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Objective: The study investigates the prognostic impact of cardiogenic shock (CS) stratified by the presence or absence of acute myocardial infarction (AMI). Background: Intensive care unit (ICU) related mortality in CS patients remains unacceptably high despite improvement concerning the treatment of CS patients. Methods: Consecutive patients with CS from 2019 to 2021 were included monocentrically. The prognostic impact of CS related to AMI was compared to patients without AMI-related CS. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan–Meier analyses, multivariable Cox proportional regression analyses and propensity score matching. Results: 273 CS patients were included (AMI-related CS: 49%; non-AMI-related CS: 51%). The risk of 30-day all-cause mortality was increased in patients with AMI-related CS (64% vs. 47%; HR = 1.653; 95% CI 1.199–2.281; p = 0.002), which was still observed after multivariable adjustment (HR = 1.696; 95% CI 1.153–2.494; p = 0.007). Even after propensity score matching (i.e., 87 matched pairs), AMI was still an independent predictor of 30-day mortality (HR = 1.524; 95% CI 1.020–2.276; p = 0.040). In contrast, non-ST-segment AMI (NSTEMI) and STEMI were associated with comparable prognosis (log-rank p = 0.528). Conclusion: AMI-related CS was associated with increased 30-day all-cause mortality compared to patients with CS not related to AMI. In contrast, the prognosis of STEMI- and NSTEMI-CS patients was comparable. [ABSTRACT FROM AUTHOR]

The emergence and development of food fraud are closely related to a country's economic system and social development. It has distinct characteristics in different historical stages, and an inherent historical logic links different historical stages. Following the thread of “what”, “why”, and “what to do”, this study uses a broad perspective and comparative historical approach to examine the evolution of the basic characteristics, underlying causes, and management tools of food fraud in China at different historical stages over 70 years from 1949 to 2022. This study argues that the historical evolution of food fraud in China has characteristics unique to China as well as features similar to those in other countries. It provides a window for academics to understand the historical evolution of food fraud in China. It also provides valuable insights for other countries, especially developing countries, for objectively understanding the evolution of food fraud during their economic development process, and how to address it.

Abstract Plain English summary The World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes. The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison. Background Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. Methods The classification of pregnancy-related deaths in Suriname during 2010–2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement. Results Out of the 89 cases certified by attending physicians, 47% (n = 42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n = 16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n = 11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ = 0.53) and underlying cause group (κ = 0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ = 0.69 vs κ = 0.63) was better than between the Surinamese and the Netherlands MDR committees (κ = 0.48 vs κ = 0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ = 0.85) and obstetric hemorrhage (κ = 0.74) and fair for unspecified (κ = 0.29) and other direct causes (κ = 0.32). Conclusions Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence.

Abstract Background To reduce maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization (WHO). All health facilities are to notify and review all maternal deaths inorder to recommend quality improvement actions to reduce deaths in future. The system relies on consistent and correct categorization of causes of maternal deaths and three phases of delays. To assess its adequacy we compared the routine MDSR categorization of causes of death and three phases of delays to those assigned by an independent expert panel with additional information from Verbal Autopsy (VA). Methods Our cross-sectional study included 109 reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the underlying medical causes of death and the three phases of delays from MDSR system records. We interviewed bereaved families using the standard WHO VA questionnaire. The obstetrician expert panel assigned underlying causes of death based on information from medical files and VA according to International Classification of Disease to Death in Pregnancy Childbirth and Puerperium (ICD-MM). They assigned causes to nine ICD-MM groups and identified the three phases of delays. We used Cohen’s K statistic to compare causes of deaths and delays categorization. Results Comparison of underlying causes was done for 99 deaths. While 109 and 84 deaths for expert panel and MDSR respectively were analyzed for delays because of missing data in MDSR system. Expert panel and MDSR system assigned the same underlying causes in 64(64.6%) deaths (K statistic 0.60). Agreement increased in 80 (80.8%) when causes were assigned by ICD-MM groups (K statistic 0.76). The obstetrician expert panel identified phase one delays in 74 (67.9%), phase two in 24 (22.0%) and phase three delays in all 101 (100%) deaths that were assessed for this delay while MDSR system identified delays in 42 (50.0%), 10 (11.9%) and 78 (92.9%).The expert panel found human errors in management in 94 (93.1%) while MDSR system reported in 53 (67.9%) deaths. Conclusions MDSR committees performed reasonably well in assigning underlying causes of death. The obstetrician expert panel found more delays than reported in MDSR system indicating difficulties within MDSR teams to critically review deaths.

