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Efficient Gossip Protocols for Verifying the Consistency of Certificate Logs  [PDF]
Laurent Chuat,Pawel Szalachowski,Adrian Perrig,Ben Laurie,Eran Messeri
Computer Science , 2015,
Abstract: The level of trust accorded to certification authorities has been decreasing over the last few years as several cases of misbehavior and compromise have been observed. Log-based approaches, such as Certificate Transparency, ensure that fraudulent TLS certificates become publicly visible. However, a key element that log-based approaches still lack is a way for clients to verify that the log behaves in a consistent and honest manner. This task is challenging due to privacy, efficiency, and deployability reasons. In this paper, we propose the first (to the best of our knowledge) gossip protocols that enable the detection of log inconsistencies. We analyze these protocols and present the results of a simulation based on real Internet traffic traces. We also give a deployment plan, discuss technical issues, and present an implementation.
Assessment of Medical Certificate of Cause of Death at a New Teaching Hospital in Vadodara  [PDF]
Amul B. Patel, Hitesh Rathod, Himanshu Rana, Viren Patel
National Journal of Community Medicine , 2011,
Abstract: The study was conducted to find out errors in the medical certification of cause of death during July 2011 at a new teaching hospital in Vadodara. All certificates of in-hospital deaths in medical record department, from May 2010 to June 2011, were assessed for major and minor errors. Data were analyzed with SPSS 17 version software. The results revealed that out of 40 death certificates, not a single was free from any error. Major errors occurred in 23(57.5%) cases with improper sequencing (55%) as most frequent. Most common minor error was the absence of time interval between the onset of disease and death (92.5%). No significant association was found between major errors and factors like age, sex, ward and underlying cause of death. This study concluded that educational intervention is necessary to increase physicians' awareness regarding importance of medical certificate of cause of death and accuracy of death certificates.
Using death certificate data to study place of death in 9 European countries: opportunities and weaknesses
Joachim Cohen, Johan Bilsen, Guido Miccinesi, Rurik L?fmark, Julia Addington-Hall, Stein Kaasa, Michael Norup, Gerrit van der Wal, Luc Deliens
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-283
Abstract: We investigated the possibility and modality of all partners in this international comparative study (BE, DK, IT, NL, NO, SE, UK) to negotiate a dataset containing all deaths of one year with their national/regional administration of mortality statistics, and analysed the availability of information about place of death as well as a number of clinical, socio-demographic, residential and healthcare system factors.All countries negotiated a dataset, but rules, procedures, and cost price to get the data varied strongly between countries. In total, about 1.1 million deaths were included. For four of the nine countries not all desired categories for place of death were available. Most desired clinical and socio-demographic information was available, be it sometimes via linkages with other population databases. Healthcare system factors could be made available by linking existing healthcare statistics to the residence of the deceased.Death certificate data provide information on place of death and on possibly associated factors and confounders in all studied countries. Hence, death certificate data provide a unique opportunity for cross-national studying and monitoring of place of death. However, modifications of certain aspects of death certificate registration and rules of data-protection are perhaps required to make international monitoring of place of death more feasible and accurate.There are several reasons why it is important for public health policy to study place of death and to gain a better understanding of the reasons why people die where they die. The place of death is often regarded as an important parameter for the quality of the end-of-life [1,2], and there seems to be a large discrepancy between the preferred and actual place of death [3,4]. Moreover, as allocation of means is becoming increasingly important in healthcare organisation, and as healthcare costs are particularly high at the end-of-life [5-7], there can be economical motives. The UK for insta
Identification of pneumonia and influenza deaths using the death certificate pipeline
Kailah Davis, Catherine Staes, Jeff Duncan, Sean Igo, Julio C Facelli
BMC Medical Informatics and Decision Making , 2012, DOI: 10.1186/1472-6947-12-37
Abstract: A Death Certificates Pipeline (DCP) was developed to automatically code death certificates and identify pneumonia and influenza cases. The pipeline used MetaMap to code death certificates from the Utah Department of Health for the year 2008. The output of MetaMap was then accessed by detection rules which flagged pneumonia and influenza cases based on the Centers of Disease and Control and Prevention (CDC) case definition. The output from the DCP was compared with the current method used by the CDC and with a keyword search. Recall, precision, positive predictive value and F-measure with respect to the CDC method were calculated for the two other methods considered here. The two different techniques compared here with the CDC method showed the following recall/ precision results: DCP: 0.998/0.98 and keyword searching: 0.96/0.96. The F-measure were 0.99 and 0.96 respectively (DCP and keyword searching). Both the keyword and the DCP can run in interactive form with modest computer resources, but DCP showed superior performance.The pipeline proposed here for coding death certificates and the detection of cases is feasible and can be extended to other conditions. This method provides an alternative that allows for coding free-text death certificates in real time that may increase its utilization not only in the public health domain but also for biomedical researchers and developers.This study did not involved any clinical trials.
