Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.

Clinico-Pathological discrepancies in the Diagnosis of Causes of Maternal Death in Sub-Saharan Africa: Retrospective Analysis

Background Maternal mortality is a major public-health problem in developing countries. Extreme differences in maternal mortality rates between developed and developing countries indicate that most of these deaths are preventable. Most information on the causes of maternal death in these areas is based on clinical records and verbal autopsies. Clinical diagnostic errors may play a significant role in this problem and might also have major implications for the evaluation of current estimations of causes of maternal death. Methods and Findings A retrospective analysis of clinico-pathologic correlation was carried out, using necropsy as the gold standard for diagnosis. All maternal autopsies (n ¼ 139) during the period from October 2002 to December 2004 at the Maputo Central Hospital, Mozambique were included and major diagnostic discrepancies were analyzed (i.e., those involving the cause of death). Major diagnostic errors were detected in 56 (40.3%) maternal deaths. A high rate of false negative diagnoses was observed for infectious diseases, which showed sensitivities under 50%: HIV/AIDS-related conditions (33.3%), pyogenic bronchopneumonia (35.3%), pyogenic meningitis (40.0%), and puerperal septicemia (50.0%). Eclampsia, was the main source of false positive diagnoses, showing a low predictive positive value (42.9%). Conclusions Clinico-pathological discrepancies may have a significant impact on maternal mortality in sub-Saharan Africa and question the validity of reports based on clinical data or verbal autopsies. Increasing clinical awareness of the impact of obstetric and nonobstetric infections with their inclusion in the differential diagnosis, together with a thorough evaluation of cases clinically thought to be eclampsia, could have a significant impact on the reduction of maternal mortality.

Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic review

Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010. A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes. Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more exposed to noise and worked longer hours than women did. This systematic review has identified a set of working and employment conditions as determinants of gender inequalities in occupational health from the occupational health literature. These results may be useful to policy makers seeking to reduce gender inequalities in occupational health, and to researchers wishing to analyse these determinants in greater depth.

Self-organization mechanisms for the formation on nearshore crescentic and transverse sand bars

The formation and development of transverse and crescentic sand bars in the coastal marine environment has been investigated by means of a nonlinear numerical model based on the shallow-water equations and on a simpli ed sediment transport parameterization. By assuming normally approaching waves and a saturated surf zone, rhythmic patterns develop from a planar slope where random perturbations of small amplitude have been superimposed. Two types of bedforms appear: one is a crescentic bar pattern centred around the breakpoint and the other, herein modelled for the rst time, is a transverse bar pattern. The feedback mechanism related to the formation and development of the patterns can be explained by coupling the water and sediment conservation equations. Basically, the waves stir up the sediment and keep it in suspension with a certain cross-shore distribution of depth-averaged concentration. Then, a current flowing with (against) the gradient of sediment concentration produces erosion (deposition). It is shown that inside the surf zone, these currents may occur due to the wave refraction and to the redistribution of wave breaking produced by the growing bedforms. Numerical simulations have been performed in order to understand the sensitivity of the pattern formation to the parameterization and to relate the hydro-morphodynamic input conditions to which of the patterns develops. It is suggested that crescentic bar growth would be favoured by high-energy conditions and ne sediment while transverse bars would grow for milder waves and coarser sediment. In intermediate conditions mixed patterns may occur.

Two necessary conditions for strategy-proofness: on what domains are they also sufficient?

A social choice function may or may not satisfy a desirable property depending on its domain of definition. For the same reason, different conditions may be equivalent for functions defined on some domains, while different in other cases. Understanding the role of domains is therefore a crucial issue in mechanism design. We illustrate this point by analyzing the role of different conditions that are always related, but not always equivalent to strategy-proofness. We define two very natural conditions that are necessary for strategy-proofness: monotonicity and reshuffling invariance. We remark that they are not always sufficient. Then, we identify a domain condition, called intertwinedness, that ensures the equivalence between our two conditions and that of strategy-proofness. We prove that some important domains are intertwined: those of single-peaked preferences, both with public and private goods, and also those arising in simple models of house allocation. We prove that other necessary conditions for strategy-proofness also become equivalent to ours when applied to functions defined on intertwined domains, even if they are not equivalent in general. We also study the relationship between our domain restrictions and others that appear in the literature, proving that we are indeed introducing a novel proposal.