Background. Understanding the causes of accidents plays a major role in learning from accidents and developing accident prevention and control strategies. Objective. This study aimed at application and modification of the Tripod Beta method for analyzing accident causes in the oil and gas industries. Materials and methods. A total of 68 accidents occurring in the oil and gas industries during 2005–2016 were analyzed. For this purpose, we used the Tripod Beta method and modified it using Reason's Swiss cheese model and analysis accident results. Results. The main causes that have been ignored in the Tripod Beta method were supervision factors involved in 66% of the accidents (underlying causes) and unsafe conditions that contributed to 55% of accidents (immediate causes). The former was incorporated as a sublayer of the underlying cause and the latter as a sublayer of immediate cause to the modified Tripod Beta method. Conclusions. The results of the present study added to the knowledge on the causes of accidents. These results can help increase the capabilities of the Tripod Beta method for analyzing accident causes, such as supervision factors and unsafe conditions, which have been ignored in analyses performed using the Tripod Beta method. [ABSTRACT FROM AUTHOR]

Cardiopulmonary Resuscitation, also called CPR, is a set of actions taken by conscious and willing individuals to restore the functions of two vital heart and lung organs and deliver blood and oxygen to the brain to prevent brain damage. This is an immediate intervention to prevent or delay death in a person who has suddenly had a cardiopulmonary arrest. About 40 years have passed since the start of cardiopulmonary resuscitation, so the survival rate is low. Research has shown that about 10 to 15 percent of people survive after resuscitation. Cardiac resuscitation is on the rise among hospitalized patients, so these measures and the factors that contribute to its success are crucial.Our aim is to review the success rate of cardiopulmonary resuscitation and its associated factors in emergency departments and hospitals. In this review study, keywords such as cardiopulmonary resuscitation, cardiopulmonary arrest, emergency, underlying cause, success rate, resuscitation outcome and related factors and search on reputable Google scientific databases Scholar, Pubmed, Web of Science, WHO Web site, Articles and theses published between 1989 and 2019, and finally a number of sources were selected and critiqued, interpreted, and analyzed. We concluded at the time of cardiopulmonary arrest, the speed of technicians, equipment, and devices and medicines used will increase the chances of successful cardiopulmonary resuscitation. [ABSTRACT FROM AUTHOR]

