Pane, Masdalina; Imari, Sholah; Alwi, Qomariah; Nyoman Kandun, I; Cook, Alex R.; Samaan, Gina
Background Indonesia provides the largest single source of pilgrims for the Hajj (10%). In the last two decades, mortality rates for Indonesian pilgrims ranged between 200–380 deaths per 100,000 pilgrims over the 10-week Hajj period. Reasons for high mortality are not well understood. In 2008, verbal autopsy was introduced to complement routine death certificates to explore cause of death diagnoses. This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings. Methods Public health surveillance was conducted by Indonesian public health authorities accompanying pilgrims to Saudi Arabia, with daily reporting of hospitalizations and deaths. Surveillance data from 2008 were analyzed for timing, geographic location and site of death. Percentages for each cause of death category from death certificates were compared to that from verbal autopsy. Results In 2008, 206,831 Indonesian undertook the Hajj. There were 446 deaths, equivalent to 1,968 deaths per 100,000 pilgrim years. Most pilgrims died in Mecca (68%) and Medinah (24%). There was no statistically discernible difference in the total mortality risk for the two pilgrimage routes (Mecca or Medinah first), but the number of deaths peaked earlier for those traveling to Mecca first (p=0.002). Most deaths were due to cardiovascular (66%) and respiratory (28%) diseases. A greater proportion of deaths were attributed to cardiovascular disease by death certificate compared to the verbal autopsy method (pIndonesian pilgrim mortality rates were very high. Correct classification of cause of death is critical for the development of risk mitigation strategies. Since verbal autopsy classified causes of death differently to death certificates, further studies are needed to assess the method’s utility in this setting. PMID:23991182
Mackenbach, J. P.; Kunst, A. E.; Lautenbach, H.; Oei, Y. B.; Bijlsma, F.
BACKGROUND: Despite the widespread interest in competing causes of death, empirical information on interrelationships between causes of death is scarce. We have used death certificate information to estimate the prevalence of competing causes of death at the moment of dying from specific underlying
Vandormael, Sofie; Meirschaert, Alexander; Steyaert, Jan; De Lepeleire, Jan
For our master thesis in medicine, we aimed to determine how many deaths were caused by and with dementia in 2014 and we compared our results with figures from abroad. The mortality rates of 2014 in Flanders were used to determine the amount of deaths related to dementia. These figures are collected by Vlaams Agentschap Zorg & Gezondheid (VAZG) and coded per ICD-10 classification. Of all deaths in Flanders in 2014, 6.60% were caused by dementia and 4.29% were caused by another condition, while also suffering from dementia. Data from abroad are ambiguous. While working on our thesis about "death & dementia", we questioned the reliability of mortality statistics. Possible explanations could be; the complexity of completing death certificates correctly and the challenges involved in properly constructing a chain of causes of death. The accuracy of mortality data can be improved by training and redrafting death certificates.
Santana, Vilma S; Algranti, Eduardo; Campos, Felipe; Cavalcante, Franciana; Salvi, Leonardo; Santos, Simone A; Inamine, Rosemeire N; Souza, William; Consonni, Dario
In Brazil, underreporting of mesothelioma and cancer of the pleura (MCP) is suspected to be high. Records from death certificates (SIM) and hospital registers (SIH-SUS) can be combined to recover missing data but only anonymous databases are available. This study shows how common data can be used for linkage and as an assessment of accuracy. Mesothelioma (all sites, ICD-10 codes C45.0-C45.9) and cancer of the pleura (C38.4) were retrieved from both information systems and combined using a linkage algorithm. Accuracy was examined with non-anonymous databases, limited to the state of São Paulo. We found 775 cases in death certificates and 283 in hospital registers. The linkage matched 57 cases, all accurately paired. Three cases, 0.4% in SIM and 1.3% in SIH-SUS, could not be matched because of data inconsistencies. A computer linkage can recover MCP cases from hospital records not found in death certificates in Brazil. © 2018 Wiley Periodicals, Inc.
McGivern, Lauri; Shulman, Leanne; Carney, Jan K; Shapiro, Steven; Bundock, Elizabeth
Errors in cause and manner of death on death certificates are common and affect families, mortality statistics, and public health research. The primary objective of this study was to characterize errors in the cause and manner of death on death certificates completed by non-Medical Examiners. A secondary objective was to determine the effects of errors on national mortality statistics. We retrospectively compared 601 death certificates completed between July 1, 2015, and January 31, 2016, from the Vermont Electronic Death Registration System with clinical summaries from medical records. Medical Examiners, blinded to original certificates, reviewed summaries, generated mock certificates, and compared mock certificates with original certificates. They then graded errors using a scale from 1 to 4 (higher numbers indicated increased impact on interpretation of the cause) to determine the prevalence of minor and major errors. They also compared International Classification of Diseases, 10th Revision (ICD-10) codes on original certificates with those on mock certificates. Of 601 original death certificates, 319 (53%) had errors; 305 (51%) had major errors; and 59 (10%) had minor errors. We found no significant differences by certifier type (physician vs nonphysician). We did find significant differences in major errors in place of death ( P statistics. Surveillance and certifier education must expand beyond local and state efforts. Simplifying and standardizing underlying literal text for cause of death may improve accuracy, decrease coding errors, and improve national mortality statistics.
Full Text Available Death certificates are a primary data source for assessing the population burden of diseases; however, there are concerns regarding their accuracy. Diagnosis-Related Group (DRG coding of a terminal hospitalization may provide an alternative view. We analyzed the rate and patterns of disagreement between death certificate data and hospital claims for patients who died during an inpatient hospitalization.We studied respondents from the Health and Retirement Study (a nationally representative sample of older Americans who had an inpatient death documented in the linked Medicare claims from 1993-2007. Causes of death abstracted from death certificates were aggregated to the standard National Center for Health Statistics List of 50 Rankable Causes of Death. Centers for Medicare and Medicaid Services (CMS-DRGs were manually aggregated into a parallel classification. We then compared the two systems via 2×2, focusing on concordance. Our primary analysis was agreement between the two data sources, assessed with percentages and Cohen's kappa statistic.2074 inpatient deaths were included in our analysis. 36.6% of death certificate cause-of-death codes agreed with the reason for the terminal hospitalization in the Medicare claims at the broad category level; when re-classifying DRGs without clear alignment as agreements, the concordance only increased to 61%. Overall Kappa was 0.21, or "fair." Death certificates in this cohort redemonstrated the conventional top 3 causes of death as diseases of the heart, malignancy, and cerebrovascular disease. However, hospitalization claims data showed infections, diseases of the heart, and cerebrovascular disease as the most common diagnoses for the same terminal hospitalizations.There are significant differences between Medicare claims and death certificate data in assigning cause of death for inpatients. The importance of infections as proximal causes of death is underestimated by current death certificate
Stone, R S; Anderson, Jr, P S
In this report evaluation of the death certificates has been on the basis of comparison with recorded autopsy diagnoses without review of the latter. An attempt has been made to evaluate limitations inherent in this method. The cases analyzed here represent the ABCC Hiroshima autopsy series from 1949 through 1959. Post mortem examinations on stillbirths and neonatal deaths that were collected during the years 1948 through 1953 were excluded from consideration because such cases are not pertinent to the general problems under study. With this limitation 1304 cases were available for matching. In 139 of these cases the death certificates were not available through the mechanisms of the overall study, so 1165 cases remained. Before comparisons are made the most important questions that must be answered about the materials and methods of the present investigation are: (1) is the autopsy-death certificate series a representative sample of all deaths in the population; (2) are the autopsy diagnoses correct; (3) are the death certificates properly understood and coded; and (4) are biologically meaningful groupings chosen for comparison between autopsy cause of death and death certificate cause of death. Because it is not possible to provide exact answers to all of these questions the doubt that they raise must be admitted but evaluated in the perspective of that part of the answer which is known.
Rhee, YongJoo; Houttekier, Dirk; MacLeod, Roderick; Wilson, Donna M; Cardenas-Turanzas, Marylou; Loucka, Martin; Aubry, Regis; Teno, Joan; Roh, Sungwon; Reinecke, Mark A; Deliens, Luc; Cohen, Joachim
The places of death for people who died of suicide were compared across eight countries and socio-demographic factors associated with home suicide deaths identified. Death certificate data were analyzed; using multivariable binary logistic regression to determine associations. National suicide death rates ranged from 1.4 % (Mexico) to 6.4 % (South Korea). The proportion of suicide deaths occurring at home was high, ranging from 29.9 % (South Korea) to 65.8 % (Belgium). Being older, female, widowed/separated, highly educated and living in an urban area were risk factors for home suicide. Home suicide deaths need specific attention in prevention programs.
Full Text Available BackgroundCancer monitoring and prevention relies on the critical aspect of timely notification of cancer cases. However, the abstraction and classification of cancer from the free-text of pathology reports and other relevant documents, such as death certificates, exist as complex and time-consuming activities.AimsIn this paper, approaches for the automatic detection of notifiable cancer cases as the cause of death from free-text death certificates supplied to Cancer Registries are investigated.Method A number of machine learning classifiers were studied. Features were extracted using natural language techniques and the Medtex toolkit. The numerous features encompassed stemmed words, bi-grams, and concepts from the SNOMED CT medical terminology. The baseline consisted of a keyword spotter using keywords extracted from the long description of ICD-10 cancer related codes.ResultsDeath certificates with notifiable cancer listed as the cause of death can be effectively identified with the methods studied in this paper. A Support Vector Machine (SVM classifier achieved best performance with an overall F-measure of 0.9866 when evaluated on a set of 5,000 free-text death certificates using the token stem feature set. The SNOMED CT concept plus token stem feature set reached the lowest variance (0.0032 and false negative rate (0.0297 while achieving an F-measure of 0.9864. The SVM classifier accounts for the first 18 of the top 40 evaluated runs, and entails the most robust classifier with a variance of 0.001141, half the variance of the other classifiers.ConclusionThe selection of features significantly produced the most influences on the performance of the classifiers, although the type of classifier employed also affects performance. In contrast, the feature weighting schema created a negligible effect on performance. Specifically, it is found that stemmed tokens with or without SNOMED CT concepts create the most effective feature when combined with
Accurate and consistent death certification facilitates morbidity and mortality surveillance, and consequently supports evidence-informed health policies. The paper initially explores the current death certification practice in Slovenia, and identifies related deficiencies and system inconsistencies. Finally, the paper outlines a conceptualization of ICT-based model of death certification including renovation of business processes and organizational changes. The research is based on focus group methodology. Structured discussions were conducted with 29 experts from cross-sectional areas related to death certification. Research results imply that effective ICT-based transformation of the existing death certification model should involve a redefinition of functions and relationships between the main actors, as well as a reconfiguration of the technological, organizational, and regulatory elements in the field. The paper provides an insight into the complexities of the death certification and may provide the groundwork for ICT-based transformation of the death certification model in Slovenia.
Burger, E H; Groenewald, P; Rossouw, A; Bradshaw, D
Despite improvements to the Death Notification Form (DNF) used in South Africa (SA), the quality of cause-of-death information remains suboptimal. To address these inadequacies, the government ran a train-the-trainer programme on completion of the DNF, targeting doctors in public sector hospitals. Training materials were developed and workshops were held in all provinces. This article reflects on the lessons learnt from the training and highlights issues that need to be addressed to improve medical certification and cause-of-death data in SA. The DNF should be completed truthfully and accurately, and confidentiality of the information on the form should be maintained. The underlying cause of death should be entered on the lowest completed line in the cause-of-death section, and if appropriate, HIV should be entered here. Exclusion clauses for HIV in life insurance policies with Association of Savings and Investments South Africa companies were scrapped in 2005. Interactive workshops provide a good learning environment, but are logistically challenging. More use should be made of online training resources, particularly with continuing professional development accreditation and helpline support. In addition, training in the completion of the DNF should become part of the curriculum in all medical schools, and part of the orientation of interns and community service doctors in all facilities.
Haque, Ahmed Suleman; Shamim, Kanza; Siddiqui, Najm Hasan; Irfan, Muhammad; Khan, Javaid Ahmed
Death certificates (DC) can provide valuable health status data regarding disease incidence, prevalence and mortality in a community. It can guide local health policy and help in setting priorities. Incomplete and inaccurate DC data, on the other hand, can significantly impair the precision of a national health information database. In this study we evaluated the accuracy of death certificates at a tertiary care teaching hospital in a Karachi, Pakistan. A retrospective study conducted at Aga Khan University Hospital, Karachi, Pakistan for a period of six months. Medical records and death certificates of all patients who died under adult medical service were studied. The demographic characteristics, administrative details, co-morbidities and cause of death from death certificates were collected using an approved standardized form. Accuracy of this information was validated using their medical records. Errors in the death certificates were classified into six categories, from 0 to 5 according to increasing severity; a grade 0 was assigned if no errors were identified, and 5, if an incorrect cause of death was attributed or placed in an improper sequence. 223 deaths occurred during the study period. 9 certificates were not accessible and 12 patients had incomplete medical records. 202 certificates were finally analyzed. Most frequent errors pertaining to patients' demographics (92%) and cause/s of death (87%) were identified. 156 (77%) certificates had 3 or more errors and 124 (62%) certificates had a combination of errors that significantly changed the death certificate interpretation. Only 1% certificates were error free. A very high rate of errors was identified in death certificates completed at our academic institution. There is a pressing need for appropriate intervention/s to resolve this important issue.
Leitao, Jordana; Chandramohan, Daniel; Byass, Peter; Jakob, Robert; Bundhamcharoen, Kanitta; Choprapawon, Chanpen; de Savigny, Don; Fottrell, Edward; França, Elizabeth; Frøen, Frederik; Gewaifel, Gihan; Hodgson, Abraham; Hounton, Sennen; Kahn, Kathleen; Krishnan, Anand; Kumar, Vishwajeet; Masanja, Honorati; Nichols, Erin; Notzon, Francis; Rasooly, Mohammad Hafiz; Sankoh, Osman; Spiegel, Paul; AbouZahr, Carla; Amexo, Marc; Kebede, Derege; Alley, William Soumbey; Marinho, Fatima; Ali, Mohamed; Loyola, Enrique; Chikersal, Jyotsna; Gao, Jun; Annunziata, Giuseppe; Bahl, Rajiv; Bartolomeus, Kidist; Boerma, Ties; Ustun, Bedirhan; Chou, Doris; Muhe, Lulu; Mathai, Matthews
Objective Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. Methods A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. Findings A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. Conclusions The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians. PMID
Redelings, Matthew D; Wise, Matthew; Sorvillo, Frank
Death rarely results from only one cause, and it can be caused by a variety of factors. Multiple cause-of-death data files can list as many as 20 contributing causes of death in addition to the reported underlying cause of death. Analysis of multiple cause-of-death data can provide information on associations between causes of death, revealing common combinations of events or conditions which lead to death. Additionally, physicians report the causal train of events through which they believe that different conditions or events may have led to each other and ultimately caused death. In this paper, the authors discuss methods used in studying associations between reported causes of death and in investigating commonly reported causal pathways between events or conditions listed on the death certificate.
Collins, C J
The documentation of infection with meticillin-resistant Staphylococcus aureus (MRSA) on death certificates has been the subject of considerable public discussion. Using data from five tertiary referral hospitals in Ireland, we compared the documentation of MRSA and meticillin-susceptible S. aureus (MSSA) on death certificates in those patients who died in hospital within 30 days of having MRSA or MSSA isolated from blood cultures. A total of 133 patients had MRSA or MSSA isolated from blood cultures within 30 days of death during the study period. One patient was excluded as the death certificate information was not available; the other 132 patients were eligible for inclusion. MRSA and MSSA were isolated from blood cultures in 59 (44.4%) and 74 (55.6%) cases respectively. One patient was included as a case in both categories as both MRSA and MSSA were isolated from a blood culture. In 15 (25.4%) of the 59 MRSA cases, MRSA was documented on the death certificate. In nine (12.2%) of the 74 patients with MSSA cases, MSSA was documented on the death certificate. MRSA was more likely to be documented on the death certificate than MSSA (odds ratio: 2.46; 95% confidence interval: 1.01-6.01; P < 0.05). These findings indicate that there may be inconsistencies in the way organisms and infections are documented on death certificates in Ireland and that death certification data may underestimate the mortality related to certain organisms. In particular, there appears to be an overemphasis by certifiers on the documentation of MRSA compared with MSSA.
Ron, E.; Carter, R.L.; Jablon, S.; Mabuchi, Kiyohiko.
Using the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation series of over 5000 autopsies, we examined death-certificate accuracy for several disease categories and assessed the effect of potential modifying factors on this accuracy. For 12 cause-of-death categories, the overall percent agreement between death-certificate and autopsy diagnoses was only 52.5%. Although neoplasms had the highest detection rate (on the death certificate) in the study, still almost 25% of cancers diagnosed at autopsy were missed on the death certificate. Only for neoplasms and external causes of death were confirmation and detection rates above 70%. Confirmation rates were between 50% and 70% for infectious and parasitic diseases and heart and other vascular diseases. Detection rates reached a similar level for infectious and parasitic, cerebrovascular, and digestive diseases. Specificity rates were above 90% for all but the cerebrovascular disease category. Overall agreement decreased with increasing age of the decedents and was lower for deaths occurring outside of hospital vs those occurring in a hospital. There was some suggestion that agreement rates were higher for more-recent deaths but no indication that radiation dose, sex, city of residence, or inclusion in a biennial clinical-examination program influenced agreement. Because the inaccuracy of death-certificate diagnoses can have major implications for many aspects of health research and planning, it is important to be aware that death-certificate accuracy is low and can vary widely depending on the patient's age at death and the place of death. (J.P.N.)
Moscovich, Mariana; Boschetti, Gabriela; Moro, Adriana; Teive, Helio A G; Hassan, Anhar; Munhoz, Renato P
Assessment of variables related to mortality in Parkinson disease (PD) and other parkinsonian syndromes relies, among other sources, on accurate death certificate (DC) documentation. We assessed the documentation of the degenerative disorder on DCs and evaluated comorbidities and causes of death among parkinsonian patients. Demographic and clinical data were systematically and prospectively collected on deceased patients followed at a tertiary movement disorder clinic. DCs data included the documentation of parkinsonism, causes, and place of death. Among 138 cases, 84 (60.9%) male, mean age 77.9 years, mean age of onset 66.7, and mean disease duration 10.9 years. Clinical diagnoses included PD (73.9%), progressive supranuclear palsy (10.9%), multiple system atrophy (7.2%), Lewy body dementia (7.2%) and corticobasal degeneration (0.7%). Psychosis occurred in 60.1% cases, dementia in 48.5%. Most PD patients died due to heterogeneous causes before reaching advanced stages. Non-PD parkinsonian patients died earlier due to causes linked to the advanced neurodegenerative process. PD was documented in 38.4% of DCs with different forms of inconsistencies. That improved, but remained significant when it was signed by a specialist. More than half of PD cases died while still ambulatory and independent, after a longer disease course and due to causes commonly seen in that age group. Deaths among advanced PD patients occurred due to causes similar to what we found in non-PD cases. These findings can be useful for clinical, prognostic and counseling purposes. Underlying parkinsonian disorders are poorly documented in DCs, undermining its' use as sources of data collection. Copyright © 2017 Elsevier Ltd. All rights reserved.
Garcia-Ptacek, Sara; Kåreholt, Ingemar; Cermakova, Pavla; Rizzuto, Debora; Religa, Dorota; Eriksdotter, Maria
The causes of death in dementia are not established, particularly in rarer dementias. The aim of this study is to calculate risk of death from specific causes for a broader spectrum of dementia diagnoses. Cohort study. Swedish Dementia Registry (SveDem), 2007-2012. Individuals with incident dementia registered in SveDem (N = 28,609); median follow-up 741 days. Observed deaths were 5,368 (19%). Information on number of deaths and causes of mortality was obtained from death certificates. Odds ratios for the presence of dementia on death certificates were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox hazards regression for cause-specific mortality, using Alzheimer's dementia (AD) as reference. Hazard ratios for death for each specific cause of death were compared with hazard ratios of death from all causes (P-values from t-tests). The most frequent underlying cause of death in this cohort was cardiovascular (37%), followed by dementia (30%). Dementia and cardiovascular causes appeared as main or contributory causes on 63% of certificates, followed by respiratory (26%). Dementia was mentioned less in vascular dementia (VaD; 57%). Compared to AD, cardiovascular mortality was higher in individuals with VaD than in those with AD (HR = 1.82, 95% CI = 1.64-2.02). Respiratory death was higher in individuals with Lewy body dementia (LBD, including Parkinson's disease dementia and dementia with Lewy bodies, HR = 2.16, 95% CI = 1.71-2.71), and the risk of respiratory death was higher than expected from the risk for all-cause mortality. Participants with frontotemporal dementia were more likely to die from external causes of death than those with AD (HR = 2.86, 95% CI = 1.53-5.32). Dementia is underreported on death certificates as main and contributory causes. Individuals with LBD had a higher risk of respiratory death than those with AD. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley
Calvo-Alén, J; Alarcón, G S; Campbell, R; Fernández, M; Reveille, J D; Cooper, G S
To determine to what extent the diagnosis of systemic lupus erythematosus (SLE) in deceased lupus patients is under-reported in death certificates, and the patient characteristics associated with such an occurrence. The death certificates of 76 of the 81 deceased SLE patients from two US lupus cohorts (LUMINA for Lupus in Minorities: Nature vs Nurture and CLU for Carolina Lupus Study), including 570 and 265 patients, respectively, were obtained from the Offices of Vital Statistics of the states where the patients died (Alabama, Georgia, North Carolina, South Carolina, Tennessee and Texas). Both cohorts included patients with SLE as per the American College of Rheumatology criteria, aged > or =16 yr, and disease duration at enrolment of < or =5 yr. The median duration of follow-up in each cohort at the time of these analyses ranged from 38.1 to 53.0 months. Standard univariable analyses were performed comparing patients with SLE recorded anywhere in the death certificate and those without it. A multivariable logistic regression model was performed to identify the variables independently associated with not recording SLE in death certificates. In 30 (40%) death certificates, SLE was not recorded anywhere in the death certificate. In univariable analyses, older age was associated with lack of recording of SLE in death certificates [mean age (standard deviation) 50.9 (15.6) years and 39.1 (18.6) yr among those for whom SLE was omitted and included on the death certificates, respectively, P = 0.005]. Patients without health insurance, those dying of a cardiovascular event and those of Caucasian ethnicity were also more likely to be in the non-recorded group. In the multivariable analysis, variables independently associated with not recording SLE as cause of death were older age [odds ratio = (95% confidence interval) 1.043 (1.005-1.083 per yr increase); P = 0.023] and lack of health insurance [4.649 (1.152-18.768); P = 0.031]. A high proportion of SLE diagnoses are not
Cohen, Joachim; Dierickx, Sigrid; Penders, Yolanda W H; Deliens, Luc; Chambaere, Kenneth
Death certificates are the main source of information on the incidence of the direct and underlying causes of death, but may be unsuitable for monitoring the practice of medical assistance in dying, e.g. euthanasia, due to possible underreporting. This study examines the accuracy of certification of euthanasia. Mortality follow-back survey using a random sample of death certificates (N = 6871). For all cases identified as euthanasia we checked whether euthanasia was reported as a cause of death on the death certificate. We used multivariable logistic regression analysis to evaluate whether reporting varied according to patient and decision-making characteristics. Through the death certificates, 0.7% of all deaths were identified as euthanasia, compared with 4.6% through the mortality follow-back survey. Only 16.2% of the cases identified from the survey were reported on the death certificate. Euthanasia was more likely to be reported on the death certificate where death was from cancer (14% covered), neurological diseases (22%) and stroke (28%) than from cardiovascular disease (7%). Even when the recommended drugs were used or the physician self-labelled the end-of-life decision as euthanasia, euthanasia was only reported on the death certificate in 24% of cases. Death certificates substantially underestimate the frequency of euthanasia as a cause of death in Belgium. Mortality follow-back studies are essential complementary instruments to examine and monitor the practice of euthanasia more accurately. Death certificate forms may need to be modified and clear guidelines provided to physicians about recording euthanasia to ensure more accurate certification.
Cirera, Lluís; Salmerón, Diego; Martínez, Consuelo; Bañón, Rafael María; Navarro, Carmen
After the return of Spain to democracy and the regional assumption of government powers, actions were initiated to improve the mortality statistics of death causes. The objective of this work was to describe the evolution of the quality activities improvements into the statistics of death causes on Murcia's region during 1989 to 2011. Descriptive epidemiological study of all death documents processed by the Murcia mortality registry. Use of indicators related to the quality of the completion of death in medical and judicial notification; recovery of information on the causes and circumstances of death; and impact on the statistics of ill-defined, unspecific and less specific causes. During the study period, the medical notification without a temporary sequence on the death certificate (DC) has decreased from 46% initial to 21% final (p less than 0.001). Information retrieval from sources was successful in 93% of the cases in 2001 compared to 38%, at the beginning of the period (p less than 0.001). Regional rates of ill-defined and unspecific causes fell more than national ones, and they were in the last year with a differential of 10.3 (p less than 0.001) and 2.8 points (p=0.001), respectively. The medical death certification improved in form and suitability. Regulated recovery of the causes of death and circumstances corrected medical and judicial information. The Murcia's region presented lower rates in less specified causes and ill-defined entities than national averages.
Ron, E.; Hoel, D.G.; Carter, R.L.; Mabuchi, Kiyohiko.
Over the past few years, several reports have suggested a recent increase in cancer mortality based on death-certificate diagnoses. To explore the effect of death-certificate errors on temporal trends in cancer mortality rates, we analyzed the data from the Atomic Bomb Casualty Commission/Radiation Effects Research Foundation's autopsy program in Hiroshima and Nagasaki. This series includes 5886 autopsies conducted between 1961 and 1987. Our analyses were focused on lymphoma, cancer of the breast, neoplasms of the brain, multiple myeloma, and melanoma (172 cases, total) because of concern over reports of their increased mortality. These 172 autopsy cases were referred to as Cancers of Interest. A significant increase in detection rates was observed for these Cancers of Interest primarily due to a large rise in mortality between 1976 and 1987. For the remaining cancers excluding stomach and lung (defined as Other), the pattern was similar to that seen for Cancers of Interest, but the fluctuation over time was not statistically significant. Confirmation rates generally increased with time except for Cancers of Interest. As a measure of bias in mortality rates due to death-certification errors and as a method to quantify under- or overestimation of death-certificate-based mortality rates,an adjustment factor (confirmation rate divided by detection rate) was calculated. The higher the adjustment factor, the greater the need to compensate for underreporting. For Cancers of Interest the adjustment factor decreased dramatically over time, but it did not change significantly for Other cancers. When the adjustment factors for Cancers of Interest and Other were compared, a statistically significant difference was found. For Cancers of Interest, a significant interaction between type of cancer and period was seen. Our findings indicate that considerable care must be shown when interpreting temporal trends in cancer vital statistics. (author)
Graham, Jason K; Hanzlick, Randy
Historically, the duty of the medical examiner in assigning cause and manner of death in drug-related death cases has been fraught with controversial challenges. The lack of standardization in certifying drug-related deaths may involve differences among practicing forensic pathologists in their approach to such cases. The central objectives of the present study include characterization of current drug death patterns and the variability among medical examiners with respect to autopsy performance and death certification practices in one county medical examiner's office. Death certificates, scene information/investigative reports, autopsy reports, and toxicological laboratory results for each of the 100 cases of drug-related death occurring in 2002 in Fulton County, Georgia were reviewed. Comparison of overall autopsy rates and autopsy rates in drug-related death cases for each medical examiner individually and for the group collectively was performed. In examining cocaine-related deaths (most common), statistical analysis was performed for comparison of drug concentrations (cocaine and benzoylecgonine) between deaths certified as cocaine toxicity (poisoning) versus cocaine-complicating disease or causing an adverse event such as cerebral hemorrhage. Causes of accidental drug deaths included cocaine 40%, mixed drug intoxication 37%, opioids 10%, ethanol 7%, and prescription medication (nonopioid) 5%. Overall total autopsy rates in 2002 for each of the 6 independent medical examiners ranged from 51% to 69% (mean 64%), whereas autopsy rates in drug-related death ranged from 55% to 91% (mean 81%). In review of the subset of 40 cocaine-related deaths, 25% were certified as cocaine toxicity (poisoning), with the remaining 75% certified as cocaine-complicating disease or causing and adverse event. Autopsy rates in cocaine-related deaths were as follows: cocaine toxicity 80%, cocaine-complicating disease 77.3%, and cocaine causing adverse event 62.5%. Thirty-eight percent of
Qaddumi, Jamal A S; Nazzal, Zaher; Yacoub, Allam; Mansour, Mahmoud
Mortality data are essential for many aspects of everyday public health practices at both national and international levels. Despite the current developments in various aspects of the medical field, the apparent inability of physicians to complete death notification forms (DNF) accurately is still worldwide concern. The aim of this study is to assess the physicians' knowledge and practice on completing the DNF. A self-administered questionnaire was distributed to 200 physicians in governmental and non-governmental hospitals in the North West-Bank in Palestine. Furthermore, a case scenario was included in the questionnaire and physicians were asked to fill the cause of death section. The percentage of errors committed while completing the cause of death section were computed. A Chi square test was used to assess the association between physicians' characteristics and their responses. Only 40.6% of the participants completed the cause of death section correctly. The immediate and underlying causes of death were correctly identified by 48.7% and 71.3% of physicians, respectively. Almost one-fifth (17.3%) of physicians wrote the mechanism of death without reporting the underlying cause of death and 14.7% of them reported the sequence of events leading to death incorrectly. Physicians' knowledge and practice on completing the DNF is poor and insufficient, which may seriously affect the accuracy of mortality data. Complicated cases, problems in the current design of the DNFs and lack of training were the most common factors contributing to inaccuracy in death certification. We recommend offering periodical training workshops on completing the DNF to all physicians, and developing a manual on completing the DNFs with clear instructions and guidelines.
Polednak, Anthony P
Temporal trends in mortality from bipolar disorder (BD) or depression in the US population, based on multiple causes (MC) rather than underlying cause (UC) alone on death certificates, apparently have not been examined. The annual US age-standardized rate (ASR) for deaths per 100,000 US residents age 15+ years, and age-specific rates, for BD or depression using MC versus UC alone was examined for 1999-2009; percentage change (PC) from 1999 to 2009 was calculated. The ASRs at age 15+ years were much higher using MC than UC alone. For BD using MC, the ASR increased from 1999 to 2009 (PC +69.2 %) with larger increases in age groups within 15-64 years (PCs about 200 %). For depression using MC, the ASR rose from 1999 to 2003 and then declined, but the decline was restricted to age 65+ years; the ASR at age 15-64 years increased from 1999 to 2009 (PC +55.5 %). For deaths at age 15-64 years with BD or depression as other than UC, the ASRs increased for external causes, cardiovascular diseases, external causes, and neoplasms as UC. The large increases in mortality from BD using MC are consistent with reported increases in BD prevalence rates in the US population. The temporal increases in death rates related to mood disorders at age 15-64 years may provide further support for the need for interventions to address the mediators of excess mortality identified from cohort studies.
Biolik, A; Heide, S; Lessig, R; Hachmann, V; Stoevesandt, D; Kellner, J; Jäschke, C; Watzke, S
One option for improving the quality of medical post mortem examinations is through intensified training of medical students, especially in countries where such a requirement exists regardless of the area of specialisation. For this reason, new teaching and learning methods on this topic have recently been introduced. These new approaches include e-learning modules or SkillsLab stations; one way to objectify the resultant learning outcomes is by means of the OSCE process. However, despite offering several advantages, this examination format also requires considerable resources, in particular in regards to medical examiners. For this reason, many clinical disciplines have already implemented computer-based OSCE examination formats. This study investigates whether the conventional exam format for the OSCE forensic "Death Certificate" station could be replaced with a computer-based approach in future. For this study, 123 students completed the OSCE "Death Certificate" station, using both a computer-based and conventional format, half starting with the Computer the other starting with the conventional approach in their OSCE rotation. Assignment of examination cases was random. The examination results for the two stations were compared and both overall results and the individual items of the exam checklist were analysed by means of inferential statistics. Following statistical analysis of examination cases of varying difficulty levels and correction of the repeated measures effect, the results of both examination formats appear to be comparable. Thus, in the descriptive item analysis, while there were some significant differences between the computer-based and conventional OSCE stations, these differences were not reflected in the overall results after a correction factor was applied (e.g. point deductions for assistance from the medical examiner was possible only at the conventional station). Thus, we demonstrate that the computer-based OSCE "Death Certificate" station
Lin, Jin-Jia; Liang, Fu-Weng; Li, Chung-Yi; Lu, Tsung-Hsueh
Little is known about the changes in the ranking of leading cause of death (COD) among people died with schizophrenia across years in the United States (U.S.). This study aims to determine the ranking of leading COD among U.S. decedents with mention of schizophrenia by age from 2000 to 2015. The mortality multiple COD files maintained by the National Center for Health Statistics were used to identify decedents aged 15 years old and above with mention of schizophrenia anywhere on the death certificates to determine the number and proportion of deaths attributed to various underlying CODs. Of 13,289, 13,655, 14,135, and 15,033 people who died in 2000-2003, 2004-2007, 2008-2011and 2012-2015 with mention of schizophrenia, similar to all decedents, heart disease and cancer was the first and the second leading COD throughout the study years. Schizophrenia ranked the third in most years except in 2004-2007. The first leading COD for decedents with mention of schizophrenia aged 15-24, 25-44, 45-64, 65-74, and 75+ years old in 2012-2015 was suicide, accidents, heart disease, heart disease, and Alzheimer's disease and related dementia, respectively. Nevertheless, it was accidents, accidents, cancer, cancer, and heart disease, respectively for all decedents. The ranking of leading CODs among U.S. decedents with mention of schizophrenia changed across years and differed from all decedents by age, which suggest that different interventions should be designed accordingly. Copyright © 2018. Published by Elsevier B.V.
Maria Isabel do Nascimento
Full Text Available OBJECTIVE: To analyze the misoprostol use in pregnancies with intrauterine fetal death (IUFD, considering mode of delivery and induction-delivery interval. METHODS: Descriptive study including 171 pregnant women with IUFD, in the second or third trimester, submitted to labor induction with vaginal misoprostol and/or induction/augmentation with intravenous oxytocin, from 2005 to 2008, at a teaching-hospital of the Brazilian Unified Health System (Sistema Único de Saúde -SUS. RESULTS: Misoprostol alone (treatment A, misoprostol plus oxytocin (treatment B, and oxytocin alone (treatment C were administered in 9.3%, 19.9%, and 70.8% of the cases, respectively. One-third of pregnancies were less than 28 weeks, and 2.9% required a caesarean section. The percentage of vaginal delivery in treatments A and B combined (98.0% was similar to treatment C (96.7%. The mean induction-delivery interval was 15.4 hours. Comparing multiple groups, the mean induction-delivery interval was significantly shorter in treatment A (20.1 hours than in treatment B (33.3 hours, and was longer than in treatment C (9.7 hours. The majority (71% of cases required a single administration of misoprostol, and the total dosage was lower in treatment A (mean: 98.4 µg compared with treatment B (mean: 157.0 µg. CONCLUSION: Misoprostol effectively contributed to delivery of IUFD by vaginal route assisted under routine conditions of a public health service in Brazil, demonstrating its importance in cases resistant to usual induction methods, and its availability in Brazilian public health services is recommended.
Thomas, T.L.; Fontham, E.T.; Norman, S.A.; Stemhagen, A.; Hoover, R.N.
Numerous studies have suggested that employment in the oil refining and chemical manufacturing industries may be associated with excess brain tumor risk. A case-referent study was undertaken to evaluate brain tumor risk by occupation and industry in three geographic areas (northern New Jersey, Philadelphia, and the Gulf Coast of Louisiana) with a heavy concentration of these industries. Seven hundred and eighteen white men dying from brain tumor at age 30 years or older were ascertained from death certificates for 1978-1981. The referents were men who died of other causes, excluding epilepsy and stroke. Usual occupation and industry were obtained from the death certificates, and the maximum likelihood estimates of the relative risk were calculated for specific industries and occupations. Small nonsignificant excess risks of brain tumors were seen among persons whose usual employment was in the petroleum refining, electrical equipment manufacturing, health services, and educational services industries. Compared with other white-collar professionals, health diagnosticians, teachers, and artists/designers had a significantly elevated brain tumor risk. Among blue-collar workers, the only group with a significantly elevated brain tumor risk was precision metal workers, who are exposed to metal dusts and fumes and substances used as coolants, lubricants, and degreasers.
Rauscher, Kimberly J; Runyan, Carol W; Radisch, Deborah
Death certificates and medical examiner records have been useful yet imperfect data sources for work-related fatality research and surveillance among adult workers. It is unclear whether this holds for work-related fatalities among adolescent workers who suffer unique detection challenges in part because they are not often thought of as workers. This study investigated the utility of using these data sources for surveillance and research pertaining to adolescent work-related fatalities. Using the state of North Carolina as a case study, we analyzed data from the death certificates and medical examiner records of all work-related fatalities data among 11- to 17-year-olds between 1990-2008 (N = 31). We compared data sources on case identification, of completeness, and consistency information. Variables examined included those on the injury (e.g., means), occurrence (e.g., place), demographics, and employment (e.g., occupation). Medical examiner records (90%) were more likely than death certificates (71%) to identify adolescent work-related fatalities. Data completeness was generally high yet varied between sources. The most marked difference being that in medical examiner records, type of business/industry and occupation were complete in 72 and 67% of cases, respectively, while on the death certificates these fields were complete in 90 and 97% of cases, respectively. Taking the two sources together, each field was complete in upward of 94% of cases. Although completeness was high, data were not always of good quality and sometimes conflicted across sources. In many cases, the decedent's occupation was misclassified as "student" and their employer as "school" on the death certificate. Even though each source has its weaknesses, medical examiner records and death certificates, especially when used together, can be useful for conducting surveillance and research on adolescent work-related fatalities. However, extra care is needed by data recorders to ensure that
Brameld, Kate; Spilsbury, Katrina; Rosenwax, Lorna; Murray, Kevin; Semmens, James
Studies aiming to identify palliative care populations have used data from death certificates and in some cases hospital records. The size and characteristics of the identified populations can show considerable variation depending on the data sources used. It is important that service planners and researchers are aware of this. To illustrate the differences in the size and characteristics of a potential palliative care population depending on the differential use of linked hospital records and death certificate data. Retrospective cohort study. The cohort consisted of 23,852 people aged 20 years and over who died in Western Australia between 1 January 2009 and 31 December 2010 after excluding deaths related to pregnancy or trauma. Within this cohort, the number, proportion and characteristics of people who died from one or more of 10 medical conditions considered amenable to palliative care were identified using linked hospital records and death certificate data. Depending on the information source(s) used, between 43% and 73% of the 23,852 people who died had a condition potentially amenable to palliative care identified. The median age at death and the sex distribution of the decedents by condition also varied with the information source. Health service planners and researchers need to be aware of the limitations when using hospital records and death certificate data to determine a potential palliative care population. The use of Emergency Department and other administrative data sources could further exacerbate this variation.
Armour, A.; Bharucha, H.
We aimed to audit nosological inaccuracies in death certification in Northern Ireland and to compare performance of hospital doctors and general practitioners. Nosology is the branch of medicine which treats of the classification of disease. 1138 deaths were registered in Northern Ireland in a 4-week period commencing 3/10/94. 195 of these were either registered by HM Coroners (HMC) or required further investigation by their staff; these cases were excluded from the study. The remaining 943 w...
Meyer, Armando; Alexandre, Pedro Celso Braga; Chrisman, Juliana de Rezende; Markowitz, Steven B; Koifman, Rosalina Jorge; Koifman, Sergio
Several studies suggest that agricultural workers are at higher risk to develop and die by certain types of cancer. Esophageal cancer is not commonly listed among these types. However, some recent studies indicated that if there is an association between agricultural working and esophageal cancer, it s more likely to be observed among workers highly exposed to pesticides. In the present study, the magnitude of the association between agricultural working and esophageal cancer mortality was evaluated in a high pesticide use area in Brazil, through a death certificate-based case-control study. Cases were individuals from both genders, 30-59 years old, for whom basic cause of death was ascertained as cancer of the esophagus. For each case, one control was randomly selected from all possible controls for which the basic cause of death was ascertained as different from neoplasm and diseases of the digestive system. In addition, controls matched their cases by sex, age, year of death, and state of residence. Crude and adjusted odds ratios were then calculated to estimate the magnitude of the risk. Results showed that, in general, agricultural workers were at significantly higher risk to die by esophageal cancer, when compared to non-agricultural workers. Stratified analysis also revealed that the magnitude of such risk was slightly higher among illiterate agricultural workers, and simultaneous adjustment for several covariates showed that the risk was quantitatively higher among younger southern agricultural workers. These results suggest the esophageal cancer may be included among those types of cancer etiologically associated to agricultural working. Copyright © 2010 Elsevier GmbH. All rights reserved.
Full Text Available Abstract Background Since most patients prefer out-of-hospital death, place of death can be considered an indicator of end-of-life care quality. The study of trends in place of death is necessary to examine causes of shifts, to evaluate efforts to alter place of death and develop future policies. This study aims to examine past trends and future projections of place of death. Methods Analysis of death certificates (decedents aged ≥ 1 year in Belgium (Flanders and Brussels Capital region 1998-2007. Trends in place of death were adjusted for cause of death, sociodemographic characteristics, environmental factors, numbers of hospital beds, and residential and skilled nursing beds in care homes. Future trends were based on age- and sex-specific mortality prognoses. Results Hospital deaths decreased from 55.1% to 51.7% and care home deaths rose from 18.3% to 22.6%. The percentage of home deaths remained stable. The odds of dying in a care home versus hospital increased steadily and was 1.65 (95%CI:1.53-1.78 in 2007 compared to 1998. This increase could be attributed to the replacement of residential beds by skilled nursing beds. Continuation of these trends would result in the more than doubling of deaths in care homes and a decrease in deaths at home and in hospital by 2040. Conclusions Additional end-of-life care resources in care homes largely explain the decrease in hospital deaths. Care homes will become the main locus of end-of-life care in the future. Governments should provide sufficient skilled nursing resources in care homes to fulfil the end-of-life care preferences and needs of patients.
Ishida, Morihiro; Jablon, S
The applicability to the JNIH-ABCC Life Span Study of secondary causes shown in Hiroshima death certificates is discussed. The analysis is based on 5526 death certificates reported among members of Selection I and II of the Life Span Study sample. Secondary causes appear to be of only limited usefulness to the Life Span Study. Factors such as age, sex, exposure status, which may influence the frequency of entry of secondary causes in medical certificates are analyzed. Age is the only factor which shows a significant relationship and this may be interpreted as resulting from the fact that chronic diseases with multiple illnesses are most prevalent among persons at older ages. The number of secondary causes in the present study is too small to delineate in detail the pattern of complications or contributory causes. However, 9 cases of malignant neoplasms were entered only as complications and were missed in the primary tabulation, representing only about one percent of all malignancies. Secondary causes shown in the death certificates and associated causes found at postmortem examination seem not to be comparably distributed, thus raising a serious problem as to the applicability of the former to the Life Span Study. Both the magnitude and accuracy of entry of the secondary causes are influenced greatly by the ease with which illnesses may be detected clinically. 9 references, 12 tables.
de Rezende, Rodrigo Poubel Vieira; Gismondi, Ronaldo Altenburg; Maleh, Haim Cesar; de Miranda Coelho, Elisa Mendes; Vieira, Carol Sartori; Rosa, Maria Luiza Garcia; Mocarzel, Luis Otavio
The objective of this study was to assess the mortality profile related to SSc in the state of Rio de Janeiro, Brazil. We retrospectively examined all registered deaths in the region (2006-2015 period) in which the diagnosis of SSc was mentioned on any line of the death certificates (underlying cause of death [UCD], n = 223; non-UCD, n = 151). Besides the analysis of gender, age, and the causes of death, we also compared the mortality from UCDs between individuals whose death causes included SSc (cases) and those whose death causes did not include SSc (deceased controls). For the latter comparison, we used the mortality odds ratio to approximate the cause-specific standardized mortality ratio. We identified 1495 death causes among the 374 SSc cases. The mean age at death of the SSc cases (85% women) was significantly lower than that of the controls (n = 1,294,117) (58.7 vs. 65.5 years, respectively). The main death causes were circulatory system diseases, infections, and respiratory diseases (36%, 34%, and 21% of SSc cases, respectively). Compared to the deceased controls, there were proportionally more deaths among the SSc cases from pulmonary arterial hypertension, lung fibrosis, septicemia, gastrointestinal hemorrhage, other systemic connective tissue diseases, and heart failure (for death age causes in this predominantly non-Caucasian sample of SSc patients. Of interest, the percentage of infection-related deaths in our report was about three times higher than that in SSc studies with predominantly Caucasian populations.