Causes of Mortality for Indonesian Hajj Pilgrims: Comparison between Routine Death Certificate and Verbal Autopsy Findings  [PDF]
Masdalina Pane, Sholah Imari, Qomariah Alwi, I Nyoman Kandun, Alex R. Cook, Gina Samaan
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0073243
Abstract: Background Indonesia provides the largest single source of pilgrims for the Hajj (10%). In the last two decades, mortality rates for Indonesian pilgrims ranged between 200–380 deaths per 100,000 pilgrims over the 10-week Hajj period. Reasons for high mortality are not well understood. In 2008, verbal autopsy was introduced to complement routine death certificates to explore cause of death diagnoses. This study presents the patterns and causes of death for Indonesian pilgrims, and compares routine death certificates to verbal autopsy findings. Methods Public health surveillance was conducted by Indonesian public health authorities accompanying pilgrims to Saudi Arabia, with daily reporting of hospitalizations and deaths. Surveillance data from 2008 were analyzed for timing, geographic location and site of death. Percentages for each cause of death category from death certificates were compared to that from verbal autopsy. Results In 2008, 206,831 Indonesian undertook the Hajj. There were 446 deaths, equivalent to 1,968 deaths per 100,000 pilgrim years. Most pilgrims died in Mecca (68%) and Medinah (24%). There was no statistically discernible difference in the total mortality risk for the two pilgrimage routes (Mecca or Medinah first), but the number of deaths peaked earlier for those traveling to Mecca first (p=0.002). Most deaths were due to cardiovascular (66%) and respiratory (28%) diseases. A greater proportion of deaths were attributed to cardiovascular disease by death certificate compared to the verbal autopsy method (p<0.001). Significantly more deaths had ill-defined cause based on verbal autopsy method (p<0.001). Conclusions Despite pre-departure health screening and other medical services, Indonesian pilgrim mortality rates were very high. Correct classification of cause of death is critical for the development of risk mitigation strategies. Since verbal autopsy classified causes of death differently to death certificates, further studies are needed to assess the method’s utility in this setting.
Dying from cancer or other chronic diseases in the Netherlands: ten-year trends derived from death certificate data
Lud FJ van der Velden, Anneke L Francke, Lammert Hingstman, Dick L Willems
BMC Palliative Care , 2009, DOI: 10.1186/1472-684x-8-4
Abstract: Secondary analysis of data from 1996 to 2006 on the "primary" or "underlying" cause of death from official death certificates filled out by physicians and additional data from 2003 to 2006 on the place of death from these certificates.Of the 135,000 people who died in the Netherlands in 2006, 77,000 (or 57%) died from a chronic disease. Cancer was the most frequent cause of death (40,000). Stroke accounted for 10,000 deaths, dementia for 8,000 deaths and COPD and heart failure each accounted for 6,000 deaths. Compared to 1996, the number of people who died from chronic diseases has risen by 6%.Of all non-acute deaths, almost three quarters were at least 70 years old when they died. Almost one third of the people died at home (31%), 28% in a hospital, 25% in a nursing home and 16% somewhere else.Further investments to facilitate dying at home are desirable. Death certificate data proved to be useful to describe and monitor trends in non-acute deaths. Advantages of the use of death certificate data concern the reliability of the data, the opportunities for selection on the basis of the ICD-10, and the availability and low cost price of the data.Some people die acutely and unexpectedly. Others die from a chronic disease. In the latter group death occurs after a more or less long period of sickness. They are therefore likely to experience palliative care needs. For the planning and organisation of palliative care it is important to gain insight into the background characteristics of people who die from cancer or other chronic diseases. This is especially important in the context of an ageing population, which will ultimately lead to a greater number of deaths.In the year 2000 the authors performed a first analysis of non-acute death. [1] The analysis of non-acute death presented here is an update and an extension of the study performed in 2000. This update was necessary because the previous study concerned mortality data that are now ten years old. It was also important
Pediatric Influenza-Associated Deaths in New York State: Death Certificate Coding and Comparison to Laboratory-Confirmed Deaths  [PDF]
Dina Hoefer,Bryan Cherry,Marilyn Kacica,Kristi McClamroch,Kimberly Kilby
Influenza Research and Treatment , 2012, DOI: 10.1155/2012/397890