Plain English summary: The World Health Organization (WHO) provides a framework (ICD-MM) to classify pregnancy-related deaths systematically, which enables global comparison among countries. We compared the classification of pregnancy-related deaths in Suriname by the attending physician and by the national maternal death review (MDR) committee and among the MDR committees of Suriname, Jamaica and the Netherlands. There were 89 possible pregnancy-related deaths in Suriname between 2010 and 2014. Nearly half (47%) were classified differently by the Surinamese MDR committee as compared to the classification of the attending physicians. All three MDR committees agreed that 18% (n = 16/89) of the cases were no maternal deaths. Out of the remaining 73 cases, there was disagreement regarding whether 15% (n = 11) were maternal deaths. The Surinamese and Jamaican MDR committees achieved greater consensus in classification than the Surinamese and the Netherlands MDR committees. The Netherlands MDR committee classified more deaths as unspecified than Surinamese and the Jamaican MDR committees. Underlying causes that achieved a high level of agreement among the three committees were abortive outcomes and obstetric hemorrhage, while little agreement was reported for unspecified and other direct causes. The issues encountered during maternal death classification using the ICD-MM guidelines included classification of suicide during early pregnancy; when to assume pregnancy without objective evidence; how to count maternal deaths occurring outside the country of residence; the relevance of direct or indirect cause attribution; and how to select the underlying cause when direct and indirect conditions or multiple comorbidities co-occur. Addressing these classification barriers in future revisions of the ICD-MM guidelines could enhance the feasibility of maternal death classification and facilitate global comparison. Background: Insight into the underlying causes of pregnancy-related deaths is essential to develop policies to avert preventable deaths. The WHO International Classification of Diseases-Maternal Mortality (ICD-MM) guidelines provide a framework to standardize maternal death classifications and enable comparison in and among countries over time. However, despite the implementation of these guidelines, differences in classification remain. We evaluated consensus on maternal death classification using the ICD-MM guidelines. Methods: The classification of pregnancy-related deaths in Suriname during 2010–2014 was compared in the country (between the attending physician and the national maternal death review (MDR) committee), and among the MDR committees from Suriname, Jamaica and the Netherlands. All reviewers applied the ICD-MM guidelines. The inter-rater reliability (Fleiss kappa [κ]) was used to measure agreement. Results: Out of the 89 cases certified by attending physicians, 47% (n = 42) were classified differently by the Surinamese MDR committee. The three MDR committees agreed that 18% (n = 16/89) of these cases were no maternal deaths, and, therefore, excluded from further analyses. However, opinions differed whether 15% (n = 11) of the remaining 73 cases were maternal deaths. The MDR committees achieved moderate agreement classifying the deaths into type (direct, indirect and unspecified) (κ = 0.53) and underlying cause group (κ = 0.52). The Netherlands MDR committee classified more maternal deaths as unspecified (19%), than the Jamaican (7%) and Surinamese (4%) committees did. The mutual agreement between the Surinamese and Jamaican MDR committees (κ = 0.69 vs κ = 0.63) was better than between the Surinamese and the Netherlands MDR committees (κ = 0.48 vs κ = 0.49) for classification into type and underlying cause group, respectively. Agreement on the underlying cause category was excellent for abortive outcomes (κ = 0.85) and obstetric hemorrhage (κ = 0.74) and fair for unspecified (κ = 0.29) and other direct causes (κ = 0.32). Conclusions: Maternal death classification differs in Suriname and among MDR committees from different countries, despite using the ICD-MM guidelines on similar cases. Specific challenges in applying these guidelines included attribution of underlying cause when comorbidities occurred, the inclusion of deaths from suicides, and maternal deaths that occurred outside the country of residence. [ABSTRACT FROM AUTHOR]

The International Labour Organisation has a systemic and overall approach to safe and health on workplace topics. “5 key elements”, “SMART outputs”, “5 steps Risk Assessment”, are some of basic approaches suggested by this Institution. European Union has adopted this concepts to define some important procedures: “Safe System of Work (SSW)”, “People-Equipment-Material-Enviroment (PEME)” and “Permit To Work (PTW)”. A careful analysis of accidents must be based on direct factors (primary causes) and indirect factors (secondary causes). Consequently, even a careful risk assessment must analyze and evaluate both factors, adopting a multi-dimensional approach. The first part of the research, focused on the analysis of some indirect factors, such as ageing workers, newly hired workers, etc, introducing the concept of attention factors. In fact, these factors are not yet governed by the current national regulations within the risk assessment. Following a systemic approach of SSW, the second part of the research is applied to a case study (construction site for a new aerospace building in Milan). Re-entering among the purposes of systematic, cyclicality and continual improvement of the measures to be taken to eliminate or reduce risks, a specific procedure has been drawn up to be associated with the scheduling and management of the site activities. Therefore, the analysis of indirect factors is performed by associating the work phase to be carried out with the employees that have these factors. The result of the research carried out has highlighted a concept of the attention factor, which if previously assessed, can involve the activation of special worker protection procedures (e.g. Permit To Work).