Wolf Susanne H
Full Text Available Abstract Background Death certificates are a potential source of sociodemographic data for decedents in epidemiologic research. However, because this information is provided by the next-of-kin or other proxies, there are concerns about validity. Our objective was to assess the agreement of job titles and occupational categories derived from death certificates with that self-reported in mid and later life. Methods Occupation was abstracted from 431 death certificates from North Carolina Atherosclerosis Risk in Communities Study participants who died between 1987 and 2001. Occupations were coded according to 1980 Bureau of Census job titles and then grouped into six 1980 census occupational categories. This information was compared with the self-reported occupation at midlife as reported at the baseline examination (1987–89. We calculated percent agreement using standard methods. Chance-adjusted agreement was assessed by kappa coefficients, with 95% confidence intervals. Results Agreement between death certificate and self-reported job titles was poor (32%, while 67% of occupational categories matched the two sources. Kappa coefficients ranged from 0.53 for technical/sales/administrative jobs to 0.68 for homemakers. Agreement was lower, albeit nonsignificant, for women (kappa = 0.54, 95% Confidence Interval, CI = 0.44–0.63 than men (kappa = 0.62, 95% CI = 0.54–0.69 and for African-Americans (kappa = 0.47, 95% CI = 0.34–0.61 than whites (kappa = 0.63, 95% CI = 0.57–0.69 but varied only slightly by educational attainment. Conclusion While agreement between self- and death certificate reported job titles was poor, agreement between occupational categories was good. This suggests that while death certificates may not be a suitable source of occupational data where classification into specific job titles is essential, in the absence of other data, it is a reasonable source for constructing measures such as occupational SES that are based on
Harding, Richard; Marchetti, Stefano; Onwuteaka-Philipsen, Bregje D; Wilson, Donna M; Ruiz-Ramos, Miguel; Cardenas-Turanzas, Maria; Rhee, YongJoo; Morin, Lucas; Hunt, Katherine; Teno, Joan; Hakanson, Cecilia; Houttekier, Dirk; Deliens, Luc; Cohen, Joachim
With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death. In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased's demographic characteristics, place of death, healthcare supply. i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged <50 (69.1%). ii) Hospital was most common place of death in all countries: from 56.6% in the Netherlands to 90.9% in South Korea. The least common places were hospice facility (3.3%-5.7%), nursing home (0%-17.6%) and home (5.9%-26.3%).iii) Age-standardised relative risks found those with HIV less likely to die at home and more likely to die in hospital compared with cancer patients, and in most countries more likely to die in a nursing home. iv) Multivariate analysis found that men were more likely to die at home in UK, Canada, USA and Mexico; a greater number of hospital beds reduced the likelihood of dying at home in Italy and Mexico; a higher number of GPs was associated with home death in Italy and Mexico. With increasing comorbidity among people ageing with HIV, it is essential that end-of-life preferences are established and met. Differences in place of death according to country and diagnosis demonstrate the importance of ensuring a "good death" for people with HIV, alongside efforts to optimise treatment.
Carter, R.L.; Ron, E.; Mabuchi, Kiyohiko.
Several investigators have observed less-than-desirable agreement between death certificate diagnoses and autopsy diagnoses for most specific causes of death, and even for some causes grouped by major disease category. Our results from data on 5130 autopsies of members of the Life Span Study cohort of atomic bomb survivors in Hiroshima and Nagasaki conducted prior to September 1987 were equally discouraging. Among diseases with more than 10 cases observed, confirmation rates ranged from 13 % to 97 % and detection rates from 6 % to 90 %. Both rates were greater than 70 % for only 6 of 60 disease categories studied and for only 1 of 16 categories defined by major International Classification of Disease categories (neoplasms). This deficiency suggests cautious interpretation of results from studies based on death certificate diagnoses. To determine whether any groupings of diagnoses might meet acceptable accuracy requirements, we applied a hierarchical clustering method to data from these 5130 cohort members. The resulting classification system had 10 categories: breast cancer; other female cancers; cancers of the digestive organs; cancer of the larynx; leukemia; nasal, ear, or sinus cancer; tongue cancer; external causes; vascular disease; and all other causes. Confirmation and detection rates for each of these categories were at least 66 %. Although the categories are broad, particularly for nonneoplastic diseases, further divisions led to unacceptable accuracy rates for some of the resulting diagnostic groups. Using the derived classification system, there was 72 % agreement overall between death certificate and autopsy diagnoses compared to 53 % agreement for a second system obtained by grouping strictly by major disease category. Eighty-seven percent agreement was observed for a similar classification system with vascular disease grouped with all other nonneoplastic diseases. Further agglomeration achieved very little additional improvement. (J.P.N.)
Jalal, Kabir; Carter, Randy L
For confidentiality reasons, US federal death certificate data are incomplete with regards to the dates of birth and death for the decedents, making calculation of total lifetime of a decedent impossible and thus estimation of mortality incidence difficult. This paper proposes the use of natality data and an imputation-based method to estimate age-specific mortality incidence rates in the face of this missing information. By utilizing previously determined probabilities of birth, a birth date and death date are imputed for every decedent in the dataset. Thus, the birth cohort of each individual is imputed, and the total on-study time can be calculated. This idea is implemented in two approaches for estimation of mortality incidence rates. The first is an extension of a person-time approach, while the second is an extension of a life table approach. Monte Carlo simulations showed that both approaches perform well in comparison to the ideal complete data methods, but that the person-time method is preferred. An application to Tay-Sachs disease is demonstrated. It is concluded that the imputation methods proposed provide valid estimates of the incidence of death from death certificate data without the need for additional assumptions under which usual mortality rates provide valid estimates. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
... significant errors in MCCD records, with the errors more likely in certificates issued by non-specialist medical officers. All the certificates audited had at least one minor error. Training of doctors on proper completion of MCCDs is strongly advocated. Funding: None of the authors received any financial support for this study.
The Concise Oxford English Dictionary defines 'dilemma' as "an argument forcing one to choose one of two alternatives both unfavourable to him (or her)". This is situation that frequently confronts the general practitioner. In this article a personal solution to the problem of 'certificates' is presented. Not every one will necessarily agree with the solutions presented and some may find them unacceptable, or have better solutions. The author warmly welcomes correspondence, either personal, or in the form of Letters to the Editor, as this is a subject in which consensus decisions are important.
Alonso, Wladimir J; Nascimento, Francielle C; Chowell, Gerardo; Schuck-Paim, Cynthia
The analysis of historical death certificates has enormous potential for understanding how the health of populations was shaped by diseases and epidemics and by the implementation of specific interventions. In Brazil, the systematic archiving of mortality records was initiated only in 1944-hence the analysis of death registers before this time requires searching for these documents in public archives, notaries, parishes, and especially ancient cemeteries, which are often the only remaining source of information about these deaths. This article describes an effort to locate original death certificates in Brazil and document their organization, accessibility, and preservation. To this end, we conducted an exploratory study in 19 of the 27 Brazilian states, focusing on the period surrounding the 1918 influenza pandemic (1913-1921). We included 55 cemeteries, 22 civil archives, and one military archive. Apart from few exceptions, the results show the absence of a curatorial policy for the organization, access or even physical preservation of this material, frequently leading to unavailability, deterioration, and ultimately its complete loss. This study indicates the need to promote the preservation of a historical heritage that is a key to understanding historical epidemiological patterns and human responses to global health threats. Copyright © 2018 Elsevier Inc. All rights reserved.
Houttekier, D.; Reyniers, T.; Deliens, L.; Den Noortgate, N.; Cohen, J.
Background: For people with dementia dying from pneumonia, hospitalization at the end of life may be of little benefit and result in unfavourable outcomes such as hospital death. Objective: The aim of this study is to estimate the incidence of and factors associated with hospital death in people
'Natural' and 'Unnatural' medical deaths and coronial law: A UK and international review of the medical literature on natural and unnatural death and how it applies to medical death certification and reporting deaths to coroners: Natural/Unnatural death: A Scientific Review.
In the United Kingdom, when people die, either a doctor writes an acceptable natural cause of death medical certificate, or a coroner (fiscal in Scotland) investigates the case, usually with an autopsy. An inquest may or may not follow. The concept of 'natural or unnatural cause' death is not internationally standardized. This article reviews scientific evidence as to what is a natural death or unnatural death and how that relates to the international classification of deaths. Whilst there is some consensus on the definition, its application in considering whether to report to the coroner is more difficult. Depictions of deaths in terminal care, medical emergencies and post-operative care highlight these difficulties. It secondly reviews to what extent natural and unnatural are criteria for notification of deaths in England and Wales and internationally. It concludes with consideration of how medical concepts of unnatural death relate in England and Wales to coroners' legal concepts of what is unnatural. Deaths that appear natural to clinicians and pathologists may be legally unnatural and vice versa. It is argued that the natural/unnatural dichotomy is not a good criterion for reporting deaths under medical care to coroners, but the notification of a medical cause of death, using the International Classification of Disease Codes and the medical professional view as to whether it is scientifically natural, is of great value to the coroner in deciding whether it is legally unnatural.
Tyrer, F.; McGrother, C.
Background: The study of premature deaths in people with intellectual disability (ID) has become the focus of recent policy initiatives in England. This is the first UK population-based study to explore cause-specific mortality in adults with ID compared with the general population. Methods: Cause-specific standardised mortality ratios (SMRs) and…
Examined whether tripling in teenage suicides since 1950s represents increase in suicides or in skill of medical examiners. Examined firearms and poisoning death from 1953-87. Concludes that increase in youth suicide is less dramatic than reported, and suicide increase indicated among youths and adults occurred from 1964-71 and has since…
Sierra Romero, María Del Carmen; Navarrete Hernández, Eduardo; Canún Serrano, Sonia; Reyes Pablo, Aldelmo E; Valdés Hernández, Javier
Down syndrome (DS) or trisomy 21 is the most common genetic cause of mental retardation with the clinical presentation of a series of well-defined characteristics. Advanced maternal age has been associated with DS. The databases of all the certificates of live births and fetal deaths in Mexico were combined. Codes based on the International Classification of Diseases 10 th Revision (ICD-10) in Chapter XVII "Congenital malformations, deformations and chromosomal abnormalities" were selected. A database of 8,250,375 births during the period 2008-2011 was constructed: 99.2% were live births with 0.8% of fetal deaths and 3,076 cases diagnosed with DS. The importance of this report is to initiate an epidemiological surveillance of newborn cases of DS nationwide and by state using census information systems available in the country since 2008. An increased risk has been observed for having a child with DS since the mother is ≥ 35 years, as has been reported in other studies. Copyright © 2014 Hospital Infantil de México Federico Gómez. Publicado por Masson Doyma México S.A. All rights reserved.
Tervonen, Hanna E; Roder, David; Morrell, Stephen; You, Hui; Currow, David C
Death Certificate Only (DCO) cancer cases are commonly excluded from survival analyses due to unknown survival time. This study examines whether socio-demographic factors are associated with DCO diagnosis, and the potential effects of excluding DCO cases on socio-demographic cancer survival disparities in NSW, Australia. NSW Cancer Registry data for cases diagnosed in 2000-2008 were used in this study. Logistic regression was used to estimate the odds of DCO registration by socio-demographic sub-group (socio-economic disadvantage, residential remoteness, country of birth, age at diagnosis). Cox proportional hazard regression was used to estimate the probability of death from cancer by socio-demographic subgroup when DCO cases were included and excluded from analyses. DCO cases consisted of 1.5% (n=4336) of all cases (n=299,651). DCO diagnosis was associated with living in socio-economically disadvantaged areas (most disadvantaged compared with least disadvantaged quintile: odds ratio OR 1.25, 95%CI 1.12-1.40), living in inner regional (OR 1.16, 95%CI 1.08-1.25) or remote areas (OR 1.48, 95%CI 1.01-2.19), having an unknown country of birth (OR 1.63, 95%CI 1.47-1.81) and older age. Including or excluding DCO cases had no significant impact on hazard ratios for cancer death by socio-economic disadvantage quintile or remoteness category, and only a minor impact on hazard ratios by age. Socio-demographic factors were associated with DCO diagnosis in NSW. However, socio-demographic cancer survival disparities remained unchanged or varied only slightly irrespective of including/excluding DCO cases. Further research could examine the upper limits of DCO proportions that significantly alter estimated cancer survival differentials if DCOs are excluded. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.
Inghelbrecht, Els; Bilsen, Johan; Mortier, Freddy; Deliens, Luc
Although nurses play an important role in end-of-life care for patients, they are not systematically involved in end-of-life decisions with a possible or certain life-shortening effect (ELDs). Until now we know little about factors relating to the involvement of nurses in these decisions. To explore which patient- and decision-characteristics are related to the consultation of nurses and to the administering of life-ending drugs by nurses in actual ELDs in institutions and home care, as reported by physicians. We sampled at random 5005 of all registered deaths in the second half of 2001--before euthanasia was legalized--in Flanders, Belgium. We mailed anonymous questionnaires to physicians who signed the death certificates and asked them to report on ELDs, including nurses' involvement. Response rate was 59% (n=2950). Physicians reported nurses involved in decision making more often in institutions than at home, and more often in care homes for the elderly than in hospitals (OR 1.70, 95% CI 1.15, 2.52). This involvement was more frequently when physicians intended to hasten the patient's death than when they had no such intention (institutions: OR 2.05, 95% CI 1.41, 2.99; home: OR 2.04, 95% CI 1.19, 3.49). In institutions, this involvement was also more likely where patients were of lower rather than higher education (OR 2.95, 95% CI 1.49, 5.84). The administering of life-ending drugs by nurses, as reported by physicians was also found more frequently in institutions than at home, and in institutions more frequently with lower rather than higher educated patients (p=.037). These findings raise questions about physicians' perception of the nurse's role in ELDs, but also about physicians' skills in interacting with all patients. Education and guidelines for physicians and nurses are needed to optimize good communication and to promote a clearer assignment of responsibilities concerning the execution of those decisions.
Houttekier, D.; Cohen, J.; Surkyn, J.; Deliens, L.
Background: Since most patients prefer out-of-hospital death, place of death can be considered an indicator of end-of-life care quality. The study of trends in place of death is necessary to examine causes of shifts, to evaluate efforts to alter place of death and develop future policies. This study
Chambaere, Kenneth; Rietjens, Judith A C; Smets, Tinne; Bilsen, Johan; Deschepper, Reginald; Pasman, H Roeline W; Deliens, Luc
A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs) and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the 'slippery slope' hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927) of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. While the rates of non-treatment decisions (NTD) and administration of life ending drugs without explicit request (LAWER) did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS) and euthanasia/assisted suicide (EAS), as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The slippery slope hypothesis cannot be confirmed either in general or
Full Text Available Abstract Background A growing body of scientific research is suggesting that end-of-life care and decision making may differ between age groups and that elderly patients may be the most vulnerable to exclusion of due care at the end of life. This study investigates age-related disparities in the rate of end-of-life decisions with a possible or certain life shortening effect (ELDs and in the preceding decision making process in Flanders, Belgium in 2007, where euthanasia was legalised in 2002. Comparing with data from an identical survey in 1998 we also study the plausibility of the ‘slippery slope’ hypothesis which predicts a rise in the rate of administration of life ending drugs without patient request, especially among elderly patients, in countries where euthanasia is legal. Method We performed a post-mortem survey among physicians certifying a large representative sample (n = 6927 of death certificates in 2007, identical to a 1998 survey. Response rate was 58.4%. Results While the rates of non-treatment decisions (NTD and administration of life ending drugs without explicit request (LAWER did not differ between age groups, the use of intensified alleviation of pain and symptoms (APS and euthanasia/assisted suicide (EAS, as well as the proportion of euthanasia requests granted, was bivariately and negatively associated with patient age. Multivariate analysis showed no significant effects of age on ELD rates. Older patients were less often included in decision making for APS and more often deemed lacking in capacity than were younger patients. Comparison with 1998 showed a decrease in the rate of LAWER in all age groups except in the 80+ age group where the rate was stagnant. Conclusion Age is not a determining factor in the rate of end-of-life decisions, but is in decision making as patient inclusion rates decrease with old age. Our results suggest there is a need to focus advance care planning initiatives on elderly patients. The
Walton, Merrilyn; Harrison, Reema; Chevalier, Anna; Esguerra, Esmond; Van Duong, Dang; Chinh, Nguyen Duc; Giang, Huong
Viet Nam does not have a system for the national collection of death data that meets international requirements for mortality reporting. It is identified as a 'no-report' country by the WHO. Verbal autopsy reports are used in the community but exclude deaths in hospitals. This project was undertaken in Bach Mai National General Hospital and Viet Duc Surgical and Trauma Hospital in Viet Nam from 1 March 2013 to 31 March 2015. In phase 1, a modified hospital death report form, consistent with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, was developed. Small group training in use of the report form was delivered to 427 doctors. In phase two, death data were collected, collated and analysed. In phase three, a random sample (7%) of all report forms was checked for accuracy and completeness against medical records. During the 23 months of the study, 3956 deaths were recorded. Across both hospitals, 222 distinct causes of deaths were recorded. Traumatic cerebral oedema was the immediate cause of death (15% of cases, 575/3956 patients), followed by septic shock (13%, 528/3956), brain compression (11%, 416/3956), intracerebral haemorrhage (8%, 336/3956) and pneumonia (5%, 186/3956); 67% (2639/3956) of patients were discharged home to die and 33% (1314/3956) of deaths were due to a road traffic accident, or injury at home or at work. This study confirms the viability of implementing a death report form system compliant with international standards in hospitals in Viet Nam and provides the foundation for introducing a national death report form scheme. These data are critical to comprehensive knowledge of causes of death in Viet Nam. Death data about patients discharged home to die is presented for the first time, with implications for countries where this is a cultural preference.
Yen, Eric Y; Singh, Ram R
Mortality statistics from the Centers for Disease Control and Prevention (CDC) is used for planning healthcare policy and allocating resources. CDC uses this data to compile its annual leading-causes-of-death ranking based on a selected list of 113 causes. SLE is not included on this list. Since the cause-of-death ranking is a useful tool for assessing the relative burden of cause-specific mortality, we ranked SLE deaths among CDC's leading causes-of-death to see whether SLE is a significant cause of death among women. Death counts were obtained from the CDC's Wide-ranging Online Data for Epidemiologic Research database in U.S. female population, and then grouped by age and race/ethnicity. Data on the leading causes-of-death were obtained from the Web-based Injury Statistics Query and Reporting System database. During 2000 to 2015, there were 28,411 female deaths with SLE recorded as the underlying or contributing causes of death. SLE ranked among the top 20 leading-causes-of-death in females between 5 and 64 years of age. SLE ranked 10 th in the 15-24 years, 14 th in the 25-34 and the 35-44 years, and 15 th in the 10-14 years age groups. Among black and Hispanic females, SLE ranked 5 th in the 15-24 years, 6 th in the 25-34 years, and 8 th -9 th in the 35-44 years age groups, after excluding the three common external injury causes of death from analysis. SLE is among the leading-causes-of-death in young women, underscoring its impact as an important public health issue. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Cohen, J.; Pivodic, L.; Miccinesi, G.; Onwuteaka-Philipsen, B.D.; Naylor, W.A.; Wilson, D.M.; Loucka, M.; Csikos, A.; Pardon, K.; Block, L.; Ruiz-Ramos, M.; Cardenas-Turanzas, M.; Rhee, Y.; Aubry, R.; Hunt, K.; Teno, J.; Houttekier, D.; Deliens, L.
Background:Where people die can influence a number of indicators of the quality of dying. We aimed to describe the place of death of people with cancer and its associations with clinical, socio-demographic and healthcare supply characteristics in 14 countries.Methods:Cross-sectional study using
Schoeps, Daniela; Lefevre, Fernando; Silva, Zilda Pereira; Novaes, Hillegonda Maria Dutilh; Raspantini, Priscila Ribeiro; de Almeida, Márcia Furquim
The insatisfactory completeness of the variables in the Death Certificate (DC) makes it difficult to obtain specific perinatal mortality indicators. To assess the social representation of physicians about the perinatal DC. Twenty-five physicians were interviewed in 15 hospitals in the city of São Paulo, in 2009. Qualitative analysis was performed with the Collective Subject Discourse technique. The DC is primarily considered according to its legal aspect. Physicians feel responsible for fulfilling the cause of death. The majority of them reported receiving help from other professionals to complete information on maternal characteristics and identification variables. There is lack of information on the mother's pre-natal conditions, which can make it difficult to identify the perinatal cause of death, mainly in the Unified Health System (SUS) hospitals. Some participants received specific DC training only when attending medical schools. The organization of medical work may affect the completion of the DC, especially in hospitals from SUS. Other professionals contributed to this task and their training can improve the quality of information.
Takegami, Misa; Miyamoto, Yoshihiro; Yasuda, Satoshi; Nakai, Michikazu; Nishimura, Kunihiro; Ogawa, Hisao; Hirata, Ken-Ichi; Toh, Ryuji; Morino, Yoshihiro; Nakamura, Motoyuki; Takeishi, Yasuchika; Shimokawa, Hiroaki; Naito, Hiroaki
Large earthquakes have been associated with cardiovascular disease (CVD) mortality. In Japan, the 1995 Great Hanshin-Awaji (H-A) Earthquake was an urban-underground-type earthquake, whereas the 2011 Great East Japan (GEJ) Earthquake was an ocean-trench type. In the present study, we examined how these different earthquake types affected CVD mortality. We examined death certificate data from 2008 to 2012 for 131 municipalities in Iwate, Miyagi, and Fukushima prefectures (n=320,348) and from 1992 to 1996 for 220 municipalities in Hyogo, Osaka, and Kyoto prefectures (n=592,670). A Poisson regression model showed significant increases in the monthly numbers of acute myocardial infarction (AMI)-related deaths (incident rate ratio [IRR] GEJ=1.34, P=0.001; IRR of H-A=1.57, Pdeaths (IRR of GEJ=1.42, Pdeaths remained significant only for H-A (IRR=1.13, P=0.029). When analyzing the standardized mortality ratio (SMR) after the earthquakes using the Cochran-Armitage trend test, seismic intensity was significantly associated with AMI mortality for 2 weeks after both the GEJ (P for trend=0.089) and H-A earthquakes (P for trend=0.005). Following the GEJ and H-A earthquakes, there was a sharp increase in CVD mortality. The effect of the disaster was sustained for months after the H-A earthquake, but was diminished after the GEJ Earthquake.
Paljärvi, Tapio; Martikainen, Pekka; Leinonen, Taina; Vuori, Erkki; Mäkelä, Pia
Physician's intention to prescribe drugs could potentially be used to improve targeting of alcohol interventions and enhanced disease management to patients with a high risk of severe alcohol-related harm within outpatient settings. Comparison of ten-year incidence trajectories of 13.8 million reimbursed purchases of prescription drugs among 303,057 Finnish men and women of whom 7490 ultimately died due to alcohol-related causes (Alc+), 14,954 died without alcohol involvement (Alc-), and 280,613 survived until the end of 2007. 5-10 years before death, 88% of the persons with an Alc+ death had received prescription medication, and over two-thirds (69%) had at least one reimbursed purchase of drugs for the alimentary tract and metabolism, the cardiovascular system, or the nervous system. Among persons with an Alc+ death, the incidence rate (IR) for purchases of hypnotics, and sedatives was 1.38 times higher (95% confidence interval (CI):1.32,1.44) compared to those with an Alc- death, and 4.07 times higher (95%CI:3.92,4.22) compared to survivors; and the IR for purchases of anxiolytics was 1.40 times higher (95%CI:1.34,1.47) compared to those with an Alc- death, and 3.61 times higher (95%CI:3.48,3.78) compared to survivors. Using physician's intention to prescribe drugs affecting the alimentary tract and metabolism, cardiovascular system and nervous system could potentially be used to flag patients who might benefit from screening, targeted interventions or enhanced disease management. In particular, patients who are to be prescribed anxiolytics, hypnotics, and sedatives, and antidepressants may benefit from enhanced interventions targeted to problem drinking. Copyright © 2018 Elsevier B.V. All rights reserved.
Validación de "infarto de miocardio" como causa de muerte en certificados de defunción, Barquisimeto, Estado Lara, Venezuela Validation of "myocardial infarction" as cause of death on death certificates in Barquisimeto, Lara state, Venezuela
Full Text Available Las tasas de mortalidad por cardiopatía isquémica (CI han sido utilizadas ampliamente en el diagnóstico de la salud cardiovascular de regiones y países. Sin embargo, su validez ha sido cuestionada fundamentalmente por lo que le da origen: el certificado de defunción (CDD. El presente estudio tiene el objetivo de establecer la validez del diagnóstico "infarto de miocardio (IM" como causa de muerte en los CDD de muertes intra-hospitalarias en la ciudad de Barquisimeto, Estado Lara, Venezuela. Entre julio de 1991 y junio de 1992, se identificaron todos los CDD con las características mencionadas, se trató de ubicar la historia clínica correspondiente a cada caso y cualquier otra información clínica pertinente. Se registraron 247 CDD elegibles y se ubicó información clínica adecuada en 136 casos (55%. Aplicando los criterios del Proyecto MONICA, se encontraron M-definitivo en 62 casos (45,6%, IM-probable en 31 casos (22,8% y No-IM en 43 casos (31,6%. Los resultados indican que existe un sobre registro de casos de muerte por IM del 32% (intervalo de confianza del 95% = 23,8-39,4. A la luz de estos resultados es necesario estudiar los factores que inciden en la exactitud de los diagnósticos IM en los CDD. Con esto tendríamos elementos para revisar las normas y los procedimientos empleados en la producción y manejo de los CDD, así como preparar un programa de educación para mejorar la precisión de los mismos.Death rates due to Ischemic Heart Disease (IHD are widely used to assess regional and national cardiovascular health status. However, their validity is questionable, essentially because they are based on death certificates (DCs. The present study was conducted in the Greater Metropolitan Area of Barquisimeto (Lara State, Venezuela, from June 1991 to July 1992. The purpose was to establish the validity of the diagnosis of myocardial infarction in DCs of intrahospital deaths. Efforts were made to locate all clinical charts and any
WaterSense recognizes certification programs for irrigation professionals that meet the specification criteria. Certification programs cover three areas: irrigation system design, installation and maintenance, and system auditing.
Mardal, Marie; Johansen, Sys Stybe; Thomsen, Ragnar; Linnet, Kristian
Three case reports are presented, including autopsy findings and toxicological screening results, which were tested positive for the potent hallucinogenic drug lysergic acid diethylamide (LSD). LSD and its main metabolites were quantified in brain tissue and femoral blood, and furthermore hematoma and urine when available. LSD, its main metabolite 2-oxo-3-hydroxy-LSD (oxo-HO-LSD), and iso-LSD were quantified in biological samples according to a previously published procedure involving liquid-liquid extraction and ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). LSD was measured in the brain tissue of all presented cases at a concentration level from 0.34-10.8μg/kg. The concentration level in the target organ was higher than in peripheral blood. Additional psychoactive compounds were quantified in blood and brain tissue, though all below toxic concentration levels. The cause of death in case 1 was collision-induced brain injury, while it was drowning in case 2 and 3 and thus not drug intoxication. However, the toxicological findings could help explain the decedent's inability to cope with brain injury or drowning incidents. The presented findings could help establish reference concentrations in brain samples and assist in interpretation of results from forensic drug screening in brain tissue. This is to the author's knowledge the first report of LSD, iso-LSD, and oxo-HO-LSD measured in brain tissue samples. Copyright © 2017 Elsevier B.V. All rights reserved.
Piper, J M; Mitchel, E F; Snowden, M; Hall, C; Adams, M; Taylor, P
In 1989, the state of Tennessee adopted a new birth certificate which incorporates changes recommended by the National Center for Health Statistics in the revised US Standard Certificate of Live Birth. The data now being collected are intended to provide improved information for understanding maternal and infant health issues. To assess data quality, the authors compared information reported on the 1989 Tennessee birth certificates with the same data obtained from an ongoing case-control study in which the delivery hospital medical records of mothers and infants were reviewed by trained nurse abstractors using a structured data collection instrument. Cases (n = 1,016) were all infants born in Tennessee in 1989 with birth weights less than 1,500 g or other infants who died during the first 28 days of life. The infants were identified from linked birth-death certificate files. Control infants (n = 634) were randomly selected from the noncase population. The most reliable information obtained from birth certificates was descriptive demographic data and birth weight. The quality of information obtained from the new birth certificate checkboxes varied. Routine medical procedures were better reported on the birth certificates than relatively uncommon conditions and occurrences, even serious ones. Caution is needed in using birth certificate data for assessment of maternal medical risk factors, complications of labor and delivery, abnormal conditions of the newborn, and congenital anomalies, since sensitivity is low.
... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Determinations of death. 880.205 Section... Determinations of death. OPM does not make findings of presumed death. A claimant for CSRS, FERS, or FEGLI death... § 880.207 must submit a death certificate or other legal certification of death issued by an authorized...
Anastassiou, George A
“Intelligent Routines II: Solving Linear Algebra and Differential Geometry with Sage” contains numerous of examples and problems as well as many unsolved problems. This book extensively applies the successful software Sage, which can be found free online http://www.sagemath.org/. Sage is a recent and popular software for mathematical computation, available freely and simple to use. This book is useful to all applied scientists in mathematics, statistics and engineering, as well for late undergraduate and graduate students of above subjects. It is the first such book in solving symbolically with Sage problems in Linear Algebra and Differential Geometry. Plenty of SAGE applications are given at each step of the exposition.
"Organisational routines" is a widely studied research area. However, there is a dearth of research on disruption of routines. The few studies on disruption of routines discussed problem-solving activities that are carried out in response to disruption. In contrast, this study develops a theory of "solution routines" that are a…
Trends in mortality burden of hepatocellular carcinoma, cirrhosis, and fulminant hepatitis before and after roll-out of the first pilot vaccination program against hepatitis B in Peru: An analysis of death certificate data.
Ramírez-Soto, Max Carlos; Ortega-Cáceres, Gutia; Cabezas, César
The first pilot vaccination program against hepatitis B in Peru was implemented in the hyperendemic Abancay province in 1991. To assess the impact of vaccination on mortality rates of hepatitis B-related hepatocellular carcinoma (HCC), cirrhosis, and fulminant hepatitis, we compared mortality trends before (1960-1990) and after (1991-2012) roll-out of the vaccination program, using death certificate data from the Municipalidad Provincial de Abancay. Our results showed that, following program roll-out, the overall mortality rates (per 100,000 population) decreased from 9.20 to 3.30 for HCC (95% CI, 1.28-10.48%; P<0.014), from 16.0 to 6.3 for cirrhosis (95% CI, 3.20-16.10%; P<0.004), and from 34.80 to 1.28 for fulminant hepatitis (95% CI, 16.70-50.30%; P<0.001). The absolute number of deaths attributable to cirrhosis (10 [8.80%] vs. 0.0%; P<0.001) and fulminant hepatitis (83 [40.0%] vs. 5 [19.20%]; P<0.026) decreased in 5-14-year-old children following vaccination. These findings showed reduced mortality rates of hepatitis B-related liver diseases, particularly cirrhosis and fulminant hepatitis in children under 15years, following implementation of the vaccination program against hepatitis B. Copyright © 2017 Elsevier Ltd. All rights reserved.
Gonca Karakus; Zehra Ozturk; Lut Tamam
Although death and life concepts seem so different from each other, some believe that death and life as a whole that death is accepted as the goal of life and death completes life. In different cultures, societies and disciplines, there have been very different definitions of death which changes according to personality, age, religion and cultural status of the individual. Attitudes towards death vary dramatically according to individuals. As for the death anxiety, it is a feeling which start...
Potencial epidemiológico da utilização das causas múltiplas de morte por meio de suas menções nas declarações de óbito, Brasil, 2003 Epidemiological potential of multiple-cause-of-death data listed on death certificates, Brazil, 2003
Augusto Hasiak Santo
. A combinação das duas metodologias é mais útil do que o uso de uma delas isoladamente.OBJECTIVE: To evaluate the automated processing and the epidemiological potential of multiple-cause-of-death data listed on death certificates in Brazil in 2003. METHODS: Data were obtained from the Brazilian Mortality Information System. The distribution of the number of causes per death certificate was processed using the Multiple Cause of Death Tabulator software and expressed as a percentage of the total deaths in federation units, regions, and in the country as a whole. For the main causes of death identified in Brazil in 2003, we calculated the rate at which each cause was listed as the "underlying cause of death" in relation to the total times the cause was mentioned. RESULTS: The mean number of causes of death per certificate ranged from 2.07 in the state of Maranhão to 3.15 in the state of São Paulo, and from 2.45 in the Northeast to 2.99 in the Mid-West. For the entire country, the mean number of causes of death per certificate was 2.81. External causes and neoplasms, unattended deaths, human immunodeficiency virus, and alcoholic liver disease were listed as the underlying cause more than 90% of the times they were mentioned; neoplasms, Chagas’ disease, congenital malformations, ischemic heart diseases, and cerebrovascular diseases, between 70% to less than 90% of the times they were mentioned; and pneumonias, heart failure, alcohol dependence, malnutrition, hypertensive diseases, anemias, ill-defined causes, prematurity, septicemias, and respiratory failure, less than 40% of the times they were mentioned. CONCLUSIONS: Although underlying causes of death are still essential to analyze historical trends, compare countries, and to guide the prevention of death, multiple-cause-of-death-data offer a new insight into the study of mortality. The combination of the two methodologies is more useful than the isolated use of either approach.
Confiabilidade e validade das Declarações de Óbito por câncer de boca no Município de Teresina, Piauí, Brasil, no período de 2004 e 2005 Reliability and validity of death certificates specifying oral cancer as cause of death in Teresina, Piauí State, Brazil, 2004-2005
Luciana Tolstenko Nogueira
Full Text Available A política de saúde brasileira depende da precisão dos dados contidos no sistema de informação em saúde. Com objetivo de avaliar a confiabilidade e validade da causa básica de morte por uma neoplasia específica, no Município de Teresina, Piauí, Brasil, foram utilizadas todas as Declarações de Óbito (DO que possuíam como causa básica de morte o câncer de boca nos anos de 2004 e 2005, contabilizando um total de 23 DO. Elas foram submetidas à nova codificação da causa básica mediante utilização de formulário direcionado à coleta de dados clínicos e de exames complementares para a confirmação do diagnóstico nos prontuários médicos. O diagnóstico foi confirmado pelo exame histopatológico e história clínica. Observou-se uma concordância simples de 91,3% e coeficiente kappa de 0,84. O valor preditivo positivo correspondeu a 90,9%. Assim, pode-se afirmar que as referidas estatísticas de mortalidade são válidas e confiáveis. Este estudo teve como limitação possíveis sub-registros de casos que tiveram como causa básica de morte a referida patologia, visto que tais dados não constam no sistema de informação em mortalidade de Teresina.Brazilian health policy depends on the accuracy of data in the health information system. This study aimed to assess the reliability and validity of data on underlying cause of death due to a specific neoplasm in the Municipality of Teresina, Piauí State, Brazil, based on all the death certificates from 2004 and 2005 that reported oral cancer as the underlying cause of death (total of 23 death certificates. The death certificates were recoded for underlying cause of death by using a form targeted at collecting clinical and laboratory data to confirm the medical diagnosis on patient charts. Diagnosis was confirmed by histopathologic examination and clinical history. Simple agreement was 91.3%, kappa coefficient 0.84, and positive predictive value 90.9%. Based on the findings, the
Couser, S.; Moore, J.
A DOE Technical Safety Appraisal in October 1986 found that training at the Portsmouth Gaseous Diffusion Plant was fragmented and lacked uniformity. Training was localized in departments and was more often handled by line supervisors, etc. - with no certification. The Trainer Certification Program has provided the means for applying standard guidelines to ensure that training is designed, applied, and evaluated in a consistent, effective, and efficient manner. The program is in a state of substantial change and a target date for compliance is set for 1989. Trainer certification will provide both current and future resources to ensure consistent and effective training. 22 figures
... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Certification process. 26.23 Section 26.23 Judicial Administration DEPARTMENT OF JUSTICE DEATH SENTENCES PROCEDURES Certification Process for... mechanism for providing legal representation to indigent prisoners in state postconviction proceedings in...
Reduced emissions of climate gases at the lowest cost require international cooperation in order to ensure that the most cost-efficient measures are taken. A market for emission rights is one way of achieving this. However, creating the right conditions for such a market to operate requires an unambiguous definition of the product to be traded. In this PM, the Swedish Power Association sketches out how such a product could be defined, and how a market for the resulting unambiguously defined product could be operated internationally, in parallel with other markets for energy products. Trade in climate certificates could become a joint EU approach to achieving common results within the field of climate policy. The main features of the proposal are as follows: Electricity producers would be allowed to issue climate certificates for electricity produced without climate-affecting emissions, e.g. in wind power plants. 1 kWh of electricity produced without emissions would entitle the utility to issue a climate certificate for 1 kWh. Electricity from power stations having low emissions, e.g. modern natural gas-fired plants, would entitle the utility to issue certificates in proportion to how much lower their emissions were in comparison with those from conventional coal-fired power stations. The number of certificates would be reduced by an individual coefficient, related directly to the quantity of climate-affecting emissions from the plant concerned. They would be traded and noted on markets in the various member countries. The certificates would not be nationally restricted, but could be traded across borders. Exchanges would be authorised by national authorities, in accordance with overall EU directives. These authorised exchanges would act as certification bodies, checking that certificates had been properly issued in accordance with a corresponding volume of electricity production. Electricity and certificates could be purchased from different suppliers. The
... certification and voucher for the death gratuity payment. The Comptroller General of the United States has... Certification and Voucher for Death Gratuity Payment, DD Form 397, in original and five copies, completing... 32 National Defense 5 2010-07-01 2010-07-01 false Payment of the death gratuity. 716.7 Section 716...
Análise do preenchimento de declarações de óbitos em localidade do Estado do Rio Grande do Sul (Brasil, 1987 An analysis of death certificate information in a locality of the State of Rio Grande do Sul (Brazil, 1987
Irajá Carneiro Heckmann
Full Text Available É analisado o preenchimento dos itens existentes nas declarações de óbito registradas para o Município de Viamão, Rio Grande do Sul, Brasil, durante 1987. Os itens foram sistematizados segundo as informações em branco, ignoradas ou incorretas. Observou-se uma pequena omissão no preenchimento dos dados de identificação do falecido, sendo maior no tocante aos antecedentes sociais e obstétricos, assistência médica e casos de morte violenta. Para melhorar o preenchimento das declarações de óbito sugere-se processo de sensibilização contínua do médico para a importância dos dados por ele assinalados, capacitação de funcionários administrativos que lidam com as declarações e realização de estudos de mortalidade setorizados por serviços de saúde.It was analyzed the quality of death certificate information for deaths registed in Viamão county (Rio Grande do Sul, Brazil during 1987, considering unfilled blanks, and unknown and incorrect responses. Small omissions were found in data identifying the person who had died; larger omissions in data concerning social and obstetric history, medical assistance, and violent deaths. To improve the quality of death certificate information it was suggested that physicians be continually reminded of the importance of giving the correct information on death certificates to allow for their later adequate administrative and research use.
... Home > Complications & Loss > Loss & grief > Neonatal death Neonatal death E-mail to a friend Please fill in ... cope with your baby’s death. What is neonatal death? Neonatal death is when a baby dies in ...
Risk of Inhospital Stroke or Death Is Associated With Age But Not Sex in Patients Treated With Carotid Endarterectomy for Asymptomatic or Symptomatic Stenosis in Routine Practice: Secondary Data Analysis of the Nationwide German Statutory Quality Assurance Database From 2009 to 2014.
Schmid, Sofie; Tsantilas, Pavlos; Knappich, Christoph; Kallmayer, Michael; König, Thomas; Breitkreuz, Thorben; Zimmermann, Alexander; Kuehnl, Andreas; Eckstein, Hans-Henning
Guideline recommendations on carotid endarterectomy are based predominantly on randomized, controlled trials, in which women or elderly patients are often under-represented. This study analyzed the association of age and sex with the risk of in-hospital stroke or death following carotid endarterectomy under routine conditions in Germany. Secondary data analysis using the Statutory German Quality Assurance Database on all carotid endarterectomy procedures (n=142 074) performed between 2009 and 2014. Primary outcome was any stroke or death until discharge; secondary outcomes were any in-hospital stroke (alone), and death (alone). Descriptive statistics and multilevel multivariable regression analyses were applied. Patients were predominately male (68%), with mean age 71 years. Carotid stenosis was symptomatic in 40%. Primary outcome occurred in 1.8% of women and 1.9% of men. Multivariable regression analysis revealed that more-advanced age was associated with a higher primary outcome rate (relative risk [RR] per 10-year increase: 1.19; 95% CI, 1.14-1.24). Risk of death (alone) was associated with age (RR, 1.68; 95% CI, 1.54-1.84). Age was associated with the risk of stroke (alone; RR, 1.05; 95% CI, 1.00-1.11). Sex was not associated with primary outcome rate (1.01; 95% CI, 0.93-1.10), nor did it significantly modify the age effect. This study shows that increasing age, but not sex, is associated with a higher risk of in-hospital stroke or death following carotid endarterectomy under everyday conditions in Germany. Whereas the risk of death (alone) is significantly associated with age, the association between age and the risk of stroke (alone) can be considered of minor importance. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.
Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza
Objectives This study sought to describe the use of pharmacotherapy in a nationwide cohort of young patients with sudden cardiac death (SCD). Background Several drugs have been associated with an increased risk of SCD and sudden arrhythmic death syndrome (SADS). It remains unclear how...... pharmacotherapy may contribute to the overall burden of SCD in the general population. Methods This was a nationwide study that included all deaths that occurred between 2000 and 2009 and between 2007 and 2009 in people age 1 to 35 years and 36 to 49 years, respectively. Two physicians identified all SCDs through...... review of death certificates. Autopsy reports were collected. Pharmacotherapy prescribed within 90 days before SCD was identified in the Danish Registry of Medicinal Product Statistics. Results We identified 1,363 SCDs; median age was 38 years (interquartile range: 29 to 45 years), and 72% (n = 975) were men...
In order to make the full benefits of neutron radiography available in the nondestructive test (NDT) field, it has been necessary to formalize its application. A group under the Penetrating Radiation Committee of the American Society for Nondestructive Testing (ASNT) was organized to prepare a recommended practice for neutron radiography. The recommended practices require the establishment of an appropriate certification program. The requirements on the employer to establish and maintain a qualification and certification program are outlined. To conduct a program of nondestructive testing using neutron radiography requires the usual three levels of qualified and certified personnel. The program is administered by a Level III person. Routine exposure, reviews, and reporting of test results are the responsibilities of Level I and Level II personnal. The amount of training and nature of the required practical examination are also specified. The recommended practices document assures users that NDT work in the field of neutron radiography is performed by qualified personnel. Although no training courses are available to provide experience in the depth required by the recommended practices document, SNT-TC-1A, short courses are provided at a number of locations to familarize user's representatives with the interpretation of neutron radiographs and capabilities and limitations of the technique
To enable the effective connection of several dissimilar computers into a network, modification of the data being passed from one computer to another may become necessary. This document describes a package of routines which permit the translation of data in PDP-8 formats to PDP-11 or DECsystem-10 formats or from PDP-11 format to DECsystem-10 format. Additional routines are described which permit the effective use of the translation routines in the environment of the Fusion Energy Division (FED) network and the Elmo Bumpy Torus (EBT) data base
Yi, Sangyoon; Becker, Markus; Knudsen, Thorbjørn
Routines have been perceived as a source of inertia in the process of organizational change. In this study, we suggest an overlooked, but prevalent, mechanism by which the inertial nature of routines helps, rather than hinders, organizational adaptation. Routine-level inertia plays a hidden role...... to cope with its task environment. In our nuanced perspective, inertia is not only a consequence of adaptation but also a source of adaptation. This logic is helpful to understand why reliable but apparently inertial organizations keep surviving and often exhibit outstanding performance. We conclude...
Sputum culture ... There, it is placed in a special dish (culture). It is then watched to see if bacteria ... Elsevier; 2018:chap 36. Chernecky CC, Berger BJ. Culture, routine. In: Chernecky CC, Berger BJ, eds. Laboratory ...
technologies and in this article these processes will be investigated from three different perspectives: an historical perspective of how new technologies have entered homes, a consumer perspective of how both houses and new technologies are purchased and finally, as the primary part of the article, a user...... perspective of how routines develop while these technologies are being used. In the conclusion these insights are discussed in relation to possible ways of influencing routines....