Abstract: Introduction. Surveillance for laboratory-confirmed influenza-associated deaths in children is used to monitor the severity of influenza at the population level and to inform influenza prevention and control policies. The goal of this study was to better estimate pediatric influenza mortality in New York state (NYS). Methods. Death certificate data were requested for all passively reported deaths and any pneumonia and influenza (P&I) coded pediatric deaths occurring between October 2004 and April 2010, excluding New York City (NYC) residents. A matching algorithm and capture-recapture analysis were used to estimate the total number of influenza-associated deaths among NYS children. Results. Thirty-four laboratory-confirmed influenza-associated pediatric deaths were reported and 67 death certificates had a P&I coded death; 16 deaths matched. No laboratory-confirmed influenza-associated death had a pneumonia code and no pneumonia coded deaths had laboratory evidence of influenza infection in their medical record. The capture-recapture analysis estimated between 38 and 126 influenza-associated pediatric deaths occurred in NYS during the study period. Conclusion. Passive surveillance for influenza-associated deaths continues to be the gold standard methodology for characterizing influenza mortality in children. Review of death certificates can complement but not replace passive reporting, by providing better estimates and detecting any missed laboratory-confirmed deaths. 1. Introduction It has long been recognized that influenza is associated with substantial mortality during both epidemics and pandemics. Death due to influenza virus infection can result from a variety of causes, such as pneumonia or exacerbations of existing cardiopulmonary or other chronic conditions. Influenza-associated death among children in particular is rare, but when it occurs, it is often rapidly fatal and may affect children with no predisposing risk factor [1, 2]. Bacterial coinfections, especially methicillin-resistant Staphylococcus aureus (MRSA), are also increasingly being documented among influenza-associated pediatric deaths [1]. These were important factors in the Advisory Committee on Immunization Practices (ACIP) expanding influenza vaccine recommendations in 2008 to include all children aged 6 months through 18 years [3] when in years prior influenza vaccine was only recommended for children less than five years of age. Due to increased reports of deaths in children associated with influenza in the 2003-04 season [4, 5], in October 2004 laboratory-confirmed
Certificado médico de defunción del adulto Death certificate of the adult  [cached]
Héctor Barreiro Ramos,Adriana Barreiro Pe?aranda,Eugenio Fernández Viera,Ofelia Marrero Martín
Revista Cubana de Medicina General Integral , 2004,
Abstract: La certificación de las causas de muerte, pese a ser uno de los procederes médicos más antiguos que existen en nuestra práctica, no se domina a plenitud, sin embargo nadie tiene dudas de la importancia que tiene desde muchos puntos de vista una correcta certificación. Aun cuando se han editado trabajos referentes a la confección correcta de los certificados de defunción del adulto, existen innumerables dificultades para realizar una secuencia lógica de las causas de muertes. Por todo esto, decidimos realizar una revisión de esta temática y brindar un material que pueda ayudar fundamentalmente a los médicos de asistencia y alumnos de 5to. a o de la carrera de Medicina a confeccionar correctamente el nuevo certificado médico de defunción del adulto. Hemos querido centrar el esfuerzo en 2 aspectos fundamentales: la distinción de las distintas causas de muerte y su secuencia. Por eso hemos hecho una recopilación de informaciones de la Décima Clasificación de Enfermedades y otras publicaciones relacionadas con el tema, ya que otros aspectos pueden ser profundizados por la bibliografía acotada en el texto y otras fuentes. The certification of death causes in spite of being one of the oldest procedures in our practice is not well managed. However, nobody doubts about the importance of a correct certification from many points of view. Although papers referring to the right making of the death certificates of the adult have been published, there are innumerable difficulties to obtain a logical sequence of death causes. Taking all this into account, we decided to make a review of this topic and to provide a material to help mainly physicians and 5th-year medical students to make the new death certificate of the adult correctly. We have focused the effort on two fundamental aspects. The distinction of the main causes of death and their sequence. To this end, we have collected information of the Tenth Classification of Diseases and other publications related to this topic, since other aspects may be thoroughly analyzed by the bibliography annotated in the text and other sources.
