Avaliação da qualidade do Sistema de Informação de Registro de Óbitos Hospitalares (SIS-ROH), Hospital Central da Beira, Moçambique

As informações de mortalidade são úteis para avaliar a situação de saúde de uma população. Dados de mortalidade confiáveis produzidos por um sistema de informação de saúde nacional constituem uma ferramenta importante para o planejamento de saúde. Em muitos países, sobretudo em desenvolvimento, o sistema de informação de mortalidade continua precário. Apesar dos esforços feitos em Moçambique para melhoria das estatísticas de mortalidade, os desafios ainda prevalecem em termos de tecnologias de informação, capacidade técnica de recursos humanos e em termos de produção estatística. O SIS-ROH é um sistema eletrônico de registro de óbitos hospitalares de nível nacional, implementado em 2008 e tem uma cobertura de apenas 4% de todos os óbitos anuais do país. Apesar de ser um sistema de nível nacional, ele presentemente funciona em algumas Unidades Sanitárias (US), incluindo o Hospital Central da Beira (HCB). Dada a importância deste sistema para monitorar o padrão de mortalidade do HCB e, no geral, da cidade da Beira, este estudo avalia a qualidade do SIS-ROH do HCB. É um estudo descritivo sobre a completitude, cobertura, concordância e consistência dos dados do SIS-ROH. Foram analisados 3.009 óbitos de menores de 5 anos ocorridos entre 2010 e 2013 e regsitrados no SIS-ROH e uma amostra de 822 Certificados de Óbitos (COs) fetais e de menores de 5 anos do HCB. O SIS-ROH apresentou uma cobertura inferior a 50% calculados com os dados de mortalidade estimados pelo Inquérito Nacional de Causas de Morte (INCAM). Verificamos a utilização de dois modelos diferentes de CO (modelo antigo e atual) para o registro de óbitos referentes ao ano de 2013. Observou-se completitude excelente para a maioria das variáveis do SISROH. Das 25 variáveis analisadas dos COs observou-se a seguinte situação: 9 apresentaram completitude muito ruim, sendo elas relativas à identificação do falecido (tipo de óbito e idade), relativas ao bloco V em que dados da mãe devem ser obrigatoriamente preenchidos em caso de óbitos fetais e de menores de 1 ano (escolaridade, ocupação habitual, número de filhos tidos vivos e mortos, duração da gestação) e relativas às condições e às causas de óbito (autópsia e causa intermédiacódigo); 3 variáveis apresentaram completitude ruim relativas à identificação do falecido (NID) e relativas às condições e causas de morte (causa intermédia - descrição e causa básica - código); 9 apresentaram completitude regular relativas à identificação do falecido (data de nascimento e idade), relativas ao bloco V (idade da mãe, tipo de gravidez, tipo de parto, peso do feto/bebé ao nascer, morte do feto/bebé em relação ao parto) e relativas às condições e causa de óbito (causa direta- código, causa básica descrição); 2 apresentaram completitude bom relativas à identificação do falecido (sexo e raça/cor) e, por último, 2 apresentaram completitude excelente relativas ao local de ocorrência de óbito (data de internamento e data de óbito ou desaparecimento do cadáver). Algumas variáveis do SIS-ROH e dos COS apresentaram inconsistências. Observou-se falta de concordância para causa direta entre o SIS-ROH e os COs. Conclusão: Moçambique tem feito esforços para aprimorar as estatísticas de mortalidade, porém há lacunas na qualidade; a análise rotineria dos dados pode identificar essas lacunas e subsidiar seu aprimoramento.

