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Abstract Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient’s values and target the best outcome possible given the patient’s desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.

Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The Japanese Society for Respiratory Care and Rehabilitation, Japanese Association on Sarcopenia and Frailty, Japanese Society of Respiratory Physical Therapy, and Japanese Association of Rehabilitation Nutrition proposed the definition and diagnosis of respiratory sarcopenia using low respiratory muscle strength and appendicular skeletal muscle mass (ASM; ASM/height2) instead of respiratory muscle mass; however, these parameters have not been validated. This study aimed to confirm the validity of the respiratory sarcopenia definition proposed by these four professional organizations.Participants of our cohort study in 2015 of 468 community‐dwelling older people who were evaluated for sarcopenia and underwent spirometry were included in this analysis. We determined two respiratory sarcopenia models based on low skeletal muscle mass and respiratory muscle strength. Low skeletal muscle mass was defined by low ASM/height2, and low respiratory muscle strength was defined by peak expiratory flow rate (PEFR) or percentage of predicted PEFR (%PEFR). Survival status was assessed 5 years after baseline assessment (in 2020). To evaluate the validity of the cut‐off values for PEFR and %PEFR, we determined different respiratory sarcopenia models by sequentially varying the cut‐off values for each parameter, including ASM/height2, from high to low. We subsequently calculated the hazard ratio (HR) for mortality for each respiratory sarcopenia model using the Cox proportional hazards model. Additionally, we plotted the HR for each combination of cut‐off values for ASM/height2 and PEFR or %PEFR on a three‐dimensional chart to observe the relationship between the different cut‐off values and HR.A total of 31 people died during the 5‐year observation period. With ASM/height2 cut‐off values of approximately 7.0 kg/m2 for men and 5.7 kg/m2 for women and %PEFR cut‐off values of 66–75%, respiratory sarcopenia was associated with mortality risk (HR, 2.36–3.27, point estimation range).The definition of respiratory sarcopenia by the four professional organizations is related to future health outcomes, and this definition is valid. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

The following is a discussion of papers by Kozlowski and Lentz that explore the presence of mortality in the analytic relationship. The author reflects on challenges to the dyad, the vulnerability of the analyst, and how the individual and analytic pair may confront their existential reality separately or together. The author includes the idea of "death origin stories" to emphasize that mortality has a presence throughout the life of the individual; she suggests how psychoanalytic theory and technique may be enhanced by including an explanation of the earliest penetration of death into consciousness and whether this lens may enhance our sensitivity to mortality and our ability to manage loss and endings. [ABSTRACT FROM AUTHOR]

This document is a response to a letter concerning a paper titled "Geriatric distal femoral fractures: post-operative complications and nine-year mortality—a retrospective analysis of two tertiary trauma centres" published in International Orthopaedics. The authors appreciate the engagement with their study and clarify key aspects of their work. They highlight the orthogeriatric program's success in providing high-quality care for elderly patients with fractures and emphasize the importance of physical therapy and rehabilitation in promoting functional recovery. The authors also address the gender distribution in their study and suggest further research to explore gender-related outcomes. They express their commitment to advancing care for elderly patients with fractures and improving patient outcomes through orthogeriatric co-management. [Extracted from the article]

People who believe they have greater control over health and longevity are typically more likely to invest in their long-term health. Investigating individual differences in perceived control over risk and exploring different determinants of health effort may help to tailor health promotion programs to more effectively encourage healthy behaviors. From a sample of 1500 adults, we measured perceived control over 20 causes of death, overall perceived uncontrollable mortality risk (PUMR), state-level optimism, self-reported health effort, and the accuracy of estimations of avoidable deaths. We found individual differences in perceptions of control over specific causes of death based on age, gender, and income. PUMR was predicted by socioeconomic variables expected to influence exposure to risk and resource availability. Higher levels of PUMR, not perceptions of control over specific causes of death, predicted self-reported health effort. The strength of relationship between PUMR and lower health effort was not moderated by state-level optimism. Age and education both positively predicted greater accuracy in assessing the prevalence of avoidable deaths. We suggest that PUMR may capture people's "general sense" of mortality risk, influenced by both exposure to hazards and the availability of resources to avoid threats. Conversely, perceived control over specific risks may involve more deliberate, considered appraisals of risk. This general sense of risk is thought to play a more notable role in determining health behaviors than specific assessments of control over risk. Further study is needed to investigate the degree to which PUMR accurately reflects objective measures of individual risk., (© 2023 The Authors. Risk Analysis published by Wiley Periodicals LLC on behalf of Society for Risk Analysis.)

Background and Aim: Due to its strong economy and a well-developed healthcare system, Germany is well positioned to achieve above-average reductions in mortality. Nevertheless, in terms of life expectancy, Germany is increasingly falling behind Western Europe. We compare mortality trends in Germany with other Western European countries, covering the period from 1960 to 2019. The focus is on long-term trends in Germany's ranking in international mortality trends. In addition, we conduct a detailed mortality analysis by age., Methods: Our analysis is mostly based on mortality data from the Human Mortality Database (HMD). Cause-specific mortality data originate from the database of the World Health Organization (WHO). For the international comparison of mortality trends, we use conventional mortality indicators (age-standardized mortality rate, period life expectancy)., Results: Compared to other Western European countries, Germany has higher mortality in the middle and older age groups. Germany's life expectancy gap compared to Western Europe has grown during the past 20 years. In 2000, Germany was 0.73 years behind for men and 0.74 years behind for women. By 2019, these figures had risen to 1.43 and 1.34 years, respectively. This is mainly due to mortality from non-communicable diseases., Conclusion: For Germany to catch up with other Western European countries, a stronger focus on further reducing mortality at ages 50+ is crucial. This also requires further research to understand the factors behind Germany's disadvantageous position., (© 2024. The Author(s).)