Arnaldo Augusto Franco de Siqueira
Full Text Available OBJETIVO: Avaliar a qualidade da certificação médica dos óbitos de mulheres de 10 a 49 anos na região Sul do Município de São Paulo. MÉTODOS: Utilizou-se a metodologia Puffer para investigar as causas de óbito de todas as mulheres de 10 a 49 anos residentes na região e falecidas no ano de 1989 (num total de 664 óbitos. Foram comparadas as causas de morte relatadas nos atestados de óbitos originais com as refeitas. Calculou-se o grau de sensibilidade das causas e o índice de kappa. RESULTADOS: Obteve-se alta sensibilidade entre as declarações de óbito originais e corrigidas nos grupos de causas (CID-9 das "Doenças do Aparelho Circulatório" (91,9%, "Neoplasias" (89,7% e "Causas Externas" (84,1%. Houve outros com sensibilidades muito baixas. Desses, chama a atenção o capítulo "Transtornos Mentais" (34,3% que, de 11, passa a ter 32 óbitos em que, na maioria dos casos, não havia sido feito o diagnóstico de alcoolismo. Também o capítulo "Complicações da Gravidez, Parto e Puerpério" apresentou uma sensibilidade baixa (44,9%. O índice de kappa foi de 0,63, o que indica uma concordância total regular. DISCUSSÃO: Ainda é insatisfatória a qualidade da certificação médica dos óbitos na área estudada. Essa má qualidade pode afetar negativamente as propostas de intervenção, tornando pouco visíveis problemas tão sérios para a atenção à saúde da mulher.OBJECTIVE: To evaluate the quality of the medical certification of deaths of 10-49 year-old women, resident in the Southern region of the city of S. Paulo METHODS: The Puffer methodology was utilized to investigate the causes of death of all 10-49 year-old women, resident in the region, and deceased in the year 1989 (664 deaths in the total. The main causes of death in the original death certificates and the "new" causes of death arisen from the research were compared. The sensitivity and the kappa index were calculated. RESULTS: In some chapters of the
Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane
Abstract Background. Incidence of sudden unexpected death in infancy (SUDI) and sudden infant death syndrome (SIDS) differs among studies and non-autopsied cases are difficult to assess. Objectives. To investigate causes of sudden death in infancy in a nationwide setting. Validate the use...... of the ICD-10 code for SIDS (R95) in the Danish Cause of Death registry. Design. A retrospective analysis of all infant deaths (death certificates and autopsy reports were read. Results. We identified 192 SUDI cases (10% of total deaths, 0.42 per 1000 births......) with autopsy performed in 87% of cases. In total, 49% of autopsied SUDI cases were defined as SIDS (5% of all deaths, 0.22 per 1000 births); Cardiac cause of death was denoted in 24% of cases. The Danish Cause of Death Registry misclassified 30% of SIDS cases. Conclusions. A large proportion of infant deaths...
Qualidade das informações registradas nas declarações de óbito fetal em São Paulo, SP Calidad de las informaciones registradas en las declaraciones de óbito fetal en Sao Paulo, Sureste de Brasil Quality of information registered on fetal deaths certificates in São Paulo, Southeastern Brazil
Marcia Furquim de Almeida
muerte. La calidad de las informaciones generadas de autopsias depende del acceso a las informaciones hospitalarias.OBJECTIVE: To evaluate the quality of information registered on fetal death certificates. METHODS: Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public were compared to medical records and to the records from Coroners Office. RESULTS: Among death certificates, 75% were issues by Coroners Office, with a greater frequency in public hospitals (78%. Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroners Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identified as unspecified fetal death as 24.3% as intrauterine hypoxia, while death certificates by hospitals reported 18.1% as unspecified and 41.7% as intrauterine hypoxia. CONCLUSIONS: Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.
Juel, K; Helweg-Larsen, K
In 1875 registration of causes of death in Denmark was established by the National Board of Health, and annual statistics of death have since been published. Until 1970 the national statistics were based upon punched cards with data collected from the death certificates. Since then the register has...... been fully computerized and includes individual based data of all deaths occurring among all residents in Denmark dying in Denmark. Furthermore, a microfilm of all death certificates from 1943 and onward is kept in the National Board of Health. The Danish Institute for Clinical Epidemiology (DICE) has...... established a computerized register of individual records of deaths in Denmark from 1943 and onwards. No other country covers computerized individual based data of death registration for such a long period, now 54 years. This paper describes the history of the registers, the data sources and access to data...
Computer Security Team
Are you already ready to use “certificates” to log into CERN or to connect to the global “eduroam” wireless network? No, I am not talking about your birth certificate, medical certificates or academic certificates. I am referring to “certificates” used for authentication where you would usually use a password. These digital certificates are a valid alternative to cumbersome passwords. Like the aforementioned personal certificates, a digital certificate is an official document that proves who you are or your qualifications. Your personal digital CERN certificate is tied to your digital identity at CERN. In that respect, a digital certificate is like a password. It is a credential that you must not share with anybody else! With your digital certificate, I can impersonate you and take over your mailbox, your web sessions and more… Digital certificates bind your digital identity to a public/private-key infrastructu...
Miles, Lizzy; Corr, Charles A
This article explains the meaning of the phrase Death Cafe and describes what typically occurs at a Death Cafe gathering. The article traces the history of the Death Cafe movement, explores some reasons why people take part in a Death Cafe gathering, and gives examples of what individuals think they might derive from their participation. In addition, this article notes similarities between the Death Cafe movement and three other developments in the field of death, dying, and bereavement. Finally, this article identifies two provisional lessons that can be drawn from Death Cafe gatherings and the Death Cafe movement itself.
Bødker, Birgit; Hvidman, Lone; Weber, Tom
OBJECTIVE: To describe a method for identification, classification and assessment of maternal deaths in Denmark and to identify substandard care. DESIGN: Register study and case audit based on data from the Registers of the Danish Medical Health Board, death certificates and hospital records. SET...
. However, low prevalence of documented comorbid psychopathology in suicides, and concomitant racial-ethnic discrepancies underscore the need for training in death certification, and routinization and standardization of timely psychological autopsies in all cases of suicide, suspected suicide, and other traumatic deaths of equivocal cause.
Landes, Scott D
Utilizing a particular case study of a woman attempting to come to terms with her death, this article explores the difficult metaphors of death present within the Christian tradition. Tracing a Christian understanding of death back to the work of Augustine, the case study is utilized to highlight the difficulties presented by past and present theology embracing ideas of punishment within death. Following the trajectory of the case study, alternative understandings of death present in recent Christian theology and within Native American spirituality are presented in an attempt to find room for a fuller meaning of death post-reconciliation, but premortem.
TTI worked closely with the Landscape Architecture and Urban Planning Department : (LAUP) of Texas A&M University (TAMU) to develop a transit management certificate : focus for the current Graduate Certificate in Transportation Planning (CTP) housed ...
Andersen, Poul Houman
Routines have traditionally been seen as an organisational feature. However, like genes, routines may be carriers and initiators of organisations as well......Routines have traditionally been seen as an organisational feature. However, like genes, routines may be carriers and initiators of organisations as well...
Baines, Lawrence A.
In this article, the author takes a close look at alternative certification programs and is convinced that, because they vary so extremely in their requirements, all of them cannot possibly be producing highly qualified teachers. Here, he talks about Non-University Certification Programs (NUCPs). These are alternative certification programs that…
Programa piloto para la mejora de la certificación de las causas de muerte en atención primaria en Cataluña A pilot program to improve causes of death certification in primary care of Catalonia, Spain
Full Text Available Objetivo: El programa piloto BEDTAR (Boletín Estadístico de Defunción en Tarragona evaluó el cambio en la calidad de la certificación de las defunciones, tras una intervención formativa a los médicos de atención primaria del Ámbito de Tarragona, en Cataluña. Diseño: Estudio evaluativo «antes-después» con intervención y sin grupo control. Emplazamiento y participantes: La población objeto de estudio estaba constituida por los médicos de la red reformada de atención primaria del AT. Material y métodos: Se iniciaba la sesión con el ejercicio «antes», que consistía en certificar 3 defunciones. Luego le seguía el seminario teórico-práctico y, finalmente, el ejercicio «después», en el que se certificaban de nuevo las defunciones del primer ejercicio. Las variables utilizadas para evaluar la calidad de la certificación fueron: certificación de las causas en secuencia lógica, posición correcta en el boletín estadístico de defunción de las causas inmediatas, intermedia y fundamental, uso del paro cardiorrespiratorio y otras entidades mal definidas, uso adecuado de las abreviaturas, letra ilegible, vocabulario y uso de toda la información disponible. Resultados: La participación final de los profesionales en el programa fue del 71% y la eficacia de cambio para la mejora global que podemos atribuir al programa fue del 59%. Conclusiones: El programa BEDTAR mejoró la calidad de la certificación y puso de manifiesto la relevancia y la aplicabilidad de los resultados obtenidos.Objective: The BEDTAR pilot program assessed changes in the quality of certification of death's causes after a training session for the primary care physicians in the Tarragona's Area of Catalonia, in the Northeast of the Iberian Peninsula. Design: Before-after evaluative study with intervention and without control group. Setting and participants: The study population was the physicians of the reformed primary health care network of the AT
Pennec, Sophie; Monnier, Alain; Pontone, Silvia; Aubry, Régis
The "Patients' Rights and End of Life Care" Act came into force in France in 2005. It allows withholding/withdrawal of life-support treatment, and intensified use of medications that may hasten death through a double effect, as long as hastening death is not the purpose of the decision. It also specifies the requirements of the decision-making process. This study assesses the situation by examining the frequency of end-of-life decisions by patients' and physicians' characteristics, and describes the decision-making processes. We conducted a nationwide retrospective study of a random sample of adult patients who died in December 2009. Questionnaires were mailed to the physicians who certified/attended these deaths. Cases were weighted to adjust for response rate bias. Bivariate analyses and logistic regressions were performed for each decision. Of all deaths, 16.9% were sudden deaths with no information about end of life, 12.2% followed a decision to do everything possible to prolong life, and 47.7% followed at least one medical decision that may certainly or probably hasten death: withholding (14.6%) or withdrawal (4.2%) of treatments, intensified use of opioids and/or benzodiazepines (28.1%), use of medications to deliberately hasten death (i.e. not legally authorized) (0.8%), at the patient's request (0.2%) or not (0.6%). All other variables held constant, cause of death, patient's age, doctor's age and specialty, and place of death, influenced the frequencies of decisions. When a decision was made, 20% of the persons concerned were considered to be competent. The decision was discussed with the patient if competent in 40% (everything done) to 86% (intensification of alleviation of symptoms) of cases. Legal requirements regarding decision-making for incompetent patients were frequently not complied with. This study shows that end-of-life medical decisions are common in France. Most are in compliance with the 2005 law (similar to some other European countries
The results of 20 years of research on brain death will be released to the public, the Chinese Ministry of Health reported in early April. A special ministry team has drafted the criteria for brain death in Criteria for the Diagnosis of Brain Death in Adults (Revised Edition) and Technical Specifications for the Diagnosis
This report presents final 2011 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements ‘‘Deaths: Final Data for 2011,’’ the National Center for Health Statistics’ annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2011. Causes of death classified by the International Classification of Diseases, 10th Revision (ICD–10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2011, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer’s disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2011 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission
Objectives-This report presents final 2015 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2015," the National Center for Health Statistics' annual report of final mortality statistics. Methods-Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2015. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. Results-In 2015, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Accidents (unintentional injuries); Cerebrovascular diseases; Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2015 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without
This report presents final 2013 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2013," the National Center for Health Statistics’ annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2013. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD–10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2013, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Accidents (unintentional injuries); Cerebrovascular diseases; Alzheimer’s disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). They accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2013 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Newborn affected by maternal complications of pregnancy; Sudden infant death syndrome; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as
This report presents final 2012 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements "Deaths: Final Data for 2012," the National Center for Health Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2012. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2012, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Influenza and pneumonia; Nephritis, nephrotic syndrome and nephrosis; and Intentional self-harm (suicide). These causes accounted for 74% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2012 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Neonatal hemorrhage. Important variations in the leading causes of infant death are noted for the neonatal and postneonatal periods.
Propuesta de un certificado de defunción para mejorar el registro y reporte de la muerte en el periodo perinatal Proposal for a death certificate to improve recording and reporting of perinatal mortality
Full Text Available Objetivo. Analizar la forma en que se registran los nacimientos y la muerte en el periodo perinatal, en el Instituto Mexicano del Seguro Social (IMSS, y documentar si el registro de la muerte, en este periodo, es adecuado. Material y métodos. Entre enero y marzo de 2000, se aplicó una encuesta en las 37 delegaciones del IMSS, para conocer, del año 1999, el total de nacimientos vivos y muertos, las defunciones ocurridas antes del séptimo día, considerando su edad gestacional y peso al nacimiento. Con estos datos se analizó la mortalidad hebdomadal e infantil y se calcularon las tasas correspondientes, incluyendo o desagregando a los niños con o = 28 semanas de gestación. Antes de la primera semana de vida extrauterina fallecieron 4 556 niños, de los cuales 1 385 (30.4% pesaron http://www.insp.mx/salud/index.htmlObjective. To analyze perinatal births and deaths recording at the Mexican Institute of Social Security (MISS, and to evaluate the correct classification of perinatal deaths. Material and methods. From January to March 2000, data were collected from the 37 MISS districts on the total number of births and deaths occurring during 1999, deaths occurring before the seventh day of life, and gestational age and weight at birth. Early neonatal and infant mortality rates were analyzed including or separating newborns with or = 28 gestation weeks. There were 4 556 newborns who died before the seventh day of extrauterine life; 1 385 of them (30.4% weighed less than 1 000 g and had a gestational age http://www.insp.mx/salud/index.html
This report presents final 2010 data on the 10 leading causes of death in the United States by age, sex, race, and Hispanic origin. Leading causes of infant, neonatal, and postneonatal death are also presented. This report supplements the Division of Vital Statistics' annual report of final mortality statistics. Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia in 2010. Causes of death classified by the International Classification of Diseases, Tenth Revision (ICD-10) are ranked according to the number of deaths assigned to rankable causes. Cause-of-death statistics are based on the underlying cause of death. In 2010, the 10 leading causes of death were, in rank order: Diseases of heart; Malignant neoplasms; Chronic lower respiratory diseases; Cerebrovascular diseases; Accidents (unintentional injuries); Alzheimer's disease; Diabetes mellitus; Nephritis, nephrotic syndrome and nephrosis; Influenza and pneumonia; and Intentional self-harm (suicide). These 10 causes accounted for 75% of all deaths occurring in the United States. Differences in the rankings are evident by age, sex, race, and Hispanic origin. Leading causes of infant death for 2010 were, in rank order: Congenital malformations, deformations and chromosomal abnormalities; Disorders related to short gestation and low birth weight, not elsewhere classified; Sudden infant death syndrome; Newborn affected by maternal complications of pregnancy; Accidents (unintentional injuries); Newborn affected by complications of placenta, cord and membranes; Bacterial sepsis of newborn; Respiratory distress of newborn; Diseases of the circulatory system; and Necrotizing enterocolitis of newborn. Important variations in the leading causes of infant death are noted for the neonatal and post-neonatal periods. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source
Full Text Available Certificate transparency (CT is an elegant mechanism designed to detect when a certificate authority (CA has issued a certificate incorrectly. Many CAs now support CT and it is being actively deployed in browsers. However, a number of privacy-related challenges remain. In this paper we propose practical solutions to two issues. First, we develop a mechanism that enables web browsers to audit a CT log without violating user privacy. Second, we extend CT to support non-public subdomains.
Certifications for technicians who maintain, service, repair, or dispose of equipment that could release ozone depleting refrigerants or, after January 1, 2018, substitute refrigerants into the atmosphere.
The French ministry of economy, finances and industry and the French agency of environment and energy mastery (Ademe) have organized on November 8, 2005, a colloquium for the presentation of the energy saving certificates, a new tool to oblige the energy suppliers to encourage their clients to make energy savings. This document gathers the transparencies presented at this colloquium about the following topics: state-of-the-art and presentation of the energy saving certificates system: presentation of the EEC system, presentation of the EEC standard operations; the energy saving certificates in Europe today: energy efficiency commitment in UK, Italian white certificate scheme, perspectives of the different European systems. (J.S.)
Department of Transportation — Provides automated risk-based decision making capability in support of medical certification and clearances processing associated fees and supporting surveillance of...
Goudevenos, J A; Papadimitriou, E D; Papathanasiou, A; Makis, A C; Pappas, K; Sideris, D A
Sudden cardiac death (SCD) has not been investigated separately in Greece. The aim of this study is to describe the epidemiological characteristics of people dying suddenly out of hospital in an area of Greece. In 1990, a population based study was started to detect the cases of people dying suddenly out of hospital (Greece (Ioannina area: 160,000 inhabitants). During a 3.5 year period, 283 potential cases aged 30-70 years were identified by monitoring the mortality in the emergency rooms of the two hospitals of the area, the coroner's office and the death certificates from the Government Department of Statistics. The diagnosis of SCD was established in 223 (183 men, 40 women; mean ages 59 and 61 years respectively) after visiting and interviewing the relatives and/or the family doctors within 12 days (range 1-28) after the death. SCD in the study accounts for 50% of all cardiovascular deaths and is the most common cause of death after neoplasia. The most common place of death was home (151 cases, 68%), and in 174 cases (78%) deaths occurred while the patients were relaxing or during routine activities. Prodromal symptoms were reported in 57 cases (26%). The time of day of death showed a circadian variation, with a peak in the late morning from 9:00 to 12:00. Ninety four (42%) had a prior history of heart disease. One hundred and ninety one cases (86%) occurred in the subgroup of age 50-70 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Ossiander, Eric M
Volatile substance misuse (VSM - also known as huffing or sniffing) causes some deaths, but because there are no specific cause-of-death codes for VSM, these deaths are rarely tabulated. Count and describe VSM deaths occurring in Washington State during 2003-2012. We used the textual cause-of-death information on death certificates to count VSM-associated deaths that occurred in Washington State during 2003-2012. We extracted records that contained words suggesting either a method of inhalation or a substance commonly used for VSM, and reviewed those records to identify deaths on which the inhalation of a volatile substance was mentioned. We conducted a descriptive analysis of those deaths. Fifty-six deaths involving VSM occurred in Washington State during 2003-2012. VSM deaths occurred primarily among adults age 20 and over (91%), males (88%), and whites (93%). Twelve different chemicals were associated with deaths, but 1 of them, difluoroethane, was named on 30 death certificates (54%), and its involvement increased during the study period. Gas duster products were named as the source of difluoroethane for 12 deaths; no source was named for the other 18 difluoroethane deaths. Most VSM deaths occurred among white male adults, and gas duster products containing difluoroethane were the primary source of inhalants. Approaches to deter VSM, such as the addition of bitterants to gas dusters, should be explored.
Federal Communications Commission — EAS (Equipment Authorization System). A Telecommunication Certification Body (TCB) is an accredited product certification body with the authority to issue Grants of...
Wisniewski, Rafael; Sloth, Christoffer
This paper shows that a barrier certificate exists for any safe dynamical system. Specifically, we prove converse barrier certificate theorems for a class of structurally stable dynamical systems. Other authors have developed a related result by assuming that the dynamical system has neither...
Carter, Karen; Tovu, Viran; Langati, Jeffrey Tila; Buttsworth, Michael; Dingley, Lester; Calo, Andy; Harrison, Griffith; Rao, Chalapati; Lopez, Alan D; Taylor, Richard
The population of the Pacific Melanesian country of Vanuatu was 234,000 at the 2009 census. Apart from subsistence activities, economic activity includes tourism and agriculture. Current completeness of vital registration is considered too low to be usable for national statistics; mortality and life expectancy (LE) are derived from indirect demographic estimates from censuses/surveys. Some cause of death (CoD) data are available to provide information on major causes of premature death. Deaths 2001-2007 were coded for cause (ICDv10) for ages 0-59 years from: hospital separations (HS) (n = 636), hospital medical certificates (MC) of death (n = 1,169), and monthly reports from community health facilities (CHF) (n = 1,212). Ill-defined causes were 3 % for hospital deaths and 20 % from CHF. Proportional mortality was calculated by cause (excluding ill-defined) and age group (0-4, 5-14 years), and also by sex for 15-59 years. From total deaths by broad age group and sex from 1999 and 2009 census analyses, community deaths were estimated by deduction of hospital deaths MC. National proportional mortality by cause was estimated by a weighted average of MC and CHF deaths. National estimates indicate main causes of deaths <5 years were: perinatal disorders (45 %) and malaria, diarrhea, and pneumonia (27 %). For 15-59 years, main causes of male deaths were: circulatory disease 27 %, neoplasms 13 %, injury 13 %, liver disease 10 %, infection 10 %, diabetes 7 %, and chronic respiratory disease 7 %; and for females: neoplasms 29 %, circulatory disease 15 %, diabetes 10 %, infection 9 %, and maternal deaths 8 %. Infection included tuberculosis, malaria, and viral hepatitis. Liver disease (including hepatitis and cancer) accounted for 18 % of deaths in adult males and 9 % in females. Non-communicable disease (NCD), including circulatory disease, diabetes, neoplasm, and chronic respiratory disease, accounted for 52 % of premature deaths in adult
Kitsaras, George; Goodwin, Michaela; Allan, Julia; Kelly, Michael P; Pretty, Iain A
Bedtime routines has shown important associations with areas associated with child wellbeing and development. Research into bedtime routines is limited with studies mainly focusing on quality of sleep. The objectives of the present study were to examine the relationship between bedtime routines and a variety of factors associated with child wellbeing and to examine possible determinants of bedtime routines. A total of 50 families with children between 3 and 5 years old took part in the study. Data on bedtime routines, parenting styles, school readiness, children's dental health, and executive function were collected. Children in families with optimal bedtime routines showed better performance in terms of executive function, specifically working memory (t (44)= - 8.51, p ≤ .001), inhibition and attention (t (48)= - 9.70, p ≤ .001) and cognitive flexibility (t (48)= - 13.1, p ≤ .001). Also, children in households with optimal bedtime routines scored higher in their readiness for school (t (48)= 6.92, p ≤ .001) and had better dental health (U = 85.5, p = .011). Parents in households with suboptimal bedtime routines showed worse performance on all measures of executive function including working memory (t (48)= - 10.47, p ≤ .001), inhibition-attention (t (48)= - 10.50, p ≤ .001) and cognitive flexibility (t (48)= - 13.6, p ≤ .001). Finally, parents with optimal bedtime routines for their children deployed a more positive parenting style in general (i.e. authoritative parenting) compared to those with suboptimal bedtime routines (t (48)= - 6.45, p ≤ .001). The results of the present study highlight the potentially important role of bedtime routines in a variety of areas associated with child wellbeing and the need for further research.
Full Text Available Abstract Background Mesothelioma is a highly fatal cancer that is caused by exposure to asbestos fibres. In many populations, the occurrence of mesothelioma is monitored with the use of mortality data from death certification. We examine certified causes of death of patients who have been diagnosed with mesothelioma, and assess the validity of death certification data as a proxy for mesothelioma incidence. Methods We extracted mesothelioma registrations in the South East of England area between 2000 and 2004 from the Thames Cancer Registry database. We retained for analysis 2200 patients who had died at the time of analysis, after having excluded seven dead cases where the causes of death were not known to the cancer registry. The 2200 deaths were classified hierarchically to identify (1 mesothelioma deaths, (2 deaths certified as lung cancer deaths or (3 deaths from unspecified cancer, and (4 deaths from other causes. Results 87% of the patients had mesothelioma mentioned on the death certificate. 6% had no mention of mesothelioma but included lung cancer as a cause of death. Another 6% had no mention of mesothelioma or lung cancer, but included an unspecified cancer as a cause of death. Lastly, 2% had other causes of death specified on the death certificate. Conclusion This analysis suggests that official mortality data may underestimate the true occurrence of mesothelioma by around 10%.
Mahoney, J; Kyle, D; Katz, G
College students (n = 172) completed Cattell's personality factor questionnaire, Rotter's locus of control scale, Speilberger's trait anxiety measure, and Sabatini and Kastenbaum's self-completed death certificate. Comparison of profiles for subjects anticipating sudden violent death (SVD, n = 59) with those anticipating natural death (ND, n = 113) disclosed that the SVD group was characteristically more anxious and socially isolated. A sex-by-type of death interaction occurred for locus of control, with SVD females being the most external, suggesting that this group was more likely to "give up" in response to stress. The data support Shneidman's concept of subintentioned death in disclosing that several personality factors may be associated with violent death.
Felin, Teppo; Foss, Nicolai Juul; Heimriks, Koen H.
We discuss the microfoundations of routines and capabilities, including why a microfoundations view is needed and how it may inform work on organizational and competitive heterogeneity. Building on extant research, we identify three primary categories of micro-level components underlying routines...
As part of the ongoing drive to simplify and streamline administrative procedures and processes, the IT and HR Departments have made employment certificates available on a self-service basis on the HRT application, in the main menu under "My self services". All members of the personnel can thus obtain a certificate of employment or association, in French or in English, for the present or past contractual period. The HR Department’s Records Office remains responsible for issuing any special certificates that might be required. IT-AIS (Administrative Information Services) HR-SPS (Services, Procedures & Social) Records Office – Tel. 73700
Wisniewski, Rafael; Sloth, Christoffer
This paper presents a converse barrier certificate theorem for a generic dynamical system.We show that a barrier certificate exists for any safe dynamical system defined on a compact manifold. Other authors have developed a related result, by assuming that the dynamical system has no singular...... points in the considered subset of the state space. In this paper, we redefine the standard notion of safety to comply with generic dynamical systems with multiple singularities. Afterwards, we prove the converse barrier certificate theorem and illustrate the differences between ours and previous work...
such phases. The aim of this paper is to explore how an organization’s identity is re-constructed after organizational death. Based on interviews with members of a bankrupted bank who narrate their bankruptcy experiences, the paper explores how legacy organizational identity is constructed after...... organizational death. The paper shows how members draw on their legacy organizational identity to justify their past interpretations and responses to the intensifying bankruptcy threats. Members refer to their firm belief in the bank’s solid and robust identity claim when they explain how they disregarded...
McCleskey, Brandi C; Davis, Gregory G; Dye, Daniel W
Obesity can involve any organ system and compromise the overall health of an individual, including premature death. Despite the increased risk of death associated with being obese, obesity itself is infrequently indicated on the death certificate. We performed an audit of our records to identify how often "obesity" was listed on the death certificate to determine how our practices affected national mortality data collection regarding obesity-related mortality. During the span of nearly 25 years, 0.2% of deaths were attributed to or contributed by obesity. Over the course of 5 years, 96% of selected natural deaths were likely underreported as being associated with obesity. We present an algorithm for certifiers to use to determine whether obesity should be listed on the death certificate and guidelines for certifying cases in which this is appropriate. Use of this algorithm will improve vital statistics concerning the role of obesity in causing or contributing to death. © 2017 American Academy of Forensic Sciences.
Rudbæk, Torsten R; Kofoed, Pernille Bouteloup; Bove, Jeppe
Death cap (Amanita phalloides) is commonly found and is one of the five most toxic fungi in Denmark. Toxicity is due to amatoxin, and poisoning is a serious medical condition, causing organ failure with potential fatal outcome. Acknowledgement and clarification of exposure, symptomatic and focused...
Jacobsen, Michael Hviid
be labelled ‘spectacular death’ in which death, dying and mourning have increasingly become spectacles. Moreover, the author proposes that what is currently happening in contemporary Western society can be interpreted as an expression of a ‘partial re-reversal’ of ‘forbidden death’ to some...
From early 2002, producers of green energy in selected countries have been able to benefit from generous financial support in the Netherlands. Thus, there has been increased sale of green certificates from Norway and Sweden. But the condition that physical energy delivery should accompany the certificates has caused a marked rise in the price of energy in transit through Germany to the Netherlands. This article discusses the green certificate concept and the experience gained from the Netherlands. One conclusion is that if large-scale trade with green certificates is introduced in Europe without the condition of accompanying energy delivery, then producers of hydro-electric power in Norway and Sweden may be the losers
At community level the problem of energy quality control in a building was introduced by EEC recommendation n. 93/76 in 1993. In this item are reported some notes on energetic certification in European countries [it
Hroch, A.; Osusky, V.
In this paper the process of certification of support services in the Slovenske elektrarne, a. s. is described. The nuclear power plants are also included into support services. Provisions and economic aspects of support services are discussed
Renewable Energy Certificates (RECs), are tradable, non-tangible energy commodities in the United States that represent proof that 1 megawatt-hour (MWh) of electricity was generated from an eligible renewable energy resource.
Zaorsky, N G; Churilla, T M; Egleston, B L; Fisher, S G; Ridge, J A; Horwitz, E M; Meyer, J E
The purpose of our study was to characterize the causes of death among cancer patients as a function of objectives: (i) calendar year, (ii) patient age, and (iii) time after diagnosis. US death certificate data in Surveillance, Epidemiology, and End Results Stat 8.2.1 were used to categorize cancer patient death as being due to index-cancer, nonindex-cancer, and noncancer cause from 1973 to 2012. In addition, data were characterized with standardized mortality ratios (SMRs), which provide the relative risk of death compared with all persons. The greatest relative decrease in index-cancer death (generally from > 60% to deaths were stable (typically >40%) among patients with cancers of the liver, pancreas, esophagus, and lung, and brain. Noncancer causes of death were highest in patients with cancers of the colorectum, bladder, kidney, endometrium, breast, prostate, testis; >40% of deaths from heart disease. The highest SMRs were from nonbacterial infections, particularly among 1,000 for lymphomas, P death from index- and nonindex-cancers varies widely among primary sites. Risk of noncancer deaths now surpasses that of cancer deaths, particularly for young patients in the year after diagnosis. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For Permissions, please email: email@example.com.
Carter Karen L
Full Text Available Abstract Background Mortality statistics are essential for population health assessment. Despite limitations in data availability, Pacific Island Countries are considered to be in epidemiological transition, with non-communicable diseases increasingly contributing to premature adult mortality. To address rapidly changing health profiles, countries would require mortality statistics from routine death registration given their relatively small population sizes. Methods This paper uses a standard analytical framework to examine death registration systems in Fiji, Kiribati, Nauru, Palau, Solomon Islands, Tonga and Vanuatu. Results In all countries, legislation on death registration exists but does not necessarily reflect current practices. Health departments carry the bulk of responsibility for civil registration functions. Medical cause-of-death certificates are completed for at least hospital deaths in all countries. Overall, significantly more information is available than perceived or used. Use is primarily limited by poor understanding, lack of coordination, limited analytical skills, and insufficient technical resources. Conclusion Across the region, both registration and statistics systems need strengthening to improve the availability, completeness, and quality of data. Close interaction between health staff and local communities provides a good foundation for further improvements in death reporting. System strengthening activities must include a focus on clear assignment of responsibility, provision of appropriate authority to perform assigned tasks, and fostering ownership of processes and data to ensure sustained improvements. These human elements need to be embedded in a culture of data sharing and use. Lessons from this multi-country exercise would be applicable in other regions afflicted with similar issues of availability and quality of vital statistics.
Moreno-Betancur, Margarita; Lamarche-Vadel, Agathe; Rey, Grégoire
Abstract Objective To investigate a new approach to calculating cause-related standardized mortality rates that involves assigning weights to each cause of death reported on death certificates. Methods We derived cause-related standardized mortality rates from death certificate data for France in 2010 using: (i) the classic method, which considered only the underlying cause of death; and (ii) three novel multiple-cause-of-death weighting methods, which assigned weights to multiple causes of death mentioned on death certificates: the first two multiple-cause-of-death methods assigned non-zero weights to all causes mentioned and the third assigned non-zero weights to only the underlying cause and other contributing causes that were not part of the main morbid process. As the sum of the weights for each death certificate was 1, each death had an equal influence on mortality estimates and the total number of deaths was unchanged. Mortality rates derived using the different methods were compared. Findings On average, 3.4 causes per death were listed on each certificate. The standardized mortality rate calculated using the third multiple-cause-of-death weighting method was more than 20% higher than that calculated using the classic method for five disease categories: skin diseases, mental disorders, endocrine and nutritional diseases, blood diseases and genitourinary diseases. Moreover, this method highlighted the mortality burden associated with certain diseases in specific age groups. Conclusion A multiple-cause-of-death weighting approach to calculating cause-related standardized mortality rates from death certificate data identified conditions that contributed more to mortality than indicated by the classic method. This new approach holds promise for identifying underrecognized contributors to mortality. PMID:27994280
Full Text Available ISO 14001 prescribes the requirements for a system, not environmental performance itself. Similarly, certification is of the management system itself, not environmental performance. An audit is not conducted to ascertain whether your flue gas emissions are less than X part per million nitrous oxide or that your wastewater effluent contains less that Y milligrams of bacteria per litre. Consequently, the procces of auditing the system for compliance to the standard entails checking to see that all of the necessary components of a functioning system are present and working properly. A company can have a complete and fully functional EMS as prescribed by ISO 14001 without being certified. As certification can add to the time and expense of EMS development, it is important for you to establish, in advance, whether certification is of net benefit to you. Although most companies that develop an EMS do in fact certify, there are cases where certification does not add immediate value. Certification is not always beneficial to small and medium sized companies. Certification is not always necessary for companies with one or two large clients with environmental demands who are satisfied that you have a functional EMS (second-party declaration. Whatever decision you make, it is important to remember that just as a driver′s licence does not automatically make you a good driver, ISO 14001 certification does not automatically make your company environmentally benign or ensure that you will continually improve environmental performance. The system is only as good as the people who operate it.
Antini, Carmen; Rajs, Danuta; Muñoz-Quezada, María Teresa; Mondaca, Boris Andrés Lucero; Heiss, Gerardo
This study evaluates the agreement of nosologic coding of cardiovascular causes of death between a Chilean coder and one in the United States, in a stratified random sample of death certificates of persons aged ≥ 60, issued in 2008 in the Valparaíso and Metropolitan regions, Chile. All causes of death were converted to ICD-10 codes in parallel by both coders. Concordance was analyzed with inter-coder agreement and Cohen's kappa coefficient by level of specification ICD-10 code for the underlying cause and the total causes of death coding. Inter-coder agreement was 76.4% for all causes of death and 80.6% for the underlying cause (agreement at the four-digit level), with differences by the level of specification of the ICD-10 code, by line of the death certificate, and by number of causes of death per certificate. Cohen's kappa coefficient was 0.76 (95%CI: 0.68-0.84) for the underlying cause and 0.75 (95%CI: 0.74-0.77) for the total causes of death. In conclusion, causes of death coding and inter-coder agreement for cardiovascular diseases in two regions of Chile are comparable to an external benchmark and with reports from other countries.
Truelsen, Thomas; Krarup, Lars-Henrik; Iversen, Helle K; Mensah, George A; Feigin, Valery L; Sposato, Luciano A; Naghavi, Mohsen
Stroke mortality estimates in the Global Burden of Disease (GBD) study are based on routine mortality statistics and redistribution of ill-defined codes that cannot be a cause of death, the so-called 'garbage codes' (GCs). This study describes the contribution of these codes to stroke mortality estimates. All available mortality data were compiled and non-specific cause codes were redistributed based on literature review and statistical methods. Ill-defined codes were redistributed to their specific cause of disease by age, sex, country and year. The reassignment was done based on the International Classification of Diseases and the pathology behind each code by checking multiple causes of death and literature review. Unspecified stroke and primary and secondary hypertension are leading contributing 'GCs' to stroke mortality estimates for hemorrhagic stroke (HS) and ischemic stroke (IS). There were marked differences in the fraction of death assigned to IS and HS for unspecified stroke and hypertension between GBD regions and between age groups. A large proportion of stroke fatalities are derived from the redistribution of 'unspecified stroke' and 'hypertension' with marked regional differences. Future advancements in stroke certification, data collections and statistical analyses may improve the estimation of the global stroke burden. © 2015 S. Karger AG, Basel.
Møller, Renate Skovgaard; Rhodes, Michael K.; Larsen, Tine Steen
for sustainable buildings. The literature describes several barriers of entry preventing actors in the industry from seeking sustainability certifications and prioritizing design methods, supporting sustainability in greater numbers. In the newly developed tool, “DGNB building certification companion: Sustainable......-language, easily digestible summaries of various topics regarding sustainability and the DGNB certification scheme. The identified barriers are described in the tool followed by a solution to overcome them. The tool, tested at multiple stages of development and moulded by many individuals both within and outside...... was that this is a desired product on the market. This new approach is expected to dramatically reduce misunderstandings, conflicts, and mistakes during a sustainable design process, helping the design team plan a project to possibly obtain the highest DGNB score if desired and properly documented....
Møller, Renate Skovgaard; Rhodes, Michael K.; Larsen, Tine Steen
for sustainable buildings. The literature describes several barriers of entry preventing actors in the industry from seeking sustainability certifications and prioritizing design methods, supporting sustainability in greater numbers. In the newly developed tool, “DGNB building certification companion: Sustainable......-language, easily digestible summaries of various topics regarding sustainability and the DGNB certification scheme. The identified barriers are described in the tool followed by a solution to overcome them. The tool, tested at multiple stages of development and moulded by many individuals both within and outside...... was that this is a desired product on the market. This new approach is expected to dramatically reduce misunderstandings, conflicts, and mistakes during a sustainable design process, helping the design team plan a project to possibly obtain the highest DGNB score if desired and properly documented....
Tomei, Julia; Semino, Stella Maris; Paul, Helena
With the rising emphasis on biofuels as a potential solution to climate change, this paper asks whether certification schemes, developed to promote sustainable feedstock production, are able to deliver genuine sustainability benefits. The Round Table on Responsible Soy (RTRS) is a certification...... the social and environmental impacts of soybean production can be mitigated by the RTRS. It concludes that at present certification schemes are unlikely to be able to address either the institutional challenges associated with their implementation or the detrimental impacts of the additional demand generated...... scheme that aims to promote responsible soy production through the development of principles and criteria. However, can and does this initiative address the negative impacts associated with the intensive production of soy? Taking the example of soy biodiesel produced in Argentina, this paper asks whether...
Massoni, F; Salesi, M; Sarra, M V; Ricci, S
Internet and dematerialization have greatly facilitated the medical profession. Contractual physicians and national health service doctors now have efficient tools for the electronic management of their routine administrative workload. A recent innovation is the medical sickness certificate issued by primary care providers and national health service physicians. Following postponements and uncertainties, procedures for the electronic completion and online transmission of the sickness certificate are now complete. The changes introduced by the so-called "Brunetta decree", however, have made its application difficult and continuous improvement to the system is needed, considering also the severe penalties imposed for violations. In the light of serious legal repercussions for health care professionals, this article examines various critical issues, highlighting the pitfalls and the network's enormous potential for ascertaining evidence of irregularities. The overheated debate on absenteeism due to illness, the diverse roles of national health physicians and self-employed doctors responsible for issuing a sickness certificate, and problems related to circumstances in which a doctor operates, are the key topics in this discussion. Computerization is an effective tool for optimizing public resources; however, it also seeks to ferret out, through the traceability of certification, abuse of medical certification, with severe penalties applied if certificates are discovered to contain misleading or untrue information.
Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza
: All deaths in persons aged 1 to 49 years were included in 2007 to 2009. Death certificates were reviewed by 2 physicians. History of previous admissions to hospital was assessed, and discharge summaries were read. Sudden unexpected death cases were identified and autopsy reports were collected...
Heck, P.M.; Klabbers, M.D.; van Eekelen, Marko
Certification of software artifacts offers organizations more certainty and confidence about software. Certification of software helps software sales, acquisition, and can be used to certify legislative compliance or to achieve acceptable deliverables in outsourcing. In this article, we present a
The U.S. Department of Energy manages the Nevada Test Site in a manner that meets evolving DOE Missions and responds to the concerns of affected and interested individuals and agencies. This Routine Radiological Monitoring Plan addressess complicance with DOE Orders 5400.1 and 5400.5 and other drivers requiring routine effluent monitoring and environmental surveillance on the Nevada Test Site. This monitoring plan, prepared in 1998, addresses the activities conducted onsite NTS under the Final Environmental Impact Statement and Record of Decision. This radiological monitoring plan, prepared on behalf of the Nevada Test Site Landlord, brings together sitewide environmental surveillance; site-specific effluent monitoring; and operational monitoring conducted by various missions, programs, and projects on the NTS. The plan provides an approach to identifying and conducting routine radiological monitoring at the NTS, based on integrated technical, scientific, and regulatory complicance data needs
Nickelsen, Niels Christian
-which has before largely been treated in overview by institutionalism-plays an important role in the making of a routine. In my empirical study, I demonstrate that the concept and practice of the valve changes, and that it is identified in a number of ways, as it passes through the testing phase...... of production. I argue that the negotiation of these changes during test production is the fulcrum in the routinization of the production procedure. It is through these identity shifts that the valve is both reified, and rendered producible and applicable in the customer world....
Luna, R.E.; Jefferson, R.J.
One precept of the current radioactive material transportation regulations is that the package is the primary protection for the public. A packaging is chosen to provide containment, shielding, and criticality control suitable to the quantity and characteristics of the radionuclide being transported. Occasionally, radioactive materials requiring transport are not of a mass or size that would allow the materials to be shipped in an appropriate packaging. This is a particular problem for materials that should be shipped in a Type B package, but because such packages are designed and certified for specific contents, the package is usually fairly expensive, available in relatively small numbers, and often requires a fairly long period to achieve certification or amended certification for new contents. Where the shipment to be made is relatively infrequent, there may be economic and time penalties that may hamper shipment or force the shipper into uneconomic or high risk options. However, there is recognition of such situations in the International Atomic Energy Agency (IAEA) regulations under the provisions for Special Arrangement
U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...
Crowley, Susan L.; Lichtenberg, James W.; Pollard, Jeffrey W.
Although specialty board certification by the American Board of Professional Psychology (ABPP) has been a valued standard for decades, the vast majority of counseling psychologists do not pursue board certification in the specialty. The present article provides a brief history of board certification in general and some historical information about…
Felin, Tippo; Foss, Nicolai Juul; Heimericks, Koen H.
This article introduces the Special Issue and discusses the microfoundations of routines and capabilities, including why a microfoundations view is needed and how it may inform work on organizational and competitive heterogeneity. Building on extant research, we identify three primary categories ...
Woerdman, Edwin; Dulleman, Minne
This article presents a market-based idea to compensate for earthquake damage caused by the extraction of natural gas and applies it to the case of Groningen in the Netherlands. Earthquake certificates give homeowners a right to yearly compensation for both property damage and degradation of living
Omar Espinoza; Urs Buehlmann; Michael Dockry
Forest certification systems are voluntary, market-based initiatives to promote the sustainable use of forests. These standards assume that consumers prefer products made from materials grown in an environmentally sustainable fashion, and this in turn creates incentives for companies to adopt responsible environmental practices. One of the major reasons for the...
Haghighi, Mohammad Hosein Hayavi; Dehghani, Mohammad; Teshnizi, Saeid Hoseini; Mahmoodi, Hamid
Accurate cause of death coding leads to organised and usable death information but there are some factors that influence documentation on death certificates and therefore affect the coding. We reviewed the role of documentation errors on the accuracy of death coding at Shahid Mohammadi Hospital (SMH), Bandar Abbas, Iran. We studied the death certificates of all deceased patients in SMH from October 2010 to March 2011. Researchers determined and coded the underlying cause of death on the death certificates according to the guidelines issued by the World Health Organization in Volume 2 of the International Statistical Classification of Diseases and Health Related Problems-10th revision (ICD-10). Necessary ICD coding rules (such as the General Principle, Rules 1-3, the modification rules and other instructions about death coding) were applied to select the underlying cause of death on each certificate. Demographic details and documentation errors were then extracted. Data were analysed with descriptive statistics and chi square tests. The accuracy rate of causes of death coding was 51.7%, demonstrating a statistically significant relationship (p=.001) with major errors but not such a relationship with minor errors. Factors that result in poor quality of Cause of Death coding in SMH are lack of coder training, documentation errors and the undesirable structure of death certificates.
Other causes of death were accidents, homicide, suicide, and undetermined ... Public enlightenment and health education about routine medical screening will help ... in formulating policies to help in reduction of preventable causes of death.
1 - Description of program or function: GRALIB is a library of graphics subroutines used by PLOTEF. 2 - Method of solution: The PLOTEF library contains routines to generate and manipulate data which are independent of the output graphics device. In order to produce output for a given graphics device - which interact with GRALIB using the DISSPLA conventions - a device driver must be written by the user for this device
Brinkop, Axel; Laudwein, Norbert; Maasen, Rudiger
COMIX (configuration of mixing machines) is a system that assists members of the EKATO Sales Department in designing a mixing machine that fulfills the requirements of a customer. It is used to help the engineer design the requested machine and prepare an offer that's to be submitted to the customer. comix integrates more traditional software techniques with explicit knowledge representation and constraint propagation. During the process of routine design, some design decisions have to be mad...
Industry compliance with minimum energy efficiency standards will be assured through a two-part program approach of certification and enforcement activities. The technical support document (TSD) presents the analyses upon which the proposed rule for assuring that consumer product comply with applicable energy efficiency standards is based. Much of the TSD is based upon support provided DOE by Vitro Laboratories. The OAO Corporation provided additional support in the development of the sampling plan incorporated in the proposed rule. Vitro's recommended approach to appliance certification and enforcement, developed after consideration of various program options, benefits, and impacts, establishes the C/E program framework, general criteria, and procedures for assuring a specified level of energy efficiency performance of covered consumer products. The results of the OAO analysis are given in Volume II of the TSD.
... sampling technician certification. 745.90 Section 745.90 Protection of Environment ENVIRONMENTAL PROTECTION... technician certification. (a) Renovator certification and dust sampling technician certification. (1) To become a certified renovator or certified dust sampling technician, an individual must successfully...
...-0001] RIN 0584-AD60 Direct Certification and Certification of Homeless, Migrant and Runaway Children... interim rule entitled Direct Certification and Certification of Homeless, Migrant and Runaway Children for...
