AGenesis is a novel of "postmortal fiction" set entirely in an afterlife. Nessie, a recently dead woman, accidentally kills an already-dead man, and in the confusion that follows, sets out to discover how he could have died and what after-afterlife he might have gone to. During her travels, she is raped and then help captive by a city of tormented souls; she descends into madness until rescued by children, and she and her newborn but "undead" daughter set out again, this time to find the end of the afterlife. Nessie's daughter eventually seeks a way to enter a living world she's never known, while Nessie tries to end her suffering and find peace.

Class of 2012 Abstract / Specific Aims: This study was aimed to evaluate inpatient clinical treatment characteristics associated with the use of intracranial implantation of chemotherapeutic wafers for malignant brain neoplasms within United States, and assess inpatient mortality and total charges regarding treatment with wafer versus without. Methods: A retrospective cohort investigation was conducted utilizing inpatient discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2005 to 2009. From this nationally- representative sample, 9,455 adults aged 18 years or older were identified with malignant neoplasms of the brain treated with implantable chemotherapeutic wafers. Outcomes of inpatient mortality and charges were assessed via multivariate regression analysis, controlling for patient characteristics, hospital structure, comorbidities, and clinical complications. Main Results: The average age of patients with brain neoplasms was 56.6 (±16.5) years, and of those patients, 42.9% were female. The odds ratio for inpatient mortality of patients treated with implantable chemotherapeutic wafers was OR=0.380 (P<0.001), and patients that received wafer treatment had increased charges exp(b)=2.147 (P<0.001). Conclusions: Multiple factors were associated with inpatient mortality and charges among the 247,829 patients that were diagnosed with malignant brain neoplasms from 2005-2009. With regards to these patients, implantable chemotherapeutic wafers were associated with increased inpatient survival and increased charges.

Class of 2010 Abstract / OBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.

Fire activity, in terms of intensity, frequency, and total area burned, is expected to increase with a changing climate. A challenge for landscape-level assessment of fire effects, often termed burn severity, is that current remote sensing assessments provide very little information regarding tree/vegetation physiological performance and recovery, limiting our understanding of fire effects on ecosystem services such as carbon storage/cycling. In this paper, we evaluated whether spectral indices common in vegetation stress and burn severity assessments could accurately quantify post-fire physiological performance (indicated by net photosynthesis and crown scorch) of two seedling species, Larix occidentalis and Pinus contorta. Seedlings were subjected to increasing fire radiative energy density (FRED) doses through a series of controlled laboratory surface fires. Mortality, physiology, and spectral reflectance were assessed for a month following the fires, and then again at one year post-fire. The differenced Normalized Difference Vegetation Index (dNDVI) spectral index outperformed other spectral indices used for vegetation stress and burn severity characterization in regard to leaf net photosynthesis quantification, indicating that landscape-level quantification of tree physiology may be possible. Additionally, the survival of the majority of seedlings in the low and moderate FRED doses indicates that fire-induced mortality is more complex than the currently accepted binary scenario, where trees survive with no impacts below a certain temperature and duration threshold, and mortality occurs above the threshold.

Evidence continues to demonstrate that racial/ethnic minority groups experience a disproportionate burden of disease and mortality in cardiovascular-related diseases (CVDs). However, emerging evidence suggests a health advantage for Latinos despite a high risk profile. The current study explored the hospital utilization trends of Latino and non-Latino patients and examined the possibility of an advantage for Latinos within the context of CVD-related events with retrospective data collected over a 12-month period from a local safety-net hospital. Contrary to my hypotheses, there was no advantage for in-hospital mortality, length of stay or re-admission in Latinos compared to non-Latinos; rather, Latinos hospitalized for a CVD-related event had a significantly longer length of stay and had greater odds for re-admission when compared to non-Latinos. Despite data suggesting a general health advantage, Latinos may experience a relative disparity within the context of hospital utilization for CVD-related events. Findings have implications for understanding the hospital utilization trends of Latinos following a CVD-related event and suggest a call for action to advance understanding of Latino cardiovascular health.

