Validating the Construct of Coercion in Family Routines: Expanding the Unit of Analysis in Behavioral Assessment with Families of Children with Developmental Disabilities

PubMed Central

Lucyshyn, Joseph M.; Irvin, Larry K.; Blumberg, E. Richard; Laverty, Robelyn; Horner, Robert H.; Sprague, Jeffrey R.

2015-01-01

We conducted an observational study of parent-child interaction in home activity settings (routines) of families raising young children with developmental disabilities and problem behavior. Our aim was to empirically investigate the construct validity of coercion in typical but unsuccessful family routines. The long-term goal was to develop an expanded ecological unit of analysis that may contribute to sustainable behavioral family intervention. Ten children with autism and/or mental retardation and their families participated. Videotaped observations were conducted in typical but unsuccessful home routines. Parent-child interaction in routines was coded in real time and sequential analyses were conducted to test hypotheses about coercive processes. Following observation, families were interviewed about the social validity of the construct. Results confirmed the presence of statistically significant, attention-driven coercive processes in routines in which parents were occupied with non-child centered tasks. Results partially confirmed the presence of escape-driven coercive processes in routines in which parent demands are common. Additional analysis revealed an alternative pattern with greater magnitude. Family perspectives suggested the social validity of the construct. Results are discussed in terms of preliminary, partial evidence for coercive processes in routines of families of children with developmental disabilities. Implications for behavioral assessment and intervention design are discussed. PMID:26321883

Coping With Existential and Emotional Challenges: Development and Validation of the Self-Competence in Death Work Scale.

PubMed

Chan, Wallace Chi Ho; Tin, Agnes Fong; Wong, Karen Lok Yi

2015-07-01

Palliative care professionals often are confronted by death in their work. They may experience challenges to self, such as aroused emotions and queries about life's meaningfulness. Assessing their level of "self-competence" in coping with these challenges is crucial in understanding their needs in death work. This study aims to develop and validate the Self-Competence in Death Work Scale (SC-DWS). Development of this scale involved three steps: 1) items generated from a qualitative study with palliative care professionals, (2) expert panel review, and (3) pilot test. Analysis was conducted to explore the factor structure and examine the reliability and validity of the scale. Helping professionals involved in death work were recruited to complete questionnaires comprising the SC-DWS and other scales. A total of 151 participants were recruited. Both one-factor and two-factor structures were found. Emotional and existential coping were identified as subscales in the two-factor structure. Correlations of the whole scale and subscales with measures of death attitudes, meaning in life, burnout and depression provided evidence for the construct validity. Discriminative validity was supported by showing participants with bereavement experience and longer experience in the profession and death work possessed a significantly higher level of self-competence. Reliability analyses showed that the entire scale and subscales were internally consistent. The SC-DWS was found to be valid and reliable. This scale may facilitate helping professionals' understanding of their self-competence in death work, so appropriate professional support and training may be obtained. Copyright © 2015 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Validation of a temperature prediction model for heat deaths in undocumented border crossers.

PubMed

Ruttan, Tim; Stolz, Uwe; Jackson-Vance, Sara; Parks, Bruce; Keim, Samuel M

2013-04-01

Heat exposure is a leading cause of death in undocumented border crossers along the Arizona-Mexico border. We performed a validation study of a weather prediction model that predicts the probability of heat related deaths among undocumented border crossers. We analyzed a medical examiner registry cohort of undocumented border crosser heat- related deaths from January 1, 2002 to August 31, 2009 and used logistic regression to model the probability of one or more heat deaths on a given day using daily high temperature (DHT) as the predictor. At a critical threshold DHT of 40 °C, the probability of at least one heat death was 50 %. The probability of a heat death along the Arizona-Mexico border for suspected undocumented border crossers is strongly associated with ambient temperature. These results can be used in prevention and response efforts to assess the daily risk of deaths among undocumented border crossers in the region.

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

PubMed

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.

Validation of a New Measure of the Concept of Good Death among Taiwanese Children

ERIC Educational Resources Information Center

Yang, Shu Ching; Lai, Sih-yi

2012-01-01

The purpose of this study was to develop and validate an instrument to measure dimensions of the concept of a good death held by Taiwanese children. The sample consisted of 1,698 Taiwanese children, approximately 12-14 years of age. Participants completed the self-administered Good Death Concept Scale (GDCS), which consists of 30 statements…

Development and validation of an electronic frailty index using routine primary care electronic health record data

PubMed Central

Clegg, Andrew; Bates, Chris; Young, John; Ryan, Ronan; Nichols, Linda; Ann Teale, Elizabeth; Mohammed, Mohammed A.; Parry, John; Marshall, Tom

2016-01-01

Background: frailty is an especially problematic expression of population ageing. International guidelines recommend routine identification of frailty to provide evidence-based treatment, but currently available tools require additional resource. Objectives: to develop and validate an electronic frailty index (eFI) using routinely available primary care electronic health record data. Study design and setting: retrospective cohort study. Development and internal validation cohorts were established using a randomly split sample of the ResearchOne primary care database. External validation cohort established using THIN database. Participants: patients aged 65–95, registered with a ResearchOne or THIN practice on 14 October 2008. Predictors: we constructed the eFI using the cumulative deficit frailty model as our theoretical framework. The eFI score is calculated by the presence or absence of individual deficits as a proportion of the total possible. Categories of fit, mild, moderate and severe frailty were defined using population quartiles. Outcomes: outcomes were 1-, 3- and 5-year mortality, hospitalisation and nursing home admission. Statistical analysis: hazard ratios (HRs) were estimated using bivariate and multivariate Cox regression analyses. Discrimination was assessed using receiver operating characteristic (ROC) curves. Calibration was assessed using pseudo-R2 estimates. Results: we include data from a total of 931,541 patients. The eFI incorporates 36 deficits constructed using 2,171 CTV3 codes. One-year adjusted HR for mortality was 1.92 (95% CI 1.81–2.04) for mild frailty, 3.10 (95% CI 2.91–3.31) for moderate frailty and 4.52 (95% CI 4.16–4.91) for severe frailty. Corresponding estimates for hospitalisation were 1.93 (95% CI 1.86–2.01), 3.04 (95% CI 2.90–3.19) and 4.73 (95% CI 4.43–5.06) and for nursing home admission were 1.89 (95% CI 1.63–2.15), 3.19 (95% CI 2.73–3.73) and 4.76 (95% CI 3.92–5.77), with good to moderate discrimination

Reliability and Validity of the Turkish Version of Abdel-Khalek's Death Anxiety Scale among College Students.

PubMed

Sariçiçek Aydoğan, Aybala; Gülseren, Şeref; Öztürk Sarikaya, Özyıl; Özen, Çiğdem

2015-12-01

Although death anxiety is considered a universal phenomenon, attitudes toward death may vary across populations that differ in terms of religion and culture. Abdel-Khalek's Death Anxiety Scale (ASDA) was developed on the basis of the rationale that there are specific concepts related to death and after death in Muslim populations. This study aims to translate and adapt ASDA in the Turkish population, examine its validity and reliability, and to compare its psychometric properties with the widely used Templer's Death Anxiety Scale (DAS). A total of 220 medical students were included in the study. The Turkish version of ASDA, DAS, and Hospital Anxiety and Depression Scale were used for data collection. Cronbach's alpha coefficients were .86 for ASDA and .66 for DAS. Analysis by principal components with varimax rotation produced five factors for ASDA that explained 65.6% of total variance. ASDA and DAS were highly correlated with each other (r=.68, p<.001). The results of this study indicate that the Turkish version of Abdel-Khalek's Death Anxiety Scale is a reliable and valid instrument. The Turkish version of ASDA revealed better psychometric properties than DAS. This finding may reflect specific cultural and religious attitudes toward death or may result from more comprehensible language use in ASDA.

Medical death certification by forensic physicians in the Netherlands: Validity and interdoctorvariation.

PubMed

Dorn, Tina; Ceelen, Manon; Reijnders, Udo; Das, Kees

2016-10-01

The aim of the study was to assess interdoctorvariation and validity in death certification by forensic physicians using 19 written scenarios. The scenarios described typical cases from forensic-medical practice. Physicians were asked to determine the manner of death (natural/unnatural) and to provide an ICD-10 code for the cause of death. In contrast to most studies on this topic, the measure of agreement among physicians was chance-corrected and a standard was used to assess the correctness of the assigned cause and manner of death. Forty-seven physicians participated in the survey. The study demonstrated that forensic physicians varied widely in their conclusions. With respect to manner of death, adequate agreement (defined as kappa>0.70) was achieved in six scenarios (32% of all scenarios). Concerning the underlying cause of death, adequate agreement was reached in three cases (16% of all scenarios). Furthermore, predictors for the correctness of manner and cause of death were studied using logistic regression. Years of experience as a forensic physician significantly predicted the correctness of cause of death (p < 0.05). Other predictors remained insignificant. With regard to manner of death, none of the studied predictors proved to be significant. To conclude, there appears to be a lack of consistency among forensic physicians regarding death certification. The ICD-10 coding of causes of death applied by forensic physicians is questionable. Less experienced physicians need supervision by more experienced colleagues when making judgments concerning the cause of death. Altogether, there is an urgent need to work out consensus-based guidelines for forensic physicians on how to certify deaths. Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Development and validation of QMortality risk prediction algorithm to estimate short term risk of death and assess frailty: cohort study.

PubMed

Hippisley-Cox, Julia; Coupland, Carol

2017-09-20

Objectives  To derive and validate a risk prediction equation to estimate the short term risk of death, and to develop a classification method for frailty based on risk of death and risk of unplanned hospital admission. Design  Prospective open cohort study. Participants  Routinely collected data from 1436 general practices contributing data to QResearch in England between 2012 and 2016. 1079 practices were used to develop the scores and a separate set of 357 practices to validate the scores. 1.47 million patients aged 65-100 years were in the derivation cohort and 0.50 million patients in the validation cohort. Methods  Cox proportional hazards models in the derivation cohort were used to derive separate risk equations in men and women for evaluation of the risk of death at one year. Risk factors considered were age, sex, ethnicity, deprivation, smoking status, alcohol intake, body mass index, medical conditions, specific drugs, social factors, and results of recent investigations. Measures of calibration and discrimination were determined in the validation cohort for men and women separately and for each age and ethnic group. The new mortality equation was used in conjunction with the existing QAdmissions equation (which predicts risk of unplanned hospital admission) to classify patients into frailty groups. Main outcome measure  The primary outcome was all cause mortality. Results  During follow-up 180 132 deaths were identified in the derivation cohort arising from 4.39 million person years of observation. The final model included terms for age, body mass index, Townsend score, ethnic group, smoking status, alcohol intake, unplanned hospital admissions in the past 12 months, atrial fibrillation, antipsychotics, cancer, asthma or chronic obstructive pulmonary disease, living in a care home, congestive heart failure, corticosteroids, cardiovascular disease, dementia, epilepsy, learning disability, leg ulcer, chronic liver disease or pancreatitis

Retrospective Validation of a Surveillance System for Unexplained Illness and Death: New Haven County, Connecticut

PubMed Central

Kluger, Michael D.; Sofair, Andre N.; Heye, Constance J.; Meek, James I.; Sodhi, Rajesh K.; Hadler, James L.

2001-01-01

Objectives. This study investigated retrospective validation of a prospective surveillance system for unexplained illness and death due to possibly infectious causes. Methods. A computerized search of hospital discharge data identified patients with potential unexplained illness and death due to possibly infectious causes. Medical records for such patients were reviewed for satisfaction of study criteria. Cases identified retrospectively were combined with prospectively identified cases to form a reference population against which sensitivity could be measured. Results. Retrospective validation was 41% sensitive, whereas prospective surveillance was 73% sensitive. The annual incidence of unexplained illness and death due to possibly infectious causes during 1995 and 1996 in the study county was conservatively estimated to range from 2.7 to 6.2 per 100 000 residents aged 1 to 49 years. Conclusions. Active prospective surveillance for unexplained illness and death due to possibly infectious causes is more sensitive than retrospective surveillance conducted through a published list of indicator codes. However, retrospective surveillance can be a feasible and much less labor-intensive alternative to active prospective surveillance when the latter is not possible or desired. PMID:11499106

Evaluation of a methodology to validate National Death Index retrieval results among a cohort of U.S. service members.

PubMed

Skopp, Nancy A; Smolenski, Derek J; Schwesinger, Daniel A; Johnson, Christopher J; Metzger-Abamukong, Melinda J; Reger, Mark A

2017-06-01

Accurate knowledge of the vital status of individuals is critical to the validity of mortality research. National Death Index (NDI) and NDI-Plus are comprehensive epidemiological resources for mortality ascertainment and cause of death data that require additional user validation. Currently, there is a gap in methods to guide validation of NDI search results rendered for active duty service members. The purpose of this research was to adapt and evaluate the CDC National Program of Cancer Registries (NPCR) algorithm for mortality ascertainment in a large military cohort. We adapted and applied the NPCR algorithm to a cohort of 7088 service members on active duty at the time of death at some point between 2001 and 2009. We evaluated NDI validity and NDI-Plus diagnostic agreement against the Department of Defense's Armed Forces Medical Examiner System (AFMES). The overall sensitivity of the NDI to AFMES records after the application of the NPCR algorithm was 97.1%. Diagnostic estimates of measurement agreement between the NDI-Plus and the AFMES cause of death groups were high. The NDI and NDI-Plus can be successfully used with the NPCR algorithm to identify mortality and cause of death among active duty military cohort members who die in the United States. Published by Elsevier Inc.

Validity of verbal autopsy method to determine causes of death among adults in the urban setting of Ethiopia

PubMed Central

2012-01-01

Background Verbal autopsy has been widely used to estimate causes of death in settings with inadequate vital registries, but little is known about its validity. This analysis was part of Addis Ababa Mortality Surveillance Program to examine the validity of verbal autopsy for determining causes of death compared with hospital medical records among adults in the urban setting of Ethiopia. Methods This validation study consisted of comparison of verbal autopsy final diagnosis with hospital diagnosis taken as a “gold standard”. In public and private hospitals of Addis Ababa, 20,152 adult deaths (15 years and above) were recorded between 2007 and 2010. With the same period, a verbal autopsy was conducted for 4,776 adult deaths of which, 1,356 were deceased in any of Addis Ababa hospitals. Then, verbal autopsy and hospital data sets were merged using the variables; full name of the deceased, sex, address, age, place and date of death. We calculated sensitivity, specificity and positive predictive values with 95% confidence interval. Results After merging, a total of 335 adult deaths were captured. For communicable diseases, the values of sensitivity, specificity and positive predictive values of verbal autopsy diagnosis were 79%, 78% and 68% respectively. For non-communicable diseases, sensitivity of the verbal autopsy diagnoses was 69%, specificity 78% and positive predictive value 79%. Regarding injury, sensitivity of the verbal autopsy diagnoses was 70%, specificity 98% and positive predictive value 83%. Higher sensitivity was achieved for HIV/AIDS and tuberculosis, but lower specificity with relatively more false positives. Conclusion These findings may indicate the potential of verbal autopsy to provide cost-effective information to guide policy on communicable and non communicable diseases double burden among adults in Ethiopia. Thus, a well structured verbal autopsy method, followed by qualified physician reviews could be capable of providing reasonable cause

Validation of a contemporary prostate cancer grading system using prostate cancer death as outcome.

PubMed

Berney, Daniel M; Beltran, Luis; Fisher, Gabrielle; North, Bernard V; Greenberg, David; Møller, Henrik; Soosay, Geraldine; Scardino, Peter; Cuzick, Jack

2016-05-10

Gleason scoring (GS) has major deficiencies and a novel system of five grade groups (GS⩽6; 3+4; 4+3; 8; ⩾9) has been recently agreed and included in the WHO 2016 classification. Although verified in radical prostatectomies using PSA relapse for outcome, it has not been validated using prostate cancer death as an outcome in biopsy series. There is debate whether an 'overall' or 'worst' GS in biopsies series should be used. Nine hundred and eighty-eight prostate cancer biopsy cases were identified between 1990 and 2003, and treated conservatively. Diagnosis and grade was assigned to each core as well as an overall grade. Follow-up for prostate cancer death was until 31 December 2012. A log-rank test assessed univariable differences between the five grade groups based on overall and worst grade seen, and using univariable and multivariable Cox proportional hazards. Regression was used to quantify differences in outcome. Using both 'worst' and 'overall' GS yielded highly significant results on univariate and multivariate analysis with overall GS slightly but insignificantly outperforming worst GS. There was a strong correlation with the five grade groups and prostate cancer death. This is the largest conservatively treated prostate cancer cohort with long-term follow-up and contemporary assessment of grade. It validates the formation of five grade groups and suggests that the 'worst' grade is a valid prognostic measure.

Reliability and Validity of the Turkish Version of Abdel-Khalek’s Death Anxiety Scale among College Students

PubMed Central

SARIÇİÇEK AYDOĞAN, Aybala; GÜLSEREN, Şeref; ÖZTÜRK SARIKAYA, Özyıl; ÖZEN, Çiğdem

2015-01-01

Introduction Although death anxiety is considered a universal phenomenon, attitudes toward death may vary across populations that differ in terms of religion and culture. Abdel-Khalek’s Death Anxiety Scale (ASDA) was developed on the basis of the rationale that there are specific concepts related to death and after death in Muslim populations. This study aims to translate and adapt ASDA in the Turkish population, examine its validity and reliability, and to compare its psychometric properties with the widely used Templer’s Death Anxiety Scale (DAS). Methods A total of 220 medical students were included in the study. The Turkish version of ASDA, DAS, and Hospital Anxiety and Depression Scale were used for data collection. Results Cronbach’s alpha coefficients were .86 for ASDA and .66 for DAS. Analysis by principal components with varimax rotation produced five factors for ASDA that explained 65.6% of total variance. ASDA and DAS were highly correlated with each other (r=.68, p<.001) Conclusion The results of this study indicate that the Turkish version of Abdel-Khalek’s Death Anxiety Scale is a reliable and valid instrument. The Turkish version of ASDA revealed better psychometric properties than DAS. This finding may reflect specific cultural and religious attitudes toward death or may result from more comprehensible language use in ASDA. PMID:28360742

Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review.

PubMed

Soo, Martin; Robertson, Lynn M; Ali, Tariq; Clark, Laura E; Fluck, Nicholas; Johnston, Marjorie; Marks, Angharad; Prescott, Gordon J; Smith, William Cairns S; Black, Corri

2014-04-21

In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease. A validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed. Median age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions. This study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was

Validation of a contemporary prostate cancer grading system using prostate cancer death as outcome

PubMed Central

Berney, Daniel M; Beltran, Luis; Fisher, Gabrielle; North, Bernard V; Greenberg, David; Møller, Henrik; Soosay, Geraldine; Scardino, Peter; Cuzick, Jack

2016-01-01

Background: Gleason scoring (GS) has major deficiencies and a novel system of five grade groups (GS⩽6; 3+4; 4+3; 8; ⩾9) has been recently agreed and included in the WHO 2016 classification. Although verified in radical prostatectomies using PSA relapse for outcome, it has not been validated using prostate cancer death as an outcome in biopsy series. There is debate whether an ‘overall' or ‘worst' GS in biopsies series should be used. Methods: Nine hundred and eighty-eight prostate cancer biopsy cases were identified between 1990 and 2003, and treated conservatively. Diagnosis and grade was assigned to each core as well as an overall grade. Follow-up for prostate cancer death was until 31 December 2012. A log-rank test assessed univariable differences between the five grade groups based on overall and worst grade seen, and using univariable and multivariable Cox proportional hazards. Regression was used to quantify differences in outcome. Results: Using both ‘worst' and ‘overall' GS yielded highly significant results on univariate and multivariate analysis with overall GS slightly but insignificantly outperforming worst GS. There was a strong correlation with the five grade groups and prostate cancer death. Conclusions: This is the largest conservatively treated prostate cancer cohort with long-term follow-up and contemporary assessment of grade. It validates the formation of five grade groups and suggests that the ‘worst' grade is a valid prognostic measure. PMID:27100731

Sodium citrate vacuum tubes validation: preventing preanalytical variability in routine coagulation testing.

PubMed

Lima-Oliveira, Gabriel; Lippi, Giuseppe; Salvagno, Gian Luca; Montagnana, Martina; Picheth, Geraldo; Guidi, Gian Cesare

2013-04-01

Sometimes in-vitro diagnostic devices (e.g. blood collection tubes) are not validated before use or when the producer's brand is changed. The aim of this study was to validate five brands of sodium citrate vacuum tubes. Blood specimens from 50 volunteers were collected in five different tube brands (I: Venosafe, II: VACUETTE, III: BD Vacutainer, IV: LABOR IMPORT and V: S-Monovette). Routine coagulation tests [activated partial thromboplastin time (aPTT), prothrombin time (PT), and fibrinogen (FIB)] were performed on ACL TOP instrument using HemosIL reagents. The significance of the differences between samples was assessed by paired Student's t-test, set at P < 0.005. Significant differences were observed for: PT when comparing I vs. II, I vs. III, I vs. V, II vs. III, II vs. IV, II vs. V, III vs. IV, III vs. V and IV vs. V; aPTT when comparing I vs. II, I vs. III, I vs. IV, II vs. IV, III vs. IV and IV vs. V. No differences were observed among brands for FIB determination. We suggest that every laboratory management should both standardize the procedures and frequently evaluate the quality of in-vitro diagnostic devices.

Death-Related Anxiety in Patients With Advanced Cancer: Validation of the German Version of the Death and Dying Distress Scale.

PubMed

Engelmann, Dorit; Scheffold, Katharina; Friedrich, Michael; Hartung, Tim J; Schulz-Kindermann, Frank; Lordick, Florian; Schilling, Georgia; Lo, Chris; Rodin, Gary; Mehnert, Anja

2016-10-01

Distress and anxiety about issues related to death and dying is commonly experienced in patients with advanced disease and a limited life expectancy. To evaluate the psychometric properties of the German version of the Death and Dying Distress Scale (DADDS-G) in advanced cancer patients. We recruited advanced patients with mixed tumor entities (Union for International Cancer Control [UICC] Stage III/IV) treated in two German University Medical Centers during their outpatient treatment. After testing a preliminary version of the state-of-the-art translated original Death and Dying Distress Scale, we analyzed the psychometric properties of the shortened nine-item adapted DADDS-G using validated instruments measuring distress, anxiety, depression, fear of progression, and quality of life. We obtained complete questionnaires from 77 of 93 patients with advanced cancer (response rate: 83%). Participants were mostly married or cohabiting (75%), well-educated, and both sexes were almost equally represented (52% men; mean age 58 years, SD = 12). The total mean DADDS-G score was 13.3 (SD = 8.5). Patients reported to be most distressed by the feeling of being a burden to others. The exploratory factor analysis led to one factor that accounted for more than 59% of the variance. The DADDS-G's internal consistency was excellent with Cronbach alpha = 0.91. The confirmatory factor analysis demonstrated a very good model fit. Death-related anxiety was significantly associated with distress, depression, anxiety, fear of progression, and lower quality of life (P < 0.001). Results provide further evidence that the DADDS-G is a valid and reliable instrument of high clinical relevance for use in patients with advanced cancer. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Killed by Police: Validity of Media-Based Data and Misclassification of Death Certificates in Massachusetts, 2004-2016.

PubMed

Feldman, Justin M; Gruskin, Sofia; Coull, Brent A; Krieger, Nancy

2017-10-01

To assess the validity of demographic data reported in news media-based data sets for persons killed by police in Massachusetts (2004-2016) and to evaluate misclassification of these deaths in vital statistics mortality data. We identified 84 deaths resulting from police intervention in 4 news media-based data sources (WGBH News, Fatal Encounters, The Guardian, and The Washington Post) and, via record linkage, conducted matched-pair analyses with the Massachusetts mortality data. Compared with death certificates, there was near-perfect correlation for age in all sources (Pearson r > 0.99) and perfect concordance for gender. Agreement for race/ethnicity ranged from perfect (The Counted and The Washington Post) to high (Fatal Encounters Cohen's κ = 0.92). Among the 78 decedents for whom finalized International Classification of Diseases, 10th Revision (ICD-10), codes were available, 59 (75.6%) were properly classified as "deaths due to legal intervention." In Massachusetts, the 4 media-based sources on persons killed by police provide valid demographic data. Misclassification of deaths due to legal intervention in the mortality data does, however, remain a problem. Replication of the study in other states and nationally is warranted.

Validating hierarchical verbal autopsy expert algorithms in a large data set with known causes of death.

PubMed

Kalter, Henry D; Perin, Jamie; Black, Robert E

2016-06-01

Physician assessment historically has been the most common method of analyzing verbal autopsy (VA) data. Recently, the World Health Organization endorsed two automated methods, Tariff 2.0 and InterVA-4, which promise greater objectivity and lower cost. A disadvantage of the Tariff method is that it requires a training data set from a prior validation study, while InterVA relies on clinically specified conditional probabilities. We undertook to validate the hierarchical expert algorithm analysis of VA data, an automated, intuitive, deterministic method that does not require a training data set. Using Population Health Metrics Research Consortium study hospital source data, we compared the primary causes of 1629 neonatal and 1456 1-59 month-old child deaths from VA expert algorithms arranged in a hierarchy to their reference standard causes. The expert algorithms were held constant, while five prior and one new "compromise" neonatal hierarchy, and three former child hierarchies were tested. For each comparison, the reference standard data were resampled 1000 times within the range of cause-specific mortality fractions (CSMF) for one of three approximated community scenarios in the 2013 WHO global causes of death, plus one random mortality cause proportions scenario. We utilized CSMF accuracy to assess overall population-level validity, and the absolute difference between VA and reference standard CSMFs to examine particular causes. Chance-corrected concordance (CCC) and Cohen's kappa were used to evaluate individual-level cause assignment. Overall CSMF accuracy for the best-performing expert algorithm hierarchy was 0.80 (range 0.57-0.96) for neonatal deaths and 0.76 (0.50-0.97) for child deaths. Performance for particular causes of death varied, with fairly flat estimated CSMF over a range of reference values for several causes. Performance at the individual diagnosis level was also less favorable than that for overall CSMF (neonatal: best CCC = 0.23, range 0

Predicting death from kala-azar: construction, development, and validation of a score set and accompanying software.

PubMed

Costa, Dorcas Lamounier; Rocha, Regina Lunardi; Chaves, Eldo de Brito Ferreira; Batista, Vivianny Gonçalves de Vasconcelos; Costa, Henrique Lamounier; Costa, Carlos Henrique Nery

2016-01-01

Early identification of patients at higher risk of progressing to severe disease and death is crucial for implementing therapeutic and preventive measures; this could reduce the morbidity and mortality from kala-azar. We describe a score set composed of four scales in addition to software for quick assessment of the probability of death from kala-azar at the point of care. Data from 883 patients diagnosed between September 2005 and August 2008 were used to derive the score set, and data from 1,031 patients diagnosed between September 2008 and November 2013 were used to validate the models. Stepwise logistic regression analyses were used to derive the optimal multivariate prediction models. Model performance was assessed by its discriminatory accuracy. A computational specialist system (Kala-Cal(r)) was developed to speed up the calculation of the probability of death based on clinical scores. The clinical prediction score showed high discrimination (area under the curve [AUC] 0.90) for distinguishing death from survival for children ≤2 years old. Performance improved after adding laboratory variables (AUC 0.93). The clinical score showed equivalent discrimination (AUC 0.89) for older children and adults, which also improved after including laboratory data (AUC 0.92). The score set also showed a high, although lower, discrimination when applied to the validation cohort. This score set and Kala-Cal(r) software may help identify individuals with the greatest probability of death. The associated software may speed up the calculation of the probability of death based on clinical scores and assist physicians in decision-making.

The McCanse Readiness for Death Instrument (MRDI): a reliable and valid measure for hospice care.

PubMed

McCanse, R P

1995-01-01

The purpose of this study was to establish whether or not readiness for death, as an indicator of healthy dying, is a measurable concept. Review of relevant literature revealed consensus regarding the universality of a human need for healthy dying. A theory of healthy dying was derived from the Rogerian paradigm. The McCanse Readiness for Death Instrument (MRDI) was constructed, which included indicators of physiological, psychological, sociological, and spiritual aspects of "healthy" field pattern as death is developmentally approached. The MRDI was a 26-item structured interview questionnaire which generated interval-ratio data through a visual analog scale. A pretest was conducted with a sample of 9 volunteer patients drawn from a small suburban outpatient hospice. The MRDI was concurrently administered to dying individuals, their primary caregivers, and their primary hospice nurses. Correlations between dying individuals' scores and their primary caregivers' estimates of patient death readiness as well as between patients and their primary hospice nurses were very encouraging. Cronbach's coefficient alpha for internal consistency reliability was .59. Content validity was supported by consensus of an expert panel of practicing hospice nurses. Construct validity was demonstrated through legitimate placement of the concept, healthy death readiness, within the theoretical web which supported it. The MRDI was then administered to a sample of 31 terminally-ill individuals, their primary caregivers, and their primary hospice nurses drawn from larger, urban hospice populations in three geographic areas of the United States. The MRDI was also administered to a contrast group of 39 cardiac-impaired individuals who were not terminally-ill. Overall internal consistency of the MRDI was found to be quite favorable (alpha = .76). Debilitating illness and actual mortality in the study sample precluded and/or confounded estimates of test-retest reliability. Convergent validity

Claims-Based Definition of Death in Japanese Claims Database: Validity and Implications

PubMed Central

Ooba, Nobuhiro; Setoguchi, Soko; Ando, Takashi; Sato, Tsugumichi; Yamaguchi, Takuhiro; Mochizuki, Mayumi; Kubota, Kiyoshi

2013-01-01

Background For the pending National Claims Database in Japan, researchers will not have access to death information in the enrollment files. We developed and evaluated a claims-based definition of death. Methodology/Principal Findings We used healthcare claims and enrollment data between January 2005 and August 2009 for 195,193 beneficiaries aged 20 to 74 in 3 private health insurance unions. We developed claims-based definitions of death using discharge or disease status and Charlson comorbidity index (CCI). We calculated sensitivity, specificity and positive predictive values (PPVs) using the enrollment data as a gold standard in the overall population and subgroups divided by demographic and other factors. We also assessed bias and precision in two example studies where an outcome was death. The definition based on the combination of discharge/disease status and CCI provided moderate sensitivity (around 60%) and high specificity (99.99%) and high PPVs (94.8%). In most subgroups, sensitivity of the preferred definition was also around 60% but varied from 28 to 91%. In an example study comparing death rates between two anticancer drug classes, the claims-based definition provided valid and precise hazard ratios (HRs). In another example study comparing two classes of anti-depressants, the HR with the claims-based definition was biased and had lower precision than that with the gold standard definition. Conclusions/Significance The claims-based definitions of death developed in this study had high specificity and PPVs while sensitivity was around 60%. The definitions will be useful in future studies when used with attention to the possible fluctuation of sensitivity in some subpopulations. PMID:23741526

Validity and reliability of the persian version of templer death anxiety scale in family caregivers of cancer patients.

PubMed

Soleimani, Mohammad Ali; Bahrami, Nasim; Yaghoobzadeh, Ameneh; Banihashemi, Hedieh; Nia, Hamid Sharif; Haghdoost, Ali Akbar

2016-01-01

Due to increasing recognition of the importance of death anxiety for understanding human nature, it is important that researchers who investigate death anxiety have reliable and valid methodology to measure. The purpose of this study was to evaluate the validity and reliability of the Persian version of Templer Death Anxiety Scale (TDAS) in family caregivers of cancer patients. A sample of 326 caregivers of cancer patients completed a 15-item questionnaire. Principal components analysis (PCA) followed by a varimax rotation was used to assess factor structure of the DAS. The construct validity of the scale was assessed using exploratory and confirmatory factor analyses. Convergent and discriminant validity were also examined. Reliability was assessed with Cronbach's alpha coefficients and construction reliability. Based on the results of the PCA and consideration of the meaning of our items, a three-factor solution, explaining 60.38% of the variance, was identified. A confirmatory factor analysis (CFA) then supported the adequacy of the three-domain structure of the DAS. Goodness-of-fit indices showed an acceptable fit overall with the full model {χ(2)(df) = 262.32 (61), χ(2)/df = 2.04 [adjusted goodness of fit index (AGFI) = 0.922, parsimonious comparative fit index (PCFI) = 0.703, normed fit Index (NFI) = 0.912, CMIN/DF = 2.048, root mean square error of approximation (RMSEA) = 0.055]}. Convergent and discriminant validity were shown with construct fulfilled. The Cronbach's alpha and construct reliability were greater than 0.70. The findings show that the Persian version of the TDAS has a three-factor structure and acceptable validity and reliability.

The Arabic Scale of Death Anxiety (ASDA): its development, validation, and results in three Arab countries.

PubMed

Abdel-Khalek, Ahmed M

2004-06-01

The Arabic Scale of Death Anxiety (ASDA) was constructed and validated in a sample of undergraduates (17-33 yrs) in 3 Arab countries, Egypt (n = 418), Kuwait (n = 509), and Syria (n = 709). In its final form, the ASDA consists of 20 statements. Each item is answered on a 5-point intensity scale anchored by 1: No, and 5: Very much. Alpha reliabilities ranged from .88 to .93, and item-remainder correlations ranged between .27 and .74; the 1-week test-retest reliability was .90 (Egyptians only), denoting high internal consistency and stability. The correlations between the ASDA and Templer's DAS ranged from .60 to .74 denoting high convergent validity of the ASDA against the DAS in the 3 Arab countries. Four factors were extracted in the Egyptian sample and labeled "Fear of dead people and tombs", "Fear of postmortem events", "Fear of lethal disease", and "death preoccupation". The first two factors were almost completely identical in the three countries. The item, "I fear the torture of the grave", had a very high mean score. There were significant correlations between the ASDA and death depression, death obsession, reasons for death fear, and general anxiety, depression, obsession-compulsion, neuroticism, and being a female. All female groups attained significantly higher mean ASDA scores than their male counterparts. Kuwaitis had higher mean ASDA total scores, in comparison with their Egyptian and Syrian counterparts, whereas female Syrians attained the lowest mean ASDA total score in proportion to their female peers.

Adjusted hospital death rates: a potential screen for quality of medical care.

PubMed

Dubois, R W; Brook, R H; Rogers, W H

1987-09-01

Increased economic pressure on hospitals has accelerated the need to develop a screening tool for identifying hospitals that potentially provide poor quality care. Based upon data from 93 hospitals and 205,000 admissions, we used a multiple regression model to adjust the hospitals crude death rate. The adjustment process used age, origin of patient from the emergency department or nursing home, and a hospital case mix index based on DRGs (diagnostic related groups). Before adjustment, hospital death rates ranged from 0.3 to 5.8 per 100 admissions. After adjustment, hospital death ratios ranged from 0.36 to 1.36 per 100 (actual death rate divided by predicted death rate). Eleven hospitals (12 per cent) were identified where the actual death rate exceeded the predicted death rate by more than two standard deviations. In nine hospitals (10 per cent), the predicted death rate exceeded the actual death rate by a similar statistical margin. The 11 hospitals with higher than predicted death rates may provide inadequate quality of care or have uniquely ill patient populations. The adjusted death rate model needs to be validated and generalized before it can be used routinely to screen hospitals. However, the remaining large differences in observed versus predicted death rates lead us to believe that important differences in hospital performance may exist.

Prospective study of one million deaths in India: rationale, design, and validation results.

PubMed

Jha, Prabhat; Gajalakshmi, Vendhan; Gupta, Prakash C; Kumar, Rajesh; Mony, Prem; Dhingra, Neeraj; Peto, Richard

2006-02-01

Over 75% of the annual estimated 9.5 million deaths in India occur in the home, and the large majority of these do not have a certified cause. India and other developing countries urgently need reliable quantification of the causes of death. They also need better epidemiological evidence about the relevance of physical (such as blood pressure and obesity), behavioral (such as smoking, alcohol, HIV-1 risk taking, and immunization history), and biological (such as blood lipids and gene polymorphisms) measurements to the development of disease in individuals or disease rates in populations. We report here on the rationale, design, and implementation of the world's largest prospective study of the causes and correlates of mortality. We will monitor nearly 14 million people in 2.4 million nationally representative Indian households (6.3 million people in 1.1 million households in the 1998-2003 sample frame and 7.6 million people in 1.3 million households in the 2004-2014 sample frame) for vital status and, if dead, the causes of death through a well-validated verbal autopsy (VA) instrument. About 300,000 deaths from 1998-2003 and some 700,000 deaths from 2004-2014 are expected; of these about 850,000 will be coded by two physicians to provide causes of death by gender, age, socioeconomic status, and geographical region. Pilot studies will evaluate the addition of physical and biological measurements, specifically dried blood spots. Preliminary results from over 35,000 deaths suggest that VA can ascertain the leading causes of death, reduce the misclassification of causes, and derive the probable underlying cause of death when it has not been reported. VA yields broad classification of the underlying causes in about 90% of deaths before age 70. In old age, however, the proportion of classifiable deaths is lower. By tracking underlying demographic denominators, the study permits quantification of absolute mortality rates. Household case-control, proportional mortality

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

PubMed

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.

Virtual microscopy: an evaluation of its validity and diagnostic performance in routine histologic diagnosis of skin tumors.

PubMed

Nielsen, Patricia Switten; Lindebjerg, Jan; Rasmussen, Jan; Starklint, Henrik; Waldstrøm, Marianne; Nielsen, Bjarne

2010-12-01

Digitization of histologic slides is associated with many advantages, and its use in routine diagnosis holds great promise. Nevertheless, few articles evaluate virtual microscopy in routine settings. This study is an evaluation of the validity and diagnostic performance of virtual microscopy in routine histologic diagnosis of skin tumors. Our aim is to investigate whether conventional microscopy of skin tumors can be replaced by virtual microscopy. Ninety-six skin tumors and skin-tumor-like changes were consecutively gathered over a 1-week period. Specimens were routinely processed, and digital slides were captured on Mirax Scan (Carl Zeiss MicroImaging, Göttingen, Germany). Four pathologists evaluated the 96 virtual slides and the associated 96 conventional slides twice with intermediate time intervals of at least 3 weeks. Virtual slides that caused difficulties were reevaluated to identify possible reasons for this. The accuracy was 89.2% for virtual microscopy and 92.7% for conventional microscopy. All κ coefficients expressed very good intra- and interobserver agreement. The sensitivities were 85.7% (78.0%-91.0%) and 92.0% (85.5%-95.7%) for virtual and conventional microscopy, respectively. The difference between the sensitivities was 6.3% (0.8%-12.6%). The subsequent reevaluation showed that virtual slides were as useful as conventional slides when rendering a diagnosis. Differences seen are presumed to be due to the pathologists' lack of experience using the virtual microscope. We conclude that it is feasible to make histologic diagnosis on the skin tumor types represented in this study using virtual microscopy after pathologists have completed a period of training. Larger studies should be conducted to verify whether virtual microscopy can replace conventional microscopy in routine practice. Copyright © 2010 Elsevier Inc. All rights reserved.

Validation of Toolkit After-Death Bereaved Family Member Interview.

PubMed

Teno, J M; Clarridge, B; Casey, V; Edgman-Levitan, S; Fowler, J

2001-09-01

The purpose of this study was to examine the reliability and validity of the Toolkit After-Death Bereaved Family Member Interview to measure quality of care at the end of life from the unique perspective of family members. The survey included proposed problem scores (a count of the opportunity to improve the quality of care) and scales. Data were collected through a retrospective telephone survey with a family member who was interviewed between 3 and 6 months after the death of the patient. The setting was an outpatient hospice service, a consortium of nursing homes, and a hospital in New England. One hundred fifty-six family members from across these settings participated. The 8 proposed domains of care, as represented by problem scores or scales, were based on a conceptual model of patient-focused, family-centered medical care. The survey design emphasized face validity in order to provide actionable information to health care providers. A correlational and factor analysis was undertaken of the 8 proposed problem scores or scales. Cronbach's alpha scores varied from 0.58 to 0.87, with two problem scores (each of which had only 3 survey items) having a low alpha of 0.58. The mean item-to-total correlations for the other problem scores varied from 0.36 to 0.69, and the mean item-to-item correlations were between 0.32 and 0.70. The proposed problem scores or scales, with the exception of closure and advance care planning, demonstrated a moderate correlation (i.e., from 0.44 to 0.52) with the overall rating of satisfaction (as measured by a five-point, "excellent" to "poor" scale). Family members of persons who died with hospice service reported fewer problems in each of the six domains of medical care, gave a higher rating of the quality of care, and reported higher self-efficacy in caring for their loved ones. These results indicate that 7 of the 8 proposed problem scores or scales demonstrated psychometric properties that warrant further testing. The domain of

Validation of Mode-S Meteorological Routine Air Report aircraft observations

NASA Astrophysics Data System (ADS)

Strajnar, B.

2012-12-01

The success of mesoscale data assimilation depends on the availability of three-dimensional observations with high spatial and temporal resolution. This paper describes an example of such observations, available through Mode-S air traffic control system composed of ground radar and transponders on board the aircraft. The meteorological information is provided by interrogation of a dedicated meteorological data register, called Meteorological Routine Air Report (MRAR). MRAR provides direct measurements of temperature and wind, but is only returned by a small fraction of aircraft. The quality of Mode-S MRAR data, collected at the Ljubljana Airport, Slovenia, is assessed by its comparison with AMDAR and high-resolution radiosonde data sets, which enable high- and low-level validation, respectively. The need for temporal smoothing of raw Mode-S MRAR data is also studied. The standard deviation of differences between smoothed Mode-S MRAR and AMDAR is 0.35°C for temperature, 0.8 m/s for wind speed and below 10 degrees for wind direction. The differences with respect to radiosondes are larger, with standard deviations of approximately 1.7°C, 3 m/s and 25 degrees for temperature, wind speed and wind direction, respectively. It is concluded that both wind and temperature observations from Mode-S MRAR are accurate and therefore potentially very useful for data assimilation in numerical weather prediction models.

The Brief Death Implicit Association Test: Scoring recommendations, reliability, validity, and comparisons with the Death Implicit Association Test.

PubMed

Millner, Alexander J; Coppersmith, Daniel D L; Teachman, Bethany A; Nock, Matthew K

2018-05-21

Assessing suicidal thoughts and behaviors is difficult because at-risk individuals often fail to provide honest or accurate accounts of their suicidal thoughts or intentions. Research has shown that the Death Implicit Association Test (D-IAT), a behavioral test that measures implicit (i.e., outside of conscious control) associations between oneself and death concepts, can differentiate among people with different suicidal histories, such as those with different severity or recency of suicidal behaviors. We report here on the development and evaluation of a shorter and simpler version of the D-IAT called the Death Brief Implicit Association Test (D-BIAT). We recruited large (ns > 1,500) samples of participants to complete the original D-IAT and shorter D-BIAT via a public web-based platform and evaluated different scoring approaches, assessed the reliability and validity of the D-BIAT and compared it with the D-IAT. We found that the D-BIAT was reliable, provided significant group differences with effect sizes on par with the D-IAT, as well as similarly sized classification metrics (i.e., receiver operator characteristics). Although the D-IAT was nonsignificantly better on most outcomes, the D-BIAT is 1-1[1/2] minutes shorter and provided larger effect sizes for distinguishing between past year and lifetime attempters. Thus, there is a trade-off between administration time and improved outcomes associated with increased data. The D-BIAT should be considered for use where time or participant burden needs to be minimized, such as in clinical settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Deaths from chickenpox in England and Wales 1995-7: analysis of routine mortality data

PubMed Central

Rawson, Helen; Crampin, Amelia; Noah, Norman

2001-01-01

Objective To evaluate the epidemiology and impact of mortality from chickenpox in England and Wales. Design Review of death certificates from the Office for National Statistics on which codes for “chickenpox” or “varicella” were mentioned. Further information ascertained from certifying physician. Participants Those certified as having died from chickenpox in England and Wales, 1995-7. Main outcome measures Diagnosis and age and sex distributions of deaths from chickenpox. Results On average, 25 people a year die from chickenpox. Overall case fatality was 9.22 per 100 000 consultations for chickenpox. Adults accounted for 81% of deaths and 19% of consultations. Deaths were twice as common in men as in women. More of those who died were born outside United Kingdom than expected (12% v 4%). Conclusions Chickenpox is not a mild disease. Deaths in adults are increasing, both in number and proportion. What is already known on this topicChickenpox can be fatal, especially in immunosuppressed people and adultsThe age distribution of cases has been shifting upwards for about 30 yearsWhat this study addsAbout 80% of deaths certified as due to chickenpox are due to chickenpoxChickenpox accounts for about 25 deaths annually in England and Wales, more than from measles, mumps, pertussis, and Hib meningitis combinedMortality in adults has been increasing for at least 30 years and now 80% of deaths from chickenpox are in adultsDeaths were twice as common in men as in women PMID:11701571

Analyzing the Trait of Routinization in Older Adults.

ERIC Educational Resources Information Center

Reich, John W.; Zautra, Alex J.

1991-01-01

Developed scale to assess routinization (tendency to maintain daily events of one's life in relatively unchanging and orderly pattern of regularity) among older adults. Findings from over 200 older adults revealed 2 underlying factors: Having Order and Routine in daily living and Disliking Disruption. Evidence was found for validity of the 20-item…

Use of Rapid Ascertainment Process for Institutional Deaths (RAPID) to identify pregnancy-related deaths in tertiary-care obstetric hospitals in three departments in Haiti.

PubMed

Boyd, Andrew T; Hulland, Erin N; Grand'Pierre, Reynold; Nesi, Floris; Honoré, Patrice; Jean-Louis, Reginald; Handzel, Endang

2017-05-16

Accurate assessment of maternal deaths is difficult in countries lacking standardized data sources for their review. As a first step to investigate suspected maternal deaths, WHO suggests surveillance of "pregnancy-related deaths", defined as deaths of women while pregnant or within 42 days of termination of pregnancy, irrespective of cause. Rapid Ascertainment Process for Institutional Deaths (RAPID), a surveillance tool, retrospectively identifies pregnancy-related deaths occurring in health facilities that may be missed by routine surveillance to assess gaps in reporting these deaths. We used RAPID to review pregnancy-related deaths in six tertiary obstetric care facilities in three departments in Haiti. We reviewed registers and medical dossiers of deaths among women of reproductive age occurring in 2014 and 2015 from all wards, along with any additional available dossiers of deaths not appearing in registers, to capture pregnancy status, suspected cause of death, and timing of death in relation to the pregnancy. We used capture-recapture analyses to estimate the true number of in-hospital pregnancy-related deaths in these facilities. Among 373 deaths of women of reproductive age, we found 111 pregnancy-related deaths, 25.2% more than were reported through routine surveillance, and 22.5% of which were misclassified as non-pregnancy-related. Hemorrhage (27.0%) and hypertensive disorders (18.0%) were the most common categories of suspected causes of death, and deaths after termination of pregnancy were statistically significantly more common than deaths during pregnancy or delivery. Data were missing at multiple levels: 210 deaths had an undetermined pregnancy status, 48.7% of pregnancy-related deaths lacked specific information about timing of death in relation to the pregnancy, and capture-recapture analyses in three hospitals suggested that approximately one-quarter of pregnancy-related deaths were not captured by RAPID or routine surveillance. Across six

Hypertrophic Cardiomyopathy: Practical Steps for Preventing Sudden Death.

ERIC Educational Resources Information Center

Maron, Barry J.

2002-01-01

Hypertrophic cardiomyopathy (HCM) is a rare cause of death among athletes, with deaths occurring in young, apparently healthy people. Differentiating HCM from conditioning hypertrophy is challenging. Routine detection involves family history, physical examination, electrocardiography, and echocardiography. Keys to differential diagnosis include…

Bugen's Coping with Death Scale: Reliability and Further Validation.

ERIC Educational Resources Information Center

Robbins, Rosemary A.

1991-01-01

Tested Bugen's Coping with Death Scale. Individuals who had written wills, planned estates and funerals, and signed organ donor cards scored higher on the Coping with Death Scale. Because Coping with Death scores were more consistently different in those who prepared for death, this scale may help in efforts to predict those who will engage in…

Derivation and validation of a diagnostic score based on case-mix groups to predict 30-day death or urgent readmission.

PubMed

van Walraven, Carl; Wong, Jenna; Forster, Alan J

2012-01-01

Between 5% and 10% of patients die or are urgently readmitted within 30 days of discharge from hospital. Readmission risk indexes have either excluded acute diagnoses or modelled them as multiple distinct variables. In this study, we derived and validated a score summarizing the influence of acute hospital diagnoses and procedures on death or urgent readmission within 30 days. From population-based hospital abstracts in Ontario, we randomly sampled 200 000 discharges between April 2003 and March 2009 and determined who had been readmitted urgently or died within 30 days of discharge. We used generalized estimating equation modelling, with a sample of 100 000 patients, to measure the adjusted association of various case-mix groups (CMGs-homogenous groups of acute care inpatients with similar clinical and resource-utilization characteristics) with 30-day death or urgent readmission. This final model was transformed into a scoring system that was validated in the remaining 100 000 patients. Patients in the derivation set belonged to 1 of 506 CMGs and had a 6.8% risk of 30-day death or urgent readmission. Forty-seven CMG codes (more than half of which were directly related to chronic diseases) were independently associated with this outcome, which led to a CMG score that ranged from -6 to 7 points. The CMG score was significantly associated with 30-day death or urgent readmission (unadjusted odds ratio for a 1-point increase in CMG score 1.52, 95% confidence interval [CI] 1.49-1.56). Alone, the CMG score was only moderately discriminative (C statistic 0.650, 95% CI 0.644-0.656). However, when the CMG score was added to a validated risk index for death or readmission, the C statistic increased to 0.759 (95% CI 0.753-0.765). The CMG score was well calibrated for 30-day death or readmission. In this study, we developed a scoring system for acute hospital diagnoses and procedures that could be used as part of a risk-adjustment methodology for analyses of postdischarge

The Validity of Race and Hispanic-origin Reporting on Death Certificates in the United States: An Update.

PubMed

Arias, Elizabeth; Heron, Melonie; Hakes, Jahn

2016-08-01

Objectives This report presents the findings of an updated study of the validity of race and Hispanic-origin reporting on death certificates in the United States, and its impact on race- and Hispanic origin-specific death rates. Methods The latest version of the National Longitudinal Mortality Study (NLMS) was used to evaluate the classification of race and Hispanic origin on death certificates for deaths occurring in 1999–2011 to decedents in NLMS. To evaluate change over time, these results were compared with those of a study based on an earlier version of NLMS that evaluated the quality of race and ethnicity classification on death certificates for 1979–1989 and 1990–1998. NLMS consists of a series of annual Current Population Survey files (1973 and 1978–2011) and a sample of the 1980 decennial census linked to death certificates for 1979–2011. Pooled 2009–2011 vital statistics mortality data and 2010 decennial census population data were used to estimate and compare observed and corrected race- and Hispanic origin-specific death rates. Results Race and ethnicity reporting on death certificates continued to be highly accurate for both white and black populations during the 1999–2011 period. Misclassification remained high at 40% for the American Indian or Alaska Native (AIAN) population. It improved, from 5% to 3%, for the Hispanic population, and from 7% to 3% for the Asian or Pacific Islander (API) population. Decedent characteristics such as place of residence and nativity affected the quality of reporting on the death certificate. Effects of misclassification on death rates were large for the AIAN population but not significant for the Hispanic or API populations.

The Arabic Scale of Death Anxiety (ASDA): Its Development, Validation, and Results in Three Arab Countries

ERIC Educational Resources Information Center

Abdel-Khalek, Ahmed M.

2004-01-01

The Arabic Scale of Death Anxiety (ASDA) was constructed and validated in a sample of undergraduates (17-33 yrs) in 3 Arab countries, Egypt (n = 418), Kuwait (n = 509), and Syria (n = 709). In its final form, the ASDA consists of 20 statements. Each item is answered on a 5-point intensity scale anchored by 1: No, and 5: Very much. Alpha…

Deconstructing the Brain Disconnection–Brain Death Analogy and Clarifying the Rationale for the Neurological Criterion of Death

PubMed Central

Moschella, Melissa

2016-01-01

This article explains the problems with Alan Shewmon’s critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised rationale for the validity of the neurological criterion of human death. PMID:27095749

Inaccuracies in oral cavity-pharynx cancer coded as the underlying cause of death on U.S. death certificates, and trends in mortality rates (1999-2010).

PubMed

Polednak, Anthony P

2014-08-01

To enhance surveillance of mortality from oral cavity-pharynx cancer (OCPC) by considering inaccuracies in the cancer site coded as the underlying cause of death on death certificates vs. cancer site in a population-based cancer registry (as the gold standard). A database was used for 9 population-based cancer registries of the Surveillance, Epidemiology and End Results (SEER) Program, including deaths in 1999-2010 for patients diagnosed in 1973-2010. Numbers of deaths and death rates for OCPC in the SEER population were modified for apparent inaccuracies in the cancer site coded as the underlying cause of death. For age groups <65 years, deaths from OCPC were underestimated by 22-35% by using unmodified (vs. modified) numbers, but temporal declines in death rates were still evident in the SEER population and were similar to declines using routine mortality data for the entire U.S. population. Deaths were underestimated by about 70-80% using underlying cause for tonsillar cancers, strongly associated with human papillomavirus (HPV) infection, but a lack of decline in death rates was still evident. Routine mortality statistics based on underlying cause of death underestimate OCPC deaths but demonstrate trends in OCPC death rates that require continued surveillance in view of increasing incidence rates for HPV-related OCPC. Copyright © 2014 Elsevier Ltd. All rights reserved.

Is routine drainage necessary after pancreaticoduodenectomy?

PubMed Central

Wang, Qiang; Jiang, Yong-Jian; Li, Ji; Yang, Feng; Di, Yang; Yao, Lie; Jin, Chen; Fu, De-Liang

2014-01-01

With the development of imaging technology and surgical techniques, pancreatic resections to treat pancreatic tumors, ampulla tumors, and other pancreatic diseases have increased. Pancreaticoduodenectomy, one type of pancreatic resection, is a complex surgery with the loss of pancreatic integrity and various anastomoses. Complications after pancreaticoduodenectomy such as pancreatic fistulas and anastomosis leakage are common and significantly associated with patient outcomes. Pancreatic fistula is one of the most important postoperative complications; this condition can cause intraperitoneal hemorrhage, septic shock, or even death. An effective way has not yet been found to avoid the occurrence of pancreatic fistula. In most medical centers, the frequency of pancreatic fistula has remained between 9% and 13%. The early detection and routine drainage of anastomotic fistulas, pancreatic fistulas, bleeding, or other intra-abdominal fluid collections after pancreatic resections are considered as important and effective ways to reduce postoperative complications and the mortality rate. However, many recent studies have argued that routine drainage after abdominal operations, including pancreaticoduodenectomies, does not affect the incidence of postoperative complications. Although inserting drains after pancreatic resections continues to be a routine procedure, its necessity remains controversial. This article reviews studies of the advantages and disadvantages of routine drainage after pancreaticoduodenectomy and discusses the necessity of this procedure. PMID:25009383

[Attitude to death and changes of death image in Hungarian society. Study of the differences in generational value-judgments and of the possibilities of measurement. Is death still a taboo?].

PubMed

Zana, Agnes

2009-06-21

The aim of our research is to examine the sociological, anthropological, and psychological aspects of attitudes towards death; review the different approaches as a complex system; present the altered death image and the changes of tendency; analyze and interpret the most significant anxiety generating factors according to gender, age, and occupation; validate the fear of death and attitudes towards death scales in the Hungarian population; review the possibilities of interventions designed to reduce anxiety generating fear of death. Our hypotheses of our quantitative research were the following: women are characterized by a marked fear of death and anxiety; young people are more afraid of death; health care workers have a higher level death anxiety in comparison to other professionals due to the fact that they are face the suddenness and inevitability of death on daily basis, and this itself is an anxiety generating factor. We validated, adapted and calibrated two psychometric scales measuring fear of death and attitudes towards death. According to our findings, both the Neimeyer and Moore Multidimensional Fear of Death Scale and the Lester Attitude Toward Death Scale proved valid and suitable for measuring fear of death and attitudes towards death. The Hungarian version of the scales proved reliable. In accordance with our hypothesis, young people and women are characterized by higher level of fear of death and anxiety. Our hypothesis, namely that fear of death among health care workers higher as the normal population, was not confirmed. Yet, contrary to a segment of preceding measurements, lower level of fear and anxiety was found.

Quantifying the Validity of Routine Neonatal Healthcare Data in the Greater Accra Region, Ghana

PubMed Central

Kayode, Gbenga A.; Amoakoh-Coleman, Mary; Brown-Davies, Charles; Grobbee, Diederick E.; Agyepong, Irene Akua; Ansah, Evelyn; Klipstein-Grobusch, Kerstin

2014-01-01

Objectives The District Health Information Management System–2 (DHIMS–2) is the database for storing health service data in Ghana, and similar to other low and middle income countries, paper-based data collection is being used by the Ghana Health Service. As the DHIMS-2 database has not been validated before this study aimed to evaluate its validity. Methods Seven out of ten districts in the Greater Accra Region were randomly sampled; the district hospital and a polyclinic in each district were recruited for validation. Seven pre-specified neonatal health indicators were considered for validation: antenatal registrants, deliveries, total births, live birth, stillbirth, low birthweight, and neonatal death. Data were extracted on these health indicators from the primary data (hospital paper-registers) recorded from January to March 2012. We examined all the data captured during this period as these data have been uploaded to the DHIMS-2 database. The differences between the values of the health indicators obtained from the primary data and that of the facility and DHIMS–2 database were used to assess the accuracy of the database while its completeness was estimated by the percentage of missing data in the primary data. Results About 41,000 data were assessed and in almost all the districts, the error rates of the DHIMS-2 data were less than 2.1% while the percentages of missing data were below 2%. At the regional level, almost all the health indicators had an error rate below 1% while the overall error rate of the DHIMS-2 database was 0.68% (95% C I = 0.61–0.75) and the percentage of missing data was 3.1% (95% C I = 2.96–3.24). Conclusion This study demonstrated that the percentage of missing data in the DHIMS-2 database was negligible while its accuracy was close to the acceptable range for high quality data. PMID:25144222

Multidimensional Treatment of Fear of Death.

