A research report submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Public Health. Johannesburg, April 2017 / Introduction Men and women working in the mines are exposed to health hazards that lead to disability and even death. The Occupational Diseases in Mines and Works Act (ODMWA) provides compensation to families of deceased mineworkers with autopsy-diagnosed occupational lung disease(s). Written consent is required from the next kin before the organs are examined. In the last couple of decades, the numbers of autopsied miners has declined and this may be related to the manner in which consent is requested from families. This study described and compared consent processes autopsy uptake, processes for obtaining consent and the experiences and perceptions of personnel involved in these processes in selected South African mines. Methods A sequential mixed-methods study was conducted. Autopsy uptake was determined using NIOH and hospital records, followed by exploratory qualitative research investigating the processes for obtaining consent in three mining hospitals among relevant staff. Transcripts of 14 audio recorded interviews and one focus group were coded and analysed using ATLAS.ti 7. Thematic content analysis was applied using a deductive and inductive approach. Results and discussion There was an overall 38% decline in autopsy uptake from 183 in 2009 to 113 in 2012 among the participating hospitals. Over the five-year period, the average autopsy uptakes for two of the hospitals were low: 34% and 12%, respectively. The third hospital recorded a high autopsy uptake of 86%. Procedures for offering autopsies were similar among the three hospitals but differed in the categories of personnel performing the tasks. In one of the hospitals with poor autopsy uptake, autopsies were offered to families only if officials thought the deceased miner had a compensable disease. A receptionist who had other competing responsibilities was responsible for offering autopsies in the other hospital. In the hospital with good uptake, the offer of autopsies was done by a prosector who was also a mine union representative and therefore understood the autopsy process and was trusted by the families. Service providers identified lack of knowledge and awareness of ODMWA autopsies as an important factor that influenced family consent amongst a basket of many other factors including language barriers; distrust in the poorly functioning compensation system; traditional, religious beliefs and practices; and the lack of access to autopsy facilities especially in rural areas of South Africa. Some participants were dissatisfied or frustrated with the legal requirements for consent as it is a time consuming task that interfered with their other duties. Conclusion This study has shown that obtaining consent for ODMWA autopsy is a tedious and long process and can be a barrier to autopsy uptake. The personnel involved in offering autopsy play a very important role and need to understand the benefits and processes of autopsy compensation. The major recommendation of this study is the training of personnel involved in offering autopsies to improve their communication skills and, understanding of the purpose and provisions of the ODMWA in order to promote autopsy uptake. / MT2017

Thesis (M.S.V.S.)--Massachusetts Institute of Technology, Dept. of Architecture, 1979. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND ROTCH. Videorecording in Rotch Visual Collections only. / by Shelley Lake. / M.S.V.S.

No description available.