Seismically-induced landslides by a low-magnitude earthquake: The Mw 4.7 Ossa De Montiel event (central Spain)

The Ossa de Montiel (2015/02/23, Mw 4.7) earthquake struck the central part of Spain and was felt far from the epicenter (> 300 km). Even though ground shaking was slight (Imax = V, EMS-98 scale), the earthquake triggered many small rock falls, most at distances of 20–30 km from the epicenter, greater than previously recorded in S Spain (16 km) for earthquakes of similar magnitudes. The comparative analysis of available data for this event with records from other quakes of the Betic cordillera (S and SE Spain) seems to indicate a slower pattern of ground-motion attenuation in central Spain. This could explain why slope instabilities occurred at larger distances. Instability was more frequent, and occurred at larger distances, in road cuts than in natural slopes, implying that such slope types are highly susceptible to seismically induced landslides.

The Central European Predicament. Jean Monnet/Robert Schuman Paper Series Vol. 14 No. 9, May 2014

From Introduction. Central and Eastern Europe (CEE) has experienced a very deep economic and political transformation since the beginning of the nineties. The early years of transition were characterized by big hopes for a quick and successful development. The international community, including the EU and the USA showed interest in the transformation of the region for a number of reasons. From a geopolitical perspective, the transformation was of tremendous importance as it confirmed the end of the cold war and the bipolar global system was replaced first by a unipolar superpower system and later gave way to a multipolar or a new bipolar system. This also signaled the weakness of the Soviet Union (and later Russia), as it was not able to prevent this transformation and was soon mired in a serious and long lasting economic and political crisis that undermined its international position. After the dissolution of the Soviet Union during the nineties Russia remained very weak, both economically and politically. The power vacuum and the transformation in Central Europe made the establishment of a new international economic and security structure possible. The new economic and political pattern that started to develop within the region was based on the liberal market economy model, with the objective of opening up markets and integrating the region into the world economy and the North Atlantic security structure.

Cardiovascular disease in Switzerland - health care, mortality and geographical pattern

SUMMARY Switzerland is facing an aging population and a growing amount of patients with chronic diseases. It is crucial to display health care processes and pathways, to identify inequalities and obstacles, and to point out possibilities for improvements of the Swiss health care system (e.g. increase efficiency). The introductory part of the thesis presents a brief description of the Swiss health care system, health services research and regional variation as well as an introduction of CVD and its epidemiological key figures, aetiology and treatments. This is followed by the description of the utilized methods and data, and the objectives of this thesis. The subsequent sections present the four articles included in this thesis. The first article focuses on a small area analysis on regional variation of avoidable hospitalisations in Switzerland including density of primary care physicians and specialists, rurality and hospital supply factors as explanatory variables in the analysis. Lower rates of avoidable hospitalisations were found in areas with very high supply of primary care physicians, increased avoidable hospitalisation rates in areas with more specialists and in areas with higher proportion of rural residents. The second article aims to examine whether emergency patients with acute ST-segment elevation myocardial infarction were adequately treated, i.e. according to the treatment guidelines, in Switzerland. Results show that older and female patients were less likely to receive revascularization which suggests that the treatment guidelines may not be uniformly applied in Switzerland. Similar to the first article, also in the third article a small area analysis was performed but this time investigating regional variation in costs at the end of life. Strongest associations of cost was found with cause of death, age and language region of the decedents. The strong spatial variation of costs could only partly be explained by the included covariates. Article four aims to examine the relationship of distance to different hospital types and mortality from AMI or stroke. We found that AMI mortality in the Swiss population 30 and older and stroke mortality in those 65 and above increased with distance to central and university hospitals, while adjusting for sociodemographic and economic characteristics of the population. The presentation of the four articles is followed by a discussion, which summarizes the main findings and the strengths and limitations of the presented articles. The thesis concludes with a discussion about the challenges for policy, practice and future research.

