Non-Fatal

The chemical process industry is vast and varied. The value of chemicals and chemical products in 1993 was 0.5 trillion for the Ll.S," involving 67,000 chemical engineers, 98,000 chemists. There were 5.5 non-fatal occupational injuries per 100 employees in 1995 involving chemical and allied products, and 4.8 per 100 workers in petroleum and coal products, There were 101 fatalities due to exposure to caustic, noxious or allergenic substances and 208 deaths from fires and explosions in 1995. 

However, intervention trials investigating the effects of P-carotene and lycopene supplementation on CVD have not reported convincing results (Table 3.1.3). Among the seven studies reviewed herein, four primary prevention trials, namely the Multicenter Skin Cancer Prevention Study, the Beta Carotene and Retinol Efficacy Trial, the ATBC cancer prevention study, " and the Physicians Health Study have shown no association between a supplementation of P-carotene and risk of death from CVD or fatal and non-fatal MI. 

Recent findings from the ATBC stndy even showed that P-carotene snpple-mentation increased the post-trial risk of a hrst-ever non-fatal MI. Two secondary prevention trials, the Heart Protection Stndy and the ATBC presented similar resnlts. The former showed no association between P-carotene and fatal or non-fatal vascular events and the latter reported signihcantly increased risks of fatal coronary events in the P-carotene-snpplemented gronp. Resnlts of clinical trials focused on the effects of carotenoids on CVD biomarkers are controversial. Although carotenoid supplementation increased sernm levels,only lycopene was shown to be inversely associated with lipid, protein, DNA and LDL oxidation, and plasma cholesterol levels. - - ... 

A fibrate derivative or niacin should be considered in select patients with a low high-density lipoprotein (HDL) cholesterol less than 40 mg/dL (1.04 mmol/L) and/or a high triglyceride level greater than 200 mg/dL (2.26 mmol/L). In a large randomized trial in men with established CAD and low levels of HDL cholesterol, the use of gemfibrozil (600 mg twice daily) significantly decreased the risk of non-fatal myocardial infarction or death from coronary causes.78... 

Randomized trials have been completed assessing the role of antiplatelet therapy with aspirin for primary stroke prevention. The use of aspirin in patients with no history of stroke or ischemic heart disease reduced the incidence of non-fatal myocardial infarction (MI) but not of stroke. A meta-analysis of eight trials found that the risk of stroke was slightly increased with aspirin use, especially hemorrhagic stroke. Major bleeding risk was also increased with aspirin use.4 Aspirin is beneficial in the primary prevention of MI, but not for primary stroke prevention. 

Hyperlipidemia has not clearly been established as a risk factor for stroke, although it is a modifiable risk factor for coronary heart disease. Recent studies show that statin use may reduce the incidence of a first stroke in high-risk patients (e.g., hypertension, coronary heart disease, or diabetes) including patients with normal lipid levels. A recent meta-analysis showed a 25% risk reduction for fatal and non-fatal strokes with statin use.4 Patients with a history of MI, elevated lipid levels, diabetes, and... 

Poor sleep architecture and fragmented sleep secondary to OSA can cause excessive daytime sleepiness (EDS) and neu-rocognitive deficits. These sequelae can affect quality of life and work performance and may be linked to occupational and motor vehicle accidents. OSA is also associated with systemic disease such as hypertension, heart failure, and stroke.21-23 OSA is likely an independent risk factor for the development of hypertension.24 Further, when hypertension is present, it is often resistant to antihypertensive therapy. Fatal and non-fatal cardiovascular events are two- to threefold higher in male patients with severe OSA.25 OSA is associated with or aggravates biomarkers for cardiovascular disease, including C-reactive protein and leptin.26,27 Patients with sleep apnea often are obese and maybe predisposed to weight gain. Hence, obesity may further contribute to cardiovascular disease in this patient population. 

Pearce, D. S. (1976) Detection and quantitation of phencyclidine in blood by use of [JH5] phencyclidine and select ion monitoring applied to non-fatal cases of phencyclidine intoxication. Clin. Chem., 22 1623-1626. 

Ansell M, Lewis FAS. 1970. A review of cyanide concentrations found in human organs A survey of literature concerning cyanide metabolism, normal, non-fatal, and fatal body cyanide levels. J Forensic Med 17 148-155. 