Background: In the South African mining sector, cardiorespiratory autopsy examinations are conducted on deceased mineworkers to determine eligibility for compensation, irrespective of the cause of death. An autopsy examination is a right under the Occupational Diseases in Mines and Works Act, Act No. 78 of 1973 (ODMWA) except for mineworkers who received maximum compensation awarded for occupational lung diseases in second degree category during life. Compensation awards to the deceased mineworkers’ dependants can contribute to short- or medium-term poverty alleviation. In spite of the possible benefits, ODMWA autopsy utilisation by black mineworkers’ families is incomplete. Increased utilisation has the potential to assist in alleviating poverty. It is imperative to understand what contributes to autopsy utilisation or non-utilisation by black mineworkers, as this will guide public health policy intervention regarding ODMWA autopsy. Aims: The study set out to quantify the monetary contribution of ODMWA autopsy to mineworkers’ families, to estimate the loss of potential financial benefits due to autopsy non-utilisation; define the characteristics of those deceased mineworkers who did not use the autopsy service (to tentatively formulate reasons for not using autopsy); and to describe the barriers and enablers that contribute to ODMWA autopsy utilisation. Methods: The study was primarily qualitative; however quantitave investigations were undertaken using data from the National Institute for Occupational Health (NIOH), the Medical Bureau for Occupational Diseases (MBOD), and The Employment Bureau of Africa (TEBA). First, a descriptive study was undertaken to determine autopsy utilisation and establish the amount of compensation paid to dependants of deceased mineworkers over a ten-year period (2001- 2010) following autopsy examination; and to estimate the loss of financial benefits from autopsy non-utilisation. Also, the characteristics of those deceased ii mineworkers recorded by MBOD in 2001-2008 but who did not undergo autopsy examination were investigated using data in the subjects’ MBOD files. The characteristics investigated included previous submissions to MBOD or date of last submission; age of the deceased at death and place and date of death; labour history, the last date of work; cause of death and medical information. Second, in-depth interviews on perceptions of autopsy were carried out with participants. The key participants were former and in-service mineworkers, relatives and widows of deceased mineworkers and others (traditional healers, occupational health practitioners, community and organised labour leaders). These categories of participants were selected because of the particular perspective that they were likely to bring to the study. A semistructured questionnaire was used to guide the in-depth interviews. All interview data were transcribed into English. Key ideas generated were noted at the end of each interview. The notes were examined for overall depth and meaning. The notes for each respondent were uploaded in their groups onto 2003 MAXqda PC (2003) and coded into segments and grouped into categories. Emerging themes were identified using a conceptual framework and meaning interpreted. Results Autopsy utilisation: 71% of in-service mineworkers over the 10-year period were employed by mines affiliated with TEBA. Using the annual TEBA-reported deaths as the denominator and ODMWA autopsies as the numerator, it was estimated that during 2000-2010, autopsy utilisation by black miners who died in service ranged from 30-46%. It is argued that these figures were an over-estimate as they did not include former mineworkers or in-service mineworkers working for TEBA non-affiliated mines. The results suggest that the majority of autopsy examinations were of TEBA registered mineworkers. Following autopsy examinations over ten years, 311 deceased mineworkers not compensated in life were certified by MBOD to suffer occupational lung disease in the first degree and 2 426 in the second degree categories respectively following autopsy examination. Autopsy non-utilisation: From the TEBA recorded deaths and ODMWA autopsies performed by NIOH, there were 15 064 mineworkers who did not undergo autopsy examination during 2001-2012. It is estimated that 355 mineworkers would have been certified in the first degree category, and 2 769 in the second degree category had they come to autopsy. Contribution of ODMWA autopsy to compensation: Each family of the 311 deceased mineworkers certified with occupational lung disease in the first degree category would have received an average lump sum payment of $8 750. Similarly each family of the 2 426 mineworkers certified with occupational lung disease in the second degree category would have received an average lump sum payment of $12 907 Additionally, each family of the 59 cases upgraded from first to second degree category following autopsy examination would have received an average lump sum payment of $5 250. If assumptions were made that Stewart (2007)’s findings on financial spending on basic needs such as food person per family of seven members were similar to that of mineworkers compensated following ODMWA autopsy; households that received $8 750 in compensation would have had sufficient money to buy food for 29-47 months. Similarly those who received $12 907.79 and $5 250 could have managed to buy food for 49-80 and 20-33 months respectively. Characteristics of deceased mineworkers: Tentative reasons of no autopsy examination were dying at home, recent MBOD submission, age of the mineworker, previous and current TB infection certified by MBOD. Ninety six percent of them died at home and four percent died in district public hospitals. Sixty four percent were recently submitted to MBOD and of these mineworkers, 70% had pulmonary tuberculosis. The majority were fairly young i.e. 52% died before the age of 50 years and a further 12% before the age of 60 years. Barriers and enablers of ODMWA autopsy: Barriers and enablers of ODMWA autopsy consent and utilisation were found to be diverse, complex, and multifaceted such that a multipronged intervention strategy would be required to increase utilisation. The barriers and enablers of ODMWA autopsy were in individual/family; socio-cultural and institutional perspectives. The respondents could rationalise their acceptance or rejection of autopsy within their own individual cultural or religious belief system and these varied according to the individual’s experiences, family beliefs and societal practices. Enablers regarding consent to ODMWA autopsy were dissociation of the body from the soul, matrilineal relations to the deceased mineworker, communication with ancestors while the mineworker was healthy, deaths described as bad by participants. Key to autopsy consent facilitation was the mineworkers communicating their acceptance of ODMWA autopsy examination to their families and by communicating this intention to their ancestors -where this was consistent with their belief system. Foremost among the barriers to ODMWA autopsy utilisation was the requirement of formal consent within a biomedical framework, which clashed with certain socio-cultural beliefs. These cultural barriers were associated with patriarchal relations to the deceased mineworkers, beliefs that being buried without cardiorespiratory organs was synonymous to burying an empty box, health workers’ attitudes, mistrust, commodification of body parts, community traditional norms and practices and unequal power relations on decision making which led to exclusion of potential beneficiaries (widows and children). Conclusion: The study documented that a large number of in-service black mineworkers did not utilise ODMWA autopsy in spite of the potential financial benefits demonstrated. Additionally, former mineworkers who did not utilise autopsy were under fifty years of age, died of PTB within twelve months of leaving mines at their homes. The study found cultural beliefs that were barriers to autopsy utilisation, but also those that may enable these barriers to be overcome. The finding that the cultural beliefs were not static or uniform suggested that increasing autopsy consent would require comprehensive communication and awareness intervention strategies aimed at individual, family and community levels. The intervention strategies should not be once-off, but long-term and should address the cultural beliefs. The enablers of autopsy utilisation could be used in the awareness messages. Further research is required to investigate the attitude of health care providers (nurses, traditional healers, medical practitioners etc) to ODMWA autopsy utilisation, investigate the process of decentralising the autopsy examination and the impact this will have on appeals, standardisation and resources; and to examine the legal framework which would make ODMWA autopsy permissible without the current consent requirements, possibly under similar conditions to forensic medicine. Revising consent requirements is important to alleviate the conflict felt by spouses, mineworkers and relatives who have to satisfy cultural imperatives which are at odds with giving consent to permanent removal of cardiorespiratory organs. ODMWA should remain in place until exposures resulting in occupational lung diseases have been reduced to non-disease-causing levels or no new occupational diseases are found at autopsy. The enablers and barriers to ODMWA autopsy found in this study may be generalisable to similar socio-cultural environments outside South Africa.

