Medical certification of death in South Africa--moving forward.

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Burger, E H; Groenewald, P; Rossouw, A; Bradshaw, D

2015-01-01

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.

Death certificate data and causes of death in patients with parkinsonism.

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Moscovich, Mariana; Boschetti, Gabriela; Moro, Adriana; Teive, Helio A G; Hassan, Anhar; Munhoz, Renato P

2017-08-01

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.

JNIH-ABCC Life Span Study, Hiroshima 1950-59. Multiple causes of death stated in medical certificates

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Ishida, Morihiro; Jablon, S

1962-08-22

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.

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring

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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

2013-01-01

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

[More than a decade improving medical and judicial certification in mortality statistics of death causes].

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Cirera, Lluís; Salmerón, Diego; Martínez, Consuelo; Bañón, Rafael María; Navarro, Carmen

2018-06-06

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.

Issues using linkage of hospital records and death certificate data to determine the size of a potential palliative care population.

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Brameld, Kate; Spilsbury, Katrina; Rosenwax, Lorna; Murray, Kevin; Semmens, James

2017-06-01

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.

Accidental drug deaths in Fulton County, Georgia, 2002: characteristics, case management and certification issues.

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Graham, Jason K; Hanzlick, Randy

2008-09-01

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

Objective structured clinical examination "Death Certificate" station - Computer-based versus conventional exam format.

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Biolik, A; Heide, S; Lessig, R; Hachmann, V; Stoevesandt, D; Kellner, J; Jäschke, C; Watzke, S

2018-04-01

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

Combining diagnostic categories to improve agreement between death certificate and autopsy classifications of cause of death for atomic bomb survivors, 1950-87

International Nuclear Information System (INIS)

Carter, R.L.; Ron, E.; Mabuchi, Kiyohiko.

1993-05-01

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.)

Occupational risk factors for brain tumors. A case-referent death-certificate analysis

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Thomas, T.L.; Fontham, E.T.; Norman, S.A.; Stemhagen, A.; Hoover, R.N.

1986-04-01

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.

Mortality incidence estimation using federal death certificate and natality data with an application to Tay-Sachs disease.

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Jalal, Kabir; Carter, Randy L

2015-09-01

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.

Nosological Inaccuracies in death certification in Northern Ireland. A comparative study between hospital doctors and general practitioners.

OpenAIRE

Armour, A.; Bharucha, H.

1997-01-01

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...

We could learn much more from 1918 pandemic-the (mis)fortune of research relying on original death certificates.

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Alonso, Wladimir J; Nascimento, Francielle C; Chowell, Gerardo; Schuck-Paim, Cynthia

2018-05-01

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.

5 CFR 880.205 - Determinations of death.

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2010-01-01

... 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...

Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data.

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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

2018-01-25

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.

'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.

Science.gov (United States)

Harris, Andrew

2017-07-01

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.

Validation of 1989 Tennessee birth certificates using maternal and newborn hospital records.

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Piper, J M; Mitchel, E F; Snowden, M; Hall, C; Adams, M; Taylor, P

1993-04-01

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.

Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes

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Deliens Luc

2011-04-01

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.

Distinct mortality profile in systemic sclerosis: a death certificate study in Rio de Janeiro, Brazil (2006-2015) using a multiple causes of death analysis.

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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

2017-12-16

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.

Trends in bipolar disorder or depression as a cause of death on death certificates of US residents, 1999-2009.

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Polednak, Anthony P

2013-07-01

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.

Quantifying cause-related mortality by weighting multiple causes of death

Science.gov (United States)

Moreno-Betancur, Margarita; Lamarche-Vadel, Agathe; Rey, Grégoire

2016-01-01

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

Leading causes of death among decedents with mention of schizophrenia on the death certificates in the United States.

Science.gov (United States)

Lin, Jin-Jia; Liang, Fu-Weng; Li, Chung-Yi; Lu, Tsung-Hsueh

2018-01-30

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.

Esophageal cancer among Brazilian agricultural workers: case-control study based on death certificates.

Science.gov (United States)

Meyer, Armando; Alexandre, Pedro Celso Braga; Chrisman, Juliana de Rezende; Markowitz, Steven B; Koifman, Rosalina Jorge; Koifman, Sergio

2011-03-01

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.

Discrepant comorbidity between minority and white suicides: a national multiple cause-of-death analysis

Directory of Open Access Journals (Sweden)

Stack Steven

2009-03-01

. 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.

Physicians' knowledge and practice on death certification in the North West Bank, Palestine: across sectional study.

Science.gov (United States)

Qaddumi, Jamal A S; Nazzal, Zaher; Yacoub, Allam; Mansour, Mahmoud

2018-01-08

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.

32 CFR 716.7 - Payment of the death gratuity.

Science.gov (United States)

2010-07-01

... 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...

28 CFR 26.23 - Certification process.

Science.gov (United States)

2010-07-01

... 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...

Certified causes of death in patients with mesothelioma in South East England

Directory of Open Access Journals (Sweden)

Peto Julian

2009-01-01

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%.

The Danish registers of causes of death

DEFF Research Database (Denmark)

Juel, K; Helweg-Larsen, K

1999-01-01

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...

Reliability of cause of death coding: an international comparison.

Science.gov (United States)

Antini, Carmen; Rajs, Danuta; Muñoz-Quezada, María Teresa; Mondaca, Boris Andrés Lucero; Heiss, Gerardo

2015-07-01

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.

Correcting the Count: Improving Vital Statistics Data Regarding Deaths Related to Obesity.

Science.gov (United States)

McCleskey, Brandi C; Davis, Gregory G; Dye, Daniel W

2017-11-15

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.

Impact of documentation errors on accuracy of cause of death coding in an educational hospital in Southern Iran.

Science.gov (United States)

Haghighi, Mohammad Hosein Hayavi; Dehghani, Mohammad; Teshnizi, Saeid Hoseini; Mahmoodi, Hamid

2014-01-01

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.

Maternal deaths in Denmark 2002-2006

DEFF Research Database (Denmark)

Bødker, Birgit; Hvidman, Lone; Weber, Tom

2009-01-01

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...

Social representations of obstetricians and neonatologists about fetal and early neonatal death certificate in the city of São Paulo.

Science.gov (United States)

Schoeps, Daniela; Lefevre, Fernando; Silva, Zilda Pereira; Novaes, Hillegonda Maria Dutilh; Raspantini, Priscila Ribeiro; de Almeida, Márcia Furquim

2014-01-01

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.

[Cause-of-death statistics and ICD, quo vadis?

Science.gov (United States)

Eckert, Olaf; Vogel, Ulrich

2018-07-01

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.

[Prevalence of Down syndrome using certificates of live births and fetal deaths in México 2008-2011].

Science.gov (United States)

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.

Incidence and other epidemiological characteristics of sudden cardiac death in northwest Greece.

Science.gov (United States)

Goudevenos, J A; Papadimitriou, E D; Papathanasiou, A; Makis, A C; Pappas, K; Sideris, D A

1995-03-24

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)

Review of errors in the issue of medical certificates of cause of death ...

African Journals Online (AJOL)

... 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.

Volatile substance misuse deaths in Washington State, 2003-2012.

Science.gov (United States)

Ossiander, Eric M

2015-01-01

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.

Disrupted day-night pattern of cardiovascular death in obstructive sleep apnea.

Science.gov (United States)

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

2017-10-01

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.

Causes of deaths data, linkages and big data perspectives.

Science.gov (United States)

Rey, Grégoire; Bounebache, Karim; Rondet, Claire

2018-07-01

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

A computer case definition for sudden cardiac death.

Science.gov (United States)

Chung, Cecilia P; Murray, Katherine T; Stein, C Michael; Hall, Kathi; Ray, Wayne A

2010-06-01

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.

Sudden Cardiac Death

DEFF Research Database (Denmark)

Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza

2017-01-01

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...

Absence from work and the medical sickness certificate.

Science.gov (United States)

Massoni, F; Salesi, M; Sarra, M V; Ricci, S

2013-03-01

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.

Analysis on the training effect of criteria and practical guidance for determination of brain death: evoked potentials

Directory of Open Access Journals (Sweden)

Yan ZHANG

2015-12-01

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

[Coding Causes of Death with IRIS Software. Impact in Navarre Mortality Statistic].

Science.gov (United States)

Floristán Floristán, Yugo; Delfrade Osinaga, Josu; Carrillo Prieto, Jesus; Aguirre Perez, Jesus; Moreno-Iribas, Conchi

2016-08-02

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.

Burden of sudden cardiac death in persons aged 1 to 49 years

DEFF Research Database (Denmark)

Risgaard, Bjarke; Winkel, Bo Gregers; Jabbari, Reza

2014-01-01

: 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...

Strangulation and Its Role in Multiple Causes of Death.

Science.gov (United States)

Hlavaty, Leigh; Sung, LokMan

2017-12-01

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%).

Does exclusion of cancers registered only from death-certificate information diminish socio-demographic disparities in recorded survival?

Science.gov (United States)

Tervonen, Hanna E; Roder, David; Morrell, Stephen; You, Hui; Currow, David C

2017-06-01

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.

Sudden unexpected death in infancy in Denmark

DEFF Research Database (Denmark)

Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane

2011-01-01

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...

Mortality and cause-of-death reporting and analysis systems in seven pacific island countries

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Carter Karen L

2012-06-01

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.

[Causes of death of German refugee children in 1945].

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Lylloff, K

2000-02-28

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.

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

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Irajá Carneiro Heckmann

1989-08-01

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.

Development and Validation of a National System for Routine Monitoring of Mortality in People Recently Released from Prison.

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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.

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

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Augusto Hasiak Santo

2007-09-01

. 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.

The anticipation of death by violence: a psychological profile.

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Mahoney, J; Kyle, D; Katz, G

1975-01-01

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.

Automatic coding and selection of causes of death: an adaptation of Iris software for using in Brazil.

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Martins, Renata Cristófani; Buchalla, Cassia Maria

2015-01-01

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.

Socioeconomic factors affecting infant sleep-related deaths in St. Louis.

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Hogan, Cathy

2014-01-01

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.

Causes of Death Data in the Global Burden of Disease Estimates for Ischemic and Hemorrhagic Stroke.

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Truelsen, Thomas; Krarup, Lars-Henrik; Iversen, Helle K; Mensah, George A; Feigin, Valery L; Sposato, Luciano A; Naghavi, Mohsen

2015-01-01

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.

Lupus - An Unrecognized Leading Cause of Death in Young Women: Population-based Study Using Nationwide Death Certificates, 2000-2015.

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Yen, Eric Y; Singh, Ram R

2018-04-18

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.

Measuring chronic liver disease mortality using an expanded cause of death definition and medical records in Connecticut, 2004.

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Ly, Kathleen N; Speers, Suzanne; Klevens, R Monina; Barry, Vaughn; Vogt, Tara M

2014-10-16

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.

Misoprostol use under routine conditions for termination of pregnancies with intrauterine fetal death

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Maria Isabel do Nascimento

2013-08-01

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.

Sudden cardiac death in children (1-18 years)

DEFF Research Database (Denmark)

Winkel, Bo Gregers; Risgaard, Bjarke; Sadjadieh, Golnaz

2014-01-01

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...

Scientific worker and licensed professional deaths in Alaska, 1990-2002

OpenAIRE

Conway, George A.; Moran, Katherine A.; Mode, Nicolle A.

2004-01-01

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 ...

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

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Luciana Tolstenko Nogueira

2009-02-01

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

Obesity-related mortality in France, Italy, and the United States: a comparison using multiple cause-of-death analysis.

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Barbieri, Magali; Désesquelles, Aline; Egidi, Viviana; Demuru, Elena; Frova, Luisa; Meslé, France; Pappagallo, Marilena

2017-07-01

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.

Potential misclassification of causes of death from COPD

DEFF Research Database (Denmark)

Jensen, Henriette Hvide; Godtfredsen, Nina Skavlan; Lange, Peter

2006-01-01

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...

Causes of death among cancer patients.

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Zaorsky, N G; Churilla, T M; Egleston, B L; Fisher, S G; Ridge, J A; Horwitz, E M; Meyer, J E

2017-02-01

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: journals.permissions@oup.com.

Post-mortem toxicology in young sudden cardiac death victims

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Bjune, Thea; Risgaard, Bjarke; Kruckow, Line

2017-01-01

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...

Febrile seizures prior to sudden cardiac death

DEFF Research Database (Denmark)

Stampe, Niels Kjær; Glinge, Charlotte; Jabbari, Reza

2018-01-01

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...

Child Maltreatment Fatalities in Children under 5: Findings from the National Violence Death Reporting System

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Klevens, Joanne; Leeb, Rebecca T.

2010-01-01

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…

Documenting death: public access to government death records and attendant privacy concerns.

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Boles, Jeffrey R

2012-01-01

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.

Potential misclassification of causes of death from COPD

DEFF Research Database (Denmark)

Jensen, Henriette Hvide; Godtfredsen, Nina Skavlan; Lange, Peter

2006-01-01

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...

Deaths: Leading Causes for 2012.

Science.gov (United States)

Heron, Melonie

2015-08-31

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.

Factors related to the involvement of nurses in medical end-of-life decisions in Belgium: a death certificate study.

Science.gov (United States)

Inghelbrecht, Els; Bilsen, Johan; Mortier, Freddy; Deliens, Luc

2008-07-01

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.

Effect of oil palm sustainability certification on deforestation and fire in Indonesia.

Science.gov (United States)

Carlson, Kimberly M; Heilmayr, Robert; Gibbs, Holly K; Noojipady, Praveen; Burns, David N; Morton, Douglas C; Walker, Nathalie F; Paoli, Gary D; Kremen, Claire

2018-01-02

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.

Effect of oil palm sustainability certification on deforestation and fire in Indonesia

Science.gov (United States)

Gibbs, Holly K.; Noojipady, Praveen; Burns, David N.; Morton, Douglas C.; Walker, Nathalie F.; Paoli, Gary D.; Kremen, Claire

2018-01-01

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

Using poison center exposure calls to predict methadone poisoning deaths.

Directory of Open Access Journals (Sweden)

Nabarun Dasgupta

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.

A 20 year retrospective analysis of medicolegal deaths in a tertiary ...

African Journals Online (AJOL)

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.

Personnel training and certification

International Nuclear Information System (INIS)

Whittemore, W.L.

1976-01-01

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

Cannabis, possible cardiac deaths and the coroner in Ireland.

LENUS (Irish Health Repository)

Tormey, W P

2012-01-10

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.

Cannabis, possible cardiac deaths and the coroner in Ireland.

Science.gov (United States)

Tormey, W P

2012-12-01

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.

A population-based case-control study of mesothelioma deaths among U.S. railroad workers.

Science.gov (United States)

Schenker, M B; Garshick, E; Muñoz, A; Woskie, S R; Speizer, F E

1986-09-01

We have completed a case-control analysis of mesothelioma deaths among current and retired U.S. railroad employees. Cause-specific death certificates were obtained for 87% of 15,059 deaths reported by the railroad retirement board, and 20 mesotheliomas were identified according to death certificate diagnosis. A 10:1 matched analysis with railroad workers dying of nonmalignant, nonaccidental causes yielded a very strong association with prior railroad work in jobs with potential asbestos exposure (odds ratio = 7.2, 95% lower confidence limit = 3.3). Consideration of railroad occupations with regular asbestos exposures (e.g., skilled trades, steam locomotive repair) yielded an odds ratio of 21.4 (95% lower confidence limit = 8.7), but the occupations with potential intermittent exposure (e.g., engineers, firemen, carmen) yielded a nonsignificant odds ratio of 2.3 (95% lower confidence limit = 0.5). Applying mesothelioma mortality rates from this study to the population of U.S. railroad workers at risk yields an estimate of 416 cases of mesothelioma occurring among U.S. railroad workers between 1981 and 2000.

Perinatal death audits in a peri-urban hospital in Kampala, Uganda ...

African Journals Online (AJOL)

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 ...

Deaths: Leading Causes for 2011.

Science.gov (United States)

Heron, Melonie

2015-07-27

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

Deaths: Leading Causes for 2015.

Science.gov (United States)

Heron, Melonie

2017-11-01

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

Deaths: Leading Causes for 2013.

Science.gov (United States)

Heron, Melonie

2016-02-16

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

Drug induced mortality: a multiple cause approach on Italian causes of death Register

Directory of Open Access Journals (Sweden)

Francesco Grippo

2015-04-01

Full Text Available Background: Drug-related mortality is a complex phenomenon that has several health, social and economic effects. In this paper trends of drug-induced mortality in Italy are analysed. Two approaches have been followed: the traditional analysis of the underlying cause of death (UC (data refers to the Istat mortality database from 1980 to 2011, and the multiple cause (MCanalysis, that is the analysis of all conditions reported on the death certificate (data for 2003-2011 period.Methods: Data presented in this paper are based on the Italian mortality register. The selection of Icd codes used for the analysis follows the definition of the European Monitoring Centre for Drugs and Drug Addiction. Using different indicators (crude and standardized rates, ratio multiple to underlying, the results obtained from the two approaches (UC and MC have been compared. Moreover, as a measure of association between drug-related causes and specific conditions on the death certificate, an estimation of the age-standardized relative risk (RR has been used.Results: In the years 2009-2011, the total number of certificates whit mention of drug use was 1,293, 60% higher than the number UC based. The groups of conditions more strongly associated with drug-related causes are the mental and behavioral disorders (especially alcohol consumption, viral hepatitis, cirrhosis and fibrosis of liver, AIDS and endocarditis.Conclusions : The analysis based on multiple cause approach shows, for the first time, a more detailed picture of the drug related death; it allows to better describe the mortality profiles and to re-evaluate  the contribution of a specific cause to death.

Routine Responses to Disruption of Routines

Science.gov (United States)

Guha, Mahua

2015-01-01

"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…

Deaths: leading causes for 2010.

Science.gov (United States)

Heron, Melonie

2013-12-20

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

Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study.

Science.gov (United States)

Varvarigou, Vasileia; Farioli, Andrea; Korre, Maria; Sato, Sho; Dahabreh, Issa J; Kales, Stefanos N

2014-11-18

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.

Impact of a hospital-level intervention to reduce heart disease overreporting on leading causes of death.

Science.gov (United States)

Al-Samarrai, Teeb; Madsen, Ann; Zimmerman, Regina; Maduro, Gil; Li, Wenhui; Greene, Carolyn; Begier, Elizabeth

2013-05-16

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.

Mortalidade feminina na região Sul do Município de São Paulo: qualidade da certificação médica dos óbitos Maternal mortality in Brazil: quality of medical certification of deaths

Directory of Open Access Journals (Sweden)

Arnaldo Augusto Franco de Siqueira

1999-10-01

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

Childhood death rates declined in Sweden from 2000 to 2014 but deaths from external causes were not always investigated.

Science.gov (United States)

Otterman, Gabriel; Lahne, Klara; Arkema, Elizabeth V; Lucas, Steven; Janson, Staffan; Hellström-Westas, Lena

2018-03-08

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.

Nationwide study of sudden cardiac death in persons aged 1-35 years

DEFF Research Database (Denmark)

Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane

2011-01-01

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...

Comparison of cardiovascular mortality in the Great East Japan and the Great Hanshin-Awaji Earthquakes　- a large-scale data analysis of death certificates.

Science.gov (United States)

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

2015-01-01

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.

Study of recent and future trends in place of death in Belgium using death certificate data: a shift from hospitals to care homes

NARCIS (Netherlands)

Houttekier, D.; Cohen, J.; Surkyn, J.; Deliens, L.

2011-01-01

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

40 CFR 745.90 - Renovator certification and dust sampling technician certification.

Science.gov (United States)

2010-07-01

... 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...

Teen Suicide and Changing Cause-of-Death Certification, 1953-1987.

Science.gov (United States)

Males, Mike

1991-01-01

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…

Climate certificates

International Nuclear Information System (INIS)

1998-10-01

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

Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants.

Directory of Open Access Journals (Sweden)

Amos Grünebaum

Full Text Available Over the last decade, planned home births in the United States (US have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status.The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States.This study is a secondary analysis of our prior study. The 2006-2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM, nurse midwives certified by the American Midwifery Certification Board, and "other" or uncertified midwives who are not certified by the American Midwifery Certification Board.Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21-0.53 than home births attended by certified midwives (NNM: 10.0/10,000; RR 1 and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83-2.38]. The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2.This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives, this difference was not statistically significant. Neonatal

Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants.

Science.gov (United States)

Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Brent, Robert L; Levene, Malcolm I; Chervenak, Frank A

2016-01-01

Over the last decade, planned home births in the United States (US) have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status. The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States. This study is a secondary analysis of our prior study. The 2006-2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life) in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams) without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM), nurse midwives certified by the American Midwifery Certification Board, and "other" or uncertified midwives who are not certified by the American Midwifery Certification Board. Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21-0.53) than home births attended by certified midwives (NNM: 10.0/10,000; RR 1) and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83-2.38]). The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2). This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives, this difference was not statistically significant. Neonatal mortality rates

Transfer of residents to hospital prior to cardiac death: the influence of nursing home quality and ownership type.