Sullivan, Gregory F.; Masson, Gerald M.
Certification trails are a recently introduced and promising approach to fault detection and fault tolerance. The applicability of the certification trail technique is significantly generalized. Previously, certification trails had to be customized to each algorithm application; trails appropriate to wide classes of algorithms were developed. These certification trails are based on common data-structure operations such as those carried out using these sets of operations such as those carried out using balanced binary trees and heaps. Any algorithms using these sets of operations can therefore employ the certification trail method to achieve software fault tolerance. To exemplify the scope of the generalization of the certification trail technique provided, constructions of trails for abstract data types such as priority queues and union-find structures are given. These trails are applicable to any data-structure implementation of the abstract data type. It is also shown that these ideals lead naturally to monitors for data-structure operations.
Rytterström, Patrik; Unosson, Mitra; Arman, Maria
The aim of this study was to illuminate the significance of routines in nursing practice. Clinical nursing is performed under the guidance of routines to varying degrees. In the nursing literature, routine is described as having both negative and positive aspects, but use of the term is inconsistent, and empirical evidence is sparse. In the research on organisational routines, a distinction is made between routine as a rule and routine as action. A qualitative design using a phenomenological-hermeneutic approach. Data collection from three focus groups focused on nurses' experience of routines. Seventeen individual interviews from a previous study focusing on caring culture were also analysed in a secondary qualitative analysis. All participants were employed as 'qualified nursing pool' nurses. Routines are experienced as pragmatic, obstructive and meaningful. The aim of the pragmatic routine was to ensure that daily working life works; this routine is practised more on the basis of rational arguments and obvious intentions. The obstructive routine had negative consequences for nursing practice and was described as nursing losing its humanity and violating the patient's integrity. The meaningful routine involved becoming one with the routine and for the nurses, it felt right and meaningful to adapt to it. Routines become meaningful when the individual action is in harmony with the cultural pattern on which the nursing work is based. Instead of letting contemporary practice passively become routine, routines can be assessed and developed using research and theoretical underpinnings as a starting point for nursing practice. Leaders have a special responsibility to develop and support meaningful routines. One approach could be to let wards examine their routines from a patient perspective on the basis of the themes of pragmatic, meaningful and obstructive routine. © 2010 Blackwell Publishing Ltd.
Eckert, Olaf; Vogel, Ulrich
The International Statistical Classification of Diseases and Related Health Problems (ICD) is the worldwide binding standard for generating underlying cause-of-death statistics. What are the effects of former revisions of the ICD on underlying cause-of-death statistics and which opportunities and challenges are becoming apparent in a possible transition process from ICD-10 to ICD-11?This article presents the calculation of the exploitation grade of ICD-9 and ICD-10 in the German cause-of-death statistics and quality of documentation. Approximately 67,000 anonymized German death certificates are processed by Iris/MUSE and official German cause-of-death statistics are analyzed.In addition to substantial changes in the exploitation grade in the transition from ICD-9 to ICD-10, regional effects become visible. The rate of so-called "ill-defined" conditions exceeds 10%.Despite substantial improvement of ICD revisions there are long-known deficits in the coroner's inquest, filling death certificates and quality of coding. To make better use of the ICD as a methodological framework for mortality statistics and health reporting in Germany, the following measures are necessary: 1. General use of Iris/MUSE, 2. Establishing multiple underlying cause-of-death statistics, 3. Introduction of an electronic death certificate, 4. Improvement of the medical assessment of cause of death.Within short time the WHO will release the 11th revision of the ICD that will provide additional opportunities for the development of underlying cause-of-death statistics and their use in science, public health and politics. A coordinated effort including participants in the process and users is necessary to meet the related challenges.
Federal Laboratory Consortium — EPG's COSPAS-SARSAT Beacon Certification Facility is one of five certification facilities in the world. Formal certifications are available for all beacon types and...
Wisconsin State Dept. of Public Instruction, Madison. Div. of Library Services.
Under Wisconsin state law (Administrative Code P1-6.03) any librarian employed in a public library system or any municipal public library, except in a city of the first class, supported in whole or in part by public funds, must hold state certification. Qualifications are delineated for three grades of certification: grade 1, for public libraries…
Full Text Available The pilot certification process is an ambitious, nationwide endeavor designed to motivate important changes in life sciences education that are in line with the recommendations of the 2011 Vision and Change Report: A Call to Action (American Association for the Advancement of Science [AAAS], 2011. It is the goal of the certification process to acknowledge departments that have progressed towards full implementation of the tenets of Vision and Change and to motivate departments that have not begun to adopt the recommendations to consider doing so. More than 70 life science departments applied to be part of the pilot certification process, funded by a National Science Foundation grant, and eight were selected based on initial evidence of transformed and innovative educational practices. The programs chosen represent a wide variety of schools, including two-year colleges, liberal-arts institutions, regional comprehensive colleges, research universities and minority serving institutions. Outcomes from this pilot were released June 1, 2015 (www.pulsecommunity.org, with all eight programs being recognized as having progressed along a continuum of change. Five levels of achievement were defined as PULSE Pilot Progression Levels. Of the eight departments in the pilot, one achieved “PULSE Progression Level III: Accomplished”. Six departments achieved “PULSE Progression Level II: Developing” and one pilot department achieved “PULSE Progression Level I: Beginning”. All of the schools have made significant movement towards the recommendations of Vision and Change relative to a traditional life sciences curriculum. Overall, the response from the eight pilot schools has been positive.
Wang, Zhipeng; Liang, Bo; Mei, Qibing
patients in the group that underwent routine early PCI than in the group that received standard treatment received clopidogrel (Ppatients who undergo PCI, as well as in those who do not, is well established,1...... with early beta-blocker therapy is taken into consideration.3 The overall benefit of clopidogrel and beta-blocker therapy could have influenced the outcome in patients who underwent early PCI. These facts leave the conclusion of the TRANSFER-AMI trial still highly uncertain.......To the Editor: Cantor et al. report that there is a significantly reduced rate of ischemic complications among patients with myocardial infarction with ST-segment elevation who are transferred for PCI within 6 hours after fibrinolysis. However, Table 2 of the article shows that significantly more...
Ashburn, Elizabeth A.
Emergency certification involves the issuance of teaching licenses to individuals who have not completed a traditional college or university teacher education program. This two-page information review examines the problems arising from emergency certification and its relationship to student achievement. Some alternatives to emergency certification…
Constance E. Helfat
Full Text Available Despite decades of research on both organization design and organizational routines, little research has analyzed the relationship between them. Here we propose a normative theory in which the effectiveness of organization design and redesign depends on the characteristics of routines. The analysis shows which types of organization designs may be useful as well as which design changes may or may not succeed depending on (a the specificity of routines and (b the dynamic versus static purposes of organizational routines.
Hlavaty, Leigh; Sung, LokMan
Forensic pathologists have a duty to determine the cause and manner of death and are bound by international guidelines in the completion of the death certificate. Sometimes, there are complex circumstances surrounding a death that cannot be captured in the structure of the death certificate and its requirement of listing only 1 cause of death per line. Cases may have multiple causes of death with comorbid medical conditions or inflicted injuries that equally contribute to the ultimate demise. Compared with other forms of homicide, autopsy evidence of strangulation will often be found with other life-threatening traumatic injuries. The Wayne County Medical Examiner's Office conducted a retrospective study of strangulation cases that came into the office from mid-2007 to the end of 2016. The purpose of the study was to examine patterns of injuries in strangulation cases and identify those with additional traumatic injuries of commensurate extent that required incorporation into the cause of death. A total of 43 strangulation cases were found, of which there were equal numbers of ligature and manual strangulations (19 each) and 5 cases in which the method was not specified, and decedents were divided: 63% female and 37% male. Fourteen of these cases were recognized to have multiple causes of death, where blunt force trauma was the most common additional cause, and the sex distribution weighed heavily toward the female (approximately 79%).
Lester, Robin Rawlings; Allanson, Patricia Bolton; Notar, Charles E.
Classroom management is the key to learning. Routines are the foundation of classroom management. Students require structure in their lives. Routines provide that in all of their life from the time they awake until the time they go to bed. Routines in a school and in the classroom provide the environment for learning to take place. The paper is…
... 42 Public Health 5 2010-10-01 2010-10-01 false Routine chemistry. 493.931 Section 493.931 Public... Proficiency Testing Programs by Specialty and Subspecialty § 493.931 Routine chemistry. (a) Program content and frequency of challenge. To be approved for proficiency testing for routine chemistry, a program...
Bjune, Thea; Risgaard, Bjarke; Kruckow, Line
Aims: Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark. Methods and results: Deaths in persons aged 1-49 years were included over a 10-year period. Death...... certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological...... findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac...
Klevens, Joanne; Leeb, Rebecca T.
Objective: To describe the distribution of child maltreatment fatalities of children under 5 by age, sex, race/ethnicity, type of maltreatment, and relationship to alleged perpetrator using data from the National Violent Death Reporting System (NVDRS). Study design: Two independent coders reviewed information from death certificates, medical…
Stuart A Kinner
Full Text Available People released from prison are at increased risk of death. However, no country has established a system for routine monitoring of mortality in this population. The aims of this study were to (a evaluate a system for routine monitoring of deaths after release from prison in Australia and (b estimate the number of deaths annually within 28 and 365 days of prison release from 2000 to 2013.Persons released from prison and deaths were identified in records held by Centrelink, Australia's national provider of unemployment benefits. Estimates generated in this manner were compared with those from a study that probabilistically linked correctional records with the National Death Index (NDI, for each calendar year 2000 to 2007. Using Centrelink data, national estimates of mortality within 28 and 365 days of release were produced for each calendar year 2000 to 2013.Compared with estimates based on linkage with the NDI, the estimated crude mortality rate based on Centrelink records was on average 52% lower for deaths within 28 days of release and 24% lower for deaths within 365 days of release. Nationally, over the period 2000 to 2013, we identified an average of 32 deaths per year within 28 days of release and 188 deaths per year within 365 days of release. The crude mortality rate for deaths within both 28 and 365 days of release increased over this time.Using routinely collected unemployment benefits data we detected the majority of deaths in people recently released from prison in Australia. These data may be sufficient for routine monitoring purposes and it may be possible to adopt a similar approach in other countries. Routine surveillance of mortality in ex-prisoners serves to highlight their extreme vulnerability and provides a basis for evaluating policy reforms designed to reduce preventable deaths.
Chung, Cecilia P; Murray, Katherine T; Stein, C Michael; Hall, Kathi; Ray, Wayne A
To facilitate studies of medications and sudden cardiac death, we developed and validated a computer case definition for these deaths. The study of community dwelling Tennessee Medicaid enrollees 30-74 years of age utilized a linked database with Medicaid inpatient/outpatient files, state death certificate files, and a state 'all-payers' hospital discharge file. The computerized case definition was developed from a retrospective cohort study of sudden cardiac deaths occurring between 1990 and 1993. Medical records for 926 potential cases had been adjudicated for this study to determine if they met the clinical definition for sudden cardiac death occurring in the community and were likely to be due to ventricular tachyarrhythmias. The computerized case definition included deaths with (1) no evidence of a terminal hospital admission/nursing home stay in any of the data sources; (2) an underlying cause of death code consistent with sudden cardiac death; and (3) no terminal procedures inconsistent with unresuscitated cardiac arrest. This definition was validated in an independent sample of 174 adjudicated deaths occurring between 1994 and 2005. The positive predictive value of the computer case definition was 86.0% in the development sample and 86.8% in the validation sample. The positive predictive value did not vary materially for deaths coded according to the ICO-9 (1994-1998, positive predictive value = 85.1%) or ICD-10 (1999-2005, 87.4%) systems. A computerized Medicaid database, linked with death certificate files and a state hospital discharge database, can be used for a computer case definition of sudden cardiac death. Copyright (c) 2009 John Wiley & Sons, Ltd.
Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane
Aims The aim of this investigation was to study the incidence of sudden cardiac death (SCD) in persons aged 1-35 years in a nationwide setting (5.38 million people) by systematic evaluation of all deaths. Methods and results All deaths in persons aged 1-35 years in Denmark in 2000-06 were included....... Death certificates were read independently by two physicians. The National Patient Registry was used to retrieve information on prior medical history. All autopsy reports were read and the cause of death was revised based on autopsy findings. We identified 625 cases of sudden unexpected death (10......% of all deaths), of which 156 (25%) were not autopsied. Of the 469 autopsied cases, 314 (67%) were SCD. The most common cardiac cause of death was ischaemic heart disease (13%); 29% of autopsied sudden unexpected death cases were unexplained. In 45% of SCD cases, the death was witnessed; 34% died during...
Gwendolyn S. Andersen
This project was primarily to develop and implement a curriculum which will train undergraduate and graduate students at the University seeking a degree as well as training for enrollees in a special certification program to prepare individuals to be employed in a broad range of occupations in the field of renewable energy and energy conservation. Curriculum development was by teams of Saint Francis University Faculty in the Business Administration and Science Departments and industry experts. Students seeking undergraduate and graduate degrees are able to enroll in courses offered within these departments which will combine theory and hands-on training in the various elements of wind power development. For example, the business department curriculum areas include economic modeling, finance, contracting, etc. The science areas include meteorology, energy conversion and projection, species identification, habitat protection, field data collection and analysis, etc.
Rey, Grégoire; Bounebache, Karim; Rondet, Claire
The study of cause-specific mortality data is one of the main sources of information for public health monitoring. In most industrialized countries, when a death occurs, it is a legal requirement that a medical certificate based on the international form recommended by World Health Organization's (WHO) is filled in by a physician. The physician reports the causes of death that directly led or contributed to the death on the death certificate. The death certificate is then forwarded to a coding office, where each cause is coded, and one underlying cause is defined, using the rules of the International Classification of Diseases and Related Health Problems, now in its 10th Revision (ICD-10). Recently, a growing number of countries have adopted, or have decided to adopt, the coding software Iris, developed and maintained by an international consortium 1 . This whole standardized production process results in a high and constantly increasing international comparability of cause-specific mortality data. While these data could be used for international comparisons and benchmarking of global burden of diseases, quality of care and prevention policies, there are also many other ways and methods to explore their richness, especially when they are linked with other data sources. Some of these methods are potentially referring to the so-called "big data" field. These methods could be applied both to the production of the data, to the statistical processing of the data, and even more to process these data linked to other databases. In the present note, we depict the main domains in which this new field of methods could be applied. We focus specifically on the context of France, a 65 million inhabitants country with a centralized health data system. Finally we will insist on the importance of data quality, and the specific problematics related to death certification in the forensic medicine domain. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All
... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Firm certification. 745.89 Section 745... § 745.89 Firm certification. (a) Initial certification. (1) Firms that perform renovations for compensation must apply to EPA for certification to perform renovations or dust sampling. To apply, a firm must...
... PROVISIONS NATIONAL ORGANIC PROGRAM Certification § 205.404 Granting certification. (a) Within a reasonable... certified operation; (2) Effective date of certification; (3) Categories of organic operation, including... operation's organic certification continues in effect until surrendered by the organic operation or...
McDaniel, Thomas R.
Although in U.S. v. State of South Carolina the Court has established important guidelines legitimating the use of validated National Teacher Examination scores in the certification of teachers, some problems and questions remain. (Author/IRT)
Stampe, Niels Kjær; Glinge, Charlotte; Jabbari, Reza
Aims: Febrile seizure (FS) is a common disorder affecting 2-5% of children up to 5 years of age. The aim of this study was to determine whether FS in early childhood are over-represented in young adults dying from sudden cardiac death (SCD). Methods and results: We included all deaths (n = 4595...... with FS was sudden arrhythmic death syndrome (5/8; 62.5%). Conclusion: In conclusion, this study demonstrates a significantly two-fold increase in the frequency of FS prior to death in young SCD cases compared with the two control groups, suggesting that FS could potentially contribute in a risk......) nationwide and through review of all death certificates, we identified 245 SCD in Danes aged 1-30 years in 2000-09. Through the usage of nationwide registries, we identified all persons admitted with first FS among SCD cases (14/245; 5.7%) and in the corresponding living Danish population (71 027/2 369 785...
Lyness, J N; Kaganove, J J
The present unconstrained proliferation of automatic quadrature routines is a phenomenon which is wasteful in human time and computing resources. At the root of the problem is an absence of generally acceptable standards or benchmarks for comparing or evaluating such routines. In this paper a general technique, based on the nature of the performance profile, is described which can be used for evaluation of routines.
This proposal extends the delivery of the recently developed graduate Certificate in Transportation : Planning to a wider audience through the establishment of an Executive Certificate Program by distance : (eCertificate). While the need for an inter...
Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya ...
... TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT...
Forsyth, Rob J; Raper, Joseph; Todhunter, Emma
; range 22 to 44), and all had severe traumatic brain injury, mostly due to traffic incidents. All were receiving care within intensive care units (ICUs) at one of six hospitals in either Bolivia or Ecuador. Investigators followed up 92% of participants for six months or until death. The trial excluded patients with a Glasgow Coma Score (GCS) less than three and fixed dilated pupils on admission on the basis that they had sustained brain injury of an unsalvageable severity.The study compared people managed using either an intracranial monitor or non-invasive monitoring (imaging and clinical examination) to identify potentially harmful raised intracranial pressure. Both study groups used imaging and clinical examination measures.Mortality at six months was 56/144 (39%) in the ICP-monitored group and 67/153 (44%) in the non-invasive group.Unfavourable outcome (defined as death or moderate to severe disability at six months) as assessed by the extended Glasgow Outcome Scale (GOS-E) was 80/144 (56%) in the ICP-monitored group and 93/153 (61%) in the non-invasive group.Six percent of participants in the ICP monitoring group had complications related to the monitoring, none of which met criteria for being a serious adverse event. There were no complications relating to the non-invasive group.Other complications and adverse events were comparable between treatment groups, 70/157 (45%) in the ICP-monitored group and 76/167 (46%) in the non-invasive group.Late mortality in both the monitored and non-invasive groups was high, with 35% of deaths occurring > 14 days after injury. The authors comment that this high late mortality may reflect inadequacies in post-ICU services for disabled survivors requiring specialist rehabilitation care. The data from the single RCT studying the role of routine ICP monitoring in acute traumatic coma fails to provide evidence to support the intervention.Research in this area is complicated by the fact that RCTs necessarily assess the combined impact
U.S. Department of Health & Human Services — The National Death Index (NDI) is a centralized database of death record information on file in state vital statistics offices. Working with these state offices, the...
This article briefly overviews the criteria for and physiological process of death, contrasting physical death with biblical passages revealing how God interceded in this universal process when Jesus was on earth.
The electricity certificate system is now in its sixth year. Since the start, both the system and the market have developed, and have undergone a number of changes. In January 2007, the Swedish Energy Agency published a report on the system, 'The electricity certificate system, 2006', to provide easily accessible information on the development of the system and to improve general understanding of it. With the passing of another year, it is now time for the third edition, 'The electricity certificate system, 2008', describing the market status of the electricity certificate system, with statistics from 2003 to 2007. This year's special theme chapter describes current support systems for renewable electricity production throughout the EU. The report also contains expanded information and statistics on biofuels, together with a new chapter that describes planned expansion of renewable electricity production up to 2012. The chapter on consumers' contribution to renewable electricity production has also been updated. A new feature this year is provided in the form of a number of tables at the end of the report, complementing the text. Through annual publication of the report, we hope to create a means of continuously developing the statistical material and analyses, in order to assist those involved in the market, and all other interested persons, to follow achievement of the objectives set out in the Government's Bill No. 205/06:154, 'Renewable electricity with green certificates'. We welcome views on the content and presentation of the report in order further to improve it. The target for the certificate system is to increase, by 2016, the annual production of electricity from renewable sources by 17 TWh relative to its production in 2002. So far, the actual production of renewable electricity is less than the indicative stage target for 2007. Nevertheless, progress is regarded as good, as there are many planned projects
Purpose: The purpose of this paper is to explore how legacy organizational identity and death relate to each other and, thereby, contribute to closing the gap in knowledge on organizational identity constructions in times of death. Design/methodology/approach: The paper opted for an exploratory....../value: This paper addresses an apparent gap in the literature on identity and death; exploring identity narratives in a bankrupted bank, the paper considers constructions of legacy organizational identities in times of disruptive death....
Ceelen, Manon; van der Werf, Christian; Hendrix, Anneke; Naujocks, Tatjana; Woonink, Frits; de Vries, Philip; van der Wal, Allard; Das, Kees
The goal of this study was to ascertain accordance between cause of death established by the forensic physician and autopsy results in young sudden death victims in the Netherlands. Sudden death victims aged 1-45 years examined by forensic physicians operating in the participating regions which also
... Staying Safe Videos for Educators Search English Español Death and Grief KidsHealth / For Teens / Death and Grief What's in this article? What Is ... the reaction we have in response to a death or loss. Grief can affect our body, mind, ...
... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Routine monitoring. 141.621 Section....621 Routine monitoring. (a) Monitoring. (1) If you submitted an IDSE report, you must begin monitoring..., you must monitor at the location(s) and dates identified in your monitoring plan in § 141.132(f...
Walter, Teri; Quint, Ashleigh; Fischer, Kim; Kiger, Joy
This article presents warm-ups that are designed to physiologically and psychologically prepare students for vigorous physical activity. An active movement warm-up routine is made up of three parts: (1) active warm-up movement exercises, (2) general preparation, and (3) the energy system. These warm-up routines can be used with all grade levels…
A D Macleod
Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.
Busse Hansen, Nicolai
Prior investigations on organizational routines have called for re- search to enlighten our understanding of how social actors establish and main- tain of routines as well as the causes of their disruption. The present paper con- tributes to this call by conducting systematic microethnographic analyses of naturally occurring interactional routine data in the form of recordings of job interviews in an international oil contractor company. The term interactional routine is used to describe recu...
The electricity certificate system is a market based support system to assist the expansion of electricity production in Sweden from renewable energy sources and peat. Its objective is to increase the production of electricity from such sources by 17 TWh by 2016 relative to the production level in 2002. It is part of the country's overall objective of moving Sweden towards a more ecologically sustainable energy system. This report describes the market status of the electricity certificate system, and includes statistics from 2003 to 2006. It is our aim to create a forum for continuously developing the statistical material and analyses, in order to assist those involved in the market, and all other interested persons, to follow achievement of the objectives set out in the Government's Bill No. 2005/06:154, Renewable Electricity with Green Certificates. It is also our aim that, in future, each issue of the report should include a more in depth theme article on some particular subject. This year the report provides expanded information and statistics on wind power. Electricity certificates are issued to those who produce electricity from various renewable energy sources, and from peat, and who have had their production plants approved by the Swedish Energy Agency. To date, certificates have been issued to producers of electricity from biofuels and peat, wind power, hydro power and solar energy. Production from the renewable sources amounted to 11.6 TWh in 2006, which is 5.1 TWh more than corresponding production in 2002
Bull, Leah E.; Oliver, Chris; Callaghan, Eleanor; Woodcock, Kate A.
Several neurodevelopmental disorders are associated with preference for routine and challenging behavior following changes to routines. We examine individuals with Prader-Willi syndrome, who show elevated levels of this behavior, to better understand how previous experience of a routine can affect challenging behavior elicited by disruption to…
ASCENT center for technical knowledge
The AutoCAD® 2014 Review for Certification book is intended for users of AutoCAD® preparing to complete the AutoCAD 2014 Certified Professional exam. This book contains a collection of relevant instructional topics, practice exercises, and review questions from the Autodesk Official Training Guides (AOTG) from ASCENT - Center for Technical Knowledge pertaining specifically to the Certified Professional exam topics and objectives. This book is intended for experienced users of AutoCAD in preparation for certification. New users of AutoCAD should refer to the AOTG training guides from ASCENT, such as AutoCAD/AutoCAD LT 2014 Fundamentals, for more comprehensive instruction.
Full Text Available Objective To analyze the training results of short-latency somatosensory-evoked potential (SLSEP for brain death determination and to improve the training program. Methods A total of 101 trainees received theoretical training, simulation skills training, bedside skills training and test analysis for SLSEP in brain death determination. The composition of trainees was analyzed and the error rates of 6 knowledge points were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional category, professional qualification and hospital level, on the error rates. Results Among them, trainees of 30-49 years old occupied 76.24% (77/101, most of them were from third grade, grade A hospitals (98.02%, 99/101, and 78 trainees (77.23% were from Department of Neurology. There were 82 clinicians (81.19%, 31 (30.69% had senior certificate and 42 (41.58% had intermediate certificate. Total error rate of 6 knowledge points was 4.50% (91/2020. Of the 6 knowledge points, the error rate of pitfalls was the highest (9.41%, 19/202, followed by result determination (5.94% , 12/202, recording techniques (4.75% , 24/505, procedures (3.96%, 32/808, sequence of confirmatory tests (1.98%, 2/101 and environmental conditions (0.99%, 2/202. Univariate and multivariate Logistic regression analyses showed that age (OR = 1.566, 95% CI: 1.116-2.197; P = 0.009 and professional qualification (OR = 1.669, 95% CI: 1.163-2.397; P = 0.005 were independent risk factors associated with high error rates. Conclusions The differences between brain death determination and routine check of SLSEP should be paid more attention to improve the quality of determination for brain death by SLSEP. DOI: 10.3969/j.issn.1672-6731.2015.12.007
Winkel, Bo Gregers; Risgaard, Bjarke; Sadjadieh, Golnaz
AIMS: Hitherto, sudden cardiac death in children (SCDc)-defined as sudden cardiac death (SCD) in the 1-18 years old-has been incompletely described in the general population. Knowledge on incidence rates, causes of death and symptoms prior to death is sparse and has been affected by reporting...... and referral bias. METHODS AND RESULTS: In a nationwide setting all deaths in children aged 1-18 years in Denmark in 2000-06 were included. To chart causes of death and incidence rates, death certificates and autopsy reports were collected and read. By additional use of the extensive healthcare registries...... in Denmark, we were also able to investigate prior disease and symptoms. During the 7-year study period there was an average of 1.11 million persons aged 1-18 years. There were a total of 1504 deaths (214 deaths per year) from 7.78 million person-years. A total of 114 (7.5%) were sudden and unexpected...
Tormey, W P
BACKGROUND: The elevated risk of triggering a myocardial infarction by smoking cannabis is limited to the first 2 h after smoking. AIM: To examine the possible role of cannabis in cardiac deaths. CASES AND RESULTS: From 3,193 coroners\\' cases over 2 years, there were 13 cases where the clinical information was compatible with a primary cardiac cause of death. An inquest was held in three cases. Myocardial infarction was the primary cause of death in 54%. Other causes were sudden adult death syndrome, sudden death in epilepsy, and poisoning by alcohol and diazepam. Cannabis was mentioned once only on a death certificate, but not as a cause of death. Blood delta9-tetrahydrocannabinol-carboxylic acid was recorded in one case and in no case was plasma tetrahydrocannabinol (THC) measured. CONCLUSIONS: To attribute sudden cardiac death to cannabis, plasma THC should be measured in the toxicology screen in coroners\\' cases where urine cannabinoids are positive. A positive urine cannabinoids immunoassay alone is insufficient evidence in the linkage of acute cardiac death and cannabis.
Tormey, W P
The elevated risk of triggering a myocardial infarction by smoking cannabis is limited to the first 2 h after smoking. To examine the possible role of cannabis in cardiac deaths. CASES AND RESULTS: From 3,193 coroners' cases over 2 years, there were 13 cases where the clinical information was compatible with a primary cardiac cause of death. An inquest was held in three cases. Myocardial infarction was the primary cause of death in 54%. Other causes were sudden adult death syndrome, sudden death in epilepsy, and poisoning by alcohol and diazepam. Cannabis was mentioned once only on a death certificate, but not as a cause of death. Blood delta9-tetrahydrocannabinol-carboxylic acid was recorded in one case and in no case was plasma tetrahydrocannabinol (THC) measured. To attribute sudden cardiac death to cannabis, plasma THC should be measured in the toxicology screen in coroners' cases where urine cannabinoids are positive. A positive urine cannabinoids immunoassay alone is insufficient evidence in the linkage of acute cardiac death and cannabis.
Martins, Emerson Ferreira; Martinez, Denis; da Silva, Fernando A Boeira Sabino; Sezerá, Lauren; da Rosa de Camargo, Rodrigo; Fiori, Cintia Zappe; Fuchs, Flávio Danni; Moraes, Ruy Silveira
Obstructive sleep apnea (OSA) patients who suffer sudden cardiac death die predominantly during the night. We aimed to investigate whether all cardiovascular-related deaths display the same night-time peak as sudden cardiac death. Data from a large cohort of adults who underwent full-night polysomnography between 1985 and 2015 in a university-affiliated sleep clinic were analyzed. Time and cause of death of these patients and of persons from the general population were identified in death certificates from the State Health Secretariat. The day-night pattern of cardiovascular death was compared among groups of non-OSA, OSA (apnea-hypopnea index, AHI ≥5), CPAP users, and persons from the general population. Among 619 certificates, 160 cardiovascular-related deaths were identified. The time of death of the 142 persons with OSA was uniformly distributed over 24 h, with neither an identifiable peak nor a circadian pattern (Rayleigh test; P = 0.8); the same flat distribution was seen in those with purported CPAP use (n = 49). Non-OSA individuals presented a morning peak and a night nadir of deaths, clearer when analyzed in eight-hour intervals. The same pattern was observed in 92 836 certificates from the State general population, with cardiovascular deaths showing the expected morning peak, night nadir, and a significant circadian pattern (Rayleigh test; P < 0.001). In OSA patients, the distribution of cardiovascular-related deaths throughout the 24-h period is virtually flat, in contrast with the described nighttime peak of sudden cardiac death. OSA-related phenomena during nighttime might be blunting the mechanisms, arrhythmic or not, behind the morning peak of cardiovascular-related deaths. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available Online Information Technologies Certificate Program Res. Ass. Erman YUKSELTURK Middle East Technical University Department of Computer Education and Instructional Technology, Faculty of Education, Ankara, TURKEY ABSTRACT In this study, Information Technologies Certificate Program which is based on synchronous and asynchronous communication methods over the Internet offered by cooperation of Middle East Technical University, Computer Engineering Department and Continuing Education Center were examined. This online certificate program started in May 1998 and it is still active. The program includes eight fundamental courses of Computer Engineering Department and comprised of four semesters lasting totally nine months. The main aim of this program is to train the participants in IT field to meet demand in the field of computer technologies in Turkey. As a conclusion, the properties of this program were discussed in a detailed way.
Otterman, Gabriel; Lahne, Klara; Arkema, Elizabeth V; Lucas, Steven; Janson, Staffan; Hellström-Westas, Lena
Countries that conduct systematic child death reviews report a high proportion of modifiable characteristics among deaths from external causes, and this study examined the trends in Sweden. We analysed individual-level data on external, ill-defined and unknown causes from the Swedish cause of death register from 2000 to 2014, and mortality rates were estimated for children under the age of one and for those aged 1-14 and 15-17 years. Child deaths from all causes were 7914, and 2006 (25%) were from external, ill-defined and unknown causes: 610 (30%) were infants, 692 (34%) were 1-14 and 704 (35%) were 15-17. The annual average was 134 cases (range 99-156) during the study period. Mortality rates from external, ill-defined and unknown causes in children under 18 fell 19%, from 7.4 to 6.0 per 100 000 population. A sizeable number of infant deaths (8.0%) were registered without a death certificate during the study period, but these counts were lower in children aged 1-14 (1.3%) and 15-17 (0.9%). Childhood deaths showed a sustained decline from 2000 to 2014 in Sweden and a quarter were from external, ill-defined or unknown causes. Systematic, interagency death reviews could yield information that could prevent future deaths. ©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.
Damiani, Ernesto; El Ioini, Nabil
Open Source Advances in Computer Applications book series provides timely technological and business information for: Enabling Open Source Systems (OSS) to become an integral part of systems and devices produced by technology companies; Inserting OSS in the critical path of complex network development and embedded products, including methodologies and tools for domain-specific OSS testing (lab code available), plus certification of security, dependability and safety properties for complex systems; Ensuring integrated systems, including OSS, meet performance and security requirements as well as achieving the necessary certifications, according to the overall strategy of OSS usage on the part of the adopter
Bruin, M. de.
This thesis describes the way in which at IRI instrumental neutron activation analysis (INAA) has been developed into an automated system for routine analysis. The basis of this work are 20 publications describing the development of INAA since 1968. (Auth.)
Busse Hansen, Nicolai
Prior investigations on organizational routines have called for re- search to enlighten our understanding of how social actors establish and main- tain of routines as well as the causes of their disruption. The present paper con- tributes to this call by conducting systematic microethnographic...... and affiliation are central to how routines are maintained but also susceptible to disruption in case of mis- management. Also the paper contributes with a more fine-tuned understanding of action in terms of them being organized in accordance with preference, which basically means that some actions are preferred...... over others. In producing an action, the relevant next action is projected. However the relevant next action is projected in a specific way and if this is not taken in to account then the routine becomes disrupted. Another core aspect is the notion of deontics that lends itself towards describing who...
... page: //medlineplus.gov/ency/patientinstructions/000613.htm Taking medicine at home - create a routine To use the ... teeth. Find Ways to Help You Remember Your Medicines You can: Set the alarm on your clock, ...
Moestrup, Lene; Hansen, Helle Ploug
psychology or Kübler-Ross’ theory about death stages. The complex concerns might be explained using Martin Heidegger’s phenomenological thinking. We aimed to illuminate dying patients´ existential concerns about the impending death through a descriptive analysis of semi-structured interviews with 17 cancer...... patients in Danish hospices. The main findings demonstrated how the patients faced the forthcoming death without being anxious of death but sorrowful about leaving life. Furthermore, patients expressed that they avoided thinking about death. However, some had reconstructed specific and positive ideas about...... afterlife and made accurate decisions for practical aspects of their death. The patients wished to focus on positive aspects in their daily life at hospice. It hereby seems important to have ongoing reflections and to include different theoretical perspectives when providing existential support to dying...
Markes, B.M., Westinghouse Hanford
This document provides the Environmental Restorations Contractor (ERC) and the Project Hanford Management Contractor.(PHMC) a schedule in accordance with the WHC-CM-7-5, Environmental Compliance` and BHI- EE-02, Environmental Requirements, of monitoring and sampling routines for the Near-Field Monitoring (NFM) program during calendar year (CY) 1997. Every attempt will be made to consistently follow this schedule; any deviation from this schedule will be documented by an internal memorandum (DSI) explaining the reason for the deviation. The DSI will be issued by the scheduled performing organization and directed to Near-Field Monitoring. The survey frequencies for particular sites are determined by the technical judgment of Near- Field Monitoring and may depend on the site history, radiological status, use, and general conditions. Additional surveys may be requested at irregular frequencies if conditions warrant. All radioactive wastes sites are scheduled to be surveyed at least annually. Any newly discovered wastes sites not documented by this schedule will be included in the revised schedule for CY 1998. The outside perimeter road surveys of 200 East and West Area and the rail survey from the 300 Area to Columbia Center will be performed in the year 2000 per agreement with Department of Energy. Richland Field Office. This schedule does not discuss staffing needs, nor does it list the monitoring equipment to be used in completing specific routines. Personnel performing routines to meet this schedule shall communicate any need for assistance in completing these routines to Radiological Control management and Near-Field Monitoring. After each routine survey is completed, a copy of the survey record, maps, and data sheets will be forwarded to Near-Field Monitoring. These routine surveys will not be considered complete until this documentation is received. At the end of each month, the ERC and PHMC radiological control organizations shall forward a copy of the Routine
Lynge, Thomas Hadberg; Risgaard, Bjarke; Jabbari, Reza
AIMS: Hypertrophic cardiomyopathy (HCM) is a frequent cause of sudden cardiac death (SCD) among the young (SCDY). The aim of this study was to characterize symptoms before SCDY due to HCM. METHODS AND RESULTS: Through review of all death certificates, we identified all SCDs in Danes aged 1-35 years...... in 2000-2009. Nationwide we included all deaths (n = 8756) and identified 431 autopsied SCDYs. All available records from hospitals and general practitioners were retrieved. To compare symptoms, we included a control groups consisting of traffic accident victims (n = 74). In the 10-year study period, 431...... autopsied SCDY cases were reviewed and 38 cases (9%) were included, of which 22 (58%) had morphologic findings diagnostic of HCM and 16 (42%) had findings suggestive, but not diagnostic, of HCM ('possible HCM'). Cardiac symptoms >1 h prior to death were reported in 21 (55%) of cases, and 16 (42%) sought...
... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Product certification. 1207.9 Section 1207.9 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION CONSUMER PRODUCT SAFETY ACT REGULATIONS SAFETY STANDARD FOR SWIMMING POOL SLIDES § 1207.9 Product certification. (a) Certification shall be in accordance...
... shall address the subject areas listed in appendix D. (c) Program Approval. Persons may seek approval of... the closed-book certification exam, within 30 days. Programs providing Type I certification using the... percent or higher on the certification exam, no later than 30 days after the program has received the exam...
David C. Mercker; Donald G. Hodges
Nonindustrial private forest owners in western Tennessee were surveyed to assess their awareness, acceptance, and perceived benefits of forest certification. More than 80 percent of the landowners indicated a willingness to consider certification for their lands. A model was created to explain landowner behavior regarding their willingness to consider certification....
Although calls continue to establish certification, several certifications for human resource development (HRD) practitioners already exist, although none use the name HRD. This Forum explores what those certification programs are and what their availability means to the development of the HRD "brand" (the impressions of the service derived from…
... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Contractor certification... CONTRACTING REQUIREMENTS PROTESTS, DISPUTES, AND APPEALS Disputes and Appeals 33.207 Contractor certification. (a) Contractors shall provide the certification specified in paragraph (c) of this section when...
The purpose of this article is to examine the proliferation of alternative certification pathways through an analysis of the role and history of teacher certification and supply followed by a synthesis of national, regional, and state research studies on alternative routes to certification programs and a review of studies conducted on well-known…
... POLLUTION FROM MOBILE SOURCES Urban Bus Rebuild Requirements § 85.1406 Certification. (a) Certification... provide some level of particulate emission reduction, and will not cause the urban bus engine to fail to... urban bus engines. (c) Test equipment selection. Certification shall be based upon tests utilizing...
An important tool for proving safety of dynamical systems is the notion of a barrier certificate. In this paper we prove that every robustly safe ordinary differential equation has a barrier certificate. Moreover, we show a construction of such a barrier certificate based on a set of states that is reachable in finite time.
... for quality control, quality assurance, and proficiency testing purposes) and specialties tested, with... collected by HHS under the laboratory program must be sufficient to cover the general costs of administering... certificates and certificates of compliance, the costs include issuing the certificates, collecting the fees...
The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions. Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications - The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research. The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.
Sudden infant death syndrome (SIDS) Overview Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a seemingly healthy baby ... year old. SIDS is sometimes known as crib death because the infants often die in their cribs. ...
Carlson, Kimberly M; Heilmayr, Robert; Gibbs, Holly K; Noojipady, Praveen; Burns, David N; Morton, Douglas C; Walker, Nathalie F; Paoli, Gary D; Kremen, Claire
Many major corporations and countries have made commitments to purchase or produce only "sustainable" palm oil, a commodity responsible for substantial tropical forest loss. Sustainability certification is the tool most used to fulfill these procurement policies, and around 20% of global palm oil production was certified by the Roundtable on Sustainable Palm Oil (RSPO) in 2017. However, the effect of certification on deforestation in oil palm plantations remains unclear. Here, we use a comprehensive dataset of RSPO-certified and noncertified oil palm plantations (∼188,000 km 2 ) in Indonesia, the leading producer of palm oil, as well as annual remotely sensed metrics of tree cover loss and fire occurrence, to evaluate the impact of certification on deforestation and fire from 2001 to 2015. While forest loss and fire continued after RSPO certification, certified palm oil was associated with reduced deforestation. Certification lowered deforestation by 33% from a counterfactual of 9.8 to 6.6% y -1 Nevertheless, most plantations contained little residual forest when they received certification. As a result, by 2015, certified areas held less than 1% of forests remaining within Indonesian oil palm plantations. Moreover, certification had no causal impact on forest loss in peatlands or active fire detection rates. Broader adoption of certification in forested regions, strict requirements to avoid all peat, and routine monitoring of clearly defined forest cover loss in certified and RSPO member-held plantations appear necessary if the RSPO is to yield conservation and climate benefits from reductions in tropical deforestation. Copyright © 2017 the Author(s). Published by PNAS.
Gibbs, Holly K.; Noojipady, Praveen; Burns, David N.; Morton, Douglas C.; Walker, Nathalie F.; Paoli, Gary D.; Kremen, Claire
Many major corporations and countries have made commitments to purchase or produce only “sustainable” palm oil, a commodity responsible for substantial tropical forest loss. Sustainability certification is the tool most used to fulfill these procurement policies, and around 20% of global palm oil production was certified by the Roundtable on Sustainable Palm Oil (RSPO) in 2017. However, the effect of certification on deforestation in oil palm plantations remains unclear. Here, we use a comprehensive dataset of RSPO-certified and noncertified oil palm plantations (∼188,000 km2) in Indonesia, the leading producer of palm oil, as well as annual remotely sensed metrics of tree cover loss and fire occurrence, to evaluate the impact of certification on deforestation and fire from 2001 to 2015. While forest loss and fire continued after RSPO certification, certified palm oil was associated with reduced deforestation. Certification lowered deforestation by 33% from a counterfactual of 9.8 to 6.6% y−1. Nevertheless, most plantations contained little residual forest when they received certification. As a result, by 2015, certified areas held less than 1% of forests remaining within Indonesian oil palm plantations. Moreover, certification had no causal impact on forest loss in peatlands or active fire detection rates. Broader adoption of certification in forested regions, strict requirements to avoid all peat, and routine monitoring of clearly defined forest cover loss in certified and RSPO member-held plantations appear necessary if the RSPO is to yield conservation and climate benefits from reductions in tropical deforestation. PMID:29229857
Fretz, Bruce R.; And Others
Certification procedures protect consumers, but when licensing institutions become monopolistic, alternative paths to credentialing need to be considered. A series of articles examine third party payments, a changing job market and consumer protection concerns, all of which have had an impact on credentialing problems. (JAC)
-, č. 364 (2008), s. 1-37 ISSN 1211-3298 R&D Projects: GA MŠk LC542 Grant - others:Univerzita Karlova(CZ) 7743/2007 Institutional research plan: CEZ:AV0Z70850503 Keywords : certification * imperfect testing * competition Subject RIV: AH - Economics http://www.cerge-ei.cz/pdf/wp/Wp364.pdf
Bravo, Eduardo Francisco; Saint-Pierre, Gustavo Enrique; Yaikin, Pabla Javiera; Meier, Martina Jose
Easter Island is a small island of 180 km2, located 3,800 km from the Chilean coast and one of the most isolated inhabited places in the world. Since the mid-twentieth century, it has been undergoing an epidemiological transition in relation to the causes of death, from a predominance of infectious to non-communicable diseases (NCDs) such as cardiovascular ailments and cancer. The aim of this study is to describe the causes of death to Easter Island between 2000 and 2012, so the statistical records of Hanga Roa Hospital and death certificates were reviewed. The period under review of 13 years there was a total of 252 deaths, an average to 19.3 deaths per year. The most frequent causes of death found in the general population of Easter Island were cardiovascular diseases (25.4%), followed by neoplasms (23.4%), accidents (18.6%). Related to Rapa Nui people, cardiovascular and neoplastic diseases (both 26.7%) predominate, while in the population without belonging to the ethnic group the main causes were traumatic (25%) and cardiovascular (22.2%). Comparing the leading causes of death of Easter Island with mainland Chile, it can be seen how they resemble. Taking the island death profile, it is necessary to work on public health strategies aimed to this, considering that some of the causes are completely preventable.
Floristán Floristán, Yugo; Delfrade Osinaga, Josu; Carrillo Prieto, Jesus; Aguirre Perez, Jesus; Moreno-Iribas, Conchi
There are few studies that analyze changes in mortality statistics derived from the use of IRIS software, an automatic system for coding multiple causes of death and for the selection of the underlying cause of death, compared to manual coding. This study evaluated the impact of the use of IRIS in the Navarre mortality statistic. We proceeded to double coding 5,060 death certificates corresponding to residents in Navarra in 2014. We calculated coincidence between the two encodings for ICD10 chapters and for the list of causes of the Spanish National Statistics Institute (INE-102) and we estimated the change on mortality rates. IRIS automatically coded 90% of death certificates. The coincidence to 4 characters and in the same chapter of the CIE10 was 79.1% and 92.0%, respectively. Furthermore, coincidence with the short INE-102 list was 88.3%. Higher matches were found in death certificate of people under 65 years. In comparison with manual coding there was an increase in deaths from endocrine diseases (31%), mental disorders (19%) and disease of nervous system (9%), while a decrease of genitourinary system diseases was observed (21%). The coincidence at level of ICD10 chapters coding by IRIS in comparison to manual coding was 9 out of 10 deaths, similar to what is observed in other studies. The implementation of IRIS has led to increased of endocrine diseases, especially diabetes and hyperlipidaemia, and mental disorders, especially dementias.