Holocene flood frequency across the Central Alps

The frequency of large-scale heavy precipitation events in the European Alps is expected to undergo substantial changes with current climate change. Hence, knowledge about the past natural variability of floods caused by heavy precipitation constitutes important input for climate projections. We present a comprehensive Holocene (10,000 years) reconstruction of the flood frequency in the Central European Alps combining 15 lacustrine sediment records. These records provide an extensive catalog of flood deposits, which were generated by flood-induced underflows delivering terrestrial material to the lake floors. The multi-archive approach allows suppressing local weather patterns, such as thunderstorms, from the obtained climate signal. We reconstructed mainly late spring to fall events since ice cover and precipitation in form of snow in winter at high-altitude study sites do inhibit the generation of flood layers. We found that flood frequency was higher during cool periods, coinciding with lows in solar activity. In addition, flood occurrence shows periodicities that are also observed in reconstructions of solar activity from 14C and 10Be records (2500-3000, 900-1200, as well as of about 710, 500, 350, 208 (Suess cycle), 150, 104 and 87 (Gleissberg cycle) years). As atmospheric mechanism, we propose an expansion/shrinking of the Hadley cell with increasing/decreasing air temperature, causing dry/wet conditions in Central Europe during phases of high/low solar activity. Furthermore, differences between the flood patterns from the Northern Alps and the Southern Alps indicate changes in North Atlantic circulation. Enhanced flood occurrence in the South compared to the North suggests a pronounced southward position of the Westerlies and/or blocking over the northern North Atlantic, hence resembling a negative NAO state (most distinct from 4.2 to 2.4 kyr BP and during the Little Ice Age). South-Alpine flood activity therefore provides a qualitative record of variations in a paleo-NAO pattern during the Holocene. Additionally, increased South Alpine flood activity contrasts to low precipitation in tropical Central America (Cariaco Basin) on the Holocene and centennial time scale. This observation is consistent with a Holocene southward migration of the Atlantic circulation system, and hence of the ITCZ, driven by decreasing summer insolation in the Northern hemisphere, as well as with shorter-term fluctuations probably driven by solar activity.

Shell preservation of Limacina inflata in surface sediments of the Central and South Atlantic

Over 300 surface sediment samples from the Central and South Atlantic Ocean and the Caribbean Sea were investigated for the preservation state of the aragonitic test of Limacina inflata. Results are displayed in spatial distribution maps and are plotted against cross-sections of vertical water mass configurations, illustrating the relationship between preservation state, saturation state of the overlying waters, and overall water mass distribution. The microscopic investigation of L. inflata (adults) yielded the Limacina dissolution index (LDX), and revealed three regional dissolution patterns. In the western Atlantic Ocean, sedimentary preservation states correspond to saturation states in the overlying waters. Poor preservation is found within intermediate water masses of southern origin (i.e. Antarctic intermediate water (AAIW), upper circumpolar water (UCDW)), which are distinctly aragonite-corrosive, whereas good preservation is observed within the surface waters above and within the upper North Atlantic deep water (UNADW) beneath the AAIW. In the eastern Atlantic Ocean, in particular along the African continental margin, the LDX fails in most cases (i.e. less than 10 tests of L. inflata per sample were found). This is most probably due to extensive "metabolic" aragonite dissolution at the sediment-water interface combined with a reduced abundance of L. inflata in the surface waters. In the Caribbean Sea, a more complex preservation pattern is observed because of the interaction between different water masses, which invade the Caribbean basins through several channels, and varying input of bank-derived fine aragonite and magnesian calcite material. The solubility of aragonite increases with increasing pressure, but aragonite dissolution in the sediments does not simply increase with water depth. Worse preservation is found in intermediate water depths following an S-shaped curve. As a result, two aragonite lysoclines are observed, one above the other. In four depth transects, we show that the western Atlantic and Caribbean LDX records resemble surficial calcium carbonate data and delta13C and carbonate ion concentration profiles in the water column. Moreover, preservation of L. inflata within AAIW and UCDW improves significantly to the north, whereas carbonate corrosiveness diminishes due to increased mixing of AAIW and UNADW. The close relationship between LDX values and aragonite contents in the sediments shows much promise for the quantification of the aragonite loss under the influence of different water masses. LDX failure and uncertainties may be attributed to (1) aragonite dissolution due to bottom water corrosiveness, (2) aragonite dissolution due to additional CO2 release into the bottom water by the degradation of organic matter based on an enhanced supply of organic matter into the sediment, (3) variations in the distribution of L. inflata and hence a lack of supply into the sediment, (4) dilution of the sediments and hence a lack of tests of L. inflata, or (5) redeposition of sediment particles.