Science.gov (United States)

Anic, Gabriella M; Pathak, Elizabeth Barnett; Tanner, Jean Paul; Casper, Michele L; Branch, Laurence G

2014-01-01

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.

No certificate, no chocolate

CERN Multimedia

Computer Security Team

2013-01-01

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...

Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial.

Science.gov (United States)

Rowley, M J; Hensley, M J; Brinsmead, M W; Wlodarczyk, J H

1995-09-18

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.

Improving hospital death certification in Viet Nam: results of a pilot study implementing an adapted WHO hospital death report form in two national hospitals.

Science.gov (United States)

Walton, Merrilyn; Harrison, Reema; Chevalier, Anna; Esguerra, Esmond; Van Duong, Dang; Chinh, Nguyen Duc; Giang, Huong

2016-01-01

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.

Óbitos em instituição asilar Deaths in nursing homes

Directory of Open Access Journals (Sweden)

Milton Luiz Gorzoni

2011-06-01

Full Text Available OBJETIVO: Definir as causas de morte em população internada em instituição de longa permanência para idosos (ILPI MÉTODOS: ILPI de 508 leitos com prontuários padronizados, reuniões periódicas sobre atestados de óbitos e com 12 médicos responsáveis pela supervisão e/ou emissão deles. Considerou-se o padrão deste procedimento suficientemente uniforme para análise dos prontuários e atestados de óbitos emitidos durante o ano de 2006, visando definir dados gerais (sexo e idade, causa da morte e causa(s básica(s. Análise estatística comparou casuísticas entre os dois sexos e faixas etárias ( 75 anos de idade. RESULTADOS: Ocorreram 118 óbitos durante o ano de 2006 (idade média: 74,5 ± 15,2 anos - 64 mulheres (idade média: 78,4 ± 14,4 anos e 54 homens (idade média: 69,8 ± 15,0 anos -, sendo as causas de morte: sepse( 41 óbitos, choque séptico (25, broncopneumonia (16, morte súbita (11, falência de múltiplos órgãos (9, outras causas (16 óbitos. As principais causas básicas foram infecciosas (63 óbitos - broncopneumonia (34, sepse (12, infecção urinária (7, úlceras de pressão infectadas (7, osteomielite (2 e colangite (1; seguidas da síndrome da imobilidade (42 óbitos. Observou-se significância estatística para a proporção de idosas > 75 anos e não houve para sazonalidade, causa de morte ou básica considerando-se infecciosas e não infecciosas versus homens e mulheres, maiores ou menores de 75 anos de idade. CONCLUSÃO: Óbitos em ILPI decorrem basicamente da somatória de imobilidade e infecções que evoluem para quadros sépticos.OBJECTIVE: To define the causes of death in a nursing home population. METHODS: The study selected a 508-bed nursing home with standard medical records, regular meetings concerning death certificates and 12 medical doctors in charge of supervising or issuing death certificates. The procedure standard (2006 death certificates was considered consistent enough to undergo the

Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark

DEFF Research Database (Denmark)

Gullach, Anders Juul; Risgaard, Bjarke; Lynge, Thomas Hadberg

2015-01-01

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...

Deaths related to lead poisoning in the United States, 1979-1998

International Nuclear Information System (INIS)

Kaufmann, R.B.; Staes, Catherine J.; Matte, Thomas D.

2003-01-01

This study was conducted to describe trends in US lead poisoning-relate deaths between 1979 and 1998. The predictive value of relevant ICD-9 codes was also evaluated. Multiple cause-of-death files were searched for record containing relevant ICD-9 codes, and underlying causes and demographic characteristics were assessed. For 1979-1988, death certificates were reviewed; lead source information was abstracted and accuracy of coding was determined. An estimated 200 lead poisoning-related deaths occurred from 1979 to 1998. Most were among males (74%), Blacks (67%), adults of age ≥45 years (76%), and Southerners (70%). The death rate was significantly lower in more recent years. An alcohol-related code was a contributing cause for 28% of adults. Only three of nine ICD-9 codes for lead poisoning were highl predictive of lead poisoning-related deaths. In conclusion, lead poisoning-related death rates have dropped dramatically since earlier decades and are continuing to decline. However, the findings imply that moonshine ingestion remains a source of high-dose lead exposure in adults

Cardiac symptoms before sudden cardiac death caused by hypertrophic cardiomyopathy

DEFF Research Database (Denmark)

Lynge, Thomas Hadberg; Risgaard, Bjarke; Jabbari, Reza

2016-01-01

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...

The place of death of patients with cancer in Kuwait.

Science.gov (United States)

Alshemmari, Salem H; Elbasmi, Amani A; Alsirafy, Samy A

2015-12-01

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/

Dengue Deaths in Puerto Rico: Lessons Learned from the 2007 Epidemic

Science.gov (United States)

Tomashek, Kay M.; Gregory, Christopher J.; Rivera Sánchez, Aidsa; Bartek, Matthew A.; Garcia Rivera, Enid J.; Hunsperger, Elizabeth; Muñoz-Jordán, Jorge L.; Sun, Wellington

2012-01-01

Background The incidence and severity of dengue in Latin America has increased substantially in recent decades and data from Puerto Rico suggests an increase in severe cases. Successful clinical management of severe dengue requires early recognition and supportive care. Methods Fatal cases were identified among suspected dengue cases reported to two disease surveillance systems and from death certificates. To be included, fatal cases had to have specimen submitted for dengue diagnostic testing including nucleic acid amplification for dengue virus (DENV) in serum or tissue, immunohistochemical testing of tissue, and immunoassay detection of anti-DENV IgM from serum. Medical records from laboratory-positive dengue fatal case-patients were reviewed to identify possible determinants for death. Results Among 10,576 reported dengue cases, 40 suspect fatal cases were identified, of which 11 were laboratory-positive, 14 were laboratory-negative, and 15 laboratory-indeterminate. The median age of laboratory-positive case-patients was 26 years (range 5 months to 78 years), including five children aged Dengue was listed on the death certificate in only 5 instances. Conclusions During a dengue epidemic in an endemic area, none of the 11 laboratory-positive case-patients who died were managed according to current WHO Guidelines. Management issues identified in this case-series included failure to recognize warning signs for severe dengue and shock, prolonged ED stays, and infrequent patient monitoring. PMID:22530072

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

Directory of Open Access Journals (Sweden)

Rafael Abós

2006-12-01

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

Professional Certification

Science.gov (United States)

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.

Causes of death in Vanuatu.

Science.gov (United States)

Carter, Karen; Tovu, Viran; Langati, Jeffrey Tila; Buttsworth, Michael; Dingley, Lester; Calo, Andy; Harrison, Griffith; Rao, Chalapati; Lopez, Alan D; Taylor, Richard

2016-01-01

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

Gender differences in sudden cardiac death in the young-a nationwide study

DEFF Research Database (Denmark)

Winkel, Bo Gregers; Risgaard, Bjarke; Bjune, Thea

2017-01-01

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...

Dying in Hospital with Dementia and Pneumonia: A Nationwide Study Using Death Certificate Data

NARCIS (Netherlands)

Houttekier, D.; Reyniers, T.; Deliens, L.; Den Noortgate, N.; Cohen, J.

2014-01-01

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

Description of deaths on Easter Island, 2000-2012 period.

Science.gov (United States)

Bravo, Eduardo Francisco; Saint-Pierre, Gustavo Enrique; Yaikin, Pabla Javiera; Meier, Martina Jose

2014-01-01

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.

One Decade of Unnatural Deaths in Yazd Province: 2003-2013

Directory of Open Access Journals (Sweden)

mohamad hassan lotfi

2016-02-01

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.

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

Directory of Open Access Journals (Sweden)

Marcia Furquim de Almeida

2011-10-01

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.

Physical activity assessed in routine care predicts mortality after a COPD hospitalisation

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Marilyn L. Moy

2016-03-01

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.

Study of deaths by suicide of homosexual prisoners in Nazi Sachsenhausen concentration camp.

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Cuerda-Galindo, Esther; López-Muñoz, Francisco; Krischel, Matthis; Ley, Astrid

2017-01-01

Living conditions in Nazi concentration camps were harsh and inhumane, leading many prisoners to commit suicide. Sachsenhausen (Oranienburg, Germany) was a concentration camp that operated from 1936 to 1945. More than 200,000 people were detained there under Nazi rule. This study analyzes deaths classified as suicides by inmates in this camp, classified as homosexuals, both according to the surviving Nazi files. This collective was especially repressed by the Nazi authorities. Data was collected from the archives of Sachsenhausen Memorial and the International Tracing Service in Bad Arolsen. Original death certificates and autopsy reports were reviewed. Until the end of World War II, there are 14 death certificates which state "suicide" as cause of death of prisoners classified as homosexuals, all of them men aged between 23 and 59 years and of various religions and social strata. Based on a population of 1,200 prisoners classified as homosexuals, this allows us to calculate a suicide rate of 1,167/100,000 (over the period of eight years) for this population, a rate 10 times higher than for global inmates (111/100,000). However, our study has several limitations: not all suicides are registered; some murders were covered-up as suicides; most documents were lost during the war or destroyed by the Nazis when leaving the camps and not much data is available from other camps to compare. We conclude that committing suicides in Sachsenhausen was a common practice, although accurate data may be impossible to obtain.

Measuring death-related anxiety in advanced cancer: preliminary psychometrics of the Death and Dying Distress Scale.

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Lo, Christopher; Hales, Sarah; Zimmermann, Camilla; Gagliese, Lucia; Rydall, Anne; Rodin, Gary

2011-10-01

The alleviation of distress associated with death and dying is a central goal of palliative care, despite the lack of routine measurement of this outcome. In this study, we introduce the Death and Dying Distress Scale (DADDS), a new, brief measure we have developed to assess death-related anxiety in advanced cancer and other palliative populations. We describe its preliminary psychometrics based on a sample of 33 patients with advanced or metastatic cancer. The DADDS broadly captures distress about the loss of time and opportunity, the process of death and dying, and its impact on others. The initial version of the scale has a one-factor structure and good internal reliability. Dying and death-related distress was positively associated with depression and negatively associated with spiritual, emotional, physical, and functional well-being, providing early evidence of construct validity. This distress was relatively common, with 45% of the sample scoring in the upper reaches of the scale, suggesting that the DADDS may be a relevant outcome for palliative intervention. We conclude by presenting a revised 15-item version of the scale for further study in advanced cancer and other palliative populations.

Deconstructing Teacher Certification

Science.gov (United States)

Baines, Lawrence A.

2006-01-01

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…

Surveillance for Violent Deaths - National Violent Death Reporting System, 17 States, 2013.

Science.gov (United States)

Lyons, Bridget H; Fowler, Katherine A; Jack, Shane P D; Betz, Carter J; Blair, Janet M

2016-08-19

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

A análise da mortalidade por causa básica e por causas múltiplas Analysis of mortality by underlying and multiple causes of death

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Ruy Laurenti

1974-12-01

Full Text Available Foram comentados alguns aspectos das estatísticas de mortalidade por causas básicas e por causas múltiplas. Utilizando uma amostra de óbitos ocorridos em hospitais e obtendo informações adicionais através dos prontuários médicos, foram refeitos os atestados comparando-os com os originais. Foi verificado que a causa básica está declarada incorretamente em 37,7% dos casos e que existem discordâncias que se compensam. O número médio de diagnósticos por atestados de óbito foi de 1,9, elevando-se para 2,9 quando se dispõem de informações adicionais. O número médio de diagnósticos adicionais que acompanhou a causa básica aumentou quanto mais longa foi a evolução da doença básica. A codificação de causas múltiplas tem como vantagens o reconhecimento de freqüências de doenças que raramente são consideradas básicas e as estatísticas de mortalidade por causas múltiplas não são afetadas pelas mudanças das regras de seleção da causa de morte.Some aspects of mortality statistics based on underlying and multiple causes of death are analysed. A sample was drawn for study from deaths ocurred in hospitals using the official death certificates. With the help of additional information taken from medical records the death certificates were filled out again and compared with the original ones showing that the basic cause of death was incorrectly stated in 37.7% of the official death certificates and that there were some counterbalancing divergences. The average number of diagnosis per official death certificate was 1.9. With additional information it went up to 2.9. The longer the evolution of the basic illness, the greater the increase of the average number of additional diagnosis accompanying the basic cause. The multiple causes of death classification allowed acknowledgement of rare causes of death that very seldomly appeared as underlying causes of death. The mortality statistics by causes are not affected by the changes

Polytrauma in the elderly: predictors of the cause and time of death

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Muwanga Cyrus

2010-05-01

Full Text Available Abstract Background Increasing age and significant pre-existing medical conditions (PMCs are independent risk factors associated with increased mortality after trauma. Our aim was to review all trauma deaths, identifying the cause and the relation to time from injury, ISS, age and PMCs. Methods A retrospective analysis of trauma deaths over a 6-year period at the study centre was conducted. Information was obtained from the Trauma Audit and Research Network (TARN dataset, hospital records, death certificates and post-mortem reports. The time and cause of death, ISS, PMCs were analysed for two age groups ( Results Patients ≥ 65 years old were at an increased risk of death (OR 6.4, 95% CI 5.2-7.8, p 15 and died within the first 24 hours of admission, irrespective of age, from causes directly related to their injuries. Twelve patients with an ISS of Conclusion Elderly patients with minor injuries and PMCs have an increased risk of death relative to their younger counterparts and are more likely to die of medical complications late in their hospital admission.

Routine one-stage exchange for chronic infection after total hip replacement.

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Jenny, Jean-Yves; Lengert, Régis; Diesinger, Yann; Gaudias, Jeannot; Boeri, Cyril; Kempf, Jean-François

2014-12-01

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.

Lightning deaths: a retrospective review of New Mexico's cases, 1977-2009.

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Pincus, Jennifer L; Lathrop, Sarah L; Briones, Alice J; Andrews, Sam W; Aurelius, Michelle B

2015-01-01

To better understand lightning deaths, a retrospective review of electronic records from New Mexico's Office of the Medical Investigator database was performed between 1977 and 2009 to update and assess current risk factors. Information on demographics, circumstances, autopsy, and death certificates were collected and analyzed. Fifty-four decedents were identified, ages 2-71 years old (mean 34 years old), 42 males and 12 females. Common racial/ethnic groups were non-Hispanic Whites and American Indians (together comprising 72% of all cases). Physical findings were often related to the heat carried by the electrical current including clothing alterations (29.6%) and burning of skin (53.7%). Most deaths occurred on weekend afternoons in summer months, associated with recreational activities or agricultural work, and rural locations (77.8%). Utilizing the demographic information, clustered events, and associated outdoor activities will assist in creating public awareness and provide a framework to support targeted warnings in an attempt to prevent future deaths. © 2014 American Academy of Forensic Sciences.

Energy saving certificates

International Nuclear Information System (INIS)

2005-11-01

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.)

Trainer certification

International Nuclear Information System (INIS)

Couser, S.; Moore, J.

1988-01-01

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

Using the National Death Index to Identify Duplicate Cancer Incident Cases in Florida and New York, 1996–2005

Science.gov (United States)

Wohler, Brad; Qiao, Baozhen; MacKinnon, Jill A.; Schymura, Maria J.

2014-01-01

Introduction Cancer registries link incidence data to state death certificates to update vital status and identify missing cases; they also link these data to the National Death Index (NDI) to update vital status among patients who leave the state after their diagnosis. This study explored the use of information from NDI linkages to identify potential duplicate cancer cases registered in both Florida and New York. Methods The Florida Cancer Data System (FCDS) and the New York State Cancer Registry (NYSCR) linked incidence data with state and NDI death records from 1996 through 2005. Information for patients whose death occurred in the reciprocal state (the death state) was exchanged. Potential duplicate cases were those that had the same diagnosis and the same or similar diagnosis date. Results NDI identified 4,657 FCDS cancer patients who died in New York and 2,740 NYSCR cancer patients who died in Florida. Matching identified 5,030 cases registered in both states; 508 were death certificate-only (DCO) cases in the death state’s registry, and 3,760 (74.8%) were potential duplicates. Among FCDS and NYSCR patients who died and were registered in the registry of the reciprocal state, more than 50% were registered with the same cancer diagnosis, and approximately 80% had similar diagnosis dates (within 1 year). Conclusion NDI identified DCO cases in the death state’s cancer registry and a large proportion of potential duplicate cases. Standards are needed for assigning primary residence when multiple registries report the same case. The registry initiating the NDI linkage should consider sharing relevant information with death state registries so that these registries can remove erroneous DCO cases from their databases. PMID:25254985

Developing an interdisciplinary certificate program in transportation planning, phase 2 : the eCertificate.

Science.gov (United States)

2011-11-01

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...

Parasitic diseases as the cause of death of prisoners of war during the Korean War (1950-1953).

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Huh, Sun

2014-06-01

To determine the cause of death of prisoners of war during the Korean War (1950-1953), death certificates or medical records were analyzed. Out of 7,614 deaths, 5,013 (65.8%) were due to infectious diseases. Although dysentery and tuberculosis were the most common infectious diseases, parasitic diseases had caused 14 deaths: paragonimiasis in 5, malaria in 3, amoebiasis in 2, intestinal parasitosis in 2, ascariasis in 1, and schistosomiasis in 1. These results showed that paragonimiasis, malaria, and amoebiasis were the most fatal parasitic diseases during the early 1950s in the Korean Peninsula. Since schistosomiasis is not endemic to Korea, it is likely that the infected private soldier moved from China or Japan to Korea.

78 FR 64153 - Direct Certification and Certification of Homeless, Migrant and Runaway Children for Free School...

Science.gov (United States)

2013-10-28

...-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...

Coding ill-defined and unknown cause of death is 13 times more frequent in Denmark than in Finland

DEFF Research Database (Denmark)

Ylijoki-Sørensen, Seija; Sajantila, Antti; Lalu, Kaisa

2014-01-01

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...

Causes of death in 2877 patients with myelodysplastic syndromes.

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Nachtkamp, Kathrin; Stark, Romina; Strupp, Corinna; Kündgen, Andrea; Giagounidis, Aristoteles; Aul, Carlo; Hildebrandt, Barbara; Haas, Rainer; Gattermann, Norbert; Germing, Ulrich

2016-05-01

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.

Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey.

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Chambaere, Kenneth; Rietjens, Judith A C; Smets, Tinne; Bilsen, Johan; Deschepper, Reginald; Pasman, H Roeline W; Deliens, Luc

2012-06-18

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

Who and where are the uncounted children? Inequalities in birth certificate coverage among children under five years in 94 countries using nationally representative household surveys

OpenAIRE

Bhatia, Amiya; Ferreira, Leonardo Zanini; Barros, Alu?sio J. D.; Victora, Cesar Gomes

2017-01-01

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...

COSPAS-SARSAT Beacon Certification Facility

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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...

Death rates for acquired hypothyroidism and thyrotoxicosis in English populations (1979-2010): comparison of underlying cause and all certified causes.

Science.gov (United States)

Goldacre, M J; Duncan, M E

2013-03-01

Overt hypothyroidism and thyrotoxicosis have widespread systemic effects and are associated with increased mortality. Most death certificates that include them do not have the thyroid disease coded as the underlying cause of death. To describe regional (1979-2010) and national (1995-2010) trends in mortality rates for acquired hypothyroidism and thyrotoxicosis, analysing all certified causes of death (termed 'mentions') and not just the underlying cause. Analysis of death registration data. Analysis of data for the Oxford region (mentions available from 1979) and English national data (mentions available from 1995). The data were grouped in periods defined by different national rules for selecting the underlying cause of death (1979-83, 1984-92, 1993-2000 and 2001-10) and were also analysed as single calendar years. Mentions mortality for acquired hypothyroidism in the Oxford region declined significantly from 1979 to 2010: the average annual percentage change (AAPC) was -2.6% (95% confidence intervals -3.5, -1.8). Most of the decrease occurred during the 1980s. The AAPC in rates for later years in England (1995-2010) was non-significant at 0.2% (-0.7, 1.0). Mortality rates for thyrotoxicosis decreased significantly: the AAPC was -2.8% (-4.1, -1.5) in the Oxford region and -3.8% (-4.7, -3.0) in England. In England, between 2001 and 2010, hypothyroidism or thyrotoxicosis was coded as the underlying cause of death on, respectively, 17 and 24% of death certificates that included them. Mortality rates for hypothyroidism and thyrotoxicosis have fallen substantially. The fall is probably wholly or mainly a result of improved care.

Deaths from cerebrovascular diseases correlated to month of birth: elevated risk of death from subarachnoid hemorrhage among summer-born

Science.gov (United States)

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.

Maternal deaths databases analysis: Ecuador 2003-2013

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Antonio Pino

2016-08-01

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.

Diagnostic accuracy of WHO verbal autopsy tool for ascertaining causes of neonatal deaths in the urban setting of Pakistan: a hospital-based prospective study.