Pipeline network facilitates transportation of hazardous materials over long distances and is considered a relatively safer mode of transportation. However, a significant number of incidents occurred over the last few years that has increased the need for development of an accurate predictive model for incidents. Pipeline incident databases have been collecting a wide range of data regarding the incidents including the background operating conditions, the causes contributed to the incident, and the severity of consequences. Most academic studies analyzing these databases have developed predictive failure models focusing only on a narrow range of factors that played a role behind certain categories of incidents. They fail to provide a holistic understanding of how interaction of multiple factors contributing to an incident or how their combined effect eventually leads to failure. The amount of data collected in the databases are however huge. For example, the current reporting format of Pipeline and Hazardous Materials Safety Administration (PHMSA) collects over six hundred datapoints from each incident. Given the large amount of information available and current technologies, it is now possible to look into ways to understand the holistic effect of all contributing factors. The current study looks into how the databases can be utilized to derive such a complete understanding. The study compares the databases of US PHMSA, Canada National Energy Board (NEB), and European Gas Pipeline Incident Data Group (EGIG) to examine the frameworks used to classify the causal factors of the incident data and shows that the background factors, underlying factors and the causal factors identified in the various databases are inter-related and show varying degrees of dependency. This curves the way forward to development of a causal model that will help identify the important factors that needs to be addressed and a prediction of future failure given existing conditions of a pipeline system. [ABSTRACT FROM AUTHOR]

Liver abscess can be defined as an accumulation of secretions within the liver parenchyma, which may be caused by bacterial, fungal, or parasitic microorganisms. In this study, we reported a case of liver microabsorption in a 16-year-old girl with no history of underlying diseases, which could ultimately lead to the diagnosis of Crohn's disease in this patient. The patient was a 16-yearold girl presenting with nausea, vomiting, diarrhea, and anorexia. Of the accompanying symptoms, she mentioned two occasions of fever and chills. The patient was also hospitalized a week ago and in the tests performed, the number of white blood cells was 12400 and the positive occult blood test in the fecal test was 8-10 red blood cells and 4-45 white blood cells. She was treated with a diagnosis of gastroenteritis and was discharged with partial recovery. There was nothing special in the examination. The only ultrasonography revealed the presence of free fluid in the loop near the ovaries. The patient-specific tests that were requested were all normal. Repeat ultrasonography of the patient reported normal liver with numerous hypovaccal nodules in the entire parenchymal artery, which had increased in size and number compared with the previous assessment. Finally, the patient was discharged 5 days after the fever stopped and due to the improvement of her general condition with the prescription of levofloxacin and metronidazole, and was referred to the clinic one week later. In this case, we attempted to review the literature on the etiology, diagnosis, and treatment of hepatic abscess for a physician. [ABSTRACT FROM AUTHOR]

Background: To reduce maternal mortality Tanzania introduced Maternal Death Surveillance and Response (MDSR) system in 2015 as recommended by World Health Organization (WHO). All health facilities are to notify and review all maternal deaths inorder to recommend quality improvement actions to reduce deaths in future. The system relies on consistent and correct categorization of causes of maternal deaths and three phases of delays. To assess its adequacy we compared the routine MDSR categorization of causes of death and three phases of delays to those assigned by an independent expert panel with additional information from Verbal Autopsy (VA).Methods: Our cross-sectional study included 109 reviewed maternal deaths from two regions in Tanzania for the year 2018. We abstracted the underlying medical causes of death and the three phases of delays from MDSR system records. We interviewed bereaved families using the standard WHO VA questionnaire. The obstetrician expert panel assigned underlying causes of death based on information from medical files and VA according to International Classification of Disease to Death in Pregnancy Childbirth and Puerperium (ICD-MM). They assigned causes to nine ICD-MM groups and identified the three phases of delays. We used Cohen's K statistic to compare causes of deaths and delays categorization.Results: Comparison of underlying causes was done for 99 deaths. While 109 and 84 deaths for expert panel and MDSR respectively were analyzed for delays because of missing data in MDSR system. Expert panel and MDSR system assigned the same underlying causes in 64(64.6%) deaths (K statistic 0.60). Agreement increased in 80 (80.8%) when causes were assigned by ICD-MM groups (K statistic 0.76). The obstetrician expert panel identified phase one delays in 74 (67.9%), phase two in 24 (22.0%) and phase three delays in all 101 (100%) deaths that were assessed for this delay while MDSR system identified delays in 42 (50.0%), 10 (11.9%) and 78 (92.9%).The expert panel found human errors in management in 94 (93.1%) while MDSR system reported in 53 (67.9%) deaths.Conclusions: MDSR committees performed reasonably well in assigning underlying causes of death. The obstetrician expert panel found more delays than reported in MDSR system indicating difficulties within MDSR teams to critically review deaths. [ABSTRACT FROM AUTHOR]