Inaccuracy of Death Certificate Diagnosis of Tuberculosis and Potential Underdiagnosis of TB in a Region of High HIV Prevalence
Theresa T. Liu,Douglas Wilson,Halima Dawood,D. William Cameron,Gonzalo G. Alvarez
Clinical and Developmental Immunology , 2012, DOI: 10.1155/2012/937013
Abstract: Despite the South African antiretroviral therapy rollout, which should reduce the incidence of HIV-associated tuberculosis (TB), the number of TB-attributable deaths in KwaZuluNatal (KZN) remains high. TB is often diagnosed clinically, without microbiologic confirmation, leading to inaccurate estimates of TB-attributed deaths. This may contribute to avoidable deaths, and impact population-based TB mortality estimates. Objectives. (1) To measure the number of cases with microbiologically confirmed TB in a retrospective cohort of deceased inpatients with TB-attributed hospital deaths. (2) To estimate the rates of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB in this cohort. Results. Of 2752 deaths at EDH between September 2006 and March 2007, 403 (15%) were attributed to TB on the death certificate. 176 of the TB-attributed deaths (44%) had a specimen sent for smear or culture; only 64 (36%) had a TB diagnosis confirmed by either test. Of the 39 culture-confirmed cases, 27/39 (69%) had fully susceptible TB and 27/39 (69%) had smear-negative culture-positive TB (SNTB). Two patients had drug monoresistance, three patients had MDR-TB, and one had XDR-TB. Conclusions. Most TB-attributed deaths in this cohort were not microbiologically confirmed. Of confirmed cases, most were smear-negative, culture positive and were susceptible to all first line drugs.
Occupation recorded on certificates of death compared with self-report: the Atherosclerosis Risk in Communities (ARIC) Study
Aurelian Bidulescu, Kathryn M Rose, Susanne H Wolf, Wayne D Rosamond
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-229
Abstract: Occupation was abstracted from 431 death certificates from North Carolina Atherosclerosis Risk in Communities Study participants who died between 1987 and 2001. Occupations were coded according to 1980 Bureau of Census job titles and then grouped into six 1980 census occupational categories. This information was compared with the self-reported occupation at midlife as reported at the baseline examination (1987–89). We calculated percent agreement using standard methods. Chance-adjusted agreement was assessed by kappa coefficients, with 95% confidence intervals.Agreement between death certificate and self-reported job titles was poor (32%), while 67% of occupational categories matched the two sources. Kappa coefficients ranged from 0.53 for technical/sales/administrative jobs to 0.68 for homemakers. Agreement was lower, albeit nonsignificant, for women (kappa = 0.54, 95% Confidence Interval, CI = 0.44–0.63) than men (kappa = 0.62, 95% CI = 0.54–0.69) and for African-Americans (kappa = 0.47, 95% CI = 0.34–0.61) than whites (kappa = 0.63, 95% CI = 0.57–0.69) but varied only slightly by educational attainment.While agreement between self- and death certificate reported job titles was poor, agreement between occupational categories was good. This suggests that while death certificates may not be a suitable source of occupational data where classification into specific job titles is essential, in the absence of other data, it is a reasonable source for constructing measures such as occupational SES that are based on grouped occupational data.Data from death certificates are used to monitor age, race and gender variations in mortality in the United States, US [1,2]. While sociodemographic information on death certificates is obtained from next of kin or other proxies, studies have indicated high validity of such information when compared with other official documents [3]. In the late 1980s the National Center for Health Statistics implemented guidelines to standardize data
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