Verbal autopsy completion rate and factors associated with undetermined cause of death in a rural resource-poor setting of Tanzania

UNLABELLED\ud \ud ABSTRACT:\ud \ud BACKGROUND\ud \ud Verbal autopsy (VA) is a widely used tool to assign probable cause of death in areas with inadequate vital registration systems. Its uses in priority setting and health planning are well documented in sub-Saharan Africa (SSA) and Asia. However, there is a lack of data related to VA processing and completion rates in assigning causes of death in a community. There is also a lack of data on factors associated with undetermined causes of death documented in SSA. There is a need for such information for understanding the gaps in VA processing and better estimating disease burden.\ud \ud OBJECTIVE\ud \ud The study's intent was to determine the completion rate of VA and factors associated with assigning undetermined causes of death in rural Tanzania.\ud \ud METHODS\ud \ud A database of deaths reported from the Ifakara Health and Demographic Surveillance System from 2002 to 2007 was used. Completion rates were determined at the following stages of processing: 1) death identified; 2) VA interviews conducted; 3) VA forms submitted to physicians; 4) coding and assigning of cause of death. Logistic regression was used to determine factors associated with deaths coded as "undetermined."\ud \ud RESULTS\ud \ud The completion rate of VA after identification of death and the VA interview ranged from 83% in 2002 and 89% in 2007. Ninety-four percent of deaths submitted to physicians were assigned a specific cause, with 31% of the causes coded as undetermined. Neonates and child deaths that occurred outside health facilities were associated with a high rate of undetermined classification (33%, odds ratio [OR] = 1.33, 95% confidence interval [CI] (1.05, 1.67), p = 0.016). Respondents reporting high education levels were less likely to be associated with deaths that were classified as undetermined (24%, OR = 0.76, 95% CI (0.60, -0.96), p = 0.023). Being a child of the deceased compared to a partner (husband or wife) was more likely to be associated with undetermined cause of death classification (OR = 1.35, 95% CI (1.04, 1.75), p = 0.023).\ud \ud CONCLUSION\ud \ud Every year, there is a high completion rate of VA in the initial stages of processing; however, a number of VAs are lost during the processing. Most of the losses occur at the final step, physicians' determination of cause of death. The type of respondent and place of death had a significant effect on final determination of the plausible cause of death. The finding provides some insight into the factors affecting full coverage of verbal autopsy diagnosis and the limitations of causes of death based on VA in SSA. Although physician review is the most commonly used method in ascertaining probable cause of death, we suggest further work needs to be done to address the challenges faced by physicians in interpreting VA forms. There is need for an alternative to or improvement of the methods of physician review

Down under the tunic: bacterial biodiversity hotspots and widespread ammonia-oxidizing archaea in coral reef ascidians

14 páginas, 3 tablas, 3 figuras.Ascidians are ecologically important components of marine ecosystems yet the ascidian microbiota remains largely unexplored beyond a few model species. We used 16S rRNA gene tag pyrosequencing to provide a comprehensive characterization of microbial symbionts in the tunic of 42 Great Barrier Reef ascidian samples representing 25 species. Results revealed high bacterial biodiversity (3 217 unique operational taxonomic units (OTU0.03) from 19 described and 14 candidate phyla) and the widespread occurrence of ammonia-oxidizing Thaumarchaeota in coral reef ascidians (24 of 25 host species). The ascidian microbiota was clearly differentiated from seawater microbial communities and included symbiont lineages shared with other invertebrate hosts as well as unique, ascidian-specific phylotypes. Several rare seawater microbes were markedly enriched (200–700 fold) in the ascidian tunic, suggesting that the rare biosphere of seawater may act as a conduit for horizontal symbiont transfer. However, most OTUs (71%) were rare and specific to single hosts and a significant correlation between host relatedness and symbiont community similarity was detected, indicating a high degree of host-specificity and potential role of vertical transmission in structuring these communities. We hypothesize that the complex ascidian microbiota revealed herein is maintained by the dynamic microenvironments within the ascidian tunic, offering optimal conditions for different metabolic pathways such as ample chemical substrate (ammonia-rich host waste) and physical habitat (high oxygen, low irradiance) for nitrification. Thus, ascidian hosts provide unique and fertile niches for diverse microorganisms and may represent an important and previously unrecognized habitat for nitrite/nitrate regeneration in coral reef ecosystems.This research was funded by the Marie Curie International Reintegration Grant FP7-PEOPLE-2010-RG 277038 (within the 7th European Community Framework Program), the Spanish Government projects CTM2010-17755 and CTM2010-22218 and the Catalan Government grant 2009 SGR-484 for Consolidated Research Groups. NSW was funded through an Australian Research Council Future Fellowship (FT1200100480).Peer reviewe

Personalizing health care: feasibility and future implications

Considerable variety in how patients respond to treatments, driven by differences in their geno- and/ or phenotypes, calls for a more tailored approach. This is already happening, and will accelerate with developments in personalized medicine. However, its promise has not always translated into improvements in patient care due to the complexities involved. There are also concerns that advice for tests has been reversed, current tests can be costly, there is fragmentation of funding of care, and companies may seek high prices for new targeted drugs. There is a need to integrate current knowledge from a payer’s perspective to provide future guidance. Multiple findings including general considerations; influence of pharmacogenomics on response and toxicity of drug therapies; value of biomarker tests; limitations and costs of tests; and potentially high acquisition costs of new targeted therapies help to give guidance on potential ways forward for all stakeholder groups. Overall, personalized medicine has the potential to revolutionize care. However, current challenges and concerns need to be addressed to enhance its uptake and funding to benefit patients

Toxicological Effects of Three Polybromodiphenyl Ethers (BDE-47, BDE-99 and BDE-154) on Growth of Marine Algae Isochrysis galbana

Polybrominated diphenyl ethers (PBDEs) are highly persistent anthropogenic contaminants found in trace amounts in many environmental compartments far from their source areas, posing a risk to aquatic ecosystems. Our objective was to determine the relative toxicities of three BDEs, BDE-47, BDE- 99 and BDE-154 on marine phytoplankton algae Isochrysis galbana. For a highly sensitive endpoint: the 72-h inhibition of autotrophic growth rate was calculated according to standards methods. Actual PBDE concentration was measured by GC-MS and toxicity parameters were calculated on the basis of time-weighted mean actual concentrations. No observable effect concentration (NOEC) values were 2.53 μg L−1 for BDE-47, 3.48 μg L−1 for BDE-99 and 12.3 μg L−1 for BDE-154, and LOEC values were 5.06, 6.96 and 24.60 μg L−1 for BDE-47, BDE-99 and BDE- 154, respectively. The calculated IC10 (the concentration inhibiting growth rate by 10 %) corresponded to 9.3, 12.78 and 54.6 μg L−1 for BDE-47, BDE-99 and BDE- 154, respectively. The 50 % inhibitions of growth rate (IC50) values were: 25.7 μg L−1 BDE-47, 30.0 μg L−1 BDE-99 and 243.7 μg L−1 BDE-154. Therefore, the acute toxicity of PBDEs decreases as the degree of bromination increases, the order of toxicity is BDE-47>BDE-99> BDE-154. Significant (p<0.05) adverse effects were observed for all compounds at concentrations >15 μg L−1. Our results indicated that under laboratory conditions PBDEs inhibited the growth of marine phytoplankton at concentrations near 10 μg L−1. However, further work is required to investigate long-term effects in these and other aquatic organisms.MAE-PCI MCINN CTM2009-10908Versión del editor1,748