scholarly journals Generating cause of death information to inform health policy: implementation of an automated verbal autopsy system in the Solomon Islands

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Matthew Reeve ◽  
Hafizur Chowdhury ◽  
Pasyodun Koralage Buddhika Mahesh ◽  
Gregory Jilini ◽  
Rooney Jagilly ◽  
...  
Keyword(s):  
Health Policy ◽  
Heart Disease ◽  
Cause Of Death ◽  
Solomon Islands ◽  
Effective Means ◽  
Diagnostic Algorithm ◽  
Cost Effective ◽  
Chronic Respiratory Disease ◽  
Tablet Devices ◽  
Medical Certification

Abstract Background Good quality cause of death (COD) information is fundamental for formulating and evaluating public health policy; yet most deaths in developing countries, including the Solomon Islands, occur at home without medical certification of cause of death (MCCOD). As a result, COD data in such contexts are often of limited use for policy and planning. Verbal autopsies (VAs) are a cost-effective way of generating reliable COD information in populations lacking comprehensive MCCOD coverage, but this method has not previously been applied in the Solomon Islands. This study describes the establishment of a VA system to estimate the cause specific mortality fractions (CSMFs) for community deaths that are not medically certified in the Solomon Islands. Methods Automated VA methods (SmartVA) were introduced into the Solomon Islands in 2016. Trained data collectors (nurses) conducted VAs on eligible deaths to December 2020 using electronic tablet devices and VA responses were analysed using the Tariff 2.0 automated diagnostic algorithm. CSMFs were generated for both non-inpatient deaths in hospitals (i.e. ‘dead on/by arrival’) and community deaths. Results VA was applied to 914 adolescent-and-adult deaths with a median (IQR) age of 62 (45–75) years, 61% of whom were males. A specific COD could be diagnosed for more than 85% of deaths. The leading causes of death for both sexes combined were: ischemic heart disease (16.3%), stroke (13.5%), diabetes (8.1%), pneumonia (5.7%) and chronic-respiratory disease (4.8%). Stroke was the top-ranked cause for females, and ischaemic heart disease the leading cause for males. The CSMFs from the VAs were similar to Global Burden of Disease (GBD) estimates. Overall, non-communicable diseases (NCDs) accounted for 73% of adult deaths; communicable, maternal and nutritional conditions 15%, and injuries 12%. Six of the ten leading causes reported for facility deaths in the Solomon Islands were also identified as leading causes of community deaths based on the VA diagnoses. Conclusions NCDs are the leading cause of adult deaths in the Solomon Islands. Automated VA methods are an effective means of generating reliable COD information for community deaths in the Solomon Islands and should be routinely incorporated into the national mortality surveillance system.

Psychophysiological Rationale for Use of Yoga in Heart Disease

2018 ◽  
pp. 203-217
Author(s):  
Subhash Manchanda ◽  
Kushal Madan
Keyword(s):  
Developing Countries ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Secondary Prevention ◽  
Cause Of Death ◽  
Economic Burden ◽  
Cost Effective ◽  
Unhealthy Lifestyle ◽  
Safe Strategy ◽  
Lack Of Exercise

Cardiovascular diseases (CVD) are the leading cause of death and disability worldwide. The main reason for increase of CVD is considered to be unhealthy lifestyle consistent of high fat, refined diet, psychosocial stress, lack of exercise and tobacco. In spite of several recent advances in the management of CVD the incidence is rapidly increasing specially in the developing countries and their economic burden is huge. There is a need for new cost effective and safe strategy to control this growing epidemic of CVD. Yoga may be such an alternative for controlling CVD. Several research studies suggest that yoga may be promising technique for primary and secondary prevention of CVD and these will be reviewed briefly in this chapter.

scholarly journals Improving quality of medical certification of causes of death in health facilities in Tanzania 2014–2019

2021 ◽  
Vol 21 (S1) ◽  
Author(s):  
Trust Nyondo ◽  
Gisbert Msigwa ◽  
Daniel Cobos ◽  
Gregory Kabadi ◽  
Tumaniel Macha ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Health Policy ◽  
Cause Of Death ◽  
Causes Of Death ◽  
Health Facilities ◽  
Mortality Data ◽  
Medical Certification ◽  
Specific Mortality ◽  
Icd 10

Abstract Background Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. Methods We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. Results 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. Conclusion Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.

