Cause-specific mortality patterns among hospital deaths in Thailand: validating routine death certification

Background: In Thailand, 35% of all deaths occur in hospitals, and the cause of death is medically certified by attending physicians. About 15% of hospital deaths are registered with nonspecific diagnoses, despite the potential for greater accuracy using information available from medical records. Further, issues arising from transcription of diagnoses from Thai to English at registration create uncertainty about the accuracy of registration data even for specified causes of death. This paper reports findings from a study to measure validity of registered diagnoses in a sample of deaths that occurred in hospitals in Thailand during 2005.Methods: A sample of 4,644 hospital deaths was selected, and for each case, medical records were reviewed. A process of medical record abstraction, expert physician review, and independent adjudication for the selection and coding of underlying causes of death was used to derive reference diagnoses. Validation characteristics were computed for leading causes of hospital deaths from registration data, and misclassification patterns were identified for registration diagnoses. Study findings were used to estimate cause-specific mortality patterns for hospital deaths in Thailand.Results: Adequate medical records were available for 3,316 deaths in the study sample. Losses to follow up were nondifferential by age, sex, and cause. Medical records review identified specific underlying causes for the majority of deaths that were originally assigned ill-defined causes as well as for those originally assigned to residual categories for specific cause groups. In comparison with registration data for the sample, we found an increase in the relative proportion of deaths in hospitals due to stroke, ischemic heart disease, transport accidents, HIV/AIDS, diabetes, liver diseases, and chronic obstructive pulmonary disease.Conclusions: Registration data on causes for deaths occurring in hospitals require periodic validation prior to their use for epidemiological research or public health policy. Procedures for death certification and coding of underlying causes of death need to be streamlined to improve reliability of registration data. Estimates of cause-specific mortality from this research will inform burden of disease estimation and guide interventions to reduce avoidable mortality in hospitals in Thailand

Environmental conditions at the Last Interglacial (Eemian) site Neumark‐Nord 2, Germany inferred from stable isotope analysis of freshwater mollusc opercula

Mollusc biogenic carbonates are valuable records of past environmental conditions. In particular, carbonate oxygen (δ18O) and carbon (δ13C) stable isotopes can be used to reconstruct different physical and chemical parameters, according to the different genera used (marine, freshwater or terrestrial). The Last Interglacial (early Eemian) palaeolake of Neumark-Nord 2 (NN2), Germany provides an excellent example of a Neanderthal archaeological site with abundant freshwater carbonate remains. As in other European contexts, one of the most abundant species is Bithynia tentaculata. In order to provide a robust regional baseline for the interpretation of the archaeological data, this study includes a calibration phase on modern B. tentaculata opercula. The results indicate that these calcitic structures are likely to be subjected to a growth slowdown/cessation during summer, which influences their geochemistry, reflecting mainly the water properties of the rest of the year. This modern calibration, together with the existing palaeoenvironmental reconstructions developed for NN2 (e.g. pollen data), represents a valuable opportunity to establish B. tentaculata opercula as reliable environmental proxies applicable to several other freshwater contexts. The isotope data of the NN2 opercula, in agreement with the pollen record, indicate that the major archaeological horizon was formed during a rather wet period and potentially in a semi-forested environment. However, human occupation occurred also during drier phases at the site and within a wide temperature range, indicating the absence of restricted environmental preferences by the local Neanderthal groups

Pengenalan dan Implementasi Metode Six Sigma pada Program Studi Teknik Industri, Fakultas Rekayasa Sistem, Universitas Teknologi Sumbawa

INTRODUCTION AND IMPLEMENTATION OF SIX SIGMA METHODS IN INDUSTRIAL ENGINEERING STUDY PROGRAM, FACULTY OF SYSTEMS ENGINEERING, SUMBAWA UNIVERSITY OF TECHNOLOGY. In implementing the six sigma method in carrying out organizational activities with the aim of improving business performance through the introduction of the stages of the six sigma methodology; namely, initializing a six sigma project through the define stage, defining and measuring variables through the measure stage, analyzing the variables that affect CTQ through the analyze stage, conducting further variable testing and optimizing variables that affect CTQ through the improve stage, and performing control to stabilize the implementation of the results of the improve stages on a regular basis through the control stages, so that participants can train themselves and immediately practice the implementation of six sigma projects for simple cases that are often encountered in the environment around the Sumbawa University of Technology. Participants who registered in the activity were students of the Industrial Engineering study program as many as 128 participants, where from the results of the search for feedback on this activity, 75 participants were carried out via google form. The results of the feedback from this PkM activity with 10 questionnaire questions with a scale of very good (4), good (3), sufficient (2) and less (1) overall that stated very good as many as 44%, good 49%, quite 7 % and less 0%