Objectives: There is a lack of prognostic information to guide the prediction of short-term all-cause mortality in patients with end-stage renal disease (ESRD). The aim was to review the risk factors that influenced the risk of short-term all-cause mortality in patients with ESRD. Methods: MEDLINE, Embase, PubMed, CINAHL, the Cochrane Library and Web of Science databases were searched for articles published between 2000 and 2020. Articles describing risk factors predicting short-term mortality (≤ 3 years) in patients with ESRD were included. Four reviewers independently performed title, abstract, full text screening and data extraction. Assessment of risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool checklist. Results: 20,840 articles were identified and 113 papers were included for this review. Of the 113 papers, 6.2% included only peritoneal dialysis (PD) patients, 67.3% included only hemodialysis (HD) patients, 20.4% included both PD and HD patients, with the remaining papers featuring patients on conservative management or awaiting renal transplant. Risk factors were categorised into 13 domains: 1)demographics/ lifestyle, 2) comorbidities 3)intradialytic blood pressure, 4)biomarkers, 5)cardiovascular measurements, 6)frailty status, 7)medications, 8)treatment related indicators, 9)renal related parameters, 10)health status, 11)cause of ESRD, 12)access to healthcare care/ information and, 13)proxy measures for poor health. C-reactive protein(CRP), age, and functional status were observed to have higher percentage of instances of being significantly associated with all-cause mortality. Conclusion: Commonly examined risk factors observed from this review may be used to build a general prognostic model for patients with ESRD, with specific treatment related risk factors added on to enhance the accuracy of the models. [ABSTRACT FROM AUTHOR]

In recent years, demographers have parsed variation in survivorship into two distinct components: the shape and the pace of ageing. The pace of ageing is defined by measures of longevity such as mean life expectancy or maximum longevity, whereas measures of the shape of ageing attempt to classify different shapes of the survivorship curve. We recently published a paper pointing out that a commonly used discretization of a shape measure, Keyfitz' entropy, does not correctly classify survivorship curves into negatively and positively senescing curves (de Vries et al., 2023). In that paper, we also suggested an alternative, accurate discrete‐time version of Keyfitz' entropy. de Vries et al. (2023) ended with two open questions, both of which have been answered by Giaimo (2024) now: (1) Can a discrete‐time entropy measure of survivorship be generalized beyond age‐based population models? Giaimo (2024) introduce a new formula that achieves this. (2) Will a discretization of Keyfitz' derivation of his measure as the elasticity of lifespan to a uniform change in mortality lead to the same formula as a discretization of Keyfitz' result? Giaimo (2024) answers: no.Here, we briefly discuss the implications of the results obtained by Giaimo (2024), and the implementation of his new formula into the Rpackage Rage, which is widely used for comparative demographic studies.We showcase the strength of the new method by reanalysing a comparison of Keyfitz' entropy to another shape measure. We find that the comparison is significantly altered by using Giaimo's new Keyfitz' formula.This example strengthens Giaimo's (2004) words of warning in approaching discretizations with attentiveness. [ABSTRACT FROM AUTHOR]

This paper compares mortality transition in China and India in the period 1950-2021, highlighting similarities and differences. Mortality transition has been inconsistent in both countries, but differences remain. In China, the transition has been spread evenly across the age range, while in India, it has primarily been confined to younger ages, being markedly slow in ages 35-90. This difference in the older ages appears to explain the main difference between the respective mortality transition in the two countries. To address its ongoing mortality transition, the paper concludes, India needs to reinvigorate its health-care delivery system to meet the health care needs of the old people. The paper also emphasises using geometric mean of the age-specific probabilities of death as an appropriate measure to analyse mortality transition. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is a global pandemic, however, estimating its burden is a complex process. As a result, many countries rely on global estimates to infer burden within their own setting. With a growing number of recent publications quantifying AMR burden in Australia, and an expansion of surveillance programs, enumerating AMR mortality for Australia is feasible. We aimed to leverage existing published data to assess methodological factors contributing to the considerable variation in AMR-related mortality and provide two reliable estimates of AMR mortality in Australia. This is a necessary step towards generating meaningful measures of AMR burden in Australia. What is known about the topic? Antimicrobial resistance is a significant global health threat, but estimating the burden of disease is complicated by data challenges. What does this paper add? This paper highlights progress in estimating the number of people dying from antimicrobial resistance in Australia and highlights the importance of rigorous antimicrobial resistance mortality estimates in Australia to assess burden of disease. What are the implications for practitioners? Practitioners should use only rigorous estimates of burden of disease to inform actions on reducing the threat of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

In this paper, we introduce an interesting model-independent lower bound for the price of the Swiss Re Mortality Bond 2003 which was the first catastrophic mortality bond to be launched in the insurance market. This bond captures the behaviour of a well-defined mortality index to generate payoffs for bondholders. Pricing of catastrophic mortality bonds is an interesting problem and no closed form solution can be found in the existing literature. In our approach, we express the pay-off of such a bond in terms of the pay-off of an Asian put option in a manner similar to [2] and present an efficient modelindependent lower bound by making some very general assumptions. We carry out Monte Carlo simulations to estimate the bond price and illustrate the quality of the bound for a variety of models. [ABSTRACT FROM AUTHOR]

Aim: To determine the effects of collaborative health management of congestive heart failure through the rigorous evaluation and extraction of evidence. Background: Over the past two decades, cardiovascular disease has been the leading cause of death worldwide. Multidisciplinary team intervention for congestive heart failure has increased with population ageing and congestive heart failure incidence rate as well as cost of care. However, the effectiveness and feasibility of collaborative health management need to be explored. Design: Systematic review and meta‐analysis. Methods: We conducted systematic literature searches in the Cochrane Library, PubMed, CINAHL and Medline for articles published between 2002 and 2022. After screening based on the inclusion and exclusion criteria, 13 articles were included in a rigorous review and evidence extraction process, evaluated methodological quality using the Jadad Quality Scale. Statistical heterogeneity was evaluated using Review Manager (RevMan Version 5.4) for the meta‐analysis. Results: In this study, a systematic review and meta‐analysis were performed on 13 studies regarding the collaborative health management of people with congestive heart failure. The common result is that the collaborative health management model enables the enhancement of self‐care and monitoring abilities, the strengthening of cardiac function, the alleviation of physiological and psychological symptoms and the improvement of readmission rates, mortality rate and quality of life. Conclusion: The congestive heart failure collaborative health management model could decrease the hospitalization rate related to congestive heart failure, all‐cause mortality rate, and all‐cause hospitalization rate, and improve the quality of life. Implications for Practice: The collaborative health management model could effectively coordinate interdisciplinary team cooperation and provide information, which decreases hospitalization and mortality risks and improves their quality of life. No patient or Public Contribution: Our paper is a systematic review and meta‐analysis, and such details do not apply to our work. What does this paper contribute to the wider global clinical community?: The Collaborative Health Management Model provides in‐depth insights, aiding in the design tailored to the specific circumstances of each country. Highlighting its critical role in the context of a global shortage of nursing staff, the model emphasizes the integration of multidisciplinary professional roles and the strengthening of collaboration as essential elements in addressing challenges posed by workforce shortages.Implementation of the Collaborative Health Management Model not only enhances patient care outcomes but also relieves pressure on healthcare systems, lowers medical costs, and addresses challenges arising from the shortage of nursing staff. Consequently, this model not only contributes to individual patient care improvement but also holds broader implications for enhancing the efficiency and sustainability of global healthcare systems. Trial and Protocol Registration: The detailed study protocol can be found on the PROSPERO website. [ABSTRACT FROM AUTHOR]