Organizational, direct support, and general support maintenance ... for generator, test pattern SG-1223/T (NSN 6625-01-127-6846).

"20 August 1984."

mecA locus diversity in methicillin-resistant Staphylococcus aureus isolates in Brisbane, Australia, and the development of a novel diagnostic procedure for the Western Samoan phage pattern clone

An emerging public health phenomenon is the increasing incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections that are acquired outside of health care facilities. One lineage of community-acquired MRSA (CA-MRSA) is known as the Western Samoan phage pattern (WSPP) clone. The central aim of this study was to develop an efficient genotyping procedure for the identification of WSPP isolates. The approach taken was to make use of the highly variable region downstream of mecA in combination with a single nucleotide polymorphism (SNP) defined by the S. aureus multilocus sequence typing (MLST) database. The premise was that a combinatorial genotyping method that interrogated both a highly variable region and the genomic backbone would deliver a high degree of informative power relative to the number of genetic polymorphisms-interrogated. Thirty-five MRSA isolates were used for this study, and their gene contents and order downstream of mecA were determined. The CA-MRSA isolates were found to contain a truncated mecA downstream region consisting of mecA-HVR-IS431 mec-dcs-Ins117, and a PCR-based method for identifying this structure was developed. The hospital-acquired isolates were found to contain eight different mecA downstream regions, three of which were novel. The Minimum SNPs computer software program was used to mine the S. aureus MLST database, and the arcC 2726 polymorph was identified as 82% discriminatory for ST-30. A real-time PCR assay was developed to interrogate this SNP. We found that the assay for the truncated mecA downstream region in combination with the interrogation of arcC position 272 provided an unambiguous identification of WSPP isolates.

Archaeological Identification and Significance of ÉSAG (Agricultural Storage Pits) at Kaman-Kalehöyük, Central Anatolia

Evidence for the presence of storage pits described in Hittite texts by the Sumerogram "ÉSAG" is presented from Kaman-Kalehöyük, a multi-period tell site in central Turkey occupied during the second and first millennia BC. Small earthen pits matching the description of "ÉSAG" were part of the normal suite of domestic installations at the site throughout the period. Similar to pits seen across western Eurasia, they were probably used to store seed corn or seed for trade. Large earthen pits (>7m in diameter) were also present that matched the description of the "ÉSAG" form, and in some cases contained archaeological cereal remains. Evidence from Kaman shows "ÉSAG" were part of Anatolian life for at least 4,000 years and suggests that the term was generic for lined, earthen storage pits. The presence of so many small pits at Kaman-Kalehöyük showed that it was an agricultural production site for much of its existence. The appearance of the large pits, confined to the Hittite period, reflects centralised control of grain supply, probably by the Hittite Kingdom, and fits a pattern seen at other sites in the region during the second millennium BC. /// Hitit metinlerinde Sumerogram "ÉSAG" ile tanimlanan depo çukurlarinin varliğina dair kanit, Orta Anadolu'da M.Ö. İkinci ve Birinci binde iskan edilmiş çok dönemli bir yerleşim alani olan Kaman-Kalehöyük'ten taninmaktadir. Küçük toprak çukurlar "ÉSAG" in tanimlamasina uygun olarak bu dönem süresince normal ev düzeninin bir parçasi olarak karşimiza çikmiştir. Çukurlar, Bati Avrasya'daki benzer çukurlar gibi olasilikla ticaret maksadi ile misir tohumu ya da tohum muhafaza etmişlerdir. "ÉSAG" formunun tanimina uyan büyük toprak çukurlara (çapi 7m. den büyük) rağmen bunlarin tahil depolama ile ilgili bağlantilari tam olarak belirlenmemiştir. Kaman'daki delil, "ÉSAG" in en az 4,000 yildir Anadolu yaşaminin bir parçasi olduğunu ve bu sözcüğün sivanmiş toprak çukurlar için kullanildiğini işaret etmektedir. Kaman-Kalehöyük'te ele geçen birçok küçük çukur, yerleşimin varliğini sürdürdüǧü sürecin büyük bir bölümünde zirai üretim yapildiğini göstermektedir. Hitit Döneminde büyük çukurlarin ortaya çikmasi muhtemelen Hitit Kralliği tarafindan gerçekleştirilen tahil tedarikinin merkezi kontrolünü yansitmakta ve M.Ö. İkinci binde bu bölgedeki diğer yerleşim alanlarinda görülen şekle uymaktadir.