Orientador: Pablo Agustin Vargas / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T04:22:01Z (GMT). No. of bitstreams: 1 Carvalho_MariannedeVasconcelos_D.pdf: 5637293 bytes, checksum: 2a8eb0432fb9178c3131d66c7baf68f0 (MD5) Previous issue date: 2013 / Resumo: A síndrome da imunodeficiência adquirida (AIDS) é causada pelo vírus da imunodeficiência humana (HIV). A infecção já acometeu mais de 60 milhões de pessoas em todo o mundo e 25 milhões de mortes. Apesar dos progressos que a comunidade internacional obteve, a AIDS ainda é uma epidemia global e constitui um dos principais problemas de saúde pública mundial. À luz dessa afirmação, este trabalho se fundamenta na abordagem das manifestações dos pacientes com AIDS, dando foco a dois tópicos relativamente distintos, porém de bastante relevância. O primeiro deles se baseia na descrição inédita da diversidade morfológica do sarcoma de Kaposi oral (SKO), o qual é umas das manifestações mais comuns associadas ao HIV, com frequente envolvimento oral. Realizamos um estudo retrospectivo de 135 casos de SKO presentes nos arquivos da Universidade de Pretoria, África do Sul. Após a revisão histológica, o SKO foi classificado em 7 categorias com base no padrão predominante de crescimento, tais como: sólido, limfangioma-like, telangiectásico, desmoplásico, linfangiectatico, equimótico e anaplásico. O significado prognóstico dessas variantes ainda precisará ser determinado, e o reconhecimento da diversidade morfológica do SKO é essencial para evitar erros diagnósticos. Em relação ao segundo capítulo, analisamos 100 tireoides obtidas de autópsias de pacientes com AIDS do Departamento de Patologia da Faculdade de Medicina da Universidade de São Paulo. Os casos foram analisados sistematicamente, a fim de determinar a frequência e as principais patologias presentes nesta glândula. Micobacteriose foi à infecção mais frequente, seguida por citomegalovírus (CMV) e criptococose. Envolvimento da glândula tiróide ocorreu geralmente como uma parte da disseminação da doença. Os médicos devem ter atenção especial para a detecção de sinais precoces de doenças na tireoide, que podem ser confundidos com sintomas gerais de manifestações da AIDS / Abstract: The acquired immunodeficiency syndrome (AIDS) is caused by the human immunodeficiency virus (HIV). The infection has affected more than 60 million people around the world and over 25 million deaths. Despite the progress of the international community, AIDS is still a global epidemic and is a considerable public health problem worldwide. Due to this, this work is based on the approach of the manifestations of AIDS patients, focusing to two relatively distinct topics, but too much relevant. The first description is based on the unpublished morphological diversity oral Kaposi's sarcoma (OKS), which is one of the most common HIV manifestations, with frequent oral involvement. We performed a retrospective study of 135 cases of OKS retrieved from the archives of the University Of Pretoria, South Africa. After histological review, the OKSs were classified into 7 categories based on the predominant pattern of growth, such as solid, lymphangioma-like, telangiectatic, desmoplastic, lymphangiectatic, ecchymotic, and anaplastic. Although the prognostic significance of these variants is yet to be determined, the appreciation and recognition of such morphologic diversity remains essential in distinguishing these lesions from possible mimickers. Regarding the second chapter, we analyzed 100 thyroid obtained from autopsies of patients with AIDS, Department of Pathology, Faculty of Medicine, University of São Paulo. The cases were systematically analyzed in order to determine the frequency and the main pathological features of the gland. Mycobacteriosis infection was the most frequent, followed by cytomegalovirus (CMV) and cryptococcosis. Involvement of the thyroid gland usually occurred as a part of dissemination of the disease. Physicians should pay special attention to the early signs of thyroid disease, which can be misdiagnosed with symptoms of general manifestations of AIDS / Doutorado / Patologia / Doutora em Estomatopatologia