Science.gov (United States)

Soofi, Sajid Bashir; Ariff, Shabina; Khan, Ubaidullah; Turab, Ali; Khan, Gul Nawaz; Habib, Atif; Sadiq, Kamran; Suhag, Zamir; Bhatti, Zaid; Ahmed, Imran; Bhal, Rajiv; Bhutta, Zulfiqar Ahmed

2015-10-05

Globally, clinical certification of the cause of neonatal death is not commonly available in developing countries. Under such circumstances it is imperative to use available WHO verbal autopsy tool to ascertain causes of death for strategic health planning in countries where resources are limited and the burden of neonatal death is high. The study explores the diagnostic accuracy of WHO revised verbal autopsy tool for ascertaining the causes of neonatal deaths against reference standard diagnosis obtained from standardized clinical and supportive hospital data. All neonatal deaths were recruited between August 2006 -February 2008 from two tertiary teaching hospitals in Province Sindh, Pakistan. The reference standard cause of death was established by two senior pediatricians within 2 days of occurrence of death using the International Cause of Death coding system. For verbal autopsy, trained female community health worker interviewed mother or care taker of the deceased within 2-6 weeks of death using a modified WHO verbal autopsy tool. Cause of death was assigned by 2 trained pediatricians. The performance was assessed in terms of sensitivity and specificity. Out of 626 neonatal deaths, cause-specific mortality fractions for neonatal deaths were almost similar in both verbal autopsy and reference standard diagnosis. Sensitivity of verbal autopsy was more than 93% for diagnosing prematurity and 83.5% for birth asphyxia. However the verbal autopsy didn't have acceptable accuracy for diagnosing the congenital malformation 57%. The specificity for all five major causes of neonatal deaths was greater than 90%. The WHO revised verbal autopsy tool had reasonable validity in determining causes of neonatal deaths. The tool can be used in resource limited community-based settings where neonatal mortality rate is high and death certificates from hospitals are not available.

Risk factors for death in patients with severe asthma

Directory of Open Access Journals (Sweden)

Andréia Guedes Oliva Fernandes

2014-08-01

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.

Pre-pregnancy weight and the risk of stillbirth and neonatal death

DEFF Research Database (Denmark)

Kristensen, J; Vestergaard, M; Wisborg, K

2005-01-01

OBJECTIVE: To evaluate the association between maternal pre-pregnancy body mass index (BMI) and the risk of stillbirth and neonatal death and to study the causes of death among the children. DESIGN: Cohort study of pregnant women receiving routine antenatal care in Aarhus, Denmark. SETTING: Aarhus...... University Hospital, Denmark, 1989-1996. POPULATION: A total of 24,505 singleton pregnancies (112 stillbirths, 75 neonatal deaths) were included in the analyses. METHODS: Information on maternal pre-pregnancy weight, height, lifestyle factors and obstetric risk factors were obtained from self......-administered questionnaires and hospital files. We classified the population according to pre-pregnancy BMI as underweight (BMI

7 CFR 205.404 - Granting certification.

Science.gov (United States)

2010-01-01

... 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...

Forensic medicine experts' opinion on medico-legal autopsies in hospital deaths: a questionnaire survey.

Science.gov (United States)

D'Souza, Deepak Herald; Pant, Sadip; Menezes, Ritesh George

2013-10-01

Medico-legal autopsy is conducted routinely in some countries and selectively in others in hospital deaths. This study was conducted to evaluate the views of the forensic medicine experts regarding this matter. A questionnaire pro forma was sent to sixty-five forensic medicine experts practicing in different medical institutions all around India. Designations and experiences of the participants were noted by requests in the same questionnaire. Their specific experience in conducting medico-legal autopsy in hospital deaths was also requested for. Responses were charted in frequency distribution tables and analyzed using SPSS, version 17.0. One-third of the participants felt that a medico-legal autopsy was necessary in all the hospital death cases as defined in the present study. Ten percent of the participants opined that a medico-legal autopsy was unnecessary in hospital deaths. The majority of the experts mentioned finding the cause of death, followed by finding the manner of death and collecting the evidentiary materials, as the reasons for medico-legal autopsy in hospital deaths. Twenty percent of the participants felt that internal findings at autopsy poorly matched with the case records. All the experts agreed that external autopsy findings matched with the hospital case records. Nearly two-third of the participants felt that it was difficult in some cases to interpret the autopsy findings without case records from the hospital where the deceased was treated. Our findings suggest that the exercise of carrying out medico-legal autopsy routinely in every hospital death as evident in the Indian framework is often unnecessary as per the experts' opinion. Autopsy findings in hospital deaths often correlate with hospital case records.

Defining and measuring suspicion of sepsis: an analysis of routine data.

Science.gov (United States)

Inada-Kim, Matthew; Page, Bethan; Maqsood, Imran; Vincent, Charles

2017-06-09

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.

Is Halal Certification Process “Green”?

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Mohd Rizal Razalli

2012-09-01

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

The influence of trade associations and group certification programs on the hardwood certification movement

Science.gov (United States)

Iris B. Montague

2013-01-01

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...

Green certificates causing inconvenience?

International Nuclear Information System (INIS)

Torgersen, Lasse

2002-01-01

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

Guidelines and recommendations on yeast cell death nomenclature

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Didac Carmona-Gutierrez

2018-01-01

Full Text Available Elucidating the biology of yeast in its full complexity has major implications for science, medicine and industry. One of the most critical processes determining yeast life and physiology is cellular demise. However, the investigation of yeast cell death is a relatively young field, and a widely accepted set of concepts and terms is still missing. Here, we propose unified criteria for the definition of accidental, regulated, and programmed forms of cell death in yeast based on a series of morphological and biochemical criteria. Specifically, we provide consensus guidelines on the differential definition of terms including apoptosis, regulated necrosis, and autophagic cell death, as we refer to additional cell death routines that are relevant for the biology of (at least some species of yeast. As this area of investigation advances rapidly, changes and extensions to this set of recommendations will be implemented in the years to come. Nonetheless, we strongly encourage the authors, reviewers and editors of scientific articles to adopt these collective standards in order to establish an accurate framework for yeast cell death research and, ultimately, to accelerate the progress of this vibrant field of research.

Guidelines and recommendations on yeast cell death nomenclature

Science.gov (United States)

Carmona-Gutierrez, Didac; Bauer, Maria Anna; Zimmermann, Andreas; Aguilera, Andrés; Austriaco, Nicanor; Ayscough, Kathryn; Balzan, Rena; Bar-Nun, Shoshana; Barrientos, Antonio; Belenky, Peter; Blondel, Marc; Braun, Ralf J.; Breitenbach, Michael; Burhans, William C.; Büttner, Sabrina; Cavalieri, Duccio; Chang, Michael; Cooper, Katrina F.; Côrte-Real, Manuela; Costa, Vítor; Cullin, Christophe; Dawes, Ian; Dengjel, Jörn; Dickman, Martin B.; Eisenberg, Tobias; Fahrenkrog, Birthe; Fasel, Nicolas; Fröhlich, Kai-Uwe; Gargouri, Ali; Giannattasio, Sergio; Goffrini, Paola; Gourlay, Campbell W.; Grant, Chris M.; Greenwood, Michael T.; Guaragnella, Nicoletta; Heger, Thomas; Heinisch, Jürgen; Herker, Eva; Herrmann, Johannes M.; Hofer, Sebastian; Jiménez-Ruiz, Antonio; Jungwirth, Helmut; Kainz, Katharina; Kontoyiannis, Dimitrios P.; Ludovico, Paula; Manon, Stéphen; Martegani, Enzo; Mazzoni, Cristina; Megeney, Lynn A.; Meisinger, Chris; Nielsen, Jens; Nyström, Thomas; Osiewacz, Heinz D.; Outeiro, Tiago F.; Park, Hay-Oak; Pendl, Tobias; Petranovic, Dina; Picot, Stephane; Polčic, Peter; Powers, Ted; Ramsdale, Mark; Rinnerthaler, Mark; Rockenfeller, Patrick; Ruckenstuhl, Christoph; Schaffrath, Raffael; Segovia, Maria; Severin, Fedor F.; Sharon, Amir; Sigrist, Stephan J.; Sommer-Ruck, Cornelia; Sousa, Maria João; Thevelein, Johan M.; Thevissen, Karin; Titorenko, Vladimir; Toledano, Michel B.; Tuite, Mick; Vögtle, F.-Nora; Westermann, Benedikt; Winderickx, Joris; Wissing, Silke; Wölfl, Stefan; Zhang, Zhaojie J.; Zhao, Richard Y.; Zhou, Bing; Galluzzi, Lorenzo; Kroemer, Guido; Madeo, Frank

2018-01-01

Elucidating the biology of yeast in its full complexity has major implications for science, medicine and industry. One of the most critical processes determining yeast life and physiology is cellular demise. However, the investigation of yeast cell death is a relatively young field, and a widely accepted set of concepts and terms is still missing. Here, we propose unified criteria for the definition of accidental, regulated, and programmed forms of cell death in yeast based on a series of morphological and biochemical criteria. Specifically, we provide consensus guidelines on the differential definition of terms including apoptosis, regulated necrosis, and autophagic cell death, as we refer to additional cell death routines that are relevant for the biology of (at least some species of) yeast. As this area of investigation advances rapidly, changes and extensions to this set of recommendations will be implemented in the years to come. Nonetheless, we strongly encourage the authors, reviewers and editors of scientific articles to adopt these collective standards in order to establish an accurate framework for yeast cell death research and, ultimately, to accelerate the progress of this vibrant field of research. PMID:29354647

The Whys and Hows of Certification. Public Librarian Certification Law.

Science.gov (United States)

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…

40 CFR 745.89 - Firm certification.

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2010-07-01

... 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...

40 CFR 85.1406 - Certification.

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2010-07-01

... 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...

Certification trails for data structures

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Sullivan, Gregory F.; Masson, Gerald M.

1993-01-01

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.

Verbal autopsy of 80,000 adult deaths in Tamilnadu, South India

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Peto Richard

2004-10-01

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.

Board Certification in Counseling Psychology

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Crowley, Susan L.; Lichtenberg, James W.; Pollard, Jeffrey W.

2012-01-01

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…

Long-term mortality and causes of death among hospitalized Swedish drug users.

Science.gov (United States)

Fugelstad, Anna; Annell, Anders; Ågren, Gunnar

2014-06-01

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.

Age-based disparities in end-of-life decisions in Belgium: a population-based death certificate survey

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Chambaere Kenneth

2012-06-01

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

ENVIRONMENTAL MANAGEMENT SYSTEMS CERTIFICATION

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Aniko Miler-Virc

2012-12-01

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.

Product-oriented Software Certification Process for Software Synthesis

Science.gov (United States)

Nelson, Stacy; Fischer, Bernd; Denney, Ewen; Schumann, Johann; Richardson, Julian; Oh, Phil

2004-01-01

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.

Certificate Transparency with Privacy

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Eskandarian Saba

2017-10-01

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.

Gaining competitive advantage in personal dosimetry services through ISO 9001 certification

International Nuclear Information System (INIS)

Noriah, M.A.

2005-01-01

Full text: In Malaysia, the harmonization of dose monitoring for almost 12,000 radiation workers is assigned to the Secondary Standard Dosimetry Laboratory of Malaysian Institute for Nuclear Technology Research, SSDL-MINT. Established in 1980, SSDL-MINT is responsible for improving personal and workplace safety by providing high quality personal dosimetry services. It is important to demonstrate that the performance of personal dosimetry meets recognized standards, to ensure radiation doses to individual workers are within the safe limits and to verify compliance with dose limits. Concern on the quality of personal dosimetry service began to be expressed in 2000. The concern led to the ISO certification, which brought an unprecedented effort characterized by high degree coordination, proper documentation and well trained of personal dosimetry operators. These huge efforts resulted with certification ISO 9002:1994 by the SIRIM International QAS Sdn. Bhd. in January 2002. The adoption of these requirements for the ISO 9002 standard makes routine handling of the process easier, and increases the reliability and effectiveness of the services. This helps to increase the quality and uniformity of personal dosimetry. The revision of the ISO 9002:1994 to ISO 9001:2000 necessitated SSDL-MINT revising its quality management system. The work began in middle 2002, and by May 2003, SSDL-MINT has been upgraded to ISO 9001:2000. Certification to the ISO 9001:2000 demonstrates our ability to consistency provide service that meets the requirements of the customer and the regulatory authority. These includes: improved consistency of service / product performance and therefore higher customer satisfaction levels; uniformity in work processes across organizations; simplified and more uniform structure for quality documents; improved customer perception of the organizations image, culture and performance; reduced number of product and process non-conformances; greater employee

Transit management certificate program.

Science.gov (United States)

2012-07-01

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 ...

General practitioners' use of sickness certificates.

Science.gov (United States)

Roope, Richard; Parker, Gordon; Turner, Susan

2009-12-01

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.

Leading Causes of Death among Asian American Subgroups (2003-2011.

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Katherine G Hastings

Full Text Available Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups.We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese and non-Hispanic Whites (NHWs from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%. Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer's disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs.Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.

Leading Causes of Death among Asian American Subgroups (2003-2011).

Science.gov (United States)

Hastings, Katherine G; Jose, Powell O; Kapphahn, Kristopher I; Frank, Ariel T H; Goldstein, Benjamin A; Thompson, Caroline A; Eggleston, Karen; Cullen, Mark R; Palaniappan, Latha P

2015-01-01

Our current understanding of Asian American mortality patterns has been distorted by the historical aggregation of diverse Asian subgroups on death certificates, masking important differences in the leading causes of death across subgroups. In this analysis, we aim to fill an important knowledge gap in Asian American health by reporting leading causes of mortality by disaggregated Asian American subgroups. We examined national mortality records for the six largest Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese) and non-Hispanic Whites (NHWs) from 2003-2011, and ranked the leading causes of death. We calculated all-cause and cause-specific age-adjusted rates, temporal trends with annual percent changes, and rate ratios by race/ethnicity and sex. Rankings revealed that as an aggregated group, cancer was the leading cause of death for Asian Americans. When disaggregated, there was notable heterogeneity. Among women, cancer was the leading cause of death for every group except Asian Indians. In men, cancer was the leading cause of death among Chinese, Korean, and Vietnamese men, while heart disease was the leading cause of death among Asian Indians, Filipino and Japanese men. The proportion of death due to heart disease for Asian Indian males was nearly double that of cancer (31% vs. 18%). Temporal trends showed increased mortality of cancer and diabetes in Asian Indians and Vietnamese; increased stroke mortality in Asian Indians; increased suicide mortality in Koreans; and increased mortality from Alzheimer's disease for all racial/ethnic groups from 2003-2011. All-cause rate ratios revealed that overall mortality is lower in Asian Americans compared to NHWs. Our findings show heterogeneity in the leading causes of death among Asian American subgroups. Additional research should focus on culturally competent and cost-effective approaches to prevent and treat specific diseases among these growing diverse populations.

Legislative Enforcement of Nonconsensual Determination of Neurological (Brain) Death in Muslim Patients: A Violation of Religious Rights.

Science.gov (United States)

Rady, Mohamed Y; Verheijde, Joseph L

2018-04-01

Death is defined in the Quran with a single criterion of irreversible separation of the ruh (soul) from the body. The Quran is a revelation from God to man, and the primary source of Islamic knowledge. The secular concept of death by neurological criteria, or brain death, is at odds with the Quranic definition of death. The validity of this secular concept has been contested scientifically and philosophically. To legitimize brain death for the purpose of organ donation and transplantation in Muslim communities, Chamsi-Pasha and Albar (concurring with the US President's Council on Bioethics) have argued that irreversible loss of capacity for consciousness and breathing (apneic coma) in brain death defines true death in accordance with Islamic sources. They have postulated that the absence of nafs (personhood) and nafas (breath) in apneic coma constitutes true death because of departure of the soul (ruh) from the body. They have also asserted that general anesthesia is routine in brain death before surgical procurement. Their argument is open to criticism because: (1) the ruh is described as the essence of life, whereas the nafs and nafas are merely human attributes; (2) unlike true death, the ruh is still present even with absent nafs and nafas in apneic coma; and (3) the routine use of general anesthesia indicates the potential harm to brain-dead donors from surgical procurement. Postmortem general anesthesia is not required for autopsy. Therefore, the conclusion must be that legislative enforcement of nonconsensual determination of neurological (brain) death and termination of life-support and medical treatment violates the religious rights of observant Muslims.

Maternal Mortality Ratio and Causes of Death in IRI Between 2009 and 2012

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Marzieh Vahiddastjerdy

2016-12-01

Full Text Available Objective: The Maternal Mortality Ratio is an important health indicator. We presented the distribution and causes of maternal mortality in Islamic Republic of Iran.Materials and methods: After provision of an electronic Registry system for date entry, a descriptive-retrospective data collection had been performed for all maternal Deaths in March 2009- March 2012. All maternal deaths and their demographic characteristic were identified by using medical registries, death certificates, and relevant codes according to International Classification of Diseases (ICD-9 during pregnancy, labor, and 42 days after parturition.Results: During 3 years, there were 5094317 deliveries and 941 maternal deaths (MMR of 18.5 per 1000000 live births. We had access to pertained data of 896 cases (95.2% for review in our study. Of 896 reported deaths, 549 were classified as direct, 302 as indirect and 45 as unknown. Hemorrhage was the most common cause of maternal mortality, followed by Preeclampsia, Eclampsia and sepsis. Among all indirect causes, cardio -vascular diseases were responsible for 10% of maternal deaths, followed by thromboembolism, HTN and renal diseases.Conclusion: Although maternal mortality ratio in IRI could be comparable with the developed countries but its pattern is following developing countries and with this study we had provided reliable data for other prospective studies.

Haloperidol and sudden cardiac death in dementia: autopsy findings in psychiatric inpatients.

Science.gov (United States)

Ifteni, Petru; Grudnikoff, Eugene; Koppel, Jeremy; Kremen, Neil; Correll, Christoph U; Kane, John M; Manu, Peter

2015-12-01

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.

Prevention of Surgical Fires: A Certification Course for Healthcare Providers.

Science.gov (United States)

Fisher, Marquessa

2015-08-01

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.

Converse Barrier Certificate Theorem

DEFF Research Database (Denmark)

Wisniewski, Rafael; Sloth, Christoffer

2013-01-01

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...

76 FR 22785 - Direct Certification and Certification of Homeless, Migrant and Runaway Children for Free School...

Science.gov (United States)

2011-04-25

... [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...

Investigating weaknesses in Android certificate security

Science.gov (United States)

Krych, Daniel E.; Lange-Maney, Stephen; McDaniel, Patrick; Glodek, William

2015-05-01

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.

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.

Science.gov (United States)

Ramírez-Soto, Max Carlos; Ortega-Cáceres, Gutia; Cabezas, César

2017-07-05

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.

7 CFR 205.405 - Denial of certification.

Science.gov (United States)

2010-01-01

... 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...

7 CFR 205.401 - Application for certification.

Science.gov (United States)

2010-01-01

... 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...

14 CFR 147.39 - Display of certificate.

Science.gov (United States)

2010-01-01

... 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 CFR 89.105 - Certificate of conformity.

Science.gov (United States)

2010-07-01

... 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...

Converse Barrier Certificate Theorems

DEFF Research Database (Denmark)

Wisniewski, Rafael; Sloth, Christoffer

2016-01-01

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...

ECOTOURISM CERTIFICATION PROGRAMS: STANDARDS AND BENEFITS

Directory of Open Access Journals (Sweden)

Mariia Holub

2015-11-01

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

40 CFR 90.106 - Certificate of conformity.

Science.gov (United States)

2010-07-01

... 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 CFR 91.106 - Certificate of conformity.

Science.gov (United States)

2010-07-01

... 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...

48 CFR 33.207 - Contractor certification.

Science.gov (United States)

2010-10-01

... 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...

WASTE CERTIFICATION PROGRAM PLAN - REVISION 7

International Nuclear Information System (INIS)

MORGAN, LK

2002-01-01

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

Death and Death Anxiety

OpenAIRE

Gonca Karakus; Zehra Ozturk; Lut Tamam

2012-01-01

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...

Meteorological conditions and sports deaths at school in Japan, 1993 1998

Science.gov (United States)

Hoshi, Akio; Inaba, Yutaka

2005-03-01

We evaluated the association between meteorological conditions and sports deaths at elementary, junior high and senior high schools. Data were collected from attached documents such as accident reports and death certificate records in the National Agency for the Advancement of Sports and Health in Japan. Evaluation of seasonal variation showed a significant concentration of deaths from heat disorders and drowning in July and August. When heart disease was evaluated according to the sports situation, significant seasonal variation with a high number of deaths in September December was observed in sports events. Concerning circadian variation, deaths from heart disease showed a high peak at 10:00 11:00 a.m. in physical education classes and sports events, and at 2:00 5:00 p.m. in sports club activities. Analysis using a multiple logistic model showed a significantly lower odds ratio from heart disease and a significantly higher odds ratio from heat disorders at a wet bulb globe temperature of ≥21.0°C than at activities was significantly lower on days with rainfall than on days without rainfall. According to the school categories in heart diseases, the odds ratio in girls in elementary school was significantly higher than that in boys, but the odds ratio in girls in senior high school was significantly lower than that in boys.

How the 2008 stock market crash and seasons affect total and cardiac deaths in Los Angeles County.