ERIC Educational Resources Information Center

Hoelter, Jon W.

1979-01-01

Presents a multidimensional conception of fear of death and provides subscales for measuring suggested dimensions (fear of the dying process, of the dead, of being destroyed, for significant others, of the unknown, of conscious death, for body after death, and of premature death). Evidence for construct validity is provided. (Author/BEF)

Routine Responses to Disruption of Routines

ERIC Educational Resources Information Center

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…

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

PubMed Central

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

2014-01-01

Objective To assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties. Design Case distribution study (case series with survey information on referent exposures). Setting United States law enforcement. Participants 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. Main outcome measures 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. Results 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. Conclusions 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

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

PubMed

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.

Predicting dementia risk in primary care: development and validation of the Dementia Risk Score using routinely collected data.

PubMed

Walters, K; Hardoon, S; Petersen, I; Iliffe, S; Omar, R Z; Nazareth, I; Rait, G

2016-01-21

Existing dementia risk scores require collection of additional data from patients, limiting their use in practice. Routinely collected healthcare data have the potential to assess dementia risk without the need to collect further information. Our objective was to develop and validate a 5-year dementia risk score derived from primary healthcare data. We used data from general practices in The Health Improvement Network (THIN) database from across the UK, randomly selecting 377 practices for a development cohort and identifying 930,395 patients aged 60-95 years without a recording of dementia, cognitive impairment or memory symptoms at baseline. We developed risk algorithm models for two age groups (60-79 and 80-95 years). An external validation was conducted by validating the model on a separate cohort of 264,224 patients from 95 randomly chosen THIN practices that did not contribute to the development cohort. Our main outcome was 5-year risk of first recorded dementia diagnosis. Potential predictors included sociodemographic, cardiovascular, lifestyle and mental health variables. Dementia incidence was 1.88 (95% CI, 1.83-1.93) and 16.53 (95% CI, 16.15-16.92) per 1000 PYAR for those aged 60-79 (n = 6017) and 80-95 years (n = 7104), respectively. Predictors for those aged 60-79 included age, sex, social deprivation, smoking, BMI, heavy alcohol use, anti-hypertensive drugs, diabetes, stroke/TIA, atrial fibrillation, aspirin, depression. The discrimination and calibration of the risk algorithm were good for the 60-79 years model; D statistic 2.03 (95% CI, 1.95-2.11), C index 0.84 (95% CI, 0.81-0.87), and calibration slope 0.98 (95% CI, 0.93-1.02). The algorithm had a high negative predictive value, but lower positive predictive value at most risk thresholds. Discrimination and calibration were poor for the 80-95 years model. Routinely collected data predicts 5-year risk of recorded diagnosis of dementia for those aged 60-79, but not those aged 80+. This

Case-finding for common mental disorders of anxiety and depression in primary care: an external validation of routinely collected data.

PubMed

John, Ann; McGregor, Joanne; Fone, David; Dunstan, Frank; Cornish, Rosie; Lyons, Ronan A; Lloyd, Keith R

2016-03-15

The robustness of epidemiological research using routinely collected primary care electronic data to support policy and practice for common mental disorders (CMD) anxiety and depression would be greatly enhanced by appropriate validation of diagnostic codes and algorithms for data extraction. We aimed to create a robust research platform for CMD using population-based, routinely collected primary care electronic data. We developed a set of Read code lists (diagnosis, symptoms, treatments) for the identification of anxiety and depression in the General Practice Database (GPD) within the Secure Anonymised Information Linkage Databank at Swansea University, and assessed 12 algorithms for Read codes to define cases according to various criteria. Annual incidence rates were calculated per 1000 person years at risk (PYAR) to assess recording practice for these CMD between January 1(st) 2000 and December 31(st) 2009. We anonymously linked the 2799 MHI-5 Caerphilly Health and Social Needs Survey (CHSNS) respondents aged 18 to 74 years to their routinely collected GP data in SAIL. We estimated the sensitivity, specificity and positive predictive value of the various algorithms using the MHI-5 as the gold standard. The incidence of combined depression/anxiety diagnoses remained stable over the ten-year period in a population of over 500,000 but symptoms increased from 6.5 to 20.7 per 1000 PYAR. A 'historical' GP diagnosis for depression/anxiety currently treated plus a current diagnosis (treated or untreated) resulted in a specificity of 0.96, sensitivity 0.29 and PPV 0.76. Adding current symptom codes improved sensitivity (0.32) with a marginal effect on specificity (0.95) and PPV (0.74). We have developed an algorithm with a high specificity and PPV of detecting cases of anxiety and depression from routine GP data that incorporates symptom codes to reflect GP coding behaviour. We have demonstrated that using diagnosis and current treatment alone to identify cases for

A biomarker-based risk score to predict death in patients with atrial fibrillation: the ABC (age, biomarkers, clinical history) death risk score

PubMed Central

Hijazi, Ziad; Oldgren, Jonas; Lindbäck, Johan; Alexander, John H; Connolly, Stuart J; Eikelboom, John W; Ezekowitz, Michael D; Held, Claes; Hylek, Elaine M; Lopes, Renato D; Yusuf, Salim; Granger, Christopher B; Siegbahn, Agneta; Wallentin, Lars

2018-01-01

Abstract Aims In atrial fibrillation (AF), mortality remains high despite effective anticoagulation. A model predicting the risk of death in these patients is currently not available. We developed and validated a risk score for death in anticoagulated patients with AF including both clinical information and biomarkers. Methods and results The new risk score was developed and internally validated in 14 611 patients with AF randomized to apixaban vs. warfarin for a median of 1.9 years. External validation was performed in 8548 patients with AF randomized to dabigatran vs. warfarin for 2.0 years. Biomarker samples were obtained at study entry. Variables significantly contributing to the prediction of all-cause mortality were assessed by Cox-regression. Each variable obtained a weight proportional to the model coefficients. There were 1047 all-cause deaths in the derivation and 594 in the validation cohort. The most important predictors of death were N-terminal pro B-type natriuretic peptide, troponin-T, growth differentiation factor-15, age, and heart failure, and these were included in the ABC (Age, Biomarkers, Clinical history)-death risk score. The score was well-calibrated and yielded higher c-indices than a model based on all clinical variables in both the derivation (0.74 vs. 0.68) and validation cohorts (0.74 vs. 0.67). The reduction in mortality with apixaban was most pronounced in patients with a high ABC-death score. Conclusion A new biomarker-based score for predicting risk of death in anticoagulated AF patients was developed, internally and externally validated, and well-calibrated in two large cohorts. The ABC-death risk score performed well and may contribute to overall risk assessment in AF. ClinicalTrials.gov identifier NCT00412984 and NCT00262600 PMID:29069359

Deconstructing the Brain Disconnection-Brain Death Analogy and Clarifying the Rationale for the Neurological Criterion of Death.

PubMed

Moschella, Melissa

2016-06-01

This article explains the problems with Alan Shewmon's critique of brain death as a valid sign of human death, beginning with a critical examination of his analogy between brain death and severe spinal cord injury. The article then goes on to assess his broader argument against the necessity of the brain for adult human organismal integration, arguing that he fails to translate correctly from biological to metaphysical claims. Finally, on the basis of a deeper metaphysical analysis, I offer a revised rationale for the validity of the neurological criterion of human death. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Validation of an imaging based cardiovascular risk score in a Scottish population.

PubMed

Kockelkoren, Remko; Jairam, Pushpa M; Murchison, John T; Debray, Thomas P A; Mirsadraee, Saeed; van der Graaf, Yolanda; Jong, Pim A de; van Beek, Edwin J R

2018-01-01

A radiological risk score that determines 5-year cardiovascular disease (CVD) risk using routine care CT and patient information readily available to radiologists was previously developed. External validation in a Scottish population was performed to assess the applicability and validity of the risk score in other populations. 2915 subjects aged ≥40 years who underwent routine clinical chest CT scanning for non-cardiovascular diagnostic indications were followed up until first diagnosis of, or death from, CVD. Using a case-cohort approach, all cases and a random sample of 20% of the participant's CT examinations were visually graded for cardiovascular calcifications and cardiac diameter was measured. The radiological risk score was determined using imaging findings, age, gender, and CT indication. Performance on 5-year CVD risk prediction was assessed. 384 events occurred in 2124 subjects during a mean follow-up of 4.25 years (0-6.4 years). The risk score demonstrated reasonable performance in the studied population. Calibration showed good agreement between actual and 5-year predicted risk of CVD. The c-statistic was 0.71 (95%CI:0.67-0.75). The radiological CVD risk score performed adequately in the Scottish population offering a potential novel strategy for identifying patients at high risk for developing cardiovascular disease using routine care CT data. Copyright © 2017 Elsevier B.V. All rights reserved.

A computer case definition for sudden cardiac death.

PubMed

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.

Forensic Analysis of Parachute Deaths.

PubMed

Burke, Michael Philip; Chitty, Johannes

2017-03-01

Deaths associated with parachuting are very uncommon. However, these deaths do tend to be "high profile" in the traditional and social media. When forensic pathologists examine the deceased after a fatal parachuting incident, the anatomical cause of death is usually not in question. For most forensic pathologists, it is usually the case that we will have very limited knowledge of parachuting equipment or the mechanics of a typical successful parachute jump. As such, the investigation of the death should involve a multidisciplinary approach with an appropriate expert providing the formal forensic examination of the parachuting equipment. We have endeavored to describe, in simple terms, the usual components of a typical parachute rig, a précis of the sequence of events in a routine skydive and BASE jump, and the various types of malfunctions that may occur. Last, we present a case report of a BASE jump fatality to illustrate how an expert examination of the BASE jumper's gear aided the medicolegal investigation of the death with some important aspects in the forensic examination of the jumper's equipment.

Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke

PubMed Central

Nevatte, Tracy; Sim, Julius; Bishop, Jon; Ives, Natalie; Ferdinand, Phillip; Gray, Richard

2017-01-01

Importance Hypoxia is common in the first few days after acute stroke, is frequently intermittent, and is often undetected. Oxygen supplementation could prevent hypoxia and secondary neurological deterioration and thus has the potential to improve recovery. Objective To assess whether routine prophylactic low-dose oxygen therapy was more effective than control oxygen administration in reducing death and disability at 90 days, and if so, whether oxygen given at night only, when hypoxia is most frequent, and oxygen administration is least likely to interfere with rehabilitation, was more effective than continuous supplementation. Design, Setting, and Participants In this single-blind randomized clinical trial, 8003 adults with acute stroke were enrolled from 136 participating centers in the United Kingdom within 24 hours of hospital admission if they had no clear indications for or contraindications to oxygen treatment (first patient enrolled April 24, 2008; last follow-up January 27, 2015). Interventions Participants were randomized 1:1:1 to continuous oxygen for 72 hours (n = 2668), nocturnal oxygen (21:00 to 07:00 hours) for 3 nights (n = 2667), or control (oxygen only if clinically indicated; n = 2668). Oxygen was given via nasal tubes at 3 L/min if baseline oxygen saturation was 93% or less and at 2 L/min if oxygen saturation was greater than 93%. Main Outcomes and Measures The primary outcome was reported using the modified Rankin Scale score (disability range, 0 [no symptoms] to 6 [death]; minimum clinically important difference, 1 point), assessed at 90 days by postal questionnaire (participant aware, assessor blinded). The modified Rankin Scale score was analyzed by ordinal logistic regression, which yields a common odds ratio (OR) for a change from one disability level to the next better (lower) level; OR greater than 1.00 indicates improvement. Results A total of 8003 patients (4398 (55%) men; mean [SD] age, 72 [13] years; median National

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

PubMed

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.

Design and Validation of a Radio-Frequency Identification-Based Device for Routinely Assessing Gait Speed in a Geriatrics Clinic.

PubMed

Barry, Lisa C; Hatchman, Laura; Fan, Zhaoyan; Guralnik, Jack M; Gao, Robert X; Kuchel, George A

2018-05-01

To evaluate the feasibility, acceptability, and validity of a radio-frequency identification (RFID)-based system to measure gait speed in a clinical setting as a first step to using unobtrusive gait speed assessment in routine clinical care. Feasibility study comparing gait speed assessed using an RFID-based system with gait speed assessed using handheld stopwatch, the criterion standard. Outpatient geriatrics clinic at a Connecticut-based academic medical center. Clinic attendees who could walk independently with or without an assistive device (N=50) and healthcare providers (N=9). Gait speed was measured in twice using 2 methods each time before participants entered an examination room. Participants walked at their usual pace while gait speed was recorded simultaneously using the RFID-based system and a handheld stopwatch operated by a trained study investigator. After 2 trials, participants completed a brief survey regarding their experience. At the end of the study period, clinic healthcare providers completed a separate survey. Test-retest reliability of the RFID-based system was high (intraclass correlation coefficient = 0.953). The mean difference ± standard deviation in gait speed between the RFID-based system and the stopwatch was -0.003±0.035 m/s (p=.53) and did not differ significantly according to age, sex, or use of an assistive walking aid. Acceptability of the device was high, and 8 of 9 providers indicated that measuring gait speed using the RFID-based system should be a part of routine clinical care. RFID technology may offer a practical means of overcoming barriers to routine measurement of gait speed in real-world outpatient clinical settings. © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

Energy expenditure estimation during daily military routine with body-fixed sensors.

PubMed

Wyss, Thomas; Mäder, Urs

2011-05-01

The purpose of this study was to develop and validate an algorithm for estimating energy expenditure during the daily military routine on the basis of data collected using body-fixed sensors. First, 8 volunteers completed isolated physical activities according to an established protocol, and the resulting data were used to develop activity-class-specific multiple linear regressions for physical activity energy expenditure on the basis of hip acceleration, heart rate, and body mass as independent variables. Second, the validity of these linear regressions was tested during the daily military routine using indirect calorimetry (n = 12). Volunteers' mean estimated energy expenditure did not significantly differ from the energy expenditure measured with indirect calorimetry (p = 0.898, 95% confidence interval = -1.97 to 1.75 kJ/min). We conclude that the developed activity-class-specific multiple linear regressions applied to the acceleration and heart rate data allow estimation of energy expenditure in 1-minute intervals during daily military routine, with accuracy equal to indirect calorimetry.

A Rasch scaling validation of a 'core' near-death experience.

PubMed

Lange, Rense; Greyson, Bruce; Houran, James

2004-05-01

For those with true near-death experiences (NDEs), Greyson's (1983, 1990) NDE Scale satisfactorily fits the Rasch rating scale model, thus yielding a unidimensional measure with interval-level scaling properties. With increasing intensity, NDEs reflect peace, joy and harmony, followed by insight and mystical or religious experiences, while the most intense NDEs involve an awareness of things occurring in a different place or time. The semantics of this variable are invariant across True-NDErs' gender, current age, age at time of NDE, and latency and intensity of the NDE, thus identifying NDEs as 'core' experiences whose meaning is unaffected by external variables, regardless of variations in NDEs' intensity. Significant qualitative and quantitative differences were observed between True-NDErs and other respondent groups, mostly revolving around the differential emphasis on paranormal/mystical/religious experiences vs. standard reactions to threat. The findings further suggest that False-Positive respondents reinterpret other profound psychological states as NDEs. Accordingly, the Rasch validation of the typology proposed by Greyson (1983) also provides new insights into previous research, including the possibility of embellishment over time (as indicated by the finding of positive, as well as negative, latency effects) and the potential roles of religious affiliation and religiosity (as indicated by the qualitative differences surrounding paranormal/mystical/religious issues).

Fearlessness about Death: The psychometric properties and construct validity of the revision to the Acquired Capability for Suicide Scale

PubMed Central

Ribeiro, Jessica D.; Witte, Tracy K.; Van Orden, Kimberly A.; Selby, Edward A.; Gordon, Kathryn H.; Bender, Theodore W.; Joiner, Thomas E.

2014-01-01

The Interpersonal Theory of Suicide proposes that suicidal behavior is so frightening that in order for an individual to engage in suicidal behavior, desire for suicide must be accompanied by the capability to do so. The capability for suicide is characterized by both a sense of fearlessness about death and elevated physiological pain tolerance. The primary aim of the current project was to reevaluate and revise the Acquired Capability for Suicide Scale (ACSS) and offer a revision to the scale. Expert review of the scale items resulted in retaining seven items assessing fearlessness about death. The recommendation is made to refer to the revised scale as the ACSS-Fearlessness about Death (ACSS-FAD) to reflect its content more specifically. A model with the 7 retained items provided good fit to the data across three independent samples of young adults. Multiple group analyses examining measurement invariance across men and women found that the latent structure of the scale is comparable across gender. Data are also presented demonstrating convergent and discriminant validity for the scale in young adults and an inpatient psychiatric sample. Findings support the viability of the ACSS-FAD, indicating the scale has a replicable factor structure that generalizes across males and females and is substantively related to the construct of fearlessness about death. Taken together, the present work extends our knowledge of the psychometrics of the ACSS-FAD in particular and the nature of fearlessness about death in general. PMID:24274043

Discretionary Death: Conditions, Dilemmas, and Normative Regulation

ERIC Educational Resources Information Center

Machado, Nora

2005-01-01

The author examines a major shift in the conceptualization and practices relating to death and dying in Western and other societies with advanced medicine. This shift is the result of socio-technical and cultural developments characterized by but not limited to the routine widespread application of life support technologies in the hospital…

Brain Death and Islam

PubMed Central

Ziad-Miller, Amna; Elamin, Elamin M.

2014-01-01

How one defines death may vary. It is important for clinicians to recognize those aspects of a patient’s religious beliefs that may directly influence medical care and how such practices may interface with local laws governing the determination of death. Debate continues about the validity and certainty of brain death criteria within Islamic traditions. A search of PubMed, Scopus, EMBASE, Web of Science, PsycNet, Sociological Abstracts, DIALOGUE ProQuest, Lexus Nexus, Google, and applicable religious texts was conducted to address the question of whether brain death is accepted as true death among Islamic scholars and clinicians and to discuss how divergent opinions may affect clinical care. The results of the literature review inform this discussion. Brain death has been acknowledged as representing true death by many Muslim scholars and medical organizations, including the Islamic Fiqh Academies of the Organization of the Islamic Conference and the Muslim World League, the Islamic Medical Association of North America, and other faith-based medical organizations as well as legal rulings by multiple Islamic nations. However, consensus in the Muslim world is not unanimous, and a sizable minority accepts death by cardiopulmonary criteria only. PMID:25287999

LACE+ index: extension of a validated index to predict early death or urgent readmission after hospital discharge using administrative data

PubMed Central

van Walraven, Carl; Wong, Jenna; Forster, Alan J

2012-01-01

Background Death or urgent readmission after hospital discharge is a common adverse event that can be used to compare outcomes of care between institutions. To accurately adjust for risk and to allow for interhospital comparisons of readmission rates, we used administrative data to derive and internally validate an extension of the LACE index, a previously validated index for 30-day death or urgent readmission. Methods We randomly selected 500 000 medical and surgical patients discharged to the community from any Ontario hospital between 1 April 2003 and 31 March 2009. We derived a logistic regression model on 250 000 randomly selected patients from this group and modified the final model into an index scoring system, the LACE+ index. We internally validated the LACE+ index using data from the remaining 250 000 patients and compared its performance with that of the original LACE index. Results Within 30 days of discharge to the community, 33 825 (6.8%) of the patients had died or had been urgently readmitted. In addition to the variables included in the LACE index (length of stay in hospital [L], acuity of admission [A], comorbidity [C] and emergency department utilization in the 6 months before admission [E]), the LACE+ index incorporated patient age and sex, teaching status of the discharge hospital, acute diagnoses and procedures performed during the index admission, number of days on alternative level of care during the index admission, and number of elective and urgent admissions to hospital in the year before the index admission. The LACE+ index was highly discriminative (C statistic 0.771, 95% confidence interval 0.767–0.775), was well calibrated across most of its range of scores and had a model performance that exceeded that of the LACE index. Interpretation The LACE+ index can be used to predict the risk of postdischarge death or urgent readmission on the basis of administrative data for the Ontario population. Its performance exceeds that of the LACE

[Quality assurance using routine data. Is outcome quality now measurable?].

PubMed

Kostuj, T; Smektala, R

2010-12-01

Health service quality in Germany can be shown by the data from the external quality assurance program (BQS) but as these records are limited to the period of in-hospital stay no information about outcome after discharge from hospital can be obtained. Secondary routine administrative data contain information about long-term outcome, such as mortality, subsequent revision and the need for care following surgical treatment due to a hip fracture.Experiences in the use of secondary data dealing with treatment of hip fractures from the BQS are available in our department. In addition we analyzed routine administrative data from the health insurance companies Knappschaft Bahn-See and AOK in a cooperative study with the WidO (scientific institute of the AOK). These routine data clearly show a bias because of poor quality in coding as well as broad interpretation possibilities of some of the ICD-10 codes used.Consequently quality assurance using routine data is less valid than register-based conclusions. Nevertheless medical expertise is necessary to avoid misinterpretation of routine administrative data.

Sentient Nonpersons and the Disvalue of Death.

PubMed

DeGrazia, David

2016-09-01

Implicit in our everyday attitudes and practices is the assumption that death ordinarily harms a person who dies. A far more contested matter is whether death harms sentient individuals who are not persons, a category that includes many animals and some human beings. On the basis of the deprivation account of the harm of death, I argue that death harms sentient nonpersons (whenever their lives would be worth continuing). I next consider possible bases for the commonsense judgment that death ordinarily harms persons more than it harms sentient nonpersons. Contrary to what some philosophers believe, it is doubtful that the familiar resources of prudential value theory can vindicate this judgment. I show that the approach that at first glance seems most promising for supporting this judgment - namely, invoking an objective account of well-being - faces substantial challenges, before arguing that McMahan's time-relative interest account supplies the needed theoretical basis. I then go on to extract a significant practical implication of the first thesis, that death ordinarily harms sentient nonpersons: We should find a way to discontinue the routine killing of animal subjects following their use in experiments. © 2016 John Wiley & Sons Ltd.

Validation of the Italian version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM).

PubMed

Palmieri, Gaspare; Evans, Chris; Hansen, Vidje; Brancaleoni, Greta; Ferrari, Silvia; Porcelli, Piero; Reitano, Francesco; Rigatelli, Marco

2009-01-01

The Clinical Outcomes in Routine Evaluation--Outcome Measure (CORE-OM) was translated into Italian and tested in non-clinical (n = 263) and clinical (n = 647) samples. The translation showed good acceptability, internal consistency and convergent validity in both samples. There were large and statistically significant differences between clinical and non-clinical datasets on all scores. The reliable change criteria were similar to those for the UK referential data. Some of the clinically significant change criteria, particularly for the men, were moderately different from the UK cutting points. The Italian version of the CORE-OM showed respectable psychometric parameters. However, it seemed plausible that non-clinical and clinical distributions of self-report scores on psychopathology and functioning measures may differ by language and culture. *A good quality Italian translation of the CORE-OM, and hence the GP-CORE, CORE-10 and CORE-5 measures also, is now available for use by practitioners and anyone surveying or exploring general psychological state. The measures can be obtained from CORE-IMS or yourself and practitioners are encouraged to share anonymised data so that good clinical and non-clinical referential databases can be established for Italy.

Lesson Unplanning: Toward Transforming Routine Tasks into Non-Routine Problems

ERIC Educational Resources Information Center

Beghetto, Ronald A.

2017-01-01

How might teachers transform routine tasks into non-routine ones? The purpose of this article is to address this question. The article opens with a discussion of why non-routine problems require creative and original thought. Specifically, I discuss how non-routine problems require students to confront uncertainty and how uncertainty can serve as…

Trauma deaths in a mature urban trauma system: is "trimodal" distribution a valid concept?

PubMed

Demetriades, Demetrios; Kimbrell, Brian; Salim, Ali; Velmahos, George; Rhee, Peter; Preston, Christy; Gruzinski, Ginger; Chan, Linda

2005-09-01

Trimodal distribution of trauma deaths, described more than 20 years ago, is still widely taught in the design of trauma systems. The purpose of this study was to examine the applicability of this trimodal distribution in a modern trauma system. A study of trauma registry and emergency medical services records of trauma deaths in the County of Los Angeles was conducted over a 3-year period. The times from injury to death were analyzed according to mechanism of injury and body area (head, chest, abdomen, extremities) with severe trauma (abbreviated injury score [AIS] >/= 4). During the study period there were 4,151 trauma deaths. Penetrating trauma accounted for 50.0% of these deaths. The most commonly injured body area with critical trauma (AIS >/= 4) was the head (32.0%), followed by chest (20.8%), abdomen (11.5%), and extremities (1.8%). Time from injury to death was available in 2,944 of these trauma deaths. Overall, there were two distinct peaks of deaths: the first peak (50.2% of deaths) occurred within the first hour of injury. The second peak occurred 1 to 6 hours after admission (18.3% of deaths). Only 7.6% of deaths were late (>1 week), during the third peak of the classic trimodal distribution. Temporal distribution of deaths in penetrating trauma was very different from blunt trauma and did not follow the classic trimodal distribution. Other significant independent factors associated with time of death were chest AIS and head AIS. Temporal distribution of deaths as a result of severe head trauma did not follow any pattern and did not resemble classic trimodal distribution at all. The classic "trimodal" distribution of deaths does not apply in our trauma system. Temporal distribution of deaths is influenced by the mechanism of injury, age of the patient, and body area with severe trauma. Knowledge of the time of distribution of deaths might help in allocating trauma resources and focusing research effort.

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

PubMed Central

Phuong Hoa, Nguyen; Walker, Sue M.; Hill, Peter S.; Rao, Chalapati

2018-01-01

Background 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. Methodology and findings 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 (p<0.01). VA methods identify more specific COD than the A6 death registers, and also allow identification of multiple CODs. Conclusions The study results suggest that data completeness in HMIS A6 death registers in the study sample of communes was relatively high (nearly 90%), but triangulation with death records from other sources would improve the completeness of this system. Further, there is an urgent need to enhance the reliability of COD recorded in the A6 death registers, for which VA methods could be effective. Focussed consultation among

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

PubMed

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 (p<0.01). VA methods identify more specific COD than the A6 death registers, and also allow identification of multiple CODs. The study results suggest that data completeness in HMIS A6 death registers in the study sample of communes was relatively high (nearly 90%), but triangulation with death records from other sources would improve the completeness of this system. Further, there is an urgent need to enhance the reliability of COD recorded in the A6 death registers, for which VA methods could be effective. Focussed consultation among stakeholders is needed to develop a suitable mechanism and

Developing everyday routines.

PubMed

McNamara, Paula; Humphry, Ruth

2008-05-01

This study obtains a deeper understanding of the processes supporting the formation of young children's routines in a child care classroom. Eight infants and toddlers and their teachers from two child care classrooms were observed for 4 to 6 months during periods of regularly occurring activities. Detailed, moment-to-moment descriptions of their behaviors and interactions were analyzed. Eleven processes supported the development of children's routines. Teachers structured and guided the children's experiences in learning routines, and children initiated requests to do routines. The study also identified three processes where children invited, coached, and modeled, supporting one another in learning routines. Finally, familiar objects used in routines elicited the children's engagement.

Forensic molecular pathology: its impacts on routine work, education and training.

PubMed

Maeda, Hitoshi; Ishikawa, Takaki; Michiue, Tomomi

2014-03-01

The major role of forensic pathology is the investigation of human death in relevance to social risk management to determine the cause and process of death, especially in violent and unexpected sudden deaths, which involve social and medicolegal issues of ultimate, personal and public concerns. In addition to the identification of victims and biological materials, forensic molecular pathology contributes to general explanation of the human death process and assessment of individual death on the basis of biological molecular evidence, visualizing dynamic functional changes involved in the dying process that cannot be detected by morphology (pathophysiological or molecular biological vital reactions); the genetic background (genomics), dynamics of gene expression (up-/down-regulation: transcriptomics) and vital phenomena, involving activated biological mediators and degenerative products (proteomics) as well as metabolic deterioration (metabolomics), are detected by DNA analysis, relative quantification of mRNA transcripts using real-time reverse transcription-PCR (RT-PCR), and immunohisto-/immunocytochemistry combined with biochemistry, respectively. Thus, forensic molecular pathology involves the application of omic medical sciences to investigate the genetic basis, and cause and process of death at the biological molecular level in the context of forensic pathology, that is, 'advanced molecular autopsy'. These procedures can be incorporated into routine death investigations as well as guidance, education and training programs in forensic pathology for 'dynamic assessment of the cause and process of death' on the basis of autopsy and laboratory data. Postmortem human data can also contribute to understanding patients' critical conditions in clinical management. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Five Data Validation Cases

ERIC Educational Resources Information Center

Simkin, Mark G.

2008-01-01

Data-validation routines enable computer applications to test data to ensure their accuracy, completeness, and conformance to industry or proprietary standards. This paper presents five programming cases that require students to validate five different types of data: (1) simple user data entries, (2) UPC codes, (3) passwords, (4) ISBN numbers, and…

Validation of inverse seasonal peak mortality in medieval plagues, including the Black Death, in comparison to modern Yersinia pestis-variant diseases.

PubMed

Welford, Mark R; Bossak, Brian H

2009-12-22

Recent studies have noted myriad qualitative and quantitative inconsistencies between the medieval Black Death (and subsequent "plagues") and modern empirical Y. pestis plague data, most of which is derived from the Indian and Chinese plague outbreaks of A.D. 1900+/-15 years. Previous works have noted apparent differences in seasonal mortality peaks during Black Death outbreaks versus peaks of bubonic and pneumonic plagues attributed to Y. pestis infection, but have not provided spatiotemporal statistical support. Our objective here was to validate individual observations of this seasonal discrepancy in peak mortality between historical epidemics and modern empirical data. We compiled and aggregated multiple daily, weekly and monthly datasets of both Y. pestis plague epidemics and suspected Black Death epidemics to compare seasonal differences in mortality peaks at a monthly resolution. Statistical and time series analyses of the epidemic data indicate that a seasonal inversion in peak mortality does exist between known Y. pestis plague and suspected Black Death epidemics. We provide possible explanations for this seasonal inversion. These results add further evidence of inconsistency between historical plagues, including the Black Death, and our current understanding of Y. pestis-variant disease. We expect that the line of inquiry into the disputed cause of the greatest recorded epidemic will continue to intensify. Given the rapid pace of environmental change in the modern world, it is crucial that we understand past lethal outbreaks as fully as possible in order to prepare for future deadly pandemics.

[Risk Prediction Using Routine Data: Development and Validation of Multivariable Models Predicting 30- and 90-day Mortality after Surgical Treatment of Colorectal Cancer].

PubMed

Crispin, Alexander; Strahwald, Brigitte; Cheney, Catherine; Mansmann, Ulrich

2018-06-04

Quality control, benchmarking, and pay for performance (P4P) require valid indicators and statistical models allowing adjustment for differences in risk profiles of the patient populations of the respective institutions. Using hospital remuneration data for measuring quality and modelling patient risks has been criticized by clinicians. Here we explore the potential of prediction models for 30- and 90-day mortality after colorectal cancer surgery based on routine data. Full census of a major statutory health insurer. Surgical departments throughout the Federal Republic of Germany. 4283 and 4124 insurants with major surgery for treatment of colorectal cancer during 2013 and 2014, respectively. Age, sex, primary and secondary diagnoses as well as tumor locations as recorded in the hospital remuneration data according to §301 SGB V. 30- and 90-day mortality. Elixhauser comorbidities, Charlson conditions, and Charlson scores were generated from the ICD-10 diagnoses. Multivariable prediction models were developed using a penalized logistic regression approach (logistic ridge regression) in a derivation set (patients treated in 2013). Calibration and discrimination of the models were assessed in an internal validation sample (patients treated in 2014) using calibration curves, Brier scores, receiver operating characteristic curves (ROC curves) and the areas under the ROC curves (AUC). 30- and 90-day mortality rates in the learning-sample were 5.7 and 8.4%, respectively. The corresponding values in the validation sample were 5.9% and once more 8.4%. Models based on Elixhauser comorbidities exhibited the highest discriminatory power with AUC values of 0.804 (95% CI: 0.776 -0.832) and 0.805 (95% CI: 0.782-0.828) for 30- and 90-day mortality. The Brier scores for these models were 0.050 (95% CI: 0.044-0.056) and 0.067 (95% CI: 0.060-0.074) and similar to the models based on Charlson conditions. Regardless of the model, low predicted probabilities were well calibrated, while

The quality of medical death certification of cause of death in hospitals in rural Bangladesh: impact of introducing the International Form of Medical Certificate of Cause of Death.

PubMed

Hazard, Riley H; Chowdhury, Hafizur Rahman; Adair, Tim; Ansar, Adnan; Quaiyum Rahman, A M; Alam, Saidul; Alam, Nurul; Rampatige, Rasika; Streatfield, Peter Kim; Riley, Ian Douglas; Lopez, Alan D

2017-10-02

Accurate and timely data on cause of death are critically important for guiding health programs and policies. Deaths certified by doctors are implicitly considered to be reliable and accurate, yet the quality of information provided in the international Medical Certificate of Cause of Death (MCCD) usually varies according to the personnel involved in certification, the diagnostic capacity of the hospital, and the category of hospitals. There are no published studies that have analysed how certifying doctors in Bangladesh adhere to international rules when completing the MCCD or have assessed the quality of clinical record keeping. The study took place between January 2011 and April 2014 in the Chandpur and Comilla districts of Bangladesh. We introduced the international MCCD to all study hospitals. Trained project physicians assigned an underlying cause of death, assessed the quality of the death certificate, and reported the degree of certainty of the medical records provided for a given cause. We examined the frequency of common errors in completing the MCCD, the leading causes of in-hospital deaths, and the degree of certainty in the cause of death data. The study included 4914 death certificates. 72.9% of medical records were of too poor quality to assign a cause of death, with little difference by age, hospital, and cause of death. 95.6% of death certificates did not indicate the time interval between onset and death, 31.6% required a change in sequence, 13.9% required to include a new diagnosis, 50.7% used abbreviations, 41.5% used multiple causes per line, and 33.2% used an ill-defined condition as the underlying cause of death. 99.1% of death certificates had at least one error. The leading cause of death among adults was stroke (15.8%), among children was pneumonia (31.7%), and among neonates was birth asphyxia (52.8%). Physicians in Bangladeshi hospitals had difficulties in completing the MCCD correctly. Physicians routinely made errors in death

The development and psychometric properties of the Turkish death anxiety scale (TDAS).

PubMed

Sarıkaya, Yusuf; Baloğlu, Mustafa

2016-08-01

The purpose of the present study was to develop the Turkish Death Anxiety Scale (TDAS) and test its initial psychometric properties. Four independent samples participated in the study: 943 college students in item generation, 388 college students in validation, 171 college students in reliability investigation, and 338 adults in cross-validation. Principal component analysis with a varimax rotation revealed that 20 items of the scale contained three factors (i.e., Ambiguity of Death, Exposure to Death, and Agony of Death), which explained over 67% of the total variability. Confirmatory factor analyses indicated acceptable fit. Significant correlations were found between the scale and death anxiety, state anxiety, trait anxiety, depression, and hopelessness in the student sample. In the adult sample, death anxiety significantly correlated with trait anxiety. Reliability coefficients were also found acceptable. The authors conclude that the TDAS is a promising instrument in assessing the death anxiety levels in Turkey.

Development and Fit-for-Purpose Validation of a Soluble Human Programmed Death-1 Protein Assay.

PubMed

Ni, Yan G; Yuan, Xiling; Newitt, John A; Peterson, Jon E; Gleason, Carol R; Haulenbeek, Jonathan; Santockyte, Rasa; Lafont, Virginie; Marsilio, Frank; Neely, Robert J; DeSilva, Binodh; Piccoli, Steven P

2015-07-01

Programmed death-1 (PD-1) protein is a co-inhibitory receptor which negatively regulates immune cell activation and permits tumors to evade normal immune defense. Anti-PD-1 antibodies have been shown to restore immune cell activation and effector function-an exciting breakthrough in cancer immunotherapy. Recent reports have documented a soluble form of PD-1 (sPD-1) in the circulation of normal and disease state individuals. A clinical assay to quantify sPD-1 would contribute to the understanding of sPD-1-function and facilitate the development of anti-PD-1 drugs. Here, we report the development and validation of a sPD-1 protein assay. The assay validation followed the framework for full validation of a biotherapeutic pharmacokinetic assay. A purified recombinant human PD-1 protein was characterized extensively and was identified as the assay reference material which mimics the endogenous analyte in structure and function. The lower limit of quantitation (LLOQ) was determined to be 100 pg/mL, with a dynamic range spanning three logs to 10,000 pg/mL. The intra- and inter-assay imprecision were ≤15%, and the assay bias (percent deviation) was ≤10%. Potential matrix effects were investigated in sera from both normal healthy volunteers and selected cancer patients. Bulk-prepared frozen standards and pre-coated Streptavidin plates were used in the assay to ensure consistency in assay performance over time. This assay appears to specifically measure total sPD-1 protein since the human anti-PD-1 antibody, nivolumab, and the endogenous ligands of PD-1 protein, PDL-1 and PDL-2, do not interfere with the assay.

Measuring Critical Care Providers' Attitudes About Controlled Donation After Circulatory Death.

PubMed

Rodrigue, James R; Luskin, Richard; Nelson, Helen; Glazier, Alexandra; Henderson, Galen V; Delmonico, Francis L

2018-06-01

Unfavorable attitudes and insufficient knowledge about donation after cardiac death among critical care providers can have important consequences for the appropriate identification of potential donors, consistent implementation of donation after cardiac death policies, and relative strength of support for this type of donation. The lack of reliable and valid assessment measures has hampered research to capture providers' attitudes. Design and Research Aims: Using stakeholder engagement and an iterative process, we developed a questionnaire to measure attitudes of donation after cardiac death in critical care providers (n = 112) and examined its psychometric properties. Exploratory factor analysis, internal consistency, and validity analyses were conducted to examine the measure. A 34-item questionnaire consisting of 4 factors (Personal Comfort, Process Satisfaction, Family Comfort, and System Trust) provided the most parsimonious fit. Internal consistency was acceptable for each of the subscales and the total questionnaire (Cronbach α > .70). A strong association between more favorable attitudes overall and knowledge ( r = .43, P < .001) provides evidence of convergent validity. Multivariable regression analyses showed that white race ( P = .002) and more experience with donation after cardiac death ( P < .001) were significant predictors of more favorable attitudes. Study findings support the utility, reliability, and validity of a questionnaire for measuring attitudes in critical care providers and for isolating targets for additional education on donation after cardiac death.

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

PubMed

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.

Validation of Inverse Seasonal Peak Mortality in Medieval Plagues, Including the Black Death, in Comparison to Modern Yersinia pestis-Variant Diseases

PubMed Central

Welford, Mark R.; Bossak, Brian H.

2009-01-01

Background Recent studies have noted myriad qualitative and quantitative inconsistencies between the medieval Black Death (and subsequent “plagues”) and modern empirical Y. pestis plague data, most of which is derived from the Indian and Chinese plague outbreaks of A.D. 1900±15 years. Previous works have noted apparent differences in seasonal mortality peaks during Black Death outbreaks versus peaks of bubonic and pneumonic plagues attributed to Y. pestis infection, but have not provided spatiotemporal statistical support. Our objective here was to validate individual observations of this seasonal discrepancy in peak mortality between historical epidemics and modern empirical data. Methodology/Principal Findings We compiled and aggregated multiple daily, weekly and monthly datasets of both Y. pestis plague epidemics and suspected Black Death epidemics to compare seasonal differences in mortality peaks at a monthly resolution. Statistical and time series analyses of the epidemic data indicate that a seasonal inversion in peak mortality does exist between known Y. pestis plague and suspected Black Death epidemics. We provide possible explanations for this seasonal inversion. Conclusions/Significance These results add further evidence of inconsistency between historical plagues, including the Black Death, and our current understanding of Y. pestis-variant disease. We expect that the line of inquiry into the disputed cause of the greatest recorded epidemic will continue to intensify. Given the rapid pace of environmental change in the modern world, it is crucial that we understand past lethal outbreaks as fully as possible in order to prepare for future deadly pandemics. PMID:20027294

Fear of Death in a Sample of Physicians

PubMed Central

Wood, Keith; Robinson, Paul J.

1984-01-01

Recently, reliable and valid methods of assessing fear of death have been developed. In this study, three well established questionnaires (the Threat Index, the Death Anxiety Scale and the Collett-Lester Fear of Death Scale) were used to assess and compare fear of death in a group of physicians (n = 30) with a group of non-physicians (n = 30). T-tests and hierarchical multiple regression analyses revealed no significant differences between physicians' and non-physicians' fear of death as measured by the Threat Index and Templer's Death Anxiety Scale. The Collett-Lester Fear of Death Scale revealed that physicians were less fearful of death. More specifically, physicians demonstrated less fear on the Collett-Lester subscales, `fear of dying of self' and `fear of dying of others', than did non-physicians. These findings and those of earlier, contradictory research, are discussed. PMID:21279021

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

PubMed

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.

Guidelines and recommendations on yeast cell death nomenclature.

PubMed

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 cel-lular 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 defi-nition 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 differ-ential definition of terms including apoptosis, regulated necrosis, and autophagic cell death, as we refer to additional cell death rou-tines 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 au-thors, 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 pro-gress of this vibrant field of research.

Guidelines and recommendations on yeast cell death nomenclature

PubMed Central

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

Measles deaths in Nepal: estimating the national case-fatality ratio.

PubMed

Joshi, Anand B; Luman, Elizabeth T; Nandy, Robin; Subedi, Bal K; Liyanage, Jayantha B L; Wierzba, Thomas F

2009-06-01

To estimate the case-fatality ratio (CFR) for measles in Nepal, determine the role of risk factors, such as political instability, for measles mortality, and compare the use of a nationally representative sample of outbreaks versus routine surveillance or a localized study to establish the national CFR (nCFR). This was a retrospective study of measles cases and deaths in Nepal. Through two-stage random sampling, we selected 37 districts with selection probability proportional to the number of districts in each region, and then randomly selected within each district one outbreak among all those that had occurred between 1 March and 1 September 2004. Cases were identified by interviewing a member of each and every household and tracing contacts. Bivariate analyses were performed to assess the risk factors for a high CFR and determine the time from rash onset until death. Each factor's contribution to the CFR was determined through multivariate logistic regression. From the number of measles cases and deaths found in the study we calculated the total number of measles cases and deaths for all of Nepal during the study period and in 2004. We identified 4657 measles cases and 64 deaths in the study period and area. This yielded a total of about 82 000 cases and 900 deaths for all outbreaks in 2004 and a national CFR of 1.1% (95% confidence interval, CI: 0.5-2.3). CFR ranged from 0.1% in the eastern region to 3.4% in the mid-western region and was highest in politically insecure areas, in the Ganges plains and among cases < 5 years of age. Vitamin A treatment and measles immunization were protective. Most deaths occurred during the first week of illness. To our knowledge, this is the first CFR study based on a nationally representative sample of measles outbreaks. Routine surveillance and studies of a single outbreak may not yield an accurate nCFR. Increased fatalities associated with political insecurity are a challenge for health-care service delivery. The short period

A diagnostic model for impending death in cancer patients: Preliminary report.

PubMed

Hui, David; Hess, Kenneth; dos Santos, Renata; Chisholm, Gary; Bruera, Eduardo

2015-11-01

Several highly specific bedside physical signs associated with impending death within 3 days for patients with advanced cancer were recently identified. A diagnostic model for impending death based on these physical signs was developed and assessed. Sixty-two physical signs were systematically documented every 12 hours from admission to death or discharge for 357 patients with advanced cancer who were admitted to acute palliative care units (APCUs) at 2 tertiary care cancer centers. Recursive partitioning analysis was used to develop a prediction model for impending death within 3 days with admission data. The model was validated with 5 iterations of 10-fold cross-validation, and the model was also applied to APCU days 2 to 6. For the 322 of 357 patients (90%) with complete data for all signs, the 3-day mortality rate was 24% on admission. The final model was based on 2 variables (Palliative Performance Scale [PPS] and drooping of nasolabial folds) and had 4 terminal leaves: PPS score ≤ 20% and drooping of nasolabial folds present, PPS score ≤ 20% and drooping of nasolabial folds absent, PPS score of 30% to 60%, and PPS score ≥ 70%. The 3-day mortality rates were 94%, 42%, 16%, and 3%, respectively. The diagnostic accuracy was 81% for the original tree, 80% for cross-validation, and 79% to 84% for subsequent APCU days. Based on 2 objective bedside physical signs, a diagnostic model was developed for impending death within 3 days. This model was applicable to both APCU admission and subsequent days. Upon further external validation, this model may help clinicians to formulate the diagnosis of impending death. © 2015 American Cancer Society.

A Diagnostic Model for Impending Death in Cancer Patients: Preliminary Report

PubMed Central

Hui, David; Hess, Kenneth; dos Santos, Renata; Chisholm, Gary; Bruera, Eduardo

2015-01-01

Background We recently identified several highly specific bedside physical signs associated with impending death within 3 days among patients with advanced cancer. In this study, we developed and assessed a diagnostic model for impending death based on these physical signs. Methods We systematically documented 62 physical signs every 12 hours from admission to death or discharge in 357 patients with advanced cancer admitted to acute palliative care units (APCUs) at two tertiary care cancer centers. We used recursive partitioning analysis (RPA) to develop a prediction model for impending death in 3 days using admission data. We validated the model with 5 iterations of 10-fold cross-validation, and also applied the model to APCU days 2/3/4/5/6. Results Among 322/357 (90%) patients with complete data for all signs, the 3-day mortality was 24% on admission. The final model was based on 2 variables (palliative performance scale [PPS] and drooping of nasolabial fold) and had 4 terminal leaves: PPS≤20% and drooping of nasolabial fold present, PPS≤20% and drooping of nasolabial fold absent, PPS 30–60% and PPS ≥ 70%, with 3-day mortality of 94%, 42%, 16% and 3%, respectively. The diagnostic accuracy was 81% for the original tree, 80% for cross-validation, and 79%–84% for subsequent APCU days. Conclusion(s) We developed a diagnostic model for impending death within 3 days based on 2 objective bedside physical signs. This model was applicable to both APCU admission and subsequent days. Upon further external validation, this model may help clinicians to formulate the diagnosis of impending death. PMID:26218612

ESGE-ESGENA technical specification for process validation and routine testing of endoscope reprocessing in washer-disinfectors according to EN ISO 15883, parts 1, 4, and ISO/TS 15883-5.

PubMed

Beilenhoff, Ulrike; Biering, Holger; Blum, Reinhard; Brljak, Jadranka; Cimbro, Monica; Dumonceau, Jean-Marc; Hassan, Cesare; Jung, Michael; Neumann, Christiane; Pietsch, Michael; Pineau, Lionel; Ponchon, Thierry; Rejchrt, Stanislav; Rey, Jean-François; Schmidt, Verona; Tillett, Jayne; van Hooft, Jeanin

2017-12-01

1 Prerequisites. The clinical service provider should obtain confirmation from the endoscope washer-disinfector (EWD) manufacturer that all endoscopes intended to be used can be reprocessed in the EWD. 2 Installation qualification. This can be performed by different parties but national guidelines should define who has the responsibilities, taking into account legal requirements. 3 Operational qualification. This should include parametric tests to verify that the EWD is working according to its specifications. 4 Performance qualification. Testing of cleaning performance, microbiological testing of routinely used endoscopes, and the quality of the final rinse water should be considered in all local guidelines. The extent of these tests depends on local requirements. According to the results of type testing performed during EWD development, other parameters can be tested if local regulatory authorities accept this. Chemical residues on endoscope surfaces should be searched for, if acceptable test methods are available. 5 Routine inspections. National guidelines should consider both technical and performance criteria. Individual risk analyses performed in the validation and requalification processes are helpful for defining appropriate test frequencies for routine inspections. © Georg Thieme Verlag KG Stuttgart · New York.

Epidemiology of chronic hepatitis B virus in Ireland using routinely collected surveillance and administrative data, 2004-2014.

PubMed

van Gemert, Caroline E; Murphy, Niamh; Mitchell, Tara A; Hellard, Margaret E; Thornton, Thornton

2017-12-09

Ireland has a low prevalence of chronic hepatitis B virus (HBV) infection; however, there are limited recently published epidemiological data. This study aimed to describe the epidemiology of chronic HBV in Ireland between 2004 and 2014 using routine surveillance data and identify and interrogate additional data sources in Ireland to complement the interpretation of HBV surveillance data. Routinely collected passive surveillance data of notified cases of HBV infection were collated for 2004-2014. Additional data sources relating to primary liver cancer and cirrhosis were collated, including hospital discharge data (2005-2013), diagnoses of primary liver cancer (2004-2013), and deaths (2007-2014). Publicly available immigration (2004-2014) data were also collated. Between 2004 and 2014, a total of 7463 notifications of HBV were made in Ireland; the majority (91%) were classified as chronic cases. Notifications peaked in 2008 and decreased until 2013. Hospital discharges, new cancer registrations, and deaths from primary liver cancer and hospital discharges from cirrhosis have increased each year. The epidemiology of HBV in Ireland mirrors immigration patterns. Without a coordinated screening and care programme for priority populations, particularly for immigrants from high prevalence countries, it is likely that hospitalisations and deaths from HBV-attributable cirrhosis and primary liver cancer will continue to rise, with considerable associated public health expense.

Simpler score of routine laboratory tests predicts liver fibrosis in patients with chronic hepatitis B.

PubMed

Zhou, Kun; Gao, Chun-Fang; Zhao, Yun-Peng; Liu, Hai-Lin; Zheng, Rui-Dan; Xian, Jian-Chun; Xu, Hong-Tao; Mao, Yi-Min; Zeng, Min-De; Lu, Lun-Gen

2010-09-01

In recent years, a great interest has been dedicated to the development of noninvasive predictive models to substitute liver biopsy for fibrosis assessment and follow-up. Our aim was to provide a simpler model consisting of routine laboratory markers for predicting liver fibrosis in patients chronically infected with hepatitis B virus (HBV) in order to optimize their clinical management. Liver fibrosis was staged in 386 chronic HBV carriers who underwent liver biopsy and routine laboratory testing. Correlations between routine laboratory markers and fibrosis stage were statistically assessed. After logistic regression analysis, a novel predictive model was constructed. This S index was validated in an independent cohort of 146 chronic HBV carriers in comparison to the SLFG model, Fibrometer, Hepascore, Hui model, Forns score and APRI using receiver operating characteristic (ROC) curves. The diagnostic values of each marker panels were better than single routine laboratory markers. The S index consisting of gamma-glutamyltransferase (GGT), platelets (PLT) and albumin (ALB) (S-index: 1000 x GGT/(PLT x ALB(2))) had a higher diagnostic accuracy in predicting degree of fibrosis than any other mathematical model tested. The areas under the ROC curves (AUROC) were 0.812 and 0.890 for predicting significant fibrosis and cirrhosis in the validation cohort, respectively. The S index, a simpler mathematical model consisting of routine laboratory markers predicts significant fibrosis and cirrhosis in patients with chronic HBV infection with a high degree of accuracy, potentially decreasing the need for liver biopsy.

Modeling causes of death: an integrated approach using CODEm

PubMed Central

2012-01-01

Background Data on causes of death by age and sex are a critical input into health decision-making. Priority setting in public health should be informed not only by the current magnitude of health problems but by trends in them. However, cause of death data are often not available or are subject to substantial problems of comparability. We propose five general principles for cause of death model development, validation, and reporting. Methods We detail a specific implementation of these principles that is embodied in an analytical tool - the Cause of Death Ensemble model (CODEm) - which explores a large variety of possible models to estimate trends in causes of death. Possible models are identified using a covariate selection algorithm that yields many plausible combinations of covariates, which are then run through four model classes. The model classes include mixed effects linear models and spatial-temporal Gaussian Process Regression models for cause fractions and death rates. All models for each cause of death are then assessed using out-of-sample predictive validity and combined into an ensemble with optimal out-of-sample predictive performance. Results Ensemble models for cause of death estimation outperform any single component model in tests of root mean square error, frequency of predicting correct temporal trends, and achieving 95% coverage of the prediction interval. We present detailed results for CODEm applied to maternal mortality and summary results for several other causes of death, including cardiovascular disease and several cancers. Conclusions CODEm produces better estimates of cause of death trends than previous methods and is less susceptible to bias in model specification. We demonstrate the utility of CODEm for the estimation of several major causes of death. PMID:22226226

Rigidity in routines and the development of resistance to change in individuals with Prader-Willi syndrome.

PubMed

Haig, E L; Woodcock, K A

2017-05-01

Individuals with Prader-Willi syndrome (PWS) commonly show debilitating resistance to change, which has been linked to cognitive deficits in task switching. Anecdotal reports suggest that exposure to flexibility in routines during development may be beneficial for limiting subsequent resistance to change in people with PWS, which is consistent with a beneficial role of such exposure on the development of task switching, highlighted in typical children. Here, we aim to investigate the development of resistance to change in individuals with PWS and hypothesise that exposure to increased rigidity in routines will be associated with increased subsequent resistance to change. An author-compiled informant report interview and two previously validated questionnaires were administered to the caregivers of 10 individuals with PWS (5-23 years). The interview examined rigidity in routines and resistance to change across life stages defined by easily distinguishable events (before school, during primary school, during secondary school, after school, currently), using open-ended and structured yes/no and 5-point Likert questions. Open-ended data were coded using an author-compiled system. Responses from two additional informants and data from the questionnaires were used to assess inter-informant reliability and concurrent validity of the structured questions. The validity of the interview was supported by acceptable inter-rater reliability of the open-ended coding system and inter-informant reliability, internal consistency and concurrent validity of structured questions. Descriptive analyses of ratings of behaviour change showed a pattern of increasing resistance to change over the life course for the four oldest individuals, who had all been exposed to substantial rigidity in routines before and during primary school. Furthermore, only one individual - currently in primary school - was exposed to very little rigidity in routines before and during primary school, and he had

Validation of the Spanish Version of the Quality of Dying and Death Questionnaire (QODD-ESP) in a Home-Based Cancer Palliative Care Program and Development of the QODD-ESP-12.

PubMed

Pérez-Cruz, Pedro E; Padilla Pérez, Oslando; Bonati, Pilar; Thomsen Parisi, Oliva; Tupper Satt, Laura; Gonzalez Otaiza, Marcela; Ceballos Yáñez, Diego; Maldonado Morgado, Armando

2017-06-01

Improving quality of death (QOD) is a key goal in palliative care (PC). To our knowledge, no instruments to measure QOD have been validated in Spanish. The goals of this study were to validate the Spanish version of the quality of dying and death (QODD) questionnaire and to develop and validate a shortened version of this instrument by phone interview. We enrolled caregivers (CGs) of consecutive deceased cancer patients who participated in a single PC clinic. CGs were contacted by phone between 4 and 12 weeks after patients' death and completed the Spanish QODD (QODD-ESP). A question assessing quality of life during last week of life was included. A 12-item QODD (QODD-ESP-12) was developed. Reliability, convergent validity, and construct validity were estimated for both versions. About 150 (50%) of 302 CGs completed the QODD-ESP. Patient's mean age (SD) was 67 (14); 71 (47%) were females, and 131 (87%) died at home. CGs' mean age (SD) was 51 (13); 128 (85%) were females. Mean QODD-ESP score was 69 (range 35-96). Kaiser-Meyer-Olkin measure of sampling adequacy was 0.322, not supporting the use of factorial analysis to assess the existence of an underlying construct. Mean QODD-ESP-12 score was 69 (range 31-97). Correlation with last week quality of life was 0.306 (P < 0.01). Confirmatory factorial analysis of QODD-ESP-12 showed that data fitted well Downey's four factors; Chi-square test = 6.32 (degrees of freedom = 60), P = 0.394 comparative fit index = 0.988; Tucker-Lewis Index = 0.987, and root mean square error of approximation = 0.016 (95% CI 0-0.052). QODD-ESP-12 is a reliable and valid instrument with good psychometric properties and can be used to assess QOD in a Spanish-speaking cancer PC population by phone interview. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Validation of aerosol extinction and water vapor profiles from routine Atmospheric Radiation Measurement Program Climate Research Facility measurements

NASA Astrophysics Data System (ADS)

Schmid, Beat; Flynn, Connor J.; Newsom, Rob K.; Turner, David D.; Ferrare, Richard A.; Clayton, Marian F.; Andrews, Elisabeth; Ogren, John A.; Johnson, Roy R.; Russell, Philip B.; Gore, Warren J.; Dominguez, Roseanne

2009-11-01

The accuracy with which vertical profiles of aerosol extinction σep(λ) can be measured using routine Atmospheric Radiation Measurement Program (ARM) Climate Research Facility (ACRF) measurements and was assessed using data from two airborne field campaigns, the ARM Aerosol Intensive Operation Period (AIOP, May 2003), and the Aerosol Lidar Validation Experiment (ALIVE, September 2005). This assessment pertains to the aerosol at its ambient concentration and thermodynamic state (i.e., σep(λ) either free of or corrected for sampling artifacts) and includes the following ACRF routine methods: Raman lidar, micropulse lidar (MPL), and in situ aerosol profiles (IAP) with a small aircraft. Profiles of aerosol optical depth τp(λ), from which the profiles of σep(λ) are derived through vertical differentiation, were measured by the NASA Ames Airborne Tracking 14-channel Sun photometer (AATS-14); these data were used as benchmark in this evaluation. The ACRF IAP σep(550 nm) were lower by 11% (during AIOP) and higher by 1% (during ALIVE) when compared to AATS-14. The ACRF MPL σep(523 nm) measurements were higher by 24% (AIOP) and 19-21% (ALIVE) compared to AATS-14, but the correlation improved significantly during ALIVE. In the AIOP, a second MPL operated by NASA showed a smaller positive bias (13%) with respect to AATS-14. The ACRF Raman lidar σep(355 nm) measurements were larger by 54% (AIOP) and by 6% (ALIVE) compared to AATS-14. The large bias in the Raman lidar measurements during AIOP stemmed from a gradual loss of Raman lidar sensitivity starting about the end of 2001 going unnoticed until after AIOP. A major refurbishment and upgrade of the instrument and improvements to a data processing algorithm led to the significant improvement and very small bias in ALIVE. Finally, we find that during ALIVE the Raman lidar water vapor densities ρw are 8% larger when compared to AATS-14, whereas in situ measured ρw aboard two different aircraft are smaller than the

Effect of cause-of-death training on agreement between hospital discharge diagnoses and cause of death reported, inpatient hospital deaths, New York City, 2008-2010.

