Quality of cause of death certification at an academic hospital in Cape Town, South Africa

Objectives. To investigate the quality of cause of deathcertification and assess the level of under-reporting of HIV/AIDS as a cause of death at an academic hospital.Design. Cross-sectional descriptive retrospective review ofdeath notification forms (DNFs) of deaths due to naturalcauses in an academic hospital in Cape Town during 2004.Errors in cause of death certification and ability to code causesof death according to the 10th revision of the InternationalStatistical Classification of Diseases and Related Health Problems(ICD-10) were assessed. The association between seriouserrors and age, gender, cause of death and hospital ward wasanalysed. A sample of DNFs (N=243) was assessed for level ofunder-reporting of HIV/AIDS.Results. A total of 983 death certificates were evaluated.Almost every DNF had a minor error; serious errors werefound in 32.2% (95% confidence interval (CI) 29.3 - 35.1%).Errors increased with patient age, and cause of death wasthe most important factor associated with serious errors.Compared with neoplasms, which had the lowest error rate,the odds ratios for errors in endocrine and metabolic diseasesand genito-urinary diseases were 17.2 (95% CI 8.7 - 34.0) and17.3 (95% CI 7.8 - 38.2), respectively. Based on the sub-sample,the minimum prevalence of HIV among the deceased patientswas 15.7% (95% CI 11.1 - 20.3%) and the under-reporting ofdeaths due to AIDS was 53.1% (95% CI 35.8 - 70.4%).Conclusion. Errors were sufficiently serious to affectidentification of underlying cause of death in almost a thirdof the DNFs, confirming the need to improve the quality ofmedical certification

The Dynamic Evolution of Solar Wind Streams Following Interchange Reconnection

Interchange reconnection is thought to play an important role in determining the dynamics and material composition of the slow solar wind that originates from near coronal hole boundaries. To explore the implications of this process we simulate the dynamic evolution of a solar wind stream along a newly-opened magnetic flux tube. The initial condition is composed of a piecewise continuous dynamic equilibrium in which the regions above and below the reconnection site are extracted from steady-state solutions along open and closed field lines. The initial discontinuity at the reconnection site is highly unstable and evolves as a Riemann problem, decomposing into an outward-propagating shock and inward-propagating rarefaction that eventually develop into a classic N-wave configuration. This configuration ultimately propagates into the heliosphere as a coherent structure and the entire system eventually settles to a quasi-steady wind solution. In addition to simulating the fluid evolution we also calculate the time-dependent non-equilibrium ionization of oxygen in real time in order to construct in situ diagnostics of the conditions near the reconnection site. This idealized description of the plasma dynamics along a newly-opened magnetic field line provides a baseline for predicting and interpreting the implications of interchange reconnection for the slow solar wind. Notably, the density and velocity within the expanding N-wave are generally enhanced over the ambient wind, as is the O7+/O6+ ionization ratio, which exhibits a discontinuity across the reconnection site that is transported by the flow and arrives later than the propagating N-wave

Chemical NOx budget in the upper troposphere over the tropical South Pacific

The chemical NOx budget in the upper troposphere over the tropical South Pacific is analyzed using aircraft measurements made at 6-12 km altitude in September 1996 during the Global Tropospheric Experiment (GTE) Pacific Exploratory Mission (PEM) Tropics A campaign. Chemical loss and production rates of NOx along the aircraft flight tracks are calculated with a photochemical model constrained by observations. Calculations using a standard chemical mechanism show a large missing source for NOx; chemical loss exceeds chemical production by a factor of 2.4 on average. Similar or greater NOx budget imbalances have been reported in analyses of data from previous field studies. Ammonium aerosol concentrations in PEM-Tropics A generally exceeded sulfate on a charge equivalent basis, and relative humidities were low (median 25% relative to ice). This implies that the aerosol could be dry in which case N2O5 hydrolysis would be suppressed as a sink for NOx. Suppression of N2O5 hydrolysis and adoption of new measurements of the reaction rate constants for NO2 + OH + M and HNO3 + OH reduces the median chemical imbalance in the NOx budget for PEM-Tropics A from 2.4 to 1.9. The remaining imbalance cannot be easily explained from known chemistry or long-range transport of primary NOx and may imply a major gap in our understanding of the chemical cycling of NOx in the free troposphere. Copyright 2000 by the American Geophysical Union