Science.gov (United States)

Schwartz, Bryan Glen; Pezzullo, John Christopher; McDonald, Scott Andrew; Poole, William Kenneth; Kloner, Robert Alan

2012-05-15

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.

42 CFR 493.638 - Certificate fees.

Science.gov (United States)

2010-10-01

... 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...

Employment certificates on HRT

CERN Multimedia

HR Department

2008-01-01

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

EAS Telecommunications Certification Bodies (TCB)

Data.gov (United States)

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...

46 CFR 107.211 - Original Certificate of Inspection.

Science.gov (United States)

2010-10-01

... 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...

16 CFR 1207.9 - Product certification.

Science.gov (United States)

2010-01-01

... 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...

Death analysis of residents in an area of twenty kilometers around Qinshan nuclear power station

International Nuclear Information System (INIS)

Ma Mingqiang; Lu Zhunrong; Zheng Wen; Sun Peizhi

2001-01-01

Objective: To set up a data bank for residents health condition 20 kilometers within around Qinshan nuclear power station. Methods: Combining with retrospective investigation, the relevant data were acquired from medical certification for resident's death reported by all local disease surveillance. Results: The mortality rate of these residents from 1988 to 1999 was 6.92%. The first course of mortality was diseases of respiratory system, the second of circulatory system, and the third was malignant tumor. The first 5 death causes among all male and female persons were diseases of respiratory system and circulatory system, malignant tumor, injuries and poisoning, diseases of digestive system. The mortality rate for malignant tumor was 121.33/100000 (the standard death rate is : 100.13/100000), and liver cancer was the first death cause, while lung and stomach cancers, the second and the third, respectively. The main death causes in juvenile and youth was leukemia, but liver cancer and lung cancer were the main courses of death in the middle-aged, and in old people, lung and liver cancers. Conclusion: The chronic non-infectious diseases in respiratory system, circulatory system etc, are the major death causes in the residents, the mortality rate for malignant tumor in them is lower than that reported by provincial disease surveillance station

Perceived value of national certification for pediatric nurses.

Science.gov (United States)

Messmer, Patricia R; Hill-Rodriguez, Deborah; Williams, Arthur R; Ernst, Mary E; Tahmooressi, Jill

2011-09-01

This study evaluated whether pediatric nurses who were certified valued national certifications to a greater degree than those who were not certified. The Gaberson, Schroeter, Killen, and Valentine (2003) Perceived Value of Certification Tool (PVCT) was used to measure nurses' perceptions of certification. The PVCT includes 18 certification-related value statements, using a five-point Likert scale response ranging from strongly agree to strongly disagree. A principal factor analysis was performed to identify clusters of related variables. Certified pediatric nurses valued national certifications to a greater degree than those who were not certified. More favorable views of certification were moderately associated with favorable views of the effects of certification on salary. The PVCT was found to have one factor, not two, as previously reported in the literature. Lower perceived relationships were reported between certification and salary, clinical competence, and consumer confidence compared with feelings of professionalism and personal satisfaction. Efforts to improve the relationship between certification and its perceived value at one institution were addressed. More attention may be needed to strengthen relationships, perceived or otherwise, between certification and competency skills, public awareness, and compensation of nurses for holding national certification. Copyright 2011, SLACK Incorporated.

14 CFR 125.7 - Display of certificate.

Science.gov (United States)

2010-01-01

... 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...

External Agents' Effect on Routine Dynamics:Lack of Compliance Resulting in Routine Breakdown

OpenAIRE

Busse Hansen, Nicolai

2014-01-01

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...

Local problems; local solutions: an innovative approach to investigating and addressing causes of maternal deaths in Zambia's Copperbelt

Directory of Open Access Journals (Sweden)

Hadley Mary B

2011-05-01

Full Text Available Abstract Background Maternal mortality in developing countries is high and international targets for reduction are unlikely to be met. Zambia's maternal mortality ratio was 591 per 100,000 live births according to survey data (2007 while routinely collected data captured only about 10% of these deaths. In one district in Zambia medical staff reviewed deaths occurring in the labour ward but no related recommendations were documented nor was there evidence of actions taken to avert further deaths. The Investigate Maternal Deaths and Act (IMDA approach was designed to address these deficiencies and is comprised of four components; identification of maternal deaths; investigation of factors contributing to the deaths; recommendations for action drawn up by multiple stakeholders and monitoring of progress through existing systems. Methods A pilot was conducted in one district of Zambia. Maternal deaths occurring over a period of twelve months were identified and investigated. Data was collected through in-depth interviews with family, focus group discussions and hospital records. The information was summarized and presented at eleven data sharing meetings to key decision makers, during which recommendations for action were drawn up. An output indicator to monitor progress was included in the routine performance assessment tool. High impact interventions were identified using frequency analysis. Results A total of 56 maternal deaths were investigated. Poor communication, existing risk factors, a lack of resources and case management issues were the broad categories under which contributing factors were assigned. Sixty three recommendations were drawn up by key decision-makers of which two thirds were implemented by the end of the pilot period. Potential high impact actions were related to management of AIDS and pregnancy, human resources, referral mechanisms, birth planning at household level and availability of safe blood. Conclusion In resource

The electricity certificate system, 2008

Energy Technology Data Exchange (ETDEWEB)

2008-07-01

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

Certification and the Branding of HRD

Science.gov (United States)

Carliner, Saul

2012-01-01

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…

Modeling landowner behavior regarding forest certification

Science.gov (United States)

David C. Mercker; Donald G. Hodges

2008-01-01

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....

40 CFR 82.161 - Technician certification.

Science.gov (United States)

2010-07-01

... 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...

Radiation protection supervisors certification in Brazil

International Nuclear Information System (INIS)

Mendonca Costa, Eduardo; Arraes Monteiro, Iara

2008-01-01

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)

Modeling of a green certificate market

International Nuclear Information System (INIS)

Marchenko, O.V.

2008-01-01

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)

Maintenance of Certification for Radiation Oncology

International Nuclear Information System (INIS)

Kun, Larry E.; Ang, Kian; Erickson, Beth; Harris, Jay; Hoppe, Richard; Leibel, Steve; Davis, Larry; Hattery, Robert

2005-01-01

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

Alternative Certification Pathways: Filling a Gap?

Science.gov (United States)

Ludlow, Carlyn

2013-01-01

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…

AutoCAD 2014 review for certification official certification preparation

CERN Document Server

ASCENT center for technical knowledge

2014-01-01

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.

The embeddedness of selfish Routines

DEFF Research Database (Denmark)

Andersen, Poul Houman

2001-01-01

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...

Reliability of sickness certificates in detecting potential sick leave reduction by modifying working conditions: a clinical epidemiology study

Directory of Open Access Journals (Sweden)

Johnsen Roar

2004-03-01

Full Text Available Abstract Background Medical sickness certificates are generally the main source for information when scrutinizing the need for aimed intervention strategies to avoid or reduce the individual and community side effects of sick leave. This study explored the value of medical sickness certificates related to daily work in Norwegian National Insurance Offices to identify sick-listed persons, where modified working conditions might reduce the ongoing sick leave. Methods The potential for reducing the ongoing sick leave by modifying working conditions was individually assessed on routine sickness certificates in 999 consecutive sick leave episodes by four Norwegian National Insurance collaborators, two with and two without formal medical competence. The study took place in Northern Norway in 1997 and 1998. Agreement analysed with differences against mean, kappa, and proportional-agreement analysis within and between groups of assessors was used in the judgement. Agreements between the assessors and the self-assessment of sick-listed subjects were additionally analysed in 159 sick-leave episodes. Results Both sick-listed subjects and National Insurance collaborators anticipated a potential reduction in sick leave in 20–30% of cases, and in another 20% the potential was assessed as possible. The chance corrected agreements, however, were poor (k Conclusion Information in medical sickness certificates proved ineffective in detecting cases where modified working conditions may reduce sick leave, and focusing on medical certificates may prevent identification of needed interventions. Strategies on how to communicate directly with sick-listed subjects would enable social authorities to exploit more of the sick leave reduction potential by modifying the working conditions than strategies on improving medical information.

Certification of Markets, Markets of Certificates: Tracing Sustainability in Global Agro-Food Value Chains

NARCIS (Netherlands)

Mol, A.P.J.; Oosterveer, P.J.M.

2015-01-01

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

Mortality and causes of death among workers exposed to phosgene in 1943-45

International Nuclear Information System (INIS)

Polednak, A.P.; Hollis, D.R.

1985-01-01

Mortality and causes of death from death certificates were analyzed among workers exposed to phosgene while working at a uranium-processing plant in Tennessee in 1943-45. Standardized mortality ratios (SMRs) were calculated by using death rates for U.S. white males. As of 1979, SMRs for all causes and for various selected causes were similar in 694 male chemical workers chronically exposed to low levels of phosgene in 1943-45 and in 9280 male controls who worked at the same plant. SMRs for diseases of the respiratory system were 107 (14 observed vs. 13.07 expected) in the chemical workers and 119 (292 observed vs. 245.75 expected) in the controls. In a group of 106 males who were acutely exposed to high levels of phosgene, there were 41 deaths observed vs. 33.87 expected (SMR = 121; 95% confidence limits = 86 and 165). One death, occurring within 24 hours of exposure, was from pulmonary edema due to phosgene poisoning (coded to accidental causes). Five deaths were coded to diseases of the respiratory system (SMR = 266; 95% CL = 86 and 622); in 2 of these 5 deaths, bronchitis due to phosgene exposure had been reported in 1945. Among 91 female workers with acute high-level phosgene exposure, frequencies of symptoms and early health effects (pneumonitis and bronchitis) differed from those reported for the 106 male cases; preliminary data on vital status of these females are too incomplete for analysis, and further follow-up is needed

Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013-2015.

Science.gov (United States)

Ely, Danielle M; Hoyert, Donna L

2018-02-01

The leading causes of infant death vary by age at death but were consistent from 2005 to 2015 (1-6). Previous research shows higher infant mortality rates in rural counties compared with urban counties and differences in cause of death for individuals aged 1 year and over by urbanization level (4,5,7,8). No research, however, has examined if mortality rates from the leading causes of infant death differ by urbanization level. This report describes the mortality rates for the five leading causes of infant, neonatal, and postneonatal death in the United States across rural, small and medium urban, and large urban counties defined by maternal residence, as reported on the birth certificate for combined years 2013-2015. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Mortality atlas of the main causes of death in Switzerland, 2008-2012.

Science.gov (United States)

Chammartin, Frédérique; Probst-Hensch, Nicole; Utzinger, Jürg; Vounatsou, Penelope

2016-01-01

Analysis of the spatial distribution of mortality data is important for identification of high-risk areas, which in turn might guide prevention, and modify behaviour and health resources allocation. This study aimed to update the Swiss mortality atlas by analysing recent data using Bayesian statistical methods. We present average pattern for the major causes of death in Switzerland. We analysed Swiss mortality data from death certificates for the period 2008-2012. Bayesian conditional autoregressive models were employed to smooth the standardised mortality rates and assess average patterns. Additionally, we developed models for age- and gender-specific sub-groups that account for urbanisation and linguistic areas in order to assess their effects on the different sub-groups. We describe the spatial pattern of the major causes of death that occurred in Switzerland between 2008 and 2012, namely 4 cardiovascular diseases, 10 different kinds of cancer, 2 external causes of death, as well as chronic respiratory diseases, Alzheimer's disease, diabetes, influenza and pneumonia, and liver diseases. In-depth analysis of age- and gender-specific mortality rates revealed significant disparities between urbanisation and linguistic areas. We provide a contemporary overview of the spatial distribution of the main causes of death in Switzerland. Our estimates and maps can help future research to deepen our understanding of the spatial variation of major causes of death in Switzerland, which in turn is crucial for targeting preventive measures, changing behaviours and a more cost-effective allocation of health resources.

Development of new NDT certification scheme in Singapore

International Nuclear Information System (INIS)

Wong, B.S.; Prabhakaran, K.G.; Babu, S.K.; Kuppuswamy, N.

2009-01-01

Nondestructive testing plays a vital role in Singapore Industry either it is construction or it it oil and gas. To cope up with the future demands for nondestructive testing personnel and cater to the local industry needs for qualified and certified NDT operators, Nondestructive Testing Society (Singapore)-NDTSS launched the SGNDT Certification Scheme. The aim of the organization is to promote and standardize the quality of NDT through education and training based on a scheme that is on par with internationally recognized 3rd party certifications. The certification also provides a greater confidence to the clients and end users who utilize the NDT test results provided by the certified operators. NDE certification in Singapore varies from industries and currently relies on the in-house certification scheme based on SNT-TC-1A where organizations find it difficult to standardize the skill and reliability of operators. NDE Certification system varies globally from countries to countries. A proper certification system is required to produce successful NDT Practitioners to suit the local industry. This paper outlines the development of Singapore NDT Certification Scheme (SGNDT), the operations, levels of qualification, the method of operation and control measures. The Training and Certification committee, Quality Management system within the certification scheme and the current system practiced in Singapore are discussed in this paper. The paper also highlights the importance of third party certification scheme. (author)

7 CFR 205.400 - General requirements for certification.

Science.gov (United States)

2010-01-01

...) 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...

BIX Certificates: Cryptographic Tokens for Anonymous Transactions Based on Certificates Public Ledger

Directory of Open Access Journals (Sweden)

Sead Muftic

2016-12-01

Full Text Available With the widespread use of Internet, Web, and mobile technologies, a new category of applications and transactions that requires anonymity is gaining increased interest and importance. Examples of such new applications are innovative payment systems, digital notaries, electronic voting, documents sharing, electronic auctions, medical applications, and many others. In addition to anonymity, these applications and transactions also require standard security services: identification, authentication, and authorization of users and protection of their transactions. Providing those services in combination with anonymity is an especially challenging issue, because all security services require explicit user identification and authentication. To solve this issue and enable applications with security and also anonymity we introduce a new type of cryptographically encapsulated objects called BIX certificates. “BIX” is an abbreviation for “Blockchain Information Exchange.” Their purpose is equivalent to X.509 certificates: to support security services for users and transactions, but also enhanced with anonymity. This paper describes the structure and attributes of BIX certificate objects and all related protocols for their creation, distribution, and use. The BIX Certification Infrastructure (BCI as a distributed public ledger is also briefly described.

Completeness and reliability of mortality data in Viet Nam: Implications for the national routine health management information system.

Science.gov (United States)

Hong, Tran Thi; Phuong Hoa, Nguyen; Walker, Sue M; Hill, Peter S; Rao, Chalapati

2018-01-01

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.

Infant Mortality Statistics From the 2013 Period Linked Birth/Infant Death Data Set.

Science.gov (United States)

Matthews, T J; MacDorman, Marian F; Thoma, Marie E

2015-08-06

This report presents 2013 period infant mortality statistics from the linked birth/infant death data set (linked file) by maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. Descriptive tabulations of data are presented and interpreted. The U.S. infant mortality rate was 5.96 infant deaths per 1,000 live births in 2013, similar to the rate of 5.98 in 2012. The number of infant deaths was 23,446 in 2013, a decline of 208 infant deaths from 2012. From 2012 to 2013, infant mortality rates were stable for most race and Hispanic origin groups; declines were reported for two Hispanic subgroups: Cuban and Puerto Rican. Since 2005, the most recent high, the U.S. infant mortality rate has declined 13% (from 6.86), with declines in both neonatal and postneonatal mortality overall and for most groups. In 2013, infants born at 37–38 weeks of gestation (early term) had mortality rates that were 63% higher than for full-term (39–40 week) infants. For multiple births, the infant mortality rate was 25.84, 5 times the rate of 5.25 for singleton births. In 2013, 36% of infant deaths were due to preterm-related causes of death, and an additional 15% were due to causes grouped into the sudden unexpected infant death category. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Generating Novelty Through Interdependent Routines: A Process Model of Routine Work

NARCIS (Netherlands)

Deken, F.; Carlile, P.R.; Berends, H.; Lauche, K.

2016-01-01

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

78 FR 30273 - Export Trade Certificate of Review

Science.gov (United States)

2013-05-22

... 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...

78 FR 62585 - Export Trade Certificate of Review

Science.gov (United States)

2013-10-22

... 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...

78 FR 36747 - Export Trade Certificate of Review

Science.gov (United States)

2013-06-19

... 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...

78 FR 72865 - Export Trade Certificate of Review

Science.gov (United States)

2013-12-04

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 92-12A001] Export Trade Certificate of Review ACTION: Notice of application to amend the Export Trade Certificate of Review issued to..., has received an application to amend an Export Trade Certificate of Review (``Certificate''). This...

78 FR 36745 - Export Trade Certificate of Review

Science.gov (United States)

2013-06-19

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 87-9A001] Export Trade Certificate of Review ACTION: Notice of Application to amend the Export Trade Certificate of Review Issued to..., has received an application to amend an Export Trade Certificate of Review (``Certificate''). This...

Leading causes of certification for blindness and partial sight in England & Wales

Directory of Open Access Journals (Sweden)

Wormald Richard

2006-03-01

Full Text Available Abstract Background Prevention of visual impairment is an international priority agreed at the World Health Assembly of 2002- yet many countries lack contemporary data about incidence and causes from which priorities for prevention, treatment and management can be identified. Methods Registration as blind or partially-sighted in England and Wales is voluntary and is initiated by certification by a consultant ophthalmologist. From all certificates completed during the year April 1999 to March 2000, the main cause of visual loss was ascertained where possible and here we present information on the leading causes observed and comment on changes in the three leading causes since the last analysis conducted for 1990–1991 data. Results 13788 people were certified as blind, 19107 were certified as partially sighted. The majority of certifications were in the older age groups. The most commonly recorded main cause of certifications for both blindness (57.2 % and partial sight (56 % was degeneration of the macula and posterior pole which largely comprises age-related macular degeneration. Glaucoma and diabetic retinopathy were the next most commonly recorded main causes. Overall, the age specific incidence of all three leading causes has increased since 1990–1991 – with changes in diabetic retinopathy being the most marked – particularly in the over 65's where figures have more than doubled. Conclusion The numbers of individuals per 100,000 population being certified blind or partially sighted due to the three leading causes – AMD, diabetic retinopathy and glaucoma have increased since 1990. This may to some extent be explained by improved ascertainment. The process of registration for severe visual impairment in England and Wales is currently undergoing review. Efforts must be made to ensure that routine collection of data on causes of severe visual impairment is continued, particularly in this age of improved technology, to allow such trends

Directory of certificates of compliance for radioactive materials packages. Certificates of compliance

International Nuclear Information System (INIS)

1979-10-01

This volume contains all Certificates of Compliance for radioactive material packages effective September 14, 1979. Purpose of this directory is to make available a convenient source of information on packagings which have been approved by the US Nuclear Regulatory Commission. To assist in identifying packaging, an index by Model Number and corresponding Certificate of Compliance number is included at the back of each volume of the directory

77 FR 12562 - Export Trade Certificate of Review

Science.gov (United States)

2012-03-01

... 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...

The WHO 2016 verbal autopsy instrument: An international standard suitable for automated analysis by InterVA, InSilicoVA, and Tariff 2.0.

Directory of Open Access Journals (Sweden)

Erin K Nichols

2018-01-01

Full Text Available Verbal autopsy (VA is a practical method for determining probable causes of death at the population level in places where systems for medical certification of cause of death are weak. VA methods suitable for use in routine settings, such as civil registration and vital statistics (CRVS systems, have developed rapidly in the last decade. These developments have been part of a growing global momentum to strengthen CRVS systems in low-income countries. With this momentum have come pressure for continued research and development of VA methods and the need for a single standard VA instrument on which multiple automated diagnostic methods can be developed.In 2016, partners harmonized a WHO VA standard instrument that fully incorporates the indicators necessary to run currently available automated diagnostic algorithms. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality. This VA instrument offers the opportunity to harmonize the automated diagnostic algorithms in the future.Despite all improvements in design and technology, VA is only recommended where medical certification of cause of death is not possible. The method can nevertheless provide sufficient information to guide public health priorities in communities in which physician certification of deaths is largely unavailable. The WHO 2016 VA instrument, together with validated approaches to analyzing VA data, offers countries solutions to improving information about patterns of cause-specific mortality.

Architect’s Certification: A Problem?

Directory of Open Access Journals (Sweden)

Yong Kum Weng

2015-01-01

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.

Purchases of prescription drugs before an alcohol-related death: A ten-year follow-up study using linked routine data.

Science.gov (United States)

Paljärvi, Tapio; Martikainen, Pekka; Leinonen, Taina; Vuori, Erkki; Mäkelä, Pia

2018-05-01

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.

46 CFR 91.60-40 - Duration of Convention certificates.

Science.gov (United States)

2010-10-01

... 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...

Certification Manual for Wisconsin Public Librarians. Bulletin No. 94111.