PubMed

Ong, Paulina; Gambatese, Melissa; Begier, Elizabeth; Zimmerman, Regina; Soto, Antonio; Madsen, Ann

2015-01-15

Accurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting. We analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diagnoses among discordant reports and calculated the proportion of inpatient deaths reporting sepsis, a condition underreported in New York City, to assess whether documentation practices changed in response to clarifications made during the intervention. Citywide discordance between death certificates and discharge data decreased from 14.9% in 2008 to 9.6% in 2010 (P < .001), driven by a decrease in discordance at intervention hospitals (20.2% in 2008 to 8.9% in 2010; P < .001). At intervention hospitals, reporting of sepsis increased from 3.7% of inpatient deaths in 2008 to 20.6% in 2010 (P < .001). Overreporting of heart disease as cause of death declined at intervention hospitals, driving a citywide decline, and sepsis reporting practices changed in accordance with health department training. Researchers should consider the effect of overreporting and data-quality changes when analyzing New York City heart disease mortality trends. Other vital records jurisdictions should employ similar interventions to

Revisiting medicalisation and 'natural' death.

PubMed

Seymour, J E

1999-09-01

The contemporary conceptualisation of natural death in social science and health care literature may be seen as elision of potentially paradoxical ideas in which the process of dying, as opposed to the moment of death, is a key determinant of the manner in which death is regarded. In the predominant rhetoric, medical-technological intervention during dying is emblematic of inhumane and unnatural death. Highly technological clinical settings, where medical intervention in the process of dying is so clearly visible, are held up as extreme examples of the metamorphosis of death from 'natural' into 'unnatural' events. This paper examines the reification of 'natural' death within these writings, focusing on the taken for granted polarisation of technology and 'natural' death with which they are underpinned. The paper then turns to an assessment of the validity of this reification by examining some ethnographic case study data concerning the experiences of the close companions of three people who died, or came near to death, within intensive care: arguably an environment in which death is at its most highly medicalised. The data, which are drawn from a wider ethnography of death and dying in two general adult intensive care units, suggest that it is perceptions of the meaning of technology, rather than its simple minimisation or absence, which determine representations of death within highly technological settings. These perceptions in their turn depend crucially on the circumstances with which dying is attended. In this study the 'natural' process of death was preserved for the companions of dying people when medical technology delivered the outcomes they expected, appeared to be amenable to human manipulation and intention, was accessible to their understanding and seemed to 'fit' with the wider context of the dying person's life. The paper concludes by arguing that it is within the phenomenology of suffering associated with the critical illness or death of a close

Brain Death and Human Organismal Integration: A Symposium on the Definition of Death

PubMed Central

Moschella, Melissa

2016-01-01

Does the ability of some brain dead bodies to maintain homeostasis with the help of artificial life support actually imply that those bodies are living human organisms? Or might it be possible that a brain dead body on life support is a mere collection of still-living cells, organs and tissues which can coordinate with one another, but which lack the genuine integration that is the hallmark of a unified human organism as a whole? To foster further study of these difficult and timely questions, a Symposium on the Definition of Death was held at The Catholic University of America in June 2014. The Symposium brought together scholars from a variety of disciplines—law, medicine, biology, philosophy and theology—who all share a commitment to the dead donor rule and to a biological definition of death, but who have differing opinions regarding the validity of neurological criteria for human death. The papers found in this special issue are among the fruits of this Symposium. PMID:27107428

Pretest probability of a normal echocardiography: validation of a simple and practical algorithm for routine use.

PubMed

Hammoudi, Nadjib; Duprey, Matthieu; Régnier, Philippe; Achkar, Marc; Boubrit, Lila; Preud'homme, Gisèle; Healy-Brucker, Aude; Vignalou, Jean-Baptiste; Pousset, Françoise; Komajda, Michel; Isnard, Richard

2014-02-01

Management of increased referrals for transthoracic echocardiography (TTE) examinations is a challenge. Patients with normal TTE examinations take less time to explore than those with heart abnormalities. A reliable method for assessing pretest probability of a normal TTE may optimize management of requests. To establish and validate, based on requests for examinations, a simple algorithm for defining pretest probability of a normal TTE. In a retrospective phase, factors associated with normality were investigated and an algorithm was designed. In a prospective phase, patients were classified in accordance with the algorithm as being at high or low probability of having a normal TTE. In the retrospective phase, 42% of 618 examinations were normal. In multivariable analysis, age and absence of cardiac history were associated to normality. Low pretest probability of normal TTE was defined by known cardiac history or, in case of doubt about cardiac history, by age>70 years. In the prospective phase, the prevalences of normality were 72% and 25% in high (n=167) and low (n=241) pretest probability of normality groups, respectively. The mean duration of normal examinations was significantly shorter than abnormal examinations (13.8 ± 9.2 min vs 17.6 ± 11.1 min; P=0.0003). A simple algorithm can classify patients referred for TTE as being at high or low pretest probability of having a normal examination. This algorithm might help to optimize management of requests in routine practice. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Comparative study of control selection in a national population-based case-control study: Estimating risk of smoking on cancer deaths in Chinese men.

PubMed

Jiang, Jingmei; Liu, Boqi; Nasca, Philip C; Han, Wei; Zou, Xiaonong; Zeng, Xianjia; Tian, Xiaobing; Wu, Yanping; Zhao, Ping; Li, Junyao

2009-10-28

To assess the validation of a novel control selection design by comparing the consistency between the new design and a routine design in a large case-control study that was incorporated into a nationwide mortality survey in China. A nationwide mortality study was conducted during 1989-1991. Surviving spouses or other relatives of all adults who died during 1986-1988 provided detailed information about their own as well as the deceased person's smoking history. In this study, 130,079 males who died of various smoking-related cancers at age 35 or over were taken as cases, while 103,248 male surviving spouses (same age range with cases) of women who died during the same period and 49,331 males who died from causes other than those related to smoking were used as control group 1 and control group 2, respectively. Consistency in the results when comparing cases with each of the control groups was assessed. Consistency in the results was observed in the analyses using different control groups although cancer deaths varied with region and age. Equivalence could be ascertained using a 15% criterion in most cancer deaths which had high death rates in urban areas, but they were uncertain for most cancers in rural areas irrespective of whether the hypothesis testing showed significant differences or not. Sex-matched living spouse control design as an alternative control selection for a case-control study is valid and feasible, and the basic principles of the equivalence study are also supported by epidemiological survey data.

Effect of Cause-of-Death Training on Agreement Between Hospital Discharge Diagnoses and Cause of Death Reported, Inpatient Hospital Deaths, New York City, 2008–2010

PubMed Central

Ong, Paulina; Gambatese, Melissa; Begier, Elizabeth; Zimmerman, Regina; Soto, Antonio

2015-01-01

Introduction Accurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting. Methods We analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diagnoses among discordant reports and calculated the proportion of inpatient deaths reporting sepsis, a condition underreported in New York City, to assess whether documentation practices changed in response to clarifications made during the intervention. Results Citywide discordance between death certificates and discharge data decreased from 14.9% in 2008 to 9.6% in 2010 (P < .001), driven by a decrease in discordance at intervention hospitals (20.2% in 2008 to 8.9% in 2010; P < .001). At intervention hospitals, reporting of sepsis increased from 3.7% of inpatient deaths in 2008 to 20.6% in 2010 (P < .001). Conclusion Overreporting of heart disease as cause of death declined at intervention hospitals, driving a citywide decline, and sepsis reporting practices changed in accordance with health department training. Researchers should consider the effect of overreporting and data-quality changes when analyzing New York City heart disease mortality trends. Other vital records jurisdictions

External validation of ADO, DOSE, COTE and CODEX at predicting death in primary care patients with COPD using standard and machine learning approaches.

PubMed

Morales, Daniel R; Flynn, Rob; Zhang, Jianguo; Trucco, Emmanuel; Quint, Jennifer K; Zutis, Kris

2018-05-01

Several models for predicting the risk of death in people with chronic obstructive pulmonary disease (COPD) exist but have not undergone large scale validation in primary care. The objective of this study was to externally validate these models using statistical and machine learning approaches. We used a primary care COPD cohort identified using data from the UK Clinical Practice Research Datalink. Age-standardised mortality rates were calculated for the population by gender and discrimination of ADO (age, dyspnoea, airflow obstruction), COTE (COPD-specific comorbidity test), DOSE (dyspnoea, airflow obstruction, smoking, exacerbations) and CODEX (comorbidity, dyspnoea, airflow obstruction, exacerbations) at predicting death over 1-3 years measured using logistic regression and a support vector machine learning (SVM) method of analysis. The age-standardised mortality rate was 32.8 (95%CI 32.5-33.1) and 25.2 (95%CI 25.4-25.7) per 1000 person years for men and women respectively. Complete data were available for 54879 patients to predict 1-year mortality. ADO performed the best (c-statistic of 0.730) compared with DOSE (c-statistic 0.645), COTE (c-statistic 0.655) and CODEX (c-statistic 0.649) at predicting 1-year mortality. Discrimination of ADO and DOSE improved at predicting 1-year mortality when combined with COTE comorbidities (c-statistic 0.780 ADO + COTE; c-statistic 0.727 DOSE + COTE). Discrimination did not change significantly over 1-3 years. Comparable results were observed using SVM. In primary care, ADO appears superior at predicting death in COPD. Performance of ADO and DOSE improved when combined with COTE comorbidities suggesting better models may be generated with additional data facilitated using novel approaches. Copyright © 2018. Published by Elsevier Ltd.

Sudden death in sports among young adults in Norway.

PubMed

Solberg, Erik Ekker; Gjertsen, Finn; Haugstad, Erlend; Kolsrud, Lars

2010-06-01

The aim of the study was to explore sudden cardiac death during physical activity in young adults in Norway. This retrospective study examined adults aged 15-34 years during the period 1990-1997. The Cause of Death Registry was used to identify cases of sudden cardiac death in sports. These cases were validated with information from medical records and autopsy reports. Twenty-three sports-related sudden deaths (22 men), mean age 27 years (17-34 years), were identified. Causes of death were myocardial infarction (11), myocarditis (5), conduction abnormalities (2), aortic stenosis (1), cardiac rupture (1), hypertrophic obstructive cardiomyopathy (1), congenital coronary anomaly (1), and coronary sclerosis without defined infarction (1). The deaths were distributed across different types of sports activities. The incidence of deaths among physically active young men was 0.9 per 100,000. The number of myocardial infarctions is higher than expected. The incidence is similar to that found in other studies. A vast majority of the cases of death were men.

Developing non-routine problems for assessing students’ mathematical literacy

NASA Astrophysics Data System (ADS)

Murdiyani, N. M.

2018-03-01

The purpose of this study is to develop non-routine problems for assessing the mathematics literacy skills of students, which is valid, practical, and effective. It is based on the previous research said that Indonesian students’ mathematical literacy is still low. The results of this study can be used as a guide in developing the evaluation questions that can train students to improve the ability of solving non-routine problems in everyday life. This research type is formative evaluation that consists of preliminary, self evaluation, expert reviews, one-to-one, small group, and field test. The sample of this research is grade 8 students at one of Junior High School in Yogyakarta. This study results in mathematics literacy problems prototype consisting of level 1 to level 6 problems similar to PISA problems. This study also discusses the examples of students’ answer and their reasoning.

Self-Consciousness and Death Cognitions from a Terror Management Perspective

ERIC Educational Resources Information Center

Taubman-Ben-Ari, Orit; Noy, Adi

2010-01-01

Two studies explored the connection between self-consciousness and death cognitions. In Study 1 (n = 56), a positive association was found between accessibility of death-related thoughts and the ruminative dimension of self-consciousness. In Study 2 (n = 212), a mortality salience induction led to higher validation of cultural worldviews (a more…

Combined aerodynamic and structural dynamic problem emulating routines (CASPER): Theory and implementation

NASA Technical Reports Server (NTRS)

Jones, William H.

1985-01-01

The Combined Aerodynamic and Structural Dynamic Problem Emulating Routines (CASPER) is a collection of data-base modification computer routines that can be used to simulate Navier-Stokes flow through realistic, time-varying internal flow fields. The Navier-Stokes equation used involves calculations in all three dimensions and retains all viscous terms. The only term neglected in the current implementation is gravitation. The solution approach is of an interative, time-marching nature. Calculations are based on Lagrangian aerodynamic elements (aeroelements). It is assumed that the relationships between a particular aeroelement and its five nearest neighbor aeroelements are sufficient to make a valid simulation of Navier-Stokes flow on a small scale and that the collection of all small-scale simulations makes a valid simulation of a large-scale flow. In keeping with these assumptions, it must be noted that CASPER produces an imitation or simulation of Navier-Stokes flow rather than a strict numerical solution of the Navier-Stokes equation. CASPER is written to operate under the Parallel, Asynchronous Executive (PAX), which is described in a separate report.

Electrotactile Feedback Improves Performance and Facilitates Learning in the Routine Grasping Task.

PubMed

Isaković, Milica; Belić, Minja; Štrbac, Matija; Popović, Igor; Došen, Strahinja; Farina, Dario; Keller, Thierry

2016-06-13

Aim of this study was to investigate the feasibility of electrotactile feedback in closed loop training of force control during the routine grasping task. The feedback was provided using an array electrode and a simple six-level spatial coding, and the experiment was conducted in three amputee subjects. The psychometric tests confirmed that the subjects could perceive and interpret the electrotactile feedback with a high success rate. The subjects performed the routine grasping task comprising 4 blocks of 60 grasping trials. In each trial, the subjects employed feedforward control to close the hand and produce the desired grasping force (four levels). First (baseline) and the last (validation) session were performed in open loop, while the second and the third session (training) included electrotactile feedback. The obtained results confirmed that using the feedback improved the accuracy and precision of the force control. In addition, the subjects performed significantly better in the validation vs. baseline session, therefore suggesting that electrotactile feedback can be used for learning and training of myoelectric control.

Parents' perspective on symptoms, quality of life, characteristics of death and end-of-life decisions for children dying from cancer.

PubMed

Hechler, T; Blankenburg, M; Friedrichsdorf, S J; Garske, D; Hübner, B; Menke, A; Wamsler, C; Wolfe, J; Zernikow, B

2008-01-01

In the present study, we investigated the situation of children who had succumbed to their malignancy in Germany as perceived by their parents. Specifically, we were interested in bereaved parents' perspective on five essential areas: 1) symptoms and quality of life, 2) characteristics of the child's death, 3) anticipation of their child's death and care delivery, 4) end-of-life decisions and 5) impact of the child's death on the parents and perceived social support by the health care team. We contacted all existing departments for paediatric oncology in the German federal state of Nordrhein Westfalen and asked them to contact all parents for participation in our study who had lost their child to cancer in 1999 and 2000. Upon agreement, we interviewed the parents utilising a validated semi-structured interview on distressing symptoms and quality of life of their children during the end-of-life care period. Six of the 19 departments agreed to participate. Parents of 48 children (31 boys, 17 girls) were interviewed. The main distressing symptoms were fatigue, pain, loss of appetite, and dyspnoea according to the parents. While parents perceived pain and constipation to have been treated successfully, loss of appetite and anxiety were not treated effectively. 75% of the children died due to a progression of their malignancy. Of these, 50% obtained cancer-directed therapy at the end of life, which was negatively rated by the parents in hindsight. 48% of the children died at home even though 88% of the parents chose 'at home' as the most appropriate locale of death in hindsight. Parents anticipated their child's death on average 9 weeks prior to the child's death. 41% of the parents provided palliative home care for their child and the majority (88%) rated the quality of care as good or very good. 64% discussed end-of-life decisions with the health care team, 36% did not have a discussion. Parents were clearly affected by their child's death. However, 15% of the parents

Randomized trial of primary PCI with or without routine manual thrombectomy.

PubMed

Jolly, Sanjit S; Cairns, John A; Yusuf, Salim; Meeks, Brandi; Pogue, Janice; Rokoss, Michael J; Kedev, Sasko; Thabane, Lehana; Stankovic, Goran; Moreno, Raul; Gershlick, Anthony; Chowdhary, Saqib; Lavi, Shahar; Niemelä, Kari; Steg, Philippe Gabriel; Bernat, Ivo; Xu, Yawei; Cantor, Warren J; Overgaard, Christopher B; Naber, Christoph K; Cheema, Asim N; Welsh, Robert C; Bertrand, Olivier F; Avezum, Alvaro; Bhindi, Ravinay; Pancholy, Samir; Rao, Sunil V; Natarajan, Madhu K; ten Berg, Jurriën M; Shestakovska, Olga; Gao, Peggy; Widimsky, Petr; Džavík, Vladimír

2015-04-09

During primary percutaneous coronary intervention (PCI), manual thrombectomy may reduce distal embolization and thus improve microvascular perfusion. Small trials have suggested that thrombectomy improves surrogate and clinical outcomes, but a larger trial has reported conflicting results. We randomly assigned 10,732 patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI to a strategy of routine upfront manual thrombectomy versus PCI alone. The primary outcome was a composite of death from cardiovascular causes, recurrent myocardial infarction, cardiogenic shock, or New York Heart Association (NYHA) class IV heart failure within 180 days. The key safety outcome was stroke within 30 days. The primary outcome occurred in 347 of 5033 patients (6.9%) in the thrombectomy group versus 351 of 5030 patients (7.0%) in the PCI-alone group (hazard ratio in the thrombectomy group, 0.99; 95% confidence interval [CI], 0.85 to 1.15; P=0.86). The rates of cardiovascular death (3.1% with thrombectomy vs. 3.5% with PCI alone; hazard ratio, 0.90; 95% CI, 0.73 to 1.12; P=0.34) and the primary outcome plus stent thrombosis or target-vessel revascularization (9.9% vs. 9.8%; hazard ratio, 1.00; 95% CI, 0.89 to 1.14; P=0.95) were also similar. Stroke within 30 days occurred in 33 patients (0.7%) in the thrombectomy group versus 16 patients (0.3%) in the PCI-alone group (hazard ratio, 2.06; 95% CI, 1.13 to 3.75; P=0.02). In patients with STEMI who were undergoing primary PCI, routine manual thrombectomy, as compared with PCI alone, did not reduce the risk of cardiovascular death, recurrent myocardial infarction, cardiogenic shock, or NYHA class IV heart failure within 180 days but was associated with an increased rate of stroke within 30 days. (Funded by Medtronic and the Canadian Institutes of Health Research; TOTAL ClinicalTrials.gov number, NCT01149044.).

Maternal deaths in Denmark 2002-2006.

PubMed

Bødker, Birgit; Hvidman, Lone; Weber, Tom; Møller, Margrethe; Aarre, Annette; Nielsen, Karen Marie; Sørensen, Jette Led

2009-01-01

To describe a method for identification, classification and assessment of maternal deaths in Denmark and to identify substandard care. Register study and case audit based on data from the Registers of the Danish Medical Health Board, death certificates and hospital records. Denmark 2002-2006. Women who died during a pregnancy or within 42 days after a pregnancy. Maternal deaths were identified by notification from maternity wards and data from the Danish National Board of Health. A national audit committee assessed hospital records of direct and indirect deaths. Maternal mortality ratio, causes of death and suboptimal care. In the study period, 26 women died during pregnancy or within 42 days from direct or indirect causes, leading to a maternal mortality ratio of 8.0/100,000 live births. Causes of death were cardiac disease, thromboembolism, hypertensive disorders of pregnancy, Streptococcus A infections, suicide, amniotic fluid embolism, cerebrovascular hemorrhage, asthma and diabetes. Our method proved valid and can be used for future research. Causes of death could be identified and learning points from the assessments could form the basis of focused education and guidelines. Future complementary 'near miss' studies and cooperation with other countries with comparable health systems are expected to improve the benefits of the enquiries, contributing to improved management of life-threatening conditions in pregnancy and childbirth.

Meaning of death: an exploration of perception of elderly in a Bangladeshi village.

PubMed

Joarder, Taufique; Cooper, Alicia; Zaman, Shahaduz

2014-09-01

The aim of this qualitative study was to explore the perceptions of meaning of death among the elderly in a Bangladeshi community, and to understand how the meaning of death affects one's overall well-being. Understandings of death were explored through the explanations respondents provided on the journey of the soul during lifetime and the afterlife, concepts of body-soul duality, and perceived "good" and "bad" deaths. The relationship to well-being was expressed in terms of longevity, anxiety/acceptance of death, and preferred circumstances for death. Seven in-depth interviews and one informal discussion session provided the bulk of the data, while Participatory Rapid Appraisal (PRA) tools, including daily routines and body mapping, supplemented our findings. Elderly members of the community had very specific ideas about the meaning of death, and provided clear explanations regarding the journey of the soul, drawing on ideas of body-soul duality to substantiate claims. Due to long coexistence fusion of Hindu and Muslim ideas around death was found. Anxiety/fear of death was associated with some secular issues, on the contrary the perception of longevity was found linked with spirituality. Insights revealed from this study of subtle differences in the perceptions regarding issues around death may aid the policy makers develop effective end-of-life interventions.

Slow Gait Speed Is an Independent Predictor of Early Death in Older Cancer Outpatients: Results from a Prospective Cohort Study.

PubMed

Pamoukdjian, F; Lévy, V; Sebbane, G; Boubaya, M; Landre, T; Bloch-Queyrat, C; Paillaud, E; Zelek, L

2017-01-01

To assess the predictive value of gait speed for early death in older outpatients with cancer. Prospective bicentric observational cohort study. The Physical Frailty in Elder Cancer patients (PF-EC) study (France). One hundred and ninety outpatients with cancer during the first 6 months of follow up in the PF-EC study. The association between usual gait speed over 4 m alone (GS) or included in the short physical performance battery (SPPB) and overall survival within 6 months following a comprehensive geriatric assessment (CGA). A Cox proportional-hazard regression model was performed in non-survivors for clinical factors from the CGA, along with c reactive protein (CRP). Two models were created to assess GS alone and from inclusion in the SPPB. The mean age was 80.6 years, and 50.5% of the participants were men. Death occurred in 11% (n=22) of the participants within the 6 month follow up period. Of these participants, 98% had solid cancers, and 33% had a metastatic disease. A GS < 0.8 m/s (HR=5.6, 95%CI=1.6-19.7, p=0.007), a SPPB < 9 (HR=5.8, 95%CI=1.6-20.9, p=0.007) and a CRP of 50 mg/l or greater (p<0.0001) were significantly associated with early death in the two multivariate analyses. Cancer site and extension were not significantly associated with early death. Walking tests are associated with early death within the 6 month follow up period after a CGA independent of cancer site and cancer extension. GS alone < 0.8 m/s is at least as efficacious as the SPPB in predicting this outcome. GS alone could be used routinely as a marker of early death to adapt oncologic therapeutics. Further studies are needed to validate these preliminary data.

Transforming Parent-Child Interaction in Family Routines: Longitudinal Analysis with Families of Children with Developmental Disabilities.

PubMed

Lucyshyn, Joseph M; Fossett, Brenda; Bakeman, Roger; Cheremshynski, Christy; Miller, Lynn; Lohrmann, Sharon; Binnendyk, Lauren; Khan, Sophia; Chinn, Stephen; Kwon, Samantha; Irvin, Larry K

2015-12-01

The efficacy and consequential validity of an ecological approach to behavioral intervention with families of children with developmental disabilities was examined. The approach aimed to transform coercive into constructive parent-child interaction in family routines. Ten families participated, including 10 mothers and fathers and 10 children 3-8 years old with developmental disabilities. Thirty-six family routines were selected (2 to 4 per family). Dependent measures included child problem behavior, routine steps completed, and coercive and constructive parent-child interaction. For each family, a single case, multiple baseline design was employed with three phases: baseline, intervention, and follow-up. Visual analysis evaluated the functional relation between intervention and improvements in child behavior and routine participation. Nonparametric tests across families evaluated the statistical significance of these improvements. Sequential analyses within families and univariate analyses across families examined changes from baseline to intervention in the percentage and odds ratio of coercive and constructive parent-child interaction. Multiple baseline results documented functional or basic effects for 8 of 10 families. Nonparametric tests showed these changes to be significant. Follow-up showed durability at 11 to 24 months postintervention. Sequential analyses documented the transformation of coercive into constructive processes for 9 of 10 families. Univariate analyses across families showed significant improvements in 2- and 4-step coercive and constructive processes but not in odds ratio. Results offer evidence of the efficacy of the approach and consequential validity of the ecological unit of analysis, parent-child interaction in family routines. Future studies should improve efficiency, and outcomes for families experiencing family systems challenges.

Routine pharmacogenetic testing in clinical practice: dream or reality?

PubMed

Grossman, Iris

2007-10-01

Pharmacogenetics (PGx) has become progressively popular in recent years, thanks to growing anticipation among scientists, healthcare providers and the general public for the incorporation of genetic tests into the diagnostic arsenal at the physician's disposal. Indeed, much research has been dedicated to elucidation of genetic determinants underlying interindividual variability in pharmacokinetic parameters, as well as drug safety and efficacy. However, few PGx applications have thus far been realized in healthcare management. This review uses examples from PGx research of psychiatric drugs to illustrate why the current published findings are inadequate and insufficient for utilization as routine clinical predictors of treatment safety, efficacy or dosing. I therefore suggest the necessary steps to demonstrate the validity, utility and cost-effectiveness of PGx. These recommendations include a whole range of aspects, starting from standardization of criteria and assessment of the technical quality of genotyping assays, up to design of prospective PGx studies, providing the basis for reimbursement programs to be recognized in routine clinical practice.

Development of the System for Observing Student Movement in Academic Routines and Transitions (SOSMART)

ERIC Educational Resources Information Center

Russ, Laura B.; Webster, Collin A.; Beets, Michael W.; Egan, Catherine; Weaver, Robert Glenn; Harvey, Rachel; Phillips, David S.

2017-01-01

National attention on whole-of-school approaches to decrease children's sedentary behavior and increase physical activity includes movement integration (MI) in classrooms. The purpose of this study was to describe instrument development, reliability, and validity of the System for Observing Student Movement in Academic Routines and Transitions…

Validation of the 2014 European Society of Cardiology Sudden Cardiac Death Risk Prediction Model in Hypertrophic Cardiomyopathy in a Reference Center in South America.

PubMed

Fernández, Adrián; Quiroga, Alejandro; Ochoa, Juan Pablo; Mysuta, Mauricio; Casabé, José Horacio; Biagetti, Marcelo; Guevara, Eduardo; Favaloro, Liliana E; Fava, Agostina M; Galizio, Néstor

2016-07-01

Sudden cardiac death (SCD) is a common cause of death in hypertrophic cardiomyopathy (HC). Our aim was to conduct an external and independent validation in South America of the 2014 European Society of Cardiology (ESC) SCD risk prediction model to identify patients requiring an implantable cardioverter defibrillator. This study included 502 consecutive patients with HC followed from March, 1993 to December, 2014. A combined end point of SCD or appropriate implantable cardioverter defibrillator therapy was assessed. For the quantitative estimation of individual 5-year SCD risk, we used the formula: 1 - 0.998(exp(Prognostic index)). Our database also included the abnormal blood pressure response to exercise as a risk marker. We analyzed the 3 categories of 5-year risk proposed by the ESC: low risk (LR) <4%; intermediate risk (IR) ≥4% to <6%, and high risk (HR) ≥6%. The LR group included 387 patients (77%); the IR group 39 (8%); and the HR group 76 (15%). Fourteen patients (3%) had SCD/appropriate implantable cardioverter defibrillator therapy (LR: 0%; IR: 2 of 39 [5%]; and HR: 12 of 76 [16%]). In a receiver-operating characteristic curve, the new model proved to be an excellent predictor because the area under the curve for the estimated risk is 0.925 (statistical C: 0.925; 95% CI 0.8884 to 0.9539, p <0.0001). In conclusion, the SCD risk prediction model in HC proposed by the 2014 ESC guidelines was validated in our population and represents an improvement compared with previous approaches. A larger multicenter, independent and external validation of the model with long-term follow-up would be advisable. Copyright © 2016 Elsevier Inc. All rights reserved.

Aetiology of sudden cardiac death in sport: a histopathologist's perspective.

PubMed

Sheppard, Mary N

2012-11-01

In the UK, when a young person dies suddenly, the coroner is responsible for establishing the cause of death. They will ask a consultant pathologist to carry out an autopsy in order to ascertain when, where and how that person died. Once the cause of death is established and is due to natural causes, the coroner can issue a death certificate. Importantly, the coroner is not particularly interested in the cause of death as long as it is due to natural causes, which avoids the need for an inquest (a public hearing about the death). However, if no identifiable cause is established at the initial autopsy, the coroner can refer the heart to a cardiac pathologist, since the cause of death is usually due to heart disease in most cases. Consultant histopathologists are responsible for the analysis of human tissue from both living individuals and the dead in order to make a diagnosis of disease. With recent advancements in the management protocols for routine autopsy practice and assessment following the sudden death of a young individual, this review describes the role of the consultant histopathologist in the event of a sudden death of a young athletic individual, together with the older middle-aged 'weekend warrior' athlete. It provides concise mechanisms for the main causes of sudden cardiac death (including coronary artery disease, cardiomyopathies, valve abnormalities, major vessel ruptures and electrical conduction abnormalities) based on detailed autopsy data from our specialised cardiac pathology laboratory. Finally, the review will discuss the role of the histopathologist in the event of a 'negative' autopsy.

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

PubMed

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.

Post-operative fatal blood aspiration after routine lung surgery.

PubMed

Plenzig, Stefanie; Soriano, Mauricio; Held, Hannelore; Verhoff, Marcel A

2017-08-01

A routine question encountered in medicolegal practice is whether the death of a patient in proximity to a surgical procedure is due to medical malpractice. The case of a 62-year-old man who died two weeks after undergoing a VATS sleeve resection of the upper right lung lobe in conjunction with radical lymphadenectomy, a routine surgical procedure, is reported. To address the issue of medical malpractice, a forensic autopsy was ordered by the investigative authority. During the autopsy, the lungs were removed as a whole and fixed in formalin and were later dissected in cooperation with a thoracic surgeon. In the course of this dissection, a bronchovascular fistula, which had led to the occlusion of the bronchial system with clotted blood, was discovered. Bronchovascular fistulas are a rare complication of bronchial sleeve resections. Because this surgical complication is essentially always fatal, it is highly pertinent to medicolegal practice. The presented case report also lists other important complications associated with bronchial anastomosis and elucidates a pragmatic approach to obtaining an expert clinical assessment of possible medical malpractice after operations through the example of a dissection performed in cooperation with a thoracic surgeon. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial.

PubMed

Roffe, Christine; Nevatte, Tracy; Sim, Julius; Bishop, Jon; Ives, Natalie; Ferdinand, Phillip; Gray, Richard

2017-09-26

Hypoxia is common in the first few days after acute stroke, is frequently intermittent, and is often undetected. Oxygen supplementation could prevent hypoxia and secondary neurological deterioration and thus has the potential to improve recovery. To assess whether routine prophylactic low-dose oxygen therapy was more effective than control oxygen administration in reducing death and disability at 90 days, and if so, whether oxygen given at night only, when hypoxia is most frequent, and oxygen administration is least likely to interfere with rehabilitation, was more effective than continuous supplementation. In this single-blind randomized clinical trial, 8003 adults with acute stroke were enrolled from 136 participating centers in the United Kingdom within 24 hours of hospital admission if they had no clear indications for or contraindications to oxygen treatment (first patient enrolled April 24, 2008; last follow-up January 27, 2015). Participants were randomized 1:1:1 to continuous oxygen for 72 hours (n = 2668), nocturnal oxygen (21:00 to 07:00 hours) for 3 nights (n = 2667), or control (oxygen only if clinically indicated; n = 2668). Oxygen was given via nasal tubes at 3 L/min if baseline oxygen saturation was 93% or less and at 2 L/min if oxygen saturation was greater than 93%. The primary outcome was reported using the modified Rankin Scale score (disability range, 0 [no symptoms] to 6 [death]; minimum clinically important difference, 1 point), assessed at 90 days by postal questionnaire (participant aware, assessor blinded). The modified Rankin Scale score was analyzed by ordinal logistic regression, which yields a common odds ratio (OR) for a change from one disability level to the next better (lower) level; OR greater than 1.00 indicates improvement. A total of 8003 patients (4398 (55%) men; mean [SD] age, 72 [13] years; median National Institutes of Health Stroke Scale score, 5; mean baseline oxygen saturation, 96.6%) were enrolled. The

External prognostic validations and comparisons of age- and gender-adjusted exercise capacity predictions.

PubMed

Kim, Esther S H; Ishwaran, Hemant; Blackstone, Eugene; Lauer, Michael S

2007-11-06

The purpose of this study was to externally validate the prognostic value of age- and gender-based nomograms and categorical definitions of impaired exercise capacity (EC). Exercise capacity predicts death, but its use in routine clinical practice is hampered by its close correlation with age and gender. For a median of 5 years, we followed 22,275 patients without known heart disease who underwent symptom-limited stress testing. Models for predicted or impaired EC were identified by literature search. Gender-specific multivariable proportional hazards models were constructed. Four methods were used to assess validity: Akaike Information Criterion (AIC), right-censored c-index in 100 out-of-bootstrap samples, the Nagelkerke Index R2, and calculation of calibration error in 100 bootstrap samples. There were 646 and 430 deaths in 13,098 men and 9,177 women, respectively. Of the 7 models tested in men, a model based on a Veterans Affairs cohort (predicted metabolic equivalents [METs] = 18 - [0.15 x age]) had the highest AIC and R2. In women, a model based on the St. James Take Heart Project (predicted METs = 14.7 - [0.13 x age]) performed best. Categorical definitions of fitness performed less well. Even after accounting for age and gender, there was still an important interaction with age, whereby predicted EC was a weaker predictor in older subjects (p for interaction <0.001 in men and 0.003 in women). Several methods describe EC accounting for age and gender-related differences, but their ability to predict mortality differ. Simple cutoff values fail to fully describe EC's strong predictive value.

Application of process mining to assess the data quality of routinely collected time-based performance data sourced from electronic health records by validating process conformance.

PubMed

Perimal-Lewis, Lua; Teubner, David; Hakendorf, Paul; Horwood, Chris

2016-12-01

Effective and accurate use of routinely collected health data to produce Key Performance Indicator reporting is dependent on the underlying data quality. In this research, Process Mining methodology and tools were leveraged to assess the data quality of time-based Emergency Department data sourced from electronic health records. This research was done working closely with the domain experts to validate the process models. The hospital patient journey model was used to assess flow abnormalities which resulted from incorrect timestamp data used in time-based performance metrics. The research demonstrated process mining as a feasible methodology to assess data quality of time-based hospital performance metrics. The insight gained from this research enabled appropriate corrective actions to be put in place to address the data quality issues. © The Author(s) 2015.

Risk prediction score for death of traumatised and injured children

PubMed Central

2014-01-01

Background Injury prediction scores facilitate the development of clinical management protocols to decrease mortality. However, most of the previously developed scores are limited in scope and are non-specific for use in children. We aimed to develop and validate a risk prediction model of death for injured and Traumatised Thai children. Methods Our cross-sectional study included 43,516 injured children from 34 emergency services. A risk prediction model was derived using a logistic regression analysis that included 15 predictors. Model performance was assessed using the concordance statistic (C-statistic) and the observed per expected (O/E) ratio. Internal validation of the model was performed using a 200-repetition bootstrap analysis. Results Death occurred in 1.7% of the injured children (95% confidence interval [95% CI]: 1.57–1.82). Ten predictors (i.e., age, airway intervention, physical injury mechanism, three injured body regions, the Glasgow Coma Scale, and three vital signs) were significantly associated with death. The C-statistic and the O/E ratio were 0.938 (95% CI: 0.929–0.947) and 0.86 (95% CI: 0.70–1.02), respectively. The scoring scheme classified three risk stratifications with respective likelihood ratios of 1.26 (95% CI: 1.25–1.27), 2.45 (95% CI: 2.42–2.52), and 4.72 (95% CI: 4.57–4.88) for low, intermediate, and high risks of death. Internal validation showed good model performance (C-statistic = 0.938, 95% CI: 0.926–0.952) and a small calibration bias of 0.002 (95% CI: 0.0005–0.003). Conclusions We developed a simplified Thai pediatric injury death prediction score with satisfactory calibrated and discriminative performance in emergency room settings. PMID:24575982

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

PubMed

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.

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

PubMed Central

Rampatige, Rasika; Mikkelsen, Lene; Hernandez, Bernardo; Riley, Ian

2014-01-01

Abstract Objective To systematically review the reliability of hospital data on cause of death and encourage periodic reviews of these data using a standard method. Methods 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. Findings 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. Conclusion 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. PMID:25378742

Do Reincarnation Beliefs Protect Older Adult Chinese Buddhists against Personal Death Anxiety?

ERIC Educational Resources Information Center

Hui, Victoria Ka-Ying; Coleman, Peter G.

2012-01-01

The aim of this exploratory survey study was to develop and validate a Buddhist reincarnation beliefs scale and explore the relation between Buddhist reincarnation beliefs and personal death anxiety in 141 older adult Hong Kong Chinese Buddhists. Buddhist reincarnation beliefs were unrelated to personal death anxiety. This suggests that not all…

Delivering value in dermatology: insights from skin cancer detection in routine clinical visits.

PubMed

Enamandram, Monica; Duncan, Lyn M; Kimball, Alexandra B

2015-02-01

There are increasing demands to demonstrate and report on outcomes in dermatology. Skin cancer diagnosis through skin examination has been well studied, and is promising as a value-delivering intervention. This study seeks to identify the rate of skin cancer diagnosis during routine visits to a large tertiary dermatology clinic. Medical records of patients presenting for routine dermatologic care at Massachusetts General Hospital between March 28 and September 28, 2012, were retrospectively reviewed. All patients given a diagnosis of nonmelanoma skin cancer (NMSC) confirmed on biopsy specimen were identified. Billing data were used to identify the total number of patients evaluated during the study period. NMSC was diagnosed in 1266 skin biopsy specimens from 1047 (7.0%) of the 14,829 patients who presented for routine care. In all, 55% of patients with NMSC were men (mean age 70 years). Chief symptoms of patients with NMSC included general dermatologic concerns (37%), routine cancer screening (43%), and specific lesion(s) of concern (19%). Retrospective design and restriction to a single institution may limit the generalizability of our findings. The incidence of NMSC in routine dermatology is high; these findings validate the value of care provided by dermatologists and highlight the likely increasing need for their diagnostic skills as the population ages in the United States. Copyright © 2014 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Brain Death and Human Organismal Integration: A Symposium on the Definition of Death.

PubMed

Moschella, Melissa

2016-06-01

Does the ability of some brain dead bodies to maintain homeostasis with the help of artificial life support actually imply that those bodies are living human organisms? Or might it be possible that a brain dead body on life support is a mere collection of still-living cells, organs and tissues which can coordinate with one another, but which lack the genuine integration that is the hallmark of a unified human organism as a whole? To foster further study of these difficult and timely questions, a Symposium on the Definition of Death was held at The Catholic University of America in June 2014. The Symposium brought together scholars from a variety of disciplines-law, medicine, biology, philosophy and theology-who all share a commitment to the dead donor rule and to a biological definition of death, but who have differing opinions regarding the validity of neurological criteria for human death. The papers found in this special issue are among the fruits of this Symposium. © The Author 2016. Published by Oxford University Press, on behalf of the Journal of Medicine and Philosophy Inc. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Increased Exposure to Rigid Routines can Lead to Increased Challenging Behavior Following Changes to Those Routines.

PubMed

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

2015-06-01

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 that routine. Play based challenges exposed 16 participants to routines, which were either adhered to or changed. Temper outburst behaviors, heart rate and movement were measured. As participants were exposed to routines for longer before a change (between 10 and 80 min; within participants), more temper outburst behaviors were elicited by changes. Increased emotional arousal was also elicited, which was indexed by heart rate increases not driven by movement. Further study will be important to understand whether current intervention approaches that limit exposure to changes, may benefit from the structured integration of flexibility to ensure that the opportunity for routine establishment is also limited.

Development and validation of the Surgical Outcome Risk Tool (SORT)

PubMed Central

Protopapa, K L; Simpson, J C; Smith, N C E; Moonesinghe, S R

2014-01-01

Background Existing risk stratification tools have limitations and clinical experience suggests they are not used routinely. The aim of this study was to develop and validate a preoperative risk stratification tool to predict 30-day mortality after non-cardiac surgery in adults by analysis of data from the observational National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Knowing the Risk study. Methods The data set was split into derivation and validation cohorts. Logistic regression was used to construct a model in the derivation cohort to create the Surgical Outcome Risk Tool (SORT), which was tested in the validation cohort. Results Prospective data for 19 097 cases in 326 hospitals were obtained from the NCEPOD study. Following exclusion of 2309, details of 16 788 patients were analysed (derivation cohort 11 219, validation cohort 5569). A model of 45 risk factors was refined on repeated regression analyses to develop a model comprising six variables: American Society of Anesthesiologists Physical Status (ASA-PS) grade, urgency of surgery (expedited, urgent, immediate), high-risk surgical specialty (gastrointestinal, thoracic, vascular), surgical severity (from minor to complex major), cancer and age 65 years or over. In the validation cohort, the SORT was well calibrated and demonstrated better discrimination than the ASA-PS and Surgical Risk Scale; areas under the receiver operating characteristic (ROC) curve were 0·91 (95 per cent c.i. 0·88 to 0·94), 0·87 (0·84 to 0·91) and 0·88 (0·84 to 0·92) respectively (P < 0·001). Conclusion The SORT allows rapid and simple data entry of six preoperative variables, and provides a percentage mortality risk for individuals undergoing surgery. PMID:25388883

SCORE should be preferred to Framingham to predict cardiovascular death in French population.

PubMed

Marchant, Ivanny; Boissel, Jean-Pierre; Kassaï, Behrouz; Bejan, Theodora; Massol, Jacques; Vidal, Chrystelle; Amsallem, Emmanuel; Naudin, Florence; Galan, Pilar; Czernichow, Sébastien; Nony, Patrice; Gueyffier, François

2009-10-01

Numerous studies have examined the validity of available scores to predict the absolute cardiovascular risk. We developed a virtual population based on data representative of the French population and compared the performances of the two most popular risk equations to predict cardiovascular death: Framingham and SCORE. A population was built based on official French demographic statistics and summarized data from representative observational studies. The 10-year coronary and cardiovascular death risk and their ratio were computed for each individual by SCORE and Framingham equations. The resulting rates were compared with those derived from national vital statistics. Framingham overestimated French coronary deaths by 2.8 in men and 1.9 in women, and cardiovascular deaths by 1.5 in men and 1.3 in women. SCORE overestimated coronary death by 1.6 in men and 1.7 in women, and underestimated cardiovascular death by 0.94 in men and 0.85 in women. Our results revealed an exaggerated representation of coronary among cardiovascular death predicted by Framingham, with coronary death exceeding cardiovascular death in some individual profiles. Sensitivity analyses gave some insights to explain the internal inconsistency of the Framingham equations. Evidence is that SCORE should be preferred to Framingham to predict cardiovascular death risk in French population. This discrepancy between prediction scores is likely to be observed in other populations. To improve the validation of risk equations, specific guidelines should be issued to harmonize the outcomes definition across epidemiologic studies. Prediction models should be calibrated for risk differences in the space and time dimensions.

The significance of routines in nursing practice.

PubMed

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.

Greed, death, and values: from terror management to transcendence management theory.

PubMed

Cozzolino, Philip J; Staples, Angela D; Meyers, Lawrence S; Samboceti, Jamie

2004-03-01

Research supporting terror management theory has shown that participants facing their death (via mortality salience) exhibit more greed than do control participants. The present research attempts to distinguish mortality salience from other forms of mortality awareness. Specifically, the authors look to reports of near-death experiences and posttraumatic growth which reveal that many people who nearly die come to view seeking wealth and possession as empty and meaningless. Guided by these reports, a manipulation called death reflection was generated. In Study 1, highly extrinsic participants who experienced death reflection exhibited intrinsic behavior. In Study 2, the manipulation was validated, and in Study 3, death reflection and mortality salience manipulations were compared. Results showed that mortality salience led highly extrinsic participants to manifest greed, whereas death reflection again generated intrinsic, unselfish behavior. The construct of value orientation is discussed along with the contrast between death reflection manipulation and mortality salience.

Death Anxiety, Reliability, Validity, and Factorial Structure of the Farsi Form of the Arabic Scale of Death Anxiety in Iranian Old-Aged Persons

PubMed Central

Dadfar, Mahboubeh; Lester, David

2016-01-01

The present study is aimed at examining the level of death anxiety and the sex-related differences among old-aged Iranian individuals sample to compare the old-aged persons with young college students and to explore the psychometric properties of the Arabic Scale of Death Anxiety (ASDA) factors in old-aged sample. A sample of 146 volunteer Iranian individuals took part in the study. The mean ages were 68.58 (SD = 7.10), men 68.81 (SD = 7.44) and women 68.28 (SD = 6.76), respectively. The mean score of the ASDA was 51.09 (SD = 20.19). Cronbach's alpha of the ASDA was found to be high (0.94); and Spearman-Brown coefficient was 0.92. Women had a significantly higher mean total score on the ASDA. Old-aged individuals had a significantly higher mean ASDA total score than younger college students (M age = 25.77). The factor analysis of the ASDA items yielded three factors accounting for 67.88% of the total variance labeled (F1) fear of dead people and tombs; (F2) fear of lethal disease and postmortem events; and (F3) death fear. These factors were highly replicable with previous factors extracted from a middle-aged Kuwaiti sample. On the basis of the present results, there are the following three general conclusions: death anxiety is not significantly correlated with age; the sex-related differences on death anxiety are striking in the Iranian samples; and the ASDA has a highly replicable factor structure among two Iranian and Arab countries. PMID:27867662

Death Anxiety, Reliability, Validity, and Factorial Structure of the Farsi Form of the Arabic Scale of Death Anxiety in Iranian Old-Aged Persons.

PubMed

Dadfar, Mahboubeh; Lester, David; Bahrami, Fazel

2016-01-01

The present study is aimed at examining the level of death anxiety and the sex-related differences among old-aged Iranian individuals sample to compare the old-aged persons with young college students and to explore the psychometric properties of the Arabic Scale of Death Anxiety (ASDA) factors in old-aged sample. A sample of 146 volunteer Iranian individuals took part in the study. The mean ages were 68.58 (SD = 7.10), men 68.81 (SD = 7.44) and women 68.28 (SD = 6.76), respectively. The mean score of the ASDA was 51.09 (SD = 20.19). Cronbach's alpha of the ASDA was found to be high (0.94); and Spearman-Brown coefficient was 0.92. Women had a significantly higher mean total score on the ASDA. Old-aged individuals had a significantly higher mean ASDA total score than younger college students (M age = 25.77). The factor analysis of the ASDA items yielded three factors accounting for 67.88% of the total variance labeled (F1) fear of dead people and tombs; (F2) fear of lethal disease and postmortem events; and (F3) death fear. These factors were highly replicable with previous factors extracted from a middle-aged Kuwaiti sample. On the basis of the present results, there are the following three general conclusions: death anxiety is not significantly correlated with age; the sex-related differences on death anxiety are striking in the Iranian samples; and the ASDA has a highly replicable factor structure among two Iranian and Arab countries.

Using cancer registries to assess the accuracy of primary liver or intrahepatic bile duct cancer as the underlying cause of death, 1999-2010.

PubMed

Polednak, Anthony P

2013-01-01

Inaccuracies in primary liver cancer (ie, excluding intrahepatic bile duct [IHBD]) or IHBD cancer as the underlying cause of death on the death certificate vs the cancer site in a cancer registry should be considered in surveillance of mortality rates in the population. Concordance between cancer site on the death record (1999-2010) and diagnosis (1973-2010) in the database for 9 cancer registries of the Surveillance, Epidemiology, and End Results (SEER) Program was examined for decedents with only 1 cancer recorded. Overreporting of deaths coded to liver cancer (ie, lack of confirmation in SEER) was largely balanced by underreporting (ie, a cancer site other than liver cancer in SEER). For IHBD cancer, overreporting was much more frequent than underreporting. Using modified rates, based on the most accurate numerators available, had little impact on trends for liver cancer in the SEER population, which were similar to trends for the entire US population based on routine statistics. An increase in the death rate for IHBD cancer, however, was no longer evident after modification. The findings support the use of routine data on underlying cause of death for surveillance of trends in death rates for liver cancer but not for IHBD cancer. Additional population-based cancer registries could potentially be used for surveillance of recent and future trends in mortality rates from these cancers.

Learning from death: a hospital mortality reduction programme.

PubMed

Wright, John; Dugdale, Bob; Hammond, Ian; Jarman, Brian; Neary, Maria; Newton, Duncan; Patterson, Chris; Russon, Lynne; Stanley, Philip; Stephens, Rose; Warren, Erica

2006-06-01

There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care. A large acute hospital in an urban district in the North of England. Before and after evaluation of a hospital mortality reduction programme. Audit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the alignment of the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistical process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation, medication safety and infection control. Hospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95% confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths than expected during the period 2002-2005. Improving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evidence and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital mortality.

Learning from death: a hospital mortality reduction programme

PubMed Central

Wright, John; Dugdale, Bob; Hammond, Ian; Jarman, Brian; Neary, Maria; Newton, Duncan; Patterson, Chris; Russon, Lynne; Stanley, Philip; Stephens, Rose; Warren, Erica

2006-01-01

Problem: There are wide variations in hospital mortality. Much of this variation remains unexplained and may reflect quality of care. Setting: A large acute hospital in an urban district in the North of England. Design: Before and after evaluation of a hospital mortality reduction programme. Strategies for change: Audit of hospital deaths to inform an evidence-based approach to identify processes of care to target for the hospital strategy. Establishment of a hospital mortality reduction group with senior leadership and support to ensure the alignment of the hospital departments to achieve a common goal. Robust measurement and regular feedback of hospital deaths using statistical process control charts and summaries of death certificates and routine hospital data. Whole system working across a health community to provide appropriate end of life care. Training and awareness in processes of high quality care such as clinical observation, medication safety and infection control. Effects: Hospital standardized mortality ratios fell significantly in the 3 years following the start of the programme from 94.6 (95% confidence interval 89.4, 99.9) in 2001 to 77.5 (95% CI 73.1, 82.1) in 2005. This translates as 905 fewer hospital deaths than expected during the period 2002-2005. Lessons learnt: Improving the safety of hospital care and reducing hospital deaths provides a clear and well supported goal from clinicians, managers and patients. Good leadership, good information, a quality improvement strategy based on good local evidence and a community-wide approach may be effective in improving the quality of processes of care sufficiently to reduce hospital mortality. PMID:16738373

Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program.

PubMed

Kwon, Steve; Morris, Arden; Billingham, Richard; Frankhouse, Joseph; Horvath, Karen; Johnson, Morrie; McNevin, Shane; Simons, Anthony; Symons, Rebecca; Steele, Scott; Thirlby, Richard; Whiteford, Mark; Flum, David R

2012-04-01

To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined. Observational, prospectively designed cohort study. Data from Washington state's Surgical Care and Outcomes Assessment Program (SCOAP). Patients undergoing elective left-sided colon or rectal resections at 40 SCOAP hospitals from October 1, 2005, to December 31, 2009. Use of leak testing, distinguishing procedures that were performed at hospitals where leak testing was selective (<90% use) or routine (≥ 90% use) in a given calendar quarter. Adjusted odds ratio of a composite adverse event (CAE) (unplanned postoperative intervention and/or in-hospital death) at routine testing hospitals. Among 3449 patients (mean [SD] age, 58.8 [14.8] years; 55.0% women), the CAE rate was 5.5%. Provocative leak testing increased (from 56% in the starting quarter to 76% in quarter 16) and overall rates of CAE decreased (from 7.0% in the starting quarter to 4.6% in quarter 16; both P ≤ .01) over time. Among patients at hospitals that performed routine leak testing, we found a reduction of more than 75% in the adjusted risk of CAEs (odds ratio, 0.23; 95% CI, 0.05-0.99). Routine leak testing of left-sided colorectal anastomoses appears to be associated with a reduced rate of CAEs within the SCOAP network and meets many of the criteria of a worthwhile quality improvement metric.

Alcohol and premature death in Estonian men: a study of forensic autopsies using novel biomarkers and proxy informants

PubMed Central

2012-01-01

Background Alcohol makes an important contribution to premature mortality in many countries in Eastern Europe, including Estonia. However, the full extent of its impact, and the mechanisms underlying it, are challenging issues to research. We describe the design and initial findings of a study aimed at investigating the association of alcohol with mortality in a large series of forensic autopsies of working-age men in Estonia. Methods 1299 male deaths aged 25-54 years were subject to forensic autopsy in 2008-2009. The routine autopsy protocol was augmented by a more systematic inspection of organs, drug testing, assay of liver enzymes and novel biomarkers of alcohol consumption (EtG, EtS and PEth), together with proxy interviews with next of kin for deaths among men who lived in or close to a major town. Results 595 augmented autopsies were performed. Of these, 66% were from external causes (26% suicide, 25% poisoning). 17% were attributed to circulatory system diseases and 7% to alcoholic liver disease. Blood alcohol concentrations (BAC) of ≥ 0.2 mg/g were found for 55% of deaths. Interviews were conducted with proxy informants for 61% of the subjects who had resided in towns. Of these, 28% were reported in the previous year to have been daily or almost daily drinkers and 10% had drunk non-beverage alcohols. Blood ethanol and the liver enzyme GGT were only associated with daily drinking. However, the novel biomarkers showed a more graded response with recent consumption. In contrast, the liver enzymes AST and ALT were largely uninformative because of post-mortem changes. The presence of extremely high PEth concentrations in some samples also suggested post-mortem formation. Conclusion We have shown the feasibility of deploying an extended research protocol within the setting of routine forensic autopsies that offer scope to deepen our understanding of the alcohol-related burden of premature mortality. The most unique feature of the study is the information on a

Applicability of the pre-death grief concept to dementia family caregivers in Asia.

PubMed

Liew, Tau Ming

2016-07-01

Pre-death grief is prevalent among dementia family caregivers. When unaddressed, it produces adverse outcomes. With its research primarily conducted in Caucasians, its applicability to non-Caucasians is uncertain. We explore the existence and the characteristics of pre-death grief in a multi-ethnic Asian population using an established pre-death grief scale-Marwit-Meuser Caregiver Grief Inventory (MM-CGI). Seventy-two dementia family caregivers were recruited from a tertiary hospital. Existence of pre-death grief was shown by its measurability on MM-CGI, together with good internal consistency reliability and construct validity. Characteristics of pre-death grief were explored through multivariate linear regression of MM-CGI and by comparing MM-CGI scores with those from the original US study using one-sample T-test. In the Asian context, pre-death grief was measurable in a reliable and valid manner. Risk factors of pre-death grief included caring for patients with severe dementia, spousal relationship and secondary or below education. Influence of culture was palpable-Asians had more worries and felt isolation, and certain ethnicity showed more pre-death grief. Pre-death grief is applicable even to the non-Caucasian population. It bears much similarity to that in Caucasians. Yet, its expression is modified by culture. Clinicians working with non-Caucasian populations need to be sensitive to its presence and to the influence of culture on its expression. © 2015 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd. © 2015 The Authors. International Journal of Geriatric Psychiatry published by John Wiley & Sons, Ltd.

Routinely collected data as a strategic resource for research: priorities for methods and workforce.