The early detection of colorectal polyps is crucial for the reduction of mortality rates. However, manually identifying polyps is time-consuming and expensive, increasing the risk of missing them. Our paper aims to address this issue by presenting an automated segmentation approach for colorectal polyps. This paper proposes a method that combines a skip connection with hybrid attention guidance (AG) using attention guidance (AG) and residual path frameworks to identify salient features. Furthermore, we augment test samples using original, horizontal flip, and vertical flip transformations to enhance model robustness through Test Time Augmentation (TTA). The model was trained with Kvasir-seg samples and evaluated on Kvasir-seg and CVC-ClinicDB datasets to gauge generalizability. A significant accuracy (0.9546), a Dice Similarity Coefficient (DSC) of 0.8557, a Cross-section over Union (IoU) of 0.8824, a Recall (0.8221), a Precision (0.8922), an area under Receiver Operating Characteristics (ROC-AUC) of 0.9454, and an area under Precision-Recall (AUC-PR) of 0.8717 were achieved without TTA. Through TTA integration, accuracy (0.9993), DSC (0.8663), IoU (0.8277), Recall (0.8060), Precision (0.9364), and ROC-AUC (0.9587) have been improved. A comparison of our framework with state-of-the-art models demonstrated its effectiveness and segmentation capabilities. Additionally, the proposed model contains only 0.47 million parameters and a weight size of 6.71 MB, illustrating its potential for clinical diagnostics. A computer-aided diagnosis (CAD) system improves patient outcomes by detecting colorectal polyps early and improving segmentation accuracy. [ABSTRACT FROM AUTHOR]

Deep learning has recently demonstrated the ability to predict long-term patient risk and its stratification when trained on imaging data such as chest radiographs. However, existing methods formulate estimating patient risk as a binary classification, typically ignoring or limiting the use of temporal information, and not accounting for the loss of patient follow-up, which reduces the fidelity of estimation and limits the prediction to a certain time horizon. In this paper, we demonstrate that deep survival and time-to-event prediction models can outperform binary classifiers at predicting mortality and risk of adverse health events. In our study, deep survival models were trained to predict risk scores from chest radiographs and patient demographic information in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial (25,433 patient data points used in this paper) for 2-, 5-, and 10-year time horizons. Binary classification models that predict mortality at these time horizons were built as baselines. Compared to the considered alternative, deep survival models improve the Brier score (5-year: 0.0455 [95% CI, 0.0427–0.0482] vs. 0.0555 [95% CI, (0.0535–0.0575)], p < 0.05) and expected calibration error (ECE) (5-year: 0.0110 [95% CI, 0.0080–0.0141] vs. 0.0747 [95% CI, 0.0718–0.0776], p < 0.05) for those fixed time horizons and are able to generate predictions for any time horizon, without the need to retrain the models. Our study suggests that deep survival analysis tools can outperform binary classification in terms of both discriminative performance and calibration, offering a potentially plausible solution for forecasting risk in clinical practice. [ABSTRACT FROM AUTHOR]

This paper studies continuing optimal lockdowns (can also be interpreted as quarantines or self-isolation) in the long run if a disease (Covid-19) is endemic and immunity can fail, that is, the disease has SIRS dynamics. We model how disease related mortality affects the optimal choices in a dynamic general equilibrium neoclassical growth framework. An extended welfare function that incorporates loss from mortality is used. In a disease endemic steady state, without this welfare loss even if there is continuing mortality, it is not optimal to impose even a partial lockdown. We characterize how the optimal restriction and equilibrium outcomes vary with the effectiveness of the lockdown, the productivity of working from home, the rate of mortality from the disease, and failure of immunity. We provide the sufficiency conditions for economic models with SIRS dynamics with disease related mortality–a class of models which are non-convex and have endogenous discounting so that no existing results are applicable. [ABSTRACT FROM AUTHOR]

Tricuspid valve repair (TVR) combined with mitral valve surgery (MVS) has been a controversial issue. It is not clear whether the combined surgery has any influence on the occurrence of postoperative complications. The aim of this study was to compare the occurrence of complications including wound infection, wound bleeding, and mortality after MVS combined with or without TVR. By meta‐analysis, a total of 1576 papers were collected from 3 databases, and 7 of them were included. We provided the necessary data of 7 included studies such as the authors, publication date, country, surgical approach and case number, patient age, and so on. Statistical analysis was carried out with RevMan 5.3 software. We found that patients with heart failure accepting MVS combined with or without TVR, performed no statistically significant difference in postoperative wound infection (OR: 0.88; 95% CI: 0.29, 2.62; P = 0.81), wound bleeding (OR: 0.74; 95% CI: 0.3, 1.48; P = 0.39), and mortality (OR: 1.05; 95% CI: 0.42, 2.61; P = 0.92). In conclusion, current evidence indicated that the combined surgery had no additional risk of postoperative complications, and might be an effective alternative surgical approach to mitral valve diseases accompany with tricuspid regurgitation. However, for the limited case size, it was required to support the findings with a large number of cases in further studies. [ABSTRACT FROM AUTHOR]