Science.gov (United States)

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…

Tradable green certificates in Flanders (Belgium)

International Nuclear Information System (INIS)

Verbruggen, Aviel

2004-01-01

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)

Design and implementation of PKI-based certification authority

Science.gov (United States)

Zheng, Ying; Bai, Qinghai; Zhao, Linna; Chun, Hua; Chen, Jing

2015-12-01

PKI achieves the management of public key by certificates. It combines the user's public key and his or her identification formation through a trusted third-party organization CA, in order to authenticate the user's identity on the Internet, thus ensuring the authenticity, integrity, confidentiality, and non- repudiation of the information transmitted on the Internet. CA is the most critical agency in the PKI system, mainly responsible for issuing and managing certificates. On the basis of the actual needs of an enterprise, in this paper the author designs and develops a small-sized PKI-based Certification Authority equipped with the functions of root CA initialization, certificate application, certificate issuance, certificate revocation, and the generation of certificate revocation list. The author also points out the problems that need to be mentioned in the design and development.

46 CFR 153.15 - Conditions under which the Coast Guard issues a Certificate of Inspection or Certificate of...

Science.gov (United States)

2010-10-01

... Certificate of Inspection required under § 153.900 for a United States ship to carry a hazardous material or... Certificate of Inspection or Certificate of Compliance. 153.15 Section 153.15 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) CERTAIN BULK DANGEROUS CARGOES SHIPS CARRYING BULK LIQUID, LIQUEFIED...

Analysis of the green certificate market

International Nuclear Information System (INIS)

Storeboe, Inger Oeydis

2001-04-01

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

Postmortem computed tomography for detecting causes of sudden death in infants and children. Retrospective review of cases

International Nuclear Information System (INIS)

Oyake, Yuji; Aoki, Takeshi; Shiotani, Seiji; Kohno, Mototsugu; Ohashi, Noriyoshi; Akutsu, Hiroyoshi; Yamazaki, Kentaro

2006-01-01

The aim of this study was to investigate the usefulness of postmortem computed tomography (PMCT) in detecting causes of sudden death in infants and children. Our subjects were 15 nontraumatically deceased patients (nine boys and six girls, ranging in age from 20 days after birth to 12 years old, mean age 1.6 years), who had been in a state of cardiopulmonary arrest on arrival at our hospital. PMCT was performed within 2 h after certification of death: head (15 cases), chest (11 cases), and abdomen (12 cases). Blood was collected from 11 of the patients at the time of cardiopulmonary resuscitation. An autopsy was conducted on two. PMCT did not show any traumatic changes indicating child abuse. It was difficult to presume the cause of death with PMCT alone, but the cause of death in 14 of 15 cases could be presumed by combining information from their medical history, clinical course before death, PMCT findings, laboratory data, and bacterial culture. The remaining subject was classified as cause unknown. The causes of sudden death in infants and children were detected at a high rate when we comprehensively investigated the PMCT and other examination findings. (author)

7 CFR 205.406 - Continuation of certification.

Science.gov (United States)

2010-01-01

..., Inspections, Marketing Practices), DEPARTMENT OF AGRICULTURE (CONTINUED) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Certification § 205.406 Continuation of certification. (a) To continue... 7 Agriculture 3 2010-01-01 2010-01-01 false Continuation of certification. 205.406 Section 205.406...

7 CFR 1421.110 - Commodity certificate exchanges.

Science.gov (United States)

2010-01-01

... commodity certificate for the marketing assistance loan collateral. (b) The exchange rate is the lesser of... assistance loan collateral. (3) Immediately exchanging the purchased commodity certificate for the outstanding loan collateral. (e) The authority to make commodity certificates available to the producer will...

A software product certification model

NARCIS (Netherlands)

Heck, P.M.; Klabbers, M.D.; van Eekelen, Marko

2010-01-01

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

Burden and Risk Factors for Cold-Related Illness and Death in New York City

Directory of Open Access Journals (Sweden)

Kathryn Lane

2018-03-01

Full Text Available Exposure to cold weather can cause cold-related illness and death, which are preventable. To understand the current burden, risk factors, and circumstances of exposure for illness and death directly attributed to cold, we examined hospital discharge, death certificate, and medical examiner data during the cold season from 2005 to 2014 in New York City (NYC, the largest city in the United States. On average each year, there were 180 treat-and-release emergency department visits (average annual rate of 21.6 per million and 240 hospital admissions (29.6 per million for cold-related illness, and 15 cold-related deaths (1.8 per million. Seventy-five percent of decedents were exposed outdoors. About half of those exposed outdoors were homeless or suspected to be homeless. Of the 25% of decedents exposed indoors, none had home heat and nearly all were living in single-family or row homes. The majority of deaths and illnesses occurred outside of periods of extreme cold. Unsheltered homeless individuals, people who use substances and become incapacitated outdoors, and older adults with medical and psychiatric conditions without home heat are most at risk. This information can inform public health prevention strategies and interventions.

Certification of thermal solar systems in the Netherlands and monitoring the results of certification

NARCIS (Netherlands)

Ree, B.G.C. van der

1996-01-01

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

Epidemiologic Risk Factors for Suicide and Attempted Suicide in the U.S. Air Force: Using Administrative Data Systems and Multiple Cause of Death Information to Improve Prevention Policy

National Research Council Canada - National Science Library

Copley, Gary

2000-01-01

...) 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...

13 CFR 120.644 - Transfers of Certificates.

Science.gov (United States)

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Transfers of Certificates. 120.644 Section 120.644 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Miscellaneous Provisions § 120.644 Transfers of Certificates. (a) General rule. Certificates are...

Bedtime routines child wellbeing & development.

Science.gov (United States)

Kitsaras, George; Goodwin, Michaela; Allan, Julia; Kelly, Michael P; Pretty, Iain A

2018-03-21

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.

Rules and routines in organizations and the management of safety rules

Energy Technology Data Exchange (ETDEWEB)

Weichbrodt, J. Ch.

2013-07-01

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

Rules and routines in organizations and the management of safety rules

International Nuclear Information System (INIS)

Weichbrodt, J. Ch.

2013-01-01

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

Characteristics of alprazolam-related deaths compiled by a centralized state medical examiner.

Science.gov (United States)

Shah, Neel A; Abate, Marie A; Smith, Michael J; Kaplan, James A; Kraner, James C; Clay, David J

2012-11-01

Unintentional drug poisoning deaths represent a major health concern, particularly in rural areas. Although alprazolam is frequently detected in drug-related deaths, characterization of its involvement is limited. Our objective was to compare the characteristics of alprazolam-related deaths with nonalprazolam deaths in a predominantly rural state. A comprehensive forensic drug database (FDD) was developed in 2005 to compile demographic, toxicology, and co-morbidity information from all West Virginia (WV) drug-related deaths. All FDD data from 2005 to mid-November 2007 were analyzed. Alprazolam contributed to 204 (17.0%) of the 1,199 drug-related deaths and was identified in 7.2% of the 363 deaths occurring during 2005 and in 27.5% of the 422 deaths entered in the database during 2007. At least one other drug, predominantly an opioid, was identified in 97.5% of the alprazolam cases, with concurrent benzodiazepines also found. Compared to nonalprazolam deaths, alprazolam decedents were significantly more likely to be obese and to have preexisting cardiovascular disease, but were less likely to have documented substance abuse. An alprazolam prescription existed in 52.5% of the alprazolam deaths, with 77.6% having a prescription for all drugs identified. Alprazolam was a contributing cause of death in a substantial and increasing number of drug-related deaths. Prescriptions for alprazolam and the other drugs detected were often present in these cases. Controlled substance monitoring programs should be routinely used as one mechanism to help prevent potential drug misuse/abuse. Our findings provide a baseline for ongoing alprazolam-related death surveillance. Copyright © American Academy of Addiction Psychiatry.

Obtaining your annual internal taxation certificate

CERN Document Server

2006-01-01

(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 ais.support@cern.ch. Former Members of the Personnel:- If you remember your AIS login and password, you can acc...

7 CFR 946.60 - Inspection and certification.

Science.gov (United States)

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Inspection and certification. 946.60 Section 946.60... WASHINGTON Order Regulating Handling Inspection and Certification § 946.60 Inspection and certification. (a... this subpart, each handler who first ships potatoes shall, prior to making shipment, cause each...

Aplicabilidad del análisis por causa múltiple de muerte para el cáncer cervicouterino: la experiencia en México Applicability of the analysis by multiple cause of death by cervical cancer: the experience in Mexico

Directory of Open Access Journals (Sweden)

Lilia Patricia Bustamante-Montes

2011-12-01

Full Text Available Objecto. Explora-se a aplicabilidad da análise por causa múltipla de morte para o estudo do cancro cervicouterino. Métodos. Desenho de mortalidade proporcional para analisar todas as causas consignadas na totalidade dos certificados de morte por cancro cervicouterino de mulheres maiores de 18 anos do Estado de México (367, e 515 certificados de mulheres falecida por outras causas. Resultados. Encontrou-se uma razão de causa básica/múltipla de 2.9 nos certificados de morte, isto é pela cada causa básica encontraram-se 2.9 As mulheres falecidas por cancro cervicouterino morrem cinco anos dantes que as que morrem por outras causas (pObjective. The study explores the applicability of the multiple-cause-of-death analysis for cervical-uterine cancer. Methods. A proportional mortality hazard design and the analysis of all causes of death due to cervical-uterine cancer from 367 death certificates of women older than 18 years of age from the State of Mexico, and 515 age and year adjusted sample of death certificates of women from the same region who died from other causes. Results. A basic multiple cause of death of 2.9 was observed in the death certificates, i.e., for every basic cause there were 2.9 multiple causes. When adjusting the multiple-causes-of-death analysis for cervical-uterine cancer by age, education, marital and insurability status, the most contributing and associated causes of death were malignant tumors from unspecified sites [OR=18.98 (2.28-157.56 and OR=14.25 (1.67-121.0] respectively; Diabetes Mellitus as a contributing [OR=1.82 (1.02-3.27 and associated cause [OR=7.78 (1.46-41.37], and systemic arterial hypertension as an associated cause [OR=3.00 (1.40-6.47]. Conclusions. The multiple-cause-of-death analysis is an adequate to observe the diseases that contribute condition and are associated to the cervical-uterine cancer.

47 CFR 76.1502 - Certification.

Science.gov (United States)

2010-10-01

... 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...

40 CFR 68.185 - Certification.

Science.gov (United States)

2010-07-01

... 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...

Emergency Teacher Certification. ERIC Digest.

Science.gov (United States)

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…

12 CFR 563.74 - Mutual capital certificates.

Science.gov (United States)

2010-01-01

... the funds for redemption are raised by the issuance of mutual capital certificates approved pursuant... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Mutual capital certificates. 563.74 Section 563...-OPERATIONS Securities and Borrowings § 563.74 Mutual capital certificates. (a) General. No savings...

19 CFR 191.10 - Certificate of delivery.

Science.gov (United States)

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Certificate of delivery. 191.10 Section 191.10... TREASURY (CONTINUED) DRAWBACK General Provisions § 191.10 Certificate of delivery. (a) Purpose; when... other party a certificate of delivery, certified by the importer or other party through whose possession...

Descriptive epidemiology of chronic liver disease in northeastern Italy: an analysis of multiple causes of death.

Science.gov (United States)

Fedeli, Ugo; Schievano, Elena; Lisiero, Manola; Avossa, Francesco; Mastrangelo, Giuseppe; Saugo, Mario

2013-10-10

The analysis of multiple causes of death data has been applied in the United States to examine the population burden of chronic liver disease (CLD) and to assess time trends of alcohol-related and hepatitis C virus (HCV)-related CLD mortality. The aim of this study was to assess the mortality for CLD by etiology in the Veneto Region (northeastern Italy). Using the 2008-2010 regional archive of mortality, all causes registered on death certificates were extracted and different descriptive epidemiological measures were computed for HCV-related, alcohol-related, and overall CLD-related mortality. The crude mortality rate of all CLD was close to 40 per 100,000 residents. In middle ages (35 to 74 years) CLD was mentioned in about 10% and 6% of all deaths in males and females, respectively. Etiology was unspecified in about half of CLD deaths. In females and males, respectively, HCV was mentioned in 44% and 21% and alcohol in 11% and 26% of overall CLD deaths. A bimodal distribution with age was observed for HCV-related proportional mortality among females, reflecting the available seroprevalence data. Multiple causes of death analyses can provide useful insights into the burden of CLD mortality according to etiology among different population subgroups.

Who and where are the uncounted children? Inequalities in birth certificate coverage among children under five years in 94 countries using nationally representative household surveys.

Science.gov (United States)

Bhatia, Amiya; Ferreira, Leonardo Zanini; Barros, Aluísio J D; Victora, Cesar Gomes

2017-08-18

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

DGNB Building Certification Companion

DEFF Research Database (Denmark)

Møller, Renate Skovgaard; Rhodes, Michael K.; Larsen, Tine Steen

2017-01-01

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....

DGNB BUILDING CERTIFICATION COMPANION

DEFF Research Database (Denmark)

Møller, Renate Skovgaard; Rhodes, Michael K.; Larsen, Tine Steen

2018-01-01

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....

Soy production and certification

DEFF Research Database (Denmark)

Tomei, Julia; Semino, Stella Maris; Paul, Helena

2010-01-01

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...

Tabulador de causas múltiplas de morte Multiple causes- of-death tabulator

Directory of Open Access Journals (Sweden)

Augusto H. Santo

1999-08-01

Full Text Available O uso de causas múltiplas de morte vem sendo atualmente preconizado para descrever e analisar os determinantes patológicos da mortalidade em populações, como complemento ao uso tradicional da causa básica de morte. O estudo das causas múltiplas pode realizar-se por meio da apresentação de todas as menções das causas básicas e associadas de morte e por meio de associações de causas. Um programa para microcomputador foi desenvolvido para processar bancos de dados contendo as causas de morte informadas no Modelo Internacional de Atestado Médico de Causa de Morte, denominado Tabulador de Causas Múltiplas, que gera uma tabela matriz a partir da qual podem ser derivadas as demais formas de apresentação e análise, além de poder ser usado como instrumento de crítica dos dados de mortalidade.The use of multiple-causes-of-death is currently being recommended in order to describe and analyze the pathological determinants of mortality in populations, as a supplement to the traditional use of the underlying cause of death. Multiple-causes-of-death can be studied by presenting all underlying and associated causes mentioned, and by means of associations of causes of death. Microcomputer software has been developed to process data files containing causes of death informed by physicians on the International Form of Medical Certificate of Causes of Death. The Multiple Cause of Death Tabulator software generates a matrix table from which the above forms of presentation and analysis can be achieved and mortality data be edited.

12 CFR 411.110 - Certification and disclosure.

Science.gov (United States)

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Certification and disclosure. 411.110 Section 411.110 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES NEW RESTRICTIONS ON LOBBYING General § 411.110 Certification and disclosure. (a) Each person shall file a certification, and a disclosure...

Green certificates and carbon trading in the Netherlands

International Nuclear Information System (INIS)

Boots, M.

2003-01-01

The combination of trading schemes for green certificates and for carbon, as they are implemented and planned in the Netherlands, imply a complete separation of green certificates and CO 2 markets. This means that the costs of CO 2 reduction will be reflected in the spot price of electricity and that the price of green certificates only reflects the additional cost of RE development. However, since the green certificate scheme is already implemented, while the carbon trading scheme is not, it is unclear if currently the green certificate value includes the CO 2 reduction value of RE production. It is important that buyers and sellers in the market for green certificates agree on what they are trading, therefore this issue should be clarified

40 CFR 92.208 - Certification.

Science.gov (United States)

2010-07-01

... 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...

[The accuracy of the causes of death and the estimated trend: the case of cervix uteri].

Science.gov (United States)

Mancuso, Pamela; Sacchettini, Claudio; Vicentini, Massimo; Caroli, Stefania; Giorgi Rossi, Paolo

2016-01-01

reduction in cervical cancer mortality is the ultimate goal of the screening. Quality of death certificate reports has been improved over time, but they are still inaccurate, making it difficult to assess time trends in mortality. to evaluate the accuracy of the topographic coding of causes of death and to estimate the mortality time trend for cervical cancer through the method of incidence-based mortality (IBM) using cancer registry (CR) data. from the mortality registry (MR), we extracted data on deaths for cervix uteri cancer, corpus uteri cancer, and uterus cancer not otherwise specified (NOS) referred to residents in Reggio Emilia (Emilia-Romagna Region, Northern Italy) from 1997 to 2013. Deaths were checked with the CR to verify the topographical site of the primary tumour. Furthermore, by using CR data, we constructed a cohort of incident cervical cancer cases diagnosed between 1997 and 2009 with a 5-year follow-up. We calculated cause-specific IBM (excluding ovary) and IBM for all cause, crude and standardized, and annual percentage change (APC). out of 369 deaths for uterine cancer, 269 were reported in the RT: 32 for cervix uteri cancer, 76 for corpus uteri cancer, 161 for uterus cancer NOS. 28 of the 32 persons who died for cervical cancer were incidents for cervix uteri cancer. 63 of the 76 who died for corpus uteri cancer were incidents for corpus uteri cancer. Of the 161 who died of uterus cancer NOS, 80 were incidents for corpus uteri cancer, 45 for cervix uteri cancer, 28 for uterus cancer NOS, 5 for vagina cancer, and 3 for cancer of other non-specified organs. Applying these proportions of misclassification, we can estimate that the real number of cervical cancer deaths is 2.4 folds the number of cases reported in the MR as cervical cancer. IBM for all causes decreased significantly over the years (APC: -9.5; 95%CI -17.1;-1.1); cause-specific IBM decreases, but not significantly (APC: -5.1; 95%IC -16.1;+7.3). There is no improvement in survival (r

Risk factors and causes of sudden noncardiac death: A nationwide cohort study in Denmark.

Science.gov (United States)

Risgaard, Bjarke; Lynge, Thomas Hadberg; Wissenberg, Mads; Jabbari, Reza; Glinge, Charlotte; Gislason, Gunnar Hilmar; Haunsø, Stig; Winkel, Bo Gregers; Tfelt-Hansen, Jacob

2015-05-01

On the performance of an autopsy, sudden deaths may be divided into 2 classifications: (1) sudden cardiac deaths and (2) sudden noncardiac deaths (SNCDs). Families of SNCD victims should not be followed up as a means of searching for cardiac disease. The purpose of this study was to report the risk factors and causes of SNCD. We conducted a retrospective, nationwide study including all deaths between 2000 and 2006 of individuals aged 1-35 years and all deaths between 2007 and 2009 of individuals aged 1-49 years. Two physicians identified all sudden death cases through review of death certificates. Autopsy reports were collected. A multivariable logistic regression model was used to identify both clinical characteristics and risk factors associated with SNCD. We identified 1039 autopsied cases of sudden death, of which 286 (28%) were classified as SNCD. The median age in the SNCD death population was 32 years. Increasing age was inversely associated with SNCD (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.87-0.98). Female sex, in-hospital location, and the absence of cardiac comorbidities were positively associated with SNCD (OR 1.7, 95% CI 1.3-2.3; OR 3.0, 95% CI 2.0-4.4; and OR 4.3, 95% CI 2.5-7.4, respectively). The most common cause of SNCD was pulmonary disease (n = 115 [40%]). Sudden death among individuals aged caused by noncardiac diseases in 28% of cases. Risk factors were female sex, age, and the absence of cardiac comorbidities. These data may guide future strategies for the follow-up of family members of nonautopsied sudden death victims, improve risk stratification, and influence public health strategies. Copyright © 2015 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Analysis on the training effect of criteria and practical guidance for determination of brain death: electroencephalogram

Directory of Open Access Journals (Sweden)

Wei-bi CHEN

2015-12-01

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

20 CFR 656.24 - Labor certification determinations.

Science.gov (United States)

2010-04-01

... certification applications. (2) If the labor certification presents a special or unique problem, the Director of... opportunity as a college or university teacher, the U.S. worker must be at least as qualified as the alien. (3... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Labor certification determinations. 656.24...

32 CFR 537.20 - Certification to Congress.

Science.gov (United States)

2010-07-01

... 32 National Defense 3 2010-07-01 2010-07-01 true Certification to Congress. 537.20 Section 537.20... BEHALF OF THE UNITED STATES § 537.20 Certification to Congress. Admiralty claims, including claims for... of the Army for approval and if in excess of $500,000 for certification to Congress for final...

9 CFR 156.6 - Certificates.

Science.gov (United States)

2010-01-01

... 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...

Introduction of China's Compulsory Product Certification System (Ⅰ)

Institute of Scientific and Technical Information of China (English)

无

2004-01-01

@@ 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.

Converse Theorems for Safety and Barrier Certificates

OpenAIRE

Ratschan, Stefan

2017-01-01

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.

Combating pharmacist shortage through labor certification.

Science.gov (United States)

Maswoswe, J J; Stewart, K R; Enigbokan, M; Egbunike, I; Jackson, D M

1994-06-01

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.

Implementation of thermographers' certification in Brazil

Science.gov (United States)

dos Santos, Laerte; Alves, Luiz M.; da Costa Bortoni, Edson

2011-05-01

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.

Software Quality Certification: identifying the real obstacles

Directory of Open Access Journals (Sweden)

Megan Baker

1996-05-01

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.

Internal medicine board certification and career pathways in Japan.