PubMed

Jorm, Louisa

2015-09-30

In the era of 'big data', research using routinely collected data offers greater potential than ever before to drive health system effectiveness and efficiency, and population health improvement. In Australia, the policy environment, and emerging frameworks and processes for data governance and access, increasingly support the use of routinely collected data for research. Capitalising on this strategic resource requires investment in both research methods and research workforce. Priorities for methods development include validation studies, techniques for analysing complex longitudinal data, exploration of bias introduced through linkage error, and a robust toolkit to evaluate policies and programs using 'natural experiments'. Priorities for workforce development include broadening the skills base of the existing research workforce, and the formation of new, larger, interdisciplinary research teams to incorporate capabilities in computer science, partnership research, research translation and the 'business' aspects of research. Large-scale, long-term partnership approaches involving government, industry and researchers offer the most promising way to maximise returns on investment in research using routinely collected data.

[Emotional Intelligence Index: a tool for the routine assessment of mental health promotion programs in schools].

PubMed

Veltro, Franco; Ialenti, Valentina; Morales García, Manuel Alejandro; Gigantesco, Antonella

2016-01-01

After critical examination of several aspects relating to the evaluation of some dimensions of emotional intelligence through self-assessment tools, is described the procedure of construction and validation of an Index for its measurement, conceived only for the routine assessment of health promotion programs mental in schools that include among their objectives the improvement of emotional intelligence specifically "outcome-oriented". On the basis of the two most common international tools, are listed 27 items plus 6 of control, illustrated two Focus Group (FG) of students (face validity). The scale obtained by FG was administered to 300 students, and the results were submitted to factorial analysis (construct validity). It was also evaluated the internal consistency with Cronbach's Alpha and studied concurrent validity with the emotional quotient inventory, a scale of perceived self-efficacy and a stress test rating. From the analysis of FG all the original items were modified, deleted 4, and reduced the encoding system from 6 to 4 levels of Likert scale. Of the 23 items included in the analysis have emerged five factors (intra-psychic dimension, interpersonal, impulsivity, adaptive coping, sense of self-efficacy) for a total of 15 items. Very satisfactory were the results of the validation process of internal consistency (0.72) and the concurrent validity. The results are positive. It is obtained in fact the shortest routine assessment tool currently available in Italy which constitutes a real Index, for which compilation are required on average 3 minutes. Is emphasized the characteristic of an Index, and not of questionnaire or interview for clinical use, highlighting the only specific use for mental health promotion programs in schools.

Innovative Telemonitoring System for Cardiology: From Science to Routine Operation

PubMed Central

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

Innovative telemonitoring system for cardiology: from science to routine operation.

PubMed

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

2010-01-01

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. 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. 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%. First results confirm the applicability of the revised telemonitoring system in routine operation.

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.

PubMed

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.

Analysis and Validation of a Predictive Model for Growth and Death of Aeromonas hydrophila under Modified Atmospheres at Refrigeration Temperatures

PubMed Central

Pin, Carmen; Velasco de Diego, Raquel; George, Susan; García de Fernando, Gonzalo D.; Baranyi, József

2004-01-01

Specific growth and death rates of Aeromonas hydrophila were measured in laboratory media under various combinations of temperature, pH, and percent CO2 and O2 in the atmosphere. Predictive models were developed from the data and validated by means of observations obtained from (i) seafood experiments set up for this purpose and (ii) the ComBase database (http://www.combase.cc; http://wyndmoor.arserrc.gov/combase/).Two main reasons were identified for the differences between the predicted and observed growth in food: they were the variability of the growth rates in food and the bias of the model predictions when applied to food environments. A statistical method is presented to quantitatively analyze these differences. The method was also used to extend the interpolation region of the model. In this extension, the concept of generalized Z values (C. Pin, G. García de Fernando, J. A. Ordóñez, and J. Baranyi, Food Microbiol. 18:539-545, 2001) played an important role. The extension depended partly on the density of the model-generating observations and partly on the accuracy of extrapolated predictions close to the boundary of the interpolation region. The boundary of the growth region of the organism was also estimated by means of experimental results for growth and death rates. PMID:15240265

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

PubMed

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

ERIC Educational Resources Information Center

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…

20 CFR 404.727 - Evidence of a deemed valid marriage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Evidence of a deemed valid marriage. 404.727... DISABILITY INSURANCE (1950- ) Evidence Evidence of Age, Marriage, and Death § 404.727 Evidence of a deemed valid marriage. (a) General. A deemed valid marriage is a ceremonial marriage we consider valid even...

A double-blind, randomized, placebo-controlled trial of misoprostol and routine uterotonics for the prevention of postpartum hemorrhage.

PubMed

Fawole, Adeniran O; Sotiloye, Oladapo S; Hunyinbo, Kehinde I; Umezulike, Augustine C; Okunlola, Michael A; Adekanle, Daniel A; Osamor, Jonathan; Adeyanju, Olusoji; Olowookere, Olufemi O; Adekunle, Adeyemi O; Singata, Mandisa; Mangesi, Lindeka; Hofmeyr, George J

2011-02-01

To assess the effects of 400-μg sublingual misoprostol plus routine uterotonics on postpartum hemorrhage. A double-blind, placebo-controlled, randomized study was performed. After delivery of the child, eligible women received routine uterotonics and were randomly allocated to receive 400-μg misoprostol or placebo sublingually. The primary outcome measure was blood loss of at least 500 mL within 1 hour of taking the trial tablets. In total, 672 women received misoprostol and 673 received placebo. The baseline data were similar for both groups. Misoprostol plus routine uterotonics reduced postpartum blood loss, but the effect was not significant for blood loss of at least 500 mL (relative risk [RR] 0.96; 95% confidence interval [CI], 0.63-1.45) or blood loss of at least 1000 mL (RR 0.50; 95% CI, 0.15-1.66). Misoprostol also reduced the need for non-routine oxytocin, manual removal of the placenta, and hysterectomy, but these differences were not significant either. Misoprostol was associated with pyrexia and moderate/severe shivering. There was no death in either group. Misoprostol plus routine uterotonics resulted in modest reductions of blood loss in the third stage of labor, but the effects did not reach statistical significance. Larger studies are recommended. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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.

Trial Watch: Immunogenic cell death inducers for anticancer chemotherapy.

PubMed

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.

Surveillance of US Death Rates from Chronic Diseases Related to Excessive Alcohol Use.

PubMed

Polednak, Anthony P

2016-01-01

To assess the utility of multiple-cause (MC) death records for surveillance of US mortality rates from chronic causes related to excessive alcohol use. The Alcohol-Related Disease Impact (ARDI) resource produced estimates of the population 'alcohol attributable fraction' (AAF) due to excessive drinking for each alcohol-related (AAF > 0%) cause of death, and used AAFs to estimate numbers of alcohol-related deaths from alcohol-related underlying causes (UC) in adults age 20-64 and 65+ years in 2006-2010. For surveillance, this study used MC death file to identify individual deaths (2006-2010) with an 'alcohol-induced' cause (AAF = 100%) anywhere on the certificate, and to obtain US rates of premature death (ages 15-64 and 65-74 years) for 1999-2012. Using the selected MC records, numbers of deaths from alcohol-related chronic UC (2006-2010) were 81% of ARDI estimates for age 20-64, but only 40% for 65+ years. The MC records identified substantial numbers of deaths from causes (e.g. certain infectious diseases) not included as alcohol-related in ARDI, but included in surveillance of premature death rates for chronic UC. Also, premature death rates for chronic alcohol-induced causes using only the UC (as in routine mortality statistics) were only about half the rates based on MC; all rates increased in recent years but some reached statistical significance only by using MC. Using MC records underestimated total US deaths from alcohol-related chronic causes as the UC, but enhanced surveillance of rates for premature deaths involving chronic causes that may be related to excessive alcohol use. © The Author 2015. Medical Council on Alcohol and Oxford University Press. All rights reserved.

Leading Causes of Death in Nonmetropolitan and Metropolitan Areas- United States, 1999-2014.

PubMed

Moy, Ernest; Garcia, Macarena C; Bastian, Brigham; Rossen, Lauren M; Ingram, Deborah D; Faul, Mark; Massetti, Greta M; Thomas, Cheryll C; Hong, Yuling; Yoon, Paula W; Iademarco, Michael F

2017-01-13

death, nationally and across public health regions. Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas.

Donation after cardiocirculatory death in Canada

PubMed Central

Shemie, Sam D.; Baker, Andrew J.; Knoll, Greg; Wall, William; Rocker, Graeme; Howes, Daniel; Davidson, Janet; Pagliarello, Joe; Chambers-Evans, Jane; Cockfield, Sandra; Farrell, Catherine; Glannon, Walter; Gourlay, William; Grant, David; Langevin, Stéphan; Wheelock, Brian; Young, Kimberly; Dossetor, John

2006-01-01

These recommendations are the result of a national, multidisciplinary, year-long process to discuss whether and how to proceed with organ donation after cardiocirculatory death (DCD) in Canada. A national forum was held in February 2005 to discuss and develop recommendations on the principles, procedures and practice related to DCD, including ethical and legal considerations. At the forum's conclusion, a strong majority of participants supported proceeding with DCD programs in Canada. The forum also recognized the need to formulate and emphasize core values to guide the development of programs and protocols based on the medical, ethical and legal framework established at this meeting. Although end-of-life care should routinely include the opportunity to donate organs and tissues, the duty of care toward dying patients and their families remains the dominant priority of health care teams. The complexity and profound implications of death are recognized and should be respected, along with differing personal, ethnocultural and religious perspectives on death and donation. Decisions around withdrawal of life-sustaining therapies, management of the dying process and the determination of death by cardiocirculatory criteria should be separate from and independent of donation and transplant processes. The recommendations in this report are intended to guide individual programs, regional health authorities and jurisdictions in the development of DCD protocols. Programs will develop based on local leadership and advance planning that includes education and engagement of stakeholders, mechanisms to assure safety and quality and public information. We recommend that programs begin with controlled DCD within the intensive care unit where (after a consensual decision to withdraw life-sustaining therapy) death is anticipated, but has not yet occurred, and unhurried consent discussions can be held. Uncontrolled donation (where death has occurred after unanticipated cardiac arrest

Routine Leak Testing in Colorectal Surgery in the Surgical Care and Outcomes Assessment Program

PubMed Central

Kwon, Steve; Morris, Arden; Billingham, Richard; Frankhouse, Joseph; Horvath, Karen; Johnson, Morrie; McNevin, Shane; Simons, Anthony; Symons, Rebecca; Steele, Scott; Thirlby, Richard; Whiteford, Mark; Flum, David R.

2014-01-01

Objective To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined. Design Observational, prospectively designed cohort study. Setting Data from Washington state’s Surgical Care and Outcomes Assessment Program (SCOAP). Patients Patients undergoing elective left-sided colon or rectal resections at 40 SCOAP hospitals from October 1, 2005, to December 31, 2009. Interventions Use of leak testing, distinguishing procedures that were performed at hospitals where leak testing was selective (<90% use) or routine (≥90% use) in a given calendar quarter. Main Outcome Measure Adjusted odds ratio of a composite adverse event (CAE) (unplanned postoperative intervention and/or in-hospital death) at routine testing hospitals. Results Among 3449 patients (mean [SD] age, 58.8[14.8] years; 55.0% women), the CAE rate was 5.5%. Provocative leak testing increased (from 56% in the starting quarter to 76% in quarter 16) and overall rates of CAE decreased (from 7.0% in the starting quarter to 4.6% in quarter 16; both P ≤ .01) over time. Among patients at hospitals that performed routine leak testing, we found a reduction of more than 75% in the adjusted risk of CAEs (odds ratio, 0.23; 95% CI, 0.05–0.99). Conclusion Routine leak testing of left-sided colorectal anastomoses appears to be associated with a reduced rate of CAEs within the SCOAP network and meets many of the criteria of a worthwhile quality improvement metric. PMID:22508778

Genetic analysis of sudden cardiac death victims: a survey of current forensic autopsy practices.

PubMed

Michaud, Katarzyna; Mangin, Patrice; Elger, Bernice S

2011-05-01

Autopsy-negative sudden cardiac deaths (SCD) seen in forensic practice are most often thought to be the result of sudden arrhythmic death syndrome. Postmortem genetic analysis is recommended in such cases, but is currently performed in only a few academic centers. In order to determine actual current practice, an on-line questionnaire was sent by e-mail to members of various forensic medical associations. The questions addressed routine procedures employed in cases of sudden cardiac death (autopsy ordering, macroscopic and microscopic cardiac examination, conduction tissue examination, immunohistochemistry and electron microscopy, biochemical markers, sampling and storage of material for genetic analyses, toxicological analyses, and molecular autopsy). Some questions concerned the legal and ethical aspects of genetic analyses in postmortem examinations, as well as any existing multidisciplinary collaborations in SCD cases. There were 97 respondents, mostly from European countries. Genetic testing in cases of sudden cardiac death is rarely practiced in routine forensic investigation. Approximately 60% of respondents reported not having the means to perform genetic postmortem testing and 40% do not collect adequate material to perform these investigations at a later date, despite working at university hospitals. The survey demonstrated that many of the problems involved in the adequate investigation of SCD cases are often financial in origin, due to the fact that activities in forensic medicine are often paid by and dependent on the judicial authorities. Problems also exist concerning the contact with family members and/or the family doctor, as well as the often-nonexistent collaboration with others clinicians with special expertise beneficial in the investigation of SCD cases, such as cardiologists and geneticists. This study highlights the importance in establishing guidelines for molecular autopsies in forensic medicine.

Misclassified maternal deaths among East African immigrants in Sweden.

PubMed

Elebro, Karin; Rööst, Mattias; Moussa, Kontie; Johnsdotter, Sara; Essén, Birgitta

2007-11-01

Western countries have reported an increased risk of maternal mortality among African immigrants. This study aimed to identify cases of maternal mortality among immigrants from the Horn of Africa living in Sweden using snowball sampling, and verify whether they had been classified as maternal deaths in the Cause of Death Registry. Three "locators" contacted immigrants from Somalia, Eritrea, and Ethiopia to identify possible cases of maternal mortality. Suspected deaths were scrutinised through verbal autopsy and medical records. Confirmed instances, linked by country of birth, were compared with Registry statistics. We identified seven possible maternal deaths of which four were confirmed in medical records, yet only one case had been classified as such in the Cause of Death Registry. At least two cases, a significant number, seemed to be misclassified. The challenges of both cultural and medical competence for European midwives and obstetricians caring for non-European immigrant mothers should be given more attention, and the chain of information regarding maternal deaths should be strengthened. We propose a practice similar to the British confidential enquiry into maternal deaths. In Sweden, snowball sampling was valuable for contacting immigrant communities for research on maternal mortality; by strengthening statistical validity, it can contribute to better maternal health policy in a multi-ethnic society.

Neuroscience and Brain Death Controversies: The Elephant in the Room.

PubMed

Verheijde, Joseph L; Rady, Mohamed Y; Potts, Michael

2018-06-21

The conception and the determination of brain death continue to raise scientific, legal, philosophical, and religious controversies. While both the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in 1981 and the President's Council on Bioethics in 2008 committed to a biological definition of death as the basis for the whole-brain death criteria, contemporary neuroscientific findings augment the concerns about the validity of this biological definition. Neuroscientific evidentiary findings, however, have not yet permeated discussions about brain death. These findings have critical relevance (scientifically, medically, legally, morally, and religiously) because they indicate that some core assumptions about brain death are demonstrably incorrect, while others lack sufficient evidential support. If behavioral unresponsiveness does not equate to unconsciousness, then the philosophical underpinning of the definition based on loss of capacity for consciousness as well as the criteria, and tests in brain death determination are incongruent with empirical evidence. Thus, the primary claim that brain death equates to biological death has then been de facto falsified. This conclusion has profound philosophical, religious, and legal implications that should compel respective authorities to (1) reassess the philosophical rationale for the definition of death, (2) initiate a critical reappraisal of the presumed alignment of brain death with the theological definition of death in Abrahamic faith traditions, and (3) enact new legislation ratifying religious exemption to death determination by neurologic criteria.

Measurement characteristics of the levels of institutionalization scales: examining reliability and validity.

PubMed

Barab, S A; Redman, B K; Froman, R D

1998-01-01

The Level of Institutionalization (LoIn) scales were developed to assess the extent to which a health promotion program has become integrated into a health care organization. The instrument was designed specifically to measure the amount of routinization and niche saturation of four subsystems (production, maintenance, supportive, and managerial) believed to make up an organization. In this study, the LoIn scales were completed for diabetes programs in 102 general hospitals and 30 home health agencies in Maryland and Pennsylvania. Reliability estimates across the four subsystems for routines (alpha = .61) and for niche saturation (alpha = .44) were substandard. Average correlation among the four subsystems for routines was .67, and among the four subsystems for niche saturation was .38, indicating moderate to large amounts of shared variance among subsystems and challenging claims of discriminant validity. Given these large correlations and a poor fit when testing the eight-factor model, higher-order confirmatory factor analyses were carried out. Results supported the existence of two second-order factors. When collapsed into two factors, the reliabilities were adequate (routines alpha = .90; niche saturation alpha = .80). Criterion-related validity also was found between length of program existence and the routine factor.

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

PubMed

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.

A multicenter study of routine versus selective intraoperative leak testing for sleeve gastrectomy.

PubMed

Bingham, Jason; Kaufman, Jedediah; Hata, Kai; Dickerson, James; Beekley, Alec; Wisbach, Gordon; Swann, Jacob; Ahnfeldt, Eric; Hawkins, Devon; Choi, Yong; Lim, Robert; Martin, Matthew

2017-09-01

Staple line leaks after sleeve gastrectomy are dreaded complications. Many surgeons routinely perform an intraoperative leak test (IOLT) despite little evidence to validate the reliability, clinical benefit, and safety of this procedure. To determine the efficacy of IOLT and if routine use has any benefit over selective use. Eight teaching hospitals, including private, university, and military facilities. A multicenter, retrospective analysis over a 5-year period. The efficacy of the IOLT for identifying unsuspected staple line defects and for predicting postoperative leaks was evaluated. An anonymous survey was also collected reflecting surgeons' practices and beliefs regarding IOLT. From January 2010 through December 2014, 4284 patients underwent sleeve gastrectomy. Of these, 37 patients (.9%) developed a postoperative leak, and 2376 patients (55%) received an IOLT. Only 2 patients (0.08%) had a positive finding. Subsequently, 21 patients with a negative IOLT developed a leak. IOLT demonstrated a sensitivity of only 8.7%. There was a nonsignificant trend toward increased leak rates when an IOLT was performed versus when IOLT was not performed. Leak rates were not statistically different between centers that routinely perform IOLT versus those that selectively perform IOLT. Routine IOLT had very poor sensitivity and was negative in 91% of patients who later developed postoperative leaks. The use of IOLT was not associated with a decrease in the incidence of postoperative leaks, and routine IOLT had no benefit over selective leak testing. IOLT should not be used as a quality indicator or "best practice" for bariatric surgery. Published by Elsevier Inc.

Validation of the Social Security Death Index (SSDI): An Important Readily-Available Outcomes Database for Researchers.

PubMed

Quinn, James; Kramer, Nathan; McDermott, Daniel

2008-01-01

To determine the accuracy of the online Social Security Death Index (SSDI) for determining death outcomes. We selected 30 patients who were determined to be dead and 90 patients thought to be alive after an ED visit as determined by a web-based searched of the SSDI. For those thought to be dead we requested death certificates. We then had a research coordinator blinded to the results of the SSDI search, complete direct follow-up by contacting the patients, family or primary care physicians to determine vital status. To determine the sensitivity and specificity of the SSDI for death at six months in this cohort, we used direct follow-up as the criterion reference and calculated 95% confidence intervals. Direct follow-up was completed for 90% (108 of 120) of the patients. For those patients 20 were determined to be dead and 88 alive. The dead were more likely to be male (57%) and older [(mean age 83.9 (95% CI 79.1 - 88.7) vs. 60.9 (95% CI 56.4 - 65.4) for those alive]. The sensitivity of the SSDI for those with completed direct follow-up was 100% (95% CI 91 -100%) with specificity of 100% (95% CI 98-100%). Of the 12 patients who were not able to be contacted through direct follow-up, the SSDI indicated that 10 were dead and two were alive. SSDI is an accurate measure of death outcomes and appears to have the advantage of finding deaths among patients lost to follow-up.

Nursing Routine Data as a Basis for Association Analysis in the Domain of Nursing Knowledge

PubMed Central

Sellemann, Björn; Stausberg, Jürgen; Hübner, Ursula

2012-01-01

This paper describes the data mining method of association analysis within the framework of Knowledge Discovery in Databases (KDD) with the aim to identify standard patterns of nursing care. The approach is application-oriented and used on nursing routine data of the method LEP nursing 2. The increasing use of information technology in hospitals, especially of nursing information systems, requires the storage of large data sets, which hitherto have not always been analyzed adequately. Three association analyses for the days of admission, surgery and discharge, have been performed. The results of almost 1.5 million generated association rules indicate that it is valid to apply association analysis to nursing routine data. All rules are semantically trivial, since they reflect existing knowledge from the domain of nursing. This may be due either to the method LEP Nursing 2, or to the nursing activities themselves. Nonetheless, association analysis may in future become a useful analytical tool on the basis of structured nursing routine data. PMID:24199122

Behavior Problems Inventory (BPI): Psychometric characteristics of an instrument for routine assessment of persons with psychoses and related disorders.

PubMed

Vázquez Morejón, Antonio J; Vázquez-Morejón, Raquel; Bellido Zanin, Gloria

2018-03-22

This study explores the psychometric characteristics of the Behavior Problems Inventory (BPI), an instrument for routine clinical assessment of behavior problems in outpatients with psychosis based on information provided by key family informants. Six hundred and twenty-one patients diagnosed with psychosis and bipolar affective disorder (ICD-10 F20-F31) attended at Community Mental Health Units were evaluated in routine reviews using the BPI and the Social Functioning Scale (SFS). Twenty-five subjects were simultaneously administered the Social Behavior Schedule (SBS) and 28 were again administered the BPI eight weeks later. The instrument shows adequate psychometric characteristics with high internal consistency and robust temporal reliability, as well as satisfactory concurrent and construct validity. Factor analysis identified three factors: Underactivity/Social Withdrawal, Active Problems and Lack of Impulse Control, with adequate saturation of the items on each of the factors. The BPI is easy to apply, reliable and valid, takes up little of valuable clinical time, allowing routine assessment in public service contexts for persons diagnosed with psychosis and bipolar affective disorder for whom key family informants are available. Published by Elsevier B.V.

Evaluation of Routine Atmospheric Sounding Measurements using Unmanned Systems (ERASMUS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bland, Geoffrey

2016-06-30

The use of small unmanned aircraft systems (sUAS) with miniature sensor systems for atmospheric research is an important capability to develop. The Evaluation of Routine Atmospheric Sounding Measurements using Unmanned Systems (ERASMUS) project, lead by Dr. Gijs de Boer of the Cooperative Institute for Research in Environmental Sciences (CIRES- a partnership of NOAA and CU-Boulder), is a significant milestone in realizing this new potential. This project has clearly demonstrated that the concept of sUAS utilization is valid, and miniature instrumentation can be used to further our understanding of the atmospheric boundary layer in the arctic.

Development and Validation of Pathogen Environmental Monitoring Programs for Small Cheese Processing Facilities.

PubMed

Beno, Sarah M; Stasiewicz, Matthew J; Andrus, Alexis D; Ralyea, Robert D; Kent, David J; Martin, Nicole H; Wiedmann, Martin; Boor, Kathryn J

2016-12-01

Pathogen environmental monitoring programs (EMPs) are essential for food processing facilities of all sizes that produce ready-to-eat food products exposed to the processing environment. We developed, implemented, and evaluated EMPs targeting Listeria spp. and Salmonella in nine small cheese processing facilities, including seven farmstead facilities. Individual EMPs with monthly sample collection protocols were designed specifically for each facility. Salmonella was detected in only one facility, with likely introduction from the adjacent farm indicated by pulsed-field gel electrophoresis data. Listeria spp. were isolated from all nine facilities during routine sampling. The overall Listeria spp. (other than Listeria monocytogenes ) and L. monocytogenes prevalences in the 4,430 environmental samples collected were 6.03 and 1.35%, respectively. Molecular characterization and subtyping data suggested persistence of a given Listeria spp. strain in seven facilities and persistence of L. monocytogenes in four facilities. To assess routine sampling plans, validation sampling for Listeria spp. was performed in seven facilities after at least 6 months of routine sampling. This validation sampling was performed by independent individuals and included collection of 50 to 150 samples per facility, based on statistical sample size calculations. Two of the facilities had a significantly higher frequency of detection of Listeria spp. during the validation sampling than during routine sampling, whereas two other facilities had significantly lower frequencies of detection. This study provides a model for a science- and statistics-based approach to developing and validating pathogen EMPs.

42 CFR 493.931 - Routine chemistry.

Code of Federal Regulations, 2010 CFR

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...

42 CFR 493.931 - Routine chemistry.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 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...

42 CFR 493.931 - Routine chemistry.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 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...

42 CFR 493.931 - Routine chemistry.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 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...

42 CFR 493.931 - Routine chemistry.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 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...

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

PubMed

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.

Psychometric Properties of the Death Anxiety Scale-Extended among Patients with End-Stage Renal Disease.

PubMed

Sharif Nia, Hamid; Pahlevan Sharif, Saeed; Koocher, Gerald P; Yaghoobzadeh, Ameneh; Haghdoost, Ali Akbar; Mar Win, Ma Thin; Soleimani, Mohammad Ali

2017-01-01

This study aimed to evaluate the validity and reliability of the Persian version of Death Anxiety Scale-Extended (DAS-E). A total of 507 patients with end-stage renal disease completed the DAS-E. The factor structure of the scale was evaluated using exploratory factor analysis with an oblique rotation and confirmatory factor analysis. The content and construct validity of the DAS-E were assessed. Average variance extracted, maximum shared squared variance, and average shared squared variance were estimated to assess discriminant and convergent validity. Reliability was assessed using Cronbach's alpha coefficient (α = .839 and .831), composite reliability (CR = .845 and .832), Theta (θ = .893 and .867), and McDonald Omega (Ω = .796 and .743). The analysis indicated a two-factor solution. Reliability and discriminant validity of the factors was established. Findings revealed that the present scale was a valid and reliable instrument that can be used in assessment of death anxiety in Iranian patients with end-stage renal disease.

Assessing the Awareness of Agents Involved in Issuance of Death Certificates About Death Registration Rules in Iran

PubMed Central

Mahdavi, Abdollah; Sedghi, Shahram; Sadoghi, Farahnaz; Azar, Farbod Ebadi Fard

2015-01-01

Introduction: In the death registration system, issuance of death certificate, as a binding rule, is considered among the major necessities of preparation of death statistics. In order to prepare death statistics that are adequately valid for subsequent applications, it is necessary to properly encode death certificates and fully follow rules on causes underlying death. This study aimed to assess the awareness and performance of agents involved in issuance of death certificate in the national death records system. Methods: It was a descriptive cross-sectional research, which was performed from September 2013 to March 2014 on 96 agents involved in issuance of death certificate Imam Khomeini, Alavi, Fatemi and BuAli education and treatment centers of Ardebil University of Medical Sciences. The population included faculty staff physicians, residents and health information management staffs. The research scale was also a researcher-made questionnaire that questioned the demographic information as well as awareness and performance of participants regarding death certificate coding rules. Research data was analyzed based on descriptive statistics and the chi-square test method in the SPSS software at a confidence level of 95%. Findings: A total of 34.42% of participants were aware of the general rules on issuance of death certificates while faculty staff higher specialists (41.67%) and clinical coders (38.34%) with five years of experience demonstrated the highest awareness levels. Only 23 participants (24.6%) were trained to issue death certificates. A total of 76 participants (79.3%) announced their need for learning how to complete death certificate forms on a constant basis. The awareness of participants about the general principle was assessed to be low (30.25%). Moreover, their awareness of selection rules and modification rules was low (27.75%) and moderate (45.25%), respectively. The chi-square test revealed a significant relationship between work experience and

Children's Daily Routines during Kindergarten Transition

ERIC Educational Resources Information Center

Wildenger, Leah K.; McIntyre, Laura Lee; Fiese, Barbara H.; Eckert, Tanya L.

2008-01-01

Routines are an important feature of family life and functioning in families with young children. Common daily routines such as dinnertime, bedtime, and waking activities are powerful organizers of family behavior and may be instrumental to children and families during times of transition, such as elementary school entry. Daily routines were…

Evolutionary Dynamics of Digitized Organizational Routines

ERIC Educational Resources Information Center

Liu, Peng

2013-01-01

This dissertation explores the effects of increased digitization on the evolutionary dynamics of organizational routines. Do routines become more flexible, or more rigid, as the mix of digital technologies and human actors changes? What are the mechanisms that govern the evolution of routines? The dissertation theorizes about the effects of…

Validation of verbal autopsy methods using hospital medical records: a case study in Vietnam.

PubMed

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

2018-05-18

Information on causes of death (COD) is crucial for measuring the health outcomes of populations and progress towards the Sustainable Development Goals. In many countries such as Vietnam where the civil registration and vital statistics (CRVS) system is dysfunctional, information on vital events will continue to rely on verbal autopsy (VA) methods. This study assesses the validity of VA methods used in Vietnam, and provides recommendations on methods for implementing VA validation studies in Vietnam. This validation study was conducted on a sample of 670 deaths from a recent VA study in Quang Ninh province. The study covered 116 cases from this sample, which met three inclusion criteria: a) the death occurred within 30 days of discharge after last hospitalisation, and b) medical records (MRs) for the deceased were available from respective hospitals, and c) the medical record mentioned that the patient was terminally ill at discharge. For each death, the underlying cause of death (UCOD) identified from MRs was compared to the UCOD from VA. The validity of VA diagnoses for major causes of death was measured using sensitivity, specificity and positive predictive value (PPV). The sensitivity of VA was at least 75% in identifying some leading CODs such as stroke, road traffic accidents and several site-specific cancers. However, sensitivity was less than 50% for other important causes including ischemic heart disease, chronic obstructive pulmonary diseases, and diabetes. Overall, there was 57% agreement between UCOD from VA and MR, which increased to 76% when multiple causes from VA were compared to UCOD from MR. Our findings suggest that VA is a valid method to ascertain UCOD in contexts such as Vietnam. Furthermore, within cultural contexts in which patients prefer to die at home instead of a healthcare facility, using the available MRs as the gold standard may be meaningful to the extent that recall bias from the interval between last hospital discharge and death

Prevention of sudden cardiac death in young athletes: controversies and conundrums.

PubMed

Rowland, Thomas

2011-01-01

Strategies for preventing sudden cardiac death in young athletes are predicated on the assumption that: (1) these events reflect pre-existing, clinically silent heart disease, and (2) means for detecting these abnormalities on the pre-participation evaluation are both feasible and accurate. Recent controversy has surrounded both of these presumptions. Some evidence suggests that the myocardial hypertrophy accompanying sports training itself might serve as a substrate for fatal arrhythmias. As well, vigorous debate has arisen over the optimal content of the pre-participation evaluation, particularly regarding the inclusion of routine screening electrocardiograms. As the rarity of these fatal events does not lend itself to an experimental approach, such disagreements are not easily resolved. Consequently, it is expected that decisions regarding approaches to prevention of sudden death in athletes will be dictated largely by region-specific financial, political, and cultural factors. This chapter examines the aetiologies of sudden cardiac death in young athletes as well as the controversies surrounding the prevention of these tragedies. Copyright © 2011 S. Karger AG, Basel.

Exact Bayesian Inference for Phylogenetic Birth-Death Models.

PubMed

Parag, K V; Pybus, O G

2018-04-26

Inferring the rates of change of a population from a reconstructed phylogeny of genetic sequences is a central problem in macro-evolutionary biology, epidemiology, and many other disciplines. A popular solution involves estimating the parameters of a birth-death process (BDP), which links the shape of the phylogeny to its birth and death rates. Modern BDP estimators rely on random Markov chain Monte Carlo (MCMC) sampling to infer these rates. Such methods, while powerful and scalable, cannot be guaranteed to converge, leading to results that may be hard to replicate or difficult to validate. We present a conceptually and computationally different parametric BDP inference approach using flexible and easy to implement Snyder filter (SF) algorithms. This method is deterministic so its results are provable, guaranteed, and reproducible. We validate the SF on constant rate BDPs and find that it solves BDP likelihoods known to produce robust estimates. We then examine more complex BDPs with time-varying rates. Our estimates compare well with a recently developed parametric MCMC inference method. Lastly, we performmodel selection on an empirical Agamid species phylogeny, obtaining results consistent with the literature. The SF makes no approximations, beyond those required for parameter quantisation and numerical integration, and directly computes the posterior distribution of model parameters. It is a promising alternative inference algorithm that may serve either as a standalone Bayesian estimator or as a useful diagnostic reference for validating more involved MCMC strategies. The Snyder filter is implemented in Matlab and the time-varying BDP models are simulated in R. The source code and data are freely available at https://github.com/kpzoo/snyder-birth-death-code. kris.parag@zoo.ox.ac.uk. Supplementary material is available at Bioinformatics online.

Cost-effectiveness of routine varicella vaccination using the measles, mumps, rubella and varicella vaccine in France: an economic analysis based on a dynamic transmission model for varicella and herpes zoster.

PubMed

Littlewood, Kavi J; Ouwens, Mario J N M; Sauboin, Christophe; Tehard, Bertrand; Alain, Sophie; Denis, François

2015-04-01

Each year in France, varicella and zoster affect large numbers of children and adults, resulting in medical visits, hospitalizations for varicella- and zoster-related complications, and societal costs. Disease prevention by varicella vaccination is feasible, wherein a plausible option involves replacing the combined measles, mumps, and rubella (MMR) vaccine with the combined MMR and varicella (MMRV) vaccine. This study aimed to: (1) assess the cost-effectiveness of adding routine varicella vaccination through MMRV, using different vaccination strategies in France; and (2) address key uncertainties, such as the economic consequences of breakthrough varicella cases, the waning of vaccine-conferred protection, vaccination coverage, and indirect costs. Based on the outputs of a dynamic transmission model that used data on epidemiology and costs from France, a cost-effectiveness model was built. A conservative approach was taken regarding the impact of varicella vaccination on zoster incidence by assuming the validity of the hypothesis of an age-specific boosting of immunity against varicella. The model determined that routine MMRV vaccination is expected to be a cost-effective option, considering a cost-effectiveness threshold of €20,000 per quality-adjusted life-year saved; routine vaccination was cost-saving from the societal perspective. Results were driven by a large decrease in varicella incidence despite a temporary initial increase in the number of zoster cases due to the assumption of exogenous boosting. In the scenario analyses, despite moderate changes in assumptions about incidence and costs, varicella vaccination remained a cost-effective option for France. Routine vaccination with MMRV was associated with high gains in quality-adjusted life-years, substantial reduction in the occurrences of varicella- and zoster-related complications, and few deaths due to varicella. Routine MMRV vaccination is also expected to provide reductions in costs related to

HERALD (health economics using routine anonymised linked data).

PubMed

Husain, Muhammad J; Brophy, Sinead; Macey, Steven; Pinder, Leila M; Atkinson, Mark D; Cooksey, Roxanne; Phillips, Ceri J; Siebert, Stefan

2012-03-29

Health economic analysis traditionally relies on patient derived questionnaire data, routine datasets, and outcomes data from experimental randomised control trials and other clinical studies, which are generally used as stand-alone datasets. Herein, we outline the potential implications of linking these datasets to give one single joined up data-resource for health economic analysis. The linkage of individual level data from questionnaires with routinely-captured health care data allows the entire patient journey to be mapped both retrospectively and prospectively. We illustrate this with examples from an Ankylosing Spondylitis (AS) cohort by linking patient reported study dataset with the routinely collected general practitioner (GP) data, inpatient (IP) and outpatient (OP) datasets, and Accident and Emergency department data in Wales. The linked data system allows: (1) retrospective and prospective tracking of patient pathways through multiple healthcare facilities; (2) validation and clarification of patient-reported recall data, complementing the questionnaire/routine data information; (3) obtaining objective measure of the costs of chronic conditions for a longer time horizon, and during the pre-diagnosis period; (4) assessment of health service usage, referral histories, prescribed drugs and co-morbidities; and (5) profiling and stratification of patients relating to disease manifestation, lifestyles, co-morbidities, and associated costs. Using the GP data system we tracked about 183 AS patients retrospectively and prospectively from the date of questionnaire completion to gather the following information: (a) number of GP events; (b) presence of a GP 'drug' read codes; and (c) the presence of a GP 'diagnostic' read codes. We tracked 236 and 296 AS patients through the OP and IP data systems respectively to count the number of OP visits; and IP admissions and duration. The results are presented under several patient stratification schemes based on disease

The revised critical thinking skills scale for a life-and-death course: preliminary scale refinement.

PubMed

Hwang, Huei-Lih; Lin, Huey-Shyan; Wang, Hsiu-Hung

2010-12-01

Death education involves acquiring knowledge, changing behavior, and developing proper views of life in both the affective and the value domains. Critical thinking that is honed through reflecting on life-and-death issues represents a way to reach these goals. Designing assessments able to measure college student content and critical thinking skills related to life-and-death issues is thus important. The Test of Critical Thinking Skills for Life-And-Death content (TCTS-LD) instrument requires the administration of additional tests to assess reliability and validity for future use in the assessment of perceptions on life and death. The purpose of this study was to refine the TCTS-LD. A cross-sectional, descriptive design was used to recruit 715 college students in southern Taiwan. Three structured scales were administered in class to the participants. Data were collected in 2004 and 2006. Confirmatory factor analysis was applied to validate the structure of scales. Examination of the reliability of the three-factor and 15-item scale revealed a Kuder-Richardson coefficient of internal consistency of .54. The split-half reliability coefficients were .47 in the Spearman-Brown correlation and .40 in the intraclass correlation coefficient (ICC). The test-retest reliability coefficients (n = 22) were .58 in Pearson correlation and .56 in ICC. In addition to content validity verification by experts and face validity by students, the validity of this test was assessed using three methods, including (a) a comparable validity rating between this test and the TCTS-A (r = .34, p < .001; (b) a contrast-group technique with different responses to the instrument between those in education and nursing majors (t = 2.71, p < .01), with scores of 10.98 (SD = 2.42) and 9.82 (SD = 2.25), respectively; and (c) a confirmatory factor analysis confirming that TCTS-LD is related to the three dimensions of assumption, evaluation, and induction (χ = 81.800, p = .158, normed chi-square �

20 CFR 404.725 - Evidence of a valid ceremonial marriage.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Evidence of a valid ceremonial marriage. 404... DISABILITY INSURANCE (1950- ) Evidence Evidence of Age, Marriage, and Death § 404.725 Evidence of a valid ceremonial marriage. (a) General. A valid ceremonial marriage is one that follows procedures set by law in...

Feasibility of using routinely collected inpatient data to monitor quality and inform choice: a case study using the UK inflammatory bowel disease audit

PubMed Central

Roberts, Stephen E; Williams, John G; Cohen, David R; Akbari, Ashley; Groves, Sam; Button, Lori A

2011-01-01

Objective To assess the utility and cost of using routinely collected inpatient data for large-scale audit. Design Comparison of audit data items collected nationally in a designed audit of inflammatory bowel disease (UK IBD audit) with routinely collected inpatient data; surveys of audit sites to compare costs. Setting National Health Service hospitals across England, Wales and Northern Ireland that participated in the UK IBD audit. Patients Patients in the UK IBD audit. Interventions None. Main outcome measures Percentage agreement between designed audit data items collected for the UK IBD audit and routine inpatient data items; costs of conducting the designed UK IBD audit and the routine data audit. Results There were very high matching rates between the designed audit data and routine data for a small subset of basic important information collected in the UK IBD audit, including mortality; major surgery; dates of admission, surgery, discharge and death; principal diagnoses; and sociodemographic patient characteristics. There were lower matching rates for other items, including source of admission, primary reason for admission, most comorbidities, colonoscopy and sigmoidoscopy. Routine data did not cover most detailed information collected in the UK IBD audit. Using routine data was much less costly than collecting designed audit data. Conclusion Although valuable for large population-based studies, and less costly than designed data, routine inpatient data are not suitable for the evaluation of individual patient care within a designed audit. PMID:28839601

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

PubMed

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 (< 1 h after onset of acute symptoms or < 6 h after being seen alive) in a closed population in Northwest 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)

Validation of the SURE Program, phase 1

NASA Technical Reports Server (NTRS)

Dotson, Kelly J.

1987-01-01

Presented are the results of the first phase in the validation of the SURE (Semi-Markov Unreliability Range Evaluator) program. The SURE program gives lower and upper bounds on the death-state probabilities of a semi-Markov model. With these bounds, the reliability of a semi-Markov model of a fault-tolerant computer system can be analyzed. For the first phase in the validation, fifteen semi-Markov models were solved analytically for the exact death-state probabilities and these solutions compared to the corresponding bounds given by SURE. In every case, the SURE bounds covered the exact solution. The bounds, however, had a tendency to separate in cases where the recovery rate was slow or the fault arrival rate was fast.

Deaths involving 1,1-difluoroethane at the San Diego County Medical Examiner's Office.

PubMed

Vance, Chris; Swalwell, Christopher; McIntyre, Iain M

2012-01-01

Intentional abuse of 1,1-difluoroethane has been reported to cause transient symptoms such as confusion, tremors, pulmonary irritation, loss of consciousness and, rarely, coma. In the last five years, 17 cases from the San Diego County Medical Examiner's Office showed the presence of 1,1-difluoroethane in postmortem tissues, and the gas was cited in the cause of death in 13 of those cases. Detected during routine ethanol screening, 1,1-difluoroethane was evaluated for concentrations in peripheral blood, central blood and vitreous humor by a slightly modified method published by Avella et al. In many cases, death from abuse of 1,1-difluoroethane seemed to occur within minutes of intentional abuse; large concentrations (>100 mg/L) of the gas were still in the blood. It is important that forensic toxicology laboratories have routine screening procedures to detect 1,1-difluoroethane because cases exist in which evidence of use from cans may not be present in proximity to the decedent, or may be undiscovered in the debris of a motor vehicle accident. It is also important to quantify concentrations of 1,1-difluoroethane in both peripheral blood and central blood, whose ratio may be useful in interpreting how recently the use of the 1,1-difluoroethane occurred.

Preferred and actual place of death in haematological malignancy.

PubMed

Howell, D A; Wang, H I; Roman, E; Smith, A G; Patmore, R; Johnson, M J; Garry, A; Howard, M

2017-06-01

Home is considered the preferred place of death for many, but patients with haematological malignancies (leukaemias, lymphomas and myeloma) die in hospital more often than those with other cancers and the reasons for this are not wholly understood. We examined preferred and actual place of death among people with these diseases. The study is embedded within an established population-based cohort of patients with haematological malignancies. All patients diagnosed at two of the largest hospitals in the study area between May 2005 and April 2008 with acute myeloid leukaemia, diffuse large B-cell lymphoma or myeloma, who died before May 2010 were included. Data were obtained from medical records and routine linkage to national death records. 323 deceased patients were included. A total of 142 (44%) had discussed their preferred place of death; 45.8% wanted to die at home, 28.2% in hospital, 16.9% in a hospice, 5.6% in a nursing home and 3.5% were undecided; 63.4% of these died in their preferred place. Compared to patients with evidence of a discussion, those without were twice as likely to have died within a month of diagnosis (14.8% vs 29.8%). Overall, 240 patients died in hospital; those without a discussion were significantly more likely to die in hospital than those who had (p≤0.0001). Of those dying in hospital, 90% and 75.8% received haematology clinical input in the 30 and 7 days before death, respectively, and 40.8% died in haematology areas. Many patients discussed their preferred place of death, but a substantial proportion did not and hospital deaths were common in this latter group. There is scope to improve practice, particularly among those dying soon after diagnosis. We found evidence that some people opted to die in hospital; the extent to which this compares with other cancers is of interest. 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/.

Using routine Haemophilia Joint Health Score for international comparisons of haemophilia outcome: standardization is needed.

PubMed

Nijdam, A; Bladen, M; Hubert, N; Pettersson, M; Bartels, B; van der Net, J; Liesner, R; Petrini, P; Kurnik, K; Fischer, K

2016-01-01

Haemophilia Joint Health Score (HJHS) is the most sensitive validated score for physical examination of joint health in haemophilia. HJHS performed at regular intervals can be used for clinical monitoring as well as for comparative outcomes research. To determine whether routinely collected HJHS could be used to compare outcome of three different prophylactic regimens in children with severe haemophilia A (primary) and which parameters caused variability in HJHS (secondary). International retrospective observational multi-centre study comparing routine HJHS in 127 children with severe haemophilia A born from 1995 to 2009, from London, Stockholm and Utrecht centres. Patient and treatment data were collected from the European Paediatric Network for Haemophilia Management registry and patient files. The independent effects of regimens, physiotherapists, age and inhibitor status on HJHS were explored, using multivariable regression analysis. Prophylaxis varied across participating centres, with differences in initial frequency of infusions (1× per week vs. 3× per week), age at reaching infusions ≥3× per week, and dose kg(-1) week(-1) at HJHS assessment. Evaluation at median age of 11 years showed an illogical association of HJHS with treatment regimen: the least intensive regimen had the lowest HJHS. The HJHS increased with age and history of inhibitor, as expected (internal validity). But the comparison of prophylactic regimens was obscured by systematic differences in assessment between physiotherapists, both within and between centres. Inter-physiotherapist discrepancies in routine HJHS hamper comparison of scores between treatment regimens. For multi-centre research, additional inter-observer standardization for HJHS scoring is needed. © 2015 John Wiley & Sons Ltd.

Medical neglect death due to acute lymphoblastic leukaemia: an autopsy case report.

PubMed

Usumoto, Yosuke; Sameshima, Naomi; Tsuji, Akiko; Kudo, Keiko; Nishida, Naoki; Ikeda, Noriaki

2014-12-01

We report the case of 2-year-old girl who died of precursor B-cell acute lymphoblastic leukaemia (ALL), the most common cancer in children. She had no remarkable medical history. She was transferred to a hospital because of respiratory distress and died 4 hours after arrival. Two weeks before death, she had a fever of 39 degrees C, which subsided after the administration of a naturopathic herbal remedy. She developed jaundice 1 week before death, and her condition worsened on the day of death. Laboratory test results on admission showed a markedly elevated white blood cell count. Accordingly, the cause of death was suspected to be acute leukaemia. Forensic autopsy revealed the cause of death to be precursor B-cell ALL. With advancements in medical technology, the 5-year survival rate of children with ALL is nearly 90%. However, in this case, the deceased's parents preferred complementary and alternative medicine (i.e., naturopathy) to evidence-based medicine and had not taken her to a hospital for a medical check-up or immunisation since she was an infant. Thus, if she had received routine medical care, she would have a more than 60% chance of being alive 5 years after diagnosis. Therefore, we conclude that the parents should be accused of medical neglect regardless of their motives.

Neonatal Death

MedlinePlus

... Home > Complications & Loss > Loss & grief > Neonatal death Neonatal death E-mail to a friend Please fill in ... cope with your baby’s death. What is neonatal death? Neonatal death is when a baby dies in ...

Linguistic adaptation, validation and comparison of 3 routinely used neuropathic pain questionnaires.

PubMed

Li, Jun; Feng, Yi; Han, Jisheng; Fan, Bifa; Wu, Dasheng; Zhang, Daying; Du, Dongping; Li, Hui; Lim, Jian; Wang, Jiashuang; Jin, Yi; Fu, Zhijian

2012-01-01

Neuropathic pain questionnaires are efficient diagnostic tools for neuropathic pain and play an important role in neuropathic pain epidemiologic studies in China. No comparison data was available in regards to the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), the Neuropathic Pain Questionnaire (NPQ) and ID Pain within and among the same population. To achieve a linguistic adaptation, validation, and comparison of Chinese versions of the 3 neuropathic pain questionnaires (LANSS, NPQ and ID Pain). A nonrandomized, controlled, prospective, multicenter trial. Ten pain centers in China. Two forward translations followed by comparison and reconciliation of the translations. Comparison of the 2 backward translations with the original version was made to establish consistency and accuracy of the translations. Pilot testing and pain specialists' evaluations were also required. A total of 140 patients were enrolled in 10 centers throughout China: 70 neuropathic pain patients and 70 nociceptive pain patients. Reliability (Cronbach's alpha coefficients and Guttman split-half coefficients) and validity (sensitivity, specificity, positive and negative predictive values, receiver operating characteristic [ROC] curves and the area under the ROC curves) of the 3 questionnaires were determined. ROC curves and the area under the ROC curves of the 3 questionnaires were also compared. Chinese versions of LANSS, NPQ and ID Pain had a good reliability (Cronbach's alpha coefficients and Guttman split-half coefficients were greater than 0.7). Sensitivity, specificity, positive and negative predictive values of the Chinese versions of LANSS and ID Pain were considerably high ( > 80%). The area under the ROC curves of LANSS and ID Pain was significantly higher than that of NPQ (P < 0.05). There was no statistically significant difference between the area under the ROC curves of LANSS and ID Pain (P > 0.05). The study was based on patients with a high school degree or above

A Thomistic defense of whole-brain death.

PubMed

Eberl, Jason T

2015-08-01

Michel Accad critiques the currently accepted whole-brain criterion for determining the death of a human being from a Thomistic metaphysical perspective and, in so doing, raises objections to a particular argument defending the whole-brain criterion by Patrick Lee and Germain Grisez. In this paper, I will respond to Accad's critique of the whole-brain criterion and defend its continued validity as a criterion for determining when a human being's death has occurred in accord with Thomistic metaphysical principles. I will, however, join Accad in criticizing Lee and Grisez's proposed defense of the whole-brain criterion as potentially leading to erroneous conclusions regarding the determination of human death. Lay summary: Catholic physicians and bioethicists currently debate the legally accepted clinical standard for determining when a human being has died-known as the "wholebrain criterion"-which has also been morally affirmed by the Magisterium. This paper responds to physician Michel Accad's critique of the whole-brain criterion based upon St. Thomas Aquinas's metaphysical account of human nature as a union of a rational soul and a material body. I defend the whole-brain criterion from the same Thomistic philosophical perspective, while agreeing with Accad's objection to an alternative Thomistic defense of whole-brain death by philosophers Patrick Lee and Germain Grisez.

Death Cafe.

PubMed

Miles, Lizzy; Corr, Charles A

2017-06-01

This article explains the meaning of the phrase Death Cafe and describes what typically occurs at a Death Cafe gathering. The article traces the history of the Death Cafe movement, explores some reasons why people take part in a Death Cafe gathering, and gives examples of what individuals think they might derive from their participation. In addition, this article notes similarities between the Death Cafe movement and three other developments in the field of death, dying, and bereavement. Finally, this article identifies two provisional lessons that can be drawn from Death Cafe gatherings and the Death Cafe movement itself.

Psychometric Properties of the Chinese Version of the Arabic Scale of Death Anxiety.

PubMed

Qiu, Qi; Zhang, Shengyu; Lin, Xiang; Ban, Chunxia; Yang, Haibo; Liu, Zhengwen; Wang, Jingrong; Wang, Tao; Xiao, Shifu; Abdel-Khalek, Ahmed M; Li, Xia

2016-06-25

Death anxiety is regarded as a risk and maintaining factor of psychopathology. While the Arabic Scale of Death Anxiety (ASDA) is a brief, commonly used assessment, such a tool is lacking in Chinese clinical practice. The current study was conducted to develop a Chinese version of the ASDA, i.e., the ASDA(C), using a multistage back-translation technique, and examine the psychometric properties of the scale. A total of 1372 participants from hospitals and universities located in three geographic areas of China were recruited for this study. To calculate the criterion-related validity of the ASDA(C) compared to the Chinese version of the longer-form Multidimensional Orientation toward Dying and Death Inventory (MODDI-F/chin), 49 undergraduates were randomly assigned to complete both questionnaires. Of the total participants, 56 were randomly assigned to retake the ASDA(C) in order to estimate the one-week, test-retest reliability of the ASDA(C). The overall Cronbach's alpha was 0.91 for the whole scale. The one-week, test-retest reliability was 0.96. Exploratory Factor Analysis (EFA) revealed three factors, "fear of dead people and tombs," "fear of lethal disease," and "fear of postmortem events," accounted for 57.09% of the total variance. Factor structure for the three-factor model was sound. The correlation between the total scores on the ASDA(C) and the MODDI-F/chin was 0.54, indicating acceptable concurrent validity. ASDA(C) has adequate psychometrics and properties that make it a reliable and valid scale to assess death anxiety in Mandarin-speaking Chinese.

Yield of Routine Image-Guided Biopsy of Renal Mass Thermal Ablation Zones: 11-Year Experience.

PubMed

Wasnik, Ashish P; Higgins, Ellen J; Fox, Giovanna A; Caoili, Elaine M; Davenport, Matthew S

2018-06-19

To determine the yield of routine image-guided core biopsy of renal cell carcinoma (RCC) thermal ablation zones. Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant quality improvement effort. Routine core biopsy of RCC ablation zones was performed 2 months postablation from July 2003 to December 2014. Routine nicotinamide adenine dinucleotide staining was performed by specialized genitourinary pathologists to assess cell viability. The original purpose of performing routine postablation biopsy was to verify, in addition to imaging, whether the mass was completely treated. Imaging was stratified as negative, indeterminate, or positive for viable malignancy. Histology was stratified as negative, indeterminate, positive, or nondiagnostic for viable malignancy. Histology results were compared to prebiopsy imaging findings. Routine ablation zone biopsy was performed after 50% (146/292) of index ablations (24 cryoablations, 122 radiofrequency ablations), and postablation imaging was performed more often with multiphasic computed tomography than magnetic resonance imaging (100 vs 46, p < 0.0001). When imaging was negative (n = 117), biopsy added no additional information (92% [n = 108] negative, 0.9% [n = 1] indeterminate, 7% [n = 8] nondiagnostic). When imaging was indeterminate (n = 19), 11% (n = 2) of biopsies had viable RCC and 89% (n = 17) were negative. When imaging was positive, biopsy detected viable neoplasm in only 10% (1/10) of cases; 80% (8/10) were negative and 10% (1/10) were nondiagnostic. Routine biopsy of renal ablation zones to validate postablation imaging results was not value-added and therefore was discontinued at the study institution. Copyright © 2018. Published by Elsevier Inc.

The Case for Reasonable Accommodation of Conscientious Objections to Declarations of Brain Death.

PubMed

Johnson, L Syd M

2016-03-01

Since its inception in 1968, the concept of whole-brain death has been contentious, and four decades on, controversy concerning the validity and coherence of whole-brain death continues unabated. Although whole-brain death is legally recognized and medically entrenched in the United States and elsewhere, there is reasonable disagreement among physicians, philosophers, and the public concerning whether brain death is really equivalent to death as it has been traditionally understood. A handful of states have acknowledged this plurality of viewpoints and enacted "conscience clauses" that require "reasonable accommodation" of religious and moral objections to the determination of death by neurological criteria. This paper argues for the universal adoption of "reasonable accommodation" policies using the New Jersey statute as a model, in light of both the ongoing controversy and the recent case of Jahi McMath, a child whose family raised religious objections to a declaration of brain death. Public policies that accommodate reasonable, divergent viewpoints concerning death provide a practical and compassionate way to resolve those conflicts that are the most urgent, painful, and difficult to reconcile.

Comparison of crude and adjusted mortality rates from leading causes of death in northeastern Brazil.

PubMed

França, Elisabeth; Rao, Chalapati; Abreu, Daisy Maria Xavier de; Souza, Maria de Fátima Marinho de; Lopez, Alan D

2012-04-01

To present how the adjustment of incompleteness and misclassification of causes of death in the vital registration (VR) system can contribute to more accurate estimates of the risk of mortality from leading causes of death in northeastern Brazil. After estimating the total numbers of deaths by age and sex in Brazil's Northeast region in 2002-2004 by correcting for undercount in the VR data, adjustment algorithms were applied to the reported cause-of-death structure. Average annual age-standardized mortality rates were computed by cause, with and without the corrections, and compared to death rates for Brazil's South region after adjustments for potential misdiagnosis. Death rates from ischemic heart disease, lower respiratory infections, chronic obstructive pulmonary disease, and perinatal conditions were more than 100% higher for both sexes than what was suggested by the routine VR data. Corrected cause-specific mortality rates were higher in the Northeast region versus the South region for the majority of causes of death, including several noncommunicable conditions. Failure to adjust VR data for undercount of cases reported and misdiagnoses will cause underestimation of mortality risks for the populations of the Northeast region, which are more vulnerable than those in other regions of the country. In order to more reliably understand the pattern of disease, all cause-specific mortality rates in poor populations should be adjusted.

10-Year Mortality Outcome of a Routine Invasive Strategy Versus a Selective Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndrome: The British Heart Foundation RITA-3 Randomized Trial.