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Death is a fact which everyone should acknowledge some or the other day, and one of its most important aspects is its certification. Mortality statistics form an integral part of the vital data of a country. Almost every physician has to fill at least one death certificate in his/her career. However, teaching the precise wording and formulation of causes of death is not usually included either in undergraduate or in postgraduate medical education. [3] Consequently, inaccuracies in the completion of death certificates may lead to biased estimation of several epidemiological parameters. After explaining the objectives of the study, a real case scenario was given and the participants were asked to fill the details in the MCCD. Then a lecture is given about filling up MCCD. After this a different case scenario is given to them. Only 2 death certificates (2.5%) were free from all errors and complete. Alteast 1 major error occurred in 51 (63.75%) cases, the most common was wrong sequencing of causal events (60%). Unrelated causal events stated as related only in 6 (7.5%) cases. Atleast 1 minor error were found in 78 (97.5%) certificates. The most common minor error was not mentioning the duration of illness, which occurred in 68 (85%) cases. This study reflects inadequate practice, training and lack of awareness about importance of medical certificate of cause of death, carelessness and negligence on the part of attending doctors. All doctors should realize that Medical Certificate of Cause of Death is an important scientific tool and has far reaching impact (on international health). [ABSTRACT FROM AUTHOR]

Long-term exposure to ambient ozone (O 3) poses a severe public health threat in China. However, the drivers of premature mortality caused by O 3 pollution are still poorly constrained, despite being prerequisites for addressing the threat. Here, we demonstrate the contributions of historical and future changes in peak-season O 3 , population size, age structure, and baseline mortality to China's O 3 -related mortality using decomposition analysis. From 2013 to 2021, O 3 -related mortality decreased dramatically from 78.8 (40.8–124.6) to 68.7 (36.0–107.2) thousand, especially in densely populated areas with high pollution. Variations in peak-season O 3 , population size, age structure, and baseline mortality led to changes in O 3 -related mortality of +27.3 (14.8–41.3), +2.6 (1.4–4.1), +22.3 (11.5–35.2), and −40.3 (20.9–63.7) thousand, respectively. The influence of peak-season O 3 on O 3 -related mortality shifted from positive during 2013–2019 (+8.4% per year) to negative during 2019–2021 (−8.8% per year), which highly regulated the interannual trend of mortality. From 2021 to 2035, O 3 -related mortality is expected to increase by 31% in the current context of peak-season O 3 levels, primarily caused by increased aging. Even reducing peak-season O 3 to the WHO interim target 1 (IT-1) would only reduce O 3 -related mortality by 3.9%, while a more rigorous standard (IT-2) would prevent 83.7% of mortality. These findings suggest that improving ambient O 3 can lead to significant health benefits, but substantial mitigation strategies are merited given the future trend of population aging. [Display omitted] • Past and future O 3 -related mortality trends and driving factors are quantified. • O 3 determines interannual variations in mortality and reducing O 3 has great benefits. • Densely populated areas with high pollution are more susceptible to O 3 changes. • Reductions in baseline mortality offset increases in other factors during 2013–2021. • Population aging is the leading factor hindering O 3 -related mortality reduction. [ABSTRACT FROM AUTHOR]

A few modifications can significantly improve root cause analysis using predefined trees. These modifications are based on adopting four ideas: (1) Causes represent deficiencies in processes. (2) Processes connected to causes are grouped into a hierarchy. Superior processes shape the subordinate ones. (3) The same safety management system can be applied to all processes in the hierarchy. (4) The structure described in the CCPS Guidelines for Risk Based Process Safety represents a universally applicable safety management system. Simultaneously, it can be transformed into a universal RBPS Root Cause Map. The resulting IPICA_Lite procedure described in this paper can serve as a tool that identifies underlying causes, including the problems inherent in a safety culture, and promotes corrective recommendations including the third layer recommendations, enforcement of which is often difficult. [ABSTRACT FROM AUTHOR]