EphA4 regulates central nervous system vascular formation

Molecules involved in axon guidance have recently also been shown to play a role in blood vessel guidance. To examine whether axon guidance molecules, such as the EphA4 receptor tyrosine kinase, might also play a role in development of the central nervous system (CNS) vasculature and repair following CNS injury, we examined wild-type and EphA4 null mutant (-/-) mice. EphA4-/- mice exhibited an abnormal CNS vascular structure in both the cerebral cortex and the spinal cord, with disorganized branching and a 30% smaller diameter. During development, EphA4 was expressed on endothelial cells. This pattern of expression was not maintained in the adult. After spinal cord injury in wild-type mice, expression of EphA4 was markedly up-regulated on activated astrocytes, many of which were tightly associated with blood vessels. In EphA4-/- spinal cord following injury, astrocytes were not as tightly associated with blood vessels as the wild-type astrocytes. In uninjured EphA4-/- mice, the blood-brain barrier (BBB) appeared normal, but it showed prolonged leakage following spinal cord injury. These results support a role for EphA4 in CNS vascular formation and guidance during development and an additional role in BBB repair.

Screening of obstructive and central apnoea/hypopnoea in children using variability: A preliminary study

Aim: Polysomnography (PSG) is the current standard protocol for sleep disordered breathing (SDB) investigation in children. Presently, there are limited reliable screening tests for both central (CE) and obstructive (OE) respiratory events. This study compared three indices, derived from pulse oximetry and electrocardiogram ( ECG), with the PSG gold standard. These indices were heart rate (HR) variability, arterial blood oxygen de-saturation (SaO(2)) and pulse transit time (PTT). Methods: 15 children (12 male) from routine PSG studies were recruited (aged 3 - 14 years). The characteristics of the three indices were based on known criteria for respiratory events (RPE). Their estimation singly and in combination was evaluated with simultaneous scored PSG recordings. Results: 215 RPE and 215 tidal breathing events were analysed. For OE, the obtained sensitivity was HR (0.703), SaO(2) (0.047), PTT (0.750), considering all three indices (0) and either of the indices (0.828) while specificity was (0.891), (0.938), (0.922), (0.953) and (0.859) respectively. For CE, the sensitivity was HR (0.715), SaO(2) (0.278), PTT (0.662), considering all indices (0.040) and either of the indices (0.868) while specificity was (0.815), (0.954), (0.901), (0.960) and (0.762) accordingly. Conclusions: Preliminary findings herein suggest that the later combination of these non-invasive indices to be a promising screening method of SDB in children.

Motivations for second position: Evidence from North-Central Australia

It has long been observed that many languages from all over the world require that certain grammatical categories (e.g., person, number, tense, modality) occur in the "second position" of a clause. Much of the research into second position has developed formal explanations for this recurring pattern, based on interactions between morphosyntax and phonology. In this article I explore how pragmatics of information packaging interacts with these other features in the development of such morphosyntactic architecture in three North-Central Australian languages: Warlpiri, Wambaya, and Garrwa.