scholarly journals Addressing the rising cause of death due to diseases of the circulatory system geared towards achieving SDG 3: evidence from data on medical certification of cause of deaths in Rajasthan State, India: 1999-2015

2017 ◽  
Vol 5 (1) ◽  
pp. 182 ◽  
Author(s):  
Manoj Kumar Raut ◽  
Ananta Basudev Sahu
Keyword(s):  
Cause Of Death ◽  
Estimation Method ◽  
Well Being ◽  
Chronic Respiratory Disease ◽  
Civil Registration System ◽  
Registration System ◽  
Civil Registration ◽  
Medical Certification ◽  
Cause Of Deaths ◽  
Circulatory Diseases

Background: Medical certification of cause of death (MCCD) scheme is imperative tool to obtain scientific and reliable information in terms causes of mortality. The office of the registrar general of India (ORGI) initiated the scheme on MCCD under civil registration system (CRS), during the third five year plan. Methods: This paper analyzes the data for the last 16 years for MCCD in Rajasthan from 1999 to 2015. The findings are based on more than half a million deaths, for which cause of death data is reported. The per cent of cause of deaths have been computed and the curve estimation method has been used to project the cause of death due to circulatory diseases. Results: The data reveals that the percentage of medically certified deaths hovers around 10 to 13 percent during 1999 to 2015 of the total deaths registered under the civil registration system, which is about 5 million deaths. The highest percentage of deaths that has been medically certified is due to circulatory diseases as seen for the combined period of sixteen years (1999-2015) (21 percent) followed by deaths due to certain infectious and parasitic diseases (16 percent). This has increased from 13.8 per cent in 1999 to 20.2 per cent in 2015. This proportion has been projected upto 2030, the target year of achievement of Sustainable Development Goals (SDGs). Conclusions: Addressing this cause, could help in the achievement of indicator of 3.4.1, mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease under the target of reducing by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being by 2030 subsumed under the SDG 3 of ensuring healthy lives and promote well-being for all at all ages. 

Psychophysiological Rationale for Use of Yoga in Heart Disease

2019 ◽  
pp. 477-491
Author(s):  
Subhash Manchanda ◽  
Kushal Madan
Keyword(s):  
Developing Countries ◽  
Heart Disease ◽  
Cardiovascular Diseases ◽  
Secondary Prevention ◽  
Cause Of Death ◽  
Economic Burden ◽  
Cost Effective ◽  
Unhealthy Lifestyle ◽  
Safe Strategy ◽  
Lack Of Exercise

Cardiovascular diseases (CVD) are the leading cause of death and disability worldwide. The main reason for increase of CVD is considered to be unhealthy lifestyle consistent of high fat, refined diet, psychosocial stress, lack of exercise and tobacco. In spite of several recent advances in the management of CVD the incidence is rapidly increasing specially in the developing countries and their economic burden is huge. There is a need for new cost effective and safe strategy to control this growing epidemic of CVD. Yoga may be such an alternative for controlling CVD. Several research studies suggest that yoga may be promising technique for primary and secondary prevention of CVD and these will be reviewed briefly in this chapter.

Parallel Computing for Tire Simulations

2011 ◽  
Vol 39 (3) ◽  
pp. 193-209 ◽  
Author(s):  
H. Surendranath ◽  
M. Dunbar
Keyword(s):  
High Performance ◽  
Effective Means ◽  
Cost Effective ◽  
Turnaround Time ◽  
Careful Consideration ◽  
Rolling Contact ◽  
Element Analysis ◽  
Parallel Solvers ◽  
Design Changes ◽  
Highly Nonlinear

Abstract Over the last few decades, finite element analysis has become an integral part of the overall tire design process. Engineers need to perform a number of different simulations to evaluate new designs and study the effect of proposed design changes. However, tires pose formidable simulation challenges due to the presence of highly nonlinear rubber compounds, embedded reinforcements, complex tread geometries, rolling contact, and large deformations. Accurate simulation requires careful consideration of these factors, resulting in the extensive turnaround time, often times prolonging the design cycle. Therefore, it is extremely critical to explore means to reduce the turnaround time while producing reliable results. Compute clusters have recently become a cost effective means to perform high performance computing (HPC). Distributed memory parallel solvers designed to take advantage of compute clusters have become increasingly popular. In this paper, we examine the use of HPC for various tire simulations and demonstrate how it can significantly reduce simulation turnaround time. Abaqus/Standard is used for routine tire simulations like footprint and steady state rolling. Abaqus/Explicit is used for transient rolling and hydroplaning simulations. The run times and scaling data corresponding to models of various sizes and complexity are presented.