Due to concerns about the welfare of fast-growing (FG) strains of broiler chicken, animal welfare organisations have advocated the use of certain slower-growing (SG) strains that meet key welfare targets under test conditions. However, a widespread transition to SG strains could negatively affect sustainability because these birds tend to have higher feed conversion ratios and longer production cycles. It is important therefore to review the extent and limits of SG welfare improvements under test conditions and on commercial farms, to support the best policy decisions. Following a systematic literature search, 63 source papers were identified. Most reported comparative welfare outcomes for at least one SG strain with at least one FG counterpart, whilst a minority examined the suitability of various SG strains for niche production. The literature review considered different types of study design and accounted for confounding factors such rearing environment and diet. Additionally, a quantitative analysis of effect size for mortality, gait score and contact dermatitis was conducted across studies that had compared birds under similar rearing conditions and that had used SG strains with an average daily growth rate of at least 40g/day. Modern, commercial SG strains performed better on most relevant welfare traits than FG strains. This was the case even when the 'fairest' comparisons were made at equivalent bodyweights (when SG birds were older), under matched-environmental conditions, experimentally or on farm. The quantitative analysis found that FG strains had a higher estimated incidence rate ratio for mortality (risk of death over a given period of time) of between 1.69 and 2.16, contact dermatitis affecting 15-25% more birds, and a mean gait score 0.65 points higher than SG strains. FG strains were also less active but other differences in behaviour were inconsistent with some behaviours (e.g. dustbathing) often absent altogether. Growth rate was generally, but not always, predictive of welfare problems. Alternative strategies, such as the slaughter of birds prior to the onset of any welfare decline, could be evaluated in future in terms of welfare improvement and efficiency of production. [ABSTRACT FROM AUTHOR]

Snakebite is a serious injury and a common reason for the increasing death rate. Thus, it should be treated and assessed as highly prior, even in cases that seem well. The paper presents a retrospective investigation of snakebites in Iraq from 2019 to 2021 conveyed by the General Administration of Statistics and Information, Ministry of Health, Republic of Iraq. After obtaining the institutional committee's approval, the authors performed the extraction, analysis, and reporting of the data. A total number of 802 patients were informed throughout three years, with the highest percentage in males (63%). The maximum rate of snake envenomation (P < 0.05) was documented in (41.64%). The highest percentage of anti-venom injections administered in 2021 was 57% (n = 1118). Snakebite cases were mainly reported during June and July in al Yarmouk Hospital, with a total of 17.36% (n = 50) and 17.46% (n = 52), respectively. In Murjan Hospital, the months were September and August with a total of 50% (n = 8) and 40.35% (n = 7), respectively. In Baqubah Hospital, the months were May and August, with a total of 17.3% (n = 52) and 16.8% (n = 50), respectively. Finally, in the Al Hussein Hospital, the months were July and September, with a total of 23.5% (n = 43) and 22.2% (n = 39), respectively. Only 10 cases out of 802 died. The incidence of snakebites showed an increasing trend during the study period, and the incidence mostly occurred in July, August, and September. [ABSTRACT FROM AUTHOR]

The concept of CBD mortality indexes was proposed in 2014. While it has been shown that the use of CBD mortality indexes can effectively reduce longevity risk exposures in idealized settings, the risk mitigation potential of such indexes in a more realistic environment, whereby, for example, population basis risk exists, is yet to be investigated. This research gap is addressed in this paper through the development of a generalized CBD model with stochastic socioeconomic differentials in mortality improvements. The proposed model incorporates possible co-integration effects between mortality dynamics of socioeconomic subgroups and the general population, and features a form of coherence that is less restrictive than the typically assumed full coherence. This paper is concluded with various numerical experiments that are conducted to demonstrate the possible bias in hedge effectiveness that may be resulted if the key features of the proposed model are altered. [ABSTRACT FROM AUTHOR]

Soluble guanylate cyclase (sGC) modulation has been scrutinized in several disease states including heart failure (HF). Recently, it was shown that an sGC modulator improved HF-related hospitalization significantly, though, there was no benefit related to mortality. Herein, a comprehensive meta-analysis of randomized controlled trials (RCTs) for sGC modulation in HF patients was provided in agreement with the PRISMA statement. A total of 10 RCTs yielding 12 papers were included. There were 7526 patients with heart failure of each phenotype, 4253 in the sGC modulator group and 3273 in the placebo group. Use of sGC modulators in HF patients yielded no significant difference in the risk of all-cause mortality compared to placebo (RR = 0.97, 95% CI 0.88–1.08, p = 0.62). The use of sGC modulators was associated with a trend toward a considerable but non-significant increase in the incidence of SAEs (RR = 1.10, 95% CI 0.99–1.22, p = 0.07), as well as an increased incidence of hypotension and anemia. There was an overall neutral effect of sGC modulation on NT-proBNP levels, 6MWD and mortality, at a cost of slight increase in hypotension and anemia. Of note, the improvement in EQ-5D-based quality of life was significant. Hence, the benefit seems to be driven by distinctive domains of quality of life. [ABSTRACT FROM AUTHOR]

The paper investigates whether exposure to a famine in the Russian Tsarist Province of Livland in 1844-1846 in early life negatively affected survival at later ages, using individual data from two rural parishes. We follow 18 birth cohorts born between 1834-1852 until age 75 and differentiate between timing and length of exposures. We find that relative to individuals born in pre- or post- crisis years, there were no significant differences in survival from age 21-75. Cohorts with longer exposure to famine conditions had increased mortality only in short term, up to age 20. Males were more vulnerable in younger ages than females. The negative effect of adverse early life exposure on survival in later life was constrained to lower social group - the landless, but for the better-off groups the effect was constrained to younger ages. The paper highlights the importance of accounting for sex and socio-economic differences in studies exploring the effects of early life conditions on later-life survival., Competing Interests: Conflict of Interest The authors report there are no competing interests to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This study examines the impact of austerity measures on mortality rates across Italian regions from 2003 to 2018. Since 2007, regions experiencing substantial healthcare financial deficits have been required to implement recovery plans (RPs). We use a recent difference-in-differences staggered matching estimator to assess the effects of this austerity policy on municipal-level monthly mortality rates. This allows us to evaluate the policy's spatial heterogeneity across treated municipalities, accounting for their distance from the nearest hospital. The analysis reveals a significant negative impact of austerity measures on health, particularly in peripheral areas and among vulnerable populations. Mortality rates are higher in regions under RPs, with this effect escalating with increasing distance from hospitals. The policy's impact is also more pronounced among vulnerable populations, with differences observed between genders and across seasons., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