PubMed

Henderson, Robert A; Jarvis, Christopher; Clayton, Tim; Pocock, Stuart J; Fox, Keith A A

2015-08-04

The RITA-3 (Third Randomised Intervention Treatment of Angina) trial compared outcomes of a routine early invasive strategy (coronary arteriography and myocardial revascularization, as clinically indicated) to those of a selective invasive strategy (coronary arteriography for recurrent ischemia only) in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). At a median of 5 years' follow-up, the routine invasive strategy was associated with a 24% reduction in the odds of all-cause mortality. This study reports 10-year follow-up outcomes of the randomized cohort to determine the impact of a routine invasive strategy on longer-term mortality. We randomized 1,810 patients with NSTEACS to receive routine invasive or selective invasive strategies. All randomized patients had annual follow-up visits up to 5 years, and mortality was documented thereafter using data from the Office of National Statistics. Over 10 years, there were no differences in mortality between the 2 groups (all-cause deaths in 225 [25.1%] vs. 232 patients [25.4%]: p = 0.94; and cardiovascular deaths in 135 [15.1%] vs. 147 patients [16.1%]: p = 0.65 in the routine invasive and selective invasive groups, respectively). Multivariate analysis identified several independent predictors of 10-year mortality: age, previous myocardial infarction, heart failure, smoking status, diabetes, heart rate, and ST-segment depression. A modified post-discharge Global Registry of Acute Coronary Events (GRACE) score was used to calculate an individual risk score for each patient and to form low-risk, medium-risk, and high-risk groups. Risk of death within 10 years varied markedly from 14.4 % in the low-risk group to 56.2% in the high-risk group. This mortality trend did not depend on the assigned treatment strategy. The advantage of reduced mortality of routine early invasive strategy seen at 5 years was attenuated during later follow-up, with no evidence of a difference in outcome at 10 years

Low-frequency quantitative ultrasound imaging of cell death in vivo

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sadeghi-Naini, Ali; Falou, Omar; Czarnota, Gregory J.

Purpose: Currently, no clinical imaging modality is used routinely to assess tumor response to cancer therapies within hours to days of the delivery of treatment. Here, the authors demonstrate the efficacy of ultrasound at a clinically relevant frequency to quantitatively detect changes in tumors in response to cancer therapies using preclinical mouse models.Methods: Conventional low-frequency and corresponding high-frequency ultrasound (ranging from 4 to 28 MHz) were used along with quantitative spectroscopic and signal envelope statistical analyses on data obtained from xenograft tumors treated with chemotherapy, x-ray radiation, as well as a novel vascular targeting microbubble therapy.Results: Ultrasound-based spectroscopic biomarkers indicatedmore » significant changes in cell-death associated parameters in responsive tumors. Specifically changes in the midband fit, spectral slope, and 0-MHz intercept biomarkers were investigated for different types of treatment and demonstrated cell-death related changes. The midband fit and 0-MHz intercept biomarker derived from low-frequency data demonstrated increases ranging approximately from 0 to 6 dBr and 0 to 8 dBr, respectively, depending on treatments administrated. These data paralleled results observed for high-frequency ultrasound data. Statistical analysis of ultrasound signal envelope was performed as an alternative method to obtain histogram-based biomarkers and provided confirmatory results. Histological analysis of tumor specimens indicated up to 61% cell death present in the tumors depending on treatments administered, consistent with quantitative ultrasound findings indicating cell death. Ultrasound-based spectroscopic biomarkers demonstrated a good correlation with histological morphological findings indicative of cell death (r{sup 2}= 0.71, 0.82; p < 0.001).Conclusions: In summary, the results provide preclinical evidence, for the first time, that quantitative ultrasound used at a clinically relevant

The Psychometric Parameters of the Farsi Form of the Arabic Scale of Death Anxiety

PubMed Central

Abdel-Khalek, Ahmed M.; Lester, David

2017-01-01

The aim of this study was to describe the psychometric properties of the Farsi Form of the Arabic Scale of Death Anxiety (ASDA). The original scale was first translated into Farsi by language experts using the back translation procedure and then administered to a total of 252 Iranian college students and 52 psychiatric outpatients from psychiatric and psychological clinics. The one-week test-retest reliability of the Farsi version in a sample of college students was 0.78, indicating good temporal stability and corroborating the trait-like nature of scores. Cronbach's α was 0.90 for the college students and 0.92 for the psychiatric outpatients, indicating high internal consistency. Scale scores correlated 0.46 with Death Obsession Scale scores, 0.56 with Death Depression Scale scores, 0.41 with Death Anxiety Scale scores, and 0.40 with Wish to be Dead Scale scores, indicating good construct and criterion-related validity. A principal component analysis with a Varimax rotation yielded four factors in the sample of Iranian college students, indicating a lack of homogeneity in the content of the scale. Male students obtained a significant higher mean score than did females. It was concluded that the Farsi ASDA had good internal consistency, temporal stability, criterion-related validity, and a factor structure reflecting important features of death anxiety. In general, the Farsi ASDA could be recommended for use in research on death anxiety among Iranian college students and psychiatric outpatients. PMID:28698887

The Psychometric Parameters of the Farsi Form of the Arabic Scale of Death Anxiety.

PubMed

Dadfar, Mahboubeh; Abdel-Khalek, Ahmed M; Lester, David; Atef Vahid, Mohammad Kazem

2017-01-01

The aim of this study was to describe the psychometric properties of the Farsi Form of the Arabic Scale of Death Anxiety (ASDA). The original scale was first translated into Farsi by language experts using the back translation procedure and then administered to a total of 252 Iranian college students and 52 psychiatric outpatients from psychiatric and psychological clinics. The one-week test-retest reliability of the Farsi version in a sample of college students was 0.78, indicating good temporal stability and corroborating the trait-like nature of scores. Cronbach's α was 0.90 for the college students and 0.92 for the psychiatric outpatients, indicating high internal consistency. Scale scores correlated 0.46 with Death Obsession Scale scores, 0.56 with Death Depression Scale scores, 0.41 with Death Anxiety Scale scores, and 0.40 with Wish to be Dead Scale scores, indicating good construct and criterion-related validity. A principal component analysis with a Varimax rotation yielded four factors in the sample of Iranian college students, indicating a lack of homogeneity in the content of the scale. Male students obtained a significant higher mean score than did females. It was concluded that the Farsi ASDA had good internal consistency, temporal stability, criterion-related validity, and a factor structure reflecting important features of death anxiety. In general, the Farsi ASDA could be recommended for use in research on death anxiety among Iranian college students and psychiatric outpatients.

Psychological and physiological responses following repeated peer death.

PubMed

Andersen, Judith Pizarro; Silver, Roxane Cohen; Stewart, Brandon; Koperwas, Billie; Kirschbaum, Clemens

2013-01-01

Undergraduates at a university in the United States were exposed - directly and indirectly - to 14 peer deaths during one academic year. We examined how individual and social factors were associated with psychological (e.g., anxiety, depression, somatization) and physiological (i.e., cortisol) distress responses following this unexpected and repeated experience with loss. Two to three months after the final peer death, respondents (N = 122, 61% female, 18-23 years, M = 20.13, SD = 1.14) reported prior adverse experiences, degree of closeness with the deceased, acute responses to the peer deaths, ongoing distress responses, social support, support seeking, and media viewing. A subset (n = 24) returned hair samples for evaluation of cortisol responses during the previous 3 months. Ongoing psychological distress was associated with a) prior interpersonal trauma, b) fewer social supports, and c) media exposure to news of the deaths (p's<.05). Participants who had no prior bereavements showed, on average, high cortisol (>25 p/mg) compared to individuals with one or two prior bereavement experiences (who were, on average, within the normal range, 10 to 25 p/mg) (p<.05). Only 8% of the sample utilized available university psychological or physical health resources and support groups. Limited research has examined the psychological and physiological impact of exposure to chronic, repeated peer loss, despite the fact that there are groups of individuals (e.g., police, military soldiers) that routinely face such exposures. Prior adversity appears to play a role in shaping psychological and physiological responses to repeated loss. This topic warrants further research given the health implications of repeated loss for individuals in high-risk occupations and university settings.

Liver Surface Nodularity Score Allows Prediction of Cirrhosis Decompensation and Death.

PubMed

Smith, Andrew D; Zand, Kevin A; Florez, Edward; Sirous, Reza; Shlapak, Darya; Souza, Frederico; Roda, Manohar; Bryan, Jason; Vasanji, Amit; Griswold, Michael; Lirette, Seth T

2017-06-01

Purpose To determine whether use of the liver surface nodularity (LSN) score, a quantitative biomarker derived from routine computed tomographic (CT) images, allows prediction of cirrhosis decompensation and death. Materials and Methods For this institutional review board-approved HIPAA-compliant retrospective study, adult patients with cirrhosis and Model for End-Stage Liver Disease (MELD) score within 3 months of initial liver CT imaging between January 3, 2006, and May 30, 2012, were identified from electronic medical records (n = 830). The LSN score was measured by using CT images and quantitative software. Competing risk regression was used to determine the association of the LSN score with hepatic decompensation and overall survival. A risk model combining LSN scores (<3 or ≥3) and MELD scores (<10 or ≥10) was created for predicting liver-related events. Results In patients with compensated cirrhosis, 40% (129 of 326) experienced decompensation during a median follow-up period of 4.22 years. After adjustment for competing risks including MELD score, LSN score (hazard ratio, 1.38; 95% confidence interval: 1.06, 1.79) was found to be independently predictive of hepatic decompensation. Median times to decompensation of patients at high (1.76 years, n = 48), intermediate (3.79 years, n = 126), and low (6.14 years, n = 152) risk of hepatic decompensation were significantly different (P < .001). Among the full cohort with compensated or decompensated cirrhosis, 61% (504 of 830) died during the median follow-up period of 2.26 years. After adjustment for competing risks, LSN score (hazard ratio, 1.22; 95% confidence interval: 1.11, 1.33) and MELD score (hazard ratio, 1.08; 95% confidence interval: 1.06, 1.11) were found to be independent predictors of death. Median times to death of patients at high (0.94 years, n = 315), intermediate (2.79 years, n = 312), and low (4.69 years, n = 203) risk were significantly different (P < .001). Conclusion The LSN score

Knee arthroscopy routines and practice.

PubMed

Brattwall, M; Jacobson, E; Forssblad, M; Jakobsson, J

2010-12-01

Knee arthroscopy is one of most commonly performed day-case orthopaedic procedures, thus consuming huge medical resources. The aim of the present questionnaire survey was to study knee arthroscopy routines and practice. An electronic web-based survey including questions around pre-, per- and postoperative routines for elective knee arthroscopy was send to all orthopaedic units associated to the Swedish Arthroscopic Society (n = 60). Responses covering 37 centres out of 60 (response rate 62%) were returned. Preoperative radiograph routines varied considerable between centres; conventional radiograph varied between 5 and 100% and preoperative MRI between 5 and 80% of patients. General anaesthesia was the preferred intra-operative technique used in all centres (median 79% of patients), local anaesthesia with or without light sedation was used in all 28 out of the 37 centres responding (median 10% of cases) and spinal anaesthesia was used in 15 centres (median 5% of cases). Intra-articular local anaesthesia was provided in all but one of centres. Perioperative administration of oral NSAIDs was common (31 out 37), 6 centres (all teaching hospitals) did not routinely give pre- or postoperative NSAID. Analgesic prescription was provided on a regular base in 18 (49%) of centres; an NSAID being the most commonly prescribed. All but one centre provided written information and instruction at discharge. Referral to physiotherapy, prescribed sick leave and scheduled follow-up in the outpatient clinic diverged considerably. Routines and practice associated to elective knee arthroscopy differed; however, no clear differences in practice were seen between teaching centres, general or local hospitals apart from a lower usage of NSAID for perioperative analgesia. There is an obvious room for further standardisation in the routine handling of patients undergoing elective arthroscopy of the knee.

Active Movement Warm-Up Routines

ERIC Educational Resources Information Center

Walter, Teri; Quint, Ashleigh; Fischer, Kim; Kiger, Joy

2011-01-01

This article presents warm-ups that are designed to physiologically and psychologically prepare students for vigorous physical activity. An active movement warm-up routine is made up of three parts: (1) active warm-up movement exercises, (2) general preparation, and (3) the energy system. These warm-up routines can be used with all grade levels…

Leading Causes of Death in Nonmetropolitan and Metropolitan Areas— United States, 1999–2014

PubMed Central

Garcia, Macarena C.; Bastian, Brigham; Rossen, Lauren M.; Ingram, Deborah D.; Faul, Mark; Massetti, Greta M.; Thomas, Cheryll C.; Hong, Yuling; Yoon, Paula W.; Iademarco, Michael F.

2017-01-01

potentially excess deaths from the five leading causes of death, nationally and across public health regions. Public Health Action Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas. PMID:28081058

Medicolegal Death Scene Investigations After Natural Disaster- and Weather-Related Events: A Review of the Literature

PubMed Central

Rocha, Luciana A.; Fromknecht, Catharine Q.; Redman, Sarah Davis; Brady, Joanne E.; Hodge, Sarah E.; Noe, Rebecca S.

2017-01-01

Background The number of disaster-related deaths recorded by vital statistics departments often differs from that reported by other agencies, including the National Oceanic and Atmospheric Administration-National Weather Service storm database and the American Red Cross. The Centers for Disease Control and Prevention (CDC) has launched an effort to improve disaster-related death scene investigation reporting practices to make data more comparable across jurisdictions, improve accuracy of reporting disaster-related deaths, and enhance identification of risk and protective factors. We conducted a literature review to examine how death scene data are collected and how such data are used to determine disaster relatedness. Methods Two analysts conducted a parallel search using Google and Google Scholar. We reviewed published peer-reviewed articles and unpublished documents including relevant forms, protocols, and worksheets from coroners, medical examiners, and death scene investigators. Results We identified 177 documents: 32 published peer-reviewed articles and 145 other documents (grey literature). Published articles suggested no consistent approach for attributing deaths to a disaster. Researchers generally depended on death certificates to identify disaster-related deaths; several studies also drew on supplemental sources, including medical examiner, coroner, and active surveillance reports. Conclusions These results highlight the critical importance of consistent, accurate data collection during a death investigation. Review of the grey literature found variation in use of death scene data collection tools, indicating the potential for widespread inconsistency in data captured for routine reporting and public health surveillance. Findings from this review will be used to develop guidelines and tools for capturing disaster-related death investigation data. PMID:28845205

Accuracy of death certification of dementia in population-based samples of older people: analysis over time

PubMed Central

Calloway, Rowan; Zhao, Emily; Brayne, Carol

2018-01-01

Abstract Background death certification data are routinely collected in most developed countries. Coded causes of death are a readily accessible source and have the potential advantage of providing complete follow-up, but with limitations. Objective to investigate the reliability of using death certificates for surveillance of dementia, the time trend of recording dementia on death certificates and predictive factors of recording of dementia. Subjects individuals aged 65 and over in six areas across England and Wales were randomly selected for the Medical Research Council Cognitive Function and Ageing Study (CFAS) and CFAS II with mortality follow-up. Methods prevalence of dementia recorded on death certificates were calculated by year. Reporting of dementia on death certificates compared with the study diagnosis of dementia, with sensitivity, specificity and Cohen’s κ were estimated. Multivariable logistic regression models explored the impact of potential factors on the reporting of dementia on the death certificate. Results the overall unadjusted prevalence of dementia on death certificates rose from 5.3% to 25.9% over the last 26 years. Dementia reported on death certificates was poor with sensitivity 21.0% in earlier cohort CFAS, but it had increased to 45.2% in CFAS II. Dementia was more likely to be recorded on death certificates in individuals with severe dementia, or those living in an institution, yet less likely reported if individuals died in hospital. Conclusion recording dementia on death certificate has improved significantly in the England and Wales. However, such information is still an underestimate and should be used alongside epidemiological estimations. PMID:29718074

Immotile Active Matter: Activity from Death and Reproduction.

PubMed

Kalziqi, Arben; Yanni, David; Thomas, Jacob; Ng, Siu Lung; Vivek, Skanda; Hammer, Brian K; Yunker, Peter J

2018-01-05

Unlike equilibrium atomic solids, biofilms-soft solids composed of bacterial cells-do not experience significant thermal fluctuations at the constituent level. However, living cells stochastically reproduce and die, provoking a mechanical response. We investigate the mechanical consequences of cellular death and reproduction by measuring surface-height fluctuations of biofilms containing two mutually antagonistic strains of Vibrio cholerae that kill one another on contact via the type VI secretion system. While studies of active matter typically focus on activity via constituent mobility, here, activity is mediated by reproduction and death events in otherwise immobilized cells. Biofilm surface topography is measured in the nearly homeostatic limit via white light interferometry. Although biofilms are far from equilibrium systems, measured surface-height fluctuation spectra resemble the spectra of thermal permeable membranes but with an activity-mediated effective temperature, as predicted by Risler, Peilloux, and Prost [Phys. Rev. Lett. 115, 258104 (2015)PRLTAO0031-900710.1103/PhysRevLett.115.258104]. By comparing the activity of killer strains of V. cholerae with that of genetically modified strains that cannot kill each other and validating with individual-based simulations, we demonstrate that extracted effective temperatures increase with the amount of death and reproduction and that death and reproduction can fluidize biofilms. Together, these observations demonstrate the unique physical consequences of activity mediated by death and reproduction events.

Immotile Active Matter: Activity from Death and Reproduction

NASA Astrophysics Data System (ADS)

Kalziqi, Arben; Yanni, David; Thomas, Jacob; Ng, Siu Lung; Vivek, Skanda; Hammer, Brian K.; Yunker, Peter J.

2018-01-01

Unlike equilibrium atomic solids, biofilms—soft solids composed of bacterial cells—do not experience significant thermal fluctuations at the constituent level. However, living cells stochastically reproduce and die, provoking a mechanical response. We investigate the mechanical consequences of cellular death and reproduction by measuring surface-height fluctuations of biofilms containing two mutually antagonistic strains of Vibrio cholerae that kill one another on contact via the type VI secretion system. While studies of active matter typically focus on activity via constituent mobility, here, activity is mediated by reproduction and death events in otherwise immobilized cells. Biofilm surface topography is measured in the nearly homeostatic limit via white light interferometry. Although biofilms are far from equilibrium systems, measured surface-height fluctuation spectra resemble the spectra of thermal permeable membranes but with an activity-mediated effective temperature, as predicted by Risler, Peilloux, and Prost [Phys. Rev. Lett. 115, 258104 (2015), 10.1103/PhysRevLett.115.258104]. By comparing the activity of killer strains of V. cholerae with that of genetically modified strains that cannot kill each other and validating with individual-based simulations, we demonstrate that extracted effective temperatures increase with the amount of death and reproduction and that death and reproduction can fluidize biofilms. Together, these observations demonstrate the unique physical consequences of activity mediated by death and reproduction events.

Multi-phase post-mortem CT-angiography: a pathologic correlation study on cardiovascular sudden death

PubMed Central

Turillazzi, Emanuela; Frati, Paola; Pascale, Natascha; Pomara, Cristoforo; Grilli, Giampaolo; Viola, Rocco Valerio; Fineschi, Vittorio

2016-01-01

Multi-phase post-mortem CT-angiography (MPMCTA) has the great potential to increase the quality of the post-mortem investigation, especially in the area of sudden death; however, its role as routine complement to the pathology toolbox is still questioned as it needs to be further standardized. The aim of this study is to investigate the contribution of MPMCTA in cases of sudden unexplained death in adults and in particular in sudden cardiovascular death. Sixty-eight sudden unexpected deaths of adults were investigated at our institution between 2012 and 2013. Ten cases underwent MPMCTA and autopsy and were included in the study. Before the angiographic step by complete filling of the vascular system, prior to any manipulation of the body, a non-contrast CT-scan was carried out. Image reconstructions were performed on a CT workstation (Vitrea) and two radiologists experienced with post mortem imaging interpreted the MPMCTA findings. In all 10 cases, we could state a good correlation between combination of post-mortem CT and MPMCTA and autopsy procedures, confirming a high diagnostic sensitivity. With this case series we want to illustrate the advantages offered by performing MPMCTA when facing a sudden death, regardless of specific suspicion for acute coronary syndrome or other vascular or ischemic disease. PMID:27928228

Non-invasive prenatal testing (NIPT): Europe's first multicenter post-market clinical follow-up study validating the quality in clinical routine.

PubMed

Flöck, Anne; Tu, Ngoc-Chi; Rüland, Anna; Holzgreve, Wolfgang; Gembruch, Ulrich; Geipel, Annegret

2017-11-01

Non-invasive prenatal tests (NIPT) for the determination of fetal aneuploidies from maternal blood are firmly established in clinical routine. For the first time, the accuracy of an NIPT for the determination of trisomies 21, 18 and 13 in singleton pregnancies was assessed by means of a prospective German-wide multicenter post-market clinical follow-up study, to reliably evaluate the quality in clinical routine. The study covered the indications for testing, the test results, the rate of invasive diagnostics and the pregnancy outcome. 2232 cases were tested for trisomy 21. Of these, 1946 cases were additionally examined for trisomy 18 and 13. Sensitivity and specificity for trisomy 21 (43/43) and for trisomy 13 (2/2) were 100%, for trisomy 18 the sensitivity was 80% (4/5) with a specificity of 99.8%. Three false-positive results for trisomy 18 were observed (FPR 0.15%). The no-call rate was 0.5%. In this subgroup, 27.3% (3/11) aneuploidies were diagnosed. The rate of invasive procedures was 2.6%. NIPT provides a very high quality for the fetal trisomies 21, 13 and 18 in clinical routine. The results support the recommendation that NIPT should be offered after genetic counseling and only in conjunction with a qualified ultrasound examination.

Lower currents: a new choice for routine testing.

PubMed

Backes, John

2007-01-01

U.S. NFPA and AAMI standards both recommend a 10A ground bond test and, as has been described above, both 25A and 200mA are also recommended internationally as valid test currents for the in-service testing and inspection of medical electrical equipment. The reality is that both high and low test currents are of value to biomedical engineers and technicians in different circumstances. For benchtop testing in a workshop environment, where required test currents can be applied safely, then it seems likely that high current testing will remain the preferred option. However, for in-service test applications, where the portability and versatility of the tester is a key requirement, modern electronic technology now means that low current testing can now be applied effectively and safely. In summary, by using a low-energy, high current pulse prior to 200 mA test current, the lower test current is preferred for routine field maintenance as this can mean: Increased safety of the operator. Reduced risk of damage to the in-service medical equipment. Smaller test instruments to include valid ground bond measurements. Battery operated test equipment. Increased flexibility of the test engineer due to lightweight test equipment. Cost reduction due to reduced down time of medical equipment. More economical availability of test equipment.

A cluster of deaths involving 5-(2-aminopropyl)indole (5-IT).

PubMed

Kronstrand, Robert; Roman, Markus; Dahlgren, Maria; Thelander, Gunilla; Wikström, Maria; Druid, Henrik

2013-10-01

During 2012, the designer drug 5-(2-aminopropyl)indole emerged in Sweden, and became available at different web sites under the name 5-IT or 5-API. This compound is an indole derivative and a positional isomer of alpha-methyltryptamine. In this paper, we report the pathology and toxicology from 15 deaths involving 5-IT. Routine postmortem toxicology was performed in femoral blood, using a targeted screening for pharmaceuticals and drugs of abuse with liquid chromatography time-of-flight technology, and positive results were quantified using chromatographic techniques. For 5-IT, a new method was developed using ultra-high-performance liquid chromatography and tandem mass spectrometry. In 11 cases, intoxication was the cause of death. Two cases were signed out as causa ignota, and they were considered to be natural deaths. All determinations of 5-IT were performed in femoral blood and the concentrations ranged from 0.7 to 18.6 µg/g. Two cases had 5-IT as the only drug identified, while the others presented with other psychotropic drugs or medications in the blood as well. Shortly after this series of deaths, 5-IT was scheduled as a hazardous substance according to the regulation Certain Goods Dangerous to Health on 18 September 2012 prohibiting the handling and selling of the drug. Since then, no positive cases have been found.

Improving care coordination using organisational routines.

PubMed

Prætorius, Thim

2016-01-01

The purpose of this paper is to systematically apply theory of organisational routines to standardised care pathways. The explanatory power of routines is used to address open questions in the care pathway literature about their coordinating and organising role, the way they change and can be replicated, the way they are influenced by the organisation and the way they influence health care professionals. Theory of routines is systematically applied to care pathways in order to develop theoretically derived propositions. Care pathways mirror routines by being recurrent, collective and embedded and specific to an organisation. In particular, care pathways resemble standard operating procedures that can give rise to recurrent collective action patterns. In all, 11 propositions related to five categories are proposed by building on these insights: care pathways and coordination, change, replication, the organisation and health care professionals. Research limitations/implications - The paper is conceptual and uses care pathways as illustrative instances of hospital routines. The propositions provide a starting point for empirical research. The analysis highlights implications that health care professionals and managers have to consider in relation to coordination, change, replication, the way the organisation influences care pathways and the way care pathways influence health care professionals. Originality/value - Theory on organisational routines offers fundamental, yet unexplored, insights into hospital processes, including in particular care coordination.

42 CFR 493.1210 - Condition: Routine chemistry.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Routine chemistry. 493.1210 Section 493....1210 Condition: Routine chemistry. If the laboratory provides services in the subspecialty of Routine chemistry, the laboratory must meet the requirements specified in §§ 493.1230 through 493.1256, § 493.1267...

42 CFR 493.1210 - Condition: Routine chemistry.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Condition: Routine chemistry. 493.1210 Section 493....1210 Condition: Routine chemistry. If the laboratory provides services in the subspecialty of Routine chemistry, the laboratory must meet the requirements specified in §§ 493.1230 through 493.1256, § 493.1267...

42 CFR 493.1210 - Condition: Routine chemistry.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Condition: Routine chemistry. 493.1210 Section 493....1210 Condition: Routine chemistry. If the laboratory provides services in the subspecialty of Routine chemistry, the laboratory must meet the requirements specified in §§ 493.1230 through 493.1256, § 493.1267...

42 CFR 493.1210 - Condition: Routine chemistry.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Condition: Routine chemistry. 493.1210 Section 493....1210 Condition: Routine chemistry. If the laboratory provides services in the subspecialty of Routine chemistry, the laboratory must meet the requirements specified in §§ 493.1230 through 493.1256, § 493.1267...

42 CFR 493.1210 - Condition: Routine chemistry.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Condition: Routine chemistry. 493.1210 Section 493....1210 Condition: Routine chemistry. If the laboratory provides services in the subspecialty of Routine chemistry, the laboratory must meet the requirements specified in §§ 493.1230 through 493.1256, § 493.1267...

Risk stratification for death and all-cause hospitalization in heart failure clinic outpatients.

PubMed

Hummel, Scott L; Ghalib, Hussam H; Ratz, David; Koelling, Todd M

2013-11-01

Most heart failure (HF) risk stratification models were developed for inpatient use, and available outpatient models use a complex set of variables. We hypothesized that routinely collected clinical data could predict the 6-month risk of death and all-cause medical hospitalization in HF clinic outpatients. Using a quality improvement database and multivariable Cox modeling, we derived the Heart Failure Patient Severity Index (HFPSI) in the University of Michigan HF clinic (UM cohort, n = 1,536; 314 reached primary outcome). We externally validated the HFPSI in the Ann Arbor Veterans' Affairs HF clinic (VA cohort, n = 445; 106 outcomes) and explored "real-time" HFPSI use (VA-RT cohort, n = 486; 141 outcomes) by tracking VA patients for 6 months from their most recently calculated HFPSI, rather than using an arbitrary start date for the cohort. The HFPSI model included blood urea nitrogen, B-type natriuretic peptide, New York Heart Association class, diabetes status, history of atrial fibrillation/flutter, and all-cause hospitalization within the prior 1 and 2 to 6 months. The concordance c statistics in the UM/VA/VA-RT cohorts were 0.71/0.68/0.74. Kaplan-Meier curves and log-rank testing demonstrated excellent risk stratification, particularly between a large, low-risk group (40% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 8%/12%/12%) and a small, high-risk group (10% of patients, 6-month event rates in the UM/VA/VA-RT cohorts 57%/58%/79%). The HFPSI uses readily available data to predict the 6-month risk of death and/or all-cause medical hospitalization in HF clinic outpatients and could potentially help allocate specialized HF resources within health systems. © 2013.

THE INCIDENCE OF SUDDEN CARDIAC DEATH IN AUSTRIA

PubMed Central

Halberg, F.; Cornélissen, G.; Schnaiter, D.; Mitsutake, G.; Otsuka, K.; Fišer, B.; Siegelová, J.; Olah, A.; Bakken, E. E.; Chibisov, S.

2008-01-01

The aim of the study was to assess the time structure (chronome) of sudden cardiac death (SCD) in Austria. The daily incidence of SCD (ICD-10 I46.1) in Austria was obtained for the 4-year span from Jan 2002 to Dec 2005. Data were available separately for men and women. This data series was analyzed by linear-nonlinear rhythmometry. The major feature is the detection of a cis-half-year that is validated nonlinearly, the estimated period of the cis-half-year is 0.408 year (95% CI: 0.389, 0.426). It is concluded that the chronobiological analysis of sudden cardiac death in Austria showed the variability of total incidence with the period of a cis-half-year. PMID:19129929

Strengthening Routine Data Systems to Track the HIV Epidemic and Guide the Response in Sub-Saharan Africa.

PubMed

Rice, Brian; Boulle, Andrew; Baral, Stefan; Egger, Matthias; Mee, Paul; Fearon, Elizabeth; Reniers, Georges; Todd, Jim; Schwarcz, Sandra; Weir, Sharon; Rutherford, George; Hargreaves, James

2018-04-03

The global HIV response has entered a new phase with the recommendation of treating all persons living with HIV with antiretroviral therapy, and with the goals of reducing new infections and AIDS-related deaths to fewer than 500,000 by 2020. This new phase has intensive data requirements that will need to utilize routine data collected through service delivery platforms to monitor progress toward these goals. With a focus on sub-Saharan African, we present the following priorities to improve the demand, supply, and use of routine HIV data: (1) strengthening patient-level HIV data systems that support continuity of clinical care and document sentinel events; (2) leveraging data from HIV testing programs; (3) using targeting data collection in communities and among clients; and (4) building capacity and promoting a culture of HIV data quality assessment and use. When fully leveraged, routine data can efficiently provide timely information at a local level to inform action, as well as provide information at scale with wide geographic coverage to strengthen estimation efforts. ©Brian Rice, Andrew Boulle, Stefan Baral, Matthias Egger, Paul Mee, Elizabeth Fearon, Georges Reniers, Jim Todd, Sandra Schwarcz, Sharon Weir, George Rutherford, James Hargreaves. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 03.04.2018.

Routines.

DTIC Science & Technology

1985-05-01

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A Thomistic defense of whole-brain death

PubMed Central

Eberl, Jason T.

2015-01-01

Michel Accad critiques the currently accepted whole-brain criterion for determining the death of a human being from a Thomistic metaphysical perspective and, in so doing, raises objections to a particular argument defending the whole-brain criterion by Patrick Lee and Germain Grisez. In this paper, I will respond to Accad's critique of the whole-brain criterion and defend its continued validity as a criterion for determining when a human being's death has occurred in accord with Thomistic metaphysical principles. I will, however, join Accad in criticizing Lee and Grisez's proposed defense of the whole-brain criterion as potentially leading to erroneous conclusions regarding the determination of human death. Lay summary: Catholic physicians and bioethicists currently debate the legally accepted clinical standard for determining when a human being has died—known as the “wholebrain criterion”—which has also been morally affirmed by the Magisterium. This paper responds to physician Michel Accad’s critique of the whole-brain criterion based upon St. Thomas Aquinas’s metaphysical account of human nature as a union of a rational soul and a material body. I defend the whole-brain criterion from the same Thomistic philosophical perspective, while agreeing with Accad’s objection to an alternative Thomistic defense of whole-brain death by philosophers Patrick Lee and Germain Grisez. PMID:26912933

Psychometric Properties of the Chinese Version of the Arabic Scale of Death Anxiety

PubMed Central

QIU, Qi; ZHANG, Shengyu; LIN, Xiang; BAN, Chunxia; YANG, Haibo; LIU, Zhengwen; WANG, Jingrong; WANG, Tao; XIAO, Shifu; ABDEL-KHALEK, Ahmed M; LI, Xia

2016-01-01

Background Death anxiety is regarded as a risk and maintaining factor of psychopathology. While the Arabic Scale of Death Anxiety (ASDA) is a brief, commonly used assessment, such a tool is lacking in Chinese clinical practice. Aim The current study was conducted to develop a Chinese version of the ASDA, i.e., the ASDA(C), using a multistage back-translation technique, and examine the psychometric properties of the scale. Methods A total of 1372 participants from hospitals and universities located in three geographic areas of China were recruited for this study. To calculate the criterion-related validity of the ASDA(C) compared to the Chinese version of the longer-form Multidimensional Orientation toward Dying and Death Inventory (MODDI-F/chin), 49 undergraduates were randomly assigned to complete both questionnaires. Of the total participants, 56 were randomly assigned to retake the ASDA(C) in order to estimate the one-week, test-retest reliability of the ASDA(C). Results The overall Cronbach’s alpha was 0.91 for the whole scale. The one-week, test-retest reliability was 0.96. Exploratory Factor Analysis (EFA) revealed three factors, “fear of dead people and tombs,” “fear of lethal disease,” and “fear of postmortem events,” accounted for 57.09% of the total variance. Factor structure for the three-factor model was sound. The correlation between the total scores on the ASDA(C) and the MODDI-F/chin was 0.54, indicating acceptable concurrent validity. Conclusions ASDA(C) has adequate psychometrics and properties that make it a reliable and valid scale to assess death anxiety in Mandarin-speaking Chinese. PMID:28638183

Trends in Alabama teen driving death and injury.

PubMed

Monroe, Kathy; Irons, Elizabeth; Crew, Marie; Norris, Jesse; Nichols, Michele; King, William D

2014-09-01

Motor vehicle crashes (MVCs) are a leading cause of morbidity and mortality in teens. Alabama has been in the Top 5 states for MVC fatality rate among teens in the United States for several years. Twelve years of teen MVC deaths and injuries were evaluated. Our hypothesis is that the teen driving motor vehicle-related deaths and injuries have decreased related to legislative and community awareness activities. A retrospective analysis of Alabama teen MVC deaths and injury for the years 2000 to 2011 was conducted. MVC data were obtained from a Fatality Analysis Reporting System data set managed by the Center for Advanced Public Safety at the University of Alabama. A Lowess regression-scattergram analysis was used to identify period specific changes in deaths and injury over time. Statistical analysis was conducted using True Epistat 5.0 software. When the Lowess regression was applied, there was an obvious change in the trend line in 2007. To test that observation, we then compared medians in the pre-2007 and post-2007 periods, which validated our observation. Moreover, it provided a near-even number of observations for comparison. The Spearman rank correlation was used to test for correlation of deaths and injury over time. The Mann-Whitney U-test was used to evaluate median differences in deaths and injury comparing pre-2007 and post-2007 data. Alabama teen MVC deaths and injury demonstrated a significant negative correlation over the 12-year period (Rs for deaths and injury, -0.87 [p < 0.001] and -0.92 [p < 0.001], respectively). Lowess regression identified a notable decline in deaths and injury after the year 2006. Median deaths and injury for the pre-2007 period were significantly higher than the post-2007 period, (U = 35.0, p = 0.003). Alabama teen driver deaths and injury have decreased during the 12-year study period, most notably after 2006. Factors that may have contributed to this trend may include stricter laws for teen drivers (enacted in 2002 and

Routine antibiotic cover for newborns intubated for aspirating meconium: is it necessary?

PubMed

Krishnan, L; Nasruddin; Prabhakar, P; Bhaskaranand, N

1995-05-01

A retrospective analysis was performed on 215 babies to evaluate the incidence of septicemia in babies intubated at birth for aspirating meconium from the trachea. Only term, appropriate for gestational age babies were included. Babies with any known perinatal risk factor for infection were excluded from the study and none of the babies had been put on "prophylactic antibiotics." There were 88 babies in the intubated group in a one year period from January 1991 to December 1991. One hundred and twenty seven babies were taken as controls. There was no significant difference in the incidence of early septicemia in the two groups. There were no deaths in either group. It is concluded that well term babies who are intubated for aspirating meconium need not be put on routine antibiotic cover.

Routines Are the Foundation of Classroom Management

ERIC Educational Resources Information Center

Lester, Robin Rawlings; Allanson, Patricia Bolton; Notar, Charles E.

2017-01-01

Classroom management is the key to learning. Routines are the foundation of classroom management. Students require structure in their lives. Routines provide that in all of their life from the time they awake until the time they go to bed. Routines in a school and in the classroom provide the environment for learning to take place. The paper is…

The death spiral: predicting death in Drosophila cohorts.

PubMed

Mueller, Laurence D; Shahrestani, Parvin; Rauser, Casandra L; Rose, Michael R

2016-11-01

Drosophila research has identified a new feature of aging that has been called the death spiral. The death spiral is a period prior to death during which there is a decline in life-history characters, such as fecundity, as well as physiological characters. First, we review the data from the Drosophila and medfly literature that suggest the existence of death spirals. Second, we re-analyze five cases with such data from four laboratories using a generalized statistical framework, a re-analysis that strengthens the case for the salience of the death spiral phenomenon. Third, we raise the issue whether death spirals need to be taken into account in the analysis of functional characters over age, in aging research with model species as well as human data.

Deliberating death.

PubMed

Landes, Scott D

2010-01-01

Utilizing a particular case study of a woman attempting to come to terms with her death, this article explores the difficult metaphors of death present within the Christian tradition. Tracing a Christian understanding of death back to the work of Augustine, the case study is utilized to highlight the difficulties presented by past and present theology embracing ideas of punishment within death. Following the trajectory of the case study, alternative understandings of death present in recent Christian theology and within Native American spirituality are presented in an attempt to find room for a fuller meaning of death post-reconciliation, but premortem.

Validation of the absolute renal risk of dialysis/death in adults with IgA nephropathy secondary to Henoch-Schönlein purpura: a monocentric cohort study.

PubMed

Mohey, Hesham; Laurent, Blandine; Mariat, Christophe; Berthoux, Francois

2013-08-01

We established earlier the absolute renal risk (ARR) of dialysis/death (D/D) in primary IgA nephropathy (IgAN) which permitted accurate prospective prediction of final prognosis. This ARR was based on the potential presence at initial diagnosis of three major, independent, and equipotent risk factors such as hypertension, quantitative proteinuria≥1 g per day, and severe pathological lesions appreciated by our local classification scoring≥8 (range 0-20). We studied the validity of this ARR concept in secondary IgAN to predict future outcome and focused on Henoch-Schönlein purpura (HSP) nephritis. Our cohort of adults IgAN concerned 1064 patients with 101 secondary IgAN and was focused on 74 HSP (59 men) with a mean age of 38.6 at initial diagnosis and a mean follow-up of 11.8 years. Three major risk factors: hypertension, proteinuria≥1 g/d, and severe pathological lesions appreciated by our global optical score≥8 (GOS integrated all elementary histological lesions), were studied at biopsy-proven diagnosis and their presence defined the ARR scoring: 0 for none present, 3 for all present, 1 or 2 for the presence of any 1 or 2 risk factors. The primary end-point was composite with occurrence of dialysis or death before (D/D). We used classical statistics and both time-dependent Cox regression and Kaplan-Meier survival curve methods. The cumulative rate of D/D at 10 and 20 years post-onset was respectively 0 and 14% for ARR=0 (23 patients); 10 and 23% for ARR=1 (N=19); 27 and 33% for ARR=2 (N=24); and 81 and 100% (before 20 y) in the 8 patients with ARR=3 (P=0.0007). Prediction at time of diagnosis (time zero) of 10y cumulative rate of D/D event was 0% for ARR=0, 10% for ARR=1, 33% for ARR=2, and 100% by 8.5y for ARR=3 (P=0.0003) in this adequately treated cohort. This study clearly validates the Absolute Renal Risk of Dialysis/Death concept in a new cohort of HSP-IgAN with utility to individual management and in future clinical trials.

Routine sputum culture

MedlinePlus

Sputum culture ... There, it is placed in a special dish (culture). It is then watched to see if bacteria ... Elsevier; 2018:chap 36. Chernecky CC, Berger BJ. Culture, routine. In: Chernecky CC, Berger BJ, eds. Laboratory ...

SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment.

PubMed

Moon, Rachel Y

2011-11-01

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death occurring during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from being only SIDS-focused to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths including SIDS. The recommendations described in this report include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunization, consideration of a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in this technical report. The recommendations are published in the accompanying "Policy Statement--Sudden Infant Death Syndrome and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue (www.pediatrics.org/cgi/doi/10.1542/peds.2011-2220).

Evaluation of the Performance of Routine Information System Management (PRISM) framework: evidence from Uganda.

PubMed

Hotchkiss, David R; Aqil, Anwer; Lippeveld, Theo; Mukooyo, Edward

2010-07-03

Sound policy, resource allocation and day-to-day management decisions in the health sector require timely information from routine health information systems (RHIS). In most low- and middle-income countries, the RHIS is viewed as being inadequate in providing quality data and continuous information that can be used to help improve health system performance. In addition, there is limited evidence on the effectiveness of RHIS strengthening interventions in improving data quality and use. The purpose of this study is to evaluate the usefulness of the newly developed Performance of Routine Information System Management (PRISM) framework, which consists of a conceptual framework and associated data collection and analysis tools to assess, design, strengthen and evaluate RHIS. The specific objectives of the study are: a) to assess the reliability and validity of the PRISM instruments and b) to assess the validity of the PRISM conceptual framework. Facility- and worker-level data were collected from 110 health care facilities in twelve districts in Uganda in 2004 and 2007 using records reviews, structured interviews and self-administered questionnaires. The analysis procedures include Cronbach's alpha to assess internal consistency of selected instruments, test-retest analysis to assess the reliability and sensitivity of the instruments, and bivariate and multivariate statistical techniques to assess validity of the PRISM instruments and conceptual framework. Cronbach's alpha analysis suggests high reliability (0.7 or greater) for the indices measuring a promotion of a culture of information, RHIS tasks self-efficacy and motivation. The study results also suggest that a promotion of a culture of information influences RHIS tasks self-efficacy, RHIS tasks competence and motivation, and that self-efficacy and the presence of RHIS staff have a direct influence on the use of RHIS information, a key aspect of RHIS performance. The study results provide some empirical support

Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700 - 10 States, July-December 2016.

PubMed

O'Donnell, Julie K; Halpin, John; Mattson, Christine L; Goldberger, Bruce A; Gladden, R Matthew

2017-11-03

Preliminary estimates of U.S. drug overdose deaths exceeded 60,000 in 2016 and were partially driven by a fivefold increase in overdose deaths involving synthetic opioids (excluding methadone), from 3,105 in 2013 to approximately 20,000 in 2016 (1,2). Illicitly manufactured fentanyl, a synthetic opioid 50-100 times more potent than morphine, is primarily responsible for this rapid increase (3,4). In addition, fentanyl analogs such as acetylfentanyl, furanylfentanyl, and carfentanil are being detected increasingly in overdose deaths (5,6) and the illicit opioid drug supply (7). Carfentanil is estimated to be 10,000 times more potent than morphine (8). Estimates of the potency of acetylfentanyl and furanylfentanyl vary but suggest that they are less potent than fentanyl (9). Estimates of relative potency have some uncertainty because illicit fentanyl analog potency has not been evaluated in humans. This report describes opioid overdose deaths during July-December 2016 that tested positive for fentanyl, fentanyl analogs, or U-47700, an illicit synthetic opioid, in 10 states participating in CDC's Enhanced State Opioid Overdose Surveillance (ESOOS) program.* Fentanyl analogs are similar in chemical structure to fentanyl but not routinely detected because specialized toxicology testing is required. Fentanyl was detected in at least half of opioid overdose deaths in seven of 10 states, and 57% of fentanyl-involved deaths also tested positive for other illicit drugs, such as heroin. Fentanyl analogs were present in >10% of opioid overdose deaths in four states, with carfentanil, furanylfentanyl, and acetylfentanyl identified most frequently. Expanded surveillance for opioid overdoses, including testing for fentanyl and fentanyl analogs, assists in tracking the rapidly changing illicit opioid market and informing innovative interventions designed to reduce opioid overdose deaths.

Revenue, relationships and routines: the social organization of acute myocardial infarction patient transfers in the United States.

PubMed

Veinot, Tiffany C; Bosk, Emily A; Unnikrishnan, K P; Iwashyna, Theodore J

2012-11-01

Heart attack, or acute myocardial infarction (AMI), is a leading cause of death in the United States (U.S.). The most effective therapy for AMI is rapid revascularization: the mechanical opening of the clogged artery in the heart. Forty-four percent of patients with AMI who are admitted to a non-revascularization hospital in the U.S. are transferred to a hospital with that capacity. Yet, we know little about the process by which community hospitals complete these transfers, and why publicly available hospital quality data plays a small role in community hospitals' choice of transfer destinations. Therefore, we investigated how community hospital staff implement patient transfers and select destinations. We conducted a mixed methods study involving: interviews with staff at three community hospitals (n = 25) in a Midwestern state and analysis of U.S. national Medicare records for 1996-2006. Community hospitals in the U.S., including our field sites, typically had longstanding relationships with one key receiving hospital. Community hospitals addressed the need for rapid AMI patient transfers by routinizing the collective, interhospital work process. Routinization reduced staff uncertainty, coordinated their efforts and conserved their cognitive resources for patient care. While destination selection was nominally a physician role, the decision was routinized, such that staff immediately contacted a "usual" transfer destination upon AMI diagnosis. Transfer destination selection was primarily driven at an institutional level by organizational concerns and bed supply, rather than physician choice or patient preference. Transfer routinization emerged as a form of social order that invoked tradeoffs between process speed and efficiency and patient-centered, quality-driven decision making. We consider the implications of routinization and institutional imperatives for health policy, quality improvement and health informatics interventions. Copyright © 2012 Elsevier Ltd

Revival of oscillations from deaths in diffusively coupled nonlinear systems: Theory and experiment

NASA Astrophysics Data System (ADS)

Zou, Wei; Sebek, Michael; Kiss, István Z.; Kurths, Jürgen

2017-06-01

Amplitude death (AD) and oscillation death (OD) are two structurally different oscillation quenching phenomena in coupled nonlinear systems. As a reverse issue of AD and OD, revival of oscillations from deaths attracts an increasing attention recently. In this paper, we clearly disclose that a time delay in the self-feedback component of the coupling destabilizes not only AD but also OD, and even the AD to OD transition in paradigmatic models of coupled Stuart-Landau oscillators under diverse death configurations. Using a rigorous analysis, the effectiveness of this self-feedback delay in revoking AD is theoretically proved to be valid in an arbitrary network of coupled Stuart-Landau oscillators with generally distributed propagation delays. Moreover, the role of self-feedback delay in reviving oscillations from AD is experimentally verified in two delay-coupled electrochemical reactions.

Revival of oscillations from deaths in diffusively coupled nonlinear systems: Theory and experiment.

PubMed

Zou, Wei; Sebek, Michael; Kiss, István Z; Kurths, Jürgen

2017-06-01

Amplitude death (AD) and oscillation death (OD) are two structurally different oscillation quenching phenomena in coupled nonlinear systems. As a reverse issue of AD and OD, revival of oscillations from deaths attracts an increasing attention recently. In this paper, we clearly disclose that a time delay in the self-feedback component of the coupling destabilizes not only AD but also OD, and even the AD to OD transition in paradigmatic models of coupled Stuart-Landau oscillators under diverse death configurations. Using a rigorous analysis, the effectiveness of this self-feedback delay in revoking AD is theoretically proved to be valid in an arbitrary network of coupled Stuart-Landau oscillators with generally distributed propagation delays. Moreover, the role of self-feedback delay in reviving oscillations from AD is experimentally verified in two delay-coupled electrochemical reactions.

COLORECTAL CANCER PREVENTION BY AN OPTIMIZED COLONOSCOPY PROTOCOL IN ROUTINE PRACTICE

PubMed Central

Xirasagar, Sudha; Li, Yi-Jhen; Hurley, Thomas G.; Tsai, Meng Han; Hardin, James W.; Hurley, Deborah M.; Hebert, James R.; de Groen, Piet C.

2014-01-01

We conducted a retrospective cohort study to investigate the colorectal cancer (CRC) incidence and mortality prevention achievable in clinical practice with an optimized colonoscopy protocol targeting near-complete polyp clearance. The protocol consisted of: a) telephonic reinforcement of bowel preparation instructions; b) active inspection for polyps throughout insertion and circumferential withdrawal; and, c) timely updating of the protocol and documentation to incorporate the latest guidelines. Of 17,312 patients provided screening colonoscopies by 59 endoscopists in South Carolina, USA from 09/2001 through 12/2008, 997 were excluded using accepted exclusion criteria. Data on 16,315 patients were merged with the South Carolina Central Cancer Registry and Vital Records Registry data from 01/1996 – 12/2009 to identify incident CRC cases and deaths, incident lung cancers and brain cancer deaths (comparison control cancers). The standardized incidence ratios (SIR) and standardized mortality ratios (SMR) relative to South Carolina and US SEER-18 population rates were calculated. Over 78,375 person-years of observation, 18 patients developed CRC vs. 104.11 expected for an SIR of 0.17, or 83% CRC protection, the rates being 68% and 91%, respectively among the adenoma- and adenoma-free subgroups (all p<0.001). Restricting the cohort to ensure minimum 5-year follow-up (mean follow-up 6.58 years) did not change the results. The CRC mortality reduction was 89% (p<0.001; 4 CRC deaths vs. 35.95 expected). The lung cancer SIR was 0.96 (p=0.67), and brain cancer SMR was 0.92 (p=0.35). Over 80% reduction in CRC incidence and mortality is achievable in routine practice by implementing key colonoscopy principles targeting near-complete polyp clearance. PMID:25242510

Using the brain criterion in organ donation after the circulatory determination of death.

PubMed

Dalle Ave, Anne L; Bernat, James L

2016-06-01

The UK, France, and Switzerland determine death using the brain criterion even in organ donation after the circulatory determination of death (DCDD), in which the United States and Canada use the circulatory-respiratory criterion. In our analysis of the scientific validity of the brain criterion in DCDD, we concluded that although it may be attractive in theory because it conceptualizes death as a unitary phenomenon, its use in practice is invalid. The preconditions (ie, the absence of reversible causes, such as toxic or metabolic disorders) for determining brain death cannot be met in DCDD. Thus, although brain death tests prove the cessation of tested brain functions, they do not prove that their cessation is irreversible. A stand-off period of 5 to 10 minutes is insufficient to achieve the irreversibility requirement of brain death. Because circulatory cessation inevitably leads to cessation of brain functions, first permanently and then irreversibly, the use of brain criterion is unnecessary to determine death in DCDD. Expanding brain death to permit it to be satisfied by permanent cessation of brain functions is controversial but has been considered as a possible means to declare death in uncontrolled DCDD. Copyright © 2016 Elsevier Inc. All rights reserved.

Death certificate completion skills of hospital physicians in a developing country.

PubMed

Haque, Ahmed Suleman; Shamim, Kanza; Siddiqui, Najm Hasan; Irfan, Muhammad; Khan, Javaid Ahmed

2013-06-06

Death certificates (DC) can provide valuable health status data regarding disease incidence, prevalence and mortality in a community. It can guide local health policy and help in setting priorities. Incomplete and inaccurate DC data, on the other hand, can significantly impair the precision of a national health information database. In this study we evaluated the accuracy of death certificates at a tertiary care teaching hospital in a Karachi, Pakistan. A retrospective study conducted at Aga Khan University Hospital, Karachi, Pakistan for a period of six months. Medical records and death certificates of all patients who died under adult medical service were studied. The demographic characteristics, administrative details, co-morbidities and cause of death from death certificates were collected using an approved standardized form. Accuracy of this information was validated using their medical records. Errors in the death certificates were classified into six categories, from 0 to 5 according to increasing severity; a grade 0 was assigned if no errors were identified, and 5, if an incorrect cause of death was attributed or placed in an improper sequence. 223 deaths occurred during the study period. 9 certificates were not accessible and 12 patients had incomplete medical records. 202 certificates were finally analyzed. Most frequent errors pertaining to patients' demographics (92%) and cause/s of death (87%) were identified. 156 (77%) certificates had 3 or more errors and 124 (62%) certificates had a combination of errors that significantly changed the death certificate interpretation. Only 1% certificates were error free. A very high rate of errors was identified in death certificates completed at our academic institution. There is a pressing need for appropriate intervention/s to resolve this important issue.

Evaluation of reporting quality for observational studies using routinely collected health data in pharmacovigilance.

PubMed

Nie, Xiaolu; Zhang, Ying; Wu, Zehao; Jia, Lulu; Wang, Xiaoling; Langan, Sinéad M; Benchimol, Eric I; Peng, Xiaoxia

2018-06-01

To appraise the reporting quality of studies which concerned linezolid related thrombocytopenia referring to REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statement. Medline, Embase, Cochrane library and clinicaltrial.gov were searched for observational studies concerning linezolid related thrombocytopenia using routinely collected health data from 2000 to 2017. Two reviewers screened potential eligible articles and extracted data independently. Finally, reporting quality assessment was performed by two senior researchers using RECORD statement. Of 25 included studies, 11 (44.0%) mentioned the type of data in the title and/or abstract. In 38 items derived from RECORD statement, the median number of items reported in the included studies was 22 (interquartile range (IQR) 18 to 27). Inadequate reporting issues were discovered in the following aspects: validation studies of the codes or algorithms, study size estimation, quantitative variables, subgroup statistical methods, missing data, follow-up/matching or sampling strategy, sensitivity analysis and cleaning methods, funding and role of funders and accessibility of protocol, raw data. This study provides the evidence that the reporting quality of post-marketing safety evaluation studies conducted using routinely collected health data was often insufficient. Future stakeholders are encouraged to endorse the RECORD guidelines in pharmacovigilance.

The PEARL score predicts 90-day readmission or death after hospitalisation for acute exacerbation of COPD

PubMed Central

Echevarria, C; Steer, J; Heslop-Marshall, K; Stenton, S C; Hughes, R; Wijesinghe, M; Harrison, R N; Steen, N; Simpson, A J; Gibson, G J; Bourke, S C

2017-01-01

Background One in three patients hospitalised due to acute exacerbation of COPD (AECOPD) is readmitted within 90 days. No tool has been developed specifically in this population to predict readmission or death. Clinicians are unable to identify patients at particular risk, yet resources to prevent readmission are allocated based on clinical judgement. Methods In participating hospitals, consecutive admissions of patients with AECOPD were identified by screening wards and reviewing coding records. A tool to predict 90-day readmission or death without readmission was developed in two hospitals (the derivation cohort) and validated in: (a) the same hospitals at a later timeframe (internal validation cohort) and (b) four further UK hospitals (external validation cohort). Performance was compared with ADO, BODEX, CODEX, DOSE and LACE scores. Results Of 2417 patients, 936 were readmitted or died within 90 days of discharge. The five independent variables in the final model were: Previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure (PEARL). The PEARL score was consistently discriminative and accurate with a c-statistic of 0.73, 0.68 and 0.70 in the derivation, internal validation and external validation cohorts. Higher PEARL scores were associated with a shorter time to readmission. Conclusions The PEARL score is a simple tool that can effectively stratify patients' risk of 90-day readmission or death, which could help guide readmission avoidance strategies within the clinical and research setting. It is superior to other scores that have been used in this population. Trial registration number UKCRN ID 14214. PMID:28235886

Routine intraoperative leak testing for sleeve gastrectomy: is the leak test full of hot air?

PubMed

Bingham, Jason; Lallemand, Michael; Barron, Morgan; Kuckelman, John; Carter, Preston; Blair, Kelly; Martin, Matthew

2016-05-01

Staple line leak after sleeve gastrectomy (SG) is a rare but dreaded complication with a reported incidence of 0% to 8%. Many surgeons routinely test the staple line with an intraoperative leak test (IOLT), but there is little evidence to validate this practice. In fact, there is a theoretical concern that the leak test may weaken the staple line and increase the risk of a postop leak. Retrospective review of all SGs performed over a 7-year period was conducted. Cases were grouped by whether an IOLT was performed, and compared for the incidence of postop staple line leaks. The ability of the IOLT for identifying a staple line defect and for predicting a postoperative leak was analyzed. Five hundred forty-two SGs were performed between 2007 and 2014. Thirteen patients (2.4%) developed a postop staple line leak. The majority of patients (n = 494, 91%) received an IOLT, including all 13 patients (100%) who developed a subsequent clinical leak. There were no (0%) positive IOLTs and no additional interventions were performed based on the IOLT. The IOLT sensitivity and positive predictive value were both 0%. There was a trend, although not significant, to increase leak rates when a routine IOLT was performed vs no routine IOLT (2.6% vs 0%, P = .6). The performance of routine IOLT after SG provided no actionable information, and was negative in all patients who developed a postoperative leak. The routine use of an IOLT did not reduce the incidence of postop leak, and in fact was associated with a higher leak rate after SG. Published by Elsevier Inc.

Potential use of routine databases in health technology assessment.

