuable Report on “Die Theorie des Sterninnern und die Entwicklung der Sterne” (Ergebnisse der exakten Naturwissenschaften, Bd. XVI, 1937) by a member of the Commission, B. Strömgren, which deals especially with progress in the last ten years, and shows very clearly the present state of the subject.

Department of Scientific and Industrial Research. Report of the Chemistry Research Board for the triennial period ended December 31, 1937

Department of Scientific and Industrial Research. Report of the Chemistry Research Board for the triennial period ended December 31, 1937

Chemical Research and Industry

DEPENDING upon the mood or the point of view, it is equally easy to be surprised at the large, or concerned at the small, impression which a single laboratory can make on the pile of industrial—even national—chemical problems awaiting solution. To read the report of the Chemistry Research Board and the report of the Director of Chemical Research for the triennial period 1935–1938* is to learn with what vigour and success the study of a great variety of these problems is being undertaken in the Chemical Research Laboratory at Teddington. At the same

Chemical Compounds as Carcinogenic Agents: First Supplementary Report: Literature of 1937

A review of the progress made in the study of the carcinogenic properties of chemical compounds, incorporating literature published during the triennial period between the First and Second International Cancer Congresses, was presented to the Second International Congress in Brussels, in September 1936, and was subsequently reprinted with an addendum covering most of the literature published up to the end of 1936 (231). The year 1937 has again witnessed a large output of new work in this field and this is summarised in the present report. For convenience of reference the general classification adopted in the original report has been retained and the references are numbered continuously. Chemical Relationships Group I. Cholanthrene Derivatives An interesting review of the carcinogenic properties of a number of compounds structurally related to cholanthrene was published early in the year by Fieser, Fieser, Hershberg, Newman, Seligman, and Shear (250). In the case of many of the compounds discussed the results of biological testing were necessarily of a preliminary character, and the points of view expressed may eventually require slight modification. Reference is made to some of these compounds under Group III (below). The synthesis of 4:10-dimethylene-1:2-benzanthracene, an isomeride of cholanthrene, has now been described by Fieser and Seligman (256) and the same compound was prepared by Dansi (239, 240) by a different method. This compound, when injected into rats, produces tumours of connective tissue (308); so the interesting fact emerges that of the four known isomeric “ace-1:2-benzanthracenes,” the three in which substitution occurs at a meso position of the benzanthracene molecule are all carcinogenic (cholanthrene, 8:9-dimethylene-1:2-benzanthracene, 4:10-dimethylene-1:2-benzanthracene), whereas the fourth, 3:4i-dimethylene-1:2-benzanthracene (228), in which this condition is not fulfilled, is inactive.

Institution of Civil Engineers: Awards for Papers

THE following awards have recently been made for papers read and discussed at ordinary meetings of the Institution of Civil Engineers: Telford Gold Medal to D. M. Watson. James Watt Gold Medal to Sir Noel Ashbridge. Coopers Hill War Memorial Prize to J. Guthrie Brown. Telford Premiums A. H. Naylor ; Dr. S. F. Dorey ; F. W. A. Handman ; C. L. Howard Humphreys ; G. E. Howorth ; B. W. Huntsman ; Dr. L. R. Wentholt ; Prof. S. M. Dixon, Gerald FitzGibbon and Dr. M. A. Hogan ; Prof. A. J. Sutton Pippard, Eric Tranter and Letitia Chitty ; and A. J. Dean. Indian Premium to Dr. H. J. Nichols. Trevithick Premium to D. A. Stewart. For papers published in the Journal with written discussion the following awards have been made: Webb Prize to Dr. P. L. Henderson. Manby Premium to Prof. H. W. Swift. Crampton Prize to B. D. Bichards. Telford Premiums to Dr. W. H. Glanville and F. G. Thomas ; J. C. Richards ; and Robert Ferguson. Trevithick Premiums to E. N. Webb and Prof. B. L. Goodlet. For students' papers read in London or at meetings of local associations the following awards have been made: James Forrest Medal and a Miller Prize to D. F. Orchard. Miller Prizes to S. K. Jordan ; N. C. C. de Jong ; D. M. Hamilton ; R. C. Whitehead ; Henry Grace ; and F. C. Squire. The Baker Gold Medal for the triennial period 1934-37 has been awarded to B. M. Hellstrom and the Howard Quinquennial Prize for the quinquennial period 1932-37 has been awarded to Prof. J. F. Baker. '