Nashelsky et al. (1995) described one non-fatal assault and three deaths in which chloroform was utilized. Blood and/or tissue concentrations of chloroform were determined in the assault victim and one decedent within 24 hours, within 10 days in another decedent who was frozen for the majority of that period, and after 5 months without preservation in the last decedent. Blood concentrations in 2 decedents were 2 and 3 pg/mL fat concentrations were 10 and 42 pg/mL brain concentrations were 3 and 46 pg/mL and the liver concentration in one decedent was 24 pg/mL. Due to the nature of the tissues analyzed, these data should be regarded as qualitative indicators of chloroform absorption only. 

NRDC estimated that between 100 and 300 deaths each year (depending on which of the provided estimates were used) may be attributable to the subtherapeutic use of penicillin and the tetracyclines in animal feeds. In addition, some 270,000 non-fatal cases of salmonellosis may also be due to the subtherapeutic use of antibiotics (penicillin and the tetracyclines) in animal feeds. 

Guinea pigs exposed to 40,000 ppm appeared uncoordinated in 3 minutes, had eye irritation, and were unable to stand after 40 minutes some animals died from exposure for 9 hours, but exposure for 4.5 hours was non-fatal histopathologic changes in the lungs, liver, and kidneys were observed in euthanized animals of the latter group. ... 

PTCA versus traditional CABG in multi-vessel disease (2 or 3 vessel disease without left main disease) yielded similar results [21-23]. Invariably, overall survival and non-fatal myocardial infarction were similar however, CABG provided more symptom... 

Fig. 5.3 Results of TACTICS TIMI 18. Primary end point of death, non-fatal myocardial infarction, and rehospitalization for acute coronary syndrome at 6 months based on baseline patient characteristics ( 2001 Massachusetts Medical Society)...

Previous randomized controlled trials of diuretic- or -blocker-based regimens, involving a total of about 47,000 patients with hypertension, have collectively demonstrated that, over an average of about 5 years, such treatment produced much of the epidemiologi-cally expected benefit of the achieved BP reductions. A net reduction of 5-6 mmHg in usual DBP was associated with a 38% reduction in stroke risk and a 16% reduction in coronary heart disease (CHD) risk, with similar effects on fatal and non-fatal events. 

Chance, T. and Scannapieco, M. (2002) Ecological correlates of child maltreatment similiarities and differences between child fatality and non-fatality cases. Child and Adolescent Social WorkJournal 19, 139-161. 

An excessive mortality or non-fatal cardiac arrest rate was observed in pat ients with non-life-threatening ventricular arrhythmias who had a recent Ml. 

Another way of avoiding adjustment is to combine the multiple measurements into a single composite variable. Examples would be disease-lfee survival in oncology, where the variable is the time to either disease recurrence or death, whichever occurs first, or a composite of death, non-fatal stroke, MI and heart failure, a binary outcome in a cardiovascular setting. This approach does not require adjustment of the significance level we are back to having a single primary endpoint. 

There are some additional requirements, however, when using composite variables and these relate to the individual components, which should all be supportive of a difference in a single direction. A large positive effect with one of the components could potentially be masking a negative effect in a different component and this would be unacceptable. One way of investigating this would be to consider treatment effects in terms of the components singly. Alternatively, clinically appropriate combinations can be considered. For example, with the binary outcome, death, non-fatal stroke, MI and heart failure, one approach could be to break down the binary outcome into three separate outcome variables at the first level ... 

Cl) = 0.30 - 0.92] was offset by an increased risk of death in remission (OR = 2.22, 95% Cl = 1.20 - 4.14), mainly due to infections. Strikingly, 11% of patients in the 6-TG arm compared to less than 2% in the 6-MP arm developed non-fatal hepatic toxicity with features of veno-occlusive disease (VOD) characterized by symptoms including tender hepatomegaly, hyperbilirubinaemia with elevated aminotransferases, thrombocytopenia out of proportion to neutropenia, and portal hypertension. In 85% of affected 6-TG recipients, these symptoms were observed during maintenance or interim maintenance. Of interest, in patients randomized to 6-MP, hepatic toxicity was associated with intensification elements in which both treatment arms received exclusively 6-TG. 

Wheeler BW et al The population impact on incidence of suicide and non-fatal self harm of regulatory action against the use of selective serotonin reuptake inhibitors in under 18s in the United Kingdom Ecological study. Br Med J 2008 336(7643) 542. [PMID 18276667]... 

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