PubMed

Raftery, J; Roderick, P; Stevens, A

2005-05-01

To develop criteria for classifying databases in relation to their potential use in health technology (HT) assessment and to apply them to a list of databases of relevance in the UK. To explore the extent to which prioritized databases could pick up those HTs being assessed by the National Coordinating Centre for Health Technology Assessment (NCCHTA) and the extent to which these databases have been used in HT assessment. To explore the validation of the databases and their cost. Electronic databases. Key literature sources. Experienced users of routine databases. A 'first principles' examination of the data necessary for each type of HT assessment was carried out, supplemented by literature searches and a historical review. The principal investigators applied the criteria to the databases. Comments of the 'keepers' of the prioritized databases were incorporated. Details of 161 topics funded by the NHS R&D Health Technology Assessment (HTA) programme were reviewed iteratively by the principal investigators. Uses of databases in HTAs were identified by literature searches, which included the title of each prioritized database as a keyword. Annual reports of databases were examined and 'keepers' queried. The validity of each database was assessed using criteria based on a literature search and involvement by the authors in a national academic network. The costs of databases were established from annual reports, enquiries to 'keepers' of databases and 'guesstimates' based on cost per record. For assessing effectiveness, equity and diffusion, routine databases were classified into three broad groups: (1) group I databases, identifying both HTs and health states, (2) group II databases, identifying the HTs, but not a health state, and (3) group III databases, identifying health states, but not an HT. Group I datasets were disaggregated into clinical registries, clinical administrative databases and population-oriented databases. Group III were disaggregated into adverse

The existential function of close relationships: introducing death into the science of love.

PubMed

Mikulincer, Mario; Florian, Victor; Hirschberger, Gilad

2003-01-01

Originally, terror management theory proposed two psychological mechanisms in dealing with the terror of death awareness-cultural worldview validation and self-esteem enhancement. In this article, we would like to promote the idea of close relationships as an additional death-anxiety buffering mechanism and review a growing body of empirical data that support this contention. Based on a comprehensive analysis of the sociocultural and personal functions of close relationships, we formulate two basic hypotheses that have received empirical support in a series of experimental studies. First, death reminders heighten the motivation to form and maintain close relationships. Second, the maintenance of close relationships provides a symbolic shield against the terror of death, whereas the breaking of close relationships results in an upsurge of death awareness. In addition, we present empirical evidence supporting the possibility that close relationships function as a related yet separate mechanism from the self-esteem and cultural worldview defenses.

The cultural environment behind successful maternal death and morbidity reviews.

PubMed

Lewis, G

2014-09-01

This paper discusses some of the background principles which, through wide experience of instituting reviews of maternal deaths or near-misses around the world, appear common to their successful introduction. A supportive culture at personal, institutional and national level underpinned by the fostering of professionalism and the development of an ethos of safety against a wider supportive environment is needed. Reviews undertaken at a local level are as beneficial as those at a regional or population level and should be encouraged as a routine part of the quality improvement agenda for each and every healthcare facility. © 2014 The Authors BJOG An International Journal of Obsetrics and Gynaecology © 2014 RCOG.

Destined to die in hospital? Systematic review and meta-analysis of place of death in haematological malignancy

PubMed Central

2010-01-01

Background Haematological malignancies are a common, heterogeneous and complex group of diseases that are often associated with poor outcomes despite intensive treatment. Research surrounding end-of-life issues, and particularly place of death, is therefore of paramount importance, yet place of death has not been formally reviewed in these patients. Methods A systematic literature review and meta-analysis was undertaken using PubMed to identify all studies published between 1966 and 2010. Studies examining place of death in adult haematology patients, using routinely compiled morbidity and mortality data and providing results specific to this disease were included. 21 studies were identified with descriptive and/or risk-estimate data; 17 were included in a meta-analysis. Results Compared to other cancer deaths, haematology patients were more than twice as likely to die in hospital (Odds Ratio 2.25 [95% Confidence Intervals, 2.07-2.44]). Conclusion Home is generally considered the preferred place of death but haematology patients usually die in hospital. This has implications for patients who may not be dying where they wish, and also health commissioners who may be funding costly end-of-life care in inappropriate acute hospital settings. More research is needed about preferred place of care for haematology patients, reasons for hospital deaths, and how these can be avoided if home death is preferred. PMID:20515452

[How to Interpret and Use Routine Laboratory Data--Our Methods to Interpret Routine Laboratory Data--Chairmen's Introductory Remarks].

PubMed

Honda, Takayuki; Tozuka, Minoru

2015-09-01

In the reversed clinicopathological conference (R-CPC), three specialists in laboratory medicine interpreted routine laboratory data independently in order to understand the detailed state of a patient. R-CPC is an educational method to use laboratory data appropriately, and it is also important to select differential diagnoses in a process of clinical reasoning in addition to the present illness and physical examination. Routine laboratory tests can be performed repeatedly at a relatively low cost, and their time-series analysis can be performed. Interpretation of routine laboratory data is almost the same as taking physical findings. General findings are initially checked and then the state of each organ is examined. Although routine laboratory tests cost little, we can gain much more information from them about the patient than physical examinations.

Factors affecting access to information on routine immunization among mothers of under 5 children in Kaduna State Nigeria, 2015

PubMed Central

Taiwo, Lydia; Idris, Suleiman; Abubakar, Aisha; Nguku, Patrick; Nsubuga, Peter; Gidado, Saheed; Okeke, Lilian; Emiasegen, Samuel; Waziri, Endie

2017-01-01

Introduction Immunization is one of the most effective interventions to prevent disease and early child death. A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. Knowledge and perception of mothers/caregivers regarding VPDs influence demand and utilization of immunization services. We examined the associations between knowledge, perception and information on routine immunization received by mothers/caregivers in Kaduna State. Methods We enrolled 379 eligible caregivers in a community-based cross-sectional study. We sampled respondents using multistage sampling technique. We collected data on socio-demographic characteristics; knowledge and perception on routine immunization using semi-structured interviewer-administered questionnaire. We conducted bivariate analysis and logistic regression using Epi-InfoTM version 7 at 5% level of significance. Results Mean age of respondents was 28.6 years (standard deviation=±6.6 years), 34% completed secondary school, 65% were unemployed, 49% lived in rural settlements. Among respondents' children 53.3% were females and 62.8% fell within 2nd-5th birth order. Only 15.6% of these children were fully immunized. Seventy-five percent of respondent did not obtain information on routine immunization within 12 months prior to the study. About 64% had unsatisfactory knowledge while 55.4% exhibited poor perceptions regarding routine immunization. Commonest source of information was radio (61.61%). On logistic regression educated participants (Adjusted odds ratio (AOR)=1.9, 95% CI: 1.1-3.3), mothers' perception (AOR=2.6, 95% CI: 1.5-4.5) and monogamous family setting (AOR=2.4, 95% CI: 0.2-0.6) were likely to have obtained information on routine immunization. Conclusion There is low access to information, poor maternal knowledge on routine immunization with low vaccination coverage in this community

Factors affecting access to information on routine immunization among mothers of under 5 children in Kaduna State Nigeria, 2015.

PubMed

Taiwo, Lydia; Idris, Suleiman; Abubakar, Aisha; Nguku, Patrick; Nsubuga, Peter; Gidado, Saheed; Okeke, Lilian; Emiasegen, Samuel; Waziri, Endie

2017-01-01

Immunization is one of the most effective interventions to prevent disease and early child death. A substantial number of children worldwide do not complete immunization schedules because neither health services nor conventional communication mechanisms regularly reach their communities. Knowledge and perception of mothers/caregivers regarding VPDs influence demand and utilization of immunization services. We examined the associations between knowledge, perception and information on routine immunization received by mothers/caregivers in Kaduna State. We enrolled 379 eligible caregivers in a community-based cross-sectional study. We sampled respondents using multistage sampling technique. We collected data on socio-demographic characteristics; knowledge and perception on routine immunization using semi-structured interviewer-administered questionnaire. We conducted bivariate analysis and logistic regression using Epi-InfoTM version 7 at 5% level of significance. Mean age of respondents was 28.6 years (standard deviation=±6.6 years), 34% completed secondary school, 65% were unemployed, 49% lived in rural settlements. Among respondents' children 53.3% were females and 62.8% fell within 2 nd -5 th birth order. Only 15.6% of these children were fully immunized. Seventy-five percent of respondent did not obtain information on routine immunization within 12 months prior to the study. About 64% had unsatisfactory knowledge while 55.4% exhibited poor perceptions regarding routine immunization. Commonest source of information was radio (61.61%). On logistic regression educated participants (Adjusted odds ratio (AOR)=1.9, 95% CI: 1.1-3.3), mothers' perception (AOR=2.6, 95% CI: 1.5-4.5) and monogamous family setting (AOR=2.4, 95% CI: 0.2-0.6) were likely to have obtained information on routine immunization. There is low access to information, poor maternal knowledge on routine immunization with low vaccination coverage in this community. Efforts should be made by the

Life Experience with Death: Relation to Death Attitudes and to the Use of Death-Related Memories

ERIC Educational Resources Information Center

Bluck, Susan; Dirk, Judith; Mackay, Michael M.; Hux, Ashley

2008-01-01

The study examines the relation of death experience to death attitudes and to autobiographical memory use. Participants (N = 52) completed standard death attitude measures and wrote narratives about a death-related autobiographical memory and (for comparison) a memory of a low point. Self-ratings of the memory narratives were used to assess their…

You don't have to believe everything you read: background knowledge permits fast and efficient validation of information.

PubMed

Richter, Tobias; Schroeder, Sascha; Wöhrmann, Britta

2009-03-01

In social cognition, knowledge-based validation of information is usually regarded as relying on strategic and resource-demanding processes. Research on language comprehension, in contrast, suggests that validation processes are involved in the construction of a referential representation of the communicated information. This view implies that individuals can use their knowledge to validate incoming information in a routine and efficient manner. Consistent with this idea, Experiments 1 and 2 demonstrated that individuals are able to reject false assertions efficiently when they have validity-relevant beliefs. Validation processes were carried out routinely even when individuals were put under additional cognitive load during comprehension. Experiment 3 demonstrated that the rejection of false information occurs automatically and interferes with affirmative responses in a nonsemantic task (epistemic Stroop effect). Experiment 4 also revealed complementary interference effects of true information with negative responses in a nonsemantic task. These results suggest the existence of fast and efficient validation processes that protect mental representations from being contaminated by false and inaccurate information.

FBEYE: Analyzing Kepler light curves and validating flares

NASA Astrophysics Data System (ADS)

Johnson, Emily; Davenport, James R. A.; Hawley, Suzanne L.

2017-12-01

FBEYE, the "Flares By-Eye" detection suite, is written in IDL and analyzes Kepler light curves and validates flares. It works on any 3-column light curve that contains time, flux, and error. The success of flare identification is highly dependent on the smoothing routine, which may not be suitable for all sources.

Airflow accelerates bovine and human articular cartilage drying and chondrocyte death.

PubMed

Paterson, S I; Amin, A K; Hall, A C

2015-02-01

Exposure of articular cartilage to static air results in changes to the extracellular matrix (ECM) and stimulates chondrocyte death, which may cause joint degeneration. However during open orthopaedic surgery, cartilage is often exposed to laminar airflow, which may exacerbate these damaging effects. We compared drying in static and moving air in terms of cartilage appearance, hydration and chondrocyte viability, and tested the ability of saline-saturated gauze to limit the detrimental effects of air exposure. Articular cartilage from bovine metatarsophalangeal joints (N = 50) and human femoral heads (N = 6) was exposed for 90 min to (1) static air (2) airflow (up to 0.34 m/s), or (3) airflow (0.18 m/s), covered with gauze. Following air exposure, cartilage was also rehydrated (0.9% saline; 120 min) to determine the reversibility of drying effects. The influence of airflow was assessed by studying macroscopic appearance, and quantifying superficial zone (SZ) chondrocyte viability and cartilage hydration. Airflow caused advanced changes to cartilage appearance, accelerated chondrocyte death, and increased dehydration compared to static air. These effects were prevented if cartilage was covered by saline-saturated gauze. Cartilage rehydration reversed macroscopic changes associated with drying but the chondrocyte death was not altered. Chondrocytes at the cut edge of cartilage were more sensitive to drying compared to cells distant from the edge. Airflow significantly increased articular cartilage dehydration and chondrocyte death compared to static air. As laminar airflow is routinely utilised in operating theatres, it is essential that articular cartilage is kept wet via irrigation or by covering with saline-saturated gauze to prevent chondrocyte death. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The relationship between consanguineous marriage and death in fetus and infants.

PubMed

Mohammadi, Majid Mehr; Hooman, Heidar Ali; Afrooz, Gholam Ali; Daramadi, Parviz Sharifi

2012-05-01

Given the high prevalence of consanguineous marriages in rural and urban areas of Iran, the aim of this study was to identify its role in increasing fetal and infant deaths. This was a cross-sectional study in which 494 mothers with more than one exceptional child (mentally retarded and physically-dynamically disabled) or with normal children were selected based on multi-stage random sampling method. Data was gathered using the features of parents with more than one exceptional child questionnaire. The validity and reliability of this questionnaire was acceptable. Hierarchical log-linear method was used for statistical analysis. Consanguineous marriage significantly increased the number of births of exceptional children. Moreover, there was a significant relation between the history of fetal/infant death and belonging to the group. There was a significant relation between consanguineous marriage and the history of fetal/infant death which means consanguineous marriage increased the prevalence of fetal/infant death in parents with exceptional children rather than in parents with normal children. The rate of fetal/infant death in exceptional births of consanguineous marriages was higher than that of non-consanguineous marriages.

The relationship between consanguineous marriage and death in fetus and infants

PubMed Central

Mohammadi, Majid Mehr; Hooman, Heidar Ali; Afrooz, Gholam Ali; Daramadi, Parviz Sharifi

2012-01-01

Background: Given the high prevalence of consanguineous marriages in rural and urban areas of Iran, the aim of this study was to identify its role in increasing fetal and infant deaths. Materials ans Methods: This was a cross-sectional study in which 494 mothers with more than one exceptional child (mentally retarded and physically-dynamically disabled) or with normal children were selected based on multi-stage random sampling method. Data was gathered using the features of parents with more than one exceptional child questionnaire. The validity and reliability of this questionnaire was acceptable. Hierarchical log-linear method was used for statistical analysis. Results: Consanguineous marriage significantly increased the number of births of exceptional children. Moreover, there was a significant relation between the history of fetal/infant death and belonging to the group. There was a significant relation between consanguineous marriage and the history of fetal/infant death which means consanguineous marriage increased the prevalence of fetal/infant death in parents with exceptional children rather than in parents with normal children. Conclusions: The rate of fetal/infant death in exceptional births of consanguineous marriages was higher than that of non-consanguineous marriages. PMID:23626609

Risk of Death in Infants Who Have Experienced a Brief Resolved Unexplained Event: A Meta-Analysis.

PubMed

Brand, Donald A; Fazzari, Melissa J

2018-06-01

To estimate an upper bound on the risk of death after a brief resolved unexplained event (BRUE), a sudden alteration in an infant's breathing, color, tone, or responsiveness, previously labeled "apparent life-threatening event" (ALTE). The meta-analysis incorporated observational studies of patients with ALTE that included data on in-hospital and post-discharge deaths with at least 1 week of follow-up after hospital discharge. Pertinent studies were identified from a published review of the literature from 1970 through 2014 and a supplementary PubMed query through February 2017. The 12 included studies (n = 3005) reported 12 deaths, of which 8 occurred within 4 months of the event. Applying a Poisson-normal random effects model to the 8 proximate deaths using a 4-month time horizon yielded a post-ALTE mortality rate of about 1 in 800, which constitutes an upper bound on the risk of death after a BRUE. This risk is about the same as the baseline risk of death during the first year of life. The meta-analysis therefore supports the return-home approach advocated in a recently published clinical practice guideline-not routine hospitalization-for BRUE patients who have been evaluated in the emergency department and determined to be at lower risk. Copyright © 2017 Elsevier Inc. All rights reserved.

Did death certificates and a death review process agree on lung cancer cause of death in the National Lung Screening Trial?

PubMed

Marcus, Pamela M; Doria-Rose, Vincent Paul; Gareen, Ilana F; Brewer, Brenda; Clingan, Kathy; Keating, Kristen; Rosenbaum, Jennifer; Rozjabek, Heather M; Rathmell, Joshua; Sicks, JoRean; Miller, Anthony B

2016-08-01

Randomized controlled trials frequently use death review committees to assign a cause of death rather than relying on cause of death information from death certificates. The National Lung Screening Trial, a randomized controlled trial of lung cancer screening with low-dose computed tomography versus chest X-ray for heavy and/or long-term smokers ages 55-74 years at enrollment, used a committee blinded to arm assignment for a subset of deaths to determine whether cause of death was due to lung cancer. Deaths were selected for review using a pre-determined computerized algorithm. The algorithm, which considered cancers diagnosed during the trial, causes and significant conditions listed on the death certificate, and the underlying cause of death derived from death certificate information by trained nosologists, selected deaths that were most likely to represent a death due to lung cancer (either directly or indirectly) and deaths that might have been erroneously assigned lung cancer as the cause of death. The algorithm also selected deaths that might be due to adverse events of diagnostic evaluation for lung cancer. Using the review cause of death as the gold standard and lung cancer cause of death as the outcome of interest (dichotomized as lung cancer versus not lung cancer), we calculated performance measures of the death certificate cause of death. We also recalculated the trial primary endpoint using the death certificate cause of death. In all, 1642 deaths were reviewed and assigned a cause of death (42% of the 3877 National Lung Screening Trial deaths). Sensitivity of death certificate cause of death was 91%; specificity, 97%; positive predictive value, 98%; and negative predictive value, 89%. About 40% of the deaths reclassified to lung cancer cause of death had a death certificate cause of death of a neoplasm other than lung. Using the death certificate cause of death, the lung cancer mortality reduction was 18% (95% confidence interval: 4.2-25.0), as

Brain death and Islam: the interface of religion, culture, history, law, and modern medicine.

PubMed

Miller, Andrew C; Ziad-Miller, Amna; Elamin, Elamin M

2014-10-01

How one defines death may vary. It is important for clinicians to recognize those aspects of a patient's religious beliefs that may directly influence medical care and how such practices may interface with local laws governing the determination of death. Debate continues about the validity and certainty of brain death criteria within Islamic traditions. A search of PubMed, Scopus, EMBASE, Web of Science, PsycNet, Sociological Abstracts, DIALOGUE ProQuest, Lexus Nexus, Google, and applicable religious texts was conducted to address the question of whether brain death is accepted as true death among Islamic scholars and clinicians and to discuss how divergent opinions may affect clinical care. The results of the literature review inform this discussion. Brain death has been acknowledged as representing true death by many Muslim scholars and medical organizations, including the Islamic Fiqh Academies of the Organization of the Islamic Conference and the Muslim World League, the Islamic Medical Association of North America, and other faith-based medical organizations as well as legal rulings by multiple Islamic nations. However, consensus in the Muslim world is not unanimous, and a sizable minority accepts death by cardiopulmonary criteria only.

Facilitating Infant/Toddler Skills in Family-Child Routines.

ERIC Educational Resources Information Center

Stremel, Kathleen; And Others

This paper on facilitating skill development of infants and toddlers with disabilities within family-child routines focuses on: (1) developing a routine analysis by incorporating multiple Individual Family Service Plan (IFSP) objectives into family-selected routines; (2) utilizing systematic family training procedures to integrate targeted skills…

SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment.

PubMed

Moon, Rachel Y

2011-11-01

Despite a major decrease in the incidence of sudden infant death syndrome (SIDS) since the American Academy of Pediatrics (AAP) released its recommendation in 1992 that infants be placed for sleep in a nonprone position, this decline has plateaued in recent years. Concurrently, other causes of sudden unexpected infant death that occur during sleep (sleep-related deaths), including suffocation, asphyxia, and entrapment, and ill-defined or unspecified causes of death have increased in incidence, particularly since the AAP published its last statement on SIDS in 2005. It has become increasingly important to address these other causes of sleep-related infant death. Many of the modifiable and nonmodifiable risk factors for SIDS and suffocation are strikingly similar. The AAP, therefore, is expanding its recommendations from focusing only on SIDS to focusing on a safe sleep environment that can reduce the risk of all sleep-related infant deaths, including SIDS. The recommendations described in this policy statement include supine positioning, use of a firm sleep surface, breastfeeding, room-sharing without bed-sharing, routine immunizations, consideration of using a pacifier, and avoidance of soft bedding, overheating, and exposure to tobacco smoke, alcohol, and illicit drugs. The rationale for these recommendations is discussed in detail in the accompanying "Technical Report--SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment," which is included in this issue of Pediatrics (www.pediatrics.org/cgi/content/full/128/5/e1341).

East-West differences in perception of brain death. Review of history, current understandings, and directions for future research.

PubMed

Yang, Qing; Miller, Geoffrey

2015-06-01

The concept of brain death as equivalent to cardiopulmonary death was initially conceived following developments in neuroscience, critical care, and transplant technology. It is now a routine part of medicine in Western countries, including the United States. In contrast, Eastern countries have been reluctant to incorporate brain death into legislation and medical practice. Several countries, most notably China, still lack laws recognizing brain death and national medical standards for making the diagnosis. The perception is that Asians are less likely to approve of brain death or organ transplant from brain dead donors. Cultural and religious traditions have been referenced to explain this apparent difference. In the West, the status of the brain as home to the soul in Enlightenment philosophy, combined with pragmatism and utilitarianism, supports the concept of brain death. In the East, the integration of body with spirit and nature in Buddhist and folk beliefs, along with the Confucian social structure that builds upon interpersonal relationships, argues against brain death. However, it is unclear whether these reasoning strategies are explicitly used when families and medical providers are faced with acknowledging brain death. Their decisions are more likely to involve a prioritization of values and a rationalization of intuitive responses. Why and whether there might be differences between East and West in the acceptance of the brain death concept requires further empirical testing, which would help inform policy-making and facilitate communication between providers and patients from different cultural and ethnic backgrounds.

A district confidential enquiry into deaths due to asthma.

PubMed Central

Wareham, N. J.; Harrison, B. D.; Jenkins, P. F.; Nicholls, J.; Stableforth, D. E.

1993-01-01

BACKGROUND--The aim was to establish a continuing district based confidential enquiry into deaths from asthma. METHODS--A confidential enquiry was conducted in an English health district. Subjects comprised 24 residents of the Norwich health district aged between 16 and 65 years who had died between 1988 and 1991 with asthma as the principal cause of death. RESULTS--Twenty one of the patients (88%) died away from hospital. Overall the routine asthma management was appropriate in all respects in only four patients. In five cases the drug treatment was considered inappropriate, in 10 cases (42%) there was no written evidence that the patient had received advice and education, and only six cases had a written management plan. In 17 patients (71%) the fatal attack of asthma developed rapidly (in under three hours). The medical care during the final attack was found to have been inappropriate in six cases. Seventeen cases (71%) had psychological or social factors that were considered to have been of potential importance. CONCLUSIONS--This study has shown the feasibility of organising a confidential enquiry into asthma deaths within a health district. The distinguishing features of such an enquiry are that it is continuing, that the quality of care given to those patients who died is compared against a recognised standard, and that there is a structured system for feeding back the conclusions of the enquiry to the local medical community. PMID:8296254

Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials.

PubMed

Damman, Peter; Clayton, Tim; Wallentin, Lars; Lagerqvist, Bo; Fox, Keith A A; Hirsch, Alexander; Windhausen, Fons; Swahn, Eva; Pocock, Stuart J; Tijssen, Jan G P; de Winter, Robbert J

2012-02-01

To perform a patient-pooled analysis of a routine invasive versus a selective invasive strategy in elderly patients with non-ST segment elevation acute coronary syndrome. A meta-analysis was performed of patient-pooled data from the FRISC II-ICTUS-RITA-3 (FIR) studies. (Un)adjusted HRs were calculated by Cox regression, with adjustments for variables associated with age and outcomes. The main outcome was 5-year cardiovascular death or myocardial infarction (MI) following routine invasive versus selective invasive management. Regarding the 5-year composite of cardiovascular death or MI, the routine invasive strategy was associated with a lower hazard in patients aged 65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged ≥75 years (HR 0.71, 95% CI 0.55 to 0.91), but not in those aged <65 years (HR 1.11, 95% CI 0.90 to 1.38), p=0.001 for interaction between treatment strategy and age. The interaction was driven by an excess of early MIs in patients <65 years of age; there was no heterogeneity between age groups concerning cardiovascular death. The benefits were smaller for women than for men (p=0.009 for interaction). After adjustment for other clinical risk factors the HRs remained similar. The current analysis of the FIR dataset shows that the long-term benefit of the routine invasive strategy over the selective invasive strategy is attenuated in younger patients aged <65 years and in women by the increased risk of early events which seem to have no consequences for long-term cardiovascular mortality. No other clinical risk factors were able to identify patients with differential responses to a routine invasive strategy. Trial registration http://www.controlled-trials.com/ISRCTN82153174 (ICTUS), http://www.controlled-trials.com/ISRCTN07752711 (RITA-3).

How nurses cope with patient death: A systematic review and qualitative meta-synthesis.

PubMed

Zheng, Ruishuang; Lee, Susan Fiona; Bloomer, Melissa Jane

2018-01-01

To review literature on nurses' coping strategies with patient death. Dealing with the loss of a patient was viewed as one of the most demanding and challenging encounters in clinical practice. Those nurses who are not competent in coping with patient death may be inadequate in supporting dying patients and their family members, and minimise the quality of end-of-life care. To get a broader understanding of how nurses cope with patient death and to develop meaningful and effective interventions, a systematic review which would help underpin the multidimensional approaches is needed. A systematic review. Exhaustive searching in ten databases: CINAHL Plus, EMBASE, MEDLINE, AMED, PsycINFO, ProQuest Health & Medical Complete, ProQuest Dissertations & Theses Global, Google Scholar, EThOS and CareSearch. Meta-aggregation was used to synthesise the findings of the included studies. This systematic review aggregated ten categories from the sixteen qualitative studies included, and then two synthesised findings were derived: intrinsic resources and extrinsic resources. The intrinsic resources consisted of setting boundaries, reflection, crying, death beliefs, life and work experience, and daily routines and activity. The extrinsic resources were comprised of talking and being heard, spiritual practices, education and programmes, and debriefing. This systematic review synthesised the findings about what resources nurses use when coping with patient death and made recommendations on future directions. Areas which could be developed to improve deficiencies that nurses had when faced with the losses of their patients were identified. Nurses need more support resources, which better assist them in coping with patient death. The results of this systematic review could provide evidence for nurses' coping strategies when dealing with patient death, and the recommendations could be employed by nurses to cope with the losses of patients. © 2017 John Wiley & Sons Ltd.

Modular thermal analyzer routine, volume 1

NASA Technical Reports Server (NTRS)

Oren, J. A.; Phillips, M. A.; Williams, D. R.

1972-01-01

The Modular Thermal Analyzer Routine (MOTAR) is a general thermal analysis routine with strong capabilities for performing thermal analysis of systems containing flowing fluids, fluid system controls (valves, heat exchangers, etc.), life support systems, and thermal radiation situations. Its modular organization permits the analysis of a very wide range of thermal problems for simple problems containing a few conduction nodes to those containing complicated flow and radiation analysis with each problem type being analyzed with peak computational efficiency and maximum ease of use. The organization and programming methods applied to MOTAR achieved a high degree of computer utilization efficiency in terms of computer execution time and storage space required for a given problem. The computer time required to perform a given problem on MOTAR is approximately 40 to 50 percent that required for the currently existing widely used routines. The computer storage requirement for MOTAR is approximately 25 percent more than the most commonly used routines for the most simple problems but the data storage techniques for the more complicated options should save a considerable amount of space.

Development and validation of a prognostic model to predict death in patients with traumatic bleeding, and evaluation of the effect of tranexamic acid on mortality according to baseline risk: a secondary analysis of a randomised controlled trial.

PubMed

Perel, P; Prieto-Merino, D; Shakur, H; Roberts, I

2013-06-01

Severe bleeding accounts for about one-third of in-hospital trauma deaths. Patients with a high baseline risk of death have the most to gain from the use of life-saving treatments. An accurate and user-friendly prognostic model to predict mortality in bleeding trauma patients could assist doctors and paramedics in pre-hospital triage and could shorten the time to diagnostic and life-saving procedures such as surgery and tranexamic acid (TXA). The aim of the study was to develop and validate a prognostic model for early mortality in patients with traumatic bleeding and to examine whether or not the effect of TXA on the risk of death and thrombotic events in bleeding adult trauma patients varies according to baseline risk. Multivariable logistic regression and risk-stratified analysis of a large international cohort of trauma patients. Two hundred and seventy-four hospitals in 40 high-, medium- and low-income countries. We derived prognostic models in a large placebo-controlled trial of the effects of early administration of a short course of TXA [Clinical Randomisation of an Antifibrinolytic in Significant Haemorrhage (CRASH-2) trial]. The trial included 20,127 trauma patients with, or at risk of, significant bleeding, within 8 hours of injury. We externally validated the model on 14,220 selected trauma patients from the Trauma Audit and Research Network (TARN), which included mainly patients from the UK. We examined the effect of TXA on all-cause mortality, death due to bleeding and thrombotic events (fatal and non-fatal myocardial infarction, stroke, deep-vein thrombosis and pulmonary embolism) within risk strata in the CRASH-2 trial data set and we estimated the proportion of premature deaths averted by applying the odds ratio (OR) from the CRASH-2 trial to each of the risk strata in TARN. For the stratified analysis according baseline risk we considered the intervention TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo. For the

When Routines Are Not so Routine: Exploring Coordination Work in Hospitals

ERIC Educational Resources Information Center

Haque, Saira Naim

2010-01-01

Many work processes take place through routines, or recurrent patterns of action. These activities involve individuals from several occupations working across spatial, temporal, and organizational boundaries. Crossing these professional, temporal and spatial boundaries has unique challenges which can lead to coordination failures. In these…

Quality insights of university teachers on dying, death, and death education.

PubMed

Mak, Mui-Hing June

One of the main responsibilities of teachers is to help individual students cope with life difficulties such as grief following a death. However, very little research explores teachers' views on death, dying, and how they handle grief and loss in schools. This study aims to explore university teachers' knowledge and attitudes on dying, death, and death education. Fifteen university teachers were recruited using a qualitative method. This study reveals that most teachers' views on death and related issues are largely affected by their death experiences, religious beliefs, professional background, and the mass media. Although they have a general negative response toward death and dying, some teachers begin to affirm their meanings of life and death. Most teachers agree that they do not feel adequate about managing and teaching on life and death issues, so they strongly support including death education in the formal programs in Hong Kong.

Death wishes among older people assessed for home support and long-term aged residential care.

PubMed

Cheung, Gary; Edwards, Siobhan; Sundram, Frederick

2017-12-01

Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. Data were collected from 35 734 people aged over 65 during 2012-2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29-2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20-2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78-3.07) had the greatest odds ratios in the full model. Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Eating routines: Embedded, value based, modifiable, and reflective

PubMed Central

Jastran, Margaret; Bisogni, Carole A.; Sobal, Jeffery; Blake, Christine; Devine, Carol M.

2009-01-01

Eating routines are a compelling issue because recurring eating behaviors influence nutrition and health. As non-traditional and individualized eating patterns have become more common, new ways of thinking about routine eating practices are needed. This study sought to gain conceptual understanding of working adults' eating routines. Forty-two purposively sampled US adults reported food intake and contextual details about eating episodes in qualitative 24-hour dietary recalls conducted over 7 consecutive days. Using the constant comparative method, researchers analyzed interview transcripts for recurrent ways of eating that were either explicitly reported by study participants as “routines” or emergent in the data. Participants' eating routines included repetition in food consumption as well as eating context, and also involved sequences of eating episodes. Eating routines were embedded in daily schedules for work, family, and recreation. Participants maintained purposeful routines that helped balance tension between demands and values, but they modified routines as circumstances changed. Participants monitored and reflected upon their eating practices and tended to assess their practices in light of their personal identities. These findings provide conceptual insights for food choice researchers and present a perspective from which practitioners who work with individuals seeking to adopt healthful eating practices might usefully approach their tasks. PMID:18835305

CPU timing routines for a CONVEX C220 computer system

NASA Technical Reports Server (NTRS)

Bynum, Mary Ann

1989-01-01

The timing routines available on the CONVEX C220 computer system in the Structural Mechanics Division (SMD) at NASA Langley Research Center are examined. The function of the timing routines, the use of the timing routines in sequential, parallel, and vector code, and the interpretation of the results from the timing routines with respect to the CONVEX model of computing are described. The timing routines available on the SMD CONVEX fall into two groups. The first group includes standard timing routines generally available with UNIX 4.3 BSD operating systems, while the second group includes routines unique to the SMD CONVEX. The standard timing routines described in this report are /bin/csh time,/bin/time, etime, and ctime. The routines unique to the SMD CONVEX are getinfo, second, cputime, toc, and a parallel profiling package made up of palprof, palinit, and palsum.

Mortality and cause-of-death reporting and analysis systems in seven Pacific Island countries.

PubMed

Carter, Karen L; Rao, Chalapati; Lopez, Alan D; Taylor, Richard

2012-06-13

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. This paper uses a standard analytical framework to examine death registration systems in Fiji, Kiribati, Nauru, Palau, Solomon Islands, Tonga and Vanuatu. 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. 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.

Comparison of land use regression models for NO2 based on routine and campaign monitoring data from an urban area of Japan.

PubMed

Kashima, Saori; Yorifuji, Takashi; Sawada, Norie; Nakaya, Tomoki; Eboshida, Akira

2018-08-01

Typically, land use regression (LUR) models have been developed using campaign monitoring data rather than routine monitoring data. However, the latter have advantages such as low cost and long-term coverage. Based on the idea that LUR models representing regional differences in air pollution and regional road structures are optimal, the objective of this study was to evaluate the validity of LUR models for nitrogen dioxide (NO 2 ) based on routine and campaign monitoring data obtained from an urban area. We selected the city of Suita in Osaka (Japan). We built a model based on routine monitoring data obtained from all sites (routine-LUR-All), and a model based on campaign monitoring data (campaign-LUR) within the city. Models based on routine monitoring data obtained from background sites (routine-LUR-BS) and based on data obtained from roadside sites (routine-LUR-RS) were also built. The routine LUR models were based on monitoring networks across two prefectures (i.e., Osaka and Hyogo prefectures). We calculated the predictability of the each model. We then compared the predicted NO 2 concentrations from each model with measured annual average NO 2 concentrations from evaluation sites. The routine-LUR-All and routine-LUR-BS models both predicted NO 2 concentrations well: adjusted R 2 =0.68 and 0.76, respectively, and root mean square error=3.4 and 2.1ppb, respectively. The predictions from the routine-LUR-All model were highly correlated with the measured NO 2 concentrations at evaluation sites. Although the predicted NO 2 concentrations from each model were correlated, the LUR models based on routine networks, and particularly those based on all monitoring sites, provided better visual representations of the local road conditions in the city. The present study demonstrated that LUR models based on routine data could estimate local traffic-related air pollution in an urban area. The importance and usefulness of data from routine monitoring networks should be

Predicting Early Death Among Elderly Dialysis Patients: Development and Validation of a Risk Score to Assist Shared Decision Making for Dialysis Initiation.

PubMed

Thamer, Mae; Kaufman, James S; Zhang, Yi; Zhang, Qian; Cotter, Dennis J; Bang, Heejung

2015-12-01

A shared decision-making tool could help elderly patients with advanced chronic kidney disease decide about initiating dialysis therapy. Because mortality may be high in the first few months after initiating dialysis therapy, incorporating early mortality predictors in such a tool would be important for an informed decision. Our objective is to derive and validate a predictive risk score for early mortality after initiating dialysis therapy. Retrospective observational cohort, with development and validation cohorts. US Renal Data System and claims data from the Centers for Medicare & Medicaid Services for 69,441 (aged ≥67 years) patients with end-stage renal disease with a previous 2-year Medicare history who initiated dialysis therapy from January 1, 2009, to December 31, 2010. Demographics, predialysis care, laboratory data, functional limitations, and medical history. All-cause mortality in the first 3 and 6 months. Predicted mortality by logistic regression. The simple risk score (total score, 0-9) included age (0-3 points), low albumin level, assistance with daily living, nursing home residence, cancer, heart failure, and hospitalization (1 point each), and showed area under the receiver operating characteristic curve (AUROC)=0.69 in the validation sample. A comprehensive risk score with additional predictors was also developed (with AUROC=0.72, high concordance between predicted vs observed risk). Mortality probabilities were estimated from these models, with the median score of 3 indicating 12% risk in 3 months and 20% in 6 months, and the highest scores (≥8) indicating 39% risk in 3 months and 55% in 6 months. Patients who did not choose dialysis therapy and did not have a 2-year Medicare history were excluded. Routinely available information can be used by patients with chronic kidney disease, families, and their nephrologists to estimate the risk of early mortality after dialysis therapy initiation, which may facilitate informed decision making

Routine DNA testing

USDA-ARS?s Scientific Manuscript database

Routine DNA testing. It’s done once you’ve Marker-Assisted Breeding Pipelined promising Qantitative Trait Loci within your own breeding program and thereby established the performance-predictive power of each DNA test for your germplasm under your conditions. By then you are ready to screen your par...

Cellular automata model for human articular chondrocytes migration, proliferation and cell death: An in vitro validation.

PubMed

Vaca-González, J J; Gutiérrez, M L; Guevara, J M; Garzón-Alvarado, D A

2017-01-01

Articular cartilage is characterized by low cell density of only one cell type, chondrocytes, and has limited self-healing properties. When articular cartilage is affected by traumatic injuries, a therapeutic strategy such as autologous chondrocyte implantation is usually proposed for its treatment. This approach requires in vitro chondrocyte expansion to yield high cell number for cell transplantation. To improve the efficiency of this procedure, it is necessary to assess cell dynamics such as migration, proliferation and cell death during culture. Computational models such as cellular automata can be used to simulate cell dynamics in order to enhance the result of cell culture procedures. This methodology has been implemented for several cell types; however, an experimental validation is required for each one. For this reason, in this research a cellular automata model, based on random-walk theory, was devised in order to predict articular chondrocyte behavior in monolayer culture during cell expansion. Results demonstrated that the cellular automata model corresponded to cell dynamics and computed-accurate quantitative results. Moreover, it was possible to observe that cell dynamics depend on weighted probabilities derived from experimental data and cell behavior varies according to the cell culture period. Thus, depending on whether cells were just seeded or proliferated exponentially, culture time probabilities differed in percentages in the CA model. Furthermore, in the experimental assessment a decreased chondrocyte proliferation was observed along with increased passage number. This approach is expected to having other uses as in enhancing articular cartilage therapies based on tissue engineering and regenerative medicine.

Markers of Developmentally Regulated Programmed Cell Death and Their Analysis in Cereal Seeds.

PubMed

Domínguez, Fernando; Cejudo, Francisco Javier

2018-01-01

Programmed cell death (PCD) is a key process for the development and differentiation of multicellular organisms, which is characterized by well-defined morphological and biochemical features. These include chromatin condensation, DNA degradation and nuclear fragmentation, with nucleases and proteases playing a relevant function in these processes. In this chapter we describe methods routinely used for the analysis of hallmarks of developmentally regulated PCD in cereal seed tissues, which are based on agarose and polyacrylamide gel electrophoresis, in situ staining of DNA fragmentation, and cell-free assays of relevant enzymatic activities.

Death Anxiety and Quality of Life in Iranian Caregivers of Patients With Cancer.

PubMed

Soleimani, Mohammad Ali; Lehto, Rebecca H; Negarandeh, Reza; Bahrami, Nasim; Chan, Yiong Huak

Concerns about death may alienate and negatively impact communication among family members of patients with life-threatening illness. Little is known about the relationship of death anxiety to quality of life in cancer family caregivers. The aim of this study was to examine relationships between sociodemographic and patient-related factors, social support, and religiosity with death anxiety and quality of life in Iranian cancer family caregivers. Three hundred thirty family caregivers from an urban regional cancer institute in Iran participated in a descriptive-correlational study that incorporated sociodemographic surveys and validated death anxiety (Templer Scale) and Quality of life (Family Version) instruments. Caregivers reported moderate levels of death anxiety and decrements in QOL. Quality of life was inversely associated with death anxiety (r = -0.30, P < .001). Female caregivers who were daughters had higher death anxiety, whereas male caregivers who were sons reported higher quality of life. Death anxiety is associated with lowered quality of life in Iranian family caregivers. Multiple factors may impact death anxiety and quality of life relevant to the socioreligious milieu. Addressing concerns that increase death anxiety may improve quality of life and lower stress associated with adapting to the family caregiver role. Caregiving responsibilities, added to challenges associated with personal, family, and professional life, impact multiple aspects of QOL. As nurses increasingly care for patients from diverse backgrounds, it becomes more imperative that support for family caregivers that promotes psychological adaptation and quality of life is needed.

Death revisited: rethinking death and the dead donor rule.

PubMed

Iltis, Ana Smith; Cherry, Mark J

2010-06-01

Traditionally, people were recognized as being dead using cardio-respiratory criteria: individuals who had permanently stopped breathing and whose heart had permanently stopped beating were dead. Technological developments in the middle of the twentieth century and the advent of the intensive care unit made it possible to sustain cardio-respiratory and other functions in patients with severe brain injury who previously would have lost such functions permanently shortly after sustaining a brain injury. What could and should physicians caring for such patients do? Significant advances in human organ transplantation also played direct and indirect roles in discussions regarding the care of such patients. Because successful transplantation requires that organs be removed from cadavers shortly after death to avoid organ damage due to loss of oxygen, there has been keen interest in knowing precisely when people are dead so that organs could be removed. Criteria for declaring death using neurological criteria developed, and today a whole brain definition of death is widely used and recognized by all 50 states in the United States as an acceptable way to determine death. We explore the ongoing debate over definitions of death, particularly over brain death or death determined using neurological criteria, and the relationship between definitions of death and organ transplantation.

Probabilistic thinking and death anxiety: a terror management based study.

PubMed

Hayslip, Bert; Schuler, Eric R; Page, Kyle S; Carver, Kellye S

2014-01-01

Terror Management Theory has been utilized to understand how death can change behavioral outcomes and social dynamics. One area that is not well researched is why individuals willingly engage in risky behavior that could accelerate their mortality. One method of distancing a potential life threatening outcome when engaging in risky behaviors is through stacking probability in favor of the event not occurring, termed probabilistic thinking. The present study examines the creation and psychometric properties of the Probabilistic Thinking scale in a sample of young, middle aged, and older adults (n = 472). The scale demonstrated adequate internal consistency reliability for each of the four subscales, excellent overall internal consistency, and good construct validity regarding relationships with measures of death anxiety. Reliable age and gender effects in probabilistic thinking were also observed. The relationship of probabilistic thinking as part of a cultural buffer against death anxiety is discussed, as well as its implications for Terror Management research.

A "good death": perspectives of Muslim patients and health care providers.

PubMed

Tayeb, Mohamad A; Al-Zamel, Ersan; Fareed, Muhammed M; Abouellail, Hesham A

2010-01-01

Twelve "good death" principles have been identified that apply to Westerners. This study aimed to review the TFHCOP good death perception to determine its validity for Muslim patients and health care providers, and to identify and describe other components of the Muslim good death perspective. Participants included 284 Muslims of both genders with different nationalities and careers. We used a 12-question questionnaire based on the 12 principles of the TFHCOP good death definition, followed by face-to-face interviews. We used descriptive statistics to analyze questionnaire responses. However, for new themes, we used a grounded theory approach with a "constant comparisons" method. On average, each participant agreed on eight principles of the questionnaire. Dignity, privacy, spiritual and emotional support, access to hospice care, ability to issue advance directives, and to have time to say goodbye were the top priorities. Participants identified three main domains. The first domain was related to faith and belief. The second domain included some principles related to self-esteem and person's image to friends and family. The third domain was related to satisfaction about family security after the death of the patient. Professional role distinctions were more pronounced than were gender or nationality differences. Several aspects of "good death," as perceived by Western communities, are not recognized as being important by many Muslim patients and health care providers. Furthermore, our study introduced three novel components of good death in Muslim society.

Operationalization and Validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Fall Risk Algorithm in a Nationally Representative Sample

PubMed Central

Lohman, Matthew C.; Crow, Rebecca S.; DiMilia, Peter R.; Nicklett, Emily J.; Bruce, Martha L.; Batsis, John A.

2017-01-01

Background Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool’s predictive validity or adaptability to survey data. Methods Data from five annual rounds (2011–2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 and older in the US. Analytic sample respondents (n=7,392) were categorized at baseline as having low, moderate, or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. Results Participants classified as having moderate and high fall risk had 2.62 (95% CI: 2.29, 2.99) and 4.76 (95% CI: 3.51, 6.47) times greater odds of falling during follow-up compared to those with low risk, respectively, controlling for sociodemographic and health related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. Conclusion The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardize screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted. PMID:28947669

Deaths, injuries, and evacuations from acute hazardous materials releases.

PubMed Central

Binder, S

1989-01-01

We examined reports from three surveillance systems of 587 acute releases of hazardous materials in 1986. These releases resulted in at least 115 deaths, 2,254 injuries, and 111 evacuations. Only eight (1 percent) of the 587 events were common to all three systems. Estimates of the public health consequences of hazardous materials releases could be improved by enforcing existing laws, modifying report forms, and validating collected information. PMID:2751024

Validation of multisource electronic health record data: an application to blood transfusion data.

PubMed

Hoeven, Loan R van; Bruijne, Martine C de; Kemper, Peter F; Koopman, Maria M W; Rondeel, Jan M M; Leyte, Anja; Koffijberg, Hendrik; Janssen, Mart P; Roes, Kit C B

2017-07-14

Although data from electronic health records (EHR) are often used for research purposes, systematic validation of these data prior to their use is not standard practice. Existing validation frameworks discuss validity concepts without translating these into practical implementation steps or addressing the potential influence of linking multiple sources. Therefore we developed a practical approach for validating routinely collected data from multiple sources and to apply it to a blood transfusion data warehouse to evaluate the usability in practice. The approach consists of identifying existing validation frameworks for EHR data or linked data, selecting validity concepts from these frameworks and establishing quantifiable validity outcomes for each concept. The approach distinguishes external validation concepts (e.g. concordance with external reports, previous literature and expert feedback) and internal consistency concepts which use expected associations within the dataset itself (e.g. completeness, uniformity and plausibility). In an example case, the selected concepts were applied to a transfusion dataset and specified in more detail. Application of the approach to a transfusion dataset resulted in a structured overview of data validity aspects. This allowed improvement of these aspects through further processing of the data and in some cases adjustment of the data extraction. For example, the proportion of transfused products that could not be linked to the corresponding issued products initially was 2.2% but could be improved by adjusting data extraction criteria to 0.17%. This stepwise approach for validating linked multisource data provides a basis for evaluating data quality and enhancing interpretation. When the process of data validation is adopted more broadly, this contributes to increased transparency and greater reliability of research based on routinely collected electronic health records.

An estimation of the clinical mastitis incidence per 100 cows per year based on routinely collected herd data.

PubMed

Santman-Berends, I M G A; Lam, T J G M; Keurentjes, J; van Schaik, G

2015-10-01

The aim of this study was to evaluate whether it was possible to (1) estimate the clinical mastitis incidence rate (CMI) for all Dutch dairy herds and (2) to detect farms with a high CMI based on routinely collected herd data. For this study, 240 dairy farms with a conventional milking system that participated in the milk recording program every 4 to 6 wk were randomly selected and agreed to participate. From the initial 240 herds, data of clinical mastitis (CM) registrations and routinely collected herd data of 227 herds were complete and could be used for analysis. Routinely collected herd data consisted of identification and registration records, antimicrobial usage, test-day records from the milk recording program, bulk tank milk (BTM) somatic cell count data and results of diagnostic tests on BTM samples. For each of the 227 herds, the CMI per 100 cows per year was calculated per quarter of the year and was combined with the available herd data. Two models were developed to predict the CMI for all dairy herds and to detect individual herds that belonged to the 25% herds with the highest CMI. Records of 156 (67%) herds were used for development of the models and the remaining 71 (33%) were used for validation. The model that estimated the CMI in all herds consisted of 11 explanatory variables. The observed and predicted averages of the validation herds were not significantly different. The model estimated a CMI per 100 cows per year of 32.5 cases (95% confidence interval=30.2-34.8), whereas the farmers registered 33.4 cases (95% confidence interval=29.5-37.4). The model that aimed at detecting individual herds with a high CMI contained 6 explanatory variables and could correctly classify 77% of all validation herds at the quarter-year level. The most important variables in the model were antibiotic usage for treating CM and BTM somatic cell count. In conclusion, models based on routinely collected herd data gave an accurate prediction of CMI for all Dutch dairy

Risk scores for outcome in bacterial meningitis: Systematic review and external validation study.

PubMed

Bijlsma, Merijn W; Brouwer, Matthijs C; Bossuyt, Patrick M; Heymans, Martijn W; van der Ende, Arie; Tanck, Michael W T; van de Beek, Diederik

2016-11-01

To perform an external validation study of risk scores, identified through a systematic review, predicting outcome in community-acquired bacterial meningitis. MEDLINE and EMBASE were searched for articles published between January 1960 and August 2014. Performance was evaluated in 2108 episodes of adult community-acquired bacterial meningitis from two nationwide prospective cohort studies by the area under the receiver operating characteristic curve (AUC), the calibration curve, calibration slope or Hosmer-Lemeshow test, and the distribution of calculated risks. Nine risk scores were identified predicting death, neurological deficit or death, or unfavorable outcome at discharge in bacterial meningitis, pneumococcal meningitis and invasive meningococcal disease. Most studies had shortcomings in design, analyses, and reporting. Evaluation showed AUCs of 0.59 (0.57-0.61) and 0.74 (0.71-0.76) in bacterial meningitis, 0.67 (0.64-0.70) in pneumococcal meningitis, and 0.81 (0.73-0.90), 0.82 (0.74-0.91), 0.84 (0.75-0.93), 0.84 (0.76-0.93), 0.85 (0.75-0.95), and 0.90 (0.83-0.98) in meningococcal meningitis. Calibration curves showed adequate agreement between predicted and observed outcomes for four scores, but statistical tests indicated poor calibration of all risk scores. One score could be recommended for the interpretation and design of bacterial meningitis studies. None of the existing scores performed well enough to recommend routine use in individual patient management. Copyright © 2016 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

Is there a need for routine follow-up after primary total hip arthroplasty?

PubMed

Hacking, Craig; Weinrauch, Patrick; Whitehouse, Sarah L; Crawford, Ross W; Donnelly, William J

2010-10-01

The objective of routine outpatient assessment of well-functioning patients after primary total hip arthroplasty (THA) is to detect asymptomatic failure of prostheses to guide recommendations for early intervention. We have observed that the revision of THAs in asymptomatic patients is highly uncommon. We therefore question the need for routine follow-up of patients after THA. A prospective analysis of an orthopaedic database identified 158 patients who received 177 revision THAs over a four-year period. A retrospective chart review was conducted. Patient demographics, primary and revision surgery parameters and follow-up information were recorded and cross-referenced with Australian Orthopaedic Association National Joint Replacement Registry data. One hundred ten THAs in 104 patients (average age 70.4 (SD 9.8 years)). There were 70 (63.6%) in total, 13 (11.8%) femoral and 27 (24.5%) acetabular revisions. The indications for revision were aseptic loosening (70%), dislocation (8.2%), peri-prosthetic fracture (7.3%), osteolysis (6.4%) and infection (4.5%). Only four (3.6%) were asymptomatic revisions. A mean of 5.3 (SD 5.2 and 1.9 (SD 5.3)) follow-up appointments were required before revision in patients with and without symptoms, respectively. The average time from the primary to revision surgery was 11.8 (SD 7.23) years. We conclude that patients with prostheses with excellent long-term clinical results as validated by joint registries, routine follow-up of asymptomatic THA should be questioned and requires further investigation. Based on the work of this study, the current practice of routine follow-up of asymptomatic THA may be excessively costly and unnecessary, and a less resource-intensive review method may be more appropriate. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.

Prospective evaluation of the utility of routine postoperative cystogram after traumatic bladder injury.

PubMed

Inaba, Kenji; Okoye, Obi T; Browder, Timothy; Best, Charles; Branco, Bernardino C; Teixeira, Pedro G; Barmparas, Galinos; Reddy, Sravanthi; Demetriades, Demetrios

2013-12-01

The value of routinely testing bladder repair integrity with a cystogram before urinary catheter removal is unclear. The purpose of this study was to prospectively evaluate the utility of routine postoperative cystogram after traumatic bladder injury. All patients sustaining a bladder injury requiring operative repair at two Level I trauma centers were prospectively enrolled during a 62-month study period ending on January 2011. Injury demographics, imaging data, and outcomes were extracted. All patients were evaluated with either a plain or a computed tomography cystogram. A total of 127 patients were enrolled (mean [SD] age, 30.4 [13.5] years; blunt trauma, 63.8%, mean [SD] Injury Severity Score [ISS], 17.7 [10.6]). A total of 75 patients (59.1%) had an intraperitoneal (IP) bladder injury, 44 (34.6%) had an extraperitoneal (EP) bladder injury, and 8 had a (6.3%) combined IP/EP bladder injury. All patients with IP and IP/EP injuries (n = 83) underwent operative repair and a postoperative cystogram at 8.6 (1.8) days (range, 5-13 days). Sixty-nine IP injuries (83.1%) were simple (dome or body disruption/penetrating injury), while 14 (16.9%) were complex (trigone/requiring ureter implantation). There were no deaths during the follow-up period. With the exception of one patient (1.2%) with a complex injury requiring ureteric implantation, there were no leaks demonstrated on postoperative cystogram, and the urinary catheters were successfully removed. In this prospective evaluation of the role of bladder evaluation after operative repair, routine use of follow-up cystograms for simple injuries did not impact clinical management. For complex repairs to the trigone or those requiring ureter implantation, a follow-up cystogram should be obtained before catheter removal. Diagnostic study, level II.

Do placebo based validation standards mimic real batch products behaviour? Case studies.

PubMed

Bouabidi, A; Talbi, M; Bouklouze, A; El Karbane, M; Bourichi, H; El Guezzar, M; Ziemons, E; Hubert, Ph; Rozet, E

2011-06-01

Analytical methods validation is a mandatory step to evaluate the ability of developed methods to provide accurate results for their routine application. Validation usually involves validation standards or quality control samples that are prepared in placebo or reconstituted matrix made of a mixture of all the ingredients composing the drug product except the active substance or the analyte under investigation. However, one of the main concerns that can be made with this approach is that it may lack an important source of variability that come from the manufacturing process. The question that remains at the end of the validation step is about the transferability of the quantitative performance from validation standards to real authentic drug product samples. In this work, this topic is investigated through three case studies. Three analytical methods were validated using the commonly spiked placebo validation standards at several concentration levels as well as using samples coming from authentic batch samples (tablets and syrups). The results showed that, depending on the type of response function used as calibration curve, there were various degrees of differences in the results accuracy obtained with the two types of samples. Nonetheless the use of spiked placebo validation standards was showed to mimic relatively well the quantitative behaviour of the analytical methods with authentic batch samples. Adding these authentic batch samples into the validation design may help the analyst to select and confirm the most fit for purpose calibration curve and thus increase the accuracy and reliability of the results generated by the method in routine application. Copyright © 2011 Elsevier B.V. All rights reserved.

The risk of venous thromboembolism, myocardial infarction, stroke, major bleeding and death in patients undergoing total hip and knee replacement: a 15-year retrospective cohort study of routine clinical practice.

PubMed

Pedersen, A B; Mehnert, F; Sorensen, H T; Emmeluth, C; Overgaard, S; Johnsen, S P

2014-04-01

We examined the risk of thrombotic and major bleeding events in patients undergoing total hip and knee replacement (THR and TKR) treated with thromboprophylaxis, using nationwide population-based databases. We identified 83 756 primary procedures performed between 1997 and 2011. The outcomes were symptomatic venous thromboembolism (VTE), myocardial infarction (MI), stroke, death and major bleeding requiring hospitalisation within 90 days of surgery. A total of 1114 (1.3%) and 483 (0.6%) patients experienced VTE and bleeding, respectively. The annual risk of VTE varied between 0.9% and 1.6%, and of bleeding between 0.4% and 0.8%. The risk of VTE and bleeding was unchanged over a 15-year period. A total of 0.7% of patients died within 90 days, with a decrease from 1% in 1997 to 0.6% in 2011 (p < 0.001). A high level of comorbidity and general anaesthesia were strong risk factors for both VTE and bleeding, with no difference between THR and TKR patients. The risk of both MI and stroke was 0.5%, which remained unchanged during the study period. In this cohort study of patients undergoing THR and TKR patients in routine clinical practice, approximately 3% experienced VTE, MI, stroke or bleeding. These risks did not decline during the 15-year study period, but the risk of dying fell substantially.

[Cause of death: from primary disease to direct cause of death].

PubMed

Oppewal, F; Smedts, F M M; Meyboom-de Jong, B

2005-07-23

Following the death of a patient, the treating physician in the Netherlands is required to fill out two forms. Form A, which is the certificate of death and Form B, which is used by the Statistics Netherlands to compile data on causes ofdeath. The latter form often poses difficulty for the physician with respect to the primary cause of death. This applies particularly to cases of sudden death, which account for one third of all deaths in the Netherlands. As a result, the statistical analyses appear to lead to an incorrect representation of the distribution of causes of death. A more thorough investigation into the primary cause of death is desirable, if necessary, supported by a request for an autopsy. The primary cause of death is to be regarded as the basic disease from which the cascade of changes ultimately leading to death originated.

Psychometric Properties of the Persian Version of Death Depression Scale-Revised in Iranian Patients with Acute Myocardial Infarction.

