A community based cross sectional study on feasibility of lay interviewers in ascertaining causes of adult deaths by using verbal autopsy in rural Wardha

Background & objectives: 1) To study the causes of adult (15 years and above) deaths using verbal autopsy (VA) and its socio-demographic characteristics. 2) To study the feasibility of use of the lay interviewer to ascertain causes of adult death using verbal autopsy and a simple algorithm. Methods: The present study was done in Wardha district, Maharashtra, India. Taking into account feasibility, out of 23 villages of Primary Health Centre, Anji, 15 villages were chosen having total population of 14,590. Out of 273 estimated adult deaths during the study period, 209 (77%) could be traced by house to house visit and a lay interviewer, interviewed the close caretakers of the deceased. Both lay interviewer and a physician individually derived their diagnosis using verbal autopsy report and a simplified algorithm. The data was entered and analyzed by using Epi_info 6.04. The inter-observer reliability between the lay interviewer and a physician for each possible diagnosis was assessed by using the Kappa statistics. Considering the diagnosis made by a physician as a gold standard, the diagnostic and predictive accuracy for each diagnosis made by the lay interviewer was calculated. Results: The communicable diseases accounted for 52 percent of the adult deaths while non-communicable for 32 percent and injuries for nine percent deaths. The overall agreement between the lay interviewer and a physician for communicable diseases was found to be good (k = 0.65 + 0.06) and for non-communicable diseases it was found to be excellent (k = 0.80 + 0.06). The lay interviewer using VA performed adequately for individual conditions of public health importance like acute febrile illness, diarrheal diseases, tuberculosis and injuries. Interpretation & conclusions: The present study has been successful to demonstrate feasibility of use of the lay interviewer to provide useful information on population-level estimation of broad causes of adult deaths and its socio-demographic characteristics that are reasonably reliable. The study suggests the possible utility of the method for rural India, where the majority of deaths occur at home. Further research work on development of sensitive and specific yet simple algorithms for lay interviewers to ascertain causes of adult deaths is required

Cricket Flour-Laden Millet Flour Blends' Physical and Chemical Composition and Adaptation in Dried Pasta Products

Increasing the protein and antioxidant content of food products is a constant challenge amongst researchers. Dried pasta products are popular amongst all groups of society. The most important factor in pasta processing is the quality of the flour. Millet (Panicum miliaceum) flour has high nutritional value, enriching it with cricket (Gryllus bimaculatus) flour is good choice to increase the quality of protein composition and antioxidant properties of products. Flour mixtures of millet and insect flours (5% and 10%) were analysed after mixing and pasta processing. Addition of wheat gluten improved both texture and nutrition value of pasta products. Total polyphenol content, antioxidant capacity, total protein content, free and total amino acid composition were studied. Quality analysis of dried pasta products were carried out according to Hungarian standards. Data was analysed with Kruskal-Wallis test, Dunn's pair-wise post hoc test was used with Bonferroni correction. The correlation was determined by Spearman's rank. Addition of cricket flour modified the pH, acid value, moisture content, and colour of the samples, these changes lasted during storage. Enrichment could increase the total phenol content significantly even at the low level of 10%. Heat treatment during pasta processing had negative effect on the antioxidant capacity except at higher cricket flour contents. Cricket flour's high protein content proportionately increased millet flour's, thus pasta products'. Dried pasta products passed all quality norms. Enrichment of millet flour with cricket flour is favourable from both nutritional and quality aspects

On Unbounded Composition Operators in L2L^2-Spaces

Fundamental properties of unbounded composition operators in $L^2$-spaces are studied. Characterizations of normal and quasinormal composition operators are provided. Formally normal composition operators are shown to be normal. Composition operators generating Stieltjes moment sequences are completely characterized. The unbounded counterparts of the celebrated Lambert's characterizations of subnormality of bounded composition operators are shown to be false. Various illustrative examples are supplied

Congenital malaria with atypical presentation: A case report from low transmission area in India

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