Analysis of mortality development in Russia using various decomposition methods Abstract The aim of this thesis is to analyze and evaluate mortality development in Russia in last 50 years by using various decomposition methods. The first part presents the method of decomposition of the difference between two demographic indicators (E. Kitagawa's method or methods from E. Arriaga, R. Pressat and J. Pollard). In the second part mortality development in Russia is analyzed by using methods that decomposed the value of demographic indicators in a given year. Mortality is divided into senescent and background component by using the Gompertz-Makeham formula and by using the logistic model. Afterwards, avoidable and unavoidable mortality and mortality due to endogenous and exogenous causes of death is analyzed. Hypotheses, set out in the introductory chapter, are verified by using different decomposition methods. Using multiple methods of decomposition enable to obtain a more complex view of the evolution of mortality in the observed period so that could be viewed from multiple perspectives and identify specific population trends in Russia. Keywords: mortality, Russia, decomposition, senescent and background mortality, avoidable mortality, endogenous, exogenous, causes of death, mortality crisis

Magister Public Health - MPH / Background: Malnutrition is a complex condition profoundly impacting child mortality and morbidity, especially in sub-Saharan Africa. Severe acute malnutrition is of growing concern locally where unacceptable mortality rates persist, despite reasonable standards of clinical care. Aim: To determine factors associated with morbidity and mortality in children under-five years admitted with severe acute malnutrition to a regional paediatric hospital in KwaZulu-Natal. Methodology: This was a quantitative study. A retrospective observational study design was used. Medical records of all children with severe acute malnutrition, under the age of five years, admitted between April 2015 and December 2016 to the regional paediatric hospital in KwaZulu-Natal were included. Data was obtained from medical records and admission books. A trained research assistant was used to extract and record data with a piloted data extraction tool. Data was entered and cleaned using Microsoft Excel and analysed using SPSS (v 20) and STATA (v 14). Descriptive summary statistics were used to describe the characteristics of the study population and bivariate analysis using t-tests and Chi-square tests to determine significance. Kaplan Meier and Multivariate Cox regression was used to assess the association of variables with morbidity and mortality. Results: Of the 276 eligible case records included in the study, 54% were male and 90% of all cases were younger than 2 years. Even though associations did not reach significance, teenage pregnancy and unemployment was high amongst the caregivers of the study population. Most of the malnourished children admitted (74%) presented with multiple comorbidities. Diarrhoea (43%), HIV- infection (30%) and respiratory tract infections (30%) were the top three comorbidities found, followed by tuberculosis (27%). The overall mortality rate was 8.7%. Survival probability was significantly reduced in children with pneumonia and those who presented with hypoglycaemia, dehydration, dermatosis, severe pallor, altered consciousness or shock on admission (p < 0.05). There was a significantly increased risk of death in males (HR = 0.174, 95%CI = 0.05 - 0.665), and in those who presented with dehydration (HR = 4.1, 95%CI = 1.25 - 13.59), evidence of lethargy or coma (HR = 4.2, 95%CI = 1.04 - 17.12) or multiple clinical signs (HR = 4.4, 95% CI =2.56 - 7.59) on admission (p < 0.05). The comorbidities HIV-infection (HR = 9.9, 95%CI = 1.39 - 70.68) and pneumonia (HR = 3.4, 95%CI = 1.56 - 7.43) showed a significantly increased mortality risk (p < 0.05). Conclusion: This study supports the body of evidence that despite reasonable standards of hospital care, it is difficult to obtain the target for severe acute malnutrition mortality (< 5%), likely due to the presence of contextually specific factors. Local interventions at hospital, primary health care and community level is needed, as well as further research to facilitate comprehensive policy-making.