PubMed

Sharif Nia, Hamid; Pahlevan Sharif, Saeed; Lehto, Rebecca H; Allen, Kelly A; Goudarzian, Amir Hossein; Yaghoobzadeh, Ameneh; Soleimani, Mohammad Ali

2017-07-01

Objective: Limited research has examined the psychometric properties of death depression scales in Persian populations with cardiac disease despite the need for valid assessment tools for evaluating depressive symptoms in patients with life-limiting chronic conditions. The present study aimed at evaluating the reliability and validity of the Persian Version of Death Depression Scale - Revised (DDS-R) in Iranian patients who had recent acute myocardial infarction (AMI). Method: This psychometric study was conducted with a convenience sample of 407 patients with AMI diagnosis who completed the Persian version of the DDS-R. The face, content, and construct validity of the scale were ascertained. Internal consistency, test-retest, and construct reliability (CR) were used to assess reliability of the Persian Version of DDS-R. Results: Based on maximum likelihood exploratory factor analysis and consideration of conceptual meaning, a 4-factor solution was identified, explaining 75.89% of the total variance. Goodness-of-fit indices (GFI), Comparative Fit Index (CFI), Normed Fit Index (NFI), Incremental Fit Index (IFI), and Root Mean Square Error of Approximation (RMSEA) in the final DDS-R structure demonstrated the adequacy of the 4-domain structure. The internal consistency, construct reliability, and Intra-class Correlation Coefficients (ICC) were greater than .70. Conclusion: The DDS-R was found to be a valid and reliable assessment tool for evaluating death depression symptoms in Iranian patients with AMI.

Building the evidence on simulation validity: comparison of anesthesiologists' communication patterns in real and simulated cases.

PubMed

Weller, Jennifer; Henderson, Robert; Webster, Craig S; Shulruf, Boaz; Torrie, Jane; Davies, Elaine; Henderson, Kaylene; Frampton, Chris; Merry, Alan F

2014-01-01

Effective teamwork is important for patient safety, and verbal communication underpins many dimensions of teamwork. The validity of the simulated environment would be supported if it elicited similar verbal communications to the real setting. The authors hypothesized that anesthesiologists would exhibit similar verbal communication patterns in routine operating room (OR) cases and routine simulated cases. The authors further hypothesized that anesthesiologists would exhibit different communication patterns in routine cases (real or simulated) and simulated cases involving a crisis. Key communications relevant to teamwork were coded from video recordings of anesthesiologists in the OR, routine simulation and crisis simulation and percentages were compared. The authors recorded comparable videos of 20 anesthesiologists in the two simulations, and 17 of these anesthesiologists in the OR, generating 400 coded events in the OR, 683 in the routine simulation, and 1,419 in the crisis simulation. The authors found no significant differences in communication patterns in the OR and the routine simulations. The authors did find significant differences in communication patterns between the crisis simulation and both the OR and the routine simulations. Participants rated team communication as realistic and considered their communications occurred with a similar frequency in the simulations as in comparable cases in the OR. The similarity of teamwork-related communications elicited from anesthesiologists in simulated cases and the real setting lends support for the ecological validity of the simulation environment and its value in teamwork training. Different communication patterns and frequencies under the challenge of a crisis support the use of simulation to assess crisis management skills.

Exploring children's understanding of death: through drawings and the Death Concept Questionnaire.

PubMed

Bonoti, Fotini; Leondari, Angeliki; Mastora, Adelais

2013-01-01

To investigate whether children's understanding of the concept of death varies as a function of death experience and age, 52 children aged 7, 9, and 11 years (26 had a personal death experience), drew a picture reflecting the meaning of the word death and completed the Death Concept Questionnaire for examination of Human and Animal Death. The results showed that the 2 methodological tools used offered complementary information and that children's understanding of death is related both to age and past experience. Children with death experience seem to have a more realistic understanding of death than their inexperienced age-mates. As regards to the effect of age, our findings support the assumption that the different components of death develop through different processes.

[The controversy of routine articulator mounting in orthodontics].

PubMed

Wang, Li; Han, Xianglong; Bai, Ding

2013-06-01

Articulators have been widely used by clinicians of dentistry. But routine articulator mounting is still controversial in orthodontics. Orthodontists oriented by gnathology approve routine articulator mounting while nongnathologic orthodontists disapprove it. This article reviews the thoughts of orthodontist that they agree or disagree with routine articulator mounting based on the considerations of biting, temporomandibular disorder (TMD), periodontitis, and so on.

The number and characteristics of newspaper and Twitter reports on suicides and road traffic deaths in young people.

PubMed

Scourfield, Jonathan; Colombo, Gualtiero; Burnap, Pete; Evans, Rhiannon; Jacob, Nina; Williams, Matthew; Caul, Sarah

2018-06-01

In the light of concern about the harmful effects of media reporting of suicides and a lack of comparative research, this study compares the number and characteristics of reports on young people's suicides and road traffic accidents (RTAs) in newspapers and Twitter. Comparison of newspaper and Twitter reporting of deaths by suicide and RTA in young people (11-18) during a six-month period. Tweets about young people's suicides were more numerous than newspaper reports. Twitter and newspaper reports were more strongly correlated for suicides than for RTAs. Recent suicides were less likely to be reported in newspapers than recent deaths by RTA. Bullying-related suicides were especially newsworthy. Suicide prevention organisations should consider routinely monitoring social media reporting.

Cardiac asystole following cannabis (marijuana) usage--additional mechanism for sudden death?

PubMed

Menahem, Samuel

2013-12-10

A 21 year old university student previously operated during infancy for an unobstructed total anomalous pulmonary venous drainage with an excellent result, was noted on a routine follow up 24 h Holter monitor to have multiple pauses related to cardiac asystole, the longest lasting 5.8 s and temporally related to marijuana inhalation. A repeat Holter was normal following a two week cessation of marijuana usage and again when carried out 3 months later. The documented periods of asystole may be a precursor of sudden death seen in addicts even without evidence of ischaemic heart disease. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Daily Routines and Crime: Using Routine Activities as Measures of Hirschi's Involvement.

ERIC Educational Resources Information Center

Hawdon, James E.

1999-01-01

Reconstitutes the "involvement" aspect of T. Hirschi's bond theory to substitute routine-activity patterns (RAPs) for involvement. Self-reports of 108 college freshmen suggest that involvement reconstituted as RAPs is an effective predictor of minor acts of delinquency. (SLD)

Prevention of group B streptococcal disease in the first 3 months of life: would routine maternal immunization during pregnancy be cost-effective?

PubMed

Oster, Gerry; Edelsberg, John; Hennegan, Kalin; Lewin, Clement; Narasimhan, Vas; Slobod, Karen; Edwards, Morven S; Baker, Carol J

2014-08-20

A vaccine against group B streptococcus (GBS) that is intended for routine maternal immunization during pregnancy is in clinical development. Addition of vaccination to screening and intrapartum antibiotic prophylaxis (IAP) may further reduce the burden of GBS disease in infancy; its potential cost-effectiveness is unknown, however. We evaluated the cost-effectiveness of routine immunization at week 28 of pregnancy with the trivalent GBS (serotypes Ia, Ib and III) vaccine that is in clinical development. The vaccine was assumed to be used in addition to screening and IAP, and reduce the risk of invasive infection in infancy due to covered serotypes. We estimated the effectiveness of immunization in terms of additional cases of GBS disease prevented, deaths averted, life-years saved, and quality-adjusted life-years (QALYs) gained; potential reductions in prematurity and stillbirths were not considered. Costs considered included those of acute care for infants with GBS disease, and chronic care for those with long-term disability. The cost of immunization was assumed to be $100 per person. Assuming 85% coverage, routine maternal immunization against GBS added to screening and IAP would prevent an additional 899 cases of GBS disease and an additional 35 deaths among infants in the US. The total annual cost of immunization would be $362.7 million; estimated cost savings from prevention of GBS disease in infancy would be $43.5 million. The cost-effectiveness of immunization was estimated to be $91,321 per QALY gained. Findings were sensitive to assumptions regarding vaccine efficacy and cost. Addition of a trivalent GBS maternal vaccine to screening and IAP might further reduce the burden of GBS disease among infants in the US, and may be comparable in cost-effectiveness to other vaccines recently approved for use in children and adolescents. Copyright © 2014 Elsevier Ltd. All rights reserved.

SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment.

PubMed

2016-11-01

Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS; International Classification of Diseases, 10th Revision [ICD-10], R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75). After an initial decrease in the 1990s, the overall death rate attributable to sleep-related infant deaths has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, the use of a firm sleep surface, room-sharing without bed-sharing, and the avoidance of soft bedding and overheating. Additional recommendations for SIDS reduction include the avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence is presented for skin-to-skin care for newborn infants, use of bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. The recommendations and strength of evidence for each recommendation are included in this policy statement. The rationale for these recommendations is discussed in detail in the accompanying technical report (www.pediatrics.org/cgi/doi/10.1542/peds.2016-2940). Copyright © 2016 by the American Academy of Pediatrics.

Analysis of routine pilot-controller communication

NASA Technical Reports Server (NTRS)

Morrow, Daniel G.; Lee, Alfred; Rodvold, Michelle

1990-01-01

Although pilot-controller communication is central to aviation safety, this area of aviation human factors has not been extensively researched. Most research has focused on what kinds of communication problems occur. A more complete picture of communication problems requires understanding how communication usually works in routine operations. A sample of routine pilot-controller communication in the TRACON environment is described. After describing several dimensions of routine communication, three kinds of communication problems are treated: inaccuracies such as incorrect readbacks, procedural deviations such as missing callsigns and readbacks, and nonroutine transactions where pilot and controller must deal with misunderstandings or other communication problems. Preliminary results suggest these problems are not frequent events in daily operations. However, analysis of the problems that do occur suggest some factors that may cause them.

Exploring Children's Understanding of Death: Through Drawings and the Death Concept Questionnaire

ERIC Educational Resources Information Center

Bonoti, Fotini; Leondari, Angeliki; Mastora, Adelais

2013-01-01

To investigate whether children's understanding of the concept of death varies as a function of death experience and age, 52 children aged 7, 9, and 11 years (26 had a personal death experience), drew a picture reflecting the meaning of the word death and completed the Death Concept Questionnaire for examination of Human and Animal Death. The…

S-Adenosyl-L-methionine protects the probiotic yeast, Saccharomyces boulardii, from acid-induced cell death.

PubMed

Cascio, Vincent; Gittings, Daniel; Merloni, Kristen; Hurton, Matthew; Laprade, David; Austriaco, Nicanor

2013-02-13

Saccharomyces boulardii is a probiotic yeast routinely used to prevent and to treat gastrointestinal disorders, including the antibiotic-associated diarrhea caused by Clostridium difficile infections. However, only 1-3% of the yeast administered orally is recovered alive in the feces suggesting that this yeast is unable to survive the acidic environment of the gastrointestinal tract. We provide evidence that suggests that S. boulardii undergoes programmed cell death (PCD) in acidic environments, which is accompanied by the generation of reactive oxygen species and the appearance of caspase-like activity. To better understand the mechanism of cell death at the molecular level, we generated microarray gene expression profiles of S. boulardii cells cultured in an acidic environment. Significantly, functional annotation revealed that the up-regulated genes were significantly over-represented in cell death pathways Finally, we show that S-adenosyl-L-methionine (AdoMet), a commercially available, FDA-approved dietary supplement, enhances the viability of S. boulardii in acidic environments, most likely by preventing programmed cell death. In toto, given the observation that many of the proven health benefits of S. boulardii are dependent on cell viability, our data suggests that taking S. boulardii and AdoMet together may be a more effective treatment for gastrointestinal disorders than taking the probiotic yeast alone.

Abnormal intra-aural pressure waves associated with death in African children with acute nontraumatic coma.

PubMed

Gwer, Samson; Kazungu, Michael; Chengo, Eddie; Ohuma, Eric O; Idro, Richard; Birch, Tony; Marchbanks, Robert; Kirkham, Fenella J; Newton, Charles R

2015-07-01

We explored the relationship between tympanic membrane displacement (TMD) measurements, a tool to monitor intracranial pressure noninvasively, and clinical features and death in children with acute coma in Kilifi, Kenya. Between November 2007 and September 2009, we made serial TMD measurements and clinical observations on children with acute coma (Blantyre coma score (BCS) ≤ 2) on the pediatric high dependency unit of Kilifi District Hospital, and on well children presenting to the hospital's outpatient department for routine follow-up. We examined middle ear function using tympanometry and measured cardiac pulse (CPA) and respiratory pulse pressure amplitudes (RPA) using the TMD analyzer. We recruited 75 children (32 (43%) females; median age 3.3 (IQR: 2.0, 4.3) years). Twenty-one (28%) children died. Higher TMD measurements predicted death. Adjusting for diagnosis, every 50 nl rise in both semirecumbent and recumbent CPA was associated with increased odds of death associated with intracranial herniation (OR: 1.61, 95% confidence interval (CI): 1.07, 2.41; P = 0.02 and OR: 1.35, 95% CI: 1.10, 1.66; P ≤ 0.01 respectively). Raised TMD pulse pressure measurements are associated with death and may be useful in detecting and monitoring risk of intracranial herniation and intracranial pressure in childhood coma.

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

PubMed

Akhiwu, W O; Nwafor, C C; Igbe, A P

2013-01-01

To determine and classify the various types of medicolegal deaths as seen at University of Benin Teaching Hospital (UBTH), Benin City, Nigeria. This is a retrospective study of all the medicolegal deaths seen in the Department of Histopathology, (UBTH, Benin City over a 20 year period (January 1990-December 2009) as recorded in the autopsy registers of the department. A total of 5035 autopsies were done during the period, 89% of which were coroner cases. Four thousand, four hundred and eighty-one coroner cases representing 12.5% of all bodies received by the mortuary during the period were studied. The male to female ratio was 1.9:1, with an overall mean age of 38.3 years. The ages ranged from 1 day to 101 years with a peak incidence in the 25-44 years age group. A total of 553 children and 3928 adults were involved. The commonest indication for coroner's autopsy was sudden unexpected natural deaths (SUNDs) which accounted for 65.5% of the cases. Other causes of death were accidents, homicide, suicide, and undetermined causes representing 28.6, 5.0, 0.5, and 0.4%, respectively. Commonest cause of SUND was cardiovascular diseases with complications of hypertension being the most common CVS disease (26.9%). Road traffic accident was the commonest form of accident causing death (88.7%). Public enlightenment and health education about routine medical screening will help to reduce causes of natural deaths. This study shows the pattern of medicolegal autopsies in UBTH and this preliminary data will provide a baseline for future research and help in formulating policies to help in reduction of preventable causes of death.

SILHIL Replication of Electric Aircraft Powertrain Dynamics and Inner-Loop Control for V&V of System Health Management Routines

NASA Technical Reports Server (NTRS)

Bole, Brian; Teubert, Christopher Allen; Cuong Chi, Quach; Hogge, Edward; Vazquez, Sixto; Goebel, Kai; George, Vachtsevanos

2013-01-01

Software-in-the-loop and Hardware-in-the-loop testing of failure prognostics and decision making tools for aircraft systems will facilitate more comprehensive and cost-effective testing than what is practical to conduct with flight tests. A framework is described for the offline recreation of dynamic loads on simulated or physical aircraft powertrain components based on a real-time simulation of airframe dynamics running on a flight simulator, an inner-loop flight control policy executed by either an autopilot routine or a human pilot, and a supervisory fault management control policy. The creation of an offline framework for verifying and validating supervisory failure prognostics and decision making routines is described for the example of battery charge depletion failure scenarios onboard a prototype electric unmanned aerial vehicle.

Does Validation during Language Comprehension Depend on an Evaluative Mindset?

ERIC Educational Resources Information Center

Isberner, Maj-Britt; Richter, Tobias

2014-01-01

Whether information is routinely and nonstrategically evaluated for truth during comprehension is still a point of contention. Previous studies supporting the assumption of nonstrategic validation have used a Stroop-like paradigm in which participants provided yes/no judgments in tasks unrelated to the truth or plausibility of the experimental…

Applying verbal autopsy to determine cause of death in rural Vietnam.

PubMed

Huong, Dao Lan; Minh, Hoang Van; Byass, Peter

2003-01-01

Verbal autopsy (VA) is an attractive method for ascertaining causes of death in settings where the proportion of people who die under medical care is low. VA has been widely used to determine causes of childhood and maternal deaths, but has had limited use in assessing causes in adults and across all age groups. The objective was to test the feasibility of using VA to determine causes of death for all ages in Bavi District, Vietnam, in 1999, leading to an initial analysis of the mortality pattern in this area. Trained lay field workers interviewed a close caretaker of the deceased using a combination closed/open-ended questionnaire. A total of 189 deaths were studied. Diagnoses were made by two physicians separately, with good agreement (kappa = 0.84) and then combined to reach one single underlying cause of death for each case. The leading causes of death were cardiovascular and infectious diseases (accounting for 20.6% and 17.9% of the total respectively). Drowning was very prevalent in children under 15 (seven out of nine cases of drowning were in this age group). One month seemed an acceptable minimum recall period to ensure mourning procedures were over. A combination VA questionnaire was an appropriate instrument provided it was supported by adequate training of interviewers. Two physicians were appropriate for making the diagnoses but predefined diagnostic methods for common causes should be developed to ensure more replicable results and comparisons, as well as to observe trends of mortality over time. The causes of death in this study area reflect a typical pattern for developing countries that are in epidemiological transition. No maternal deaths and a low infant mortality rate may be the result of improvements in maternal and child health in this study area. Using the VA gave more precise causes of death than those reported at death registration. Although the validity of the VA method used has not been fully assessed, it appeared to be an appropriate

A Critical Analysis of Criticisms of the Oregon Death with Dignity Act

ERIC Educational Resources Information Center

Werth, James L., Jr.; Wineberg, Howard

2005-01-01

This article critically examines the validity of common criticisms of the Oregon Death with Dignity Act, primarily through reviewing published research and analyses. After summarizing the law and recent developments, 11 areas of concerns are examined: (a) the amount of data collected, (b) the availability of the data, (c) the reporting process,…

[Suicide due to mental diseases based on the Vital Statistics Survey Death Form].

PubMed

Takizawa, Tohru

2012-06-01

Mental diseases such as schizophrenia and depression put patients at risk for suicide. It is extremely important to understand that one way of preventing suicide is to determine the actual mental state of the individual. The purpose of this study was to analyze the true mental state of suicide victims reported in the vital statistics. This study investigated the vital statistics of 30,299 suicide victims in Japan in 2008. The use of these basic statistics for non-statistical purposes was approved by the Japanese Ministry of Health, Labour and Welfare. The method involved reviewing the Vital Statistics Survey Death Form at the Ministry of Health, Labour and Welfare as well as analyzing their Online Reporting of Vital Statistics. Furthermore, this study was able to validate 29,799 of the 30,299 suicides (98.3%) that occurred in 2008. Mental diseases were validated not only from the "Cause of death" section as marked on the death certificate, but also by information found in sections for "Additional items for death by external cause" and "Other special remarks." RESULTS; From the Vital Statistics Survey Death Form and Online Reporting of Vital Statistics, 2964 individuals with either a mental disease or mental disorder were identified. Of the 2964 identified individuals, 55 had dementia (of which 13 were dementia in Alzheimer's disease), 116 had alcohol dependence/psychotic disorder, 550 had schizophrenia, 101 had bipolar affective disorder, 1,913 has had a depressive episode, 13 had obsessive-compulsive disorder, 22 had adjustment disorders, 14 had eating disorders, 49 had nonorganic sleep disorders, 24 had personality disorder, and 6 had pervasive developmental disorders. In addition, 125 individuals had more than one mental disease. The national police statistics from 2008 show that 1,368 suicide victims had schizophrenia and 6,490 had depression. These figures show quite a difference between the results of this study and the police statistics. Further, there have

EOS Terra Validation Program

NASA Technical Reports Server (NTRS)

Starr, David

1999-01-01

The EOS Terra mission will be launched in July 1999. This mission has great relevance to the atmospheric radiation community and global change issues. Terra instruments include ASTER, CERES, MISR, MODIS and MOPITT. In addition to the fundamental radiance data sets, numerous global science data products will be generated, including various Earth radiation budget, cloud and aerosol parameters, as well as land surface, terrestrial ecology, ocean color, and atmospheric chemistry parameters. Significant investments have been made in on-board calibration to ensure the quality of the radiance observations. A key component of the Terra mission is the validation of the science data products. This is essential for a mission focused on global change issues and the underlying processes. The Terra algorithms have been subject to extensive pre-launch testing with field data whenever possible. Intensive efforts will be made to validate the Terra data products after launch. These include validation of instrument calibration (vicarious calibration) experiments, instrument and cross-platform comparisons, routine collection of high quality correlative data from ground-based networks, such as AERONET, and intensive sites, such as the SGP ARM site, as well as a variety field experiments, cruises, etc. Airborne simulator instruments have been developed for the field experiment and underflight activities including the MODIS Airborne Simulator (MAS), AirMISR, MASTER (MODIS-ASTER), and MOPITT-A. All are integrated on the NASA ER-2, though low altitude platforms are more typically used for MASTER. MATR is an additional sensor used for MOPITT algorithm development and validation. The intensive validation activities planned for the first year of the Terra mission will be described with emphasis on derived geophysical parameters of most relevance to the atmospheric radiation community. Detailed information about the EOS Terra validation Program can be found on the EOS Validation program

DEATH, DYING AND NEAR DEATH EXPERIENCE

PubMed Central

Singh, Ajai R.; Bagadia, V.N.; Pradhan, P.V.; Acharya, V.N.

1988-01-01

SUMMARY Psychology of deaths due to acute medical emergencies is under-researched. Most studies till now have concentrated on extended-death situations like malignancy. This open pilot study of twenty five patients examines the psychological state of patients during a life threatening acute medical illness (Group A, ten patients) and of those who survive such an experience (Group B, fifteen patients). The study finds psychological exploration both possible and necessary if carried out in a discreet manner. Salient features of the interview technique are discussed. The study finds out whether patients are aware of the possibility of terminality. The psychological disturbances manifest and nature of care expected are also discussed. Near Death Experiences of those who acknowledge their occurence are reported. Some nuances of thanatological research are high-lighted: What are the abilities needed in an interviewer? Can such exploration increase psychological distress in a patient already prone to it because of serious medical sickness? What impact such research can have on the interviewer himself? The paper answers some of these common questions while developing the method of thanatological study in acute medical death-situations. PMID:21927325

Influence of pesticide regulation on acute poisoning deaths in Sri Lanka.

PubMed Central

Roberts, Darren M.; Karunarathna, Ayanthi; Buckley, Nick A.; Manuweera, Gamini; Sheriff, M. H. Rezvi; Eddleston, Michael

2003-01-01

OBJECTIVES: To assess in a developing Asian country the impact of pesticide regulation on the number of deaths from poisoning. These regulations, which were implemented in Sri Lanka from the 1970s, aimed to reduce the number of deaths - the majority from self-poisoning - by limiting the availability and use of highly toxic pesticides. METHODS: Information on legislative changes was obtained from the Ministry of Agriculture, national and district hospital admission data were obtained from the Sri Lanka Health Statistics Unit, and individual details of deaths by pesticide poisoning were obtained from a manual review of patients' notes and intensive care unit records in Anuradhapura. FINDINGS: Between 1986 and 2000, the total national number of admissions due to poisoning doubled, and admissions due to pesticide poisoning increased by more than 50%. At the same time, the case fatality proportion (CFP) fell for total poisonings and for poisonings due to pesticides. In 1991_92, 72% of pesticide-induced deaths in Anuradhapura were caused by organophosphorus (OP) and carbamate pesticides - in particular, the WHO class I OPs monocrotophos and methamidophos. From 1991, the import of these pesticides was reduced gradually until they were banned for routine use in January 1995, with a corresponding fall in deaths. Unfortunately, their place in agricultural practice was taken by the WHO class II organochlorine endosulfan, which led to a rise in deaths from status epilepticus - from one in 1994 to 50 in 1998. Endosulfan was banned in 1998, and over the following three years the number of endosulfan deaths fell to three. However, at the end of the decade, the number of deaths from pesticides was at a similar level to that of 1991, with WHO class II OPs causing the most deaths. Although these drugs are less toxic than class I OPs, the management of class II OPs remains difficult because they are, nevertheless, still highly toxic, and their toxicity is exacerbated by the paucity

Children and Death.

ERIC Educational Resources Information Center

Brennan, Andrew J. J.

Health professionals and educators should develop their abilities to educate about death and to comfort the bereaved. Due to lower death rates, the lack of philosophical religious views, and distorted perceptions of death contributed by television, death has become a mystery instead of a segment of the common experience. Particularly when a child…

Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample.

PubMed

Lohman, Matthew C; Crow, Rebecca S; DiMilia, Peter R; Nicklett, Emily J; Bruce, Martha L; Batsis, John A

2017-12-01

Preventing falls and fall-related injuries among older adults is a public health priority. The Stopping Elderly Accidents, Deaths, and Injuries (STEADI) tool was developed to promote fall risk screening and encourage coordination between clinical and community-based fall prevention resources; however, little is known about the tool's predictive validity or adaptability to survey data. Data from five annual rounds (2011-2015) of the National Health and Aging Trends Study (NHATS), a representative cohort of adults age 65 years and older in the USA. Analytic sample respondents (n=7392) were categorised at baseline as having low, moderate or high fall risk according to the STEADI algorithm adapted for use with NHATS data. Logistic mixed-effects regression was used to estimate the association between baseline fall risk and subsequent falls and mortality. Analyses incorporated complex sampling and weighting elements to permit inferences at a national level. Participants classified as having moderate and high fall risk had 2.62 (95% CI 2.29 to 2.99) and 4.76 (95% CI 3.51 to 6.47) times greater odds of falling during follow-up compared with those with low risk, respectively, controlling for sociodemographic and health-related risk factors for falls. High fall risk was also associated with greater likelihood of falling multiple times annually but not with greater risk of mortality. The adapted STEADI clinical fall risk screening tool is a valid measure for predicting future fall risk using survey cohort data. Further efforts to standardise screening for fall risk and to coordinate between clinical and community-based fall prevention initiatives are warranted. © 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.

42 CFR 493.1267 - Standard: Routine chemistry.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Standard: Routine chemistry. 493.1267 Section 493.1267 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Systems § 493.1267 Standard: Routine chemistry. For blood gas analyses, the laboratory must perform the...

42 CFR 493.1267 - Standard: Routine chemistry.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard: Routine chemistry. 493.1267 Section 493.1267 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Systems § 493.1267 Standard: Routine chemistry. For blood gas analyses, the laboratory must perform the...

42 CFR 493.1267 - Standard: Routine chemistry.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Standard: Routine chemistry. 493.1267 Section 493.1267 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Systems § 493.1267 Standard: Routine chemistry. For blood gas analyses, the laboratory must perform the...

42 CFR 493.1267 - Standard: Routine chemistry.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Standard: Routine chemistry. 493.1267 Section 493.1267 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Systems § 493.1267 Standard: Routine chemistry. For blood gas analyses, the laboratory must perform the...

42 CFR 493.1267 - Standard: Routine chemistry.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Standard: Routine chemistry. 493.1267 Section 493.1267 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Systems § 493.1267 Standard: Routine chemistry. For blood gas analyses, the laboratory must perform the...

Religiosity and the Construction of Death in Turkish Death Announcements, 1970-2009

ERIC Educational Resources Information Center

Ergin, Murat

2012-01-01

Death and rituals performed after death reflect and reproduce social distinctions despite death's popular reputation as a great leveler. This study examines expressions of religiosity and constructions of death in Turkish death announcements, paying particular attention to gendered, ethnic, and temporal variations as well as markers of status and…

An assessment of routine primary care health information system data quality in Sofala Province, Mozambique

PubMed Central

2011-01-01

Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS) are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sample of primary health care HIS data from nine health facilities across three districts in Sofala Province, Mozambique. HIS data were also compared with results from large community-based surveys. Methodology We used a methodology similar to the Global Fund to Fight AIDS, Tuberculosis and Malaria data verification bottom-up audit to assess primary health care HIS data availability and reliability. The quality of HIS data was validated by comparing three key indicators (antenatal care, institutional birth, and third diptheria, pertussis, and tetanus [DPT] immunization) with population-level surveys over time. Results and discussion The data concordance from facility clinical registries to monthly facility reports on five key indicators--the number of first antenatal care visits, institutional births, third DPT immunization, HIV testing, and outpatient consults--was good (80%). When two sites were excluded from the analysis, the concordance was markedly better (92%). Of monthly facility reports for immunization and maternity services, 98% were available in paper form at district health departments and 98% of immunization and maternity services monthly facility reports matched the Ministry of Health electronic database. Population-level health survey and HIS data were strongly correlated (R = 0.73), for institutional birth, first antenatal care visit, and third DPT immunization. Conclusions Our results suggest that in this setting, HIS data are both reliable and consistent, supporting their

PA6 Death chat: engaging with dying and death.

PubMed

Goodhead, Andrew; Hartley, Nigel

2015-04-01

Talking about death continues to be a social taboo. St Christopher's has a large, welcoming social space, (The Anniversary Centre) and is committed to opening up its buildings in a number of ways. The St Christopher's social programme, of which Death Chat is part, aims to break down social taboos. Hospices have a responsibility to engage creatively with patients, family members, carers and the wider community. Death Chat, held in the hospice buildings, enables honest discussion about dying and death and topics surrounding these themes. Death Chat meets weekly and is an open meeting that takes a different subject each week as the starting point for conversation. Cheese and wine are shared and participants quickly find a place in the group. Death Chat has attracted patients, family members, bereaved relatives and the community since September 2013. Attendees have reflected that coming has broken taboos. Peter said, 'it's nowhere near as depressing as it sounds; it's a nice, friendly atmosphere - a convivial place.' Molly found Death Chat to be a welcoming, open and challenging space, 'I have learnt that death is more about my attitude to life than anything else. It has been by far the most important lesson I have learnt since dealing with bereavement.' Death Chat provides a forum in which discussion of dying and death for recognises that these are social events and reclaims them from being taboo, to being a normal part of life's experience. © 2015, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Validity of Diagnostic Codes for Acute Stroke in Administrative Databases: A Systematic Review

PubMed Central

McCormick, Natalie; Bhole, Vidula; Lacaille, Diane; Avina-Zubieta, J. Antonio

2015-01-01

Objective To conduct a systematic review of studies reporting on the validity of International Classification of Diseases (ICD) codes for identifying stroke in administrative data. Methods MEDLINE and EMBASE were searched (inception to February 2015) for studies: (a) Using administrative data to identify stroke; or (b) Evaluating the validity of stroke codes in administrative data; and (c) Reporting validation statistics (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), or Kappa scores) for stroke, or data sufficient for their calculation. Additional articles were located by hand search (up to February 2015) of original papers. Studies solely evaluating codes for transient ischaemic attack were excluded. Data were extracted by two independent reviewers; article quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Results Seventy-seven studies published from 1976–2015 were included. The sensitivity of ICD-9 430-438/ICD-10 I60-I69 for any cerebrovascular disease was ≥ 82% in most [≥ 50%] studies, and specificity and NPV were both ≥ 95%. The PPV of these codes for any cerebrovascular disease was ≥ 81% in most studies, while the PPV specifically for acute stroke was ≤ 68%. In at least 50% of studies, PPVs were ≥ 93% for subarachnoid haemorrhage (ICD-9 430/ICD-10 I60), 89% for intracerebral haemorrhage (ICD-9 431/ICD-10 I61), and 82% for ischaemic stroke (ICD-9 434/ICD-10 I63 or ICD-9 434&436). For in-hospital deaths, sensitivity was 55%. For cerebrovascular disease or acute stroke as a cause-of-death on death certificates, sensitivity was ≤ 71% in most studies while PPV was ≥ 87%. Conclusions While most cases of prevalent cerebrovascular disease can be detected using 430-438/I60-I69 collectively, acute stroke must be defined using more specific codes. Most in-hospital deaths and death certificates with stroke as a cause-of-death correspond to true stroke deaths. Linking vital

Breaking the Waves: Routines and Rituals in Entrepreneurship Education

ERIC Educational Resources Information Center

Neergaard, Helle; Christensen, Dorthe Refslund

2017-01-01

Learning is related to the environment created for the learning experience. This environment is often highly routinized and involves a certain social structure, but in entrepreneurship education, such routinization and structure may actually counteract the learning goals. This article investigates how classroom routines and rituals impact on…

Cardiac Glycoside Glucoevatromonoside Induces Cancer Type-Specific Cell Death

PubMed Central

Schneider, Naira F. Z.; Cerella, Claudia; Lee, Jin-Young; Mazumder, Aloran; Kim, Kyung Rok; de Carvalho, Annelise; Munkert, Jennifer; Pádua, Rodrigo M.; Kreis, Wolfgang; Kim, Kyu-Won; Christov, Christo; Dicato, Mario; Kim, Hyun-Jung; Han, Byung Woo; Braga, Fernão C.; Simões, Cláudia M. O.; Diederich, Marc

2018-01-01

Cardiac glycosides (CGs) are natural compounds used traditionally to treat congestive heart diseases. Recent investigations repositioned CGs as potential anticancer agents. To discover novel cytotoxic CG scaffolds, we selected the cardenolide glucoevatromonoside (GEV) out of 46 CGs for its low nanomolar anti-lung cancer activity. GEV presented reduced toxicity toward non-cancerous cell types (lung MRC-5 and PBMC) and high-affinity binding to the Na+/K+-ATPase α subunit, assessed by computational docking. GEV-induced cell death was caspase-independent, as investigated by a multiparametric approach, and culminates in severe morphological alterations in A549 cells, monitored by transmission electron microscopy, live cell imaging and flow cytometry. This non-canonical cell death was not preceded or accompanied by exacerbation of autophagy. In the presence of GEV, markers of autophagic flux (e.g. LC3I-II conversion) were impacted, even in presence of bafilomycin A1. Cell death induction remained unaffected by calpain, cathepsin, parthanatos, or necroptosis inhibitors. Interestingly, GEV triggered caspase-dependent apoptosis in U937 acute myeloid leukemia cells, witnessing cancer-type specific cell death induction. Differential cell cycle modulation by this CG led to a G2/M arrest, cyclin B1 and p53 downregulation in A549, but not in U937 cells. We further extended the anti-cancer potential of GEV to 3D cell culture using clonogenic and spheroid formation assays and validated our findings in vivo by zebrafish xenografts. Altogether, GEV shows an interesting anticancer profile with the ability to exert cytotoxic effects via induction of different cell death modalities. PMID:29545747

[Physician's competence and obligations at the place of subject's death outside the health-care facilities].

PubMed

Dvorácek, I

2005-10-01

The valid law does not unequivocally define a physician's competence and obligations at the place of a subject's death outside the health-care facilities. The scheme creates a general instruction for the medical personnel to be used in cases of death outside health-care facilities. It is aimed at a better understanding of the problem, and it is supplemented with relevant legal regulations. The scheme is divided into 3 horizontal levels, the death being placed on the first level, the decision about autopsy on the second level, and the burial on the third level. These three levels are interconnected vertically, in order to represent the chronological sequence of individual steps and the respective decisions made by the examining physician. The schematic representation of the problems of death outside health-care facilities resulted in several lines of action, all that with regard to the medical and forensic aspects of the death. In every line of action, the work of the examining physician's is summarised.

Towards shared patient records: an architecture for using routine data for nationwide research.

PubMed

Knaup, Petra; Garde, Sebastian; Merzweiler, Angela; Graf, Norbert; Schilling, Freimut; Weber, Ralf; Haux, Reinhold

2006-01-01

Ubiquitous information is currently one of the most challenging slogans in medical informatics research. An adequate architecture for shared electronic patient records is needed which can use data for multiple purposes and which is extensible for new research questions. We introduce eardap as architecture for using routine data for nationwide clinical research in a multihospital environment. eardap can be characterized as terminology-based. Main advantage of our approach is the extensibility by new items and new research questions. Once the definition of items for a research question is finished, a consistent, corresponding database can be created without any informatics skills. Our experiences in pediatric oncology in Germany have shown the applicability of eardap. The functions of our core system were in routine clinical use in several hospitals. We validated the terminology management system (TMS) and the module generation tool with the basic data set of pediatric oncology. The multiple usability depends mainly on the quality of item planning in the TMS. High quality harmonization will lead to a higher amount of multiply used data. When using eardap, special emphasis is to be placed on interfaces to local hospital information systems and data security issues.

42 CFR 493.841 - Standard; Routine chemistry.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Standard; Routine chemistry. 493.841 Section 493.841 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.841 Standard; Routine chemistry. (a) Failure to attain a score of at least 80 percent...

42 CFR 493.841 - Standard; Routine chemistry.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 5 2011-10-01 2011-10-01 false Standard; Routine chemistry. 493.841 Section 493.841 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.841 Standard; Routine chemistry. (a) Failure to attain a score of at least 80 percent...

42 CFR 493.841 - Standard; Routine chemistry.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 5 2013-10-01 2013-10-01 false Standard; Routine chemistry. 493.841 Section 493.841 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.841 Standard; Routine chemistry. (a) Failure to attain a score of at least 80 percent...

42 CFR 493.841 - Standard; Routine chemistry.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 5 2014-10-01 2014-10-01 false Standard; Routine chemistry. 493.841 Section 493.841 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.841 Standard; Routine chemistry. (a) Failure to attain a score of at least 80 percent...

42 CFR 493.841 - Standard; Routine chemistry.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 5 2012-10-01 2012-10-01 false Standard; Routine chemistry. 493.841 Section 493.841 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... These Tests § 493.841 Standard; Routine chemistry. (a) Failure to attain a score of at least 80 percent...

Online registration of monthly sports participation after anterior cruciate ligament injury: a reliability and validity study

PubMed Central

Grindem, Hege; Eitzen, Ingrid; Snyder-Mackler, Lynn; Risberg, May Arna

2013-01-01

Background Current methods measuring sports activity after anterior cruciate ligament (ACL) injury are commonly restricted to the most knee-demanding sport, and do not consider participation in multiple sports. We therefore developed an online activity survey to prospectively record monthly participation in all major sports relevant to our patient-group. Objective To assess the reliability, content validity, and concurrent validity of the survey, and evaluate if it provided more complete data on sports participation than a routine activity questionnaire. Methods One hundred and forty-five consecutively included ACL-injured patients were eligible for the reliability study. The retest of the online activity survey was performed two days after the test response had been recorded. A subsample of 88 ACL-reconstructed patients were included in the validity study. The ACL-reconstructed patients completed the online activity survey from the first to the twelfth postoperative month, and a routine activity questionnaire 6 and 12 months postoperatively. Results The online activity survey was highly reliable (κ ranging from 0.81 to 1). It contained all the common sports reported on the routine activity questionnaire. There was substantial agreement between the two methods on return to preinjury main sport (κ = 0.71 and 0.74 at 6 and 12 months postoperatively). The online activity survey revealed that a significantly higher number of patients reported to participate in running, cycling and strength training, and patients reported to participate in a greater number of sports. Conclusion The online activity survey is a highly reliable way of recording detailed changes in sports participation after ACL injury. The findings of this study support the content and concurrent validity of the survey, and suggest that the online activity survey can provide more complete data on sports participation than a routine activity questionnaire. PMID:23645830

Online registration of monthly sports participation after anterior cruciate ligament injury: a reliability and validity study.

PubMed

Grindem, Hege; Eitzen, Ingrid; Snyder-Mackler, Lynn; Risberg, May Arna

2014-05-01

The current methods measuring sports activity after anterior cruciate ligament (ACL) injury are commonly restricted to the most knee-demanding sports, and do not consider participation in multiple sports. We therefore developed an online activity survey to prospectively record the monthly participation in all major sports relevant to our patient-group. To assess the reliability, content validity and concurrent validity of the survey and to evaluate if it provided more complete data on sports participation than a routine activity questionnaire. 145 consecutively included ACL-injured patients were eligible for the reliability study. The retest of the online activity survey was performed 2 days after the test response had been recorded. A subsample of 88 ACL-reconstructed patients was included in the validity study. The ACL-reconstructed patients completed the online activity survey from the first to the 12th postoperative month, and a routine activity questionnaire 6 and 12 months postoperatively. The online activity survey was highly reliable (κ ranging from 0.81 to 1). It contained all the common sports reported on the routine activity questionnaire. There was a substantial agreement between the two methods on return to preinjury main sport (κ=0.71 and 0.74 at 6 and 12 months postoperatively). The online activity survey revealed that a significantly higher number of patients reported to participate in running, cycling and strength training, and patients reported to participate in a greater number of sports. The online activity survey is a highly reliable way of recording detailed changes in sports participation after ACL injury. The findings of this study support the content and concurrent validity of the survey, and suggest that the online activity survey can provide more complete data on sports participation than a routine activity questionnaire.

Intimate partner homicide and corollary victims in 16 states: National Violent Death Reporting System, 2003-2009.

PubMed

Smith, Sharon G; Fowler, Katherine A; Niolon, Phyllis H

2014-03-01

We estimated the frequency and examined the characteristics of intimate partner homicide and related deaths in 16 US states participating in the National Violent Death Reporting System (NVDRS), a state-based surveillance system. We used a combination of quantitative and qualitative methods to analyze NVDRS data from 2003 to 2009. We selected deaths linked to intimate partner violence for analysis. Our sample comprised 4470 persons who died in the course of 3350 intimate partner violence-related homicide incidents. Intimate partners and corollary victims represented 80% and 20% of homicide victims, respectively. Corollary homicide victims included family members, new intimate partners, friends, acquaintances, police officers, and strangers. Our findings, from the first multiple-state study of intimate partner homicide and corollary homicides, demonstrate that the burden of intimate partner violence extends beyond the couple involved. Systems (e.g., criminal justice, medical care, and shelters) whose representatives routinely interact with victims of intimate partner violence can help assess the potential for lethal danger, which may prevent intimate partner and corollary victims from harm.

Risk factors for anaesthetic-related death in cats: results from the confidential enquiry into perioperative small animal fatalities (CEPSAF).

PubMed

Brodbelt, D C; Pfeiffer, D U; Young, L E; Wood, J L N

2007-11-01

Cats are commonly anaesthetized in veterinary practice, but recent figures describing the frequency of or risk factors for anaesthetic-related death are not available. The aims of this study were to address these deficiencies. A nested case-control study was undertaken in 117 UK veterinary centres. All anaesthetic and sedation procedures and anaesthetic and sedation-related deaths (i.e. 'cases') occurring within 48 h were recorded. Details of patient, procedure, and perioperative management were recorded for all cases and randomly selected non-deaths (controls). A detailed statistical model of factors associated with anaesthetic and sedation-related death was constructed. Between June 2002 and June 2004, 175 deaths were classified as anaesthetic and sedation-related and 14 additional deaths (with insufficient information to be excluded) were included for the estimation of risk. During the study, 79 178 anaesthetic and sedation procedures were recorded and the overall risk of anaesthetic and sedation-related death was 0.24% (95% CI 0.20-0.27). Factors associated with increased odds of anaesthetic-related death were poor health status (ASA physical status classification), increasing age, extremes of weight, increasing procedural urgency and complexity, endotracheal intubation, and fluid therapy. Pulse monitoring and pulse oximetry were associated with reduced odds. The risk of anaesthetic-related death in cats appears to have decreased since the last published study in the UK. The results should aid the preoperative identification of cats at greatest risk. Greater care with endotracheal intubation and fluid administration are recommended, and pulse and pulse oximetry monitoring should be routinely implemented in cats.

Child Passenger Deaths Involving Alcohol-Impaired Drivers

PubMed Central

Quinlan, Kyran; Shults, Ruth A.; Rudd, Rose A.

2017-01-01

BACKGROUND AND OBJECTIVE Approximately 1 in 5 child passenger deaths in the United States involves an alcohol-impaired driver, most commonly the child’s own driver. The objective of this study was to document recent trends and state-specific rates of these deaths. METHODS A descriptive analysis of 2001–2010 Fatality Analysis Reporting System data for child passengers aged <15 years killed in alcohol-impaired driving crashes. Driver impairment was defined as a blood alcohol concentration of ≥0.08 g/dL. RESULTS During 2001–2010, 2344 children <15 years were killed in crashes involving at least 1 alcohol-impaired driver. Of these children, 1515 (65%) were riding with an impaired driver. Annual deaths among children riding with an alcohol-impaired driver decreased by 41% over the decade. Among the 37 states included in the state-level analysis, Texas (272) and California (135) had the most children killed while riding with an impaired driver and South Dakota (0.98) and New Mexico (0.86) had the highest annualized child passenger death rates (per 100 000 children). Most (61%) child passengers of impaired drivers were unrestrained at the time of the crash. One-third of the impaired drivers did not have a valid driver’s license. CONCLUSIONS Alcohol-impaired driving remains a substantial threat to the safety of child passengers in the United States, and typically involves children being driven by impaired drivers. This risk varies meaningfully among states. To make further progress, states and communities could consider increased use of effective interventions and efforts aimed specifically at protecting child passengers from impaired drivers. PMID:24799550

Psychometric evaluation of the Persian version of the Templer's Death Anxiety Scale in cancer patients.

PubMed

Soleimani, Mohammad Ali; Yaghoobzadeh, Ameneh; Bahrami, Nasim; Sharif, Saeed Pahlevan; Sharif Nia, Hamid

2016-10-01

In this study, 398 Iranian cancer patients completed the 15-item Templer's Death Anxiety Scale (TDAS). Tests of internal consistency, principal components analysis, and confirmatory factor analysis were conducted to assess the internal consistency and factorial validity of the Persian TDAS. The construct reliability statistic and average variance extracted were also calculated to measure construct reliability, convergent validity, and discriminant validity. Principal components analysis indicated a 3-component solution, which was generally supported in the confirmatory analysis. However, acceptable cutoffs for construct reliability, convergent validity, and discriminant validity were not fulfilled for the three subscales that were derived from the principal component analysis. This study demonstrated both the advantages and potential limitations of using the TDAS with Persian-speaking cancer patients.

Feasibility of opportunistic osteoporosis screening in routine contrast-enhanced multi detector computed tomography (MDCT) using texture analysis.

PubMed

Mookiah, M R K; Rohrmeier, A; Dieckmeyer, M; Mei, K; Kopp, F K; Noel, P B; Kirschke, J S; Baum, T; Subburaj, K

2018-04-01

This study investigated the feasibility of opportunistic osteoporosis screening in routine contrast-enhanced MDCT exams using texture analysis. The results showed an acceptable reproducibility of texture features, and these features could discriminate healthy/osteoporotic fracture cohort with an accuracy of 83%. This aim of this study is to investigate the feasibility of opportunistic osteoporosis screening in routine contrast-enhanced MDCT exams using texture analysis. We performed texture analysis at the spine in routine MDCT exams and investigated the effect of intravenous contrast medium (IVCM) (n = 7), slice thickness (n = 7), the long-term reproducibility (n = 9), and the ability to differentiate healthy/osteoporotic fracture cohort (n = 9 age and gender matched pairs). Eight texture features were extracted using gray level co-occurrence matrix (GLCM). The independent sample t test was used to rank the features of healthy/fracture cohort and classification was performed using support vector machine (SVM). The results revealed significant correlations between texture parameters derived from MDCT scans with and without IVCM (r up to 0.91) slice thickness of 1 mm versus 2 and 3 mm (r up to 0.96) and scan-rescan (r up to 0.59). The performance of the SVM classifier was evaluated using 10-fold cross-validation and revealed an average classification accuracy of 83%. Opportunistic osteoporosis screening at the spine using specific texture parameters (energy, entropy, and homogeneity) and SVM can be performed in routine contrast-enhanced MDCT exams.

Accuracy and usefulness of the AVOXimeter 4000 as routine analysis of carboxyhemoglobin.

PubMed

Fujihara, Junko; Kinoshita, Hiroshi; Tanaka, Naoko; Yasuda, Toshihiro; Takeshita, Haruo

2013-07-01

The measurement of blood carboxyhemoglobin (CO-Hb) is important to determine the cause of death. The AVOXimeter 4000 (AVOX), a portable CO-oximeter, has the advantages of a low purchase price and operating cost, ease of operation, and rapid results. Little information is available on the usefulness of AVOX in the forensic sample, and the previous study investigated only six samples. Therefore, in this study, we confirmed the usefulness of the AVOX through a comparison of its results with data previously obtained using the double wavelength spectrophotometric method in autopsies. Regression analysis was performed between CO-Hb levels measured by the AVOX and those measured by the conventional double wavelength spectrophotometric method in postmortem blood samples: a significant correlation was observed. This study suggests the usefulness of the AVOX to analyze postmortem blood, and the AVOX is suitable for routine forensic analysis and can be applied at the crime scene. © 2013 American Academy of Forensic Sciences.

Multiplex Staining by Sequential Immunostaining and Antibody Removal on Routine Tissue Sections.

PubMed

Bolognesi, Maddalena Maria; Manzoni, Marco; Scalia, Carla Rossana; Zannella, Stefano; Bosisio, Francesca Maria; Faretta, Mario; Cattoretti, Giorgio

2017-08-01

Multiplexing, labeling for multiple immunostains in the very same cell or tissue section in situ, has raised considerable interest. The methods proposed include the use of labeled primary antibodies, spectral separation of fluorochromes, bleaching of the fluorophores or chromogens, blocking of previous antibody layers, all in various combinations. The major obstacles to the diffusion of this technique are high costs in custom antibodies and instruments, low throughput, and scarcity of specialized skills or facilities. We have validated a method based on common primary and secondary antibodies and diffusely available fluorescent image scanners. It entails rounds of four-color indirect immunofluorescence, image acquisition, and removal (stripping) of the antibodies, before another stain is applied. The images are digitally registered and the autofluorescence is subtracted. Removal of antibodies is accomplished by disulfide cleavage and a detergent or by a chaotropic salt treatment, this latter followed by antigen refolding. More than 30 different antibody stains can be applied to one single section from routinely fixed and embedded tissue. This method requires a modest investment in hardware and materials and uses freeware image analysis software. Multiplexing on routine tissue sections is a high throughput tool for in situ characterization of neoplastic, reactive, inflammatory, and normal cells.

The Ontological Representation of Death: A Scale to Measure the Idea of Annihilation Versus Passage.

PubMed

Testoni, Ines; Ancona, Dorella; Ronconi, Lucia

2015-01-01

Since the borders between natural life and death have been blurred by technique, in Western societies discussions and practices regarding death have became infinite. The studies in this area include all the most important topics of psychology, sociology, and philosophy. From a psychological point of view, the research has created many instruments for measuring death anxiety, fear, threat, depression, meaning of life, and among them, the profiles on death attitude are innumerable. This research presents the validation of a new attitude scale, which conjoins psychological dimensions and philosophical ones. This scale may be useful because the ontological idea of death has not yet been considered in research. The hypothesis is that it is different to believe that death is absolute annihilation than to be sure that it is a passage or a transformation of one's personal identity. The hypothetical difference results in a greater inner suffering caused by the former idea. In order to measure this possibility, we analyzed the correlation between Testoni Death Representation Scale and Beck Hopelessness Scale, Suicide Resilience Inventory-25, and Reasons for Living Inventory. The results confirm the hypothesis, showing that the representation of death as total annihilation is positively correlated to hopelessness and negatively correlated to resilience.

Risk of cardiovascular events and death in the life after aneurysmal subarachnoid haemorrhage: a nationwide study.

PubMed

Nieuwkamp, Dennis J; Vaartjes, Ilonca; Algra, Ale; Rinkel, Gabriel J E; Bots, Michiel L

2014-12-01

The increased mortality rates of survivors of aneurysmal subarachnoid haemorrhage have been attributed to an increased risk of cardiovascular events in a registry study in Sweden. Swedish registries have however not been validated for subarachnoid haemorrhage and Scandinavian incidences of cardiovascular disease differ from that in Western European countries. We assessed risks of vascular disease and death in subarachnoid haemorrhage survivors in the Netherlands. From the Dutch hospital discharge register, we identified all patients with subarachnoid haemorrhage admission between 1997 and 2008. We determined the accuracy of coding of the diagnosis subarachnoid haemorrhage for patients admitted to our centre. Conditional on survival of three-months after the subarachnoid haemorrhage, we calculated standardized incidence and mortality ratios for fatal or nonfatal vascular diseases, vascular death, and all-cause death. Cumulative risks were estimated with survival analysis. The diagnosis of nontraumatic subarachnoid haemorrhage was correct in 95·4% of 1472 patients. Of 11,263 admitted subarachnoid haemorrhage patients, 6999 survived more than three-months. During follow-up (mean 5·1 years), 874 (12·5%) died. The risks of death were 3·3% within one-year, 11·3% within five-years, and 21·5% within 10 years. The standardized mortality ratio was 3·4 (95% confidence interval: 3·1 to 3·7) for vascular death and 2·2 (95% confidence interval: 2·1 to 2·3) for all-cause death. The standardized incidence ratio for fatal or nonfatal vascular diseases was 2·7 (95% confidence interval: 2·6 to 2·8). Dutch hospital discharge and cause of death registries are a valid source of data for subarachnoid haemorrhage, and show that the increased mortality rate in subarachnoid haemorrhage survivors is explained by increased risks for vascular diseases and death. © 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.

Nursing Care at the Time of Death: A Bathing and Honoring Practice.

PubMed

Rodgers, Debra; Calmes, Beth; Grotts, Jonathan

2016-05-01

To explore family members' experience of a bathing and honoring practice after a loved one's death in the acute care setting.
. A descriptive, qualitative design using a semistructured telephone interview script.
. The Inpatient Adult Oncology Unit at Santa Barbara Cottage Hospital in California. 
. 13 family members who participated in the bathing and honoring practice after their loved one's death on the oncology unit.
. Participants were selected by purposive sampling and interviewed by telephone three to six months after their loved one's death. Interviews using a semistructured script with open-ended questions were recorded, transcribed, verified, and analyzed using phenomenologic research techniques to identify common themes of experience.
. 24 first-level themes and 11 superordinate themes emerged from the data. All participants indicated that the bathing and honoring practice was a positive experience and supported the grieving process. The majority found the practice to be meaningful and stated that it honored their loved one. Many expressed that the bathing and honoring was spiritually significant in a nondenominational way and that they hope it will be made available to all families of patients who die in the hospital. 
. After patient death, a bathing and honoring practice with family member participation is positive and meaningful, and it supports family members' initial grieving.
. This study is a first step toward establishing specific nursing interventions as evidence-based practice that can be incorporated in routine nursing care for patients and families at the end of life.

How do family physicians measure blood pressure in routine clinical practice?

PubMed Central

Kaczorowski, Janusz; Myers, Martin G.; Gelfer, Mark; Dawes, Martin; Mang, Eric J.; Berg, Angelique; Grande, Claudio Del; Kljujic, Dragan

2017-01-01

Abstract Objective To describe the techniques currently used by family physicians in Canada to measure blood pressure (BP) for screening for, diagnosing, and treating hypertension. Design A Web-based cross-sectional survey distributed by e-mail. Setting Stratified random sample of family physicians in Canada. Participants Family physician members of the College of Family Physicians of Canada with valid e-mail addresses. Main outcome measures Physicians’ self-reported routine methods for recording BP in their practices to screen for, diagnose, and manage hypertension. Results A total of 774 valid responses were received, for a response rate of 16.2%. Respondents were similar to nonrespondents except for underrepresentation of male physicians. Of 769 respondents, 417 (54.2%) indicated that they used manual office BP measurement with a mercury or aneroid device and stethoscope as the routine method to screen patients for high BP, while 42.9% (330 of 769) reported using automated office BP (AOBP) measurement. The method most frequently used to make a diagnosis of hypertension was AOBP measurement (31.1%, 240 of 771), followed by home BP measurement (22.4%, 173 of 771) and manual office BP measurement (21.4%, 165 of 771). Ambulatory BP monitoring (ABPM) was used for diagnosis by 14.4% (111 of 771) of respondents. The most frequently reported method for ongoing management was home BP monitoring (68.7%, 528 of 769), followed by manual office BP measurement (63.6%, 489 of 769) and AOBP measurement (59.2%, 455 of 769). More than three-quarters (77.8%, 598 of 769) of respondents indicated that ABPM was readily available for their patients. Conclusion Canadian family physicians exhibit overall high use of electronic devices for BP measurement, However, more efforts are needed to encourage practitioners to follow current Canadian guidelines, which advocate the use of AOBP measurement for hypertension screening, ABPM and home BP measurement for making a diagnosis, and both

Characteristics of deaths occurring in hospitalised children: changing trends

PubMed Central

Ramnarayan, Padmanabhan; Craig, Finella; Petros, Andy; Pierce, Christine

2007-01-01

Background Despite a gradual shift in the focus of medical care among terminally ill patients to a palliative model, studies suggest that many children with life‐limiting chronic illnesses continue to die in hospital after prolonged periods of inpatient admission and mechanical ventilation. Objectives To (1) examine the characteristics and location of death among hospitalised children, (2) investigate yearwise trends in these characteristics and (3) test the hypothesis that professional ethical guidance from the UK Royal College of Paediatrics and Child Health (1997) would lead to significant changes in the characteristics of death among hospitalised children. Methods Routine administrative data from one large tertiary‐level UK children's hospital was examined over a 7‐year period (1997–2004) for children aged 0–18 years. Demographic details, location of deaths, source of admission (within hospital vs external), length of stay and final diagnoses (International Classification of Diseases‐10 codes) were studied. Statistical significance was tested by the Kruskal–Wallis analysis of ranks and median test (non‐parametric variables), χ2 test (proportions) and Cochran–Armitage test (linear trends). Results Of the 1127 deaths occurring in hospital over the 7‐year period, the majority (57.7%) were among infants. The main diagnoses at death included congenital malformations (22.2%), perinatal diseases (18.1%), cardiovascular disorders (14.9%) and neoplasms (12.4%). Most deaths occurred in an intensive care unit (ICU) environment (85.7%), with a significant increase over the years (80.1% in 1997 to 90.6% in 2004). There was a clear increase in the proportion of admissions from in‐hospital among the ICU cohort (14.8% in 1998 to 24.8% in 2004). Infants with congenital malformations and perinatal conditions were more likely to die in an ICU (OR 2.42, 95% CI 1.65 to 3.55), and older children with malignancy outside the ICU (OR 6.5, 95% CI 4.4 to 9

Support after perinatal death: a study of support and counselling after perinatal bereavement.