Science.gov (United States)

Koike, Soichi; Matsumoto, Masatoshi; Ide, Hiroo; Kawaguchi, Hideaki; Shimpo, Masahisa; Yasunaga, Hideo

2017-05-08

Establishing and managing a board certification system is a common concern for many countries. In Japan, the board certification system is under revision. The purpose of this study was to describe present status of internal medicine specialist board certification, to identify factors associated with maintenance of board certification and to investigate changes in area of practice when physicians move from hospital to clinic practice. We analyzed 2010 and 2012 data from the Survey of Physicians, Dentists and Pharmacists. We conducted logistic regression analysis to identify factors associated with the maintenance of board certification between 2010 and 2012. We also analyzed data on career transition from hospitals to clinics for hospital physicians with board certification. It was common for physicians seeking board certification to do so in their early career. The odds of maintaining board certification were lower in women and those working in locations other than academic hospitals, and higher in physicians with subspecialty practice areas. Among hospital physicians with board certification who moved to clinics between 2010 and 2012, 95.8% remained in internal medicine or its subspecialty areas and 87.7% maintained board certification but changed their practice from a subspecialty area to more general internal medicine. Revisions of the internal medicine board certification system must consider different physician career pathways including mid-career moves while maintaining certification quality. This will help to secure an adequate number and distribution of specialists. To meet the increasing demand for generalist physicians, it is important to design programs to train specialists in general practice.

12 CFR 4.65 - Certification.

Science.gov (United States)

2010-01-01

... 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...

Harmonisation of wind turbine certification in Europe JOULE project EWTC

Energy Technology Data Exchange (ETDEWEB)

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)

1999-03-01

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.

Photovoltaic module certification/laboratory accreditation criteria development

Energy Technology Data Exchange (ETDEWEB)

Osterwald, C.R. [National Renewable Energy Lab., Golden, CO (United States); Hammond, R.L.; Wood, B.D.; Backus, C.E.; Sears, R.L. [Arizona State Univ., Tempe, AZ (United States); Zerlaut, G.A. [SC-International Inc., Phoenix, AZ (United States); D`Aiello, R.V. [RD Associates, Tempe, AZ (United States)

1995-04-01

This document provides an overview of the structure and function of typical product certification/laboratory accreditation programs. The overview is followed by a model program which could serve as the basis for a photovoltaic (PV) module certification/laboratory accreditation program. The model covers quality assurance procedures for the testing laboratory and manufacturer, third-party certification and labeling, and testing requirements (performance and reliability). A 30-member Criteria Development Committee was established to guide, review, and reach a majority consensus regarding criteria for a PV certification/laboratory accreditation program. Committee members represented PV manufacturers, end users, standards and codes organizations, and testing laboratories.

Nursing Informatics Certification Worldwide: History, Pathway, Roles, and Motivation

Science.gov (United States)

Cummins, M. R.; Gundlapalli, A. V.; Murray, P.; Park, H.-A.; Lehmann, C. U.

2016-01-01

Summary Introduction Official recognition and certification for informatics professionals are essential aspects of workforce development. Objective: To describe the history, pathways, and nuances of certification in nursing informatics across the globe; compare and contrast those with board certification in clinical informatics for physicians. Methods (1) A review of the representative literature on informatics certification and related competencies for nurses and physicians, and relevant websites for nursing informatics associations and societies worldwide; (2) similarities and differences between certification processes for nurses and physicians, and (3) perspectives on roles for nursing informatics professionals in healthcare Results The literature search for ‘nursing informatics certification’ yielded few results in PubMed; Google Scholar yielded a large number of citations that extended to magazines and other non-peer reviewed sources. Worldwide, there are several nursing informatics associations, societies, and workgroups dedicated to nursing informatics associated with medical/health informatics societies. A formal certification program for nursing informatics appears to be available only in the United States. This certification was established in 1992, in concert with the formation and definition of nursing informatics as a specialty practice of nursing by the American Nurses Association. Although informatics is inherently interprofessional, certification pathways for nurses and physicians have developed separately, following long-standing professional structures, training, and pathways aligned with clinical licensure and direct patient care. There is substantial similarity with regard to the skills and competencies required for nurses and physicians to obtain informatics certification in their respective fields. Nurses may apply for and complete a certification examination if they have experience in the field, regardless of formal training. Increasing

78 FR 16779 - Type Certification Procedures for Changed Products

Science.gov (United States)

2013-03-19

...-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...

13 CFR 120.612 - Loans eligible to back Certificates.

Science.gov (United States)

2010-01-01

... 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...

Guidelines for developing certification programs for newly generated TRU waste

International Nuclear Information System (INIS)

Whitty, W.J.; Ostenak, C.A.; Pillay, K.K.S.; Geoffrion, R.R.

1983-05-01

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

Enacting Third-Party Certification: A Case Study of Science and Politics in Organic Shrimp Certification

Science.gov (United States)

Konefal, Jason; Hatanaka, Maki

2011-01-01

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…

Certification of medical librarians, 1949--1977 statistical analysis.

Science.gov (United States)

Schmidt, D

1979-01-01

The Medical Library Association's Code for Training and Certification of Medical Librarians was in effect from 1949 to August 1977, a period during which 3,216 individuals were certified. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on each type of certificate granted each year are provided. Because 54.5% of those granted certification were awarded it in the last three-year, two-month period of the code's existence, these applications are reviewed in greater detail. Statistics on MLA membership, sex, residence, library school, and method of meeting requirements are detailed. Questions relating to certification under the code now in existence are raised.

The benefit of external cephalic version with tocolysis as a routine procedure in late pregnancy

DEFF Research Database (Denmark)

Thunedborg, P; Fischer-Rasmussen, W; Tollund, L

1991-01-01

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...

The significance of routines in nursing practice.

Science.gov (United States)

Rytterström, Patrik; Unosson, Mitra; Arman, Maria

2011-12-01

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.

Certifications of citizenship: reflections through an African lens

DEFF Research Database (Denmark)

Hammar, Amanda

2018-01-01

A focus on certifications of citizenship as a range of inter-related practices of identity classification, categorisation, registration and validation, provides productive opportunities to explore the many ways that different authorities and/or different citizens engage with both the meaning...... and materiality of identity documents. At the heart of such practices is a complex politics of recognition that in turn is linked to the political economies of certification and of certificates themselves. A selection of African cases helps to highlight some of the paradoxes of certification – such as its...... and Asia and beyond, making transnational conversations especially meaningful for deeper understandings of the complexities of the authority-certification-citizenship nexus....

77 FR 71691 - Type Certification Procedures for Changed Products

Science.gov (United States)

2012-12-04

...-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...

21 CFR 80.37 - Treatment of batch pending certification.

Science.gov (United States)

2010-04-01

... 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...

Green certificates and greenhouse gas emissions certificates - Instruments of the liberalized electricity market in Romania

International Nuclear Information System (INIS)

Matei, Magdalena; Salisteanu, Cornel; Enescu, Diana; Ene, Simona; Matei, Lucian; Marinescu, Mihai

2006-01-01

Governmental Decision No. 443/2003 and GD 1892 / 2004 aimed to the harmonization of the Romanian legislative framework with EU Directive 2001/77/EC which purposes to promote an increasing in the contribution of RES to electricity production in the internal market for electricity. In Romania's case green certificate system was adopted with mandatory quotas for suppliers as a national target for 2010 of 33 % of total consumption to be covered by electricity produced from renewable energy sources. The annual maximum and minimum value for Green Certificates trading is 24 Euro/certificate and 42 Euro/certificate, respectively. Suppliers are obliged to buy yearly a number of Green certificates equal with the mandatory quota multiplied with the amount of electricity sold yearly to their final consumers. The additional price received for the Green Certificates sold is determined on a parallel market, separated from the electricity market, where the environmental benefits of the 'clean' electricity production are traded. The regulator can modify these quotas established by Government Decision when the installed capacity in the power plants which use RES cannot secure the demand of Green Certificates; This system was introduced in November 2005. The number of issued green certificates in 2005 was only 345, so by ANRE Order no. 46 / 2005, the mandatory quota for 2005 was reduced at 2.6% from legal quota established for 2005. In the first month of 2006 5997 Green Certificates were sold at the price of 146 RON. Emissions trading is the most compatible flexible mechanisms of Kyoto Protocol with deregulated electricity markets. The Directive 2003/87/CE referring at CO 2 emission trading within Europe came into force and till 31 March 2004 all the countries had to present to the Commission their national plan to comply with Directive's rules. There is great uncertainty worldwide on how GHG emissions reduction and trading schemes will develop. Previous visions of a single (Kyoto

Impact of Rabies Vaccination History on Attainment of an Adequate Antibody Titre Among Dogs Tested for International Travel Certification, Israel - 2010-2014.

Science.gov (United States)

Yakobson, B; Taylor, N; Dveres, N; Rotblat, S; Spero, Ż; Lankau, E W; Maki, J

2017-06-01

Rabies is endemic in wildlife or domestic carnivore populations globally. Infection of domestic dogs is of particular concern in many areas. In regions where domestic animals are at risk of exposure to rabies virus, dogs should be routinely vaccinated against rabies to protect both pet and human populations. Many countries require demonstration of an adequate level of serum rabies neutralizing antibodies to permit entry of dogs during international travel. We analysed rabies titres of dogs seeking travel certification in Israel to assess demographic and vaccine history factors associated with antibody titres below the acceptable threshold for travel certification. Having received only one previous rabies vaccination and a longer duration since the most recent vaccination was received were primary risk factors for not achieving an adequate rabies virus neutralizing antibody titre for travel certification. These risk factors had stronger effects in younger animals, but were consistent for dogs of all ages. In particular, these findings reiterate the importance of administering at least two rabies vaccinations (the primo vaccination and subsequent booster) to ensure population-level protection against rabies in dogs globally. © 2016 Blackwell Verlag GmbH.

Data format translation routines

International Nuclear Information System (INIS)

Burris, R.D.

1981-02-01

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

Routines and Organizational Change

DEFF Research Database (Denmark)

Yi, Sangyoon; Becker, Markus; Knudsen, Thorbjørn

2014-01-01

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...

45 CFR 170.457 - Authorized testing and certification methods.

Science.gov (United States)

2010-10-01

... TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT...

Environmental aspects of the forest management certification process

CSIR Research Space (South Africa)

Scott, DF

2000-01-01

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...

Directory of certificates of compliance for radioactive materials packages: Certificates of compliance

International Nuclear Information System (INIS)

1987-11-01

This directory contains a Summary Report of the US Nuclear Regulatory Commission's Certificates of Compliance (Volume 2) for Radioactive Material Packages effective October 1, 1987. This directory makes available a convenient source of information on packagings which have been approved by the US Nuclear Regulatory Commission. To assist in identifying packaging, an index by Model Number and corresponding Certificate of Compliance Number is included at the back of Volume 2 of the directory. A listing by packaging types is included in the back of Volume 2

Symptoms Before Sudden Arrhythmic Death Syndrome: A Nationwide Study Among the Young in Denmark.

Science.gov (United States)

Glinge, Charlotte; Jabbari, Reza; Risgaard, Bjarke; Lynge, Thomas Hadberg; Engstrøm, Thomas; Albert, Christine M; Haunsø, Stig; Winkel, Bo Gregers; Tfelt-Hansen, Jacob

2015-07-01

No studies in an unselected and nationwide setting have characterized the symptoms and medical history of patients with sudden arrhythmic death syndrome (SADS). The aim of this study was to identify and describe the symptoms and medical history of patients before the presentation of SADS. We have previously identified all of the autopsied sudden cardiac deaths (SCD; n = 314) in Danes aged 1-35 years between 2000 and 2006. After comprehensive pathological and toxicological investigation did not reveal a cause of SCD, 136 of the patients were identified as SADS. The National Patient Registry was utilized to obtain information on all in- and outpatient activity in Danish hospitals. All medical records from hospitals and general practitioners, including death certificates and autopsy reports were reviewed. Before death, 48 (35%) SADS patients had cardiac symptoms; among these, 30 (22%) had contacted the healthcare system. Antecedent symptoms (symptoms >24 hours before death) were present in 34 (25%) patients. Prodromal symptoms (symptoms ≤24 hours before death) were present in 23 (17%) patients. Cardiac symptoms included chest pain (n = 16, 12%), dyspnea (n = 18, 13%), palpitations (n = 2, 1%), presyncope/syncope (n = 23, 17%), and aborted SCD (n = 2, 1%). In addition, seizures (n = 25, 18%) were prevalent. In 61 (45%) SADS cases, no previous medical history were recorded. In this unselected, nationwide study of 136 young SADS patients, 35% had experienced cardiac symptoms before death, most commonly presyncope/syncope, but only one out of five had contacted a healthcare provider with cardiac symptoms. © 2015 Wiley Periodicals, Inc.

Cause-Specific Mortality and Death Certificate Reporting in Adults with Moderate to Profound Intellectual Disability

Science.gov (United States)

Tyrer, F.; McGrother, C.

2009-01-01

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…

Causes of death among undocumented migrants in Sweden, 1997–2010

Directory of Open Access Journals (Sweden)

Anna Wahlberg

2014-06-01

Full Text Available Background: Undocumented migrants are one of the most vulnerable groups in Swedish society, where they generally suffer from poor health and limited health care access. Due to their irregular status, such migrants are an under-researched group and are not included in the country's Cause of Death Register (CDR. Objective: To determine the causes of death among undocumented migrants in Sweden and to ascertain whether there are patterns in causes of death that differ between residents and undocumented migrants. Design: This is a cross-sectional study of death certificates issued from 1997 to 2010 but never included in the CDR from which we established our study sample of undocumented migrants. As age adjustments could not be performed due to lack of data, comparisons between residents and undocumented migrants were made at specific age intervals, based on the study sample's mean age at death±a half standard deviation. Results: Out of 7,925 individuals surveyed, 860 were classified as likely to have been undocumented migrants. External causes (49.8% were the most frequent cause of death, followed by circulatory system diseases, and then neoplasms. Undocumented migrants had a statistically significant increased risk of dying from external causes (odds ratio [OR] 3.57, 95% confidence interval [CI]: 2.83–4.52 and circulatory system diseases (OR 2.20, 95% CI: 1.73–2.82 compared to residents, and a lower risk of dying from neoplasms (OR 0.07, 95% CI: 0.04–0.14. Conclusions: We believe our study is the first to determine national figures on causes of death of undocumented migrants. We found inequity in health as substantial differences in causes of death between undocumented migrants and residents were seen. Legal ambiguities regarding health care provision must be addressed if equity in health is to be achieved in a country otherwise known for its universal health coverage.

24 CFR 232.610 - Certification of cost requirements.

Science.gov (United States)

2010-04-01

... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Certification of cost requirements... ASSISTED LIVING FACILITIES Eligibility Requirements-Supplemental Loans To Finance Purchase and Installation of Fire Safety Equipment Cost Certification Requirements § 232.610 Certification of cost requirements...

Autodesk Revit Architecture 2014 review for certification official certification preparation

CERN Document Server

ASCENT center for technical knowledge

2014-01-01

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.

Accounting Changes on Green Certificates in Romania

Directory of Open Access Journals (Sweden)

Sava Raluca

2017-01-01

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.

48 CFR 1609.471 - Contractor certification.

Science.gov (United States)

2010-10-01

... 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...

Systematic review of statistics on causes of deaths in hospitals: strengthening the evidence for policy-makers.

Science.gov (United States)

Rampatige, Rasika; Mikkelsen, Lene; Hernandez, Bernardo; Riley, Ian; Lopez, Alan D

2014-11-01

To systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method. We searched Google Scholar, Pubmed and Biblioteca Virtual de la Salud for articles in English, Spanish and Portuguese that reported validation studies of data on cause of death. We analysed the results of 199 studies that had used medical record reviews to validate the cause of death reported on death certificates or by the vital registration system. The screened studies had been published between 1983 and 2013 and their results had been reported in English (n = 124), Portuguese (n = 25) or Spanish (n = 50). Only 29 of the studies met our inclusion criteria. Of these, 13 had examined cause of death patterns at the population level - with a view to correcting cause-specific mortality fractions - while the other 16 had been undertaken to identify discrepancies in the diagnosis for specific diseases before and after medical record review. Most of the selected studies reported substantial misdiagnosis of causes of death in hospitals. There was wide variation in study methodologies. Many studies did not describe the methods used in sufficient detail to be able to assess the reproducibility or comparability of their results. The assumption that causes of death are being accurately reported in hospitals is unfounded. To improve the reliability and usefulness of reported causes of death, national governments should do periodic medical record reviews to validate the quality of their hospital cause of death data, using a standard.

Mortality and causes of death in children referred to a tertiary epilepsy center.

Science.gov (United States)

Grønborg, Sabine; Uldall, Peter

2014-01-01

Patients with epilepsy, including children, have an increased mortality rate when compared to the general population. Only few studies on causes of mortality in childhood epilepsy exist and pediatric SUDEP rate is under continuous discussion. To describe general mortality, incidence of sudden unexpected death in epilepsy (SUDEP), causes of death and age distribution in a pediatric epilepsy patient population. The study retrospectively examined the mortality and causes of death in 1974 patients with childhood-onset epilepsy at a tertiary epilepsy center in Denmark over a period of 9 years. Cases of death were identified through their unique civil registration number. Information from death certificates, autopsy reports and medical notes were collected. 2.2% (n = 43) of the patient cohort died during the study period. This includes 9 patients with SUDEP (8 SUDEP cases per 10,000 patient years). 9 patients died in the course of neurodegenerative disease and 28 children died of various causes. Epilepsy was considered drug resistant in more than 95% of the deceased patients, 90% were diagnosed with intellectual disability. Mortality of patients that underwent dietary epilepsy treatment was slightly higher than in the general cohort. There were no epilepsy-related deaths due to drowning. This study confirms that SUDEP must not be disregarded in the pediatric age group. The vast majority of SUDEP cases in this study displays numerous risk factors similar to those described in adult epilepsy patients. Including SUDEP, only 30% of the mortality was directly seizure related. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Environmental certification for more sustainable imports

International Nuclear Information System (INIS)

Henry, Lucile; Monnoyer-Smith, Laurence; Demeulenaere, Laurence

2017-12-01

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)

47 CFR 2.1043 - Changes in certificated equipment.

Science.gov (United States)

2010-10-01

... certificated or formerly type accepted AM broadcast stereophonic exciter-generator with a certificated or... interconnection of a multiplexing exciter with a certificated or formerly type accepted AM broadcast transmitter... generators to a type accepted FM broadcast transmitter, provided the transmitter exciter is designed for...

77 FR 2036 - Export Trade Certificate of Review

Science.gov (United States)

2012-01-13

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 92-10A001] Export Trade Certificate of Review ACTION: Notice of issuance of an Export Trade Certificate of Review to Aerospace... an amended Export Trade Certificate of Review to Aerospace Industries of America on September 27...

78 FR 78816 - Export Trade Certificate of Review

Science.gov (United States)

2013-12-27

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 87-9A001] Export Trade Certificate of Review ACTION: Notice of Issuance of an Amended Export Trade Certificate of Review to... issued an amended Export Trade Certificate of Review to Independent Film and Television Alliance (``IFTA...

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

Directory of Open Access Journals (Sweden)

Ricardo Granero

1997-09-01

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

Accidents and undetermined deaths: re-evaluation of nationwide samples from the Scandinavian countries.

Science.gov (United States)

Tøllefsen, Ingvild Maria; Thiblin, Ingemar; Helweg-Larsen, Karin; Hem, Erlend; Kastrup, Marianne; Nyberg, Ullakarin; Rogde, Sidsel; Zahl, Per-Henrik; Østevold, Gunvor; Ekeberg, Øivind

2016-05-27

National mortality statistics should be comparable between countries that use the World Health Organization's International Classification of Diseases. Distinguishing between manners of death, especially suicides and accidents, is a challenge. Knowledge about accidents is important in prevention of both accidents and suicides. The aim of the present study was to assess the reliability of classifying deaths as accidents and undetermined manner of deaths in the three Scandinavian countries and to compare cross-national differences. The cause of death registers in Norway, Sweden and Denmark provided data from 2008 for samples of 600 deaths from each country, of which 200 were registered as suicides, 200 as accidents or undetermined manner of deaths and 200 as natural deaths. The information given to the eight experts was identical to the information used by the Cause of Death Register. This included death certificates, and if available external post-mortem examinations, forensic autopsy reports and police reports. In total, 69 % (Sweden and Norway) and 78 % (Denmark) of deaths registered in the official mortality statistics as accidents were confirmed by the experts. In the majority of the cases where disagreement was seen, the experts reclassified accidents to undetermined manner of death, in 26, 25 and 19 % of cases, respectively. Few cases were reclassified as suicides or natural deaths. Among the extracted accidents, the experts agreed least with the official mortality statistics concerning drowning and poisoning accidents. They also reported most uncertainty in these categories of accidents. In a second re-evaluation, where more information was made available, the Norwegian psychiatrist and forensic pathologist increased their agreement with the official mortality statistics from 76 to 87 %, and from 85 to 88 %, respectively, regarding the Norwegian and Swedish datasets. Among the extracted undetermined deaths in the Swedish dataset, the two experts

78 FR 13861 - Export Trade Certificate of Review

Science.gov (United States)

2013-03-01

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 85-17A18] Export Trade Certificate of Review ACTION: Notice of Issuance of an Amended Export Trade Certificate of Review to U.S..., Office of Competition and Economic Analysis (OCEA), has issued an amended Export Trade Certificate of...