The purpose of this conference to provide a multidisciplinary forum for exchange of state-of-the-art information on the role programmed cell death plays in normal development and homeostasis of many organisms. This volume contains abstracts of papers in the following areas: invertebrate development; immunology/neurology; bcl-2 family; biochemistry; programmed cell death in viruses; oncogenesis; vertebrate development; and diseases.
Full Text Available Brain death (BD diagnosis should be established based on the following set of principles, i.e. excluding major confusing factors, identifying the cause of coma, determining irreversibility, and precisely testing brainstem reflexes at all levels of the brainstem. Nonetheless, most criteria for BD diagnosis do not mention that this is not the only way of diagnosing death. The Cuban Commission for the Determination of Death has emphasized the aforesaid three possible situations for diagnosing death: a outside intensive care environment (without life support physicians apply the cardio-circulatory and respiratory criteria; b in forensic medicine circumstances, physicians utilize cadaveric signs (they do not even need a stethoscope; c in the intensive care environment (with life support when cardiorespiratory arrest occurs physicians utilize the cardio-circulatory and respiratory criteria. This methodology of diagnosing death, based on finding any of the death signs, is not related to the concept that there are different types of death. The irreversible loss of cardio-circulatory and respiratory functions can only cause death when ischemia and anoxia are prolonged enough to produce an irreversible destruction of the brain. The sign of irreversible loss of brain functions, that is to say BD diagnosis, is fully reviewed.
Full Text Available Sudden cardiac death is one of the most common cause of mortality worldwide. Despite significant advances in the medical science, there is little improvement in the sudden cardiac death related mortality. Coronary artery disease is the most common etiology behind sudden cardiac death, in the above 40 years population. Even in the apparently healthy population, there is a small percentage of patients dying from sudden cardiac death. Given the large denominator, this small percentage contributes to the largest burden of sudden cardiac death. Identification of this at risk group among the apparently healthy individual is a great challenge for the medical fraternity. This article looks into the causes and methods of preventing SCD and at some of the Indian data. Details of Brugada syndrome, Long QT syndrome, Genetics of SCD are discussed. Recent guidelines on many of these causes are summarised.
The purpose of this article is to develop a conception of death with dignity and to examine whether it is vulnerable to the sort of criticisms that have been made of other conceptions. In this conception "death" is taken to apply to the process of dying; "dignity" is taken to be something that attaches to people because of their personal qualities. In particular, someone lives with dignity if they live well (in accordance with reason, as Aristotle would see it). It follows that health care professionals cannot confer on patients either dignity or death with dignity. They can, however, attempt to ensure that the patient dies without indignity. Indignities are affronts to human dignity, and include such things as serious pain and the exclusion of patients from involvement in decisions about their lives and deaths. This fairly modest conception of death with dignity avoids the traps of being overly subjective or of viewing the sick and helpless as "undignified". PMID:12161582
Kastner, P.; Morak, J.; Modre, R.; Kollmann, A.; Ebner, C.; Fruhwald, FM.; Schreier, G.
Objective Results of the Austrian MOBITEL (MOBIle phone based TELemonitoring for heart failure patients) trial indicate that home-based telemonitoring improves outcome of chronic heart failure (CHF) patients and reduces both frequency and duration of hospitalizations. Based on lessons learned, we assessed the weak points to clear the way for routine operations. Methods We analyzed the system with respect to recommendations of the ESC Guidelines and experiences gained throughout the trial to identify potential improvements. The following components have been identified: a patient terminal with highest usability, integrated way to document drug-intake and well-being, and automated event detection for worsening of CHF. As a consequence the system was extended by Near Field Communication (NFC) technology and by an event management tool. Results Usability evaluation with 30 adults (14f, median 51y. IQR[45-65]) showed that 21 (8f) were able to immediately operate the system after reading a step-by-step manual. Eight (6f) needed one time demonstration and one man (80y) failed to operate the blood pressure meter. Routine operation of the revised system started in March 2009. Within 9 months, 15 patients (4f, median 74y. IQR[71-83], all NYHA-III) transmitted 17,149 items. 43 events were detected because of body weight gain of more then 2kg within 2 days. 49 therapy adjustments were documented. Three patients stopped using the system, two (1f) because of non-compliance and one (m, 82y) because of death. Overall, the rate of adherence to daily data transfer was 78%. Conclusion First results confirm the applicability of the revised telemonitoring system in routine operation. PMID:23616835
Andersen, Christen Bertel L; Siersma, Volkert Dirk; Hasselbalch, HC
Eosinophilia may represent an early paraclinical sign of hematological malignant disease, but no reports exist on its predictive value for hematological malignancies. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differ...
Hong, Tran Thi; Phuong Hoa, Nguyen; Walker, Sue M; Hill, Peter S; Rao, Chalapati
Mortality statistics form a crucial component of national Health Management Information Systems (HMIS). However, there are limitations in the availability and quality of mortality data at national level in Viet Nam. This study assessed the completeness of recorded deaths and the reliability of recorded causes of death (COD) in the A6 death registers in the national routine HMIS in Viet Nam. 1477 identified deaths in 2014 were reviewed in two provinces. A capture-recapture method was applied to assess the completeness of the A6 death registers. 1365 household verbal autopsy (VA) interviews were successfully conducted, and these were reviewed by physicians who assigned multiple and underlying cause of death (UCOD). These UCODs from VA were then compared with the CODs recorded in the A6 death registers, using kappa scores to assess the reliability of the A6 death register diagnoses. The overall completeness of the A6 death registers in the two provinces was 89.3% (95%CI: 87.8-90.8). No COD recorded in the A6 death registers demonstrated good reliability. There is very low reliability in recording of cardiovascular deaths (kappa for stroke = 0.47 and kappa for ischaemic heart diseases = 0.42) and diabetes (kappa = 0.33). The reporting of deaths due to road traffic accidents, HIV and some cancers are at a moderate level of reliability with kappa scores ranging between 0.57-0.69 (pViet Nam.
ASCENT center for technical knowledge
The Autodesk® Revit® Architecture 2014 Review for Certification guide is intended for users of the Autodesk Revit Architecture software who are preparing to complete the Autodesk Revit Architecture 2014 Certified Professional exam. This guide contains a collection of relevant instructional topics, practices, and review questions from the Autodesk Official Training Guides (AOTG) training guides created by ASCENT - Center for Technical Knowledge® and pertaining specifically to the Certified Professional exam topics and objectives. This training guide is intended for experienced users of the Autodesk Revit Architecture software in preparation for certification. New users of the software should refer to the AOTG training guides from ASCENT, such as Autodesk Revit Architecture 2014 Fundamentals, for more comprehensive instruction.
The medical certificate of no contraindication to the practice of sport, requires prudence during the exam preceding its writing for medicals and medico-legal reasons. It needs a careful questioning on important points relative to the risk of health problems during a sportive effort, especially to seek for the prodoms which can be found in 7 to 50% of cases. This questioning can sometimes be specific to certain specialities of sport. Actually, even if the concept of mass screening identify for sports people, amateurs or not, is still much debated, we can consider as a reasonable attitude, in consulting with the general medicine, to practice a careful cardiovascular examination and an ECG whose the interpretation, done with the expertise required, could help to detect about 60% of the possible lethal abnormalities to the physical effort. In case of doubt during the exam, the complementary investigations are needed in some cases (echocardiogram, stress testing, myocardial perfusion, electrophysiological endocavitary exploration). After that, the used advices can be given to the sportive candidate to minimize the risks. Despite these precautions, a subit death because of the effort can non totally be avoided. Finally, it must be remembered that the behaviour to have for kid and for elderly person involves certain specificities to know.
Ly, Kathleen N; Speers, Suzanne; Klevens, R Monina; Barry, Vaughn; Vogt, Tara M
Chronic liver disease (CLD) is a leading cause of death and is defined based on a specific set of underlying cause-of-death codes on death certificates. This conventional approach to measuring CLD mortality underestimates the true mortality burden because it does not consider certain CLD conditions like viral hepatitis and hepatocellular carcinoma. We measured how much the conventional CLD mortality case definition will underestimate CLD mortality and described the distribution of CLD etiologies in Connecticut. We used 2004 Connecticut death certificates to estimate CLD mortality two ways. One way used the conventional definition and the other used an expanded definition that included more conditions suggestive of CLD. We compared the number of deaths identified using this expanded definition with the number identified using the conventional definition. Medical records were reviewed to confirm CLD deaths. Connecticut had 29 314 registered deaths in 2004. Of these, 282 (1.0%) were CLD deaths identified by the conventional CLD definition while 616 (2.1%) were CLD deaths defined by the expanded definition. Medical record review confirmed that most deaths identified by the expanded definition were CLD-related (550/616); this suggested a 15.8 deaths/100 000 population mortality rate. Among deaths for which hepatitis B, hepatitis C and alcoholic liver disease were identified during medical record review, only 8.6%, 45.4% and 36.5%, respectively, had that specific cause-of-death code cited on the death certificate. An expanded CLD mortality case definition that incorporates multiple causes of death and additional CLD-related conditions will better estimate CLD mortality. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.
The U.S. Department of Energy manages the Nevada Test Site in a manner that meets evolving DOE Missions and responds to the concerns of affected and interested individuals and agencies. This Routine Radiological Monitoring Plan addressess complicance with DOE Orders 5400.1 and 5400.5 and other drivers requiring routine effluent monitoring and environmental surveillance on the Nevada Test Site. This monitoring plan, prepared in 1998, addresses the activities conducted onsite NTS under the Final Environmental Impact Statement and Record of Decision. This radiological monitoring plan, prepared on behalf of the Nevada Test Site Landlord, brings together sitewide environmental surveillance; site-specific effluent monitoring; and operational monitoring conducted by various missions, programs, and projects on the NTS. The plan provides an approach to identifying and conducting routine radiological monitoring at the NTS, based on integrated technical, scientific, and regulatory complicance data needs.
Purpose – The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change......: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications – The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research....... Practical implications – The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality...
mohamad hassan lotfi
Full Text Available Abstract Introduction: Death is defined as the permanent loss of all signs of life at any time after birth (Irrevocable disappearance of all vital signs after birth. Unnatural deaths seem to be either suspicious or unexpected. Deaths that occur suddenly and their causes need to be investigated, are termed unnatural deaths. According to the death certificate contents of Ministry of Health and Forensics, if the cause of death is unnatural, the corpse will be submitted to the forensic medicine departments in 19 cases in order to determine the death cause and to issue the burial permit. Material & Methods: In this descriptive study, the data were extracted from unnatural death cases in the province of Yazd during 2003 to 2013 recorded by Yazd Forensic Medicine. Results: During 2003 -2013, 5552 cases of unnatural deaths were recorded by the Forensic Medicine of Yazd, out of which 4373 cases of unnatural deaths were caused by road traffic accidents (outside and inside the city, 89 deaths from electrocution, 439 deaths from poisoning, 72 deaths from drowning, 129 deaths from asphyxia (by carbon monoxide, 56 deaths from work incidents, and 394 deaths from burns. The group of males aged 20-29 years allocated the highest number of unnatural deaths to themselves. Conclusion: Road traffic accidents are the second leading cause of unnatural deaths in Iran. The number of unnatural death incidents in men is more than women indicating that men are more exposed to risk factors than women, though regarding the deaths due to the burns, women are exposed to the high risk factors.
Gullach, Anders Juul; Risgaard, Bjarke; Lynge, Thomas Hadberg
BACKGROUND: Asthma is a common chronic disease among young adults, and several studies have reported increased mortality rates in patients with asthma. However, no study has described sudden unexpected death in a nationwide setting in patients with uncontrolled asthma. We defined uncontrolled...... in preventing sudden unexpected deaths. We therefore aimed to describe clinical characteristics, symptoms, causes of death, and contact with the healthcare system prior to sudden unexpected death in young persons with uncontrolled asthma. METHODS: Through the review of death certificates, we found 625 sudden...... individuals who suffered from uncontrolled asthma. This corresponds to an incidence rate of 0.32 per 100,000 person-years. The cause of death in 31 cases (63%) was sudden cardiac death, and in 13 cases (27%), it was a fatal asthma attack. Symptoms (chest pain, dyspnea, seizures, general malaise, syncope...
Joehnemark, Maria; Oestberg, Roger; Johansson, Martin
Over the years, the electricity certificate system has been maturing and consolidating, so that it is today an effective and functional policy measure that has won wide acceptance from all parties concerned. The long term approach and security of the system are attracting an increasing number of investors, which is described more fully in this report. This year's special theme chapter, Investing in Renewable Energy, presents the status of the system from an investment point of view. In addition to this chapter, the report includes, as always, an introduction to how the certificate system works, together with an updating with the latest statistics. A quick glance at external factors that can affect the system indicates that there are several that may do so in the future. Just the fact that the climate problem is still high on the political agenda, despite strong competition from economic crises, shows that there is a need for more renewable energy. The EU Renewable Energy Directive, which was adopted at the end of 2008, requires the Swedish energy system to deliver 49 % of its output from renewable sources by 2020. In addition, the Energy Bill adopted by the Swedish Parliament identifies the electricity certificate system as one of the most important means of achieving the country's objectives. Taken together, this indicates that there are many factors that will further strengthen the role of the certificate system in the next few years. If we look at the system itself, we can see that a number of important changes have been made since the previous report. With effect from 1st January 2009, the definition of electricity-intensive industries has changed, bringing it more closely in line with the definition used in energy taxation. Since 1st May, the rules have changed concerning entitlement to a new allocation period of certificates after a plant has been substantially modified. In addition, certificates can now be allocated for increases in output from
Nachtkamp, Kathrin; Stark, Romina; Strupp, Corinna; Kündgen, Andrea; Giagounidis, Aristoteles; Aul, Carlo; Hildebrandt, Barbara; Haas, Rainer; Gattermann, Norbert; Germing, Ulrich
Patients with myelodysplastic syndromes face a poor prognosis. The exact causes of death have not been described properly in the past. We performed a retrospective analysis of causes of death using data of 3792 patients in the Düsseldorf registry who have been followed up for a median time of 21 months. Medical files as well as death certificates were screened and primary care physicians were contacted. Death after AML evolution, infection, and bleeding was considered to be clearly disease-related. Further categories of causes of death were heart failure, other possibly disease-related reasons, such as hemochromatosis, disease-independent reasons as well as cases with unclear causes of death. Median age at the time of diagnosis was 71 years. At the time of analysis, 2877 patients (75.9 %) had deceased. In 1212 cases (42.1 %), the exact cause of death could not be ascertained. From 1665 patients with a clearly documented cause of death, 1388 patients (83.4 %) succumbed directly disease-related (AML (46.6 %), infection (27.0 %), bleeding (9.8 %)), whereas 277 patients (16.6 %) died for reasons not directly related with myelodysplastic syndromes (MDS), including 132 patients with cardiac failure, 77 non-disease-related reasons, 23 patients with solid tumors, and 45 patients with possibly disease-related causes like hemochromatosis. Correlation with IPSS, IPSS-R, and WPSS categories showed a proportional increase of disease-related causes of death with increasing IPSS/IPSS-R/WPSS risk category. Likewise, therapy-related MDS were associated with a higher percentage of disease-related causes of death than primary MDS. This reflects the increasing influence of the underlying disease on the cause of death with increasing aggressiveness of the disease.
It is surprising how much of everyday conversation consists of repetitive expressions such as 'thank you', 'sorry', would you mind?' and their many variants. However commonplace they may be, they do have important functions in communication.This thorough study draws upon original data from the London-Lund Corpus of Spoken English to provide a discoursal and pragmatic account of the more common expressions found in conversational routines, such as apologising, thanking, requesting and offering.The routines studied in this book range from conventionalized or idiomatized phrases t
Hurst, T.; Lannom, R.W.; Divine, D.L.
This paper reports that routine maintenance of electric submersible motors (ESPs) significantly lengthened the mean time between motor failures (MTBF), decreased operating costs, and extended motor run life in the Sacroc Unit of the Kelly-Snyder field in West Texas. After the oil price boom of the early 1980s. rapidly eroding profit margins from producing properties caused a much stronger focus on reducing operating costs. In Sacroc, ESP operating life and repair costs became a major target of cost reduction efforts. The routine ESP maintenance program has been in place for over 3 years
Fernando E. García-Muiña
We enrich the treatment of the absorptive capacity phases including the moderating effects between routines associated to the traditional potential-realized absorptive capacities. Taking into account external knowledge search strategies, the deeper external relationships, the better transference and appropriation of specific external knowledge. Nevertheless, when the moderating role of assimilation is included, cooperation agreements appear as the most efficient source of external knowledge. Finally, we show that technological tools let firms store and structure the information making easier its use for international patenting. This positive effect is reinforced in the presence of exploitation routines, since technological knowledge will better fit to the industry's key factors of success.
Full Text Available PURPOSE: There are more drug overdose deaths in the Untied States than motor vehicle fatalities. Yet the US vital statistics reporting system is of limited value because the data are delayed by four years. Poison centers report data within an hour of the event, but previous studies suggested a small proportion of poisoning deaths are reported to poison centers (PC. In an era of improved electronic surveillance capabilities, exposure calls to PCs may be an alternate indicator of trends in overdose mortality. METHODS: We used PC call counts for methadone that were reported to the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS® System in 2006 and 2007. US death certificate data were used to identify deaths due to methadone. Linear regression was used to quantify the relationship of deaths and poison center calls. RESULTS: Compared to decedents, poison center callers tended to be younger, more often female, at home and less likely to require medical attention. A strong association was found with PC calls and methadone mortality (b=0.88, se=0.42, t=9.5, df=1, p<0.0001, R(2 =0.77. These findings were robust to large changes in a sensitivity analysis assessing the impact of underreporting of methadone overdose deaths. CONCLUSIONS: Our results suggest that calls to poison centers for methadone are correlated with poisoning mortality as identified on death certificates. Calls received by poison centers may be used for timely surveillance of mortality due to methadone. In the midst of the prescription opioid overdose epidemic, electronic surveillance tools that report in real-time are powerful public health tools.
Martins, Renata Cristófani; Buchalla, Cassia Maria
To prepare a dictionary in Portuguese for using in Iris and to evaluate its completeness for coding causes of death. Iniatially, a dictionary with all illness and injuries was created based on the International Classification of Diseases - tenth revision (ICD-10) codes. This dictionary was based on two sources: the electronic file of ICD-10 volume 1 and the data from Thesaurus of the International Classification of Primary Care (ICPC-2). Then, a death certificate sample from the Program of Improvement of Mortality Information in São Paulo (PRO-AIM) was coded manually and by Iris version V4.0.34, and the causes of death were compared. Whenever Iris was not able to code the causes of death, adjustments were made in the dictionary. Iris was able to code all causes of death in 94.4% death certificates, but only 50.6% were directly coded, without adjustments. Among death certificates that the software was unable to fully code, 89.2% had a diagnosis of external causes (chapter XX of ICD-10). This group of causes of death showed less agreement when comparing the coding by Iris to the manual one. The software performed well, but it needs adjustments and improvement in its dictionary. In the upcoming versions of the software, its developers are trying to solve the external causes of death problem.
Conway, George A.; Moran, Katherine A.; Mode, Nicolle A.
Objectives. Between 1990-2002, 797 Alaskans died while working. After a scientific survey team member drowned, we examined the hazards of traumatic death to scientific and professional workers in Alaska. Study design. Surveillance and analysis methods for acute traumatic occupational injuries: The Alaska Occupational Injury Surveillance System (AOISS) uses direct investigation, jurisdictional agency reports, and death certificates to gather data for active surveillance on occupational injury ...
Tartaro, Christine; Lester, David
Despite the level of supervision of inmates on death row, their suicide rate is higher than both the male prison population in the United States and the population of males over the age of 14 in free society. This study presents suicide data for death row inmates from 1978 through 2010. For the years 1978 through 2010, suicide rates on death row were higher than that for the general population of males over the age of 15 and for state prisons for all but 2 years. © 2016 American Academy of Forensic Sciences.
In the last months of the second World War, 250,000 German refugees landed in Denmark. A third of them were children under the age of 15. Seven thousand German refugee children under the age of five died in Denmark in 1945. Using birth certificates and death certificates from the Danish national archives and burial lists from the German refugee cemetaries I have collected data to reveal causes of death, age distributions and time of the deaths of the 7000 fatal cases among children under the age of five. Three thousand children under the age of one, 2000 children one year old and 2000 children 2-4 years old died. Most of them died just before and after the German surrender, but many died in the months following the German surrender. The infant mortality was extremely high all during 1945. The infants died from diseases due to malnutrition, but the older the children the more likely the causes of death were due to infectious diseases such as pneumonia, measles, diphtheria and gastroenteritis.
More than 200 educators will receive fellowships over the next 5 years to participate in NASA's Endeavor Science Teaching Certificate Project, the agency announced on 14 November. Through workshops, online and on-site graduate courses, and NASA educational materials, the project will expose educators to NASA science and engineering and support them in translating the information for use in classrooms. ``Through the program, educators will learn to deliver cutting-edge science into the classroom, promoting science, technology, engineering, and mathematics education,'' according to Joyce Winterton, assistant administrator for education at NASA Headquarters, in Washington, D. C. Project fellows will earn a certificate from Teachers College Innovations at Teachers College, Columbia University, New York, and graduate credit from other institutional partners. For more information, visit http://education.nasa.gov/home/index.html.
Deken, F.; Carlile, P.R.; Berends, H.; Lauche, K.
We investigate how multiple actors accomplish interdependent routine performances directed at novel intended outcomes and how this affects routine dynamics over time. We report findings from a longitudinal ethnographic study in an automotive company where actors developed a new business model around
Jensen, Henriette Hvide; Godtfredsen, Nina Skavlan; Lange, Peter
Little is known about causes of death in chronic obstructive pulmonary disease (COPD) and the validity of mortality statistics in COPD. The present authors examined causes of death using data from the Copenhagen City Heart Study. Of the 12,979 subjects with sufficient data from the baseline...... examination during 1976-1978, 6,709 died before 2001. Of these, 242 died with COPD as cause of death. Among subjects with at least severe COPD at baseline, only 24.9% had COPD as cause of death and, in almost half of the cases where COPD was listed as cause of death, the subject had a normal forced expiratory...... COPD, CMH and smoking were predictors of COPD as underlying cause of death, ORs 2.3 (1.5-3.7) and 2.2 (1.4-3.6), respectively. It was concluded that chronic obstructive pulmonary disease is underreported on death certificates, that biases in the use of chronic obstructive pulmonary disease as cause...
Alshemmari, Salem H; Elbasmi, Amani A; Alsirafy, Samy A
The place of death (PoD) has a significant effect on end-of-life care for patients dying of cancer. Little is known about the place of cancer deaths in our region. To identify the PoD of patients with cancer in Kuwait, we reviewed the death certificates submitted to the Kuwait Cancer Registry in 2009. Of 611 cancer deaths, 603 (98.7%) died in hospitals and only 6 (1%) patients died at home. More than half (57.3%) of inhospital deaths were in the Kuwait Cancer Control Center. Among those for whom the exact PoD within the hospital was identified (484 patients), 116 (24%) patients died in intensive care units and 12 (2.5%) patients died in emergency rooms. This almost exclusive inhospital death of patients with cancer in Kuwait is the highest ever reported. Research is needed to identify the reasons behind this pattern of PoD and to explore interventions promoting out-of-hospital death among terminally ill cancer patients in Kuwait. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
This chapter explores the potential of Fairtrade in hired labour situations in terms of improving conditions for agricultural workers. The chapter will address various aspects including the contentious issue of Fairtrade and trade union organisation as well as on issues of worker empowerment....... At a local level, analysis focuses on the implications of Fairtrade certification for large enterprises and workers, drawing on a field-based studies of certified flower farms in Ecuador and Kenya....
Schwartz, Bryan Glen; Pezzullo, John Christopher; McDonald, Scott Andrew; Poole, William Kenneth; Kloner, Robert Alan
Various stressors trigger cardiac death. The objective was to investigate a possible relation between a stock market crash and cardiac death in a large population within the United States. We obtained daily stock market data (Dow Jones Industrial Average Index), death certificate data for daily deaths in Los Angeles County (LA), and annual LA population estimates for 2005 through 2008. The 4 years death rate curves (2005 through 2008) were averaged into a single curve to illustrate annual trends. Data were "deseasonalized" by subtracting from the daily observed value the average value for that day of year. There was marked seasonal variation in total and cardiac death rates. Even in the mild LA climate, death rates were higher in winter versus summer including total death (+17%), circulatory death (+24%), coronary heart disease death (+28%), and myocardial infarction death (+38%) rates (p stock market crash in October 2008 did not affect death rates in LA. Death rates remained at or below seasonal averages during the stock market crash. In conclusion, after correcting for seasonal variation, the stock market crash in October 2008 was not associated with an increase in total or cardiac death in LA. Annual coronary heart disease death rates continue to decrease. However, seasonal variation (specifically winter) remains a trigger for death and coronary heart disease death even in LA where winters are mild. Copyright © 2012 Elsevier Inc. All rights reserved.
Method: Sixty (60) pre-tested questionnaires were randomly administered to community pharmacists. Forty-three (43) questionnaires were retrieved for analysis. Results: The study revealed that the use of community pharmacies as places where routine immunization services can be provided is feasible as shown by 95.3% ...
Age at BCG administration during routine immunization. R.D. Wammanda , M.J. Gambo and I. Abdulkadir. Department of Paediatrics,. Ahmadu Bello University Teaching Hospital,. Zaria. Correspondence to: Dr.R.D. Wammanda. Email: firstname.lastname@example.org. Summary. In Nigeria, as part of the National Programme on ...
Dietz, Franziska; Hofer, Manfred; Fries, Stefan
Background: Academic procrastination, the tendency to postpone learning activities, is regarded as a consequence of postmodern values that are prominent in post-industrialized societies. When students strive for leisure goals and have no structured routines for academic tasks, delaying strenuous learning activities becomes probable. Aims: The…
Dietz, Franziska; Hofer, Manfred; Fries, Stefan
Academic procrastination, the tendency to postpone learning activities, is regarded as a consequence of postmodern values that are prominent in post-industrialized societies. When students strive for leisure goals and have no structured routines for academic tasks, delaying strenuous learning activities becomes probable. The model tested in this study posits that postmodern value orientations are positively related to procrastination and to a lack of daily routines concerning the performance of academic activities. In contrast, modern values are negatively related to procrastination and positively to learning routines. Academic procrastination, in-turn, should be associated with the tendency to prefer leisure activities to schoolwork in case of conflicts between these two life domains. Seven hundred and four students from 6th and 8th grade with a mean age of 13.5 years participated in the study. The sample included students from all tracks of the German educational system. Students completed a questionnaire containing two value prototypes as well as scales on learning routines and procrastination. Decisions in motivational conflicts were measured using two vignettes. Results from structural equation modelling supported the proposed model for the whole sample as well as for each school track. A planned course of the day can prevent procrastination and foster decisions for academic tasks in case of conflicts. Students' learning takes place within a societal context and reflects the values held in the respective culture.
Presents a high school lesson on Hitler's death camps and the widespread policy of brutality and oppression against European Jews. Includes student objectives, instructional procedures, and a chart listing the value of used clothing taken from the Jews. (CFR)
U.S. Department of Health & Human Services — Complications and deaths - state data. This data set includes state-level data for the hip/knee complication measure, the Agency for Healthcare Research and Quality...
Shortall, Joseph M.; Merrill, Denise W.
Presents a lesson on capital punishment for juveniles based on three hypothetical cases. The goal of the lesson is to have students understand the complexities of decisions regarding the death penalty for juveniles. (JDH)
U.S. Department of Health & Human Services — Complications and deaths - state data. This data set includes state-level data for the hip/knee complication measure, the CMS Patient Safety Indicators, and 30-day...
Jensen, Anja Marie Bornø
processes of facing brain death and deciding about organ donation. This study suggests that organ donation should be understood as a ‘strange figure’ challenging traditions and attitudes regarding the boundaries between life and death and the practices surrounding dead human bodies. Simultaneously, organ...... donation can be comforting and furthermore enable some families to make sense of a sudden tragic death. Throughout the thesis, the concept of ‘orchestration’ serves as the overall theoretical framework to understand how families, hospital staff and, on a larger scale, Danish society attempt to perform......, reinterpret and translate death and organ donation into something culturally acceptable and sense making. With chapters focusing analytically on the performance of trust, the transformative practices of hope, the aesthetization of ambiguous bodies, the sociality of exchangeable organs and the organ donation...
Background Research suggests that addressing dying patients’ existential concerns can help improve their quality of life. Common existential conditions, such as a search for meaning and considerations about faith, are probably intensified in a palliative setting and existential concerns about death...... are likewise intensified when patients face their impending death. Knowledge of modern, secular existential concerns about death is under-researched, and therefore, it is difficult to develop and implement specifically targeted support to dying patients. Aim The aim of this paper is to present the results from...... a qualitative field study illuminating the variety of dying patients´ existential concerns about their impending death. Method Data was generated through ethnographic fieldwork comprising 17 semi-structured interviews with dying patients and 38 days of participant observation at three Danish hospices. Results...
Milner, George R.; Boldsen, Jesper L.
Analytically sophisticated paleoepidemiology is a relatively new development in the characterization of past life experiences. It is based on sound paleopathological observations, accurate age-at-death estimates, an explicit engagement with the nature of mortality samples, and analytical procedures...
U.S. Department of Health & Human Services — Complications and deaths - provider data. This data set includes provider data for the hip/knee complication measure, CMS Patient Safety Indicators of serious...
U.S. Department of Health & Human Services — Complications and deaths - national data. This data set includes national-level data for the hip/knee complication measure, the CMS Patient Safety Indicators, and...
... VESSELS INSPECTION AND CERTIFICATION Certificates Under International Convention for Safety of Life at Sea... period of not more than 60 months. (1) A Cargo Ship Safety Construction Certificate. (2) A Cargo Ship Safety Equipment Certificate. (3) A Safety Management Certificate. (4) A Cargo Ship Safety Radio...
Lamb, Donald K.
This manual contains the guidelines and procedures for public librarian certification and certification renewal in Wisconsin. Certification is not required for library personnel other than administrators, but nonadministrators may apply for certification at the level for which they are eligible. Requirements for voluntary library certification are…
... 46 Shipping 4 2010-10-01 2010-10-01 false Original Certificate of Inspection. 107.211 Section 107... INSPECTION AND CERTIFICATION Inspection and Certification § 107.211 Original Certificate of Inspection. (a) The owner or builder of a unit applies for an inspection for an original Certificate of Inspection by...
Mol, A.P.J.; Oosterveer, P.J.M.
There is a blossoming of voluntary certification initiatives for sustainable agro-food products and production processes. With these certification initiatives come traceability in supply chains, to guarantee the sustainability of the products consumed. No systematic analysis exists of traceability
Lyons, Bridget H; Fowler, Katherine A; Jack, Shane P D; Betz, Carter J; Blair, Janet M
In 2013, more than 57,000 persons died in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 17 U.S. states for 2013. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics. 2013. NVDRS collects data from participating states regarding violent deaths obtained from death certificates, coroner/medical examiner reports, law enforcement reports, and secondary sources (e.g., child fatality review team data, supplemental homicide reports, hospital data, and crime laboratory data). This report includes data from 17 states that collected statewide data for 2013 (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, North Carolina, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and Wisconsin). NVDRS collates documents for each death and links deaths that are related (e.g., multiple homicides, a homicide followed by a suicide, or multiple suicides) from a single incident. For 2013, a total of 18,765 fatal incidents involving 19,251 deaths were captured by NVDRS in the 17 states included in this report. The majority (66.2%) of deaths were suicides, followed by homicides (23.2%), deaths of undetermined intent (8.8%), deaths involving legal intervention (1.2%) (i.e., deaths caused by law enforcement and other persons with legal authority to use deadly force, excluding legal executions), and unintentional firearm deaths (Revision [ICD-10] and does not denote the lawfulness or legality of the circumstances surrounding a death caused by law enforcement.) Suicides occurred at higher rates among males, non-Hispanic whites, American Indian/Alaska Natives, persons aged 45-64 years, and males aged ≥75 years. Suicides were preceded primarily by a mental health, intimate partner, or physical
U.S. Department of Health & Human Services — The Mortality - Infant Deaths (from Linked Birth / Infant Death Records) online databases on CDC WONDER provide counts and rates for deaths of children under 1 year...
Risse, Manfred; Weilbächer, Nadine; Birngruber, Christoph; Verhoff, Marcel A
There are no verified statistics about deaths occurring in hotels, and only a few cases have been described in the literature. A recent case induced us to conduct a systematic search for deaths in hotels in the autopsy reports of the Institute of Legal Medicine in Giessen for the period from 1968 to 2009. This search yielded 22 evaluable cases in which persons had been found dead or had died in hotels. Data evaluated in the study were sex and age of the deceased, reason for the stay in the hotel and cause of death. Among the deaths, 18 were males and 4 females and the average age was 41 and 40 years respectively. 6 of the male guests had died from a natural and 10 from a non-natural cause. In the remaining two cases, the cause of death could not be determined, but as there was no evidence that another party had been involved, the cases were not further investigated. Of the 4 female guests, 3 had died of a natural cause; in one case, the cause of death remained unclear even after morphological and toxicological investigations. Surprisingly, a third of the men were found to be temporarily living in hotels due to social circumstances. This was not true for any of the women. Our retrospective analysis is based on a comparatively small number of deaths in what were mostly hotels in small to medium-sized towns. Interestingly, the gender ratio of 18:4 for deceased men and women was significantly higher than the usual gender ratio of 2:1 found for forensic autopsies. To be able to draw further conclusions, a greater number of cases would have to be analysed, for example by recruiting additional case files from other institutes of legal medicine. This would also open up the option of investigating possible regional variations.
Storeboe, Inger Oeydis
This report studies the advantages and disadvantages of a separate financial market for the environmental advantages in the production of electricity from renewable energy sources. This market solution is evaluated against other financial systems used to promote the production of green electricity. By starting from a general equilibrium model for the green certificate market, the report discusses how the adaptation in the certificate market is influenced by changes in the market conditions. The certificate market is combined with a quota market for carbon dioxide, with and without international trade with electricity and certificate and market power in the production of electricity from renewable energy sources
Krych, Daniel E.; Lange-Maney, Stephen; McDaniel, Patrick; Glodek, William
Android's application market relies on secure certificate generation to establish trust between applications and their users; yet, cryptography is often not a priority for application developers and many fail to take the necessary security precautions. Indeed, there is cause for concern: several recent high-profile studies have observed a pervasive lack of entropy on Web-systems leading to the factorization of private keys.1 Sufficient entropy, or randomness, is essential to generate secure key pairs and combat predictable key generation. In this paper, we analyze the security of Android certificates. We investigate the entropy present in 550,000 Android application certificates using the Quasilinear GCD finding algorithm.1 Our results show that while the lack of entropy does not appear to be as ubiquitous in the mobile markets as on Web-systems, there is substantial reuse of certificates only one third of the certificates in our dataset were unique. In other words, we find that organizations frequently reuse certificates for different applications. While such a practice is acceptable under Google's specifications for a single developer, we find that in some cases the same certificates are used for a myriad of developers, potentially compromising Android's intended trust relationships. Further, we observed duplicate certificates being used by both malicious and non-malicious applications. The top 3 repeated certificates present in our dataset accounted for a total of 11,438 separate APKs. Of these applications, 451, or roughly 4%, were identified as malicious by antivirus services.
Roope, Richard; Parker, Gordon; Turner, Susan
At present, sickness certification is largely undertaken by general practitioners (GPs). Guidance from the Department of Work and Pensions (DWP) is available to help with this task; however, there has been little formal evaluation of the DWP's guidance in relation to day-to-day general practice. To assess GPs' training, knowledge and application of the DWP's sickness certification guidelines. A structured questionnaire was sent to GPs within a (former) primary care trust (PCT). It probed demographics, training and knowledge of sickness certification guidelines. Case histories and structured questions were used to assess current practice. In this group of 113 GPs, there was a low awareness and use of the DWP's guidelines and Website relating to sickness certification. The majority of the GPs (63%) had received no training in sickness certification, and the mean length of time for those who had received training was 4.1 h. Most GPs also felt that patients and GPs have equal influence on the duration of sickness certification. This evidence of variable practice indicates that GPs should have more guidance and education in sickness certification. Closer sickness certification monitoring through existing GP computer systems may facilitate an improvement in practice that benefits patients and employers. The DWP, medical educators and PCTs may all have an additional role in further improving sickness certification practice.
Mendonca Costa, Eduardo; Arraes Monteiro, Iara
In order to accomplish its legal assignments CNEN certifies the qualification of radiation protection supervisors. The current certification process is presented and discussed in this paper. This paper discusses the main points of the certification process including: knowledge tests, stake holder's communication, standards, supervisor responsibilities and profiles. The importance of safety certification of nuclear facilities and radiation protection of public individuals and workers are also discussed. Taking into account the characteristics of the Brazilian Nuclear program, the future improvements and goals in the certification process is also presented. (author)
Full Text Available The purpose of green certificates is to get more renewable electric energy into the energy market at the expense of traditional energy, which in most countries is based on fossil fuel. These renewable technologies are too expensive to enter the market on commercial terms. A key feature of the scheme is that producers of energy based on new renewable energy sources receive certificates from the authorities, proportional to their output. The users of electric energy are required to buy a certain amount of these certificates when they buy electricity. Green certificates may in principle contribute to a reduction of the production of traditional energy.
Iris B. Montague
Forest certification has gained momentum around the world over the past two decades. Although there are advantages to being certified, many forest landowners and forest products manufacturers consider forest certification of U.S. forest and forest products unnecessary. Many believe that U.S. forests are already sustainably managed, the current certification systems are...
... [FNS-2008-0001] RIN 0584-AD60 Direct Certification and Certification of Homeless, Migrant and Runaway... concerning the certification of certain children who are homeless, runaway, or migratory. This rule affects... children who are homeless, runaway, or migratory, as determined by the homeless coordinator for homeless or...
Lloyd, J W
In contrast with the other lectures given in the course on humanics and bioethics at the UOEH, which address the questions of life and death from the standpoint of the physician or the philosopher, this lecture considers these issues as seen by the cancer patient who has had a close encounter with death. The attitudes of Americans concerning abortion, the use of life-support systems, "mercy killings", suicide and the use of cancer chemotherapy are discussed with particular emphasis on restraints imposed by the courts, the churches and the family systems. An attempt is made to contrast the American and Japanese attitudes on these questions but this is difficult because of different cultural and religious backgrounds. The author describes his own experiences as a cancer patient who has approached death very closely and the changes in his own attitude toward life which results from the encounter with death. He also talks about the joy of being alive and describes his own experience with receiving cancer chemotherapy, the resulting discomfort and inconveniences and his feelings about a "tolerable" existence. Finally, the author considers the question of the "quality of life" for the cancer patient who has a violent reaction to certain forms of chemotherapy. This is a dilemma for the patient and the doctor who must consider the choice between death and a miserable existence.
Sparre-Sørensen, Maja; Kristensen, Gustav N
Studies have shown that malnutrition increases the risk of morbidity, mortality, the length of hospital stay, and costs in the elderly population. Approximately one third of all patients admitted to geriatric wards in Denmark are malnourished according to the Danish Geriatric database. The aim of this study is to describe and examine the sudden increase in deaths due to malnutrition in the elderly population in Denmark from 1999 and, similarly, the sudden decline in malnutrition related deaths in 2007. A descriptive epidemiologic study was performed. All Danes listed in the national death registry who died from malnutrition in the period from 1994 to 2012 are included. The number of deaths from malnutrition increased significantly during the period from 1999 to 2007, especially in the age group 70 years and over. Additionally, we document a surprising similarity between the development in excess mortality from malnutrition in the five Danish regions during the same period. During the period 1999-2007 malnutrition was the direct cause of 340 extra deaths, and probably ten times more registered under other diseases. This development in excess mortality runs parallel in all five Danish regions over time. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.
Full Text Available Following previous research on the linguistic concept of а 'bad death' which lexical expression is the word family of the verb ginuti, I focus my attention in this paper on the relationship between language conceptualization of а 'bad death' and the representation of а 'bad death' in traditional and contemporary culture. Diachronically based language corpus makes possible to trace the changes of referential frame and use of verb ginuti and its derivatives. In the traditional culture а 'bad death' is marked in action code by irregular way of burial and beliefs in demons stemming from the 'impure dead'. In the paper I explore the degree of synonymy of the symbols of all three codes: verbal code, action code and code of beliefs. In the contemporary culture the lack of individual control and choice is considered to be the key element of the concept of a 'bad death'. This change of conceptual content manifests itself in the use of its lexical expressions.
Farag, Tamer H; Koplan, Jeffrey P; Breiman, Robert F; Madhi, Shabir A; Heaton, Penny M; Mundel, Trevor; Ordi, Jaume; Bassat, Quique; Menendez, Clara; Dowell, Scott F
Little is known about the specific causes of neonatal and under-five childhood death in high-mortality geographic regions due to a lack of primary data and dependence on inaccurate tools, such as verbal autopsy. To meet the ambitious new Sustainable Development Goal 3.2 to eliminate preventable child mortality in every country, better approaches are needed to precisely determine specific causes of death so that prevention and treatment interventions can be strengthened and focused. Minimally invasive tissue sampling (MITS) is a technique that uses needle-based postmortem sampling, followed by advanced histopathology and microbiology to definitely determine cause of death. The Bill & Melinda Gates Foundation is supporting a new surveillance system called the Child Health and Mortality Prevention Surveillance network, which will determine cause of death using MITS in combination with other information, and yield cause-specific population-based mortality rates, eventually in up to 12-15 sites in sub-Saharan Africa and south Asia. However, the Gates Foundation funding alone is not enough. We call on governments, other funders, and international stakeholders to expand the use of pathology-based cause of death determination to provide the information needed to end preventable childhood mortality.
Probability & Statistics with Integrated Software Routines is a calculus-based treatment of probability concurrent with and integrated with statistics through interactive, tailored software applications designed to enhance the phenomena of probability and statistics. The software programs make the book unique.The book comes with a CD containing the interactive software leading to the Statistical Genie. The student can issue commands repeatedly while making parameter changes to observe the effects. Computer programming is an excellent skill for problem solvers, involving design, prototyping, data gathering, testing, redesign, validating, etc, all wrapped up in the scientific method.See also: CD to accompany Probability and Stats with Integrated Software Routines (0123694698)* Incorporates more than 1,000 engaging problems with answers* Includes more than 300 solved examples* Uses varied problem solving methods
Bhatia, Amiya; Ferreira, Leonardo Zanini; Barros, Alu?sio J. D.; Victora, Cesar Gomes
Background Birth registration, and the possession of a birth certificate as proof of registration, has long been recognized as a fundamental human right. Data from a functioning civil registration and vital statistics (CRVS) system allows governments to benefit from accurate and universal data on birth and death rates. However, access to birth certificates remains challenging and unequal in many low and middle-income countries. This paper examines wealth, urban/rural and gender inequalities i...
Sittek, H.; Perlet, C.; Helmberger, R.; Linsmeier, E.; Kessler, M.; Reiser, M.
Purpose: Computer-aided diagnosis in mammography is a topic many study groups have been concerned with since the first presentation of a system for computer-aided interpretation in 1967. Currently, there is only one system avilable for clinical use in mammography, the CAD-System Image Checker (R2 Technology). The purpose of our prospective study was to evaluate whether the integration of the CAD-system into the routine of a radiological breast diagnosis unit is feasible. Results: After the installation of the CAD-system, 300 patients with 1110 mammograms were included for evaluation in the present study. In 54 of these cases histological examination was indicated due to suspect criteria on conventional mammography. In 39 of 54 cases (72,2%) malignancy could be proven histologically. The CAD-system marked 82,1% of the histologically verified carcinomas correctly 94,3% of all 1797 marks made by the CAD-system indicated normal or benign structures. Routinely performed CAD analysis prolonged patients waiting time by about 15 min because the marks of the CAD system had to be interpreted in addition to the routine diagnostic investigations. Conclusion: Our experience with the use of the CAD-system in daily routine showed that CAD analysis can easily be integrated into a preexisting mammography unit. However, the diagnostic benefit is not yet clearly established. Since the rate of false negative marks by the CAD-system Image Checker is still high, the results of CAD analysis must be checked and corrected by an observer well experienced in mammography reading. (orig.) [de
Felin, Teppo; Foss, Nicolai Juul
Sidney Winter (2011), Brian Pentland (2011), and Geoffrey Hodgson and Thorbjørn Knudsen (2011) take issue with the arguments in Teppo Felin and Nicolai J. Foss (2011), along with more generally critiquing the ‘microfoundations project’ related to routines and capabilities. In this rejoinder we ar...... chauvinism; (3) models of mind and man; (4) levels of analysis; (5) agency and uncaused causes; and then further discuss (6) a rationalist alternative....
Felicity Page; Olfunso Adedeji
Introduction: We present a case of an extra-luminal haematoma following routine colonoscopy. This case highlights an uncommon but potentially life threatening complication in which there is little published literature to date. Presentation of case: A 73 year old male presented with abdominal pain and a reduction in haemoglobin following an uneventful colonoscopy. The imaging had been required as part of colorectal cancer follow up. Initial differential diagnosis included colonic perforatio...