Limited information on age- and sex-specific estimates of influenza-associated death with different underlying causes is currently available. We regressed weekly age- and sex-specific US mortality outcomes underlying several causes between 1997 and 2007 to incidence proxies for influenza A/H3N2, A/H1N1, and B that combine data on influenzalike illness consultations and respiratory specimen testing, adjusting for seasonal baselines and time trends. Adults older than 75 years of age had the highest average annual rate of influenza-associated mortality, with 141.15 deaths per 100,000 people (95% confidence interval (CI): 118.3, 163.9), whereas children under 18 had the lowest average mortality rate, with 0.41 deaths per 100,000 people (95% CI: 0.23, 0.60). In addition to respiratory and circulatory causes, mortality with underlying cancer, diabetes, renal disease, and Alzheimer disease had a contribution from influenza in adult age groups, whereas mortality with underlying septicemia had a contribution from influenza in children. For adults, within several age groups and for several underlying causes, the rate of influenza-associated mortality was somewhat higher in men than in women. Of note, in men 50–64 years of age, our estimate for the average annual rate of influenza-associated cancer mortality per 100,000 persons (1.90, 95% CI: 1.20, 2.62) is similar to the corresponding rate of influenza-associated respiratory deaths (1.81, 95% CI: 1.42, 2.21). Age, sex, and underlying health conditions should be considered when planning influenza vaccination and treatment strategies. [ABSTRACT FROM AUTHOR]

Trevor Kletz belongs to the pioneers in root cause analysis of accidents. This article summarizes Kletz's approach to accident investigations, and it points out that his approach has some gaps that sometimes need to be addressed. These gaps seem to be related to certain assumptions taken for granted by Kletz but not always fulfilled in the real world. In general, Kletz assumes that professionals and leaders are honest and responsible. In fact, Kletz deliberately strives to avoid 'blaming.' Therefore, Kletz gives no guidance of what to do when leaders' negligence contributes to an accident. This article expands the Kletz approach to include this aspect of process safety. Two acronyms are used to describe the difference between the Kletzian (more ideal) and non-Kletzian world. The engineering approach that follows Mr. Kletz's vision is depicted by the word RUDE, where R is for Reliable equipment-the need for engineers to provide R; U is for Understanding it-the need for engineers to understand the properties, hazards, and correct use of equipment; D is for Disciplined personnel-the need for leadership to select and support D, E is for Empathy-the need for leaders to recognize the deficiencies and incompetence of their employees. An expanded approach is depicted by the word RUDENESS, where NE is for Navigators in Ethics-the need for the leaders of society to act as role models and stress ethic fundamentals of process safety, and SS is for a Safety-demanding Society-the need for both government and the governed to place a high priority on safety performance with appropriate laws and standards. © 2012 American Institute of Chemical Engineers Process Saf Prog, 2012 [ABSTRACT FROM AUTHOR]

Objective: To report on trends in mortality for asthma using all certified causes of death mentioned on death certificates (conventionally termed 'mentions'), not just the underlying cause. Study design: Retrospective analysis using death certificate information and population data. Method: Analysis of mortality records in the Oxford region (mentions available from 1979 to 2007) and English national data (mentions available from 1995 to 2007). The data were considered in periods defined by different national rules for selecting underlying cause of death (1979-1983, 1984-1992, 1993-2000, 2001-2007), and were also analysed as single calendar years. Results: In Oxford, underlying cause mortality rates per million population in the four periods were 25, 32, 22 and 15, respectively. Rates for mentions were 44, 47, 41 and 29, respectively. Rule changes exaggerated the increase in underlying cause mortality in 1984-1992 (when 67% of asthma deaths were coded as underlying cause). Conversely, the decrease in underlying cause mortality for asthma by 2001-2007 is less than it seems (because just under 50% of asthma deaths in 2001-2007 were coded as underlying cause). Comparisons of trends in asthma and chronic obstructive airways disease (COPD) for individuals aged ≥55 years showed a decrease for both asthma and COPD in men; in women, a decrease in asthma and an increase in COPD was seen from the early 1990s. Conclusions: Approximately half of all deaths certified for asthma are missed when asthma mortality is analysed using underlying cause alone. The long-term decreasing trend in asthma mortality is real, and is not attributable to a trend in transferring certification from underlying to contributing cause. Nonetheless, caution is needed when comparing asthma deaths using underlying cause alone across periods that include changes to rules for the selection of underlying cause. [ABSTRACT FROM AUTHOR]