77 FR 61744 - Export Trade Certificate of Review

Science.gov (United States)

2012-10-11

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 10-3A001] Export Trade Certificate of Review ACTION: Notice of Issuance of an Export Trade Certificate of Review to Alaska Longline... Commerce issued an amended Export Trade Certificate of Review to the Alaska Longline Cod Commission (``ALCC...

78 FR 25060 - Export Trade Certificate of Review

Science.gov (United States)

2013-04-29

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 92-11A001] Export Trade Certificate of Review ACTION: Notice of Issuance of an amended Export Trade Certificate of Review to Aerospace... issued an amended Export Trade Certificate of Review to Aerospace Industries Association of America on...

13 CFR 120.611 - Pools backing Pool Certificates.

Science.gov (United States)

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Pools backing Pool Certificates. 120.611 Section 120.611 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Secondary Market Certificates § 120.611 Pools backing Pool Certificates. (a) Pool characteristics. As set...

78 FR 5778 - Export Trade Certificate of Review

Science.gov (United States)

2013-01-28

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 92-11A01] Export Trade Certificate of Review ACTION: Notice of Application (92-11A01) to amend the Export Trade Certificate of Review... of Commerce, has received an application to amend an Export Trade Certificate of Review...

Plasma HIV-1 Tropism and the Risk of Short-Term Clinical Progression to AIDS or Death

DEFF Research Database (Denmark)

Casadellà, Maria; Cozzi-Lepri, Alessandro; Phillips, Andrew

2017-01-01

OBJECTIVE: To investigate if plasma HIV-1 tropism testing could identify subjects at higher risk for clinical progression and death in routine clinical management. DESIGN: Nested case-control study within the EuroSIDA cohort. METHODS: Cases were subjects with AIDS or who died from any cause...

System certification: An alternative to package certification?

International Nuclear Information System (INIS)

Luna, R.E.; Jefferson, R.J.

1992-01-01

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

PMP Certification All-In-One Desk Reference For Dummies

CERN Document Server

Stackpole, Cynthia Snyder

2011-01-01

Be as prepared as possible to take the PMP certification exam The PMP certification is the most popular project management certification available, but also a very difficult certification to obtain with very demanding requirements. That's where this All-in-One reference comes in. Packed with valuable information for taking the exam, the nine books in one covers everything from the certification process to gathering information for the application and signing up to take the exam, as well as studying for the most pertinent parts of the Project Management Body of Knowledge (PMBOK), and review que

14 CFR 121.437 - Pilot qualification: Certificates required.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Pilot qualification: Certificates required... Pilot qualification: Certificates required. (a) No pilot may act as pilot in command of an aircraft (or... pilots) unless he holds an airline transport pilot certificate and an appropriate type rating for that...

77 FR 28853 - Export Trade Certificate of Review

Science.gov (United States)

2012-05-16

... DEPARTMENT OF COMMERCE International Trade Administration [Application No. 10-2A001] Export Trade Certificate of Review ACTION: Notice of issuance of an Export Trade Certificate of Review to Alaska Longline... Export Trade Certificate of Review Alaska Longline Cod Commission (``ALCC'') on May 7, 2012. This is the...

46 CFR 115.910 - Passenger Ship Safety Certificate.

Science.gov (United States)

2010-10-01

...) The route specified on the Certificate of Inspection and the SOLAS Passenger Ship Safety Certificate... 46 Shipping 4 2010-10-01 2010-10-01 false Passenger Ship Safety Certificate. 115.910 Section 115... MORE THAN 150 PASSENGERS OR WITH OVERNIGHT ACCOMMODATIONS FOR MORE THAN 49 PASSENGERS INSPECTION AND...

49 CFR 179.11 - Welding certification.

Science.gov (United States)

2010-10-01

... 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...

THE THIRD PARTY CERTIFICATION SYSTEM FOR ORGANIC PRODUCTS

Directory of Open Access Journals (Sweden)

Adina-Roxana MUNTEANU

2015-12-01

Full Text Available In the context of an increasing organic trade worldwide, the organic standards and the certification of the organic practices are ever more important and relevant for both business and consumers. The certification by third parties of the organic operators is meant to ensure the application of an organic standard. However, the documented fraud cases are proof that the current system can undergo further improvement. The current paper gives an overview of the mechanisms of certification and inspection worldwide and discusses the issues raised by third party certification of the organic operators in the European context. Moreover, the paper reviews the major arguments for the effectiveness of the third party certification and also points to the improvement possibilities of the systems.

Detection of programmed cell death in plant embryos.

Science.gov (United States)

Filonova, Lada H; Suárez, María F; Bozhkov, Peter V

2008-01-01

Programmed cell death (PCD) is an integral part of embryogenesis. In plant embryos, PCD functions during terminal differentiation and elimination of the temporary organ, suspensor, as well as during establishment of provascular system. Embryo abortion is another example of embryonic PCD activated at pathological situations and in polyembryonic seeds. Recent studies identified the sequence of cytological events leading to cellular self-destruction in plant embryos. As in most if not all the developmental cell deaths in plants, embryonic PCD is hallmarked by autophagic degradation of the cytoplasm and nuclear disassembly that includes breakdown of the nuclear envelope and DNA fragmentation. The optimized setup of terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) allows the routine in situ analysis of nuclear DNA fragmentation in plant embryos. This chapter provides step-by-step procedure of how to process embryos for TUNEL and how to combine TUNEL with immunolocalization of the protein of interest.

Certification of a weld produced by friction stir welding

Science.gov (United States)

Obaditch, Chris; Grant, Glenn J

2013-10-01

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.

Innovative Telemonitoring System for Cardiology: From Science to Routine Operation

Science.gov (United States)

Kastner, P.; Morak, J.; Modre, R.; Kollmann, A.; Ebner, C.; Fruhwald, FM.; Schreier, G.

2010-01-01

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

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.

Science.gov (United States)

Schmid, Sofie; Tsantilas, Pavlos; Knappich, Christoph; Kallmayer, Michael; König, Thomas; Breitkreuz, Thorben; Zimmermann, Alexander; Kuehnl, Andreas; Eckstein, Hans-Henning

2017-03-13

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.

7 CFR 1250.530 - Certification of exempt producers.

Science.gov (United States)

2010-01-01

... section 2103 of the Organic Foods Production Act of 1990 (7 U.S.C. 6502), a signed certification that the... 7 Agriculture 10 2010-01-01 2010-01-01 false Certification of exempt producers. 1250.530 Section... RESEARCH AND PROMOTION Rules and Regulations Registration, Certification and Reports § 1250.530...

29 CFR 570.12 - Revoked certificates of age.

Science.gov (United States)

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Revoked certificates of age. 570.12 Section 570.12 Labor Regulations Relating to Labor (Continued) WAGE AND HOUR DIVISION, DEPARTMENT OF LABOR REGULATIONS CHILD LABOR REGULATIONS, ORDERS AND STATEMENTS OF INTERPRETATION Certificates of Age § 570.12 Revoked certificates of age...

46 CFR 176.910 - Passenger Ship Safety Certificate.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Passenger Ship Safety Certificate. 176.910 Section 176... 100 GROSS TONS) INSPECTION AND CERTIFICATION International Convention for Safety of Life at Sea, 1974, as Amended (SOLAS) § 176.910 Passenger Ship Safety Certificate. (a) A vessel, which carries more than...

Medical Certification System -

Data.gov (United States)

Department of Transportation — Provides automated risk-based decision making capability in support of medical certification and clearances processing associated fees and supporting surveillance of...

5th international conference on certification and standardization in NDT

International Nuclear Information System (INIS)

2007-01-01

This CD-ROM contains 30 lectures (in form of manuscripts or abstracts) and 6 posters with the following topics: 1. Some Critical Remarks from German Chemical Industry on Certification and Accreditation in NDT. 2. Global Impact of International Standard ISO 9712. 3. Maintaining Concurrent Compliance with Multiple NDT Personnel Certification Standards. 4. The Revision of the New Approach. 5. Comparison between prEN 473 Currently Submitted to Formal Vote and ISO 9712:2005. 6. Accreditation and Certification - a Contradiction?. 7. The Way We Were. 8. EFNDT-Question-Data-Bank (QDB). 9. NDT Certification in Turkey as an European Country- How It Couldn't Work as the Only Example?. 10. Validation of Practical Examination Specimens. 11. Examination Bank Structure for Radiographic Testing (RT) - An Example. 12. About the New Classification of NDT Methods Based on Positions of Risks and Equipment Life Assessment. 13. Olympus NDT Training Academy. 14. Harmonisation of Personnel Certification Schemes for Non-destructive Testing in the Asia-Pacific Region. 15. How EFNDT Can Help in Accreditation or Recognition/Approval of NDT Certification Bodies? 16. SNT-TC-1A - 40 Years of Employer Certification for NDT Personnel. 17. The Same NDT Certification Scheme for Everybody: a Dream or a Need. 18. 19. Personnel Certification for Thermographers - Status and Trends. 20. Guided Wave Training and Certification. 21. Examination Radiographs and Master Reports for the Industrial Sectors 6 and 7. 22. New Standards ISO 24497 on the Metal Magnetic Memory Method. The Program of Personnel Training and Certification. 23. The Use of the Psychometrics in NDT Certification Programs. 24. EFNDT Guidelines ''Overall NDT Quality System''. 25. The Role of the Forum for National Aerospace NDT Boards. 26. Don't Forget, We Are Supposed to Be Representing Industry. 27. Don't Forget, We Are Supposed to Be Representing Industry. 28. The Need for Standardization in NDT Personnel Certification. 29. NDT

40 CFR 86.007-30 - Certification.

Science.gov (United States)

2010-07-01

... 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...

5 CFR 430.404 - Certification criteria.

Science.gov (United States)

2010-01-01

... 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...

29 CFR 1926.29 - Acceptable certifications.

Science.gov (United States)

2010-07-01

... 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. ...

Solid low-level waste certification strategy

International Nuclear Information System (INIS)

Smith, M.A.

1991-08-01

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

Maternal and pregnancy-related death: causes and frequencies in an autopsy study population.

Science.gov (United States)

Buschmann, Claas; Schmidbauer, Martina; Tsokos, Michael

2013-09-01

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.

Increased Exposure to Rigid Routines Can Lead to Increased Challenging Behavior Following Changes to Those Routines

Science.gov (United States)

Bull, Leah E.; Oliver, Chris; Callaghan, Eleanor; Woodcock, Kate A.

2015-01-01

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…

15 CFR 50.60 - Request for certification.

Science.gov (United States)

2010-01-01

... 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...

[Optimization of registry of deaths from chronic kidney disease in agricultural communities in Central America].

Science.gov (United States)

Escamilla-Cejudo, José Antonio; Báez, Jorge Lara; Peña, Rodolfo; Luna, Patricia Lorena Ruiz; Ordunez, Pedro

2016-11-01

Several Central American countries are seeing continued growth in the number of deaths from chronic kidney disease of nontraditional causes (CKDnT) among farm workers and there is underreporting. This report presents the results of a consensus process coordinated by the Pan American Health Organization/World Health Organization (PAHO/WHO), the United States Centers for Disease Control and Prevention (CDC), and the Latin American Society of Nephrology and Hypertension (SLANH). This consensus seeks to increase the probability of detecting and recording deaths from these causes. There has been recognition of the negative impact of the lack of a standardized instrument and the lack of training in the medical profession for adequate registration of the cause or causes of death. As a result of the consensus, the following has been proposed: temporarily use a code from the Codes for Special Purposes in the International Classification of Diseases (ICD-10); continue to promote use of the WHO international standardized instrument for recording causes and preceding events related to death; increase training of physicians responsible for filling out death certificates; take action to increase the coverage and quality of information on mortality; and create a decision tree to facilitate selection of CKDnT as a specific cause of death, while presenting the role that different regional and subregional mechanisms in the Region of the Americas should play in order to improve CKD and CKDnT mortality records.

The electricity certificate system, 2007

Energy Technology Data Exchange (ETDEWEB)

2007-07-01

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

Causes of Death among AIDS Patients after Introduction of Free Combination Antiretroviral Therapy (cART) in Three Chinese Provinces, 2010-2011.

Science.gov (United States)

Wang, Liyan; Ge, Lin; Wang, Lu; Morano, Jamie P; Guo, Wei; Khoshnood, Kaveh; Qin, Qianqian; Ding, Zhengwei; Sun, Dingyong; Liu, Xiaoyan; Luo, Hongbing; Tillman, Jonas; Cui, Yan

2015-01-01

Although AIDS-related deaths have had significant economic and social impact following an increased disease burden internationally, few studies have evaluated the cause of AIDS-related deaths among patients with AIDS on combination anti-retroviral therapy (cART) in China. This study examines the causes of death among AIDS-patients in China and uses a methodology to increase data accuracy compared to the previous studies on AIDS-related mortality in China, that have taken the reported cause of death in the National HIV Registry at face-value. Death certificates/medical records were examined and a cross-sectional survey was conducted in three provinces to verify the causes of death among AIDS patients who died between January 1, 2010 and June 30, 2011. Chi-square analysis was conducted to examine the categorical variables by causes of death and by ART status. Univariate and multivariate logistic regression were used to evaluate factors associated with AIDS-related death versus non-AIDS related death. This study used a sample of 1,109 subjects. The average age at death was 44.5 years. AIDS-related deaths were significantly higher than non-AIDS and injury-related deaths. In the sample, 41.9% (465/1109) were deceased within a year of HIV diagnosis and 52.7% (584/1109) of the deceased AIDS patients were not on cART. For AIDS-related deaths (n = 798), statistically significant factors included CD4 count causes compared to those who didn't initiate ART at all.

“Laugh or I’ll Die”: Facing Death on the Stand-up Comedy Stage

DEFF Research Database (Denmark)

Keisalo, Marianna Päivikki

may be at odds with the idea that humor is supposed to be enjoyable, but stand-up comedy comes with risks for both performer and audience. What draws the comedian to keep trying, to face annihilation time after time? I suggest these high emotional stakes are part of the value of comedy, which may...... be at its most enjoyable when it provides a way to engage with fear and pain. Death is also a fairly common topic in comedy routines – death of a loved one, fear of death, etc. Thus, I present a view of stand-up comedy as facing death in both its off-stage and on-stage forms, in relation to the digressions...... on semiotic excess. Comedic digression allows – even requires – us to find new perspectives on the imperatives of life, and a well-timed improvised digression can save a show going badly. The research is based on 20 months of field work in Finland, including becoming an amateur comedian myself....

Online news media reporting of football-related fatalities in Australia: A matter of life and death.

Science.gov (United States)

Fortington, Lauren V; Bekker, Sheree; Finch, Caroline F

2018-03-01

While deaths in sports settings are rare, they do occur. To develop an understanding of the sports and people most at risk, and to identify opportunities for prevention, routine and systematic data detailing the occurrence of these fatalities is required. There is currently no routine reporting of data of this nature in Australia. As there is often strong community interest in these incidents, the media offers an opportunity for surveillance. However before this can occur, understanding of the terminology used by the media is required. The aim of this study was to identify the terminology most frequently used in online Australian news media coverage of football-related deaths. Retrospective review of online news media. Three databases were searched for online news media reports of people who died while participating in football (all football codes) in Australia. A descriptive analysis of terminology was undertaken to identify the common language applied. Thirty-four football-related fatalities in Australia were identified between 2010-2016, via 149 separate articles. The most frequent terms identified in the media items were: Family; Club; Rugby; Football; Player; League; Died; Game; Death; Life; Loved; Hospital; Match; Young; Community; Playing; Friends; Sport; Heart; AFL [Australian Football League]. This study identified terminology used in reporting football-related fatalities in Australia, identifying common reference to terms relating to 'death' as metaphors and the frequent celebration of 'life.' The findings suggest that a reliance on researcher-generated terminology will be insufficient to reflect media discourse in prospective monitoring of sports deaths for surveillance. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

21 CFR 1311.20 - Coordinators for CSOS digital certificate holders.

Science.gov (United States)

2010-04-01

... application that the DEA Certification Authority provides and submit the following: (1) Two copies of... Certification Authority, all digital certificate activities are the responsibility of the registrant with whom... designated, coordinators must identify themselves, on a one-time basis, to the Certification Authority. If a...

The electricity certificate system, 2009

Energy Technology Data Exchange (ETDEWEB)

Joehnemark, Maria; Oestberg, Roger; Johansson, Martin

2009-07-01

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

General certification procedure of formation organizations

CERN Document Server

Int. At. Energy Agency, Wien

2002-01-01

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.)

9 CFR 93.913 - Health certificate.

Science.gov (United States)

2010-01-01

... 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...

40 CFR 94.210 - Amending the application and certificate of conformity.

Science.gov (United States)

2010-07-01

... certificate of conformity. 94.210 Section 94.210 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Certification Provisions § 94.210 Amending the application and certificate of conformity. (a) The manufacturer... for certification are to be made to a product line covered by a certificate of conformity. This...

Intraoperative Death During Cervical Spinal Surgery: A Retrospective Multicenter Study.

Science.gov (United States)

Wang, Jeffrey C; Buser, Zorica; Fish, David E; Lord, Elizabeth L; Roe, Allison K; Chatterjee, Dhananjay; Gee, Erica L; Mayer, Erik N; Yanez, Marisa Y; McBride, Owen J; Cha, Peter I; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

A retrospective multicenter study. Routine cervical spine surgeries are typically associated with low complication rates, but serious complications can occur. Intraoperative death is a very rare complication and there is no literature on its incidence. The purpose of this study was to determine the intraoperative mortality rates and associated risk factors in patients undergoing cervical spine surgery. Twenty-one surgical centers from the AOSpine North America Clinical Research Network participated in the study. Medical records of patients who received cervical spine surgery from January 1, 2005, to December 31, 2011, were reviewed to identify occurrence of intraoperative death. A total of 258 patients across 21 centers met the inclusion criteria. Most of the surgeries were done using the anterior approach (53.9%), followed by posterior (39.1%) and circumferential (7%). Average patient age was 57.1 ± 13.2 years, and there were more male patients (54.7% male and 45.3% female). There was no case of intraoperative death. Death during cervical spine surgery is a very rare complication. In our multicenter study, there was a 0% mortality rate. Using an adequate surgical approach for patient diagnosis and comorbidities may be the reason how the occurrence of this catastrophic adverse event was prevented in our patient population.

Trial Watch: Immunogenic cell death inducers for anticancer chemotherapy.

Science.gov (United States)

Pol, Jonathan; Vacchelli, Erika; Aranda, Fernando; Castoldi, Francesca; Eggermont, Alexander; Cremer, Isabelle; Sautès-Fridman, Catherine; Fucikova, Jitka; Galon, Jérôme; Spisek, Radek; Tartour, Eric; Zitvogel, Laurence; Kroemer, Guido; Galluzzi, Lorenzo

2015-04-01

The term "immunogenic cell death" (ICD) is now employed to indicate a functionally peculiar form of apoptosis that is sufficient for immunocompetent hosts to mount an adaptive immune response against dead cell-associated antigens. Several drugs have been ascribed with the ability to provoke ICD when employed as standalone therapeutic interventions. These include various chemotherapeutics routinely employed in the clinic (e.g., doxorubicin, epirubicin, idarubicin, mitoxantrone, bleomycin, bortezomib, cyclophosphamide and oxaliplatin) as well as some anticancer agents that are still under preclinical or clinical development (e.g., some microtubular inhibitors of the epothilone family). In addition, a few drugs are able to convert otherwise non-immunogenic instances of cell death into bona fide ICD, and may therefore be employed as chemotherapeutic adjuvants within combinatorial regimens. This is the case of cardiac glycosides, like digoxin and digitoxin, and zoledronic acid. Here, we discuss recent developments on anticancer chemotherapy based on ICD inducers.

Linking Halal Food Certification and Business Performance

DEFF Research Database (Denmark)

Ab Talib, Mohamed Syazwan; Chin, Thoo Ai; Fischer, Johan

2017-01-01

, 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...

Methodologies for certification of transuranic waste packages

International Nuclear Information System (INIS)

Christensen, R.N.; Kok, K.D.

1980-10-01

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

Cerebrovascular and hypertensive diseases as multiple causes of death in Brazil from 2004 to 2013.