The Variation in the Mortality from Cancer of different Parts of the Body in Groups of Men of Different Social Status

This paper is the result of an attempt to determine if, in the different social classes obtained by a grading of a large section of the male working population of England and Wales for the triennial period 1910–12, as described by the Registrar-General in the Supplement to his 75th Annual Report, there was shown any special susceptibility to cancer in particular parts of the body. From a comparison of the standardised mortality-rates from cancer in 16 different sites in (1) men of three social grades, namely, the upper and middle classes, skilled workmen and unskilled workmen, (2) two sub-groups of the upper and middle classes and (3) men of two social classes, a higher and a lower intermediate to classes 1 and 3 and 3 and 5 respectively, it seems reasonable to draw the following conclusions:1. The mortality-rates from cancer in the majority of the parts of the body considered, including amongst others the tongue, oesophagus and stomach, which altogether account for 92 per cent, of the total deaths, are definitely higher in the men of lowest social status; the incidence decreases, though not always regularly, with ascent in the social scale.2. The mortality from cancer in other parts of the body, namely, the bowel, the prostate and probably the pancreas, is definitely highest, however, in men of the best social status.3. Though the relatively high cancer mortality-rates in these sites in the best social class may probably be attributed in some measure, which it is difficult or impossible to assess, to improved facilities for, and methods of diagnosis in this class, as compared with those in the lowest classes, this cannot be the whole explanation as the differences are considerable and as no increased mortality from cancer is evident in any of the sites except the pancreas with such an ascent in the social scale as takes place in passing from social group 1 b, to social group 1 a, where the influence of more skilful diagnosis might also be expected to reveal itself. If we may accept the mortality from hepatic cancer in the different social classes as an approximate index of the general accuracy of diagnosis of malignant disease therein, then varying accuracy of diagnosis can have little influence in producing the divergencies in mortality from cancer in these special sites that are found in the social groups under review.4. The excessive mortality from cancer of the bowel amongst males of the best social class cannot reasonably be ascribed to their habits of life such as high-feeding and easy-living or to their alleged greater liability to autointoxication. If this were so, cancer of the stomach and cancer of the rectum might also be expected to show a higher incidence in the same social class; the mortality-rates from cancer in these sites, however, are not higher in this class than in the lower social classes.

Address by Sir Wyville Thomson on delivering the Neill Prize to Dr Traquair

Dr Ramsay Traquair,—The Neill prize for the triennial period 1874-77 has been awarded to you by the Council of this Society, nominally for your paper on the structures and affinities of Tristichopterus alatus (Egerton), communicated to this Society within the required period, and published in the 27th volume of the Transactions of the Society. The Council have, however, also taken into account, as they are entitled to do by the conditions of the prize, the many contributions which you have made during some years past to the knowledge of the structure of recent and fossil fishes.

Presentation of the Neill Prize to Charles Wm. Peach

The Council having awarded the Neill Prize for the Triennial Period, 1871–74, to Mr Charles William Peach, for his contributions to Scottish Zoology and Geology, and for his recent contributions to Fossil Botany, Professor Geikie, on the presentation of the medal, addressed the President as follows:—Sir,—The Council of the Royal Society of Edinburgh has awarded the Neill Prize for the triennial period, 1871–74, to Mr Charles William Peach, and on the part of the Council I am requested to describe briefly to the Society on the present occasion the nature of his scientific work, which has been judged well deserving of one of the Society's medals.

4. Orthogonal Isothermal Surfaces

The Council reported that they had awarded the Keith Prize for the biennial period 1863–65, to Principal FORBES, St Andrews, for his “Experimental Inquiry into the Laws of Conduction of Heat in Iron Bars” which was printed in the last Part of the Transactions of the Society.The Council also reported that they had awarded the Neill Prize for the triennial period 1862–65 to Andrew Crombie Ramsay, F.R.S., Professor of Geology in the Government School of Mines, and Local Director of the Geological Survey of Great Britain, for his various works and memoirs published during the last five years, in which he has applied the large experience acquired by him in the Direction of the arduous work of the Geological Survey of Great Britain to the elucidation of important questions bearing on Geological Science.