Simplified Symptom Pattern Method for verbal autopsy analysis: multisite validation study using clinical diagnostic gold standards

Background: Verbal autopsy can be a useful tool for generating cause of death data in data-sparse regions around the world. The Symptom Pattern (SP) Method is one promising approach to analyzing verbal autopsy data, but it has not been tested rigorously with gold standard diagnostic criteria. We propose a simplified version of SP and evaluate its performance using verbal autopsy data with accompanying true cause of death.Methods: We investigated specific parameters in SP's Bayesian framework that allow for its optimal performance in both assigning individual cause of death and in determining cause-specific mortality fractions. We evaluated these outcomes of the method separately for adult, child, and neonatal verbal autopsies in 500 different population constructs of verbal autopsy data to analyze its ability in various settings.Results: We determined that a modified, simpler version of Symptom Pattern (termed Simplified Symptom Pattern, or SSP) performs better than the previously-developed approach. Across 500 samples of verbal autopsy testing data, SSP achieves a median cause-specific mortality fraction accuracy of 0.710 for adults, 0.739 for children, and 0.751 for neonates. In individual cause of death assignment in the same testing environment, SSP achieves 45.8% chance-corrected concordance for adults, 51.5% for children, and 32.5% for neonates.Conclusions: The Simplified Symptom Pattern Method for verbal autopsy can yield reliable and reasonably accurate results for both individual cause of death assignment and for determining cause-specific mortality fractions. The method demonstrates that verbal autopsies coupled with SSP can be a useful tool for analyzing mortality patterns and determining individual cause of death from verbal autopsy data

Paleo-watertable definition using cave ferromanganese stromatolites and associated cave-wall notches (Sierra de Arnero, Spain)

The steeply-dipping-dolostone-hosted caves of the Sierra de Arnero (N Spain) contain low-gradient relict canyons with up to ten mapped levels of ferromanganese stromatolites and associated wall notches over a vertical range of 85 m, the highest occurring ~ 460 m above base level. Despite a plausible speleogenetic contribution by pyrite oxidation, and the irregular cave-wall mesomorphologies suggestive of hypogenic speleogenesis, the Arnero relict caves are dominantly epigenic, as indicated by the conduit pattern and the abundant allogenic sediments. Allogenic input declined over time due to a piracy-related decrease in the drainage area of allogenic streams, explaining the large size of the relict Arnero caves relative to the limited present-day outcrop area of the karstified carbonates. Allogenic-sediment input also explains the observed change from watertable canyons to phreatic conduits in the paleo-downstream direction. Stromatolites and notches arguably formed in cave-stream passages at the watertable. The best-defined paleo-watertables show an overall slope of 1.7°, consistent with the present-day relief of the watertable, with higher-slope segments caused by barriers related to sulfide mineralization. The formation of watertable stromatolites favored wall notching by the combined effect of enhanced acidity by Mn–Fe oxidation and shielding of cave floors against erosion. Abrasive bedload further contributed to notch formation by promoting lateral mechanical erosion and protecting passage floors. The irregular wallrock erosional forms of Arnero caves are related partly to paragenesis and partly to the porous nature of the host dolostones, which favored irregular dissolution near passage walls, generating friable halos. Subsequent mechanical erosion contributed to generate spongework patterns. The dolostone porosity also contributes to explain the paradox that virtually all Arnero caves are developed in dolostone despite being less soluble than adjacent limestone. U-series dating of carbonate speleothems and paleomagnetic data from ferromanganese stromatolites and clastic sediments indicate that the paleo-watertables recorded ~ 320 m above the present-day watertable formed during the Matuyama Chron but prior to ~ 1.5 Ma, implying long-term base-level-lowering rates from ~ 125 to ~ 213 m/Ma. To our knowledge, this is the first attempt of paleomagnetic dating of cave ferromanganese stromatolites. These deposits are excellent geomagnetic recorders and offer a direct way to delineate and date paleo-watertables, especially in caves developed in dolostone.Financial support was provided by grants ICT-Soplao-53.5.00.12.00 (IGME - Provincial Government of Cantabria - Turismo del Nansa) and CGL2012-38481 (Ministerio de Economía y Competitividad - European Regional Development Fund

Health-related quality of life (HRQoL) in a population at risk of type 2 diabetes: a cross-sectional study in two Latin American cities