Exploring the Benefits of Early Contractor Involvement (ECI) and the Mechanism for Automated 5D BIM Quantification Process in Offsite Modular Construction

2016 ◽  
Author(s):  
Tochukwu Moses ◽  
David Heesom ◽  
David Oloke ◽  
Martin Crouch
Keyword(s):  
Effective Means ◽  
Cost Effective ◽  
Modular Construction ◽  
Automated Quantification ◽  
Building Information ◽  
Project Risks ◽  
Value Add ◽  
The Uk ◽  
The Impact ◽  
Level 2

The UK Construction Industry through its Government Construction Strategy has recently been mandated to implement Level 2 Building Information Modelling (BIM) on public sector projects. This move, along with other initiatives is key to driving a requirement for 25% cost reduction (establishing the most cost-effective means) on. Other key deliverables within the strategy include reduction in overall project time, early contractor involvement, improved sustainability and enhanced product quality. Collaboration and integrated project delivery is central to the level 2 implementation strategy yet the key protocols or standards relative to cost within BIM processes is not well defined. As offsite construction becomes more prolific within the UK construction sector, this construction approach coupled with BIM, particularly 5D automated quantification process, and early contractor involvement provides significant opportunities for the sector to meet government targets. Early contractor involvement is supported by both the industry and the successive Governments as a credible means to avoid and manage project risks, encourage innovation and value add, making cost and project time predictable, and improving outcomes. The contractor is seen as an expert in construction and could be counter intuitive to exclude such valuable expertise from the pre-construction phase especially with the BIM intent of äóÖbuild it twiceäó», once virtually and once physically. In particular when offsite construction is used, the contractoräó»s construction expertise should be leveraged for the virtual build in BIM-designed projects to ensure a fully streamlined process. Building in a layer of automated costing through 5D BIM will bring about a more robust method of quantification and can help to deliver the 25% reduction in overall cost of a project. Using a literature review and a case study, this paper will look into the benefits of Early Contractor Involvement (ECI) and the impact of 5D BIM on the offsite construction process.

scholarly journals mRNA-Based Vaccines

Vaccines ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 390
Author(s):  
Frank Kowalzik ◽  
Daniel Schreiner ◽  
Christian Jensen ◽  
Daniel Teschner ◽  
Stephan Gehring ◽  
...  
Keyword(s):  
Large Scale ◽  
New Technologies ◽  
Vaccine Development ◽  
Effective Means ◽  
Cost Effective ◽  
Clinical Applications ◽  
Cell Mediated Immunity ◽  
Healthy Individuals ◽  
Emerging Pathogens ◽  
Cell Genome

Increases in the world’s population and population density promote the spread of emerging pathogens. Vaccines are the most cost-effective means of preventing this spread. Traditional methods used to identify and produce new vaccines are not adequate, in most instances, to ensure global protection. New technologies are urgently needed to expedite large scale vaccine development. mRNA-based vaccines promise to meet this need. mRNA-based vaccines exhibit a number of potential advantages relative to conventional vaccines, namely they (1) involve neither infectious elements nor a risk of stable integration into the host cell genome; (2) generate humoral and cell-mediated immunity; (3) are well-tolerated by healthy individuals; and (4) are less expensive and produced more rapidly by processes that are readily standardized and scaled-up, improving responsiveness to large emerging outbreaks. Multiple mRNA vaccine platforms have demonstrated efficacy in preventing infectious diseases and treating several types of cancers in humans as well as animal models. This review describes the factors that contribute to maximizing the production of effective mRNA vaccine transcripts and delivery systems, and the clinical applications are discussed in detail.

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

scholarly journals Evaluation of a diagnostic algorithm for heart disease in neonates.

BMJ ◽  
1991 ◽  
Vol 302 (6782) ◽  
pp. 935-939 ◽  
Author(s):  
R C Franklin ◽  
D J Spiegelhalter ◽  
F J Macartney ◽  
K Bull
Keyword(s):  
Heart Disease ◽  
Diagnostic Algorithm
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