A method of trace element analysis using proton-induced X-ray emission (PIXE) techniques with energy dispersive X-ray detection methods is described. Data were processed using the computer program ANALEX. PIXE analysis methods were applied to the analysis of liver, spleen, aorta, kidney medulla, kidney cortex, abdominal fat, pancreas and hair from autopsies of Pima Indians. Tissues were freeze dried and low temperature ashed before analysis. Concentrations were tabulated for K, Ca, Ti, Mn, Fe, Co, Ni, Cu, Zn, Pb, Se, Br, Rb, Sr, Cd and Cs and examined for significant differences related to diabetes. Concentrations of Ca and Sr in aorta, Fe and Rb in spleen and Mn in liver had different patterns in diabetics than in nondiabetics. High Cs concentrations were also observed in the kidneys of two subjects who died of renal disorders. Analyses by atomic absorption and PIXE methods were compared. PIXE methods were also applied to elemental analysis of obsidian artifacts from Campeche, Mexico. Based on K, Ba, Mn, Fe, Rb, Sr and Zr concentrations, the artifacts were related to several Guatemalan sources.

The main purpose of this study was to assess the value of the autopsy in clinical medicine today. This has been achieved by analysing several variables. Clinical diagnostic accuracy was determined by assessing the concordance/discrepancy of clinical and autopsy diagnoses. In addition, several variables were assessed, namely whether or not the size of the hospital, type of ward, autopsy rate, age of the patient, and degree of confidence with which the clinical diagnosis was made had any bearing on the accuracy of the diagnosis. The impact of the newer diagnostic tests on clinical diagnosis was also assessed to confirm or refute the widely held opinion amongst clinicians that diagnostic advances have indeed reduced the need for autopsies. The attitudes of pathology registrars and consultants towards the autopsy were analysed, using a questionnaire proposed by Stubbs et al.