PubMed Central

Forrest, G C; Standish, E; Baum, J D

1982-01-01

After an earlier study into the practical aspects of the management of perinatal death, a counselling service was introduced for parents whose baby had died in the perinatal period. The service was monitored, and the parents who received the service were compared with a group that did not. Fifty families were allocated randomly either to the counselling (supported) group or to the contrast group, who received routine hospital care. Assessment was carried out at six and 14 months after the death, using a semi-structured interview and two self-rating scales (the general health questionnaire and the Leeds scales). Two of 16 mothers in the supported group showed psychiatric disorder at six months, compared with 10 of 19 in the contrast group (p less than 0.01, Fisher's exact test). There was no significant difference between the two groups at 14 months, when 80% of all the women studied had recovered psychiatric symptoms. Socially isolated women and those who marital relations lacked intimacy had a higher incidence of psychiatric symptoms at six months. Early pregnancy (within six months) was associated with a higher incidence of psychiatric symptoms in the unsupported group. The duration of bereavement reaction after perinatal death was appreciably shortened by support and counselling. PMID:6814610

Routines and Transitions: A Guide for Early Childhood Professionals

ERIC Educational Resources Information Center

Malenfont, Nicole

2006-01-01

In early childhood settings, children spend over 50 percent of their time on handwashing, dressing, napping, and other routines and transitions. "Routines and Transitions" is a guide to help turn these routine daily activities into learning experiences. By using transitions wisely, providers not only help children develop skills, but also run a…

Assessment of the wish to hasten death in patients with advanced disease: A systematic review of measurement instruments.

PubMed

Bellido-Pérez, Mercedes; Monforte-Royo, Cristina; Tomás-Sábado, Joaquín; Porta-Sales, Josep; Balaguer, Albert

2017-06-01

Patients with advanced conditions may present a wish to hasten death. Assessing this wish is complex due to the nature of the phenomenon and the difficulty of conceptualising it. To identify and analyse existing instruments for assessing the wish to hasten death and to rate their reported psychometric properties. Systematic review based on PRISMA guidelines. The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of validation studies and the measurement properties of the instrument described. The CINAHL, PsycINFO, Pubmed and Web of Science databases were searched from inception to November 2015. A total of 50 articles involving assessment of the wish to hasten death were included. Eight concerned instrument validation and were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments criteria. They reported data for between two and seven measurement properties, with ratings between fair and excellent. Of the seven instruments identified, the Desire for Death Rating Scale or the Schedule of Attitudes toward Hastened Death feature in 48 of the 50 articles. The Schedule of Attitudes toward Hastened Death is the most widely used and is the instrument whose psychometric properties have been most often analysed. Versions of the Schedule of Attitudes toward Hastened Death are available in five languages other than the original English. This systematic review has analysed existing instruments for assessing the wish to hasten death. It has also explored the methodological quality of studies that have examined the measurement properties of these instruments and offers ratings of the reported properties. These results will be useful to clinicians and researchers with an interest in a phenomenon of considerable relevance to advanced patients.

Assessment of the wish to hasten death in patients with advanced disease: A systematic review of measurement instruments

PubMed Central

Bellido-Pérez, Mercedes; Monforte-Royo, Cristina; Tomás-Sábado, Joaquín; Porta-Sales, Josep; Balaguer, Albert

2016-01-01

Background: Patients with advanced conditions may present a wish to hasten death. Assessing this wish is complex due to the nature of the phenomenon and the difficulty of conceptualising it. Aim: To identify and analyse existing instruments for assessing the wish to hasten death and to rate their reported psychometric properties. Design: Systematic review based on PRISMA guidelines. The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of validation studies and the measurement properties of the instrument described. Data sources: The CINAHL, PsycINFO, Pubmed and Web of Science databases were searched from inception to November 2015. Results: A total of 50 articles involving assessment of the wish to hasten death were included. Eight concerned instrument validation and were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments criteria. They reported data for between two and seven measurement properties, with ratings between fair and excellent. Of the seven instruments identified, the Desire for Death Rating Scale or the Schedule of Attitudes toward Hastened Death feature in 48 of the 50 articles. The Schedule of Attitudes toward Hastened Death is the most widely used and is the instrument whose psychometric properties have been most often analysed. Versions of the Schedule of Attitudes toward Hastened Death are available in five languages other than the original English. Conclusion: This systematic review has analysed existing instruments for assessing the wish to hasten death. It has also explored the methodological quality of studies that have examined the measurement properties of these instruments and offers ratings of the reported properties. These results will be useful to clinicians and researchers with an interest in a phenomenon of considerable relevance to advanced patients. PMID:28124578

From Death to Death Certificate: What do the Dead say?

PubMed

Gill, James R

2017-03-01

This is an overview of medicolegal death investigation and death certification. Postmortem toxicological analysis, particularly for ethanol and drugs of abuse, plays a large role in the forensic investigation of natural and unnatural deaths. Postmortem drug concentrations must be interpreted in light of the autopsy findings and circumstances. Interpretations of drug and ethanol concentrations are important for death certification, but they also may be important for other stakeholders such as police, attorneys, public health practitioners, and the next-of-kin.

Evoked potentials recorded during routine EEG predict outcome after perinatal asphyxia.

PubMed

Nevalainen, Päivi; Marchi, Viviana; Metsäranta, Marjo; Lönnqvist, Tuula; Toiviainen-Salo, Sanna; Vanhatalo, Sampsa; Lauronen, Leena

2017-07-01

To evaluate the added value of somatosensory (SEPs) and visual evoked potentials (VEPs) recorded simultaneously with routine EEG in early outcome prediction of newborns with hypoxic-ischemic encephalopathy under modern intensive care. We simultaneously recorded multichannel EEG, median nerve SEPs, and flash VEPs during the first few postnatal days in 50 term newborns with hypoxic-ischemic encephalopathy. EEG background was scored into five grades and the worst two grades were considered to indicate poor cerebral recovery. Evoked potentials were classified as absent or present. Clinical outcome was determined from the medical records at a median age of 21months. Unfavorable outcome included cerebral palsy, severe mental retardation, severe epilepsy, or death. The accuracy of outcome prediction was 98% with SEPs compared to 90% with EEG. EEG alone always predicted unfavorable outcome when it was inactive (n=9), and favorable outcome when it was normal or only mildly abnormal (n=17). However, newborns with moderate or severe EEG background abnormality could have either favorable or unfavorable outcome, which was correctly predicted by SEP in all but one newborn (accuracy in this subgroup 96%). Absent VEPs were always associated with an inactive EEG, and an unfavorable outcome. However, presence of VEPs did not guarantee a favorable outcome. SEPs accurately predict clinical outcomes in newborns with hypoxic-ischemic encephalopathy and improve the EEG-based prediction particularly in those newborns with severely or moderately abnormal EEG findings. SEPs should be added to routine EEG recordings for early bedside assessment of newborns with hypoxic-ischemic encephalopathy. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

The military social health index: a partial multicultural validation.

PubMed

Van Breda, Adrian D

2008-05-01

Routine military deployments place great stress on military families. Before South African soldiers can be deployed, they undergo a comprehensive health assessment, which includes a social work assessment. The assessment focuses on the resilience of the family system to estimate how well the family will cope when exposed to the stress of deployments. This article reports on the development and validation of a new measuring tool, the Military Social Health Index, or MSHI. The MSHI is made up of four scales, each comprising 14 items, viz social support, problem solving, stressor appraisal, and generalized resistance resources. An initial, large-scale, multicultural validation of the MSHI revealed strong levels of reliability (Cronbach a and standard error of measurement) and validity (factorial, construct, convergent, and discriminant).

Early death in those previously hospitalised for mental healthcare in Scotland: a nationwide cohort study, 1986-2010.

PubMed

Ajetunmobi, Omotomilola; Taylor, Mark; Stockton, Diane; Wood, Rachael

2013-07-30

To compare the mortality in those previously hospitalised for mental disorder in Scotland to that experienced by the general population. Population-based historical cohort study using routinely available psychiatric hospital discharge and death records. All Scotland. Individuals with a first hospital admission for mental disorder between 1986 and 2009 who had died by 31 December 2010 (34 243 individuals). The main outcome measure was death from any cause, 1986-2010. Excess mortality was presented as standardised mortality ratios (SMRs) and years of life lost (YLL). Excess mortality was assessed overall and by age, sex, main psychiatric diagnosis, whether the psychiatric diagnosis was 'complicated' (ie, additional mental or physical ill-health diagnoses present), cause of death and time period of first admission. 111 504 people were included in the study, and 34 243 had died by 31 December 2010. The average reduction in life expectancy for the whole cohort was 17 years, with eating disorders (39-year reduction) and 'complicated' personality disorders (27.5-year reduction) being worst affected. 'Natural' causes of death such as cardiovascular disease showed modestly elevated relative risk (SMR1.7), but accounted for 67% of all deaths and 54% of the total burden of YLL. Non-natural deaths such as suicide showed higher relative risk (SMR5.2) and tended to occur at a younger age, but were less common overall (11% of all deaths and 22% of all YLL). Having a 'complicated' diagnosis tended to elevate the risk of early death. No worsening of the overall excess mortality experienced by individuals with previous psychiatric admission over time was observed. Early death for those hospitalised with mental disorder is common, and represents a significant inequality even in well-developed healthcare systems. Prevention of suicide and cardiovascular disease deserves particular attention in the mentally disordered.

libvaxdata: VAX data format conversion routines

USGS Publications Warehouse

Baker, Lawrence M.

2005-01-01

libvaxdata provides a collection of routines for converting numeric data-integer and floating-point-to and from the formats used on a Digital Equipment Corporation1 (DEC) VAX 32-bit minicomputer (Brunner, 1991). Since the VAX numeric data formats are inherited from those used on a DEC PDP-11 16-bit minicomputer, these routines can be used to convert PDP-11 data as well. VAX numeric data formats are also the default data formats used on DEC Alpha 64-bit minicomputers running OpenVMS The libvaxdata routines are callable from Fortran or C. They require that the caller use two's-complement format for integer data and IEEE 754 format (ANSI/IEEE, 1985) for floating-point data. They also require that the 'natural' size of a C int type (integer) is 32 bits. That is the case for most modern 32-bit and 64-bit computer systems. Nevertheless, you may wish to consult the Fortran or C compiler documentation on your system to be sure. Some Fortran compilers support conversion of VAX numeric data on-the-fly when reading or writing unformatted files, either as a compiler option or a run-time I/O option. This feature may be easier to use than the libvaxdata routines. Consult the Fortran compiler documentation on your system to determine if this alternative is available to you. 1Later Compaq Computer Corporation, now Hewlett-Packard Company

Feasibility and validity of frailty measurement in geriatric rehabilitation.

PubMed

Arjunan, Aparna; Peel, Nancye M; Hubbard, Ruth E

2018-02-10

The measurement of frailty using a Frailty Index (FI) has been criticised as too time-consuming for use in hospital settings. We aimed to assess the feasibility and characteristics of an FI derived from routinely collected data. A total of 258 participants aged 65 and older were included in a single-centre prospective cohort study conducted in inpatient geriatric rehabilitation wards. The functional independence measure (FIM™), medication count and comorbidities were coded as deficits. An FI could be derived in all participants. It was normally distributed with a mean (SD) of 0.42 (0.13) and reached a submaximal limit of 0.69. Adjusting for age and sex, the odds ratio of a poor outcome (death/discharge to higher care) was 1.38 (confidence interval 1.11-1.70) per unit (0.1) increase in FI. Derivation of an FI from routinely collected data is feasible in geriatric rehabilitation settings and is predictive of poor outcomes. © 2018 AJA Inc.

Aging and Death Education.

ERIC Educational Resources Information Center

Pinder, Margaret M.; Hayslip, Bert, Jr.

1980-01-01

The elderly death rate is somewhat higher than the death rate in general. Numbers of schools with gerontological curricula and frequency of death education courses are positively related to elderly death rates. The contention that elderly deaths have less social impact is not supported. (JAC)

ANSYS duplicate finite-element checker routine

NASA Technical Reports Server (NTRS)

Ortega, R.

1995-01-01

An ANSYS finite-element code routine to check for duplicated elements within the volume of a three-dimensional (3D) finite-element mesh was developed. The routine developed is used for checking floating elements within a mesh, identically duplicated elements, and intersecting elements with a common face. A space shuttle main engine alternate turbopump development high pressure oxidizer turbopump finite-element model check using the developed subroutine is discussed. Finally, recommendations are provided for duplicate element checking of 3D finite-element models.

[Routine episiotomy in modern obstetrics. Is it necessary?].

PubMed

Korczyński, Jerzy

2002-01-01

The study presents a literature review on the benefits and risk of the routine episiotomy during the second stage of labour. Perineal trauma complications as well as perinatal outcomes are discussed. The risk of stress incontinence and sexual dysfunction are described. New techniques for improve of perinatal outcomes and prevention of post partum incontinence are described. Routine episiotomy gives poor effects in many cases. Perineal massage during pregnancy, waterbirth, are most interesting methods to avoid routine episiotomy and improve the quality of life in post partum women.

Routine cystoscopy after robotic gynecologic oncology surgery.

PubMed

Nguyen, My-Linh T; Stevens, Erin; LaFargue, Christopher J; Karsy, Michael; Pua, Tarah L; Gorelick, Constantine; Tedjarati, Sean S; Pradhan, Tana S

2014-01-01

Our aim was to determine whether the use of routine cystoscopy increases lower urinary tract injury detection (bladder and/or ureter) after robotic surgery performed by gynecologic oncologists. A retrospective chart review of patients who presented for robotic hysterectomy from 2009-2012 was performed at 2 separate academic medical centers, one that performed routine cystoscopy and one that did not. Statistical analysis was performed with t tests and χ2 tests. We identified 140 cases without cystoscopy and 109 cases with routine cystoscopy. There were no intraoperative or postoperative urinary injuries detected in either group. There were no significant differences in age and body mass index. In the non-cystoscopy group, a larger specimen size (P<.001), less blood loss (P=.013), and a longer mean operative time were observed (P<.0001). In the routine cystoscopy group, more lymphadenectomies were performed with hysterectomy (P=.007) and more patients underwent hysterectomy for ovarian cancer (P=.0192). There were no differences in surgical indications or secondary procedures including bilateral salpingo-oophorectomy, radical hysterectomy, ureterolysis, and pelvic organ prolapse-related procedures. The minimum follow-up period was 30 days in both groups. Routine use of cystoscopy did not appear to affect the detection rate of intraoperative lower urinary tract injury during robotic gynecologic surgery because this rate was zero in both groups. However, cystoscopy is relatively simple to perform and can be efficiently incorporated into robotic surgery to avoid the severe morbidity and possible litigation surrounding a urinary tract injury.

Manner of Death Determination in Fire Fatalities: 5-Year Autopsy Data of Istanbul City.

PubMed

Esen Melez, İpek; Arslan, Murat Nihat; Melez, Deniz Oguzhan; Gürler, Ahmet Selçuk; Büyük, Yalçin

2017-03-01

Death resulting from burns is an important social problem and a frequent accident. However, because approximately 10% of cases are estimated to result from a fire that was deliberately started, all fire-related deaths should be treated as suspicious, and the cause of a fire should be investigated. For the bodies recovered from the scene of a fire, the manner of death could also be suicide or homicide. The objective of this study was to contribute to the clarification of controversial data present in the literature on the manner of death determination of fire-related deaths, through evaluation of autopsy findings of bodies recovered from fires. We reviewed 20,135 autopsies performed in a 5-year period, in Istanbul, as the whole autopsy data of the city and found 133 fire-related deaths. The death scene investigation reports and other judicial documents, autopsy findings, and toxicological analysis results were evaluated to determine the parameters of age, sex, level of the burn, vital signs [red flare; soot in the lower respiratory tract, esophagus, and/or stomach; and screening of carboxyhemoglobin (COHb) levels in the blood], toxicological substances, presence of accelerants, cause of death, and manner of death. The manner of death was determined to be an accident in 98 (73.7%) and homicide in 12 (9%) cases, whereas there was no suicide. In addition, it could not be determined in 23 (17.2%) cases. In accidental deaths, the most frequent cause of death was COHb poisoning with statistically significant blood COHb levels greater than 10%. Further, the presence of soot in the lower respiratory tract, esophagus, and/or stomach and the existence of at least 1 or 2 vital signs together were found to be valid deterministic criteria with statistical significance in terms of identifying the manner of death.

Assessing the quality of life of adults with chronic respiratory diseases in routine primary care: construction and first validation of the 10-Item Respiratory Illness Questionnaire-monitoring 10 (RIQ-MON10).

PubMed

Jacobs, J E; Maillé, A R; Akkermans, R P; van Weel, C; Grol, R P T M

2004-08-01

As doctors' judgements about the burden of a disease often differ from patients' own assessments a manageable method to incorporate the latter into routine care might support patient-centered decision-making. For this purpose we shortened the 55-Item Quality of Life for Respiratory Illness Questionnaire (QoL-RIQ). Secondary analyses of the data of 3 controlled studies (n = 328, 502 and 555). inter-item correlations, scale distributions, Cronbach's alpha and factor analysis. Dyspnoea, forced expiratory volume in 1 s (FEV1), COOP/WONCA charts, the Medical Research Council-ECCS symptoms questionnaire and the MOS-SF 36 served as criteria to test validity and responsiveness. Item-reduction resulted in a 10-item short form (alpha's 0.87-0.90), consisting of 2 5-item factors: (1) physical and emotional complaints and (2) physical and social limitations. The correlations of the short form with dyspnoea (r from 0.57 to 0.60), the generic health status instruments (r from 0.39 to 0.59) and lung function (r from 0.10 to 0.15) fulfilled the criteria. FURTHER RESULTS: a clinical relevant score difference (> 0.5) between upper and lower quartiles of the convergent instruments, an intraclass correlation between repeated scores in a stable group of 0.82 and a standardised response mean of 0.86 in an improved group of patients. The short form (RIQ-MON10) maintained the psychometric properties of the original instrument and is promising for assessing quality of life (QoL) during routine primary care visits.

Liver Transplant From Unexpected Donation After Circulatory Determination of Death Donors: A Challenge in Perioperative Management.

PubMed

Blasi, A; Hessheimer, A J; Beltrán, J; Pereira, A; Fernández, J; Balust, J; Martínez-Palli, G; Fuster, J; Navasa, M; García-Valdecasas, J C; Taurá, P; Fondevila, C

2016-06-01

Unexpected donation after circulatory determination of death (uDCD) liver transplantation is a complex procedure, in particular when it comes to perioperative recipient management. However, very little has been published to date regarding intraoperative and immediate postoperative care in this setting. Herein, we compare perioperative events in uDCD liver recipients with those of a matched group of donation after brain death liver recipients. We demonstrate that the former group of recipients suffers significantly greater hemodynamic instability and derangements in coagulation following graft reperfusion. Based on our experience, we recommend a proactive recipient management strategy in uDCD liver transplantation that involves early use of vasopressor support; maintaining adequate intraoperative levels of red cells, platelets, and fibrinogen; and routinely administering tranexamic acid before graft reperfusion. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

A 'beautiful death': mortality, death, and holidays in a Mexican municipality.

PubMed

Wilches-Gutiérrez, José L; Arenas-Monreal, Luz; Paulo-Maya, Alfredo; Peláez-Ballestas, Ingris; Idrovo, Alvaro J

2012-03-01

Several studies have reported increased mortality during holidays. Using a cultural epidemiological, sequential mixed-methods approach, this study explored holiday-related trends using mortality data from Yautepec (Morelos, Mexico) collected between 1986 and 2008 (N=5027 deaths). This analysis found that mortality increased on Christmas Day and All Saints' Day. Mortality increased on Candlemas Day among women, and increased on New Year's Day among men. More deaths caused by cardiovascular disease among women and traumatic injuries among men occurred during holidays than in non-holiday periods. To ascertain the elements comprising the health/illness/death process in the context of a holiday in this municipality, we conducted semi-structured interviews in March and April 2009 with relatives of seven individuals who had died during holidays in the previous 4 years (N=11); data from these interviews were analyzed from a grounded theory perspective to ascertain common conceptual themes. The "beautiful death" emerged as the main concept in the interpretation of death; this concept was related to the expectation of a good death and the particularly special nature of death during a holiday because of the involvement of religious entities, such as God, the Virgin Mary, and/or a saint, at the moment of death. Quantitative and qualitative results provided information about the important effects of holidays, culture, and religious belief on mortality patterns within a Mexican context, and contributed to a better understanding of the relationships among mortality, the nature of death, and holidays. Our results suggest that, in the studied region, death can be interpreted as a "beautiful process". More research is needed to explore this process in other similar contexts and to address topics related to the care and attention given the dying person and the expectation of a good death. Copyright © 2012 Elsevier Ltd. All rights reserved.

SIDS and Other Sleep-Related Infant Deaths: Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment.

PubMed

Moon, Rachel Y

2016-11-01

Approximately 3500 infants die annually in the United States from sleep-related infant deaths, including sudden infant death syndrome (SIDS), ill-defined deaths, and accidental suffocation and strangulation in bed. After an initial decrease in the 1990s, the overall sleep-related infant death rate has not declined in more recent years. Many of the modifiable and nonmodifiable risk factors for SIDS and other sleep-related infant deaths are strikingly similar. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. Recommendations for a safe sleep environment include supine positioning, use of a firm sleep surface, room-sharing without bed-sharing, and avoidance of soft bedding and overheating. Additional recommendations for SIDS risk reduction include avoidance of exposure to smoke, alcohol, and illicit drugs; breastfeeding; routine immunization; and use of a pacifier. New evidence and rationale for recommendations are presented for skin-to-skin care for newborn infants, bedside and in-bed sleepers, sleeping on couches/armchairs and in sitting devices, and use of soft bedding after 4 months of age. In addition, expanded recommendations for infant sleep location are included. The recommendations and strength of evidence for each recommendation are published in the accompanying policy statement, "SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment," which is included in this issue. Copyright © 2016 by the American Academy of Pediatrics.

S-Adenosyl-L-Methionine protects the probiotic yeast, Saccharomyces boulardii, from acid-induced cell death

PubMed Central

2013-01-01

Background Saccharomyces boulardii is a probiotic yeast routinely used to prevent and to treat gastrointestinal disorders, including the antibiotic-associated diarrhea caused by Clostridium difficile infections. However, only 1-3% of the yeast administered orally is recovered alive in the feces suggesting that this yeast is unable to survive the acidic environment of the gastrointestinal tract. Results We provide evidence that suggests that S. boulardii undergoes programmed cell death (PCD) in acidic environments, which is accompanied by the generation of reactive oxygen species and the appearance of caspase-like activity. To better understand the mechanism of cell death at the molecular level, we generated microarray gene expression profiles of S. boulardii cells cultured in an acidic environment. Significantly, functional annotation revealed that the up-regulated genes were significantly over-represented in cell death pathways Finally, we show that S-adenosyl-L-methionine (AdoMet), a commercially available, FDA-approved dietary supplement, enhances the viability of S. boulardii in acidic environments, most likely by preventing programmed cell death. Conclusions In toto, given the observation that many of the proven health benefits of S. boulardii are dependent on cell viability, our data suggests that taking S. boulardii and AdoMet together may be a more effective treatment for gastrointestinal disorders than taking the probiotic yeast alone. PMID:23402325

Validation and Adjustment of the Leipzig-Halifax Acute Aortic Dissection Type A Scorecard.

PubMed

Mejàre-Berggren, Hanna; Olsson, Christian

2017-11-01

The novel Leipzig-Halifax (LH) scorecard for acute aortic dissection type A (AADA) stratifies risk of in-hospital death based on age, malperfusion syndromes, critical preoperative state, and coronary disease. The study aim was to externally validate the LH scorecard performance and, if adequate, propose adjustments. All consecutive AADA patients operated on from 1996 to 2016 (n = 509) were included to generate an external validation cohort. Variables related to in-hospital death were analyzed using univariable and multivariable analysis. The LH scorecard was applied to the validation cohort, compared with the original study, and variable selection was adjusted using validation measures for discrimination and calibration. In-hospital mortality rate was 17.7% (LH cohort 18.7%). Critical preoperative state and Penn class non-Aa were independent predictors (odds ratio [OR] 2.42 and 2.45, respectively) of in-hospital death. The LH scorecard was adjusted to include Penn class non-Aa, critical preoperative state, and coronary disease. Assessing discrimination, area under receiver operator characteristic curve for the LH scorecard was 0.61 versus 0.66 for the new scorecard (p = 0.086). In-hospital mortality rates in low-, medium-, and high-risk groups were 14%, 15%, and 48%, respectively (LH scorecard) versus 11%, 23%, and 43%, respectively (new scorecard), and goodness-of-fit p value was 0.01 versus 0.86, indicating better calibration by the new scorecard. A lower Akaike information criterion value, 464 versus 448, favored the new scorecard. Through adjustment of the LH scorecard after external validation, prognostic performance improved. Further validated, the LH scorecard could be a valuable risk prediction tool. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Emotional eating and routine restraint scores are associated with activity in brain regions involved in urge and self-control.

PubMed

Wood, Samantha M W; Schembre, Susan M; He, Qinghua; Engelmann, Jeffrey M; Ames, Susan L; Bechara, Antoine

2016-10-15

Researchers have proposed a variety of behavioral traits that may lead to weight gain and obesity; however, little is known about the neurocognitive mechanisms underlying these weight-related eating behaviors. In this study, we measured activation of reward circuitry during a task requiring response and inhibition to food stimuli. We assessed participants' emotional eating, external eating, and two subscales of dietary restraint-routine restraint and compensatory restraint-using the Weight-Related Eating Questionnaire. For routine restraint, we found positive associations with activation in the insula, dorsolateral prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex and ventromedial prefrontal cortex in response to high-calorie versus low-calorie foods. For emotional eating, we found positive associations with insula and dorsolateral prefrontal cortex activation in response to high-calorie versus low-calorie foods. We also found positive associations between emotional eating and dorsolateral prefrontal cortex activation in response to approach versus inhibition towards high-calorie foods. Thus, our results demonstrate an increase in activation across brain regions related to self-control and urges in response to high-calorie food associated with both emotional eating and routine restraint. Overall, these results support the construct validity of both emotional eating and routine restraint and provide preliminary evidence that these subscales have similar neural correlates. Copyright © 2016 Elsevier Inc. All rights reserved.

Intimate Partner Homicide and Corollary Victims in 16 States: National Violent Death Reporting System, 2003–2009

PubMed Central

Fowler, Katherine A.; Niolon, Phyllis H.

2014-01-01

Objectives. We estimated the frequency and examined the characteristics of intimate partner homicide and related deaths in 16 US states participating in the National Violent Death Reporting System (NVDRS), a state-based surveillance system. Methods. We used a combination of quantitative and qualitative methods to analyze NVDRS data from 2003 to 2009. We selected deaths linked to intimate partner violence for analysis. Results. Our sample comprised 4470 persons who died in the course of 3350 intimate partner violence–related homicide incidents. Intimate partners and corollary victims represented 80% and 20% of homicide victims, respectively. Corollary homicide victims included family members, new intimate partners, friends, acquaintances, police officers, and strangers. Conclusions. Our findings, from the first multiple-state study of intimate partner homicide and corollary homicides, demonstrate that the burden of intimate partner violence extends beyond the couple involved. Systems (e.g., criminal justice, medical care, and shelters) whose representatives routinely interact with victims of intimate partner violence can help assess the potential for lethal danger, which may prevent intimate partner and corollary victims from harm. PMID:24432943

Adoption of routine telemedicine in Norway: the current picture

PubMed Central

Zanaboni, Paolo; Knarvik, Undine; Wootton, Richard

2014-01-01

Background Telemedicine appears to be ready for wider adoption. Although existing research evidence is useful, the adoption of routine telemedicine in healthcare systems has been slow. Objective We conducted a study to explore the current use of routine telemedicine in Norway, at national, regional, and local levels, to provide objective and up-to-date information and to estimate the potential for wider adoption of telemedicine. Design A top-down approach was used to collect official data on the national use of telemedicine from the Norwegian Patient Register. A bottom-up approach was used to collect complementary information on the routine use of telemedicine through a survey conducted at the five largest publicly funded hospitals. Results Results show that routine telemedicine has been adopted in all health regions in Norway and in 68% of hospitals. Despite being widely adopted, the current level of use of telemedicine is low compared to the number of face-to-face visits. Examples of routine telemedicine can be found in several clinical specialties. Most services connect different hospitals in secondary care, and they are mostly delivered as teleconsultations via videoconference. Conclusions Routine telemedicine in Norway has been widely adopted, probably for geographical reasons, as in other settings. However, the level of use of telemedicine in Norway is rather low, and it has significant potential for further development as an alternative to face-to-face outpatient visits. This study is a first attempt to map routine telemedicine at regional, institutional, and clinical levels, and it provides useful information to understand the adoption of telemedicine in routine healthcare and to measure change in future updates. PMID:24433942

Death and Grief

MedlinePlus

... Staying Safe Videos for Educators Search English Español Death and Grief KidsHealth / For Teens / Death and Grief What's in this article? What Is ... the reaction we have in response to a death or loss. Grief can affect our body, mind, ...

[Quality of information analysis on basic causes of neonatal deaths recorded in the Mortality Information System: a study in Maceió, Alagoas State, Brazil, 2001-2002].

PubMed

Pedrosa, Linda Délia C O; Sarinho, Silvia W; Ordonha, Manoelina R

2007-10-01

Analysis of the quality of information on basic causes of neonatal deaths in Brazil is crucially important, since it allows one to estimate how many deaths are avoidable and provide support for policies to decrease neonatal mortality. The current study aimed to evaluate the reliability and validity of the Mortality Information System (MIS) for discriminating between basic causes of neonatal deaths and defining percentages of reducible causes. The basic causes of early neonatal deaths in hospitals in Maceió, Alagoas State, were analyzed, and the causes recorded in medical records were compared to the MIS data in order to measure reliability and validity. The modified SEADE Foundation and Wigglesworth classifications were compared to analyze the capacity for reduction of neonatal mortality. Maternal causes predominated in the medical records, as compared to respiratory disorders on the death certificates and in the MIS. The percentage of avoidable deaths may be much higher than observed from the MIS, due to imprecision in completing death certificates. Based on the MIS, the greatest problems are in early diagnosis and treatment of neonatal causes. However, the results show that the most pressing problems relate to failures in prenatal care and lack of control of diseases.

A Death in the Family: Death as a Zen Concept

ERIC Educational Resources Information Center

Black, Helen K.; Rubinstein, Robert L.

2013-01-01

This study is based on original research that explored family reaction to the death of an elderly husband and father. We interviewed 34 families (a family included a widow and two adult biological children) approximately 6 to 10 months after the death. In one-on-one interviews, we discussed family members' initial reaction to the death, how the…

Hepatic lipidosis and other test findings in two captive adult porcupines (Erethizon dorsatum) dying from a "sudden death syndrome".

PubMed

Barigye, Robert; Schamber, Ev; Newell, Teresa K; Dyer, Neil W

2007-11-01

Routine postmortem examination and histologic evaluation of tissue sections demonstrated hepatic lipidosis (HL) in 2 adult captive porcupines with a history of sudden death. The male porcupine had a markedly enlarged pale liver that microscopically showed large unilocular vacuoles within hepatocellular cytoplasm. The periparturient female had similar but less marked hepatic lesions and an incidental pulmonary mycosis. These findings suggest HL as an important differential of spontaneous death in captive porcupines. It is hypothesized that in addition to the widely documented causes, HL in captive porcupines may be specifically associated with nutritional imbalances caused by the feeding of unsuitable commercial diets. The possible association of the condition with dietary and other factors in captive porcupines needs to be thoroughly investigated.

A risk score for in-hospital death in patients admitted with ischemic or hemorrhagic stroke.

PubMed

Smith, Eric E; Shobha, Nandavar; Dai, David; Olson, DaiWai M; Reeves, Mathew J; Saver, Jeffrey L; Hernandez, Adrian F; Peterson, Eric D; Fonarow, Gregg C; Schwamm, Lee H

2013-01-28

We aimed to derive and validate a single risk score for predicting death from ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Data from 333 865 stroke patients (IS, 82.4%; ICH, 11.2%; SAH, 2.6%; uncertain type, 3.8%) in the Get With The Guidelines-Stroke database were used. In-hospital mortality varied greatly according to stroke type (IS, 5.5%; ICH, 27.2%; SAH, 25.1%; unknown type, 6.0%; P<0.001). The patients were randomly divided into derivation (60%) and validation (40%) samples. Logistic regression was used to determine the independent predictors of mortality and to assign point scores for a prediction model in the overall population and in the subset with the National Institutes of Health Stroke Scale (NIHSS) recorded (37.1%). The c statistic, a measure of how well the models discriminate the risk of death, was 0.78 in the overall validation sample and 0.86 in the model including NIHSS. The model with NIHSS performed nearly as well in each stroke type as in the overall model including all types (c statistics for IS alone, 0.85; for ICH alone, 0.83; for SAH alone, 0.83; uncertain type alone, 0.86). The calibration of the model was excellent, as demonstrated by plots of observed versus predicted mortality. A single prediction score for all stroke types can be used to predict risk of in-hospital death following stroke admission. Incorporation of NIHSS information substantially improves this predictive accuracy.

Routine intracranial pressure monitoring in acute coma.

PubMed

Forsyth, Rob J; Raper, Joseph; Todhunter, Emma

2015-11-02

; range 22 to 44), and all had severe traumatic brain injury, mostly due to traffic incidents. All were receiving care within intensive care units (ICUs) at one of six hospitals in either Bolivia or Ecuador. Investigators followed up 92% of participants for six months or until death. The trial excluded patients with a Glasgow Coma Score (GCS) less than three and fixed dilated pupils on admission on the basis that they had sustained brain injury of an unsalvageable severity.The study compared people managed using either an intracranial monitor or non-invasive monitoring (imaging and clinical examination) to identify potentially harmful raised intracranial pressure. Both study groups used imaging and clinical examination measures.Mortality at six months was 56/144 (39%) in the ICP-monitored group and 67/153 (44%) in the non-invasive group.Unfavourable outcome (defined as death or moderate to severe disability at six months) as assessed by the extended Glasgow Outcome Scale (GOS-E) was 80/144 (56%) in the ICP-monitored group and 93/153 (61%) in the non-invasive group.Six percent of participants in the ICP monitoring group had complications related to the monitoring, none of which met criteria for being a serious adverse event. There were no complications relating to the non-invasive group.Other complications and adverse events were comparable between treatment groups, 70/157 (45%) in the ICP-monitored group and 76/167 (46%) in the non-invasive group.Late mortality in both the monitored and non-invasive groups was high, with 35% of deaths occurring > 14 days after injury. The authors comment that this high late mortality may reflect inadequacies in post-ICU services for disabled survivors requiring specialist rehabilitation care. The data from the single RCT studying the role of routine ICP monitoring in acute traumatic coma fails to provide evidence to support the intervention.Research in this area is complicated by the fact that RCTs necessarily assess the combined impact

Cell Death and Cell Death Responses in Liver Disease: Mechanisms and Clinical Relevance

PubMed Central

Luedde, Tom; Kaplowitz, Neil; Schwabe, Robert F.

2015-01-01

Summary Hepatocellular death is present in almost all types of human liver disease and is used as a sensitive parameter for the detection of acute and chronic liver disease of viral, toxic, metabolic, or autoimmune origin. Clinical data and animal models suggest that hepatocyte death is the key trigger of liver disease progression, manifested by the subsequent development of inflammation, fibrosis, cirrhosis, and hepatocellular carcinoma. Modes of hepatocellular death differ substantially between liver diseases. Different modes of cell death such as apoptosis, necrosis, and necroptosis trigger specific cell death responses and promote progression of liver disease through distinct mechanisms. In this review, we first discuss molecular mechanisms by which different modes of cell death, damage-associated molecular patterns, and specific cell death responses contribute to the development of liver disease. We then review the clinical relevance of cell death, focusing on biomarkers; the contribution of cell death to drug-induced, viral, and fatty liver disease and liver cancer; and evidence for cell death pathways as therapeutic targets. PMID:25046161

Cot Deaths.

ERIC Educational Resources Information Center

Tyrrell, Shelagh

1985-01-01

Addresses the tragedy of crib deaths, giving particular attention to causes, prevention, and medical research on Sudden Infant Death Syndrome (SIDS). Gives anecdotal accounts of coping strategies used by parents and families of SIDS infants. (DT)

Geographic Information Systems to Assess External Validity in Randomized Trials.

PubMed

Savoca, Margaret R; Ludwig, David A; Jones, Stedman T; Jason Clodfelter, K; Sloop, Joseph B; Bollhalter, Linda Y; Bertoni, Alain G

2017-08-01

To support claims that RCTs can reduce health disparities (i.e., are translational), it is imperative that methodologies exist to evaluate the tenability of external validity in RCTs when probabilistic sampling of participants is not employed. Typically, attempts at establishing post hoc external validity are limited to a few comparisons across convenience variables, which must be available in both sample and population. A Type 2 diabetes RCT was used as an example of a method that uses a geographic information system to assess external validity in the absence of a priori probabilistic community-wide diabetes risk sampling strategy. A geographic information system, 2009-2013 county death certificate records, and 2013-2014 electronic medical records were used to identify community-wide diabetes prevalence. Color-coded diabetes density maps provided visual representation of these densities. Chi-square goodness of fit statistic/analysis tested the degree to which distribution of RCT participants varied across density classes compared to what would be expected, given simple random sampling of the county population. Analyses were conducted in 2016. Diabetes prevalence areas as represented by death certificate and electronic medical records were distributed similarly. The simple random sample model was not a good fit for death certificate record (chi-square, 17.63; p=0.0001) and electronic medical record data (chi-square, 28.92; p<0.0001). Generally, RCT participants were oversampled in high-diabetes density areas. Location is a highly reliable "principal variable" associated with health disparities. It serves as a directly measurable proxy for high-risk underserved communities, thus offering an effective and practical approach for examining external validity of RCTs. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

DEVELOPING AND INSTRUCTING PRE-PERFORMANCE ROUTINES FOR TENPIN BOWLING COMPETITIONS (1).

PubMed

Lee, Seungmin; Lee, Keunchul; Kwon, Sungho

2015-06-01

This preliminary study developed pre-performance routines for tenpin bowlers and instructed them. To develop the routine, the situations before throwing the ball were divided into four phases; participants were examined through interviews and observations. This study used an A-B design; the A stage included the development of the routines for 3 wk., while the B stage included the instruction and two evaluations of the routine consistency. Practice was implemented for 4 hr. per day for 9 wk. The participants noted they understood the developed routine easily and experienced an atmosphere similar to that of a competition during training through the routines. They found it difficult to practice the relaxation phase, but emphasized that the relaxation phase was helpful. Consistent routines were associated with an improved mental state and performance in a competition. This study suggests that pre-performance routines stabilize the mental state of the athletes, apparently giving them a competitive advantage.

Motivation through Routine Documentation

ERIC Educational Resources Information Center

Koth, Laurie J.

2016-01-01

This informed commentary article offers a simple, effective classroom management strategy in which the teacher uses routine documentation to motivate students both to perform academically and to behave in a manner consistent with established classroom rules and procedures. The pragmatic strategy is grounded in literature, free to implement,…

Correlates of Family Satisfaction with Hospice Care: General Inpatient Hospice Care versus Routine Home Hospice Care.

PubMed

Ong, Jeremy; Brennsteiner, Alex; Chow, Elizabeth; Hebert, Randy S

2016-01-01

The quality of communication and support provided to families is associated with greater satisfaction with hospice care. Prior work has not explored whether the predictors of family satisfaction are different in different hospice care settings. The study objective was to explore whether correlates of family satisfaction are different in general inpatient hospice care versus routine home hospice care. Survey data from bereaved family members of approximately 1600 patients from a nonprofit, midsized hospice in western Pennsylvania were used. Data was obtained from Family Evaluation of Hospice Care (FEHC) survey responses from 2008-2013 and separated into two groups, general inpatient hospice care and routine home hospice care. The analysis was completed using a binomial logistic regression model. Three variables were associated with greater overall satisfaction in both care settings: being kept informed about the patient's condition (adjusted odds ratio [AOR]: 9.64, CI: 6.56-14.36); being provided with clear/consistent information (AOR: 2.34, CI: 1.47-3.72); and the perception that patients were provided with adequate treatment for anxiety (AOR: 2.64, CI: 1.19-5.81). Two variables, sufficient discussion with hospice team members concerning family members' religious or spiritual beliefs (AOR: 1.64, CI: 1.17-2.30) and being provided with the correct amount of emotional support after the patient's death (AOR: 2.01, CI: 1.10-3.66), were correlated with greater satisfaction in routine home hospice care only. Good communication is strongly associated with greater family satisfaction across hospice care settings. Hospices must ensure that they provide patients and families with consistent information and support.

Do Spanish Medical Students Understand the Concept of Brain Death?

PubMed

Ríos, Antonio; López-Navas, A; López-López, A; Gómez, F J; Iriarte, J; Herruzo, R; Blanco, G; Llorca, F J; Asunsolo, A; Sánchez, P; Gutiérrez, P R; Fernández, A; de Jesús, M T; Alarcón, L Martínez; Del Olivo, M; Fuentes, L; Hernández, J R; Virseda, J; Yelamos, J; Bondía, J A; Hernández, A M; Ayala, M A; Ramírez, P; Parrilla, P

2018-03-01

To analyze the level of understanding of the brain death concept among medical students in universities in Spain. This cross-sectional sociological, interdisciplinary, and multicenter study was performed on 9598 medical students in Spain. The sample was stratified by geographical area and academic year. A previously validated self-reported measure of brain death knowledge (questionnaire Proyecto Colaborativo Internacional Donante sobre la Donación y Transplante de Organos) was completed anonymously by students. Respondents completed 9275 surveys for a completion rate of 95.7%. Of those, 67% (n = 6190) of the respondents understood the brain death concept. Of the rest, 28% (n = 2652) did not know what it meant, and the remaining 5% (n = 433) believed that it did not mean that the patient was dead. The variables related to a correct understanding of the concept were: (1) being older ( P < .001), (2) studying at a public university ( P < .001), (3) year of medical school ( P < .001), (4) studying at one of the universities in the south of Spain ( P = .003), (5) having discussed donation and transplantation with the family ( P < .001), (6) having spoken to friends about the matter ( P < .001), (7) a partner's favorable attitude toward donation and transplantation ( P < .001), and (8) religious beliefs ( P < .001). Sixty-seven percent of medical students know the concept of brain death, and knowledge improved as they advanced in their degree.

Cross-cultural adaptation and psychometric testing of the Quality of Dying and Death Questionnaire for the Spanish population.

PubMed

Gutiérrez Sánchez, Daniel; Cuesta-Vargas, Antonio I

2018-04-01

Many measurements have been developed to assess the quality of death (QoD). Among these, the Quality of Dying and Death Questionnaire (QODD) is the most widely studied and best validated. Informal carers and health professionals who care for the patient during their last days of life can complete this assessment tool. The aim of the study is to carry out a cross-cultural adaptation and a psychometric analysis of the QODD for the Spanish population. The translation was performed using a double forward and backward method. An expert panel evaluated the content validity. The questionnaire was tested in a sample of 72 Spanish-speaking adult carers of deceased cancer patients. A psychometric analysis was performed to evaluate internal consistency, divergent criterion-related validity with the Mini-Suffering State Examination (MSSE) and concurrent criterion-related validity with the Palliative Outcome Scale (POS). Some items were deleted and modified to create the Spanish version of the QODD (QODD-ESP-26). The instrument was readable and acceptable. The content validity index was 0.96, suggesting that all items are relevant for the measure of the QoD. This questionnaire showed high internal consistency (Cronbach's α coefficient = 0.88). Divergent validity with MSSE (r = -0.64) and convergent validity with POS (r = -0.61) were also demonstrated. The QODD-ESP-26 is a valid and reliable instrument for the assessment of the QoD of deceased cancer patients that can be used in a clinical and research setting. Copyright © 2018 Elsevier Ltd. All rights reserved.

Monitoring child mortality through community health worker reporting of births and deaths in Malawi: validation against a household mortality survey.

PubMed

Amouzou, Agbessi; Banda, Benjamin; Kachaka, Willie; Joos, Olga; Kanyuka, Mercy; Hill, Kenneth; Bryce, Jennifer

2014-01-01

The rate of decline in child mortality is too slow in most African countries to achieve the Millennium Development Goal of reducing under-five mortality by two-thirds between 1990 and 2015. Effective strategies to monitor child mortality are needed where accurate vital registration data are lacking to help governments assess and report on progress in child survival. We present results from a test of a mortality monitoring approach based on recording of births and deaths by specially trained community health workers (CHWs) in Malawi. Government-employed community health workers in Malawi are responsible for maintaining a Village Health Register, in which they record births and deaths that occur in their catchment area. We expanded on this system to provide additional training, supervision and incentives. We tested the equivalence between child mortality rates obtained from data on births and deaths collected by 160 randomly-selected and trained CHWs over twenty months in two districts to those computed through a standard household mortality survey. CHW reports produced an under-five mortality rate that was 84% (95%CI: [0.71,1.00]) of the household survey mortality rate and statistically equivalent to it. However, CHW data consistently underestimated under-five mortality, with levels of under-estimation increasing over time. Under-five deaths were more likely to be missed than births. Neonatal and infant deaths were more likely to be missed than older deaths. This first test of the accuracy and completeness of vital events data reported by CHWs in Malawi as a strategy for monitoring child mortality shows promising results but underestimated child mortality and was not stable over the four periods assessed. Given the Malawi government's commitment to strengthen its vital registration system, we are working with the Ministry of Health to implement a revised version of the approach that provides increased support to CHWs.

Objections to routine clinical outcomes measurement in mental health services: any evidence so far?

PubMed

MacDonald, Alastair J D; Trauer, Tom

2010-12-01

Routine clinical outcomes measurement (RCOM) is gaining importance in mental health services. To examine whether criticisms published in advance of the development of RCOM have been borne out by data now available from such a programme. This was an observational study of routine ratings using HoNOS65+ at inception/admission and again at discharge in an old age psychiatry service from 1997 to 2008. Testable hypotheses were generated from each criticism amenable to empirical examination. Inter-rater reliability estimates were applied to observed differences between scores between community and ward patients using resampling. Five thousand one hundred eighty community inceptions and 862 admissions had HoNOS65+ ratings at referral/admission and discharge. We could find no evidence of gaming (artificially worse scores at inception and better at discharge), selection, attrition or detection bias, and ratings were consistent with diagnosis and level of service. Anticipated low levels of inter-rater reliability did not vitiate differences between levels of service. Although only hypotheses testable from within RCOM data were examined, and only 46% of eligible episodes had complete outcomes data, no evidence of the alleged biases were found. RCOM seems valid and practical in mental health services.

[Pharmacogenomics in routine medical care].

PubMed

Rosskopf, D; Meyer zu Schwabedissen, H E; Kroemer, H K; Siegmund, W

2010-01-01

Pharmacogenomics investigates inherited differences in drug responses including beneficial and adverse reactions. While a considerable amount of evidence for genetic influences on drug responses has been accumulated within the last decade, predominantly in small studies, its value in routine therapy is still a matter of debate. The aim of this review is to discuss well established examples where pharmacogenomic techniques can improve routine treatment. Examples include genotyping of CYP2D6 in the context of antidepressant therapy, analysis of TPMT variants for the prediction of mercaptopurine-induced bone marrow depression, VKORC1 and CYP2C9 analyses for a better control of anticoagulant administration and the SLCO1B1 variant in the context of statin-induced myopathies. Georg Thieme Verlag KG Stuttgart.New York.

An automation-assisted generic approach for biological sample preparation and LC-MS/MS method validation.

PubMed

Zhang, Jie; Wei, Shimin; Ayres, David W; Smith, Harold T; Tse, Francis L S

2011-09-01

Although it is well known that automation can provide significant improvement in the efficiency of biological sample preparation in quantitative LC-MS/MS analysis, it has not been widely implemented in bioanalytical laboratories throughout the industry. This can be attributed to the lack of a sound strategy and practical procedures in working with robotic liquid-handling systems. Several comprehensive automation assisted procedures for biological sample preparation and method validation were developed and qualified using two types of Hamilton Microlab liquid-handling robots. The procedures developed were generic, user-friendly and covered the majority of steps involved in routine sample preparation and method validation. Generic automation procedures were established as a practical approach to widely implement automation into the routine bioanalysis of samples in support of drug-development programs.

Technical note: A 3D-printed phantom for routine accuracy check of Gamma Knife Icon HDMM system.

PubMed

Wu, Chuan; Radevic, Marlyn B; Glass, Jennifer S; Skubic, Stan E

2018-05-23

To report a novel 3D-printed device ("SH phantom") that is designed for routine accuracy check of the Gamma Knife Icon High Definition Motion Management (HDMM) system. SH phantom was designed using tinkerCAD software and printed on a commercial 3D printer. We evaluated the SH phantom on our Gamma Knife Icon unit regarding its usability and accuracy for routine HDMM QA. Single-axis and multiple-axis measurements validated the SH phantom design and implementation. An HDMM QA accuracy of 0.22 mm or better along single axis was found using SH phantom. The SH phantom proved to be a quick and simple tool to use to perform the HDMM system QA. The SH phantom was tested successfully and adopted by us as part of monthly QA for the Gamma Knife Icon. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

A follow-up meeting post death is appreciated by family members of deceased patients.

PubMed

Kock, M; Berntsson, C; Bengtsson, A

2014-08-01

A practice with a follow-up meeting post death (FUMPD) with physician and staff for family members of patients who died in the intensive care unit (ICU) was started as a quality project to improve the support of families in post-ICU bereavement. A quality improvement control was conducted after 4 years. The quality improvement control was made retrospectively as an anonymous non-coded questionnaire. Part A related to the FUMPD. Part B inquired if we could contact the family member again for a research project to evaluate family support post-ICU bereavement. The questionnaires were sent to 84 family members of 56 deceased patients. Part A: 46 out of 84 family members answered and had attended a FUMPD. Ninety-one percent of the family members thought that we should continue to offer FUMPD. Seventy-eight percent were satisfied with their meeting. Eighty percent felt that they understood the cause of death. The majority wanted the meeting to take place within 6 weeks of death. Ninety-one percent rated the physician as important to be present at the meeting. The social worker was rated more important to attend the meeting than the assistant nurse. Ninety-one percent wanted to discuss the cause of death.Part B: 54 out of 84 family members answered. Twenty out of 54 did not want us to contact them again. A routine with a Follow-Up Meeting Post Death with the ICU team for the families of the patients who die in the ICU is appreciated. The presence of the physician is important. © 2014 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Rip current related drowning deaths and rescues in Australia 2004-2011

NASA Astrophysics Data System (ADS)

Brighton, B.; Sherker, S.; Brander, R.; Thompson, M.; Bradstreet, A.

2013-04-01

Rip currents are a common hazard to beachgoers found on many beaches around the world, but it has proven difficult to accurately quantify the actual number of rip current related drowning deaths in many regions and countries. Consequently, reported estimates of rip current drowning can fluctuate considerably and are often based on anecdotal evidence. This study aims to quantify the incidence of rip current related drowning deaths and rescues in Australia from 2004 to 2011. A retrospective search was undertaken for fatal and non-fatal rip-related drowning incidents from Australia's National Coronial Information System (NCIS), Surf Life Saving Australia's (SLSA, 2005-2011) SurfGuard Incident Report Database (IRD), and Media Monitors for the period 1 July 2004 to 30 June 2011. In this time, rip currents were recorded as a factor in 142 fatalities of a total of 613 coastal drowning deaths (23.2%), an average of 21 per year. Rip currents were related to 44% of all beach-related drowning deaths and were involved in 57.4% of reported major rescues in Australian locations where rips occur. A comparison with international operational statistics over the same time period describes rip-related rescues as 53.7% of the total rescues in the US, 57.9% in the UK and 49.4% in New Zealand. The range 49-58% is much lower than 80-89% traditionally cited. The results reported are likely to underestimate the size of the rip current hazard, because we are limited by the completeness of data on rip-related events; however this is the most comprehensive estimate to date. Beach safety practitioners need improved data collection and standardized definitions across organisations. The collection of drowning data using consistent categories and the routine collection of rip current information will allow for more accurate global comparisons.

Development and validation of an epidemiologic case definition of epilepsy for use with routinely collected Australian health data.

PubMed

Tan, Michael; Wilson, Ian; Braganza, Vanessa; Ignatiadis, Sophia; Boston, Ray; Sundararajan, Vijaya; Cook, Mark J; D'Souza, Wendyl J

2015-10-01

We report the diagnostic validity of a selection algorithm for identifying epilepsy cases. Retrospective validation study of International Classification of Diseases 10th Revision Australian Modification (ICD-10AM)-coded hospital records and pharmaceutical data sampled from 300 consecutive potential epilepsy-coded cases and 300 randomly chosen cases without epilepsy from 3/7/2012 to 10/7/2013. Two epilepsy specialists independently validated the diagnosis of epilepsy. A multivariable logistic regression model was fitted to identify the optimum coding algorithm for epilepsy and was internally validated. One hundred fifty-eight out of three hundred (52.6%) epilepsy-coded records and 0/300 (0%) nonepilepsy records were confirmed to have epilepsy. The kappa for interrater agreement was 0.89 (95% CI=0.81-0.97). The model utilizing epilepsy (G40), status epilepticus (G41) and ≥1 antiepileptic drug (AED) conferred the highest positive predictive value of 81.4% (95% CI=73.1-87.9) and a specificity of 99.9% (95% CI=99.9-100.0). The area under the receiver operating curve was 0.90 (95% CI=0.88-0.93). When combined with pharmaceutical data, the precision of case identification for epilepsy data linkage design was considerably improved and could provide considerable potential for efficient and reasonably accurate case ascertainment in epidemiological studies. Copyright © 2015 Elsevier Inc. All rights reserved.

Prediction of mode of death in heart failure: the Seattle Heart Failure Model.

PubMed

Mozaffarian, Dariush; Anker, Stefan D; Anand, Inder; Linker, David T; Sullivan, Mark D; Cleland, John G F; Carson, Peter E; Maggioni, Aldo P; Mann, Douglas L; Pitt, Bertram; Poole-Wilson, Philip A; Levy, Wayne C

2007-07-24

Prognosis and mode of death in heart failure patients are highly variable in that some patients die suddenly (often from ventricular arrhythmia) and others die of progressive failure of cardiac function (pump failure). Prediction of mode of death may facilitate decisions about specific medications or devices. We used the Seattle Heart Failure Model (SHFM), a validated prediction model for total mortality in heart failure, to assess the mode of death in 10,538 ambulatory patients with New York Heart Association class II to IV heart failure and predominantly systolic dysfunction enrolled in 6 randomized trials or registries. During 16,735 person-years of follow-up, 2014 deaths occurred, which included 1014 sudden deaths and 684 pump-failure deaths. Compared with a SHFM score of 0, patients with a score of 1 had a 50% higher risk of sudden death, patients with a score of 2 had a nearly 3-fold higher risk, and patients with a score of 3 or 4 had a nearly 7-fold higher risk (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.68). Stratification of risk of pump-failure death was even more pronounced, with a 4-fold higher risk with a score of 1, a 15-fold higher risk with a score of 2, a 38-fold higher risk with a score of 3, and an 88-fold higher risk with a score of 4 (P<0.001 for all comparisons; 1-year area under the receiver operating curve, 0.85). The proportion of deaths caused by sudden death versus pump-failure death decreased from a ratio of 7:1 with a SHFM score of 0 to a ratio of 1:2 with a SHFM score of 4 (P trend <0.001). The SHFM score provides information about the likely mode of death among ambulatory heart failure patients. Investigation is warranted to determine whether such information might predict responses to or cost-effectiveness of specific medications or devices in heart failure patients.

Comparison of performance of tile drainage routines in SWAT 2009 and 2012 in an extensively tile-drained watershed in the Midwest

NASA Astrophysics Data System (ADS)

Guo, Tian; Gitau, Margaret; Merwade, Venkatesh; Arnold, Jeffrey; Srinivasan, Raghavan; Hirschi, Michael; Engel, Bernard

2018-01-01

the validation results showed that the new routine has the potential to accurately simulate hydrologic processes in mildly sloped watersheds.

High serum serotonin in sudden infant death syndrome.

PubMed