Evaluation of work-related volatile organic compounds (VOCs) exposition in automotive painting cabins industrial cleanings

Automotive painting cabins are cleaned with several solvents, being great part of them mixtures of volatile organic compounds (VOCs), where the three xylene isomers are the most important constituents. To evaluate the work-related exposition of the cleaners that use these mixtures of solvents, xylenes have been determined in the working ambient air as well as its metabolite, o-m-p-methyl hippuric acid, has been analysed in urine to establish the dermal and respiratory exposition. This evaluation has been done in order to assess the occupational exposure to VOCs and to know the working conditions of the cleaners, but also to evaluate the effectiveness of personal protective equipment (PPE), the engineering control and the work practices.The xylenes have been chosen as indicators of exposition because they are the main components in the cleaning solvents used, with a level of concentration between 50% and 85%.The Xylenes have an occupational exposure limit (8 h TWA) of 50 ppm (221 mg/m3) and a short-term exposure limit (STEL) of 100 ppm (442 mg/m3). On the other hand, the biological exposure index (BEI) for xylenes is the sum of the total methyl hippuric acids in urine at the end of the work-shift, being the value 1500 mg/g creatinine.

A qualitative study about immigrant workers’ perceptions of their working conditions in Spain

Background: Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions.Methods: Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain.Results: Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions.Conclusions: The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants' work experiences should be considered and how these may influence health outcomes.

Proteomic analysis of peach fruit mesocarp softening and chilling injury using difference gel electrophoresis (DIGE)

Background: Peach fruit undergoes a rapid softening process that involves a number of metabolic changes. Storing fruit at low temperatures has been widely used to extend its postharvest life. However, this leads to undesired changes, such as mealiness and browning, which affect the quality of the fruit. In this study, a 2-D DIGE approach was designed to screen for differentially accumulated proteins in peach fruit during normal softening as well as under conditions that led to fruit chilling injury. Results:The analysis allowed us to identify 43 spots -representing about 18% of the total number analyzed- that show statistically significant changes. Thirty-nine of the proteins could be identified by mass spectrometry. Some of the proteins that changed during postharvest had been related to peach fruit ripening and cold stress in the past. However, we identified other proteins that had not been linked to these processes. A graphical display of the relationship between the differentially accumulated proteins was obtained using pairwise average-linkage cluster analysis and principal component analysis. Proteins such as endopolygalacturonase, catalase, NADP-dependent isocitrate dehydrogenase, pectin methylesterase and dehydrins were found to be very important for distinguishing between healthy and chill injured fruit. A categorization of the differentially accumulated proteins was performed using Gene Ontology annotation. The results showed that the 'response to stress', 'cellular homeostasis', 'metabolism of carbohydrates' and 'amino acid metabolism' biological processes were affected the most during the postharvest. Conclusions: Using a comparative proteomic approach with 2-D DIGE allowed us to identify proteins that showed stage-specific changes in their accumulation pattern. Several proteins that are related to response to stress, cellular homeostasis, cellular component organization and carbohydrate metabolism were detected as being differentially accumulated. Finally, a significant proportion of the proteins identified had not been associated with softening, cold storage or chilling injury-altered fruit before; thus, comparative proteomics has proven to be a valuable tool for understanding fruit softening and postharvest.

Endogenous spillovers, increased competition and re-organization waves

We consider an entrepreneur that is the sole producer of a costreducing skill, but the entrepreneur that hires a team to usethe skill cannot prevent collusive trade for the innovation related knowledge between employees and competitors. We showthat there are two types of diffusion avoiding strategies forthe entrepreneur to preempt collusive communication i) settingup a large productive capacity (the traditional firm) and ii)keeping a small team (the lean firm). The traditional firm ischaracterized by its many "marginal" employees that work shortdays, receive flat wages and are incompletely informed about the innovation. The lean firm is small in number of employees,engages in complete information sharing among members, that are paid with stock option schemes. We find that the lean firm is superior to the traditional firm when technological entry costsare low and when the sector is immature.