Magister Philosophiae - MPhil / According to a 2010 report by the United Nations, mortality rates among children under the age of five remain extremely high in most countries in sub-Saharan Africa in which Zimbabwe is one of them. Child mortality in Zimbabwe is found to be associated with the specific causes with differing factors. This thesis analyses main causes of child mortality in Zimbabwe with selected socioeconomic, bio-demographic, maternal fertility behaviour, sexual reproductive health and services delivery factors in the study area, and Zimbabwe’s progress towards reaching MDG 4&5, which is to improve maternal health and reduce child mortality. The study used secondary data from the Demographic and Health Survey Zimbabwe of 2010-11, which is a nationally representative sample of all deaths based on household interviews to assess the impact of socioeconomic factors, health care accessibility and HIV/AIDS on infant and child mortality. This is a theoretical and descriptive study which uses odds and hazard rates of analysis and also used bio-demographic variables to understand the problem by exploring the data to obtain the most plausible estimates of infant and child mortality in the past decades. The findings, to a great extent showed that, socioeconomic factors have a huge contribution to infant and child mortality rates in Zimbabwe. Preceding birth interval, family size, birth type, breastfeeding status, source of drinking water, mother education, mother income, area of residence, and father education have significant effect at univariate level, whereas, area of residence, mother education and father education were not significant at multivariate level. The finding from the study revealed that mother’s educational level is not a determinant factor of infant and child mortality in Zimbabwe unlike other studies. However, awareness about the influencing factors of infant and child mortality is vital in order to control them, so also is enlightenment on the need of birth control and family size and benefit of breastfeeding. Improvement on the socioeconomic status and empowerment of citizens most especially women will help to reduce infant and child mortality.

A Dissertation submitted to the faculty of Medicine, University of the Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of Medicine in paediatrics. / The aims of this study were to establish the incidence of perinatally and nosocomially acquired bacteraemia and funqaemia as determinad by blood and cerebrospinal fluid (CSF) isolates in the neonatal population seen at the Baraqwanath Neonatal Unit; to identify risk factors for infection and record the outcome. Other aims were to analyze tha susceptibility patterns of the organisms isolated with respect to changing antimicrobial policies and to compare these with previously reported studies. (Abbreviation abstract) / Andrew Chakane 2018

M.MSc. (Med.), Faculty of Health Sciences, University of the Witwatersrand, 2009 / Violence is a hidden problem in most communities, yet it is among the leading causes of death and non-fatal injury worldwide. It is an essential public health issue for every country and needs to be addressed as a matter of priority. While rural areas of South Africa are believed to be safer than urban areas, they are not necessarily safe per se. The main objective of this study is to examine the burden of fatal violent injuries on a rural South African community. The violent deaths data used in this report were collected through a verbal autopsy (VA) process during the period 1992 to 2000 in Agincourt, Bushbuckridge, a rural area in the north-eastern part of South Africa with a population of about 69 000 people. Person-years data for the same period, obtained from the Agincourt Health and Demographic Surveillance System (AHDSS), were used for the denominator in the computation of rates. Violence accounted for 5.9% (170/2 859) of deaths from all causes in the Agincourt area between 1992 and 2000. Of the 170 violent deaths, 68.2% were due to assault while the remaining 31.8% were suicides. The proportion of violent deaths, as proportion of deaths from all causes, is highest in the 15–19 year age group (20.9%, compared to 1.0% amongst those under the age of 15 years and 2.0% among those 60 years and older). The small number of victims in each age group results in wide confidence intervals. The violent deaths proportion, as a proportion of deaths from all causes, is higher in males (9%) than in females (2.3%). Violence levels appear to be higher among South Africans than among self-settled former Mozambicans, though the observed difference between these two populations is not statistically significant. However, a statistically significant difference is found between levels of death due to assault among migrants and permanent residents. To address this situation, violence prevention strategies and programmes need to be put in place to reduce violence. However, more research is required in order to identify more risk factors associated with violent behaviour, to study the identified risk factors, and to inform the development of these programmes.