Causes underlying mortality disparities are often determined by causal decomposition. This method is based on the decomposition of differences in mortality or life expectancy into parameters representing the contribution of underlying causes. It quantifies disparities as differences in mortality rates and does not account for the fact that many underprivileged groups are more likely to die from nearly all causes. Results are driven by the frequency of cause of death. Alternatively, the cause deleted index quantifies the role of underlying causes in mortality disparities as the change in the relative risk of dying that is related to deleting a specific cause. The consistency between the methods in estimating cause of death contributions is analyzed using 2000 U.S. mortality data and simulated mortality profiles. The two methods often produce divergent results because causal decomposition relies on the prevalence of causes of death. [ABSTRACT FROM AUTHOR]

Abstract: Background: The underlying causes of chordae tendinae rupture (CTR) and their frequencies vary. Different publications reached conflicting conclusions due to diverse definitions, different detection measures, and morbidity trends over time. Methods: Systematic literature review of unselected CTR series and underlying cause frequencies reanalysis. Results: Primary CTR overall rates before and since 1985 remain considerable (52.5% vs. 51.2%), yet median decreased (35% and 14%). Sub-acute endocarditis (SBE) and rheumatic heart disease (RHD) were the most frequent causes before 1985 (54.4% and 42.1%, respectively); since 1985 SBE and RHD have dropped sharply to 37.4% and 24.8%, respectively. Since 1985, mitral valve prolapse (MVP) and myxomatous degeneration (MD) have caused 44.5% and 11.7%, respectively. All other causes were almost not evident. Conclusions: “Primary CTR” remains significant. MD may be underestimated, as microscopic evaluation was not routinely performed. MD is probably the most frequent underlying cause given it is also the underlying cause of MVP. MVP may be overestimated due to detection criteria and misinterpretation of leaflet prolapse. SBE, frequently coexistent with other underlying causes, may be overestimated either due to detection bias or being a consequence rather than CTR cause. RHD is expected to further decline, following rheumatic fever. Previous significant underlying causes proved to be episodic if at all causative, e.g., blunt chest trauma, generalized connective tissue disorder, ischemic heart disease, and other heart and valvular diseases. CTR can occur in apparently healthy subjects having no atypical appearance and who may be unaware of carrying risk. [ABSTRACT FROM AUTHOR]

Although cigarette smoking has been extensively researched, surprising little knowledge has been produced by demographers using demographic perspectives and techniques. Thus, this paper contributes to the literature by extending a demographic framework to an important behavior for mortality research: cigarette smoking. In earlier works, the authors used nationally-representative data to show that cause of death patterns varied by smoking status and that multiple causes of death characterized smokers moreso than non-smokers. The present work extends previous analysis by estimating smoking status mortality differentials by underlying and multiple causes of death and by age and sex. Data from the 1986 National Mortality Followback Survey are related to data from the 1985 and 1987 National Health Interview Survey supplements to assess the smoking-related mortality differentials. We find that cigarette smoking is associated with higher mortality for all population categories studied, that the smoking mortality differentials vary across the different smoking status categories and by demographic group, and that the mortality differentials vary according to whether underlying cause or multiple cause patterns of death are examined. Moreover, the multiple cause analysis highlights otherwise obscured smoking-mortality relations and points to the importance of respiratory diseases and cancers other than lung cancer for cigarette smoking research. [ABSTRACT FROM AUTHOR]