The extent to which populations will successfully adapt to continued warming temperatures will be a crucial factor in determining future health burdens. Previous health impact assessments of future temperature-related mortality burdens mostly disregard adaptation or make simplistic assumptions. We apply a novel evidence-based approach to model adaptation that takes into account the fact that adaptation potential is likely to vary at different temperatures. Temporal changes in age-specific mortality risk associated with low and high temperatures were characterised for Scotland between 1974 and 2018 using temperature-specific RR ratios to reflect past changes in adaptive capacity. Three scenarios of future adaption were constructed consistent with the SSPs. These adaptation projections were combined with climate and population projections to estimate the mortality burdens attributable to high (above the 90th percentile of the historical temperature distribution) and low (below the 10th percentile) temperatures up to 2080 under five RCP-SSP scenarios. A decomposition analysis was conducted to attribute the change in the mortality burden into adaptation, climate and population. In 1980-2000, the heat burden (21 deaths/year) was smaller than the colder burden (312 deaths/year). In the 2060-2080 period, the heat burden was projected to be the highest under RCP8.5-SSP5 (1285 deaths/year), and the cold burden was the highest under RCP4.5-SSP4 (320 deaths/year). The net burden was lowest under RCP2.6-SSP1 and highest under RCP8.5-SSP5. Improvements in adaptation was the largest factor reducing the cold burden under RCP2.6-SSP1 whilst temperature increase was the biggest factor contributing to the high heat burdens under RCP8.5-SSP5. Ambient heat will become a more important health determinant than cold in Scotland under all climate change and socio-economic scenarios. Adaptive capacity will not fully counter projected increases in heat deaths, underscoring the need for more ambitious climate mitigation measures for Scotland and elsewhere., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objectives: Belgium experienced multiple COVID-19 waves that hit various groups in the population, which changed the mortality pattern compared to periods before the pandemic. In this study, we investigated the geographical excess mortality trend in Belgium during the first year of the COVID-19 pandemic., Methods: We retrieved the number of deaths and population data in 2020 based on gender, age, and municipality of residence, and we made a comparison with the mortality data in 2017-2019 using a spatially discrete model., Results: Excess mortality was significantly associated with age, gender, and COVID-19 incidence, with larger effects in the second half of 2020. Most municipalities had higher risks of mortality with a number of exceptions in the northeastern part of Belgium. Some discrepancies in excess mortality were observed between the north and south regions., Conclusions: This study offers useful insight into excess mortality and will aid local and regional authorities in monitoring mortality trends., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: The aim of this study was to investigate the incidence, predictors, and outcomes of delirium in intensive care units. Background: Delirium is a common complication in intensive care units. In developing countries, it can be misdiagnosed or unrecognised. Design: Prospective cohort study reported according to the strengthening the reporting of observational studies in epidemiology criteria. Methods: We included patients who were conscious, >18 years old, and admitted to the intensive care units for at least 8 h between December 2019 and February 2020. Patients with a Richmond score of −4 or −5, mental disability, receptive aphasia and/or visual or auditory impairment were excluded from the study. Delirium was assessed using the Confusion Assessment Method for the ICU (CAM‐ICU), whereas the functional outcome was assessed by the Katz Activity of Daily Living Index. Results: This study included 111 patients with a delirium incidence of 31.5%. The severity of illness was the only significant predictor of delirium. Patients with delirium had longer intensive care unit and in‐hospital stays in contrast to those without delirium. Delirium was associated with in‐hospital and 4‐month mortality but not the activities of daily living. Conclusions: Delirium is associated with increased length of stay and mortality. Further investigation to determine whether delirium management can improve outcomes is warranted. Summary statement: What is already known about this topic? Delirium is a common complication in the intensive care unit and can affect patients' outcomes.The incidence and the effect of delirium on patients' outcomes in low‐resource countries remain largely unexplored. Delirium is potentially underdiagnosed and commonly undetected in these countries. What this paper adds? Delirium is associated with a longer duration of stay in the hospital and the intensive care unit as well as mortality in the hospital and 4 months after discharge.Delirium may not affect long‐term functional outcomes after discharge.The severity of illness is an independent predictor of delirium. The implications of this paper In low‐resource countries, the increased length of stay can add a significant burden on healthcare systems.Proper management of delirium will potentially maximise resource utilisation.Delirium affects mortality and length of stay, thus investigating the effect of the current management protocols on these outcomes is warranted. [ABSTRACT FROM AUTHOR]

An empirical question that has motivated demographers is whether there is convergence or divergence in mortality/longevity around the world. The epidemiological transition is the starting point for studying a global process of mortality convergence. This manuscript aims to provide an update on the concept of mortality convergence/divergence. We perform a comprehensive examination of nine different mortality indicators from a global perspective using clustering methods in the period 1990-2030. In addition, we include analyses of projections to provide insights into prospective trajectories of convergence clubs, a dimension unexplored in previous work. The results indicate that mortality convergence clubs of 194 countries by sex resemble the configuration of continents. These five clubs show a common steady upward trend in longevity indicators, accompanied by a progressive reduction in disparities between sexes and between groups of countries. Furthermore, this paper shows insights into the historical evolution of the convergence clubs in the period 1990-2020 and expands their scope to include projections of their expected future evolution in 2030. [ABSTRACT FROM AUTHOR]

This paper aims to enhance our knowledge about late-medieval epidemic outbreaks in specific parts of Eastern Central Europe. The first part on modern-day Eastern Germany discusses narrative evidence and its use in the current research on plague history, before bringing in municipal records on testaments and conveyances from Görlitz and Stralsund for the reconstruction of seasonality and mortality rates, as well as funeral inscriptions and pictorial evidence from Erfurt as indirect indicators of plague waves. After a brief discussion of the scarce narrative sources, the second part of the paper concerning Bohemia works with the evidence of the Libri Confirmationum, a source originating from the chancellery of the archbishops of Prague. Every new appointment to a benefice was supposed to be approved by one of the vicars general of the archbishop, and this confirmation usually gives the reason for the vacancy. Expanding on Eduard Maur's research, death statistics and their frequency are analyzed statistically. The paper provides insight into new evidence for the reconstruction of plague waves, mortality rates and seasonality, and thereby highlights the characteristics of the plague in Eastern Central Europe. [ABSTRACT FROM AUTHOR]

Climate change increases the risk of illness through rising temperature, severe precipitation and worst air pollution. This paper investigates how monthly excess mortality rate is associated with the increasing frequency and severity of extreme temperature in Canada during 2000-2020. The extreme associations were compared among four age groups across five sub-blocks of Canada based on the datasets of monthly T90 and T10, the two most representative indices of severe weather monitoring measures developed by the actuarial associations in Canada and US. We utilize a combined seasonal Auto-regressive Integrated Moving Average (ARIMA) and bivariate Peaks-Over-Threshold (POT) method to investigate the extreme association via the extreme tail index χ and Pickands dependence function plots. It turns out that it is likely (more than 10%) to occur with excess mortality if there are unusual low temperature with extreme intensity (all χ > 0.1 except Northeast Atlantic (NEA), Northern Plains (NPL) and Northwest Pacific (NWP) for age group 0-44), while extreme frequent high temperature seems not to affect health significantly (all χ ≤ 0.001 except NWP). Particular attention should be paid to NWP and Central Arctic (CAR) since population health therein is highly associated with both extreme frequent high and low temperatures (both χ = 0.3182 for all age groups). The revealed extreme dependence is expected to help stakeholders avoid significant ramifications with targeted health protection strategies from unexpected consequences of extreme weather events. The novel extremal dependence methodology is promisingly applied in further studies of the interplay between extreme meteorological exposures, social-economic factors and health outcomes., (© 2024. The Author(s).)