Flexible Causal Inference for Political Science

Measuring the causal impact of state behavior on outcomes is one of the biggest methodological challenges in the field of political science, for two reasons: behavior is generally endogenous, and the threat of unobserved variables that confound the relationship between behavior and outcomes is pervasive. Matching methods, widely considered to be the state of the art in causal inference in political science, are generally ill-suited to inference in the presence of unobserved confounders. Heckman-style multiple-equation models offer a solution to this problem; however, they rely on functional-form assumptions that can produce substantial bias in estimates of average treatment effects. We describe a category of models, flexible joint likelihood models, that account for both features of the data while avoiding reliance on rigid functional-form assumptions. We then assess these models’ performance in a series of neutral simulations, in which they produce substantial (55% to 90%) reduction in bias relative to competing models. Finally, we demonstrate their utility in a reanalysis of Simmons’ (2000) classic study of the impact of Article VIII commitment on compliance with the IMF’s currency-restriction regime

Secreted Glycoside Hydrolase Proteins as Effectors and Invasion Patterns of Plant-Associated Fungi and Oomycetes.

During host colonization, plant-associated microbes, including fungi and oomycetes, deliver a collection of glycoside hydrolases (GHs) to their cell surfaces and surrounding extracellular environments. The number and type of GHs secreted by each organism is typically associated with their lifestyle or mode of nutrient acquisition. Secreted GHs of plant-associated fungi and oomycetes serve a number of different functions, with many of them acting as virulence factors (effectors) to promote microbial host colonization. Specific functions involve, for example, nutrient acquisition, the detoxification of antimicrobial compounds, the manipulation of plant microbiota, and the suppression or prevention of plant immune responses. In contrast, secreted GHs of plant-associated fungi and oomycetes can also activate the plant immune system, either by acting as microbe-associated molecular patterns (MAMPs), or through the release of damage-associated molecular patterns (DAMPs) as a consequence of their enzymatic activity. In this review, we highlight the critical roles that secreted GHs from plant-associated fungi and oomycetes play in plant-microbe interactions, provide an overview of existing knowledge gaps and summarize future directions.Published onlin

Inequality, material well-being, and subjective well-being: Exploring associations for children across 15 diverse countries

Children's material well-being, and the levels of wealth and inequality in societies within which children live, are important factors in determining outcomes. However, less is known about the extent to which these factors have an impact children's subjective well-being, especially in an internationally comparative context. This study draws on data from the Children's Worlds survey, an international study of child subjective well-being, to explore links between national level indicators of wealth and inequality (GDP and Gini coefficients), individual indicators of material well-being (the material resources children report having access to), and subjective well-being. The survey covers 15 diverse countries covering the continents of Europe, Asia, Africa and South America, with samples of at least 3000 per country, ages 8, 10 and 12. Analysis takes the form of a multilevel, varying intercepts and slopes model, examining the association between financial and material resources and inequality and subjective well-being across and between countries. Findings suggest that material resources that children report are significantly associated with subjective well-being, while indicators of financial resources and inequality at the national level are not. While a significant association between material resources and subjective well-being is found across the whole sample, the magnitude of this association, and the association between school- and country-level material resources, varies markedly. Within different countries, the strongest material resources-related predictor of overall subjective well-being may be either at the individual, school or country level

Summertime partitioning and budget of NOycompounds in the troposphere over Alaska and Canada: ABLE 3B

As part of NASA's Arctic Boundary Layer Expedition 3A and 3B field measurement programs, measurements of NO(x) HNO31, PAN, PPN, and NOy were made in the middle to lower troposphere over Alaska and Canada during the summers of 1988 and 1990. These measurements are used to assess the degree of closure within the reactive odd nitrogen (NxOy) budget through the comparison of the values of NOy measured with a catalytic convertor to the sum of individually measured NOy(i) compounds (i.e., Sigma NOy(i) = NOx + HNO3 + PAN + PPN). Significant differences were observed between the various study regions. In the lower 6 km of the troposphere over Alaska and the Hudson Bay lowlands of Canada a significant traction of the NOy budget (30 to 60 per cent) could not be accounted for by the measured Sigma NOy(i). This deficit in the NOy budget is about 100 to 200 parts per trillion by volume (pptv) in the lower troposphere (0.15 to 3 km) and about 200 to 400 pptv in the middle free troposphere (3 to 6.2 km). Conversely, the NOy budget in the northern Labrador and Quebec regions or Canada is almost totally accounted for within the combined measurement uncertainties of NOy and the various NOy(i) compounds. A substantial portion of the NOx budget's 'missing compounds' appears to be coupled to the photochemical and/or dynamical parameters influencing the tropospheric oxidative potential over these regions. A combination of factors are suggested as the causes for the variability observed in the NOy budget. In addition, the apparent stability of compounds represented by the NOy budget deficit in the lower-attitude range questions the ability of these compounds to participate as reversible reservoirs for "active" odd nitrogen and suggest that some portion of the NOy budget may consist of relatively unreactive nitrogencontaining compounds. Bei der Rationalisierung von Kommissioniersystemen besteht bei vielen Unternehmen noch Nachholbedarf. Dies ergab eine Umfrage des Fraunhofer-Instituts für Materialfluss und Logistik in Dortmund bei ca. 800 Unternehmen. Keins der Unternehmen setzt Kommissionierautomaten ein, die Voraussetzungen für durchgehende Automatisierung fehlen