Influence activity and the organization of research and development

The organizational design of research and development conditions theincentives of the researchers of the research project. In particular,the organizational form determines the allocation of effort of theresearcher between time spent on research and time spent lobbying management. Researchers prefer to spend their time on research. However,the researchers only get utility from performing research if theproject is approved for its full duration. Spending time lobbyingmanagement for the continuation of the researcher s project increasesthe probability that the management observes a favorable signal aboutthe project. Organizing a research joint venture increases theflexibility of the organizational form with respect to the continuationdecision. For low correlation between the signals of the partners aboutthe expected profitability of the project, we find that the organizationof a research joint venture reduces influence activity by the researchersand increases expected profits of the partners. For high correlationbetween the signals, internal research projects lower influence activityby the researchers. We try to relate the correlation of the partnerssignals to the characteristics of basic research versus more appliedresearch projects, and find that the model is consistent with theobservation that research joint ventures seem involved in more basicresearch projects compared to internal R&D departments, whichconcentrate on more applied research.

Ophiolite-related ultramafic rocks (Serpentinites) in the Caribbean region: a review of their occurrence, composition, origin, emplacements and Ni-Laterite soil formation

Ultramafic rocks, mainly serpentinized peridotites of mantle origin, are mostly associated with the ophiolites of Mesozoic age that occur in belts along three of the margins of the Caribbean plate. The most extensive exposures are in Cuba. The ultramafic-mafic association (ophiolites) were formed and emplaced in several different tectonic environments. Mineralogical studies of the ultramafic rocks and the chemistry of the associated mafic rocks indicate that most of the ultramafic-mafic associations in both the northern and southern margins of the plate were formed in arc-related environments. There is little mantle peridotite exposed in the ophiolitic associations of the west coast of Central America, in the south Caribbean in Curacao and in the Andean belts in Colombia. In these occurrences the chemistry and age of the mafic rocks indicates that this association is mainly part of the 89 Ma Caribbean plateau province. The age of the mantle peridotites and associated ophiolites is probably mainly late Jurassic or Early Cretaceous. Emplacement of the ophiolites possibly began in the Early Cretaceous in Hispaniola and Puerto Rico, but most emplacement took place in the Late Cretaceous to Eocene (e.g. Cuba). Along the northern South America plate margin, in the Caribbean mountain belt, emplacement was by major thrusting and probably was not completed until the Oligocene or even the early Miocene. Caribbean mantle peridotites, before serpentinization, were mainly harzburgites, but dunites and lherzolites are also present. In detail, the mineralogical and chemical composition varies even within one ultramafic body, reflecting melting processes and peridotite/melt interaction in the upper mantle. At least for the northern Caribbean, uplift (postemplacement tectonics) exposed the ultramafic massifs as a land surface to effective laterization in the beginning of the Miocene. Tectonic factors, determining the uplift, exposing the peridotites to weathering varied. In the northern Caribbean, in Guatemala, Jamaica, and Hispaniola, uplift occurred as a result of transpresional movement along pre-existing major faults. In Cuba, uplift occurred on a regional scale, determined by isostatic adjustment. In the south Caribbean, uplift of the Cordillera de la Costa and Serrania del Interior exposing the peridotites, also appears to be related to strike-slip movement along the El Pilar fault system. In the Caribbean, Ni-laterite deposits are currently being mined in the central Dominican Republic, eastern Cuba, northern Venezuela and northwest Colombia. Although apparently formed over ultramafic rocks of similar composition and under similar climatic conditions, the composition of the lateritic soils varies. Factors that probably determined these differences in laterite composition are geomorphology, topography, drainage and tectonics. According to the mineralogy of principal ore-bearing phases, Dominican Ni-laterite deposits are classified as the hydrous silicate-type. The main Ni-bearing minerals are hydrated Mg-Ni silicates (serpentine and ¿garnierite¿) occurring deeper in the profile (saprolite horizon). In contrast, in the deposits of eastern Cuba, the Ni and Cooccurs mainly in the limonite zone composed of Fe hydroxides and oxides as the dominant mineralogy in the upper part of the profile, and are classified as the oxide-type.

Alkaline phosphatase activity as a tool for assessing nutritional conditions in the seagrass Posidonia oceanica.(L.) Delile

The effects of experimental phosphorus enrichments on alkaline phosphatase activity (APA) of the seagrass Posidonia oceanica (L.) Delile were tested. Short-term additions (as phosphate, 12 hours, in the laboratory) decreased APA by 18-2896, depending on the plant part considered (roots, young leaves or old leaves). The values of APA after this treatment were well correlated with interna1 phosphorus pools (as P concentration in plant tissues). Long-term additions (as phosphate, added to the sediment, 1 month in situ) decreased APA by 40-75%, also depending on the plant part. We conclude that alkaline phosphatase activity is a good indicator of P deficiency in this seagrass. We used this indicator to assess the P-nutritional status in a series of meadows in the NW Mediterranean, finding a high geographical variability, but correlations between APA and basic features of the meadows (carbonate content of the sediment, organic content of the sediment, shoot density, etc.) were not significant. Consequently, phosphorus deficiency does not seem to be directly related to these descriptors.