Assessing the association between temperature frequency and mortality can provide insights into human adaptation to local ambient temperatures. We collected daily time-series data on mortality and temperature from 757 locations in 47 countries/regions during 1979-2020. We used a two-stage time series design to assess the association between temperature frequency and all-cause mortality. The results were pooled at the national, regional, and global levels. We observed a consistent decrease in the risk of mortality as the normalized frequency of temperature increases across the globe. The average increase in mortality risk comparing the 10th to 100th percentile of normalized frequency was 13.03% (95% CI: 12.17-13.91), with substantial regional differences (from 4.56% in Australia and New Zealand to 33.06% in South Europe). The highest increase in mortality was observed for high-income countries (13.58%, 95% CI: 12.56-14.61), followed by lower-middle-income countries (12.34%, 95% CI: 9.27-15.51). This study observed a declining risk of mortality associated with higher temperature frequency. Our findings suggest that populations can adapt to their local climate with frequent exposure, with the adapting ability varying geographically due to differences in climatic and socioeconomic characteristics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Haze weather, characterized by low visibility due to severe air pollution, has aroused great public concern. However, haze definitions are inconclusive, and multicentre studies on the health impacts of haze are scarce. We collected data on the daily number of deaths and environmental factors in 190 Chinese cities from 2014 to 2020. The city-specific association was estimated using quasi-Poisson regression and then pooled using meta-analysis. We found a negative association between daily visibility and non-accidental deaths, and mortality risk sharply increased when visibility was < 10 km. Haze weather, defined as a daily average visibility of < 10 km without a limit for humidity, produced the best model fitness and greatest effect on mortality. A haze day was associated with an increase of 2.53% (95% confidence interval [CI]:1.96, 3.10), 2.84 (95% CI: 2.13, 3.56), and 2.99% (95% CI: 1.94, 4.04) in all non-accident, cardiovascular and respiratory mortality, respectively. Haze had the greatest effect on lung cancer mortality. The haze-associated risk of mortality increased with age. Severe haze (visibility <2 km) and damp haze (haze with relative humidity >90%) had greater health impacts. Our findings can help in the development of early warning systems and effective public health interventions for haze., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

This paper explores the long-run health benefits of education for longevity. Using mortality data from the Social Security Administration (1988-2005) linked to geographic locations in the 1940-census data, we exploit changes in college availability across cohorts in local areas. Our treatment on the treated calculations suggest increases in longevity between 1.3 and 2.7 years. Some further analyses suggest the results are not driven by pre-tends, endogenous migration, and other time-varying local confounders. This paper adds to the literature on the health and social benefits of education., (© 2023 John Wiley & Sons Ltd.)

Background: This paper investigates the consequences of the COVID-19 pandemic on mortality and hospitalization among nursing home residents in Norway. While existing evidence shows that nursing home residents were overrepresented among COVID-19-related deaths, suggesting inadequate protection measures, this study argues that the observed overrepresentation in mortality and hospitalization may partly stem from the inherent frailty of this demographic. Using nationwide administrative data, we assessed excess deaths and hospitalization by comparing pandemic-era rates to those of a pre-pandemic cohort. Methods: We compared mortality and hospitalization rates between a pandemic cohort of nursing home residents as of September 2019 (N = 30,052), and a pre-pandemic cohort as of September 2017 (N = 30,429). Both cohorts were followed monthly for two years, beginning in September 2019 and 2017, respectively. This analysis was conducted at the national level and separately for nursing home residents in areas with low, medium, and high SARS-CoV-2 community transmission. Event studies and difference-in-difference models allowed us to separate the impact of the pandemic on mortality and hospitalization from secular and seasonal changes. Results: The pandemic cohort experienced a non-significant 0.07 percentage points (95% confidence interval (CI): − 0.081 to 0.221) increase in all-cause mortality during the 18 months following pandemic onset, compared to the pre-pandemic cohort. Moreover, our findings indicate a substantial reduction in hospitalizations of 0.27 percentage points (95% CI: − 0.464 to − 0.135) and a non-significant decrease of 0.80 percentage points (95% CI: − 2.529 to 0.929) in the proportion of nursing home residents hospitalized before death. The effect on mortality remained consistent across regions with both high and low levels of SARS-CoV-2 community transmission. Conclusions: Our findings indicate no clear evidence of excess all-cause mortality in Norway during the pandemic, neither nationally nor in areas with high infection rates. This suggests that early implementation of nationwide and nursing home-specific infection control measures during the pandemic effectively protected nursing home residents. Furthermore, our results revealed a decrease in hospitalizations, both overall and prior to death, suggesting that nursing homes adhered to national guidelines promoting on-site treatment for residents. [ABSTRACT FROM AUTHOR]

Background: Ischemic-reperfusion injury resulting from kidney transplantation declines the post-transplant graft function. Remote ischemic conditioning (RIC) is known to be able to reduce the criticality of ischemic reperfusion injury. This study aimed to meta-analyze whether the application of remote ischemic conditioning to kidney transplantation patients improves clinical outcomes. Methods: Researchers included randomized controlled studies of the application of RIC to either kidney donors or recipients. Articles were retrieved from PubMed, Embase, Web of Science, and Cochrane Library. The risk of bias was evaluated using RoB 2.0. The primary outcome was mortality after transplantation. Secondary outcomes were the incidence of delayed graft function, graft rejection, and post-transplant laboratory results. All outcomes were integrated by RevMan 5.4.1. Results: Out of 90 papers, 10 articles (8 studies, 1977 patients) were suitable for inclusion criteria. Mortality collected at all time points did not show a significant difference between the groups. Three-month mortality (RR, 3.11; 95% CI, 0.13–75.51, P = 0.49) tended to increase in the RIC group, but 12-month (RR, 0.70; 95% CI, 0.14–3.45, P = 0.67) or final-reported mortality (RR, 0.49; 95% CI, 0.23–1.06, P = 0.07) was higher in the sham group than the RIC group. There was no significant difference between the RIC and sham group in delayed graft function (RR, 0.64; 95% CI, 0.30–1.35, P = 0.24), graft rejection (RR, 1.13; 95% CI, 0.73–1.73, P = 0.59), and the rate of time required for a 50% reduction in baseline serum creatinine concentration of less than 24 h (RR, 0.98; 95% CI, 0.61–1.56, P = 0.93). Conclusions: It could not be concluded that the application of RIC is beneficial to kidney transplantation patients. However, it is noteworthy that long-term mortality tended to decrease in the RIC group. Since there were many limitations due to the small number of included articles, researchers hope that large-scale randomized controlled trials will be included in the future. Systematic review registration: PROSPERO CRD42022336565. [ABSTRACT FROM AUTHOR]