Gärtner, D; Ernst, A; Fedtke, K; Jenkner, J; Schöttler, A; Reimer, P; Blüher, M; Schön, M R
Staple line and anastomotic leakages are life-threatening complications after bariatric surgery. Upper gastrointestinal (GI) tract X-ray examination with oral administration of a water-soluble contrast agent can be used to detect leaks. The aim of this study was to evaluate the impact of routine upper GI tract fluoroscopy after primary bariatric surgery. Between January 2009 and December 2014 a total of 658 bariatric interventions were carried out of which 442 were primary bariatric operations. Included in this single center study were 307 sleeve gastrectomies and 135 Roux-en-Y gastric bypasses. Up to December 2012 upper GI tract fluoroscopy was performed routinely between the first and third postoperative days and the detection of leakages was evaluated. In the investigation period 8 leakages (2.6 %) after sleeve gastrectomy, 1 anastomotic leakage in gastrojejunostomy and 1 in jejunojejunostomy after Roux-en-Y gastric bypass occurred. All patients developed clinical symptoms, such as abdominal pain, tachycardia or fever. In one case the leakage was detected by upper GI fluoroscopy and in nine cases radiological findings were unremarkable. No leakages were detected in asymptomatic patients. Routine upper GI fluoroscopy is not recommended for uneventful postoperative courses after primary bariatric surgery.
... Section 170.445 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH INFORMATION TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.445...
Full Text Available Certification has been responsible for a very large improvement in the standard of forest management in South Africa. The reasons for the positive role of certification are set out briefly below. Firstly, and most importantly, certification has...
Hugenschmitt, Delphine; Allonneau, Alexandre; Cesareo, Éric; Gueugniaud, Pierre-Yves; Lefort, Hugues
In the past, death was a family and community affair, but today it is institutional and entrusted to healthcare personnel. Thanks to a questionnaire on their feelings about prehospitalisation deaths, the experience and training needs for healthcare personnel at a mobile emergency and intensive care service were analysed. The majority of these professionals had been confronted with difficulties when faced with prehospitalisation deaths. There is little understanding of religious rites, even though this is an important point in dealing with the situation. There is a strong desire for training. The pedagogical support offered in response to the needs expressed was recognised as being useful and should be more widespread. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Lora-Tamayo, C; Tena, T; Rodríguez, A
Amphetamine its methylendioxy (methylendioxyamphetamine methylenedioxymethylamphetamine, methylenedioxyethylamphetamine) and methoxy derivatives (p-methoxyamphetamine and p-methoxymethylamphetamine) are widely abused in Spanish society. We present here the results of a systematic study of all cases of deaths brought to the attention of the Madrid department of the Instituto Nacional de Toxicologia from 1993 to 1995 in which some of these drugs have been found in the cadaveric blood. The cases were divided into three categories: amphetamine and derivatives, amphetamines and alcohol, amphetamines and other drugs. Data on age, sex, clinical symptoms, morphological findings, circumstances of death, when known, and concentration of amphetamine derivatives, alcohol and other drugs in blood are given for each group. The information provided here may prove to be useful for the forensic interpretation of deaths which are directly or indirectly related to abuse of amphetamine derivatives.
Full Text Available Objective To analyze the training results of electroencephalogram (EEG for brain death determination and to improve the training program. Methods A total of 114 trainees received theoretical training, simulation skills training, bedside skills training and test analysis. The composition of the trainees and the results of EEG tests were analyzed. The error rates of 5 knowledge points of EEG tests were calculated. Univariate and multivariate backward Logistic regression analyses were used to analyze the influence of factors including sex, age, specialty, professional category, professional qualification and hospital level on the error rates. Results All of 114 trainees came from 72 hospitals. Among them, 91 trainees (79.82% were between 30-49 years old, 108 trainees (94.74% came from third grade, grade A hospitals, and most of them were from Department of Neurology (57.89% , 66/114 and Electrophysiology (19.30% , 22/114. There were 98 clinicians (85.96% and 52 trainees (45.61% had intermediate certificate. Of the 5 knowledge points, the total error rate was 9.19% (204/2221. Among them, the error rate of parameter setting was the highest (11.40% , 26/228, followed by those of result determination (10.44%, 80/766, recording techniques (10.25%, 69/673, environmental requirements (7.46%, 17/228 and pitfalls (3.68%, 12/326. The error rate of trainees who were older than 50 was significantly higher than that in other ages (P = 0.000, for all. The error rate of technicians was higher than that of clinicians (P = 0.039. Univariate and multivariate Logistic regression analyses showed that age was independent risk factor associated with high error rates (OR = 1.382, 95%CI: 1.156-1.652; P = 0.000. Conclusions Among the trainees, degree of mastering the knowledge points is different. The training program should be optimized according to the trainees. More attention should be paid to the difference of EEG between brain death determination and routine check to
Jensen, Henriette Hvide; Godtfredsen, Nina Skavlan; Lange, Peter
Little is known about causes of death in chronic obstructive pulmonary disease (COPD) and the validity of mortality statistics in COPD. The present authors examined causes of death using data from the Copenhagen City Heart Study. Of the 12,979 subjects with sufficient data from the baseline...... examination during 1976-1978, 6,709 died before 2001. Of these, 242 died with COPD as cause of death. Among subjects with at least severe COPD at baseline, only 24.9% had COPD as cause of death and, in almost half of the cases where COPD was listed as cause of death, the subject had a normal forced expiratory...... volume in one second /forced vital capacity ratio at baseline. In COPD patients, having COPD on the death certificate was associated with chronic mucus hypersecretion (CMH) at baseline, an odds ratio (OR) of 3.6 (95% confidence interval 1.7-7.7), and being female (OR 2.7 (1.3-5.6)). In subjects without...
Schürmann, Carsten; Barrat, Jordi; Bolo, Eden
Information and communication technologies play a critical role in the administration and organization of modern elections. Any breakdown of an election technology, security breach or programming error can incur tremendous cost for the electoral management body (EMB)—and may undermine voters’ trust......, starting during the feasibility study, and especially if it is bound by law to provide such a certification. The evaluation reports and related documents can also be used to increase the transparency of the election, improve the dialogue between EMBs and voters, and increase the EMB’s credibility....
Defossez, A C; Fassin, D
Nearly 99% of maternal deaths in the world each year occur in developing countries. New efforts have recently been undertaken to combat maternal mortality through research and action. The medical causes of such deaths are coming to be better understood, but the social mechanisms remain poorly grasped. Maternal mortality rates in developing countries are difficult to interpret because they tend to exclude all deaths not occurring in health care facilities. The countries of Europe and North America have an average maternal mortality rate of 30/100,000 live births, representing about 6000 deaths each year. The developing countries of Asia, Africa, and Latin America have rates of 270-640/100,000, representing some 492,000 deaths annually. For a true comparison of the risks of maternal mortality in different countries, the risk itself and the average number of children per woman must both be considered. A Nigerian woman has 375 times greater risk of maternal death than a Swedish woman, but since she has about 4 times more children, her lifetime risk of maternal death is over 1500 times greater than that of the Swedish woman. The principal medical causes of maternal death are known: hemorrhages due to placenta previa or retroplacental hematoma, mechanical dystocias responsible for uterine rupture, toxemia with eclampsia, septicemia, and malaria. The exact weight of abortion in maternal mortality is not known but is probably large. The possible measures for improving such rates are of 3 types: control of fertility to avoid early, late, or closely spaced pregnancies; effective medical surveillance of the pregnancy to reduce the risk of malaria, toxemia, and hemorrhage, and delivery in an obstetrical facility, especially for high-risk pregnancies. Differential access to high quality health care explains much of the difference between mortality rates in urban and rural, wealthy and impoverished areas of the same country. The social determinants of high maternal mortality
The purpose of this article is to develop a conception of death with dignity and to examine whether it is vulnerable to the sort of criticisms that have been made of other conceptions. In this conception "death" is taken to apply to the process of dying; "dignity" is taken to be something that attaches to people because of their personal qualities. In particular, someone lives with dignity if they live well (in accordance with reason, as Aristotle would see it). It follows that health care pr...
...) which uses multiple cause of death (certificate) information. The AFMR was fotmd to be the most valid and reliable source of mortality information, largely due to the "120-day retiree" sub-cohort missed by the official data...
Nath, C [Germanischer Lloyd, Hamburg (Germany); Eriksson, C [Det Norske Veritas, Hellerup (Denmark); Hulle, F van [Frans van Hulle, Petten (Netherlands); Skamris, C [Risoe National Lab., Roskilde (Denmark); Stam, W [CIWI Holland, Arnheim (Netherlands); Vionis, P [CRES, Attki (Greece)
Wind turbine certification requirements are currently fairly divers within Europe. Therefore the leading European certification bodies initiated a JOULE project to harmonise the certification procedure on the basis of the current set of IEC/EN 61400 series standards. The paper presents a review of the state of the art of wind turbine certification in European countries and an outline of the sturcture of the project. The main steps of the project are (a) the collection of differences in certification practices by round robin certification of three wind turbine types; (b) assessment of the different certification results and (c) the development of a harmonised certification procedure. (au) EU-JOULE-3. 19 refs.
... accreditation bodies for issues related to mammography image quality and clinical practice. The certification... interest. The certification agency shall establish and implement measures that FDA has approved in...
Al-Samarrai, Teeb; Madsen, Ann; Zimmerman, Regina; Maduro, Gil; Li, Wenhui; Greene, Carolyn; Begier, Elizabeth
The quality of cause-of-death reporting on death certificates affects the usefulness of vital statistics for public health action. Heart disease deaths are overreported in the United States. We evaluated the impact of an intervention to reduce heart disease overreporting on other leading causes of death. A multicomponent intervention comprising training and communication with hospital staff was implemented during July through December 2009 at 8 New York City hospitals reporting excessive heart disease deaths. We compared crude, age-adjusted, and race/ethnicity-adjusted proportions of leading, underlying causes of death reported during death certification by intervention and nonintervention hospitals during preintervention (January-June 2009) and postintervention (January-June 2010) periods. We also examined trends in leading causes of death for 2000 through 2010. At intervention hospitals, heart disease deaths declined by 54% postintervention; other leading causes of death (ie, malignant neoplasms, influenza and pneumonia, cerebrovascular disease, and chronic lower respiratory diseases) increased by 48% to 232%. Leading causes of death at nonintervention hospitals changed by 6% or less. In the preintervention period, differences in leading causes of death between intervention and nonintervention hospitals persisted after controlling for race/ethnicity and age; in the postintervention period, age accounted for most differences observed between intervention and nonintervention hospitals. Postintervention, malignant neoplasms became the leading cause of premature death (ie, deaths among patients aged 35-74 y) at intervention hospitals. A hospital-level intervention to reduce heart disease overreporting led to substantial changes to other leading causes of death, changing the leading cause of premature death. Heart disease overreporting is likely obscuring the true levels of cause-specific mortality.
Ryan, John Paul; Eden, John Michael
Examines the reasons for the death penalty, the reasons why the death penalty attracts so much attention, whether the death penalty is applied consistently, and the evidence that the application of the death penalty may be racially biased. Provides an accompanying article on "Teaching Ideas" by Ronald A. Banaszak. (CMK)
... of its franchise agreement with the manufacturer and the dealer certification requirements of § 85... contrary to the terms of its franchise agreement with the manufacturer and the dealer certification... part because a manufacturer has located its facility in a foreign jurisdiction where local law...
... products, if the inspector finds that the requirements as stated in the certification have been met. The... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Certificates. 156.6 Section 156.6 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE...
... 49 Transportation 2 2010-10-01 2010-10-01 false Welding certification. 179.11 Section 179.11 Transportation Other Regulations Relating to Transportation PIPELINE AND HAZARDOUS MATERIALS SAFETY... Design Requirements § 179.11 Welding certification. (a) Welding procedures, welders and fabricators shall...
... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Certification. 4.65 Section 4.65 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY ORGANIZATION AND FUNCTIONS, AVAILABILITY...; Contracting for Goods and Services § 4.65 Certification. (a) Objective. To preserve the integrity and foster...
... the construction of a locomotive or locomotive engine, where such step may reasonably be expected to... POLLUTION FROM LOCOMOTIVES AND LOCOMOTIVE ENGINES Certification Provisions § 92.208 Certification. (a) This paragraph (a) applies to manufacturers of new locomotives and new locomotive engines. If, after a review of...
... MANAGEMENT Performance Appraisal Certification for Pay Purposes § 430.404 Certification criteria. (a) To be... system(s) must provide for the following: (1) Alignment, so that the performance expectations for... that the performance expectations for senior employees meet the requirements of 5 CFR part 430...
... 34 Education 1 2010-07-01 2010-07-01 false Employer certification. 34.21 Section 34.21 Education Office of the Secretary, Department of Education ADMINISTRATIVE WAGE GARNISHMENT § 34.21 Employer... by the Secretary of the Treasury. (b) The employer must complete and return the certification to us...
Mohd Rizal Razalli
Full Text Available These days, the environmental perspective on operations is becoming more common. In fact, any effort in improving efficiency in the organization is closely related to sustainability of our environment. The Environmental Management System (EMS certification such as ISO 14001 has been accepted as the world standard. In addition to these ISO standards, there are other certifications such as Halal certification. There is no research that investigates the relationship between Halal Certification process and its effect on our environment. Hence, our main research question is that is Halal Certification process can be considered as environmental friendly? In this paper, we argue that Halal Certification also contributes towards green initiatives. We used EDC-UUM as our case study. EDC-UUM is actively seeking the Halal certification from Malaysian authority agency or JAKIM. In this study, we assessed the perception of the EDC-UUM staff on the issue of going green. The findings and implications are discussed in the paper. Keywords: halal certification, hotel operations, sustainability, green
Int. At. Energy Agency, Wien
This document presents the procedure dealing with the certification of formation organizations dispensing the formation and the risks prevention to the personnel of A or B category in nuclear facilities. This certification proves the organization ability to satisfy the ''F'' specification of the CEFRI. (A.L.B.)
... States Department of Labor. In the case of an agricultural association acting as a joint employer... determination by the CO to grant an Application for Temporary Employment Certification in whole or in part will include a bill for the required certification fees. Each employer of H-2A workers under the Application...
... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Certification. 68.185 Section 68.185 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CHEMICAL... certification that, to the best of the signer's knowledge, information, and belief formed after reasonable...
... the certification the words “herein-named” may be substituted for the words “above-named”. (2) “I... respects in proper condition for transport according to applicable international and national governmental... national governmental regulations. Note to paragraph (c)(1): In the certification, the word “packed” may be...
... of its franchise agreement with the manufacturer and the dealer certification requirements of § 85... test vehicle(s) (or test engine(s)) meets the requirements of the Act and of this subpart, he will... requirements of the Act and this subpart have been met, he will issue one certificate of conformity per...
... sufficient time to comply with the Commission's notification requirements. (b) Certifications must be... certification in its cable franchise area, a statement that the applicant is qualified to operate an open video... that the applicant will comply with the Commission's notice and enrollment requirements for...
... be covered by the certificate(s). (ii) Failure to comply fully with the prohibition against selling... selling credits that are not generated or that are not available, as specified in § 86.1864-10, will be... paragraph (c)(9), effective July 6, 2010. For the convenience of the user, the added text is set forth as...
... certificate furnishes protection to the employer as provided by the act only if it shows the minor to be above the minimum age applicable thereunder to the occupation in which he is employed. Thus, a State.... Pursuant to the regulations of the Secretary, State employment or age certificates are accepted as proof of...
... number”) for any brand name, trademark or other label name under which the manufacturer or private... Certification, the Department will determine whether the document contains all of the elements required by this... Certification is acceptable, it will provide a unique CC number for any brand name, trademark or other name when...
... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Contractor certification... EMPLOYEES HEALTH BENEFITS ACQUISITION REGULATION ACQUISITION PLANNING CONTRACTOR QUALIFICATIONS Debarment, Suspension, and Ineligibility 1609.471 Contractor certification. All FEHBP carriers and applicant carriers...
Perritt, Patsy H.
Presents a compilation of school library media certification requirements taken from responses to a national survey. For each state, existing certificates or endorsements are listed, along with credit hours and/or experience required, whether it is an accredited or approved program, and required subject areas or competencies. A directory of…
Glauber, Joseph W.
The Food Security Act of 1985 authorizes the U.S. Department of Agriculture to issue generic certificates in lieu of cash payments due to program participants and merchants of agricultural products under provisions of several programs. The certificates may be used to acquire stocks held as collateral on government loans or owned by the Commodity…
... landing certificate shall be waived by the requiring Customs authority if the claimant demonstrates... 19 Customs Duties 2 2010-04-01 2010-04-01 false Landing certificate. 191.76 Section 191.76 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY...
Under the constraint of the European directive on energy efficiency, several countries have created or strengthened their white-certificate-type (or certificate of energy saving) obligation system. This article proposes brief overviews of the situation and implemented systems in Austria, Bulgaria, Croatia, Denmark, Greece, Ireland, Italy, Luxembourg, Poland, Slovenia, Spain, and United Kingdom
... who issues the health certificate. (2) Cleaning and disinfection must be sufficient to neutralize any VHS virus to which shipping containers may have been exposed. (3) The cleaning and disinfection protocols used must be referenced in the health certificate or in a separate cleaning and disinfection...
... Acceptable certifications. (a) Pressure vessels. Current and valid certification by an insurance company or... by an insurance company or regulatory authority attesting to the safe installation, inspection, and... types of pressure vessels and similar equipment are contained in subparts F and O of this part. ...
In order to better manage its numerous certifications, the French CEA decided to implement an integrated management system. It aims at simplifying these certifications, at sharing best practices, and at obtaining a better efficiency. For this project, i.e. the management of quality, safety and environment, the CEA asked for the support of experts in integrated complex system management
Boles, Jeffrey R
This Article examines the contentious relationship between public rights to access government-held death records and privacy rights concerning the deceased, whose personal information is contained in those same records. This right of access dispute implicates core democratic principles and public policy interests. Open access to death records, such as death certificates and autopsy reports, serves the public interest by shedding light on government agency performance, uncovering potential government wrongdoing, providing data on public health trends, and aiding those investigating family history, for instance. Families of the deceased have challenged the release of these records on privacy grounds, as the records may contain sensitive and embarrassing information about the deceased. Legislatures and the courts addressing this dispute have collectively struggled to reconcile the competing open access and privacy principles. The Article demonstrates how a substantial portion of the resulting law in this area is haphazardly formed, significantly overbroad, and loaded with unintended consequences. The Article offers legal reforms to bring consistency and coherence to this currently disordered area of jurisprudence.
Of the approximately 7,000 languages spoken today, some 2,500 are generally considered endangered. Here we argue that this consensus figure vastly underestimates the danger of digital language death, in that less than 5% of all languages can still ascend to the digital realm. We present evidence of a massive die-off caused by the digital divide. PMID:24167559
Full Text Available Of the approximately 7,000 languages spoken today, some 2,500 are generally considered endangered. Here we argue that this consensus figure vastly underestimates the danger of digital language death, in that less than 5% of all languages can still ascend to the digital realm. We present evidence of a massive die-off caused by the digital divide.
Clifford, Amie L.
Examines the legal and moral issues, controversies, and unique trial procedures involved with the death penalty. Discusses the 1972 landmark Supreme Court decision that resulted in many states abolishing this punishment, only to reintroduce it later with different provisions. Reviews the controversial case of Sam Sheppard. (MJP)
Provides a lesson plan on the Eighth Amendment to the U.S. Constitution and the imposition of the death penalty. Focuses on the controversy concerning capital punishment and stimulates critical thinking in an analysis and discussion of eight hypothetical situations. Includes suggestions for readings, videotapes, and writing assignments. (NL)
Dalgaard, Carl-Johan Lars; Strulik, Holger
This study introduces physiological aging into a simple model of optimal intertemporal consumption. In this endeavor we draw on the natural science literature on aging. According to the purposed theory, the speed of the aging process and the time of death are endogenously determined by optimal...
Dalgaard, Carl-Johan; Strulik, Holger
the representative consumer is subject to physiological aging. In modeling aging we draw on recent research in the fields of biology and medicine. The speed of the aging process, and thus the time of death, are endogenously determined by optimal health investments. We calibrate the model to US data and proceed...
Hansen, Casper Worm; Jensen, Peter S.; Madsen, Peter
Tuberculosis (TB) is a leading cause of death worldwide and, while treatable by antibiotics since the 1940s, drug resistant strains have emerged. This paper estimates the effects of the establishment of a pre-antibiotic era public health institution, known as a TB dispensary, designed to prevent...
Molitoris, Joseph John
and accidents, (5) perinatal causes, and (6) unspecified causes. RESULTS The results show that class differentials in nearly all causes of death converged during the demographic transition. The only exception to this was the airborne infectious disease category, for which the gap between white collar...
) in Bhubaneswar, the capital city of Orissa. The chapter explores the heterogeneous and hierarchical composition of the basti and unfolds the case of the social exclusion and ultimate death of a patient with tuberculosis who belonged to the poorest section of the basti, called Pradhan sahi. The case of both...
Harvig, Lise Lock; Kveiborg, Jacob; Lynnerup, Niels
This paper presents osteoarchaeological analyses of the human skeletal material from a burnt down house in Jutland, Denmark, dated to the first century bc. We describe how the osteological analyses of this complex site were approached and illustrate how we reconstructed the death of the human...
Hougen, H P; Valenzuela, Antonio Jesus Sanchez; Lachica, E
case was inconclusive. After studying the circumstances of death, the number of discrepancies were reduced to 20, so that concordance was reached in 86% of all the cases. The results show that the combination of different methods leads to a diagnosis of myocardial infarction in far more cases than...
Alarm bells are ringing all over the world about the death of bee populations. Although it is not known exactly how severe the decline is, it is important to take the problem seriously. The signals are alarming and the bee is important, not just for natural ecosystems but also for the pollination of
The causa mortis of Napoleon Bonaparte has been vexata quaestio for a long time. The author tries to outline a picture of Napoleon from a sanitary point of view. From the report of doctor Francesco Antonmarchi who performed the autopsy, the author tries to understans the cause of death: gastric perforation due to malignant ulcer and subsequent peritonitis with pulmonary tubercolosis.
Moh. Toriqul Chaer
Full Text Available When the tide of unemployment hit the USA and Europe, in Japan the opposite phenomenon occurs. In 2002, in Japan deaths were recorded because of excessive works. In this country, the phenomenon of death because of excessive works is called Karoshi. Karoshi is common in Japan. It becomes deadly syndrome as a consequence of long hours works. The debate about deaths from excessive work already sticking out in Japan since the 70s. The first official case of Karoshi was reported in 1969 when a 29-year-old male worker died because of stroke. It is estimated over ten thousand workers died each year due to death by brain and stroke caused by an overload work. Karoshi often happen to male workers dominantly. The main cause of karoshi is stress due to high pressure in the work environment, and work habits of exceeding a standard of normal working time (8 hours. In addition, their extra time to work is imbalance with and the salary they earn. In its development, the phenomenon of karoshi contributes to the term salaryman and workaholic.
Bhattacharyya, Siddhartha; Cofer, Darren; Musliner, David J.; Mueller, Joseph; Engstrom, Eric
Advanced capabilities planned for the next generation of aircraft, including those that will operate within the Next Generation Air Transportation System (NextGen), will necessarily include complex new algorithms and non-traditional software elements. These aircraft will likely incorporate adaptive control algorithms that will provide enhanced safety, autonomy, and robustness during adverse conditions. Unmanned aircraft will operate alongside manned aircraft in the National Airspace (NAS), with intelligent software performing the high-level decision-making functions normally performed by human pilots. Even human-piloted aircraft will necessarily include more autonomy. However, there are serious barriers to the deployment of new capabilities, especially for those based upon software including adaptive control (AC) and artificial intelligence (AI) algorithms. Current civil aviation certification processes are based on the idea that the correct behavior of a system must be completely specified and verified prior to operation. This report by Rockwell Collins and SIFT documents our comprehensive study of the state of the art in intelligent and adaptive algorithms for the civil aviation domain, categorizing the approaches used and identifying gaps and challenges associated with certification of each approach.
An Adaptive Intrusion Data System (AIDS) was developed to collect information from intrusion alarm sensors as part of an evaluation system to improve sensor performance. AIDS is a unique digital data-compression, storage, and formatting system; it also incorporates a capability for video selection and recording for assessment of the sensors monitored by the system. The system is software reprogrammable to numerous configurations that may be used for the collection of environmental, bilevel, analog, and video data. This report describes the software routines that control the different AIDS data-collection modes, the diagnostic programs to test the operating hardware, and the data format. Sample data printouts are also included
Kishida, Ken; Funahashi, Tohru; Shimomura, Iichiro
Adiponectin is a protein synthesized and secreted predominantly by adipocytes into the peripheral blood. However, circulating adiponectin level is inversely related with body weight, especially visceral fat accumulation. The mechanism of this paradoxical relation remains obscure. Low circulating adiponectin concentrations (hypoadiponectinemia; osteoporosis, and cancer (endometrial cancer, postmenopausal breast cancer, leukemia, colon cancer, gastric cancer, prostate cancer). On the other hand, hyperadiponectinemia is associated with cardiac, renal and pulmonary diseases. This review article focuses on the significance of adiponectin as a clinical biomarker of obesity-related diseases. Routine measurement of adiponectin in patients with lifestyle-related diseases is highly recommended. Copyright © 2013 Elsevier Ltd. All rights reserved.
V. E. Gromov
Full Text Available Purpose. The paper studies the problem of death penalty justifiableness in terms of democratic society from the metaphysical viewpoint. Philosophical argumentation to justify death penalty is proposed as opposed to the common idea of inhuman and uncivilized nature of court practice of sentencing to death. The essence of the study is not to rehabilitate law-based murder but to explain dialectic relation of the degrees of moral responsibility of criminals and society nourishing evildoers. The author believes that refusal from death penalty under the pretence of rule of humanism is just a liberal façade, plausible excuse for defective moral state of the society which, rejecting its own guiltiness share as for current disregards of the law, does not grow but downgrades proper human dignity. Methodology. The author applies an approach of dialectic reflection being guided by the perception of unity, relativeness and complementarity of evil and good striving to determine efficient way of resolving their contradictions in the context of moral progress of the society. Originality. Proposing philosophic approach to a death penalty problem instead of legal one, the author is not going to discuss the role of horrification, control or cruelty of the measure of restraint; moreover, he does not consider the issue of its efficiency or inefficiency. The author also does not concern vexation of mind of a criminal sentenced to life imprisonment for “humanitarian” reasons. The purpose of the author is to demonstrate that aim of the punishment is to achieve justice which becomes spiritual challenge and moral recompense not only for the criminal but for the whole society. Conclusions. Crime is first of all a problem of a society; thus, criminal behaviour of certain individuals should only be considered through a prism of moral state of the whole community. Attitude to a death penalty is the problem of spirituality and its dramatic sophistication. The author
Guberina, Nika [UK Essen (Germany). Radiology
Here we describe the first clinical experiences regarding the use of an automated radiation dose management software to monitor the radiation dose of patients during routine examinations. Many software solutions for monitoring radiation dose have emerged in the last decade. The continuous progress in radiological techniques, new scan features, scanner generations and protocols are the primary challenge for radiation dose monitoring software systems. To simulate valid dose calculations, radiation dose monitoring systems have to follow current trends and stay constantly up-to-date. The dose management software is connected to all devices at our institute and conducts automatic data acquisition and radiation dose calculation. The system incorporates 18 virtual phantoms based on the Cristy phantom family, estimating doses in newborns to adults. Dose calculation relies on a Monte Carlo simulation engine. Our first practical experiences demonstrate that the software is capable of dose estimation in the clinical routine. Its implementation and use have some limitations that can be overcome. The software is promising and allows assessment of radiation doses, like organ and effective doses according to ICRP 60 and ICRP 103, patient radiation dose history and cumulative radiation doses. Furthermore, we are able to determine local diagnostic reference doses. The radiation dose monitoring software systems can facilitate networking between hospitals and radiological departments, thus refining radiation doses and implementing reference doses at substantially lower levels.
Full Text Available Introduction: Successful implementation of whole slide imaging (WSI for routine clinical practice has been accomplished in only a few pathology laboratories worldwide. We report the transition to an effective and complete digital surgical pathology workflow in the pathology laboratory at Cannizzaro Hospital in Catania, Italy. Methods: All (100% permanent histopathology glass slides were digitized at ×20 using Aperio AT2 scanners. Compatible stain and scanning slide racks were employed to streamline operations. eSlide Manager software was bidirectionally interfaced with the anatomic pathology laboratory information system. Virtual slide trays connected to the two-dimensional (2D barcode tracking system allowed pathologists to confirm that they were correctly assigned slides and that all tissues on these glass slides were scanned. Results: Over 115,000 glass slides were digitized with a scan fail rate of around 1%. Drying glass slides before scanning minimized them sticking to scanner racks. Implementation required introduction of a 2D barcode tracking system and modification of histology workflow processes. Conclusion: Our experience indicates that effective adoption of WSI for primary diagnostic use was more dependent on optimizing preimaging variables and integration with the laboratory information system than on information technology infrastructure and ensuring pathologist buy-in. Implementation of digital pathology for routine practice not only leveraged the benefits of digital imaging but also creates an opportunity for establishing standardization of workflow processes in the pathology laboratory.
An estimated 550 to 650 surgical fires occur annually in the United States. Surgical fires may have severe consequences, including burns, disfigurement, long-term medical care, or death. This article introduces a potential certification program for the prevention of surgical fires. A pilot study was conducted with a convenience sample of 10 anesthesia providers who participated in the education module. The overall objective was to educate surgical team members and to prepare them to become certified in surgical fire prevention. On completion of the education module, participants completed the 50-question certification examination. The mean pretest score was 66%; none of the participants had enough correct responses (85%) to be considered competent in surgical fire prevention. The mean post- test score was 92.80%, with all participants answering at least 85% of questions correct. A paired-samples t test showed a statistically significant increase in knowledge: t (df = 9) = 11.40; P = .001. Results of the pilot study indicate that this course can remediate gaps in knowledge of surgical fire prevention for providers. Their poor performance on the pretest suggests that many providers may not receive sufficient instruction in surgical fire prevention.
Nelson, Stacy; Fischer, Bernd; Denney, Ewen; Schumann, Johann; Richardson, Julian; Oh, Phil
The purpose of this document is to propose a product-oriented software certification process to facilitate use of software synthesis and formal methods. Why is such a process needed? Currently, software is tested until deemed bug-free rather than proving that certain software properties exist. This approach has worked well in most cases, but unfortunately, deaths still occur due to software failure. Using formal methods (techniques from logic and discrete mathematics like set theory, automata theory and formal logic as opposed to continuous mathematics like calculus) and software synthesis, it is possible to reduce this risk by proving certain software properties. Additionally, software synthesis makes it possible to automate some phases of the traditional software development life cycle resulting in a more streamlined and accurate development process.
Bäckström, Björn; Johansson, Bengt; Eriksson, Anders
Nitrous oxide is an inflammable gas that gives no smell or taste. It has a history of abuse as long as its clinical use, and deaths, although rare, have been reported. We describe two cases of accidental deaths related to voluntary inhalation of nitrous oxide, both found dead with a gas mask covering the face. In an attempt to find an explanation to why the victims did not react properly to oncoming hypoxia, we performed experiments where a test person was allowed to breath in a closed system, with or without nitrous oxide added. Vital signs and gas concentrations as well as subjective symptoms were recorded. The experiments indicated that the explanation to the fact that neither of the descendents had reacted to oncoming hypoxia and hypercapnia was due to the inhalation of nitrous oxide. This study raises the question whether nitrous oxide really should be easily, commercially available. © 2015 American Academy of Forensic Sciences.
Karoshi (death by overwork) is one of social medical terms, which used by survivors of victims who attacked with cardiovascular diseases such as stroke, myocardial infarction and sudden cardiac death. In Dec. 2000, Compensation Standard of cardiovascular diseases in Workers' Insurance was changed and admitted the relationship between chronic fatigue and cardiovascular attacks. As a result, compensation numbers of Karoshi attributed to three hundred and more from about 80 cases. The Ministry of Health, Labour and Welfare thinks that most of Karoshi caused by long working hours continuing for several months, especially without payment, so that the Labour Standard Inspector Office requests to decrease overtime work more than 45 hours per month to firm administrators.
Full Text Available OBJECTIVES: A study of maternal death conducted to evaluate various factors responsible for maternal deaths. To identify complications in pregnancy, a childbirth which result in maternal death, and to identify opportunities for preventive intervention and understand the events leading to death; so that improving maternal health and reducing maternal mortality rate significantly. To analyze the causes and epidemiological amounts maternal mortality e.g. age parity, socioeconomic status and literacy. In order to reduce maternal mortality and to implement safe motherhood program and complications of pregnancy and to find out safe motherhood program. METHODS: The data collected was a retrograde by a proforma containing particulars of the diseased, detailed history and relatives were interviewed for additional information. The data collected was analysed. RESULTS: Maternal mortality rate in our own institution is 200/ 100,000 live births. Among 30 maternal deaths, 56% deaths (17 were among low socio - economic status, groups 60% deaths among unbooked 53.5% deaths more along illiterates evidenced by direct and indirect deaths about 25% of deaths were preventable. CONCLUSION: Maternal death is a great tragedy in the family life. It is crusade to know not just the medical cause of the death but the circumstances what makes these continued tragic death even more unacceptable is that deaths are largely preventable
Nishino, Shigeki; Itoh, Takahiko; Tuchida, Shohei; Kinugasa, Kazushi; Asari, Shoji; Nishimoto, Akira; Sanou, Kazuo.
Magnetic resonance imaging (MRI) was undertaken for two patients who suffered from severe cerebrovascular diseases and were clinically brain dead. The MRI system we used was Resona (Yokogawa Medical Systems, superconductive system 0.5 T) and the CT apparatus was Toshiba TCT-300. Initial CT and MRI were undertaken as soon as possible after admission, and repeated sequentially. After diagnosis of brain death, we performed angiography to determine cerebral circulatory arrest, and MRI obtained at the same time was compared with the angiogram and CT. Case 1 was a 77-year-old man who was admitted in an unconscious state. CT and MRI on the second day after hospitalization revealed cerebellar infarction. He was diagnosed as brain dead on day 4. Case 2 was a 35-year-old man. When he was transferred to our hospital, he was in cardiorespiratory arrested. Cardiac resuscitation was successful but no spontaneous respiration appeared. CT and MRI on admission revealed right intracerebral hemorrhage. Angiography revealed cessation of contrast medium in intracranial vessels in both of the patients. We found no 'flow signal void sign' in the bilateral internal carotid and basilar arteries on MRI images in both cases after brain death. MRI, showing us the anatomical changes of the brain, clearly revealed brain herniations, even though only nuclear findings of 'brain tamponade' were seen on CT. But in Case 1, we could not see the infarct lesions in the cerebellum on MR images obtained after brain death. This phenomenon was caused by the whole brain ischemia masking the initial ischemic lesions. We concluded that MRI was useful not only the anatomical display of lesions and brain herniation with high contrast resolution but for obtaining information on cerebral circulation of brain death. (author)
Asmundo, A; Aragona, M; Gualniera, P; Aragona, F
The sudden death by hypoglycemia is an aspect of the forensic pathology frequently neglected. Authors initially described the pathogenesis of different hypoglycemia forms, distinguishing the primary ones due to hyperinsulinism and the secondary ones due to functional insufficiency of other organs (hypophysis, thyroid, adrenal gland, liver); after that Authors described three cases of sudden death induced hypoglycemia by hyperinsulinism: two were unweaned with nesidioblastosis and one adolescent. In any form of hypoglycemia the central nervous system damage is present with evident neuronal degenerative-necrotic phenomena, widespread edema with microhemorrhage, swollen and dissociation of myelin sheath, glial cells hyperplasia. Death caused by primary hypoglycemia is histopathologically different from the secondary one because of the maintenance of hepatic glycogen content in the former, that increase in striated muscles, including the heart, in spite of the constant secretion of catecholamine from the adrenal medulla. Glycogen is depleted in secondary hypoglycemia. In the primary form, behind the adrenal medulla hyperfunction, the increased functional activity of the adrenal cortex is moderate, contrasting with the seriousness of the syndrome, due prevalently to inhibit the gluconeogenesis response conditioned by the persistence of stored glycogen in the liver, heart and striated muscles. The rare anoxic processes coming with resynthesis of hepatic glycogen have to be considered in the differential diagnosis. The primary hypoglycemic death, especially in unweaned, is frequently promoted by other processes inducing hypoxia (fetal asphyxia outcome, pneumonia, etc.) or worsening the hypoglycemia (hypothyroidism, etc.). The secondary hypoglycemias are characterized by the normality of exocrine pancreas and by organic alterations that cause glycogen depletion from the liver.
Full Text Available This essay considers new possibilities for photographing the dying and dead in Australia that have been enabled by digital technologies. It argues that vernacular digital photographs demonstrate unprecedented degrees of control and privacy and further that they are purposefully withheld from public view, thus raising issues about visibility and secrecy.Some historical context is provided. Post mortem photographs were not uncommon in the nineteenth century but were in the domain of professional studio photographers. Commissioning post mortem portraits was rare for most of the twentieth century, due to changing attitudes to death and the transformation of the photographic industry. Photographing the deceased re-emerged in the 1980s, notably in the area of neonatal death.In the last five years death-related vernacular photographs have begun to proliferate. Unlike analogue processes, digital photography bypasses the involvement of others in processing and printing private images. Distribution to intimates can be achieved instantaneously via the internet, reinforcing social and familial connections.Vernacular digital photographs of the deceased do not address historical tradition but share their domestic and intimate contexts. Nor do they belong to a unified group, yet they have a common vocabulary which emphasises specificity and detail.
Full Text Available This essay considers new possibilities for photographing the dying and dead in Australia that have been enabled by digital technologies. It argues that vernacular digital photographs demonstrate unprecedented degrees of control and privacy and further that they are purposefully withheld from public view, thus raising issues about visibility and secrecy. Some historical context is provided. Post mortem photographs were not uncommon in the nineteenth century but were in the domain of professional studio photographers. Commissioning post mortem portraits was rare for most of the twentieth century, due to changing attitudes to death and the transformation of the photographic industry. Photographing the deceased re-emerged in the 1980s, notably in the area of neonatal death. In the last five years death-related vernacular photographs have begun to proliferate. Unlike analogue processes, digital photography bypasses the involvement of others in processing and printing private images. Distribution to intimates can be achieved instantaneously via the internet, reinforcing social and familial connections. Vernacular digital photographs of the deceased do not address historical tradition but share their domestic and intimate contexts. Nor do they belong to a unified group, yet they have a common vocabulary which emphasises specificity and detail.
Penson, Richard T; Partridge, Rosamund A; Shah, Muhammad A; Giansiracusa, David; Chabner, Bruce A; Lynch, Thomas J
Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH) founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. For many, cancer is synonymous with death. Fearing death is a rational response. For too long, medicine has ignored this primeval fear. Increasingly, clinicians recognize and address end-of-life issues, facing patients' and our own emotional vulnerabilities in order to connect and explore problems and fears. Listening and learning from the patient guides us as we acknowledge much of the mystery that still surrounds the dying process. Rarely is there a simple or right answer. An empathetic response to suffering patients is the best support. Support is vital in fostering the adjustment of patients. A silent presence may prove more helpful than well-meant counsel for many patients. Through an examination of eight caregiver narratives of their patients' experiences, the role of the health care provider in the dying process, particularly in regard to challenging fear, is reviewed.
Hassan Kavarodi Maracair
Ruane-TATI Sdn Bhd was the first accredited training centre in Asia approved by The British Institute of Non Destructive Testing (BINDT) as per EN 473, ISO 9712 and EN 45013 requirements. Meanwhile, Ruane-TATI is also accredited by National Vocational Training Center ( MLVK ).This mean that Ruane-TATI is the first training and examination center that accredited by both international and national bodies in providing quality , qualification and certification for comprehensive training and examination in Inspection and Non Destructive Testing (NDT). There are several NDT examinations scheme available in Malaysia due to differences requirement from the industrials. This has put the difficulties to services company in upgrading their NDT technician qualifications. The intention of this paper is to discuss the basic different among the NDT examinations scheme used in Malaysia ( mostly offered by Ruane-TATI ) and the development of certain schemes in covering their schemes to more sectors and NDT methods. (Author)
, this study discusses the consequences resulting from score and feedback interpretations and uses as part of the validation process of TOEPAS (Test of Oral English Proficiency for Academic Staff), which is a performance-based test used for oral English certification of lecturers at the University......Internationalization of higher education has resulted in rapid developments of English-medium instruction (EMI) courses in non-Anglophone countries in Europe and Asia. Due to the growing concerns about lecturers' ability to teach in English, several European universities have implemented policies...... for internal assessment of lecturers' English proficiency to ensure the quality of teaching in EMI programs. However, research on the measured construct and the reliability and the validity of these assessments remains scarce. Based on interviews with tested university lecturers and formative feedback analysis...
The paper considers one of the economic mechanisms, stimulating the introduction of renewable energy sources (RES) - a green certificate market. A mathematical model was developed to describe a supply and demand balance in the electricity and green certificate markets simultaneously. The sellers of certificates are RES owners, who obtain certificates for each unit of electricity produced, and the buyers are consumers, who are obliged by law to buy a certain share of this electricity. Equilibrium structures of the power system including RES with stochastic operation conditions are calculated. The prices of electricity and certificates, as well as the total economic effect of the system are determined taking into account external costs (environmental damages). The paper shows that a mechanism of green certificates is not an ideal means for minimizing the impact of energy on the environment: the economic effect turns out to be smaller than the maximum possible one. However, this deviation is relatively small, therefore the green certificate market allows the external effects to be partially taken into account. Such a market creates incentives for investors, electricity producers and consumers to make power sources mix, modes of electricity production and consumption closer to the optimum ones in terms of the economy as a whole. (author)
Kun, Larry E.; Ang, Kian; Erickson, Beth; Harris, Jay; Hoppe, Richard; Leibel, Steve; Davis, Larry; Hattery, Robert
Maintenance of Certification (MOC) recognizes that in addition to medical knowledge, several essential elements involved in delivering quality care must be developed and maintained throughout one's career. The MOC process is designed to facilitate and document professional development of American Board of Radiology (ABR) diplomates in the essential elements of quality care in Radiation Oncology and Radiologic Physics. ABR MOC has been developed in accord with guidelines of the American Board of Medical Specialties. All Radiation Oncology certificates issued since 1995 are 10-year, time-limited certificates; diplomates with time-limited certificates who wish to maintain specialty certification must complete specific requirements of the American Board of Radiology MOC program. Diplomates with lifelong certificates are not required to participate but are strongly encouraged to do so. Maintenance of Certification is based on documentation of participation in the four components of MOC: (1) professional standing, (2) lifelong learning and self-assessment, (3) cognitive expertise, and (4) performance in practice. Through these components, MOC addresses six competencies-medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. Details of requirements for components 1, 2, and 3 of MOC are outlined along with aspects of the fourth component currently under development
Andréia Guedes Oliva Fernandes
Full Text Available OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4. Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.
Full Text Available Background: Maternal mortality ratio in Ecuador is the only millennium goal on which national agencies are still making strong efforts to reach 2015 target. The purpose of the study was to process national maternal death databases to identify a specific association pattern of variable included in the death certificate. Design and methods: The study processed mortality databases published yearly by the National Census and Statistics Institute (INEC. Data analysed were exclusively maternal deaths. Data corresponds to the 2003-2013 period, accessible through INEC’s website. Comparisons are based on number of deaths and use an ecological approach for geographical coincidences. Results: The study identified variable association into the maternal mortality national databases showing that to die at home or in a different place than a hospital is closely related to women’s socioeconomic characteristics; there was an association with the absence of a public health facility. Also, to die in a different place than the usual residence could mean that women and families are searching for or were referred to a higher level of attention when they face complications. Conclusions: Ecuadorian maternal deaths showed Patterns of inequity in health status, health care provision and health risks. A predominant factor seems unclear to explain the variable association found processing national databases; perhaps every pattern of health systems development played a role in maternal mortality or factors different from those registered by the statistics system may remain hidden. Some random influences might not be even considered in an explanatory model yet.
Ritterbusch, S. E.; Brinkman, C. B.; Crump, M. W.