The aim of this study was to determine the extent to which the cause of death in sudden natural death in adults could be ascertained without autopsy, based on information provided in the police report, and to evaluate any degree of error between that and the officially certified cause of death. Two methods were carried out: 1. A questionnaire-based retrospective survey of sudden natural deaths distributed to practitioners. The predicted cause of death was compared with the actual cause of death as determined after autopsy. The difference between the two causes of death was classified into 'no difference', minor and major difference according to the classification scheme developed for this study. 2. A prospective study of adult sudden natural deaths referred by the procurators fiscal in Lothian and Borders to the department during 2009 and 2010. The police reports were reviewed and a cause of death was ascribed by the author. This cause was compared with the actual cause of death in the final autopsy report and any difference assessed according to the classification scheme. In the view of the retrospective study results, it is possible to determine the cause of death which is with no or minor difference to that determined by autopsy if, in addition to provide sufficient information regarding deceased’s medical history and circumstances of death, the participants are given the option to select which cases should undergo external examination only. The prospective study results indicate that in certain circumstances the cause of death could be ascribed correctly based on the available information prior to autopsy. Causes of death such as ischaemic heart disease, hypertensive heart disease and alcohol related death are more frequently ascribed correctly. However, ischaemic and hypertensive heart disease were over-predicted. Results indicate that there are criteria to select which cases might be subject to a "view and grant" procedure with no significant loss of accuracy. The implications of the study for the development of medico-legal services are considered with specific reference to Kuwait.

Photocopy of typescript. / Digitized by Kansas Correctional Industries

The tap-water treated by water treatment plants in southern Taiwan is coming from surface water of the rivers, subsurface stream and underground water of deep wells. The original raw water possesses were high level of hardness and ammonia- nitrogen solute due to affection by terrain, geology and human activities within water origin area. And considering the water quality from Kao-ping river origin is hard to control during in rain fall and dry season, we were to construction efficiency procedure of water treatment to obtain a high quality of drink water. There were high hardness and TDS from strata limestone of groundwater to increase treatment difficulty in southern Taiwan water treatment plant. Therefore, recommended that the influent water standards were limited hardness and silicate (SiO2) less than 300 mg/L and 15 mg/L, respectively. On the other hand, the metal substances Ca, Mg, Si and Al in influent water were 74.3 mg/L, 18.7 mg/L, 12.9 mg/L and 0.1 mg/L, respectively. Results show high inorganic substances that could increase the treatment loading. This project of the study, were make sure the problem of membrane clogging and fouling happened to the finest water treatment plants who use LPRO membrane system to remove the impurity in the influent water. Moreover, by accumulation of processes operation experience on site were according to water quality statistics data and membrane autopsy of single LPRO membrane by processes. In the same time, we prepared three single tube of RO membrane to experiment on site and collected data from before and after antifouling additive, that could find the membrane fouling and clogging results of the influent raw water. Obviously, the influent raw water quality into LPRO membrane is closely connected to the efficiency of treatment plant. The results show when the temperature decreased of influent raw water that could decrease the effluent volume from LPRO, because the water temperature affected by increase viscosity of raw water. The first part clogging substances of membrane were aluminum (Al), that could be use aluminate coagulant to make increase more aluminum. And the TOC value of the effluent were from 0.2 to 1.4 mg/L, that shows the effluent water was kept stably but UV254 value were have more than 75% efficiency. Results of organic analysis on LPRO effluent indicates the pretreatment process could leave annular structure organic. In other hand, when using EEFM to analysis the spectra sampling of organic of LPRO, there finding a lot low emission wavelength fluoresces of influent on EX/EM 230/340 and decrease the wavelength fluoresces value on EX/EM 280/330 and 240/340 by RO membrane system of LPRO. To be worth mentioning, when organism of sampling fluoresces value during high emission wavelength on EX/EM 240/400 nm was disappeared, that indicates RO membrane has good performance to separation organism of water. And results of elements analysis on RO membrane surface were using SEM and EDX have a lot aluminum and silicate on segment RO membrane module. Therefore, results show pretreatment process of coagulation and sedimentation could not treatment metal substances and organic efficiency, that was to effect directly cause to make the problems of membrane fouling and clogging.