Family burden related to clinical and functional variables of people with intellectual disability with and without a mental disorder

Few studies have been found that to assess the factors that explain higher levels of familyburden in adults with intellectualdisability (ID) and intellectualdisability and mental disorders (ID-MD). The aims of this study were to assess familyburden in people with ID and ID-MD and to determine which sociodemographic, clinical and functionaldisabilityvariables account for familyburden. The sample is composed of pairs of 203 participants with disability and their caregivers, of which 33.5% are caregivers of people with ID and 66.5% of ID-MD. Assessments were performed using scales of clinical and functionaldisability as the following instruments: Weschler Adult Intelligence Scale-III (WAIS-III), Inventory for Client and Agency Planning (ICAP), Psychiatric Assessment Schedule for Adults with Development Disability (PAS-ADD checklist), Disability Assessment Schedule of the World Health Organization (WHO-DAS-II) and familyburden (Subjective and Objective FamilyBurden Inventory - SOFBI/ECFOS-II). People with ID-MD presented higher levels of functionaldisability than those with ID only. Higher levels of familyburden were related to higher functionaldisability in all the areas (p < 0.006-0.001), lower intelligence quotient (p < 0.001), diagnosis of ID-MD (p < 0.001) and presence of organic, affective, psychotic and behavioral disorders (p < 0.001). Stepwise multiple regression showed that behavioral problems, affective and psychotic disorder, disability in participation in society, disability in personal care and presence of ID-MD explained more than 61% of the variance in familyburden. An integrated approach using effective multidimensional interventions is essential for both people with ID and ID-MD and their caregivers in order to reduce familyburden.

Effects of anomalous propagation conditions on weather radar observations

In this chapter our objective is to provide an overview of the effects of anomalous propagation conditions on weather radar observations, based mostly on studies performed by the authors during the last decade, summarizing results from recent publications, presentations, or unpublished material. We believe this chapter may be useful as an introductory text for graduate students, or researchers and practitioners dealing with this topic. Throughout the text a spherical symmetric atmosphere is assumed and the focus is on the occurrence of ground and sea clutter and subsequent problems for weather radar applications. Other related topics such as long-path, over-the-horizon propagation and detection of radar targets (either clutter or weather systems) at long ranges is not considered here; however readers should be aware of the potential problems these phenomena may have as range aliasing may cause these echoes appear nearer than they are ¿ for more details see the discussion about second trip echoes by Zrnic, this volume.

Comparison of flag leaf and ear photosynthesis with biomass and grain yield of durum wheat under various water conditions and genotypes

Photosynthetic activity of cereals has traditionally been studied using leaves, thus neglecting the role of other organs such as ears. Here, we studied the effects of water status and genotypes on the photosynthetic activity of the flag leaf blade and the ear of durum wheat. The various parameters related to the photosynthetic activity were analysed in relation to the total above-ground plant biomass and grain yield at maturity. Four local varieties plus two cultivars adapted to the semiarid areas of South Morocco were grown in pots in a greenhouse. Five different water treatments were maintained from the beginning of stem elongation to maturity, when shoot biomass and grain yield were recorded. The net photosynthesis (A), stomatal conductance (gs) and transpiration (T) of the ear and the flag leaf were measured at anthesis. In both organs these factors decreased significantly with water deficit, whereas the A/T and A/gs ratios increased. The genotype effect was also significant for all traits studied. Whole-organ photosynthesis was much higher in the ear than in the flag leaf in well-watered conditions. As water stress developed, photosynthesis decreased less in the ear than in the flag leaf. Whole-ear photosynthesis correlated better than flag leaf photosynthesis with biomass and yield. Nevertheless, the relationships of the whole flag leaf with biomass and yield improved as the water stress became more severe, suggesting a progressive shift of yield from sink to source limitation. For all water regimes the ratios A/gs and A/T of the ear also showed a higher (negative) correlation with both biomass and yield than those of the flag leaf. The results indicate that the ear has a greater photosynthetic role than the flag leaf in determining grain yield, not only in drought but also in the absence of stress.