Asymptotic theory of time varying networks with memory and heterogeneous activation pattern

In this thesis work we develop a new generative model of social networks belonging to the family of Time Varying Networks. The importance of correctly modelling the mechanisms shaping the growth of a network and the dynamics of the edges activation and inactivation are of central importance in network science. Indeed, by means of generative models that mimic the real-world dynamics of contacts in social networks it is possible to forecast the outcome of an epidemic process, optimize the immunization campaign or optimally spread an information among individuals. This task can now be tackled taking advantage of the recent availability of large-scale, high-quality and time-resolved datasets. This wealth of digital data has allowed to deepen our understanding of the structure and properties of many real-world networks. Moreover, the empirical evidence of a temporal dimension in networks prompted the switch of paradigm from a static representation of graphs to a time varying one. In this work we exploit the Activity-Driven paradigm (a modeling tool belonging to the family of Time-Varying-Networks) to develop a general dynamical model that encodes fundamental mechanism shaping the social networks' topology and its temporal structure: social capital allocation and burstiness. The former accounts for the fact that individuals does not randomly invest their time and social interactions but they rather allocate it toward already known nodes of the network. The latter accounts for the heavy-tailed distributions of the inter-event time in social networks. We then empirically measure the properties of these two mechanisms from seven real-world datasets and develop a data-driven model, analytically solving it. We then check the results against numerical simulations and test our predictions with real-world datasets, finding a good agreement between the two. Moreover, we find and characterize a non-trivial interplay between burstiness and social capital allocation in the parameters phase space. Finally, we present a novel approach to the development of a complete generative model of Time-Varying-Networks. This model is inspired by the Kaufman's adjacent possible theory and is based on a generalized version of the Polya's urn. Remarkably, most of the complex and heterogeneous feature of real-world social networks are naturally reproduced by this dynamical model, together with many high-order topological properties (clustering coefficient, community structure etc.).

Category learning induces position invariance of pattern recognition across the visual field

Human object recognition is considered to be largely invariant to translation across the visual field. However, the origin of this invariance to positional changes has remained elusive, since numerous studies found that the ability to discriminate between visual patterns develops in a largely location-specific manner, with only a limited transfer to novel visual field positions. In order to reconcile these contradicting observations, we traced the acquisition of categories of unfamiliar grey-level patterns within an interleaved learning and testing paradigm that involved either the same or different retinal locations. Our results show that position invariance is an emergent property of category learning. Pattern categories acquired over several hours at a fixed location in either the peripheral or central visual field gradually become accessible at new locations without any position-specific feedback. Furthermore, categories of novel patterns presented in the left hemifield are distinctly faster learnt and better generalized to other locations than those learnt in the right hemifield. Our results suggest that during learning initially position-specific representations of categories based on spatial pattern structure become encoded in a relational, position-invariant format. Such representational shifts may provide a generic mechanism to achieve perceptual invariance in object recognition.

Language against the odds, or rather not:the weak central coherence hypothesis and language

EV is a child with a talent for learning language combined with Asperger syndrome. EV’s talent is evident in the unusual circumstances of her acquisition of both her first (Bulgarian) and second (German) languages and the unique patterns of both receptive and expressive language (in both the L1 and L2), in which she shows subtle dissociations in competence and performance consistent with an uneven cognitive profile of skills and abilities. We argue that this case provides support for theories of language learning and usage that require more general underlying cognitive mechanisms and skills. One such account, the Weak Central Coherence (WCC) hypothesis of autism, provides a plausible framework for the interpretation of the simultaneous co-occurrence of EV’s particular pattern of cognitive strengths and weaknesses. Furthermore, we show that specific features of the uneven cognitive profile of Asperger syndrome can help explain the observed language talent displayed by EV. Thus, rather than demonstrating a case where language learning takes place despite the presence of deficits, EV’s case illustrates how a pattern of strengths within this profile can specifically promote language learning.