Natural population dynamics is a topic that is largely dealt with at national level, but little analysed on a smaller scale (at county or basic administrative-territorial unit level), which could provide an opportunity for a more in-depth analysis and highlight possible areas where the situation is different from that existing at national level. Over time, the changes that have occurred in the natural dynamics of the population in Romania have highlighted numerous changes and shifts at the societal level, influencing either positively or negatively its subsequent trajectory. The aim of this paper is to capture the demographic evolution of Bistrița-Năsăud County and to outline the current situation. The focus will also be on capturing the impact of the current demographic evolution, an impact noted at territorial, demographic, social and economic level. Furthermore, possible solutions will be proposed to solve the emerging problems. [ABSTRACT FROM AUTHOR]

Eating disorders are historically underserved in healthcare, but are increasingly prevalent and recognised for their high costs regarding mortality, quality of life and the economy. Those with longstanding eating disorders are commonly labelled 'severe and enduring' (SEED), which has been challenged for its conceptual vagueness and potential to discourage patients. Attempts to define individuals from this cohort as having 'terminal' illness have also gained traction in recent years. This paper is grounded in lived/living experience and relevant research. It challenges the logical coherence and utility of SEED, arguing that the word 'enduring' unhelpfully situates intractability of longstanding illness within patients themselves and the nature of their illness. This risks a sense of inevitability and overlooks the important role of contextual factors such as lacking resources and insufficient evidence for withholding active treatment. Recommendations suggest approaches to dismantling unhelpful binaries between early intervention and intensive support, recovery and decline. [ABSTRACT FROM AUTHOR]

Aim: The early warning scores (EWS), quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria have been proposed as sepsis screening tools. This review aims to summarise and compare the performance of EWS with the qSOFA and SIRS criteria for predicting sepsis diagnosis and in‐hospital mortality in patients with sepsis. Design: A systematic review with meta‐analysis. Review Methods: Seven databases were searched from January 1, 2016 until March 10, 2022. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Sensitivity, specificity, likelihood ratios and diagnostic odd ratios were pooled by using the bivariate random effects model. Overall performance was summarised by using the hierarchical summary receiver–operating characteristics curve. This paper adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses of Diagnostic Test Accuracy Studies (PRISMA‐DTA) guidelines. Results: Ten studies involving 52,474 subjects were included in the review. For predicting sepsis diagnosis, the pooled sensitivity of EWS (65%, 95% CI: 55, 75) was similar to SIRS ≥2 (70%, 95% CI: 49, 85) and higher than qSOFA ≥2 (37%, 95% CI: 20, 59). The pooled specificity of EWS (77%, 95% CI: 64, 86) was higher than SIRS ≥2 (62%, 95% CI: 41, 80) but lower than qSOFA ≥2 (94%, 95% CI: 86, 98). Results were similar for the secondary outcome of in‐hospital mortality. Conclusions: Although no one scoring system had both high sensitivity and specificity, the EWS had at least equivalent values in most measures of diagnostic accuracy compared with SIRS or qSOFA. Implications for the profession: Healthcare systems in which EWS is already in place should consider whether there is any clinical benefit in adopting qSOFA or SIRS. No patient or public contribution: This systematic review did not directly involve patient or public contribution to the manuscript. [ABSTRACT FROM AUTHOR]

Reliable estimates of age-specific vital rates are crucial in demographic studies, while ages are, in most cases, commonly grouped in bins of five years. Indeed, public health and national systems require single age-specific data to achieve accurate social planning. This paper introduces a deep learning approach for splitting the abridged death rates, providing a more comprehensive perspective on the indirect age-specific vital rates estimation from grouped data. Additionally, we contribute to the existing literature by introducing a multi-population (countries and genders) approach, providing reliable estimates considering the heterogeneity of longevity dynamics over age, years, and across populations. We also contribute to the state of the art in indirect estimation by introducing, for the first time, a multi-population indirect estimation leveraging subnational data. Our model accurately captures mortality dynamics by age over time and among different populations. We prove the model's ability to estimate reliable predictions of age-specific mortality rates by also studying how the hyperparameters' choice affects the model reliability and analyzing the age-specific relative differences between the real and the estimated mortality rates. [ABSTRACT FROM AUTHOR]

Amid an aging population and a growing role for private equity (PE) in the care of older adults, this paper studies how PE ownership affects U.S. nursing homes using patient-level Medicare data. We show that PE ownership leads to a patient cohort with lower health risk. However, after instrumenting for the patient-nursing home match, we find that PE ownership increases mortality by 11%. Declines in measures of patient well-being, nurse staffing, and compliance with care standards help to explain the mortality effect. Overall, we conclude that PE has nuanced effects with adverse outcomes for a subset of patients. [ABSTRACT FROM AUTHOR]