PURPOSE: The purpose of this study was to describe the health-related quality of life (HRQoL) characteristics in a population at risk of developing type 2 diabetes in Barranquilla and Bogotá, Colombia. METHODS: A cross-sectional study with 1135 participants older than 30 years-of-age recruited in Bogotá D.C., and Barranquilla by cluster sampling in 2018 to 2019. The Finnish Diabetes Risk Score (FINDRISC) was used to detect participants at risk of developing type 2 diabetes (T2D). HRQoL was assessed using the EQ-5D-3L questionnaire. Unadjusted and adjusted logistic regression models were used to calculate odds ratios (OR) and their corresponding 95% confidence intervals CI). RESULTS: Moderate or extreme problems appeared more frequently in the dimensions of Pain/Discomfort (60.8%) and Anxiety/Depression (30.8%). The mean score of the EQ-VAS was 74.3 (± 17.3), significantly larger in the state of complete health (11111) compared with those with problems in more than one of the quality-of-life dimensions. Being female and living in Bogota D.C., were associated with greater odds of reporting problems in the Pain (OR 1.6; 95% CI 1.2-2.2) and Discomfort dimensions (OR 1.6; 95% CI 1.2-2.0) respectively and Anxiety/Depression (OR 1.9; 95% CI 1.3-2.7), (OR 9.1; 95% CI 6.6-12.4), respectively. CONCLUSIONS: As living place and sex were associated with dimensions of Pain/Discomfort and Anxiety/Depression in the HRQoL in people at risk of T2D, greater attention should be paid to these determinants of HRQoL to design and reorient strategies with a territorial and gender perspective to achieve better health outcomes. Diabetes is one of the four non-communicable diseases with increasing prevalence in the world, which has made it a serious public health problem. In Colombia, in 2019 diabetes affected 8.4% of the Colombian adult population and more than one million Colombian adults of this age group have hidden or undetected diabetes. This disease is not only characterized by increased premature mortality, loss of productivity, and economic impact, but it also involves a deterioration in the quality of life of people with diabetes with their respective families. However, very Little is known about health-related quality of life (HRQoL) in a population at risk or with prediabetes. This study has evaluated the quality of life in patients at risk of diabetes and their behavior with some variables as sociodemographic, lifestyle, history, and established their difference in two territories of the Colombian Caribbean. The results of this study indicate that the HRQoL of people at risk of type 2 diabetes is affected by factors such as gender, city, dysglycemia, medication for hypertension and education level. Therefore, greater attention should be paid to these determinants of HRQL to design and implement strategies that reduce this risk of developing type 2 diabetes, prevent prediabetes and improve the quality of life in prediabetic or diabetic patients

Health-related quality of life (HRQoL) in a population at risk of type 2 diabetes: a cross-sectional study in two Latin American cities

Purpose: The purpose of this study was to describe the health-related quality of life (HRQoL) characteristics in a population at risk of developing type 2 diabetes in Barranquilla and Bogotá, Colombia. Methods: A cross-sectional study with 1135 participants older than 30 years-of-age recruited in Bogotá D.C., and Barranquilla by cluster sampling in 2018 to 2019. The Finnish Diabetes Risk Score (FINDRISC) was used to detect participants at risk of developing type 2 diabetes (T2D). HRQoL was assessed using the EQ-5D-3L questionnaire. Unadjusted and adjusted logistic regression models were used to calculate odds ratios (OR) and their corresponding 95% confidence intervals CI). Results: Moderate or extreme problems appeared more frequently in the dimensions of Pain/Discomfort (60.8%) and Anxiety/Depression (30.8%). The mean score of the EQ-VAS was 74.3 (± 17.3), significantly larger in the state of complete health (11111) compared with those with problems in more than one of the quality-of-life dimensions. Being female and living in Bogota D.C., were associated with greater odds of reporting problems in the Pain (OR 1.6; 95% CI 1.2–2.2) and Discomfort dimensions (OR 1.6; 95% CI 1.2–2.0) respectively and Anxiety/Depression (OR 1.9; 95% CI 1.3–2.7), (OR 9.1; 95% CI 6.6–12.4), respectively. Conclusions: As living place and sex were associated with dimensions of Pain/Discomfort and Anxiety/Depression in the HRQoL in people at risk of T2D, greater attention should be paid to these determinants of HRQoL to design and reorient strategies with a territorial and gender perspective to achieve better health outcomes. Plain English summary: Diabetes is one of the four non-communicable diseases with increasing prevalence in the world, which has made it a serious public health problem. In Colombia, in 2019 diabetes affected 8.4% of the Colombian adult population and more than one million Colombian adults of this age group have hidden or undetected diabetes. This disease is not only characterized by increased premature mortality, loss of productivity, and economic impact, but it also involves a deterioration in the quality of life of people with diabetes with their respective families. However, very Little is known about health-related quality of life (HRQoL) in a population at risk or with prediabetes. This study has evaluated the quality of life in patients at risk of diabetes and their behavior with some variables as sociodemographic, lifestyle, history, and established their diference in two territories of the Colombian Caribbean. The results of this study indicate that the HRQoL of people at risk of type 2 diabetes is afected by factors such as gender, city, dysglycemia, medication for hypertension and education level. Therefore, greater attention should be paid to these determinants of HRQL to design and implement strategies that reduce this risk of developing type 2 diabetes, prevent prediabetes and improve the quality of life in prediabetic or diabetic patients.This project was financed by the Colombian National Program for Science, Technology, and Health Innovation (COLCIENCIAS) in line with the theme focused on chronic non-transmutable diseases. This was in response to the 744 Call for projects in science, technology, and health innovation of 2016 in association with the Universidad del Norte of Barranquilla and the Colombian Diabetes Association.S