Science.gov (United States)

Villela, P B; Klein, C H; Oliveira, G M M

2018-06-02

The proportion of deaths attributed to hypertensive diseases (HYPDs) was only 50% of that registered for cerebrovascular diseases (CBVDs) in 2013 in Brazil. This article aims to evaluate mortality related to HYPDs and CBVDs as multiple causes of death, in Brazil from 2004 to 2013. Analysis of historical series of secondary data obtained from Brazilian official registries. Data about the deaths were obtained from the Mortality Information System of the Brazilian Ministry of Health, available on the DATASUS website. CBVDs and HYPDs were evaluated according to their mentions as the underlying cause of death or entry in any line of the death certificates (DCs), according to their International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. When CBVDs were the underlying causes of death, HYPDs were mentioned in 40.9% of the DCs. When HYPDs were the underlying causes of death, CBVDs were mentioned in only 5.0%. When CBVDs were mentioned without HYPDs, they were selected as the underlying cause of death 74.4% of the time. When HYPDs were mentioned in DCs without CBVDs, HYPDs were selected 30.0% of the time. In 2004, the frequency of any mention of HYPDs relative to the frequency of HYPDs cited as underlying causes increased fourfold and was followed by a plateau until 2013. In contrast, the frequency of any mention of CBVDs relative to the frequency of CBVDs as underlying causes decreased in the same period. Because this study was based on DC records, it was limited by the way these documents were completed, which may have included lack of record of the causes related to the sequence that culminated in death. When deaths related to HYPDs were evaluated as multiple causes of death, they were mentioned up to four times more often than when they were selected as underlying causes of death. This reinforces the need for better control of hypertension to prevent deaths. Copyright © 2018 The Royal Society for Public Health. Published by

40 CFR 91.122 - Amending the application and certificate of conformity.

Science.gov (United States)

2010-07-01

... certificate of conformity. 91.122 Section 91.122 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... Standards and Certification Provisions § 91.122 Amending the application and certificate of conformity. (a... to a certificate of conformity or changes are to be made to a product line covered by a certificate...

Access control based on attribute certificates for medical intranet applications.

Science.gov (United States)

Mavridis, I; Georgiadis, C; Pangalos, G; Khair, M

2001-01-01

Clinical information systems frequently use intranet and Internet technologies. However these technologies have emphasized sharing and not security, despite the sensitive and private nature of much health information. Digital certificates (electronic documents which recognize an entity or its attributes) can be used to control access in clinical intranet applications. To outline the need for access control in distributed clinical database systems, to describe the use of digital certificates and security policies, and to propose the architecture for a system using digital certificates, cryptography and security policy to control access to clinical intranet applications. We have previously developed a security policy, DIMEDAC (Distributed Medical Database Access Control), which is compatible with emerging public key and privilege management infrastructure. In our implementation approach we propose the use of digital certificates, to be used in conjunction with DIMEDAC. Our proposed access control system consists of two phases: the ways users gain their security credentials; and how these credentials are used to access medical data. Three types of digital certificates are used: identity certificates for authentication; attribute certificates for authorization; and access-rule certificates for propagation of access control policy. Once a user is identified and authenticated, subsequent access decisions are based on a combination of identity and attribute certificates, with access-rule certificates providing the policy framework. Access control in clinical intranet applications can be successfully and securely managed through the use of digital certificates and the DIMEDAC security policy.

Overview of the DOE packaging certification process

Energy Technology Data Exchange (ETDEWEB)

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)

1995-12-31

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.

Overview of recent developments in sustainable biomass certification

International Nuclear Information System (INIS)

Dam, Jinke van; Junginger, Martin; Faaij, Andre; Juergens, Ingmar; Best, Gustavo; Fritsche, Uwe

2008-01-01

The objective of this paper is to give a comprehensive review of initiatives on biomass certification from different viewpoints of stakeholders, including national governments (such as The Netherlands, the UK, Belgium and Germany), the EC, NGOs, companies, and international bodies up until October 2007. Furthermore, opportunities and restrictions in the development of biomass certification are described, including international trade law limitations, lack of adequate methodologies, stakeholder involvement requirements and certification costs. Next, five different approaches for the implementation of a biomass certification system are compared and discussed. Main differences are the voluntary or mandatory character and the geographical extent of the proposed strategies in terms of biomass end-use. It is concluded that criteria to ensure the sustainable production of biomass are needed urgently. To some extent criteria categories can be covered using existing systems, but others (such as GHG and energy balances, changing land-use) require the development of new methodologies. A gradual development of certification systems with learning (through pilot studies and research) and expansion over time, linked to the development of advanced methodologies can provide valuable experience, and further improve the feasibility and reliability of biomass certification systems. However, better international coordination between initiatives is required to improve coherence and efficiency in the development of sustainable biomass certification systems, to avoid the proliferation of standards and to provide a clearer direction in the approach to be taken. Finally, next to certification, alternative policy tools should be considered as well to ensure sustainable biomass production. (author)

49 CFR 172.204 - Shipper's certification.

Science.gov (United States)

2010-10-01

... 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...

34 CFR 34.21 - Employer certification.

Science.gov (United States)

2010-07-01

... 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...

19 CFR 191.76 - Landing certificate.

Science.gov (United States)

2010-04-01

... 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...

7 CFR 652.23 - Certification process for private-sector entities.

Science.gov (United States)

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Certification process for private-sector entities. 652... ASSISTANCE Certification § 652.23 Certification process for private-sector entities. (a) A private sector... individual basis as part of the private-sector entity's certification and ensures that the requirements set...

46 CFR 91.60-5 - Cargo Ship Safety Construction Certificate.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Cargo Ship Safety Construction Certificate. 91.60-5... VESSELS INSPECTION AND CERTIFICATION Certificates Under International Convention for Safety of Life at Sea, 1974 § 91.60-5 Cargo Ship Safety Construction Certificate. (a) All vessels on an international voyage...

46 CFR 189.60-10 - Cargo Ship Safety Equipment Certificate.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Cargo Ship Safety Equipment Certificate. 189.60-10... VESSELS INSPECTION AND CERTIFICATION Certificates Under International Convention for Safety of Life at Sea, 1974 § 189.60-10 Cargo Ship Safety Equipment Certificate. (a) All vessels on an international voyage...

46 CFR 167.60-10 - Exhibition of certificate of inspection.

Science.gov (United States)

2010-10-01

... PUBLIC NAUTICAL SCHOOL SHIPS Certificates of Inspection § 167.60-10 Exhibition of certificate of inspection. On every nautical school ship, the original certificate of inspection shall be framed under glass... 46 Shipping 7 2010-10-01 2010-10-01 false Exhibition of certificate of inspection. 167.60-10...

46 CFR 189.60-5 - Cargo Ship Safety Construction Certificate.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Cargo Ship Safety Construction Certificate. 189.60-5... VESSELS INSPECTION AND CERTIFICATION Certificates Under International Convention for Safety of Life at Sea, 1974 § 189.60-5 Cargo Ship Safety Construction Certificate. (a) All vessels on an international voyage...

45 CFR 170.445 - Complete EHR testing and certification.

Science.gov (United States)

2010-10-01

... 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...

Methodology for forecasting in the Swedish–Norwegian market for el-certificates

International Nuclear Information System (INIS)

Wolfgang, Ove; Jaehnert, Stefan; Mo, Birger

2015-01-01

In this paper we describe a novel methodology for forecasting in the Swedish–Norwegian el-certificate market, which is a variant of a tradable green certificate scheme. For the forecasting, the el-certificate market is integrated in the electricity-market model EMPS, which has weekly to hourly time-step length, whereas the planning horizon can be several years. Strategies for the certificate inventory are calculated by stochastic dynamic programming, whereas penalty-rates for non-compliance during the annual settlement of certificates are determined endogenously. In the paper the methodology is described, and we show the performance of the model under different cases that can occur in the el-certificate market. The general results correspond to theoretical findings in previous studies for tradable green certificate markets, in particular that price-scenarios spread out in such a way that the unconditional expected value of certificates is relatively stable throughout the planning period. In addition the presented methodologies allows to assess the actual dynamics of the certificate price due to climatic uncertainty. Finally, special cases are indentified where the certificate price becomes excessively high respectively zero, due the design-specific dynamics of the penalty rate. - Highlights: • A method for forecasting in the Swedish–Norwegian el-certificate market is proposed. • The developed model integrates the el-certificate and the power market. • Banking of certificates and the endogenously calculated penalty rate are included. • The certificate value is calculated using Stochastic-Dynamic-Programming. • Price dynamics due to climatic weather uncertainties are assessed and illustrated

45 CFR 170.490 - Sunset of the temporary certification program.

Science.gov (United States)

2010-10-01

... TECHNOLOGY HEALTH INFORMATION TECHNOLOGY STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA AND CERTIFICATION PROGRAMS FOR HEALTH INFORMATION TECHNOLOGY Temporary Certification Program for HIT...

45 CFR 170.410 - Types of testing and certification.

Science.gov (United States)

2010-10-01

... Section 170.410 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 § 170.410 Types...

45 CFR 170.450 - EHR module testing and certification.

Science.gov (United States)

2010-10-01

... Section 170.450 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 § 170.450 EHR...

46 CFR 189.60-15 - Cargo Ship Safety Radio Certificate.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Cargo Ship Safety Radio Certificate. 189.60-15 Section... VESSELS INSPECTION AND CERTIFICATION Certificates Under International Convention for Safety of Life at Sea, 1974 § 189.60-15 Cargo Ship Safety Radio Certificate. Every vessel equipped with a radio installation...

46 CFR 91.60-10 - Cargo Ship Safety Equipment Certificate.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Cargo Ship Safety Equipment Certificate. 91.60-10... VESSELS INSPECTION AND CERTIFICATION Certificates Under International Convention for Safety of Life at Sea, 1974 § 91.60-10 Cargo Ship Safety Equipment Certificate. (a) All vessels on an international voyage are...

Causes of deaths in children under-five years old at a tertiary hospital in Limpopo province of South Africa.

Science.gov (United States)

Ntuli, Sam Thembelihle; Malangu, Ntambwe; Alberts, Marianne

2013-02-15

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.

10 CFR 431.36 - Compliance Certification.

Science.gov (United States)

2010-01-01

... 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...

Perceived Benefits of National Recreation and Park Association Certifications. A Case Study of Certification Holders in Ohio

Science.gov (United States)

Xie, Philip F.; Yeatts, Emily; Lee, Bob

2013-01-01

The aim of this study is to assess the perceived benefits of National Recreation and Park Association (NRPA) certifications. The NRPA offered three certifications in 2010: Certified Park and Recreation Professional (CPRP), Aquatic Facility Operator (AFO), and Certified Playground Safety Inspector (CPS). The electronic survey sent from authors…

Causes of death in long-term survivors of head and neck cancer.

Science.gov (United States)

Baxi, Shrujal S; Pinheiro, Laura C; Patil, Sujata M; Pfister, David G; Oeffinger, Kevin C; Elkin, Elena B

2014-05-15

Survivors of head and neck squamous cell carcinoma (HNSCC) face excess mortality from multiple causes. We used the population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry data to evaluate the causes of death in patients with nonmetastatic HNSCC diagnosed between 1992 and 2005 who survived at least 3 years from diagnosis (long-term survivors). We used competing-risks proportional hazards regression to estimate probabilities of death from causes: HNSCC, second primary malignancy (SPM) excluding HNSCC, cardiovascular disease, and other causes. We identified 35,958 three-year survivors of HNSCC with a median age at diagnosis of 60 years (range = 18-100 years) and a median follow-up of 7.7 years (range = 3-18 years). There were 13,120 deaths during the study period. Death from any cause at 5 and 10 years was 15.4% (95% confidence interval [CI] = 15.0%-15.8%) and 41.0% (95% CI = 40.4%-41.6%), respectively. There were 3852 HNSCC deaths including both primary and subsequent head and neck tumors. The risk of death from HNSCC was greater in patients with nasopharynx or hypopharynx cancer and in patients with locally advanced disease. SPM was the leading cause of non-HNSCC death, and the most common sites of SPM death were lung (53%), esophagus (10%), and colorectal (5%) cancer. Many long-term HNSCC survivors die from cancers other than HNSCC and from noncancer causes. Routine follow-up care for HNSCC survivors should expand beyond surveillance for recurrent and new head and neck cancers. © 2014 American Cancer Society.

46 CFR 91.60-15 - Cargo Ship Safety Radio Certificate.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Cargo Ship Safety Radio Certificate. 91.60-15 Section 91... VESSELS INSPECTION AND CERTIFICATION Certificates Under International Convention for Safety of Life at Sea, 1974 § 91.60-15 Cargo Ship Safety Radio Certificate. Every vessel equipped with a radio installation on...

30 CFR 875.13 - Certification of completion of coal sites.

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Certification of completion of coal sites. 875... Certification of completion of coal sites. (a) The Governor of a State, or the equivalent head of an Indian tribe, may submit to the Secretary a certification of completion of coal sites. The certification must...

14 CFR 21.273 - Airworthiness certificates other than experimental.

Science.gov (United States)

2010-01-01

... TRANSPORTATION AIRCRAFT CERTIFICATION PROCEDURES FOR PRODUCTS AND PARTS Delegation Option Authorization... airworthiness certificate for aircraft manufactured under a delegation option authorization if he finds, on the... authorize any employee to sign airworthiness certificates if that employee— (1) Performs, or is in direct...

Online Information Technologies Certificate Program

Directory of Open Access Journals (Sweden)

Erman YUKSELTURK

2005-01-01

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.

40 CFR 86.094-30 - Certification.

Science.gov (United States)

2010-07-01

... 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...

20 CFR 655.163 - Certification fee.

Science.gov (United States)

2010-04-01

... 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...

29 CFR 570.121 - Age certificates.

Science.gov (United States)

2010-07-01

... 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...

ISO and software quality assurance - licensing and certification of software professionals

Energy Technology Data Exchange (ETDEWEB)

Hare, J.; Rodin, L.

1997-11-01

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.

Acute exacerbations and deaths in the group of respiratory diseases and cardiovascular diseases in the city of Lodzin relation to atmospheric pollution

Energy Technology Data Exchange (ETDEWEB)

Swiatczak, J; Olejnik, A

1974-01-01

The effect of air pollution episodes (sulfur dioxide and dust) on the morbidity and mortality of a group of people suffering from upper respiratory disease and cardiovascular disease was studied by examining air monitoring data and health statistics (ambulance service records and death certificates) for the city of Lodz. During the month of January in 1971, when the atmospheric pollution reached a 7-year peak, ambulance station statistics revealed the incidnce of acute cardiovascular and respiratory diseases to be at a maximum. The number of deaths from these diseases reached a maximum of 18 on the first day of the episode; on subsequent days, however, the mortalities returned to average.

Certification renewal process of the American Board of Orthodontics.

Science.gov (United States)

Castelein, Paul T; DeLeon, Eladio; Dugoni, Steven A; Chung, Chun-Hsi; Tadlock, Larry P; Barone, Nicholas D; Kulbersh, Valmy P; Sabott, David G; Kastrop, Marvin C

2015-05-01

The American Board of Orthodontics was established in 1929 and is the oldest specialty board in dentistry. Its goal is to protect the public by ensuring competency through the certification of eligible orthodontists. Originally, applicants for certification submitted a thesis, 5 case reports, and a set of casts with appliances. Once granted, the certification never expired. Requirements have changed over the years. In 1950, 15 cases were required, and then 10 in 1987. The Board has continued to refine and improve the certification process. In 1998, certification became time limited, and a renewal process was initiated. The Board continues to improve the recertification process. Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

Product-based Safety Certification for Medical Devices Embedded Software.

Science.gov (United States)

Neto, José Augusto; Figueiredo Damásio, Jemerson; Monthaler, Paul; Morais, Misael

2015-01-01

Worldwide medical device embedded software certification practices are currently focused on manufacturing best practices. In Brazil, the national regulatory agency does not hold a local certification process for software-intensive medical devices and admits international certification (e.g. FDA and CE) from local and international industry to operate in the Brazilian health care market. We present here a product-based certification process as a candidate process to support the Brazilian regulatory agency ANVISA in medical device software regulation. Center of Strategic Technology for Healthcare (NUTES) medical device embedded software certification is based on a solid safety quality model and has been tested with reasonable success against the Class I risk device Generic Infusion Pump (GIP).

42 CFR 493.931 - Routine chemistry.

Science.gov (United States)

2010-10-01

... 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...

FROM THE EXPERIENCE OF TEACHER CERTIFICATION IN FOREIGN COUNTRIES

Directory of Open Access Journals (Sweden)

Elina N. Yakovleva

2015-01-01

Full Text Available The purpose of the article is to review foreign experience of teacher certification according to requirements of the Teacher Professional Standards.Methods. The authors use analysis and generalization of official documents and methodical recommendations of the European Commission on introduction of a system of professional competences (standards of the teacher; guides for certification of teachers in the EU countries, the USA and Australia according to standards of the teacher; regulations of Russian centers for certification of pedagogical workers using in their activities overseas experience of similar centers and the international standard of personnel certification.Results. Various options for the use of a system of the teacher professional competencies (standards, as well as models of independent certification of teachers in terms of approaches, goals, objectives and organizational forms used in the EU, the USA and Australia are considered and analysed.Scientific novelty. As a result of the analysis of teacher certification experience in a number of foreign countries some general tendencies are identified and taken into account in the recommendations on the establishment of the system of Russian teachers certification as consistent with the Professional Standard «Teacher (pedagogical activity in the field of pre-school, primary general, basic general, secondary general education (educator, teacher».Practical significance. The results can be used while developing of regional centres for teachers’ independent certification.

A scoping research literature review to assess the state of existing evidence on the "bad" death.

Science.gov (United States)

Wilson, Donna M; Hewitt, Jessica A

2018-02-01

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.

An eCertificate Program in Transportation Planning

Science.gov (United States)

2012-08-01

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)....

Certification and equity: Applying an “equity framework” to compare certification schemes across product sectors and scales

International Nuclear Information System (INIS)

McDermott, Constance L.

2013-01-01

Highlights: ► Assessing equity requires a comprehensive conceptual framework. ► The framing of equity varies across sectors and schemes. ► Schemes vary in prioritizing the environment, communities or equity in the supply chain. ► Addressing contextual equity is essential lest certification reinforce inequities of global trade. -- Abstract: This paper applies a comprehensive equity framework to compare the priorities and trade-offs of different environmental and social certification schemes. The schemes selected for comparison are the Forest Stewardship Council (FSC), the Programme for the Endorsement of Forest Certification Schemes (PEFC), the Fairtrade Labelling Organization (FLO), and the Climate, Community and Biodiversity Alliance (CCBA). The framework considers how the parameters of equity are set in certification scheme governance, including who are the primary decision-makers and intended beneficiaries, and how this is reflected in the content of scheme standards and certification outcomes. Each of these parameters is assessed across the dimensions of procedural, contextual and distributive equity. Results reveal significant variation in the prioritization of the environment, non-commercial stakeholders or equity across the supply chain. In forestry, the FSC has placed primary emphasis on the procedural rights of non-commercial interests in standard-setting processes, the contextual rights of indigenous peoples, and the conservation of natural ecosystems, while the PEFC places more emphasis on procedural equity for producers and the legitimacy of sovereign governments as rule-makers. Both FLO and CCBA prioritize distributive equity regarding the sharing of material benefits with small-scale and/or community producers or workers, while FLO also emphasizes the contextual issue of “empowerment” and capacity-building. In all schemes, contextual factors related to capacity and access have disproportionately advantaged Northern and large

On the Detection of Fake Certificates via Attribute Correlation

Directory of Open Access Journals (Sweden)

Xiaojing Gu

2015-06-01

Full Text Available Transport Layer Security (TLS and its predecessor, SSL, are important cryptographic protocol suites on the Internet. They both implement public key certificates and rely on a group of trusted certificate authorities (i.e., CAs for peer authentication. Unfortunately, the most recent research reveals that, if any one of the pre-trusted CAs is compromised, fake certificates can be issued to intercept the corresponding SSL/TLS connections. This security vulnerability leads to catastrophic impacts on SSL/TLS-based HTTPS, which is the underlying protocol to provide secure web services for e-commerce, e-mails, etc. To address this problem, we design an attribute dependency-based detection mechanism, called SSLight. SSLight can expose fake certificates by checking whether the certificates contain some attribute dependencies rarely occurring in legitimate samples. We conduct extensive experiments to evaluate SSLight and successfully confirm that SSLight can detect the vast majority of fake certificates issued from any trusted CAs if they are compromised. As a real-world example, we also implement SSLight as a Firefox add-on and examine its capability of exposing existent fake certificates from DigiNotar and Comodo, both of which have made a giant impact around the world.

Nurse leader certification preparation: how are confidence levels impacted?

Science.gov (United States)

Junger, Stacey; Trinkle, Nicole; Hall, Norma

2016-09-01

The aim was to examine the effect of a nurse leader certification preparation course on the confidence levels of the participants. Limited literature is available regarding nurse leader development and certifications. Barriers exist related to lack of confidence, high cost, time and lack of access to a preparation course. Nurse leaders (n = 51) completed a pre- and post-survey addressing confidence levels of participants related to the topics addressed in the nurse leader certification preparation course. There were statistically significant increases in confidence levels related to all course content for the participants. At the time of the study, there were 31.4% of participants intending to sit for the certification examination, and 5 of the 51 participants successfully sat for and passed the examination. A nurse leader certification preparation course increases confidence levels of the participants and removes barriers, thereby increasing the number of certifications obtained. The health-care climate is increasingly complex and nurse leaders need the expertise to navigate the ever-changing health-care environment. Certification in a specialty, such as leadership, serves as an indicator of a high level of competence in the field. © 2016 John Wiley & Sons Ltd.

Reducing routine vaccination dropout rates: evaluating two interventions in three Kenyan districts, 2014