The desire for safer plants arose primarily as the result of the Three Mile Island accident and the realization that plant safety could be impacted by complex plant systems interactions that are not easily identified through the traditional 'system-by-system' design process. Hence, it became apparent that the ALWR designs would have to be addressed through plant-wide Probabilistic Safety Assessments (PSAs) that addressed both accident-prevention and accident-mitigation design features. Prior to Design Certification the 'two-step' licensing process in the United States was not efficient. Utilities had to commit large amounts of capital to plant construction without confidence that an operating license would be issued when construction permit was issued often required design changes that resulted in significant construction delays. The 55 utilities operating nuclear plants in the U. S. each had their own design and operating preferences, resulting in many customized plants with a minimum of economic benefit from standardization. This was addressed by the U. S. Nuclear Regulatory Commission (NRC) in a new regulation (Title 10 of the Code of Federal Regulations, Part 52 or '10 CFR 52') which provides certification of a design that can later be referenced by an applicant for a Combined Operating License (COL). Identifying an ALWR solution for previously unanalyzed severe accident scenarios appeared difficult, at best, since severe accident research had to be performed and since there was no regulatory precedent. This meant that complex technical issues and licensing review policies had to be developed without the benefit of licensing standards or experience. As a result, a system of iterative interactions between the regulator and the industry was established, wherein a design or safety requirement would be proposed, then discussed along with development of the corresponding design feature, and finally revised and documented via NRC 'guidance'
Ylijoki-Sørensen, Seija; Sajantila, Antti; Lalu, Kaisa
Exact cause and manner of death determination improves legislative safety for the individual and for society and guides aspects of national public health. In the International Classification of Diseases, codes R00-R99 are used for "symptoms, signs and abnormal clinical and laboratory findings......, not elsewhere classified" designated as "ill-defined" or "with unknown etiology". The World Health Organisation recommends avoiding the use of ill-defined and unknown causes of death in the death certificate as this terminology does not give any information concerning the possible conditions that led...... autopsy. Our study suggests that if all deaths in all age groups with unclear cause of death were systematically investigated with a forensic autopsy, only 2-3/1000 deaths per year would be coded as an ill-defined and unknown cause of death in national mortality statistics. At the same time the risk...
...-8994; Amdt. No. 21-96] RIN 2120-AK19 Type Certification Procedures for Changed Products AGENCY: Federal... requirements for the certification of changes to type-certificated products. The revision required the... entitled, ``Type Certification Procedures for Changed Products'' (December 4, 2012, 77 FR 71691). The 2000...
...-8994; Amdt. No. 21-96] RIN 2120-AK19 Type Certification Procedures for Changed Products AGENCY: Federal... regulations for the certification of changes to type-certificated products. That amendment was to enhance... (certification) of the entire changed product. Therefore, Sec. 21.101 is amended to replace ``changed product...
... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Loans eligible to back Certificates. 120.612 Section 120.612 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Certificates § 120.612 Loans eligible to back Certificates. (a) Pool Certificates...
... PROVISIONS NATIONAL ORGANIC PROGRAM Certification § 205.405 Denial of certification. (a) When the certifying... organic program. (e) An applicant for certification who has received a written notification of... 7 Agriculture 3 2010-01-01 2010-01-01 false Denial of certification. 205.405 Section 205.405...
...) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Certification § 205.400 General requirements for certification. A person seeking to receive or maintain organic certification under the... 7 Agriculture 3 2010-01-01 2010-01-01 false General requirements for certification. 205.400...
... PROVISIONS NATIONAL ORGANIC PROGRAM Certification § 205.401 Application for certification. A person seeking... certification to a certifying agent. The application must include the following information: (a) An organic... 7 Agriculture 3 2010-01-01 2010-01-01 false Application for certification. 205.401 Section 205.401...
... 21 Food and Drugs 1 2010-04-01 2010-04-01 false Treatment of batch pending certification. 80.37 Section 80.37 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL COLOR ADDITIVE CERTIFICATION Certification Procedures § 80.37 Treatment of batch pending certification...
... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 10-2A001] Export Trade Certificate of Review ACTION: Notice of Application (10-2A001) to Amend the Export Trade Certificate of Review..., has received an application to amend an Export Trade Certificate of Review (``Certificate''). This...
... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 84-24A12] Export Trade Certificate of Review ACTION: Notice of Application to Amend the Export Trade Certificate of Review Issued to... application to amend an Export Trade Certificate of Review (``Certificate''). This notice summarizes the...
... OR MORE; AND RULES GOVERNING PERSONS ON BOARD SUCH AIRCRAFT General § 125.7 Display of certificate. (a) The certificate holder must display a true copy of the certificate in each of its aircraft. (b... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Display of certificate. 125.7 Section 125.7...
... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Display of certificate. 147.39 Section 147...) SCHOOLS AND OTHER CERTIFICATED AGENCIES AVIATION MAINTENANCE TECHNICIAN SCHOOLS Operating Rules § 147.39 Display of certificate. Each holder of an aviation maintenance technician school certificate and ratings...
... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Certificate of conformity. 89.105... and Certification Provisions § 89.105 Certificate of conformity. Every manufacturer of a new nonroad compression-ignition engine must obtain a certificate of conformity covering the engine family, as described...
... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Certificate of conformity. 90.106... Standards and Certification Provisions § 90.106 Certificate of conformity. (a)(1) Except as provided in § 90... certificate of conformity covering such engines; however, engines manufactured during an annual production...
... 40 Protection of Environment 20 2010-07-01 2010-07-01 false Certificate of conformity. 91.106... Provisions § 91.106 Certificate of conformity. (a) Every manufacturer of a new marine SI engine produced... obtain a certificate of conformity covering each engine family. The certificate of conformity must be...
... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 89-5A018] Export Trade Certificate of Review ACTION: Notice of Application to amend the Export Trade Certificate of Review Issued to... received an application to amend an Export Trade Certificate of Review (``Certificate''). This notice...
... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 89-4A018] Export Trade Certificate of Review ACTION: Notice of Application to amend the Export Trade Certificate of Review Issued to... received an application to amend an Export Trade Certificate of Review (``Certificate''). This notice...
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Obaditch, Chris; Grant, Glenn J
Methods, devices, and systems for providing certification of friction stir welds are disclosed. A sensor is used to collect information related to a friction stir weld. Data from the sensor is compared to threshold values provided by an extrinsic standard setting organizations using a certification engine. The certification engine subsequently produces a report on the certification status of the weld.
Winkel, Bo Gregers; Risgaard, Bjarke; Bjune, Thea
Background: Hitherto, sudden cardiac death (SCD) in the young has been described with no distinction between genders. SCD occurs more often in men (SCDm) than women (SCDw), but this disparity is not understood and has not been investigated systematically in a nationwide setting. Our objective......=0.02) and died less often in a public place (16 vs. 26%, p=0.01). Age at death, ratios of autopsies and sudden unexplained deaths, and comorbidities, did not differ. Causes of SCD were largely comparable between genders. The incidence rate of SCDw was half of that of SCDm (1.8 vs. 3.6 per 100...... was to report gender differences in SCD in the young in a nationwide (Denmark) setting. Methods: All deaths in persons aged 1-35 years nationwide in Denmark between 2000 and 2009 were included. Death certificates and autopsy reports were obtained. The extensive health care registries in Denmark were used...
Full Text Available The problem of researching the ecotourism certification processes in the world is very up-to-date nowadays. The relevance of the research is stipulated by current state of environ-mental pollutants, the development of sustainable politics implementation and the fact that now people aware of real danger of environmental catastrophe that threatens the survival of civilization. That’s why the purpose of the article is conducting a complex analysis of foreign ecotourism certi-fication programs. Moreover, it is necessary to study the evolution of ecotourism development to understand the key issues of this problem. The object of this article is the analysis of ecotourism certification worldwide. The subject of the article is the detection of theoretical, methodological and practical aspects of implementation of effective ecotourism certification programs in Ukraine. To clarify all aspects of studying this issue it is necessary to use such theoretical and methodological basis as: modern theories of the genesis and evolution of ecological tourism, logical and analogy analysis, historical method, hypothetical method, classification and graphical method. Using such methods it was found that the development of ecotourism formation has taking three evolutionary steps, which affected the creation of its definition. This fact reveals the classification of different types of sustainable tourism and provides an impetus of ecotourism certification studies. Moreover, it was identified that there is a logical regularity in ecotourism certification programs all over the world. As the result, it was found that practically all the ecotourism certification processes are functioning successfully nowadays. By the way, it can be observed the rapid increase in the amount of ecocertified companies. Moreover, the programs which were analyzed in this article were divided into several steps (depends on the ecotourism certification program following which a company can
White certificates are a supple and suitable economical system for the quest of diffuse energy saving. It relies on the energy distribution networks and is complementary to other existing system (fiscality, regulation, etc). It is an open system, based on a market logics in order to make energy savings where they are the less costly. This document gathers the synthesis of the conference about white certificates, held in Paris in October 2005, the presentations (transparencies) given by J. Percebois (Creden) about the French system of energy savings and by P. Guyonnet (ATEE) about the way to launch the system of white certificates. The debate with the audience is also reported. (J.S.)
The purpose of the Solid Low-Level Waste (SLLW) Certification Program is to provide assurance that SLLW generated at the ORNL meets the applicable waste acceptance criteria for those facilities to which the waste is sent for treatment, handling, storage, or disposal. This document describes the strategy to be used for certification of SLLW or ORNL. The SLLW Certification Program applies to all ORNL operations involving the generation, shipment, handling, treatment, storage and disposal of SLLW. Mixed wastes, containing both hazardous and radioactive constituents, and transuranic wastes are not included in the scope of this document. 13 refs., 3 figs
Rachlin, Susan; Schonberger, Alison; Nocera, Nicole; Acharya, Jay; Shah, Nidhi; Henkel, Jacqueline
Given that maintaining compliance with Maintenance of Certification is necessary for maintaining licensure to practice as a radiologist and provide quality patient care, it is important for radiology residents to practice fulfilling each part of the program during their training not only to prepare for success after graduation but also to adequately learn best practices from the beginning of their professional careers. This article discusses ways to implement continuous certification (called Continuous Residency Certification) as an educational model within the residency training program. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.
Van Kats, J.M.; Rusman, C.J.; Van der Vorst, H.A.
Description of program or function - ACCULIB is a collection of programs and subprograms for: - approximation and interpolation problems; - the evaluation of series of orthogonal polynomials; - evaluation of the complementary error function; - sorting problems and permutations; - differential equation problems; - linear algebra eigenvalue problems; - optimization problems; - fast Fourier transformations and Fourier series; - numerical quadrature of continuous functions; - linear systems and other linear algebra problems; - bit manipulation and character handling/transmission; - systems of nonlinear equations, in particular the determination of zeros of polynomials; - solution of over-complete systems; - plotting routines for contouring and surface representation; - statistical investigation of data. In addition, many utilities such as code conversion, microfiche production, disk file surveys, layout improvements for ALGOL60 and FORTRAN programs, and the conversion of IBM FORTRAN programs to CDC FORTRAN are included in the collection
Le Goff, J.-M.; Berthois, Y.; Martin, P.-M.
The need to repurify the commercially available radioligands [ 3 H]estradiol and [ 3 H]testosterone before use in routine assays was investigated. Storage of these products for 2 months after delivery led to appreciable degradation of [ 3 H]estradiol compared to [ 3 H]testosterone. Unexpectedly, TLC and even HPLC procedures were ineffective in completely restoring the purity of [ 3 H]-estradiol and the unremoved polar products induced important variations in our estrogen receptor assays. An increase in non-specific binding and a concomitant decrease in total binding were observed resulting in an underestimation of specific binding sites and of the affinity constant. In some cases Scatchard analysis was not possible. The authors therefore strongly recommend the repurification of low-stability radioligands and propose an economic time-saving procedure for the purification of [ 3 H]estradiol by solvent differential partition which requires no high-cost investment in apparatus. (author)
1 - Description of program or function: ITMETH is a collection of iterative routines for solving large, sparse linear systems. 2 - Method of solution: ITMETH solves general linear systems of the form AX=B using a variety of methods: Jacobi iteration; Gauss-Seidel iteration; incomplete LU decomposition or matrix splitting with iterative refinement; diagonal scaling, matrix splitting, or incomplete LU decomposition with the conjugate gradient method for the problem AA'Y=B, X=A'Y; bi-conjugate gradient method with diagonal scaling, matrix splitting, or incomplete LU decomposition; and ortho-min method with diagonal scaling, matrix splitting, or incomplete LU decomposition. ITMETH also solves symmetric positive definite linear systems AX=B using the conjugate gradient method with diagonal scaling or matrix splitting, or the incomplete Cholesky conjugate gradient method
Schmidt, J.W.; Markes, B.M.; McKinney, S.M.
This document provides Bechtel Hanford, Inc. (BHI) and Westinghouse Hanford Company (WHC) a schedule of monitoring and sampling routines for the Operational Environmental Monitoring (OEM) program during calendar year (CY) 1995. Every attempt will be made to consistently follow this schedule; any deviation from this schedule will be documented by an internal memorandum (DSI) explaining the reason for the deviation. The DSI will be issued by the scheduled performing organization and directed to Near-Field Monitoring. The survey frequencies for particular sites are determined by the technical judgment of Near-Field Monitoring and may depend on the site history, radiological status, use and general conditions. Additional surveys may be requested at irregular frequencies if conditions warrant. All radioactive wastes sites are scheduled to be surveyed at least annually. Any newly discovered wastes sites not documented by this schedule will be included in the revised schedule for CY 1995
Black, Helen K.; Rubinstein, Robert L.
This study is based on original research that explored family reaction to the death of an elderly husband and father. We interviewed 34 families (a family included a widow and two adult biological children) approximately 6 to 10 months after the death. In one-on-one interviews, we discussed family members' initial reaction to the death, how the…
Full Text Available The Universal Immunization Programme is possibly the longest and one of the biggest public health intervention measures undertaken in India. To improve immunization coverage in the country various initiatives have been undertaken since the inception of the programme in 1985; key inputs being strengthening and expanding the cold chain system, establishing a network of outreach immunization sites, alternate vaccine delivery model, capacity building of health functionaries and medical officers and intensified polio control measures. Introduction of new and underutilized vaccines, drafting of the national vaccine policy, tracking of beneficiaries through the Maternal and Child Tracking system are some of the recent developments. However in spite of more than 25 years since inception the programme is still adversely impacted by challenges across key thematic areas of programme management, cold chain and vaccine management, recording and reporting and injection safety. To further strengthen and improve service delivery 2012-13 has been declared as the “Year of Intensification of Routine Immunization” with the objective of improving immunization coverage rates across poor performing districts and states so as to attain Global Immunization Vision and Strategy goals of 90% coverage at national and more than 80% coverage at district level. Key activities planned during the year include sustained advocacy at all levels, improved communication and social mobilization, robust and regular program reviews, comprehensive microplanning, strengthening cold chain and vaccine logistics system, special catch up rounds through immunization weeks, piloting the teeka express, improved surveillance systems, strengthened partnerships and operational research activities. The current review pertains to the existing scenario of Universal Immunization Program in the country with impetus on the existing challenges, progress achieved till date as a result of various
Gergin, Ozgul; Adil, Eelam; Kawai, Kosuke; Watters, Karen; Moritz, Ethan; Rahbar, Reza
The aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients. Retrospective chart review at tertiary referral children's hospital. A retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015. A total of 303 patients met inclusion criteria. The median time interval between tracheostomy and first follow-up DLB was 12.0 months (IQR 4.8-28.9 months). There was no significant difference in the incidence of airway lesions between patients who underwent endoscopy tracheostomy versus those who had a longer time interval between tracheostomy and DLB (p = 0.16). One hundred sixty seven patients (55.1%) were diagnosed with lesions, with suprastomal granulation (39.9%) being the most common. Symptomatic patients were significantly more likely to have an airway lesion identified (69.9% versus 42.0%; p tracheostomy were significantly more likely to have an airway lesion (p = 0.01). The high incidence of airway lesions noted during surveillance DLB support the utility of routine airway endoscopy in pediatric tracheostomy patients. Symptomatic patients, those with ventilator dependence, or cardiopulmonary or trauma indications for tracheostomy are more likely to have airway lesions and should be monitored closely. The ideal time interval between surveillance endoscopies needs to be examined further. Copyright © 2017. Published by Elsevier B.V.
Radtke, M A; Reich, K; Spehr, C; Augustin, Matthias
The treatment goal algorithm for psoriasis, first originated in 2007, has ever since been adopted into treatment guidelines. It remained unclear how many patients have experienced the use of treatment goals in routine care and how these are perceived. The aim of the pilot study was to get first insight in the use and impact of therapeutic goals in a large cohort of patients with psoriasis in routine care. This study is a multicenter, non-interventional, cross-sectional health care study in n = 213 dermatology centers across Germany. A standardized physician and patient questionnaire was used, including demographics, disease and treatment characteristics. To evaluate patient treatment perception and satisfaction, a questionnaire (PsoSat) addressing 8 specific items was designed. Consistency and validity of the questionnaire were controlled by factor analyses and reliability tests. In total n = 1,883 patients were included for analysis (54.2% male). Mean age was 52 years, mean disease duration 19 years. In total 45.5% (n = 856) stated an improvement of psoriatic symptoms in the last 4 weeks. In patients including treatment goals, the course of psoriasis in the last 4 weeks was rated significantly better and predicted significantly higher patient satisfaction. Patients reporting periodic outcomes measurement of psoriasis treatment, also had significantly better course of disease, higher satisfaction and a lower psoriasis severity. A majority of patients experienced the use of treatment goals in practice. The association of using treatment goals with clinical outcomes and treatment satisfaction was markedly positive. These findings indicate that the use of treatment goals and outcome measurements in fact improve psoriasis management.
Blumer, P.J.; Myers, D.A.; Fix, J.J.
This report provides the current schedule of data collection for the routine environmental surveillance program at the Hanford Site. No results are presented in this report. The data collected are available in routine reports issued by the Environmental Evaluations staff
Barbieri, Magali; Désesquelles, Aline; Egidi, Viviana; Demuru, Elena; Frova, Luisa; Meslé, France; Pappagallo, Marilena
We investigate the reporting of obesity on death certificates in three countries (France, Italy, and the United States) with different levels of prevalence, and we examine which causes are frequently associated with obesity. We use cause-of-death data for all deaths at ages 50-89 in 2010-2011. Since obesity may not be the underlying cause (UC) of death, we compute age- and sex-standardized death rates considering all mentions of obesity (multiple causes or MC). We use cluster analyses to identify patterns of cause-of-death combinations. Obesity is selected as UC in no more than 20% of the deaths with a mention of obesity. Mortality levels, whether measured from the UC or the MC, are weakly related to levels of prevalence. Patterns of cause-of-death combinations are similar across the countries. In addition to strong links with cardiovascular diseases and diabetes, we identify several less familiar associations. Considering all mentions on the deaths certificates reduces the underestimation of obesity-related mortality based on the UC only. It also enables us to describe the various mortality patterns involving obesity.
Anic, Gabriella M; Pathak, Elizabeth Barnett; Tanner, Jean Paul; Casper, Michele L; Branch, Laurence G
We hypothesised that among nursing home decedents, nursing home for-profit status and poor quality-of-care ratings, as well as patient characteristics, would lower the likelihood of transfer to hospital prior to heart disease death. Using death certificates from a large metropolitan area (Tampa Florida Metropolitan Statistical Area) for 1998-2002, we geocoded residential street addresses of heart disease decedents to identify 2172 persons who resided in nursing homes (n=131) at the time of death. We analysed decedent place of death as an indicator of transfer prior to death. Multilevel logistic regression modelling was used for analysis. Cause of death and decedent characteristics were obtained from death certificates. Nursing home characteristics, including state inspector ratings for multiple time points, were obtained from Florida's Agency for Healthcare Administration. Nursing home for-profit status, level of nursing care and quality-of-care ratings were not associated with the likelihood of transfer to hospital prior to heart disease death. Nursing homes >5 miles from a hospital were more likely to transfer decedents, compared with facilities located close to a hospital. Significant predictors of no transfer for nursing home residents were being white, female, older, less educated and widowed/unmarried. In this study population, contrary to our hypotheses, sociodemographic characteristics of nursing home decedents were more important predictors of no transfer prior to cardiac death than quality rankings or for-profit status of nursing homes.
Whitty, W.J.; Ostenak, C.A.; Pillay, K.K.S.; Geoffrion, R.R.
These guidelines were prepared with direction from the US Department of Energy (DOE) Transuranic (TRU) Waste Management Program in support of the DOE effort to certify that newly generated TRU wastes meet the Waste Isolation Pilot Plant (WIPP) Waste Acceptance Criteria. The guidelines provide instructions for generic Certification Program preparation for TRU-waste generators preparing site-specific Certification Programs in response to WIPP requirements. The guidelines address all major aspects of a Certification Program that are necessary to satisfy the WIPP Waste Acceptance Criteria and their associated Compliance Requirements and Certification Quality Assurance Requirements. The details of the major element of a Certification Program, namely, the Certification Plan, are described. The Certification Plan relies on supporting data and control documentation to provide a traceable, auditable account of certification activities. Examples of specific parts of the Certification Plan illustrate the recommended degree of detail. Also, a brief description of generic waste processes related to certification activities is included
Varvarigou, Vasileia; Farioli, Andrea; Korre, Maria; Sato, Sho; Dahabreh, Issa J; Kales, Stefanos N
To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. Case distribution study (case series with survey information on referent exposures). United States law enforcement. Summaries of deaths of over 4500 US police officers provided by the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page from 1984 to 2010. Observed and expected sudden cardiac death counts and relative risks for sudden cardiac death events during specific strenuous duties versus routine/non-emergency activities. Independent estimates of the proportion of time that police officers spend across various law enforcement duties obtained from surveys of police chiefs and front line officers. Impact of varying exposure assessments, covariates, and missing cases in sensitivity and stability analyses. 441 sudden cardiac deaths were observed during the study period. Sudden cardiac death was associated with restraints/altercations (25%, n=108), physical training (20%, n=88), pursuits of suspects (12%, n=53), medical/rescue operations (8%, n=34), routine duties (23%, n=101), and other activities (11%, n=57). Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. Results were robust to all sensitivity and stability analyses. Stressful law enforcement duties are associated with a risk of sudden cardiac death that is markedly higher than the risk during routine/non-emergency duties. Restraints/altercations and pursuits are associated with the greatest risk. Our findings have public health implications and suggest that primary and secondary cardiovascular prevention efforts are needed among law enforcement officers. © Varvarigou et al 2014.
Neergaard, Helle; Christensen, Dorthe Refslund
Learning is related to the environment created for the learning experience. This environment is often highly routinized and involves a certain social structure, but in entrepreneurship education, such routinization and structure may actually counteract the learning goals. This article investigates how classroom routines and rituals impact on…
Wang, Li; Han, Xianglong; Bai, Ding
Articulators have been widely used by clinicians of dentistry. But routine articulator mounting is still controversial in orthodontics. Orthodontists oriented by gnathology approve routine articulator mounting while nongnathologic orthodontists disapprove it. This article reviews the thoughts of orthodontist that they agree or disagree with routine articulator mounting based on the considerations of biting, temporomandibular disorder (TMD), periodontitis, and so on.
... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Routine chemistry. 493.1210 Section 493....1210 Condition: Routine chemistry. If the laboratory provides services in the subspecialty of Routine chemistry, the laboratory must meet the requirements specified in §§ 493.1230 through 493.1256, § 493.1267...
Leth, Peter Mygind
not found at the CT-scanning. The cause of death could be established by CT in 31%, by autopsy in 74%, and by toxicology in 22%. CT combined with data from the inquest could establish the cause of death in a majority of deaths due to severe trauma, but only in a minority of deaths caused by disease...
Steele, Caroline; Kidd, David C; Castano, Emanuele
Being rejected, excluded, or simply ignored is a painful experience. Ostracism researchers have shown its powerful negative consequences (Williams, 2007), and sociologists have referred to such experiences as social death (Bauman, 1992). Is this is just a metaphor or does being ostracized make death more salient in people's minds? An experiment was conducted in which participants experienced ostracism or inclusion using the Cyberball manipulation, and the accessibility of death-related thoughts was measured via a word-stem completion puzzle. Results showed enhanced death-thought accessibility in the ostracism condition, as well as a negative effect of dispositional self-esteem on the accessibility of death-related thoughts.
Rowley, M J; Hensley, M J; Brinsmead, M W; Wlodarczyk, J H
To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives. A stratified, randomised controlled trial. 814 women attending the antenatal clinic of a tertiary referral, university hospital. Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives. Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment. 405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% CI, 1.23-2.42); less likely to use pethidine during labour (OR, 0.32; 95% CI, 0.22-0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% CI, 1.28-2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% CI, 0.41-0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% CI, 0.29-2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%. Continuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, our study found that continuity of care by a midwife team was as safe as routine care.
Weinlich, Ricardo; Dillon, Christopher P; Green, Douglas R
An old puzzle in the field of cell death was recently solved: the mysterious embryonic lethality of animals deficient either in caspase-8 or FADD, proteins involved in a pathway of apoptosis. This lethality is caused by a failure to develop the yolk sac vasculature rather than a lack of apoptosis. Remarkably, development is rescued by ablation of either of two Receptor Interacting Protein Kinases (RIPKs). Despite being well-known cell killers, caspase-8 and FADD act together to block RIPK-med...
The Hanford Site Transuranic Waste Certification Plan establishes the programmatic framework and criteria with in which the Hanford Site ensures that contract-handled TRU wastes can be certified as compliant with the WIPP WAC and TRUPACT-II SARP
This website provides information about the EPA Plan for the Federal Certification of Applicators of Restricted Use Pesticides within Indian Country, including plan requirements, how to become certified, how to register for training, and who is certified.
The Hanford Site Transuranic Waste Certification Plan establishes the programmatic framework and criteria within which the Hanford Site ensures that contract-handled TRU wastes can be certified as compliant with the WIPP WAC and TRUPACT-II SARP.
Henry, Lucile; Monnoyer-Smith, Laurence; Demeulenaere, Laurence
As France imports high quantities of products which have environmental impacts abroad due to extraction, transformations, and transports of used materials, and which are not visible for consumers, environmental certification could be a mean to reduce these impacts as it would allow consumers to identify the less polluting products, and incite producers to put such products on the market. After having discussed these issues, the author outlines key factors of success for such a certification, briefly identifies required adjustments at the technical level (requirement level, cost anticipation), and at the social and political level. She also evokes accompanying measures, and outlines that environmental certification is only a tool among others such as partnership agreements currently being negotiated between the European Union and other countries, or a combination of certification and cooperation with extracting countries (as practiced by Germany)
This advisory circular (AC) transmits a consolidated directory of all : certificated Federal Aviation Administration (FAA) repair stations and : manufacturer's maintenance facilities. The repair stations and manufacturer's : maintenance facilities we...
... PERSONNEL MANAGEMENT HUMAN RESOURCES MANAGEMENT Performance Appraisal Certification for Pay Purposes § 1330... the performance expectations for individual senior employees derive from, and clearly link to, the... and budget priorities; (2) Consultation, so that the performance expectations for senior employees...
Federal Laboratory Consortium — The ATD Certification Laboratory consists of several test fixtures to ensure ATDs are functioning correctly and within specifications prior to use in any OP testing....
Identifies some of the topics covered on Section 608 Technician Certification tests such as ozone depletion, the Clean Air Act and Montreal Protocol, Substitute Refrigerants and oils, Refrigeration and Recovery Techniques.
Ab Talib, Mohamed Syazwan; Chin, Thoo Ai; Fischer, Johan
, operational performance mediates the relationship between HFC and financial performance. Altogether, this signifies that Halal food certificate implementation positively influences business performance. Practical implications By linking HFC and business performance, managers may be aware of the significant......Purpose The purpose of this paper is to explore the relationship between Halal food certification (HFC) and business performance. This study argues that Halal food certificate implementation positively influences business performance. Design/methodology/approach A total of 210 Halal certified food...... role of HFC in influencing operational and financial performance. It would entice more food companies to become Halal certified that opens up an opportunity to a lucrative Halal food industry. It also empirically justifies that a religion-based food certification has the ability to influence business...
The AG Certification is a letter confirming legal authority to implement the electronic reporting covered by the application and enforce the affected programs using the electronic documents received under those programs.
Kamara, Irene; Burnik, Jelena
The objective of this report is to identify and analyse challenges and opportunities of data protection certification mechanisms, including seals and marks, as introduced by the GDPR, focusing also on existing initiatives and voluntary schemes.
The annual Aerospace Medical Certification Statistical Handbook reports descriptive : characteristics of all active U.S. civil aviation airmen and the aviation medical examiners (AMEs) that : perform the required medical examinations. The 2012 annual...
The annual Aerospace Medical Certification Statistical Handbook reports descriptive characteristics of all active U.S. civil aviation airmen and the aviation medical examiners (AMEs) that perform the required medical examinations. The 2011 annual han...
Christensen, R.N.; Kok, K.D.
The objective of this study was to postulate methodologies for certification that a waste package is acceptable for disposal in a licensed geologic repository. Within the context of this report, certification means the overall process which verifies that a waste package meets the criteria or specifications established for acceptance for disposal in a repository. The overall methodology for certification will include (1) certifying authorities, (2) tests and procedures, and (3) documentation and quality assurance programs. Each criterion will require a methodology that is specific to that criterion. In some cases, different waste forms will require a different methodology. The purpose of predicting certification methodologies is to provide additional information as to what changes, if any, are needed for the TRU waste in storage
Worldwide, approximately three million people suffer sudden cardiac death annually. These deaths often emerge from a complex interplay of substrates and triggers. Disturbed potassium homeostasis among heart cells is an example of such a trigger. Thus, hypokalemia and, also, more transient...... of fatal arrhythmia and sudden cardiac death a patient is, the more attention should be given to the potassium homeostasis....
Though the Back to Sleep Campaign that began in 1994 caused an overall decrease in sudden infant death syndrome (SIDS) rates, racial disparity has continued to increase in St. Louis. Though researchers have analyzed and described various sociodemographic characteristics of SIDS and infant deaths by unintentional suffocation in St. Louis, they have not simultaneously controlled for contributory risk factors to racial disparity such as race, poverty, maternal education, and number of children born to each mother (parity). To determine whether there is a relationship between maternal socioeconomic factors and sleep-related infant death. This quantitative case-control study used secondary data collected by the Missouri Department of Health and Senior Services between 2005 and 2009. The sample includes matched birth/death certificates and living birth certificates of infants who were born/died within time frame. Descriptive analysis, Chi-square, and logistic regression. The controls were birth records of infants who lived more than 1 year. Chi-square and logistic regression analyses confirmed that race and poverty have significant relationships with infant sleep-related deaths. The social significance of this study is that the results may lead to population-specific modifications of prevention messages that will reduce infant sleep-related deaths. © 2013 Wiley Periodicals, Inc.
The primary changes that have been made to this revision reflect the relocation of the Waste Certification Official (WCO) organizationally from the Quality Services Division (QSD) into the Laboratory Waste Services (LWS) Organization. Additionally, the responsibilities for program oversight have been differentiated between the QSD and LWS. The intent of this effort is to ensure that those oversight functions, which properly belonged to the WCO, moved with that function; but retain an independent oversight function outside of the LWS Organization ensuring the potential for introduction of organizational bias, regarding programmatic and technical issues, is minimized. The Waste Certification Program (WCP) itself has been modified to allow the waste certification function to be performed by any of the personnel within the LWS Waste Acceptance/Certification functional area. However, a single individual may not perform both the technical waste acceptance review and the final certification review on the same 2109 data package. Those reviews must be performed by separate individuals in a peer review process. There will continue to be a designated WCO who will have lead programmatic responsibility for the WCP and will exercise overall program operational oversite as well as determine the overall requirements of the certification program. The quality assurance organization will perform independent, outside oversight to ensure that any organizational bias does not degrade the integrity of the waste certification process. The core elements of the previous WCP have been retained, however, the terms and process structure have been modified.. There are now two ''control points,'' (1) the data package enters the waste certification process with the signature of the Generator Interface/Generator Interface Equivalent (GI/GIE), (2) the package is ''certified'', thus exiting the process. The WCP contains three steps, (1) the technical review for waste acceptance, (2) a review of the
2012 Aerospace Medical Certification Statistical Handbook Valerie J. Skaggs Ann I. Norris Civil Aerospace Medical Institute Federal Aviation...Certification Statistical Handbook December 2013 6. Performing Organization Code 7. Author(s) 8. Performing Organization Report No. Skaggs VJ, Norris AI 9...2.57 Hayfever 14,477 2.49 Asthma 12,558 2.16 Other general heart pathology (abnormal ECG, open heart surgery, etc.). Wolff-Parkinson-White syndrome
Organised by the French National Health Authority (HAS), certification is an external assessment process which is obligatory for all public and private health facilities, whatever their size or activity. The aim is to independently evaluate the quality of the health care provision of hospitals and clinics in France. This article looks at the investigation methods and the procedure used during the certification assessment of Henri Mondor University Hospitals in 2016. Copyright © 2018 Elsevier Masson SAS. All rights reserved.
The paper provides details on green certificate systems in Belgium. The Flemish region has established a system and the Walloon region is preparing a slightly different one. The lack of uniformity and consequently of transparency in one country emphasises the need for more EU leadership in the field. The main part of the article analyses the established Flemish system. Green certificates are complementary to other instruments that promote renewable electricity, e.g. direct subventions on the feed-in price of green electricity or direct subventions on capital investments. Certificates execute a forcing effect on the actual development of green power if the imposed shares of green power in total sales are significant and if the fine level is at the height to enforce the quota. If the fine is too low the incentive effect turns into a financing tax effect. When the green certificate system does the job it is designed for, i.e. operating at the edge of the RES-E development and organise the transition from a non-sustainable to a sustainable power system, certificate prices will be high and reduce end-use consumption of electricity. A segmentation of the RES-E sector along the various RES-E technologies is a necessity to keep any certificate system affordable, effective and efficient. One can segment the tradable certificate market or one can assign a different number of certificates to a different RES-E technology project. Both solutions require an intensive follow-up of cost structures and of other policy measures (subventions), but given the infant state of understanding and experience segmenting markets may be best in the nearby years. (Author)
Gindre, C; Swendsen, J
Bipolar patients relapse more frequently under conditions of stress, even when compliant with prescribed medication. Although the biological bases of stress reactivity remain widely debated, the disruption of biological or circadian rhythms has been suggested as one possible mechanism through which stress increases the risk of episodes. This hypothesis has gained support from recent evidence demonstrating that the disruption of social rhythms is particularly implicated in the onset of manic episodes. However, it is currently unknown to what extent bipolar patients may differ from normal controls in terms of the basic prevalence and nature of daily life routines, or if such individuals are more sensitive to the disruption of such rhythms following exposure to stress. Using a dimensional perspective of bipolar disorder, 1728 French university students were first screened concerning diverse psychological and clinical characteristics. Two hundred and twelve individuals at high or low-risk for mood and substance use disorders were then invited to participate in a week-long period of ambulatory monitoring using the experience sampling method (ESM). During this phase, participants were given a preprogrammed PDA microcomputer which provided ambulatory assessments of behaviour and stress at fixed intervals (randomized across participants). At the end of the ESM phase, the microcomputers were collected and structured diagnostic interviews were administered to each participant. For the purposes of the current study, analyses focused on a subsample of 92 individuals, reflecting the 28 participants who met lifetime criteria for a manic (n=15) or hypomanic episode (n=13), and the 64 individuals who were free of any lifetime disorder. Data were analyzed using hierarchical nonlinear (Bernoulli) models for repeated measures. Covariates included age, sex, frequency of substance use and cognitive vulnerabilities assessed at screening. A Bonferroni correction was applied to adjust
Thunedborg, P; Fischer-Rasmussen, W; Tollund, L
The effectiveness of external cephalic version with tocolysis when routinely used in the 37th week of gestation is reported. The procedure had earlier been ruled out in our department, was found effective in a prospective study, and afterwards settled as a routine. Among 1038 women with single...... breech presentation, 882 could be offered an attempt of external cephalic version during the period 1982-1988. Attempt of version was carried out in 316 women resulting in a vertex presentation at delivery in 100. The success rate on average was 35%. The estimated reduction of breech deliveries was 100...... serious complications were associated with the procedure. Two cases of intra-uterine fetal death occurred 2 and 5 weeks, respectively, after successful, uncomplicated version to vertex presentation. No obvious connection with the external cephalic version could be demonstrated. The effectiveness...
Ramapriyan, H. K.
NASA's Earth Observing System Data and Information System (EOSDIS) has been in operation since August 1994, managing most of NASA's Earth science data from satellites, airborne sensors, filed campaigns and other activities. Having been designated by the Federal Government as a project responsible for production, archiving and distribution of these data through its Distributed Active Archive Centers (DAACs), the Earth Science Data and Information System Project (ESDIS) is responsible for EOSDIS, and is legally bound by the Office of Management and Budgets circular A-130, the Federal Records Act. It must follow the regulations of the National Institute of Standards and Technologies (NIST) and National Archive and Records Administration (NARA). It must also follow the NASA Procedural Requirement 7120.5 (NASA Space Flight Program and Project Management). All these ensure that the data centers managed by ESDIS are trustworthy from the point of view of efficient and effective operations as well as preservation of valuable data from NASA's missions. Additional factors contributing to this trust are an extensive set of internal and external reviews throughout the history of EOSDIS starting in the early 1990s. Many of these reviews have involved external groups of scientific and technological experts. Also, independent annual surveys of user satisfaction that measure and publish the American Customer Satisfaction Index (ACSI), where EOSDIS has scored consistently high marks since 2004, provide an additional measure of trustworthiness. In addition, through an effort initiated in 2012 at the request of NASA HQ, the ESDIS Project and 10 of 12 DAACs have been certified by the International Council for Science (ICSU) World Data System (WDS) and are members of the ICSUWDS. This presentation addresses questions such as pros and cons of the certification process, key outcomes and next steps regarding certification. Recently, the ICSUWDS and Data Seal of Approval (DSA) organizations
The Canadian Nuclear Safety Commission (CNSC) regulates the use of nuclear energy and materials to protect health, safety, security of Canadians and the environment, and to implement Canada's international commitments on the peaceful use of nuclear energy. As part of its mandate, the CNSC requires certification of those who work in positions with direct impact on the safety of Canadian nuclear power plants (NPPs) and research reactors. Other positions, such as exposure device operators and radiation safety officers at other nuclear facilities, also require CNSC certification. In this paper, the certification process of Canadian NPP personnel will be examined. In keeping with the CNSC's regulatory philosophy and international practice, licensees bear the primary responsibility for the safe operation of their NPPs. They are therefore held entirely responsible for training and testing their workers, in accordance with applicable regulatory requirements, to ensure they are fully qualified to perform their duties. The CNSC obtains assurance that all persons it certifies are qualified to carry out their respective duties. It achieves this by overseeing a regime of licensee training programs and certification examinations, which are based on a combination of appropriate regulatory guidance and compliance activities. Reviews of the knowledge-based certification examination methodology and of lessons learned from Fukushima have generated initiatives to further strengthen the CNSC's certification programs for NPP workers. Two of those initiatives are discussed in this paper. (author)
Yong Kum Weng
Full Text Available Currently the problems of some architects issuing fraudulent progress certificates for Malaysia’s housing projects result in many house buyers losing their life savings. Unfortunately, these house buyers still remain contractually responsible for all the associated, present and future financial obligations such as their bank loans. Fraudulent certification is the most frequent incident of complaints amongst the range of problems complained about to the Board of Architects, Malaysia or Lembaga Arkitek Malaysia (LAM. This paper highlights the underlying pertinent issues such as when an architect does not fully understand the ramifications, or exercise due care when performing the certifier’s role with its inherent responsibilities under the Housing Development Act (HDA and Housing Development Regulations (HDR. Also at what stage the architect is legally required to issue progressive work completion certificates, particularly the scope ranging from the inception stage through to the completion stage. This includes the relevant housing laws and regulations that enshrine the architects’ professional status and confers legal certification duties. This is designed to protect the public interest, yet many architects fail to perform this duty inde-pendently, or impartially and fairly to the new house buyers and the public at-large. Recognizing the systemic weakness, the elements that contribute to the fraudulent certification and illustrates how the fraudulent certification exploits the trust of house buyers. In the analysis, a quantitative framework was used to measure, quantify and discuss the best all round outcomes.
Full Text Available A case study of software certification reveals the real difficulty of certifying quality beyond superficial assessment - readers are invited to form their own conclusions. AS 3563 Software Quality Management System is the Australian version of ISO 9001, developed specifically for the software industry. For many Australian software houses, gaining certification with AS 3563 is a priority since certification has become a prerequisite to doing business with government departments and major corporations. However, the process of achieving registration with this standard is a lengthy and resource intensive process, and may have little impact on actual software quality. This case study recounts the experience of the consulting arm of one of Australia's accounting firms in its quest for certification. By using a number of specific management strategies this company was able to successfully implement AS 3563 in less than half the time usually taken to achieve certification - a feat for which its management should be congratulated. However, because the focus of the project was on gaining certification, few internal benefits have been realised despite the successful implementation of the standard.
Full Text Available Organizational routines are a frequently researched phenomenon in contemporary management science. Although the available theoretical foundations of Routine Theory seem to have reached a significant degree of maturity over the last thirty years, the same could not be said about the availability of material advice for the management practice. This paper addresses this gap and proposes a framework for an effective routine shaping process. It builds on a brief analysis of available literature on routine formation, supported by case study findings. The approach proposed stresses the importance of the controlled learning process and underlines the importance of deliberate implementation, in contrast to the evolutionary and engineering views on routine emergence.
1 - Description of program or function: FASTPLOT is a library of routines that can be used to interface with the Microsoft FORTRAN Graphics library (GRAPHICS.LIB). The FASTPLOT routines simplify the development of graphics applications and add capabilities such as histograms, Splines, symbols, and error bars. FASTPLOT also includes routines that can be used to create menus. 2 - Methods: FASTPLOT is a library of routines which must be linked with a user's FORTRAN programs that call any FASTPLOT routines. In addition, the user must link with the Microsoft FORTRAN Graphics library (GRAPHICS.LIB). 3 - Restrictions on the complexity of the problem: None noted
Nonaka, K.; Imaizumi, Y.
It has been suggested that maternal nutrition, and fetal and infant growth have an important effect on the risk of cardiovascular disease in adult life. We investigated the population-based distribution of deaths from cerebrovascular diseases (ICD9 codes 430, 431, or 434) in Japan in 1986-1994 as a function of birth month, by examining death-certificate records. For a total of 853 981 people born in the years 1900-1959, the distribution of the number of deaths according to the month of birth was compared with the distribution expected from the monthly numbers of all births for each sex and for the corresponding birth decade. For those born between 1920 and 1949, there were significant discrepancies between the actual numbers of deaths from subarachnoid hemorrhage (ICD9 430) and the numbers expected, and these differences were related to the month of birth. Those born in summer, June-September, consistently had an elevated risk of death, particularly men, where the excess risk was 8%-23%. This tendency was also observed, less distinctly but significantly, for deaths from intracerebral hemorrhage (ICD9 431), but was not observed for those dying from occlusion of the cerebral arteries (ICD9 434). The observation that the risk of dying from subarachnoid hemorrhage was more than 10% higher among those born in the summer implies that at least one in ten deaths from subarachnoid hemorrhage has its origin at a perinatal stage. Although variations in hypertension in later life, which could possibly be ''programmed'' during the intra-uterine stages, could be an explanation for this observation, the disease-specific nature of the observation suggests the involvement of aneurysm formation, which is a predominant cause of subarachnoid hemorrhage.
Bordalo-Rodrigues, Marcelo; Schweitzer, Mark; Bergin, Diane; Culp, Randall; Barakat, Mohamed S
Chondromalacia is a commonly encountered abnormality at arthroscopy and may be responsible for significant clinical symptoms and disability. In the wrist, the most common location for chondromalacia is the lunate bone. Consequently, we sought to study the accuracy of clinical MRI in the assessment of lunate articular cartilage. MR images of 34 patients who underwent arthroscopy and had an MRI examination within 1 month of surgery were evaluated by two reviewers for the presence and location of lunate cartilage defects and subchondral edema. Lunate cartilage defects were seen on MRI in 10 of the 13 patients with chondromalacia, but these defects were also incorrectly noted in three of 21 of patients without chondromalacia. The visible locations for cartilage defects were the ulnar aspect of the proximal lunate bone (n = 3), radial aspect of the proximal lunate bone (n = 4), ulnar aspect of the distal lunate bone (n = 2), and radial aspect of the distal lunate bone (n = 1). Subchondral marrow edema was observed in six of the 10 patients with chondromalacia seen on MRI; in all six patients, the edema was seen in the same quadrant as the cartilage defect. Marrow edema was detected in one patient without chondromalacia. We conclude that lunate chondromalacia can be accurately assessed using routine MRI sequences, although there are occasional false-positive interpretations.
Dreuille, O. de; Carbonieres, H. de; Briand-Champlong, J.; Foehrenbach, H.; Guevel, E.; Maserlin, P.; Gaillard, J.F.; Treguier, J.Y.