Implications of large scale shifts in tropospheric NOx levels in the remote tropical Pacific

A major observation recorded during NASA's western Pacific Exploratory Mission (PEM-West B) was the large shift in tropical NO levels as a function of geographical location. High-altitude NO levels exceeding 100 pptv were observed during portions of tropical flights 5-8, while values almost never exceeded 20 pptv during tropical flights 9 and 10. The geographical regions encompassing these two flight groupings are here labeled "high" and "low" NOx regimes. A comparison of these two regimes, based on back trajectories and chemical tracers, suggests that air parcels in both were strongly influenced by deep convection. The low NOx regime appears to have been predominantly impacted by marine convection, whereas the high NOx regime shows evidence of having been more influenced by deep convection over a continental land mass. DMSP satellite observations point strongly toward lightning as the major source of NOx in the latter regime. Photochemical ozone formation in the high NOx regime exceeded that for low NOx by factors of 2 to 6, whereas O3 destruction in the low NOx regime exceeded that for high NOx by factors of up to 3. Taking the tropopause height to be 17 km, estimates of the net photochemical effect on the O3 column revealed that the high NOx regime led to a small net production. By contrast, the low NOx regime was shown to destroy O3 at the rate of 3.4% per day. One proposed mechanism for off-setting this projected large deficit would involve the transport of O3 rich midlatitude air into the tropics. Alternatively, it is suggested that O3 within the tropics may be overall near self-sustaining with respect to photochemical activity. This scenario would require that some tropical regions, unsampled at the time of PEM-B, display significant net column O3 production, leading to an overall balanced budget for the "greater" tropical Pacific basin. Details concerning the chemical nature of such regimes are discussed

Influence of biomass combustion emissions on the distribution of acidic trace gases over the southern Pacific basin during austral springtime

This paper describes the large-scale distributions of HNO3, HCOOH, and CH3COOH over the central and South Pacific basins during the Pacific Exploratory Mission-Tropics (PEM-Tropics) in austral springtime. Because of the remoteness of this region from continental areas, low part per trillion by volume (pptv) mixing ratios of acidic gases were anticipated to be pervasive over the South Pacific basin. However, at altitudes of 2–12 km over the South Pacific, air parcels were encountered frequently with significantly enhanced mixing ratios (up to 1200 pptv) of acidic gases. Most of these air parcels were centered in the 3–7 km altitude range and occurred within the 15°−65°S latitudinal band. The acidic gases exhibited an overall general correlation with CH3Cl, PAN, and O3, suggestive of photochemical and biomass burning sources. There was no correlation or trend of acidic gases with common industrial tracer compounds (e.g., C2Cl4 or CH3CCl3). The combustion emissions sampled over the South Pacific basin were relatively aged exhibiting C2H2/CO ratios in the range of 0.2–2.2 pptv/ppbv. The relationships between acidic gases and this ratio were similar to what was observed in aged air parcels (i.e., \u3e3–5 days since they were over a continental area) over the western North Pacific during the Pacific Exploratory Mission-West Phases A and B (PEM-West A and B). In the South Pacific marine boundary layer a median C2H2/CO ratio of 0.6 suggested that this region was generally not influenced by direct inputs of biomass combustion emissions. Here we observed the lowest mixing ratios of acidic gases, with median values of 14 pptv for HNO3, 19 pptv for HCOOH, and 18 pptv for CH3COOH. These values were coincident with low mixing ratios of NOx(\u3c10 pptv), CO (≈50 parts per billion by volume (ppbv)), O3 (\u3c 20 ppbv), and long-lived hydrocarbons (e.g., C2H6 \u3c300 pptv). Overall, the PEM-Tropics data suggest an important influence of aged biomass combustion emissions on the distributions of acidic gases over the South Pacific basin in austral springtime