Background: Heatwaves are expected to increase with climate change, posing a significant threat to population health. In India, with the world's largest population, heatwaves occur annually but have not been comprehensively studied. Accordingly, we evaluated the association between heatwaves and all-cause mortality and quantifying the attributable mortality fraction in India., Methods: We obtained all-cause mortality counts for ten cities in India (2008-2019) and estimated daily mean temperatures from satellite data. Our main extreme heatwave was defined as two-consecutive days with an intensity above the 97th annual percentile. We estimated city-specific heatwave associations through generalised additive Poisson regression models, and meta-analysed the associations. We reported effects as the percentage change in daily mortality, with 95% confidence intervals (CI), comparing heatwave vs non-heatwave days. We further evaluated heatwaves using different percentiles (95th, 97th, 99th) for one, two, three and five-consecutive days. We also evaluated the influence of heatwave duration, intensity and timing in the summer season on heatwave mortality, and estimated the number of heatwave-related deaths., Findings: Among ∼ 3.6 million deaths, we observed that temperatures above 97th percentile for 2-consecutive days was associated with a 14.7 % (95 %CI, 10.3; 19.3) increase in daily mortality. Alternative heatwave definitions with higher percentiles and longer duration resulted in stronger relative risks. Furthermore, we observed stronger associations between heatwaves and mortality with higher heatwave intensity. We estimated that around 1116 deaths annually (95 %CI, 861; 1361) were attributed to heatwaves. Shorter and less intense definitions of heatwaves resulted in a higher estimated burden of heatwave-related deaths., Conclusions: We found strong evidence of heatwave impacts on daily mortality. Longer and more intense heatwaves were linked to an increased mortality risk, however, resulted in a lower burden of heatwave-related deaths. Both definitions and the burden associated with each heatwave definition should be incorporated into planning and decision-making processes for policymakers., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Despite the significant body of research on social determinants of health (SDH) and mortality, limited knowledge is available on the epidemiology of aggregated Latino health overall, and by women and subgroups. In population health studies, U.S. Latinos often are considered a monolithic population and presented as an aggregate, obscuring the diversity and variations within and across Latino subgroups, contributing to missed opportunities to identify SDH of health outcomes, and limiting the understanding of health differences. Given diverse environmental, racial, class, and geographic factors, a specific focus on women facilitates a more in-depth view of health disparities. This paper provides a scoping review of current gaps in research that assesses the relationships between SDH and mortality rates for the five leading causes of chronic-disease related deaths among Latinas by ethnic origin, place, race, and SES. We analyzed 2020 national mortality statistics from the CDC WONDER Online database jointly with reviews of empirical articles on Latina health, employing the EBSCOhost MEDLINE databases. These findings challenge the phenomenon of the Hispanic paradox that identified Latinos as a relatively healthy population compared to non-Hispanic White populations despite their lower economic status. The findings confirm that prior research on Latino women had methodological limitations due to the exclusion of SDH and an overemphasis on culturalist perspectives, while overlooking the critical role of socioeconomic impacts on health. Findings indicate major knowledge gaps in Latina mortality by SDH and subgroups that may undermine surveillance efforts and treatment efficacy. We offer forward-looking recommendations to assure the inclusion of key SDH associated with Latina mortality by subgroup as essential to inform future studies, intervention programs, and health policy., (© 2024. The Author(s).)

Background: The primary objective is to evaluate the safety and effectiveness of Stryker second generation Target® Nano Coils in the treatment of ruptured and unruptured small (<7 mm) intracranial aneurysms. Methods: The TARGET Registry is a prospective, two-arm study with independent medical event monitoring and core-lab adjudication. This paper describes the second arm of the TARGET registry. Patients with de novo intracranial aneurysms were embolized with 2nd generation TARGET Nano coils in 12 US centers. The primary efficacy outcome was adequate aneurysm occlusion (RR occlusion grade I-II) on follow-up. Primary safety outcome was treatmentrelated morbidity and mortality. Secondary outcomes included aneurysm packing density immediately post-procedure, immediate adequate occlusion, aneurysm re-access rate, retreatment rate and clinical outcomes using modified ranking scale. A secondary analysis investigated the influence of using Nanopredominant coils (=2/3 of total coil-length) vs. non-Nano-predominant coils (<2/3 of total length). Results: 150 patients with 155 aneurysms met the inclusion and exclusion criteria. (31%) patients with ruptured and (69%) with unruptured aneurysms were treated using TARGET coils. Median age was 58.8 (SD 12.7), 74.7% were females, and 80% were Caucasians. Mean follow-up was 5.23 (SD 2.27) months. Periprocedural mortality was seen in 2.0% of patients. Good outcome at discharge (mRS 0-2) was seen in 81.3% of the cohort. The median packing density (SD) was 29.4% (14.9). Mid-term complete/near complete occlusion rate was seen in 96% of aneurysms and complete obliteration was seen in 75.2% of aneurysms. Patients treated predominantly with Nano coils had higher PD (32.6% vs. 26.1%, p < 0.001). There was no significant difference in clinical and angiographic outcomes. The mid-term mRS0-2 was achieved in 106/109 (97.2%) patients. All-cause mortality was 5/115 (4.3%). Conclusion: In the multicenter TARGET Registry, 75.8% of aneurysms achieved mid-term complete occlusion, and 96% achieved complete/near complete occlusion with excellent independent functional outcome. [ABSTRACT FROM AUTHOR]

A growing number of studies have produced results that suggest the shape of the concentration-response (C-R) relationship between PM2.5 exposure and mortality is "supralinear" such that incremental risk is higher at the lowest exposure levels than at the highest exposure levels. If the C-R function is in fact supralinear, then there may be significant health benefits associated with reductions in PM2.5 below the current US National Ambient Air Quality Standards (NAAQS), as each incremental tightening of the PM2.5 NAAQS would be expected to produce ever-greater reductions in mortality risk. In this paper we undertake a series of tests with simulated cohort data to examine whether there are alternative explanations for apparent supralinearity in PM2.5 C-R functions. Our results show that a linear C-R function for PM2.5 can falsely appear to be supralinear in a statistical estimation process for a variety of reasons, such as spatial variation in the composition of total PM2.5 mass, the presence of confounders that are correlated with PM2.5 exposure, and some types of measurement error in estimates of PM2.5 exposure. To the best of our knowledge, this is the first simulation-based study to examine alternative explanations for apparent supralinearity in C-R functions. [ABSTRACT FROM AUTHOR]

This paper documents the short-run macroeconomic impacts of influenza pandemics across 16 countries spanning 1871–2016 using the Jordà–Schularick–Taylor Macrohistory Database and the Human Mortality Database. We find pandemic-induced mortality contributed meaningfully to business cycle fluctuations in the post 1870 era. We identify negative causal impacts on the cyclical component of GDP using pandemics to instrument for working-age mortality. The analysis of short-run economic outcomes extends literature dominated by long-run economic growth outcomes and case studies of several specific health shocks such as the Black Death, Spanish Flu or COVID-19. Our findings illustrate that less catastrophic pandemics still have important economic implications. [ABSTRACT FROM AUTHOR]