The nuclear medicine department of the Val de Grace Hospital, in cooperation with the Radiological Protection Army Service, has performed an evaluation of the staff's radio-exposure based on routine dosimetry for six months. The most exposed people are the technicians (2.6 mSv/yr) and the nurse (1.7 mS/yr). The nuclear medicine physicians (0.6 mSv/yr) and the secretaries (0.07 mSv/yr) are far less exposed. The most irradiant occupations are the preparation and the injection of the radiopharmaceuticals (18 mSv/dy) and the realization of the Positron Emission Tomography examinations (19 mSv/dy). The increasing number of PET exams and the development of new tomographs, requiring higher activities, will still increase the exposition level of this working post. This study demonstrates that the exposition doses in nuclear medicine are low compared to the regular limits. Based on these results, only the technicians and the nurse are relevant to the A class. However, these dose levels cannot be neglected for particular positions such as the injection and the PET management. (author)
Hirata, Hideki; Saito, Tsutomu
As an introduction of the title series, outlines of radiation in physics, chemistry, biochemistry, biological effect and protection are explained from the clinical doctors' aspect of routine medicare, and of radiation exposure in which people's interest is raised after the Fukushima Nuclear Power Plant Accident in 2011. For physics, ionizing effects of radiation are described in relation to its quantum energy transfer and its medical utilization like imaging and radiotherapy. Then mentioned in brief is the radiation from elements consisting of human body, cosmic ray and background radiation from the earth, with reference to natural and standardized limits of exposure doses. Radiations from 226 Rn and 40 K are explained as an instance of environmental natural sources together with the concepts of radioactive decay series/scheme, of internal exposure, of hazard like double strand break (DSB) and of medical use such as boron neutron capture therapy (BNCT). For an artifact radiation source, shown are fission products of 235 U by neutron, first yielded in 1945. Evidence of evolution in biochemical repair mechanisms of DSB is explained with a comparison of irradiated drosophila mutation where linear non-threshold (LNT) hypothesis is proposed, and human non-homologous end joining and homologous recombination. Historical process of occupational, medical, public exposures and their protection is finally described from the discovery of X-ray in 1895 to the first ICRP publication in 1958 via the A-bomb explosion in 1945. (T.T.)
... TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT...
Full Text Available BACKGROUND AND OBJECTIVE: In today's world, Islamic jurisprudence encounters new issues. One of the areas where jurisprudence gets involved is the issues concerned with brain death, whether brain death in jurisprudence and Islamic law is considered the end of life. In this study, brain death was discussed from the Shiite jurisprudence perspective and also the opinions of the specialists are taken into account. METHODS: This study is designed based on library collection and review of the literature in the field of brain death. Also, Quranic verses, hadiths and fatwas (religious opinions of the scholars are used. Some of the articles which were centered around Islamic jurisprudence, particularly Shiite jurisprudence that explain and deal with brain death were given special consideration. FINDINGS: Brain death from religious and jurisprudence perspective is considered the termination of life and removing the vital organs from the body is not viewed as committing manslaughter. A person with brain death is not a normally known injured man who is still alive. The brain death patinets have no life and getting rid of the body does not constitute a case of manslaughter. Amputation of the organs of brain death patients for donation and transplantation amounts to the amputation of a dead body. If the life of a Muslim is subject to transplant of organs from the body of a brain death patient, it will be permissible. CONCLUSION: In principle, if the life of a Muslim entails transplant of organs of brain death patients, it will be permissible
Weichbrodt, J. Ch.
This thesis is concerned with the relationship between rules and routines in organizations and how the former can be used to steer the latter. Rules are understood as formal organizational artifacts, whereas organizational routines are collective patterns of action. While research on routines has been thriving, a clear understanding of how rules can be used to influence or control organizational routines (and vice-versa) is still lacking. This question is of particular relevance to safety rules in high-risk organizations, where the way in which organizational routines unfold can ultimately be a matter of life and death. In these organizations, an important and related issue is the balancing of standardization and flexibility – which, in the case of rules, takes the form of finding the right degree of formalization. In high-risk organizations, the question is how to adequately regulate actors’ routines in order to facilitate safe behavior, while at the same time leaving enough leeway for actors to make good decisions in abnormal situations. The railroads are regarded as high-risk industries and also rely heavily on formal rules. In this thesis, the Swiss Federal Railways (SBB) were therefore selected for a field study on rules and routines. The issues outlined so far are being tackled theoretically (paper 1), empirically (paper 2), and from a practitioner’s (i.e., rule maker’s) point of view (paper 3). In paper 1, the relationship between rules and routines is theoretically conceptualized, based on a literature review. Literature on organizational control and coordination, on rules in human factors and safety, and on organizational routines is combined. Three distinct roles (rule maker, rule supervisor, and rule follower) are outlined. Six propositions are developed regarding the necessary characteristics of both routines and rules, the respective influence of the three roles on the rule-routine relationship, and regarding organizational aspects such as
Weichbrodt, J. Ch.
This thesis is concerned with the relationship between rules and routines in organizations and how the former can be used to steer the latter. Rules are understood as formal organizational artifacts, whereas organizational routines are collective patterns of action. While research on routines has been thriving, a clear understanding of how rules can be used to influence or control organizational routines (and vice-versa) is still lacking. This question is of particular relevance to safety rules in high-risk organizations, where the way in which organizational routines unfold can ultimately be a matter of life and death. In these organizations, an important and related issue is the balancing of standardization and flexibility – which, in the case of rules, takes the form of finding the right degree of formalization. In high-risk organizations, the question is how to adequately regulate actors’ routines in order to facilitate safe behavior, while at the same time leaving enough leeway for actors to make good decisions in abnormal situations. The railroads are regarded as high-risk industries and also rely heavily on formal rules. In this thesis, the Swiss Federal Railways (SBB) were therefore selected for a field study on rules and routines. The issues outlined so far are being tackled theoretically (paper 1), empirically (paper 2), and from a practitioner’s (i.e., rule maker’s) point of view (paper 3). In paper 1, the relationship between rules and routines is theoretically conceptualized, based on a literature review. Literature on organizational control and coordination, on rules in human factors and safety, and on organizational routines is combined. Three distinct roles (rule maker, rule supervisor, and rule follower) are outlined. Six propositions are developed regarding the necessary characteristics of both routines and rules, the respective influence of the three roles on the rule-routine relationship, and regarding organizational aspects such as
Hoshi, Shu-Ling; Kondo, Masahide; Okubo, Ichiro
Two rotavirus vaccines are currently available in Japan. We estimated the incremental cost-effectiveness ratio (ICER) of routine infant rotavirus immunisation program without defining which vaccine to be evaluated, which reflects the current deliberation at the Health Science Council in charge of Immunisation and Vaccine established by the Ministry of Health, Labor and Welfare of Japan. Three ICERs were estimated, one from payers' perspective and 2 from societal perspective depending on the scenarios to uptake vaccines. The health statuses following the birth cohort were as follows: not infected by rotavirus, asymptomatic infection, outpatients after infection, hospitalised after infection, developing encephalitis/encephalopathy followed by recovery, sequelae, and death. Costs of per course of vaccination was ¥30,000 (US$283; US$1 = ¥106). The model runs for 60 months with one month cycle. From payers' perspective, estimated ICERs were ¥6,877,000 (US$64,877) per QALY. From societal perspective, immunisation program turns out to be cost-saving for 75% simultaneous vaccination scenario, while it is at ¥337,000 (US$3,179) per QALY gained with vaccine alone scenario. The probability of rotavirus immunisation program to be under ¥5,000,000 (US$47,170) per QALY was at 19.8%, 40.7%, and 75.6% when costs per course of vaccination were set at ¥30,000 (US$283), ¥25,000 (US$236), and ¥20,000 (US$189), respectively. Rotavirus immunisation program has a potential to be cost-effective from payers' perspective and even cost-saving from societal perspective in Japan, however, caution should be taken with regard to the interpretation of the results as cost-effectiveness is critically dependent on vaccination costs.
Bhatia, Amiya; Ferreira, Leonardo Zanini; Barros, Aluísio J D; Victora, Cesar Gomes
Birth registration, and the possession of a birth certificate as proof of registration, has long been recognized as a fundamental human right. Data from a functioning civil registration and vital statistics (CRVS) system allows governments to benefit from accurate and universal data on birth and death rates. However, access to birth certificates remains challenging and unequal in many low and middle-income countries. This paper examines wealth, urban/rural and gender inequalities in birth certificate coverage. We analyzed nationally representative household surveys from 94 countries between 2000 and 2014 using Demographic Health Surveys and Multiple Indicator Cluster Surveys. Birth certificate coverage among children under five was examined at the national and regional level. Absolute measures of inequality were used to measure inequalities in birth certificate coverage by wealth quintile, urban/rural residence and sex of the child. Over four million children were included in the analysis. Birth certificate coverage was over 90% in 29 countries and below 50% in 36 countries, indicating that more than half the children under five surveyed in these countries did not have a birth certificate. Eastern & Southern Africa had the lowest average birth certificate coverage (26.9%) with important variability among countries. Significant wealth inequalities in birth certificate coverage were observed in 74 countries and in most UNICEF regions, and urban/rural inequalities were present in 60 countries. Differences in birth certificate coverage between girls and boys tended to be small. We show that wealth and urban/rural inequalities in birth certificate coverage persist in most low and middle income countries, including countries where national birth certificate coverage is between 60 and 80%. Weak CRVS systems, particularly in South Asia and Africa lead rural and poor children to be systematically excluded from the benefits tied to a birth certificate, and prevent these
Konefal, Jason; Hatanaka, Maki
As third-party certification has become a prominent governance mechanism, conflicting understandings of it have emerged. Proponents advance third-party certification as a technical and objective governance mechanism, while critics argue that politics and relations of power characterize it. We reject this dichotomization both in terms of how TPC is…
Ree, B.G.C. van der
Due to the rapid growth of the solar energy market in the Netherlands, quality control of solar systems is well under way. An important tool to improve the infrastructure of the solar market is certification of solar energy systems. Certification in the Netherlands is being developed in two projects
Dalgaard, Carl-Johan Lars; Strulik, Holger
health investments. At the same time, physiological aspects of the aging process influence optimal savings and health investment. We calibrate the model for the average US male in 2000 and proceed to show that the calibrated model accounts well for the cross-country link between labor productivity......This study introduces physiological aging into a simple model of optimal intertemporal consumption. In this endeavor we draw on the natural science literature on aging. According to the purposed theory, the speed of the aging process and the time of death are endogenously determined by optimal...... and life expectancy in the same year ("the Preston curve"); cross-country income differences can explain differences in life expectancy at age 20 of up to a decade. Moreover, technological change in health care of about 1.1% per year can account for the observed shift in the Preston curve between 1980...
Full Text Available The paper discusses public opinion on post-mortem organ donation, especially the difference between high support of public opinion to transplant activity, its general readiness to donate organs and the low number of signed organ donor cards. Through different approaches the article tries to point out possible factors relevant to the decision to donate organs. Early studies showed demographic variables and information as significant factors when deciding to donate organs after death. As there was not enough evidence that long-term effect through these factors is significant, the need for new investigation has grown. Social cognition theories helped understanding the difference mentioned above. It seems that the use of this approach might contribute to the understanding the problem and to delimit most useful factors when working with public.
Marilyn L. Moy
Full Text Available The independent relationship between physical inactivity and risk of death after an index chronic obstructive pulmonary disease (COPD hospitalisation is unknown. We conducted a retrospective cohort study in a large integrated healthcare system. Patients were included if they were hospitalised for COPD between January 1, 2011 and December 31, 2011. All-cause mortality in the 12 months after discharge was the primary outcome. Physical activity, expressed as self-reported minutes of moderate to vigorous physical activity (MVPA, was routinely assessed at outpatient visits prior to hospitalisation. 1727 (73% patients were inactive (0 min of MVPA per week, 412 (17% were insufficiently active (1–149 min of MVPA per week and 231 (10% were active (≥150 min of MVPA per week. Adjusted Cox regression models assessed risk of death across the MVPA categories. Among 2370 patients (55% females and mean age 73±11 years, there were 464 (20% deaths. Patients who were insufficiently active or active had a 28% (adjusted HR 0.72 (95% CI 0.54–0.97, p=0.03 and 47% (adjusted HR 0.53 (95% CI 0.34–0.84, p<0.01 lower risk of death, respectively, in the 12 months following an index COPD hospitalisation compared to inactive patients. Any level of MVPA is associated with lower risk of all-cause mortality after a COPD hospitalisation. Routine assessment of physical activity in clinical care would identify persons at high risk for dying after COPD hospitalisation.
Macrocytosis, a condition in which erythrocytes are larger than normal manifests as an increase in mean corpuscular volume (MCV) more than 100 fl. The aim of this study was to identify the underlying causes of macrocytosis, detected in routine hemograms and to evaluate the hematological features in different etiologies. This study included 178 adult patients whose detailed medical history was recorded, and Vitamin B12 assay, folate assay, thyroid function tests, liver function tests, complete blood counts and peripheral smear evaluation was performed. Alcoholism was identified as the etiological factor in 65 cases (36.5%), Vitamin B12 deficiency in 43 cases (24.1%) and drug related in 23 cases (12.9%). These three conditions accounted for 73.6% of macrocytosis. Other causes identified were folate deficiency, liver disease, Myelodysplastic syndrome, chronic renal failure and Aplastic anemia. In 41 cases, the cause of macrocytosis could not be explained. Anemia was observed in 95 cases (53.3%) being most common in Vitamin B12 deficiency. 9 cases (20.9%) of Vitamin B12 deficiency presented with isolated macrocytosis without anemia. It was observed that mean hemoglobin was lower and red cell distribution width (RDW) higher in megaloblastic conditions. Peripheral smear revealed hypersegmented neutrophils in 86% and macro-ovalocytes in 72% of the megaloblastic cases. Complete medical history, red cell parameters and peripheral blood smear are simple, inexpensive tools which assist in identifying the underlying cause of macrocytosis, particularly in resource limited settings. Macrocytosis needs to be evaluated even in the absence of anemia, as it may be the first clue to an underlying pathology.
Goldberg, James D
Ultrasound has become a routine part of prenatal care. Despite this, the sensitivity and specificity of the procedure is unclear to many patients and healthcare providers. In a small study from Canada, 54.9% of women reported that they had received no information about ultrasound before their examination. In addition, 37.2% of women indicated that they were unaware of any fetal problems that ultrasound could not detect. Most centers that perform ultrasound do not have their own statistics regarding sensitivity and specificity; it is necessary to rely on large collaborative studies. Unfortunately, wide variations exist in these studies with detection rates for fetal anomalies between 13.3% and 82.4%. The Eurofetus study is the largest prospective study performed to date and because of the time and expense involved in this type of study, a similar study is not likely to be repeated. The overall fetal detection rate for anomalous fetuses was 64.1%. It is important to note that in this study, ultrasounds were performed in tertiary centers with significant experience in detecting fetal malformations. The RADIUS study also demonstrated a significantly improved detection rate of anomalies before 24 weeks in tertiary versus community centers (35% versus 13%). Two concepts seem to emerge from reviewing these data. First, patients must be made aware of the limitations of ultrasound in detecting fetal anomalies. This information is critical to allow them to make informed decisions whether to undergo ultrasound examination and to prepare them for potential outcomes.Second, to achieve the detection rates reported in the Eurofetus study, ultrasound examination must be performed in centers that have extensive experience in the detection of fetal anomalies.
Ifteni, Petru; Grudnikoff, Eugene; Koppel, Jeremy; Kremen, Neil; Correll, Christoph U; Kane, John M; Manu, Peter
Treatment with haloperidol has been shown, in studies using death certificates and prescription files, to be associated with an excess of sudden cardiac deaths, and regulatory warnings highlight this risk in patients with dementia. We used autopsy findings to determine whether the rate of sudden cardiac death is greater in cases of unexpected deaths of patients with dementia treated with haloperidol. From 1989 through 2013, 1219 patients with a primary diagnosis of dementia with behavioral disturbance were admitted to a psychiatric hospital, and 65 (5.3%) died suddenly. Sixty-five patients (5.3%) died unexpectedly. Complete post-mortem examinations after the sudden death were performed in 55 (84.6%) patients. Twenty-seven of the autopsied cases (49.1%) had been treated with haloperidol orally (2.2 mg ± 2.1 mg/day), the only antipsychotic used in this cohort. Univariable comparisons and multivariable regression analyses compared the groups of patients with or without sudden cardiac death. The leading causes of death were sudden cardiac death (32.7%), myocardial infarction (25.5% of patients), pneumonia (23.6%), and stroke (10.9%). Patients with sudden cardiac death and those with anatomically established cause of death were similar regarding the use of haloperidol (p = 0.5). Sudden cardiac death patients were more likely to suffer from Alzheimer's dementia (p = 0.027) and to have a past history of heart disease (p = 0.0094), and less likely to have been treated with a mood stabilizer (p = 0.024), but none of these variables were independent predictors of sudden cardiac death. Autopsy data suggest that oral haloperidol is not associated with increased risk of sudden cardiac death in psychiatric inpatients with dementia. Copyright © 2015 John Wiley & Sons, Ltd.
Wilson, Donna M; Hewitt, Jessica A
A scoping research literature review on "bad death" was undertaken to assess the overall state of the science on this topic and to determine what evidence exists on how often bad deaths occur, what contributes to or causes a bad death, and what the outcomes and consequences of bad deaths are. A search for English-language research articles was conducted in late 2016, with 25 articles identified and all retained for examination, as is expected with scoping reviews. Only 3 of the 25 articles provided incidence information, specifying that 7.8 to 23% of deaths were bad and that bad deaths were more likely to occur in hospitals than in community-care settings. Many different factors were associated with bad deaths, with unrelieved pain being the most commonly identified. Half of the studies provided information on the possible consequences or outcomes of bad deaths, such as palliative care not being initiated, interpersonal and team conflict, and long-lasting negative community effects. This review identified a relatively small number of research articles that focused in whole or in part on bad deaths. Although the reasons why people consider a death to be bad may be highly individualized and yet also socioculturally based, unrelieved pain is a commonly held reason for bad deaths. Although bad and good deaths may have some opposing causative factors, this literature review revealed some salient bad death attributes, ones that could be avoided to prevent bad deaths from occurring. A routine assessment to allow planning so as to avoid bad deaths and enhance the probability of good deaths is suggested.
Ntuli, Sam Thembelihle; Malangu, Ntambwe; Alberts, Marianne
Accurate and timely information on the causes of child deaths is essential in guiding efforts to improve child survival, by providing data from which health profiles can be constructed and relevant health policies formulated. The purpose of this study was to identify causes of death in children younger than 5 years-old in a tertiary hospital in South Africa. Death certificates from the Pietersburg/Mankweng hospital complex, for the period of January 1, 2008 through December 31, 2010, were obtained for all patients younger than 5 years and were retrospectively reviewed. Data were collected using a data collection form designed for the study. Information abstracted included: date of death, age, sex, and cause of death. A total of 1266 deaths were recorded, the sex ratio was 1.26 boys per girl. About 611 (48%) of deaths were listed as neonatal deaths (0-28 days), 387 (31%) were listed as infant deaths (29 days-11 months), and 268 (21%) as children's death (1-4 years). For neonates the leading causes of death were: prematurity/low birth weight, birth asphyxia and pneumonia. For the infant death group, the leading causes of death were pneumonia, diarrhea, and HIV/AIDS; and in the children's group, the leading causes were injuries, diarrhea and pneumonia. There was no statistical significant difference in the proportions of causes of death based on the sex of children. The top 10 leading causes of death in children under-5 years old treated at Pietersburg/Mankweng Hospital Complex were in descending order: prematurity/low birth weight, pneumonia, diarrheal diseases, birth asphyxia, and severe malnutrition, HIV/AIDS, hydrocephalus, unintentional injuries, meningitis and other infections. These ten conditions represent 73.9% of causes of death at this facility. A mix of multi-faceted interventions is needed to address these causes of death in children.
dos Santos, Laerte; Alves, Luiz M.; da Costa Bortoni, Edson
In recent years Brazil has experienced extraordinary growth despite the recent economic global crisis. The demand for infrared thermography products and services has accompanied this growth. Like other non-destructive testing and inspection, the results obtained by thermography are highly dependent on the skills of thermographer. Therefore, it is very important to establish a serious and recognized process of certification to assess thermographers' qualifications and help services suppliers to establish credibility with their customers and increase the confidence of these costumers on the quality of these services. The Brazilian Society of Non-Destructive Testing and Inspection, ABENDI, a non-profitable, private technical-scientific entity, recognized nationally and internationally, has observed the necessity of starting a process for certification of thermographers in Brazil. With support of a work group composed by experts from oil and energy industries, transportation, universities and manufactures, the activities started in 2005. This paper describes the economic background required for installation of the certification process, its initial steps, the main characteristics of the Brazilian certification and the expectation for initiating the certification process.
Maswoswe, J J; Stewart, K R; Enigbokan, M; Egbunike, I; Jackson, D M
Several solutions, ranging from increased technician duties to salary raises, automation, and increasing job satisfaction, have been presented in the literature as methods of assuaging the pharmacist shortage. Although a significant portion of pharmacy graduates from American pharmacy colleges are foreign nationals, no marketing strategies have been elucidated in the retention and recruitment of foreign nationals through labor certification. Labor certifications are generally approved by the Secretary of Labor if the following factors have been verified: 1) there are not sufficient United States workers who are able, willing, qualified, and available for employment; and 2) the employment of the foreign national will not adversely affect the wages and working conditions of U.S. workers similarly employed. When properly understood, the labor certification process is a test of the job market where foreigners, by virtue of their skills and qualifications, attain certification which subsequently leads to permanent residency (green card). The objective of this report is to elucidate the tedious yet effective method of retaining American-educated foreign nationals through labor certification.
Liu, Y.Y.; Carlson, R.D. [Argonne National Lab., IL (United States); Carlson, R.W. [Lawrence Livermore National Lab., CA (United States); Kapoor, A. [USDOE, Washington, DC (United States)
This paper gives an overview of the DOE packaging certification process, which is implemented by the Office of Facility Safety Analysis, under the Assistance Secretary for Environment, Safety and Health, for packagings that are not used for weapons and weapons components, nor for naval nuclear propulsion. The overview will emphasize Type B packagings and the Safety Analysis Report for Packaging (SARP) review that parallels the NRC packaging review. Other important elements in the DOE packaging certification program, such as training, methods development, data bases, and technical assistance, are also emphasized, because they have contributed significantly to the improvement of the certification process since DOE consolidated its packaging certification function in 1985. The paper finishes with a discussion of the roles and functions of the DOE Packaging Safety Review Steering Committee, which is chartered to address issues and concerns of interest to the DOE packaging and transportation safety community. Two articles related to DOE packaging certification were published earlier on the SARP review procedures and the DOE Packaging Review Guide. These articles may be consulted for additional information.
(cf. Article R IV 2.04 of the Staff Regulations) Your annual internal taxation certificate will state the taxable amount of your CERN remuneration, payments and other financial benefits and the amount of tax levied by the Organization during the previous financial year. In France, your tax return must be accompanied by this certificate. Current Members of the Personnel (including Members of the Personnel participating in a pre-retirement programme): - You will receive an e-mail containing a link to your printable annual certificate, which will be stored together with your pay and leave statements (e-Payslips). - You can also access your annual certificate via https://hrt.cern.ch (open 'My Payslips' at the bottom of the main menu.) - If you experience any technical difficulties in accessing your annual certificate (e.g. invalid AIS login or password), please contact CERN's AIS support team at email@example.com. Former Members of the Personnel:- If you remember your AIS login and password, you can acc...
Foss, Nicolai Juul; Felin, Teppo
In this paper we discuss the origins and emergence of organizational routines and capabilities. We first argue that there are theoretical and endogeneity-related concerns associated with the key antecedents and mechanisms specified by the extant routines and capabilities literature. Specifically,...... or rationalist, choice-based approach can provide a more fruitful (though preliminary) foundation for understanding organizational behavior and capabilities.......In this paper we discuss the origins and emergence of organizational routines and capabilities. We first argue that there are theoretical and endogeneity-related concerns associated with the key antecedents and mechanisms specified by the extant routines and capabilities literature. Specifically......, we explicate the behaviorist and empiricist foundations of the organizational routines and capabilities literature and the extant emphasis placed on experience, repetition, and observation as the key antecedents and mechanisms of routines and capabilities. Based on this discussion we highlight...
Marcussen, Jette; Thuen, Frode; Poul, Bruun
The aim of this review was to identify research on children and adolescents who experience double bereavement, i.e. the experience of loss through parental divorce followed by either parental death or critical illness with imminent death. This knowledge may identify evidence to underpin knowledge......; challenges in both custodial and non-custodial parental death; risk of mental health problems, and the need of support and interventions....
... INFORMATION TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.455 Testing and certification to newer versions of certain standards. (a) ONC-ATCBs...
... INFORMATION TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT § 170.465 Revocation of authorized testing and certification body status. (a) Type-1...
Hare, J.; Rodin, L.
This report contains viewgraphs on licensing and certifing of software professionals. Discussed in this report are: certification programs; licensing programs; why became certified; certification as a condition of empolyment; certification requirements; and examination structures.
David, Karen Kate; Andrabi, Shaida Ahmad; Dawson, Ted Murray; Dawson, Valina Lynn
Poly-ADP-ribose polymerase-1 (PARP-1)'s multiple roles in the cell span from maintaining life to inducing death. The processes PARP-1 is involved in include, but are not limited to DNA repair, DNA transcription, mitosis, and cell death. Of PARP-1's different cellular functions, its active role in cell death is of particular interest to designing therapies for diseases. Genetic deletion of PARP-1 revealed that PARP-1 over activation underlies cell death in experimental models of stroke, diabet...
Wolf, J; Safer, A; Wöhrle, J C; Palm, F; Nix, W A; Maschke, M; Grau, A J
Amyotrophic lateral sclerosis (ALS) is associated with an increased mortality. Knowledge of possible causes of death could lead to an individualization of the palliative treatment concept and result in a differentiated palliative treatment pathway. Currently, only few systematic data are available on the heterogeneity of causes of death associated with ALS. Analysis of the various causes of death in a prospective population-based German cohort of ALS patients. Analysis of data of the Rhineland-Palatinate ALS registry in which newly diagnosed patients who had been identified between October 2009 and September 2012 were prospectively enrolled and followed up at regular intervals. From this prospective cohort study the causes of death were elicited based on information provided by the attending physicians, family members and by means of death certificates registered by the regional health authorities in Rhineland-Palatinate. Out of 200 ALS patients registered 148 died between register initiation on 1 October 2009 and the end of follow-up on 30 September 2015 (78 males and 70 females, death rate 74%). The most frequent cause of death was respiratory failure as a consequence of weakness of respiratory muscles (n = 91, 61%). Less frequent causes of death were pneumonia (n = 13, 9%), terminal cachexia (n = 9, 6%) and death from cardiovascular causes including sudden death (n = 9, 6%). Cases of suicide were rare (n = 3, 2%) as were deaths due to concurrent diseases (n = 2). In 21 cases (14%) the exact cause of death could not be clarified. Differences in the causes of death only showed a tendency towards the ALS phenotype. Respiratory failure was the cause of death in all patients with a respiratory phenotype and in 78% of patients with flail arm syndrome. Despite the low number of patients (8%) with additional frontotemporal dementia (FTD) a distinct difference in causes of death between those with and without FTD could be observed. Death due to respiratory
Corrado, Domenico; Zorzi, Alessandro
Competitive sports activity is associated with an increased risk of sudden cardiovascular death (SCD) in adolescents and young adults with clinically silent cardiovascular disorders. While in middle-aged/senior athletes atherosclerotic coronary artery disease accounts for the vast majority of SCDs, in young athletes the spectrum of substrates is wider and includes inherited (cardiomyopathies) and congenital (anomalous origin of coronary arteries) structural heart diseases. Inherited ion channel diseases have been implicated in SCDs occurring with an apparently normal heart at autopsy. Screening including the ECG allows identification of athletes affected by heart muscle diseases at a pre-symptomatic stage and may lead to reduction of the risk of SCD during sports. The use of modern criteria for interpretation of the ECG in the athlete offers the potential to improve the screening accuracy by reducing the number of false positives. Screening with exercise testing middle aged/senior athletes engaged in leisure sports activity is likely to be effective in patients with significant coronary risk factors, while it is not useful in low-risk subgroups. The availability of automated external defibrillator on the athletic field provides a "back-up" preventive strategy for unpredictable arrhythmic cardiac arrest, mostly occurring in patients with coronary artery diseases. Copyright © 2017. Published by Elsevier B.V.
Wallner, Simon; Pichlmair, Martin; Hecher, Michael
Routinization is the result of practicing until an action stops being a goal-directed process. This paper formulates a definition of routinization in games based on prior research in the fields of activity theory and practice theory. Routinization is analyzed using the formal model of discrete......-time, discrete-space Markov chains and information theory to measure the actual error between the dynamically trained models and the player interaction. Preliminary research supports the hypothesis that Markov chains can be effectively used to model routinization in games. A full study design is presented...
... discharge, the borrower— (A) Has annual earnings from employment that exceed 100 percent of the poverty... of the poverty guideline for a family of two, as published annually by the United States Department... history assigned to the loan. (3) Borrower qualification for discharge. Except as provided in paragraph (d...
Trout, E.D.; Kelley, J.P.; Larson, V.L.; Herbert, G.L.
Public Law 91-173, often referred to as the Black Lung Law, called for a chest radiograph of all active coal miners at stated intervals. The National Institute for Occupational Safety and Health was responsible for carrying out the provisions of the law. Among other requirements was a provision for certification of radiological facilities where radiological examinations would be provide. A test object to be radiographed by each such facility was designed and sent to those facilities applying for certification. To date, 284 facilities have applied for certification of which 215 have been approved. A record has been kept of the number of times any approved facility submitted radiographs before approval. A complete listing of the types of equipment used, personnel qualifications and other pertinent data will be reported
This article discusses the certification of power generated from sewage gas in packaged co-generation units in Switzerland. Since 2003, such electricity can be sold as 'green power' to consumers, who pay an additional charge for this ecologically generated power. Since the eco-balance of this electricity generated in wastewater treatment plant is considered as being excellent, the prestigious 'Naturemade Star' label has been awarded to it. This label sets most stringent requirements. The Canius wastewater treatment plant in the 'Lenzerheide' in eastern Switzerland is taken as an example to illustrate the procedure that has to be gone through to receive certification. This certification is carried out by independent auditors and guarantees that the 'green' electricity offered by the utility meets the high ecological criteria set by the label
Frank G. A. Verheijen
Full Text Available Biochar has a relatively long half-life in soil and can fundamentally alter soil properties, processes, and ecosystem services. The prospect of global-scale biochar application to soils highlights the importance of a sophisticated and rigorous certification procedure. The objective of this work was to discuss the concept of integrating biochar properties with environmental and socioeconomic factors, in a sustainable biochar certification procedure that optimizes complementarity and compatibility between these factors over relevant time periods. Biochar effects and behavior should also be modelled at temporal scales similar to its expected functional lifetime in soils. Finally, when existing soil data are insufficient, soil sampling and analysis procedures need to be described as part of a biochar certification procedure.
Sloth, Christoffer; Pappas, George J.; Wisniewski, Rafael
This paper proposes a compositional method for verifying the safety of a dynamical system, given as an interconnection of subsystems. The safety verification is conducted by the use of the barrier certificate method; hence, the contribution of this paper is to show how to obtain compositional...... conditions for safety verification. We show how to formulate the verification problem, as a composition of coupled subproblems, each given for one subsystem. Furthermore, we show how to find the compositional barrier certificates via linear and sum of squares programming problems. The proposed method makes...... it possible to verify the safety of higher dimensional systems, than the method for centrally computed barrier certificates. This is demonstrated by verifying the safety of an emergency shutdown of a wind turbine....
Inada-Kim, Matthew; Page, Bethan; Maqsood, Imran; Vincent, Charles
To define the target population of patients who have suspicion of sepsis (SOS) and to provide a basis for assessing the burden of SOS, and the evaluation of sepsis guidelines and improvement programmes. Retrospective analysis of routinely collected hospital administrative data. Secondary care, eight National Health Service (NHS) Acute Trusts. Hospital Episode Statistics data for 2013-2014 was used to identify all admissions with a primary diagnosis listed in the 'suspicion of sepsis' (SOS) coding set. The SOS coding set consists of all bacterial infective diagnoses. We identified 47 475 admissions with SOS, equivalent to a rate of 17 admissions per 1000 adults in a given year. The mortality for this group was 7.2% during their acute hospital admission. Urinary tract infection was the most common diagnosis and lobar pneumonia was associated with the most deaths. A short list of 10 diagnoses can account for 85% of the deaths. Patients with SOS can be identified in routine administrative data. It is these patients who should be screened for sepsis and are the target of programmes to improve the detection and treatment of sepsis. The effectiveness of such programmes can be evaluated by examining the outcomes of patients with SOS. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Full Text Available Abstract Background Registration of the fact of death is almost complete in the city of Chennai and not so in the rural Villupuram district in Tamilnadu, India. The cause of death is often inadequately recorded on the death certificate in developing countries like India. A special verbal autopsy (VA study of 48 000 adult (aged ≥ 25 yrs deaths in the city of Chennai (urban during 1995–97 and 32 000 in rural Villupuram during 1997–98 was conducted to arrive at the probable underlying cause of death to estimate cause specific mortality. Methods A ten day training on writing verbal autopsy (VA report for adult deaths was given to non-medical graduates with at least 15 years of formal education. They interviewed surviving spouse/close associates of the deceased to write a verbal autopsy report in local language (Tamil on the complaints, symptoms, signs, duration and treatment details of illness prior to death. Each report was reviewed centrally by two physicians independently. Random re-interviewing of 5% of the VA reports was done to check the reliability and reproducibility of the VA report. The validity of VA diagnosis was assessed only for cancer deaths. Results Verbal autopsy reduced the proportion of deaths attributed to unspecified and unknown causes from 54% to 23% (p Conclusion A ten day training programme to write verbal autopsy report with adequate feed back sessions and random sampling of 5% of the verbal autopsy reports for re-interview worked very well in Tamilnadu, to arrive at the probable underlying cause of death reliably for deaths in early adult life or middle age (25–69 years and less reliably for older ages (70+. Thus VA is practicable for deaths in early adult life or middle age and is of more limited value in old age.
Fugelstad, Anna; Annell, Anders; Ågren, Gunnar
To study long-term mortality and causes of death in a cohort of drug users in relation to main type of drug use and HIV-status. A total of 1640 hospitalized drug users in Stockholm was followed up from 1985 to the end of 2007. The mortality was compared with the general Swedish population and hazard ratios (HR) for the main risk indicators were calculated. The causes of death were studied, using information from death certificates. 630 persons died during the observation period. The Standard Mortality Ratio (SMR) was 16.1 (males 13.8, females 18.5). The crude mortality rate was 2.0 % (males 2.2% and females 1.5%). The mortality rate was higher in heroin users than among amphetamine users, HR 1.96, controlled for age and other risk factors. The mortality rate among individuals infected with the human immunodeficiency virus (HIV) was high (4.9 %), HR 2.64, compared with HIV-negative individuals. Most of the deaths were from other causes than acquired immune deficiency syndrome. One-third of deaths (227) were caused by heroin intoxication. The number of deaths from HIV-related causes decreased after 1996, when highly active anti-retroviral therapy was introduced. In all, there were 92 HIV-related deaths. Deaths from natural causes increased during the observation period. The SMR was highest for cardiovascular and gastrointestinal diseases. The results indicate a correlation between amphetamine use and death from cerebral haemorrhage. A high proportion of natural deaths were alcohol-related. The death rate among illicit drug users was persistently high. Alcohol consumption was a contributing factor to premature death. © 2014 the Nordic Societies of Public Health.
... set cost of the product (one certificate). Certification fees may increase somewhat if the customer.... These governmental units include a variety of legally defined general- and special-purpose governmental...
... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 85-17A18] Export Trade Certificate of Review ACTION: Notice of Application to Amend the Export Trade Certificate of Review Issued to... to amend an Export [[Page 72325
..., DEPARTMENT OF THE TREASURY LIQUORS LABELING AND ADVERTISING OF DISTILLED SPIRITS Requirements for Approval of... certificates of label approval and certificates of exemption from label approval, as well as appeal procedures...
In this project, researchers developed a proposal to extend the delivery of the recently developed : Graduate Certificate in Transportation Planning at Texas A&M University (TAMU) to a wider audience via : distance education (online or eCertificate)....
Sturgeon, Catharine; Hill, Robert; Hortin, Glen L; Thompson, Douglas
There is increasing pressure to provide cost-effective healthcare based on “best practice.” Consequently, new biomarkers are only likely to be introduced into routine clinical biochemistry departments if they are supported by a strong evidence base and if the results will improve patient management and outcome. This requires convincing evidence of the benefits of introducing the new test, ideally reflected in fewer hospital admissions, fewer additional investigations and/or fewer clinic visits. Carefully designed audit and cost-benefit studies in relevant patient groups must demonstrate that introducing the biomarker delivers an improved and more effective clinical pathway. From the laboratory perspective, pre-analytical requirements must be thoroughly investigated at an early stage. Good stability of the biomarker in relevant physiological matrices is essential to avoid the need for special processing. Absence of specific timing requirements for sampling and knowledge of the effect of medications that might be used to treat the patients in whom the biomarker will be measured is also highly desirable. Analytically, automation is essential in modern high-throughput clinical laboratories. Assays must therefore be robust, fulfilling standard requirements for linearity on dilution, precision and reproducibility, both within- and between-run. Provision of measurements by a limited number of specialized reference laboratories may be most appropriate, especially when a new biomarker is first introduced into routine practice. PMID:21137030
This paper reports that 1991 was a year of great progress in the design certification process for ABB Combustion Engineering Nuclear Power's 1300 MWe evolutionary advanced light water reactor (ALWR) plant, System 80+. As the next generation of nuclear power plants move toward final design approval by the U.S. Nuclear Regulatory Commission (NRC), elements of the design process that emphasize operation and maintenance have become the focus. For System 80+, licensing under the new design certification process is now concentrated on operational support, human engineering, plant layout, and computer-aided engineering
Buschmann, Claas; Schmidbauer, Martina; Tsokos, Michael
Maternal deaths during pregnancy, both from pregnancy-related or other causes, are rare in Western industrialized countries. In this study we report maternal and pregnancy-related deaths in a large autopsy population focusing on medical history, autopsy findings and histological examinations. Medico-legal autopsy files (n = 11,270) from the Institute of Legal Medicine and Forensic Sciences, University Medical Centre Charité, University of Berlin, and the State Institute of Legal and Social Medicine, Berlin, from 2005 to 2010 were reviewed. All female cases between 15 and 49 years were checked for maternal and pregnancy-related death, and deaths of pregnant women from non-natural causes were also included. Fatalities that met the chosen criteria were classified as "direct gestational death," "indirect gestational death" or "non-gestational death." 13 female fatalities (0.12 %) met the chosen criteria (median age 28 years ± 6.87 SD). Eight (61.5 %) women died in-hospital, four (30.8 %) at home, and one woman died in public. Three cases (23.1 %) were "non-gestational deaths," and one case (7.7 %) remained unclear after autopsy and additional examinations. Of the remaining nine cases, six cases (46.5 %) were "direct gestational deaths," and two cases (15.4 %) were "indirect gestational deaths." One case (7.7 %) was not to be defined as "late maternal death," but the cause of death seemed to be directly related to previous gestation ["(very) late maternal death"]. Maternal deaths during pregnancy, both from pregnancy-related or other causes, remain an uncommon event in routine forensic autopsy practice. We report on the collection and analysis of maternal and pregnancy-related deaths in a large autopsy population, with particular attention to the phenomenology of pregnancy, pathophysiological changes in different organ systems and their detection, and the forensic autopsy assessment.
Full Text Available The preponderance of death imagery in the mass media and a recent interest of photography in the practice of death suggest the need to reevaluate our approach to death and dying, especially when violence is involved. This essay is a case study of History of Violence, Claudio Cravero's last photographic project. His collection of "portraits" reproduce apparent dead bodies, mostly attacked in their own domestic spheres, but neither the perpetrator of death (a mysterious murderer?, nor the weapon used (an omnipresent knife, should be considered as main focal points of the artist's inquiry. The undoubtful protagonist of these photographs, instead, is the light, that illuminates fear: not of death itself, rather of the obnoxious indifference to it, as the result of generalized death imagery saturation. The staged apparent death displayed in Cravero's photographs serve both as a memento mori and as a strategy to come to terms with the idea of death. In short, it is an apprentship in dying through a domesticating translation practice. Eventually, Cravero's History of Violence offers a complex reflection on the interplay between each individual story and macrolevel social History, thus providing some hypotheses of where violence and death fit in that odd geometry of time and space that we call life.
A nurse at the Center for Voluntary Pregnancy Interruption and Contraception in Angers, which receives 30 abortion requests each week, describes psychological aspects of nursing care for abortion patients. Abortion patients statistically are most likely to be married women around 27 years old with husbands aged 31 on average and with 2 children. Abortions are done under local anesthesia, so that there is no hiatus between the time "before" and that "after" the procedure. Women speak about their moral and physical suffering; their choice is respected by the staff. Despite the regret or mild depression that may follow an abortion, most women experience the greatest difficulty before the procedure and feel primarily relieved afterwards. Nursing work with abortion patients consists in being open to them and accompanying them for a few hours. The patients' comfort and postabortion morbidity depend largely on the reception and understanding they are given by the staff. After the procedure, the topic of contraception is discussed with the patient. Abortion and contraception cannot be dissociated because fertility regulation involves greater well-being for all members of the family. The abortion center is a place of life in which women and couples take responsibility for their sexuality and begin again. It is important not to impose beliefs or feelings about sexuality on the patient. A training which encouraged reflection on the grand problems of life and death as well as understanding of emotions, sentiments, and reactions would be helpful in gaining self knowledge and in living through events such as abortion. A meeting with a psychiatrist every 3 weeks is arranged for all staff members who desire it in order to maintain their emotional balance and work out troubling situations encountered at work. The work at the abortion center is 1 of listening and gaining the patient's confidence in order to dedramatize the abortion and permit the woman and the couple to elect an
... data, views, or arguments to the above listed address. Please identify ``SOP: AIR-100-001 Standard... Certification Offices (ACOs). The certification programs include: Type certificate (TC), Amended Type Certificate (ATC), Supplemental Type Certificated ATC), Amended Supplemental Type Certificate (ASTC), and...
Cheng, Pi-Yueh; Hsu, Ping-Kun; Chiou, Wen-Bin
Previous research on professional certification has primarily focused on graduate certificates in intensive care nursing, writing certificates for practitioners, maintenance of certification in radiation oncology, and the certification of teachers and surgeons. Research on certification in the domain of business and management from an…
@@ Why does China establish a new Compulso-ry Product Certification System? For a long time, our compulsory product certification system has had problems such as lack of a unified management department, repeated assessments,repeated charging and no separation between certification activities and behaviors of law enforcement.The most obvious problem is that two certification management systems exist respectively for domestic products and imported products.
Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François
We hypothesized that a routine one-stage exchange for treatment of chronically infected total hip replacement (THR) will lead to (1) a higher rate of infection recurrence and (2) a poorer hip outcome than the published rates after two-stage exchange. Sixty-five cases have been treated consecutively with one-stage exchange. All patients have been followed for a period of three to six years or until death or infection recurrence. The five-year rate for infection recurrence was 16%. The five-year survival rate for recurrence of the index infection was 8%. Forty-two percent of the hips had a good or excellent PMA score, and 46% a good or excellent OH score. Routine one-stage exchange was not associated with a higher recurrence rate and a poorer hip function than previously published series of two-stage exchange. Therefore, there is little support to choose two-stage exchange as the routine treatment for management of chronically infected THR.
Christiansen, Dorte M.; Elklit, Ask; Olff, Miranda
stress disorder (PTSD) symptoms and potential correlates in 634 mothers and fathers up to 18 years (M=3.4 years) after the death of their infant. Members of a private national support organization for parents bereaved by infant death were contacted and asked to participate in the study. Participants...
Gamino, Louis A.; Ritter, R. Hal, Jr.
The authors argued that death competence, defined as specialized skill in tolerating and managing clients' problems related to dying, death, and bereavement, is a necessary prerequisite for ethical practice in grief counseling. A selected review of the literature tracing the underpinnings of this concept reveals how a robust construct of death…
Park, C. H.; Bai, M. S.; Cho, K. K.; Kim, S. J.; Yoon, S. N.; Cho, C. W.
A law recognizing brain death is a life saving legal measure in patients suffering from badly diseased organs such as kidney, liver, heart, and lung. Such law is being discussed for legalization at the Korean National Assembly. There are various criteria used for brain death in western world and brain scintiscan is one of them. However, the scintiscan is not considered in establishing brain death in the draft of the law. The purpose of this report is to spread this technique in nuclear medicine society as well as in other medical societies. We evaluated 7 patients with clinical suspicion of brain death by various causes. The patient's age ranged from 5 to 39 years. We used 5-20mCi 99m Tc-HMPAO (d.1-hexamethyl propylene amine oxime) or ECD (Ethyl Cysteinate Dimer), lipophilic agents that cross BBB (blood brain barrier). A dynamic study followed by static or SPECT (single photon emission tomography) was performed. Interpretive criteria used for brain death were 1) no intracranial circulation 2) no brain uptake. The second criteria is heavily used. Five of 7 patients were scintigraphically brain dead and the remaining 2 had some brain uptake excluding the diagnosis of scintigraphic brain death. In conclusion, cerebral perfusion study using a lipophilic brain tracer offers a noninvasive, rapid, easy, accurate and reliable mean in the diagnosis of brain death. We believe that this modality should be included in the criteria of brain death in the draft of the proposed Korean law