Robust metrics for assessing the performance of different verbal autopsy cause assignment methods in validation studies

<p>Abstract</p> <p>Background</p> <p>Verbal autopsy (VA) is an important method for obtaining cause of death information in settings without vital registration and medical certification of causes of death. An array of methods, including physician review and computer-automated methods, have been proposed and used. Choosing the best method for VA requires the appropriate metrics for assessing performance. Currently used metrics such as sensitivity, specificity, and cause-specific mortality fraction (CSMF) errors do not provide a robust basis for comparison.</p> <p>Methods</p> <p>We use simple simulations of populations with three causes of death to demonstrate that most metrics used in VA validation studies are extremely sensitive to the CSMF composition of the test dataset. Simulations also demonstrate that an inferior method can appear to have better performance than an alternative due strictly to the CSMF composition of the test set.</p> <p>Results</p> <p>VA methods need to be evaluated across a set of test datasets with widely varying CSMF compositions. We propose two metrics for assessing the performance of a proposed VA method. For assessing how well a method does at individual cause of death assignment, we recommend the average chance-corrected concordance across causes. This metric is insensitive to the CSMF composition of the test sets and corrects for the degree to which a method will get the cause correct due strictly to chance. For the evaluation of CSMF estimation, we propose CSMF accuracy. CSMF accuracy is defined as one minus the sum of all absolute CSMF errors across causes divided by the maximum total error. It is scaled from zero to one and can generalize a method's CSMF estimation capability regardless of the number of causes. Performance of a VA method for CSMF estimation by cause can be assessed by examining the relationship across test datasets between the estimated CSMF and the true CSMF.</p> <p>Conclusions</p> <p>With an increasing range of VA methods available, it will be critical to objectively assess their performance in assigning cause of death. Chance-corrected concordance and CSMF accuracy assessed across a large number of test datasets with widely varying CSMF composition provide a robust strategy for this assessment.</p

Elastocaloric evidence for a multicomponent superconductor stabilized within the nematic state in Ba(Fe1−x_{1-x}Cox_x)2_2As2_2

The iron-based high-$T_c$ superconductors exhibit rich phase diagrams with intertwined phases, including magnetism, nematicity and superconductivity. The superconducting $T_c$ in many of these materials is maximized in the regime of strong nematic fluctuations, making the role of nematicity in influencing the superconductivity a topic of intense research. Here, we use the AC elastocaloric effect (ECE) to map out the phase diagram of Ba(Fe$_{1-x}$Co$_x$)$_2$As$_2$ near optimal doping. The ECE signature at $T_c$ on the overdoped side, where superconductivity condenses without any nematic order, is quantitatively consistent with other thermodynamic probes that indicate a single-component superconducting state. In contrast, on the slightly underdoped side, where superconductivity condenses within the nematic phase, ECE reveals a second thermodynamic transition proximate to and below $T_c$. We rule out magnetism and re-entrant tetragonality as the origin of this transition, and find that our observations strongly suggest a phase transition into a multicomponent superconducting state. This implies the existence of a sub-dominant pairing instability that competes strongly with the dominant $s^\pm$ instability. Our results thus motivate a re-examination of the pairing state and its interplay with nematicity in this extensively studied iron-based superconductor, while also demonstrating the power of ECE in uncovering strain-tuned phase diagrams of quantum materials

Hacia una reforma municipal genuina

El gobierno local es cada vez más importante en un entorno cultural de globalización. Ahí está la responsabilidad de gestar las bases de un desarrollo sustentable, de promover la igualdad de oportunidades y de educar al ciudadano en las responsabilidades políticas y cívicas congruentes con los nuevos retos. Este trabajo reúne la discusión y reflexiones de investigadores, funcionarios municipales y estatales, analistas y otros interesados en los gobiernos locales que intentan identificar los cambios administrativos, políticos, sociales y jurídicos para una reforma de los gobiernos locales capaz de resolver los problemas actuales de los municipios y conducir al desarrollo sustentable.ITESO, A.C