Death Classification Research Articles

A Method for Filling Missing Values in Multivariate Sequence Bidirectional Recurrent Neural Networks Based on Feature Correlations

Multivariate real-life time series data often contain missing values. These missing values often affect subsequent prediction tasks. Traditional imputation methods generally consider only some of the characteristics of multivariate time series data. This can easily lead to inaccurate filling results. In this paper, a feature correlation-based bidirectional recurrent network (BRNN-FR) is proposed to solve the problem of missing values in multivariate sequence data. First, this method involves the design of a bidirectional prediction network based on time intervals and the use of forward and reverse time series information between data points to obtain the characteristics of data changes with time to the greatest extent. Second, considering the correlation between features, a combined feature selection strategy based on the Pearson correlation coefficient and mutual information was proposed. A multiple regression model was established to predict between features. Finally, a bidirectional network ensemble filling algorithm based on the relationships between features is established to predict missing values. Comprehensive experiments on four public datasets show that the mean absolute error (MAE), root mean square error (RMSE) and maximum R2 value (R2_score) of the BRNN-FR algorithm in the direct imputation test are better than those of the other comparison methods in most cases. BRNN-FR also achieved a better area under the curve (AUC) in the indirect comparison experiment of two classifications of in-hospital death after filling the medical dataset. Using the AIR air quality dataset and the power transformer temperature dataset from the ETTH1 interpolation regression to predict the next 3hours and 6hours of average numerical results, most of the optimal regression results are obtained.

How common is emergency department as a death place in Portugal and who is more likely to die there?

Abstract Background Most people would prefer to die at home but most die in hospitals or other healthcare settings. Some of the latter deaths may have taken place in Emergency Departments (EDs), as EDs are a major hospital gateway. However, EDs have not been consistently categorised as a place of death (PoD) across countries. Portugal is an exception. This study aimed to examine trends in deaths at EDs in Portugal from 2015 to 2021, identifying who is more likely to die at the ED. Methods We obtained national death certificate data on PoD for 2015 to 2021 from the the Portuguese General-Directorate for Health. We analysed the percentage of deaths taking place at the ED by sex, age group (0-17y, 18-49y, 50-69y, 70-79y, ≥80y), underlying cause of death (cancer, dementia, and other causes) and year of death. Results 804.971 people died in Portugal from 2015-2021 (50.1% male; 0.4% aged 0-17y, 58.0% aged ≥80y; 23.3% died from cancer, 5.6% from dementia, and 71.1% from other causes). Of these, 13.2% died at the ED. The percentage of ED deaths was higher in female (13.7% vs. 12.8% in male), in adults (13.3% vs. 9.0% in children), in those dying from dementia (15.7% compared to 9.6% in cancer and 14.3% in other causes). The percentage of ED deaths rose from 10.6% in 2015 to 14.3% in 2021, increasing steadily over time (average 0.6 percentual points per year, representing 1069 additional deaths per year). Conclusions One in every ten deaths in Portugal happens at ED and this is increasing. Patients with non-cancer conditions are more likely to die at the ED, in particular those dying from dementia. To understand if this reality compares with other countries, we are developing a pioneering international classification of place of death which includes the ED. Funding: European Research Council (agreement nr. 948609). Key messages • Emergency department (ED) is a significant PoD in Portugal and has increased from 10.6% to 14.3% (2015-2021). Non-cancer patients, especially those with dementia, more likely to die at ED. • This study highlights the need for an international place of death classification to compare emergency department death trends across countries.

A Pilot Study of Age Estimation and Cause of Death: Insights into Skeletal Aging

Background/Objectives: Forensic anthropological age estimations are often limited by a lack of diversity in reference samples, imprecision, and, for certain populations, inaccuracy. This study aims to explore the relationship between health, as indicated by cause of death, and skeletal age estimation, with the goal of determining whether including health information can improve accuracy and precision in age estimation. Methods: Skeletal age data were collected from the Maxwell Museum Documented Skeletal Collection using the Lovejoy et al. method for the auricular surface and the Suchey-Brooks method for the pubic symphysis. All individuals had a known cause of death, which was categorized into two broad groups: disease-related and trauma-related. Cause of death category served as a proxy for health status. Results: Individuals who died from disease-related causes often fell within the upper end of the age ranges for both the auricular surface and pubic symphysis methods. In contrast, those who died from trauma-related causes tended to fall within the lower end of these age ranges. Conclusions: These results indicate that incorporating factors such as health into existing forensic age estimation methods could enhance the precision of age estimates, particularly by addressing the influence of environmental and lifestyle factors on skeletal aging.

Sepsis mortality prediction with Machine Learning Tecniques

ObjectiveTo develop a sepsis death classification model based on machine learning techniques for patients admitted to the Intensive Care Unit (ICU). DesignCross-sectional descriptive study. SettingThe Intensive Care Units (ICUs) of three Hospitals from Murcia (Spain) and patients from the MIMIC III open-access database. Patients180 patients diagnosed with sepsis in the ICUs of three hospitals and a total of 4559 patients from the MIMIC III database. Main variables of interestAge, weight, heart rate, respiratory rate, temperature, lactate levels, partial oxygen saturation, systolic and diastolic blood pressure, pH, urine, and potassium levels. ResultsA random forest classification model was calculated using the local and MIMIC III databases. The sensitivity of the model of our database, considering all the variables classified as important by the random forest, was 95.45%, the specificity was 100%, the accuracy was 96.77%, and an AUC of 95%. . In the case of the model based on the MIMIC III database, the sensitivity was 97.55%, the specificity was 100%, and the precision was 98.28%, with an AUC of 97.3%. ConclusionsAccording to random forest classification in both databases, lactate levels, urine output and variables related to acid.base equilibrium were the most important variable in mortality due to sepsis in the ICU. The potassium levels were more critical in the MIMIC III database than the local database.

Understanding Causes of Death in Patients With Acute Respiratory Distress Syndrome: A Narrative Review.

To provide a comprehensive summary of the published data on cause of death in patients with acute respiratory distress syndrome (ARDS). PubMed (January 2015 to April 2024), bibliographies of relevant articles, and ARDS Network and Prevention & Early Treatment of Acute Lung Injury (PETAL) network websites. Observational studies and clinical trials that reported on cause of death in greater than or equal to 30 patients with ARDS, not obtained from death certificates. Animal studies, case reports, review articles, study protocols, and studies in pediatrics were excluded. Causes of death among ARDS patients who died were extracted and tabulated along with other pertinent study characteristics. We identified 15 observational studies (nine non-COVID ARDS, five COVID-related ARDS; one both) and five clinical trials (all non-COVID ARDS). Mutually exclusive prespecified categories were used for recording the cause of death in only eight studies although studies differed in the categories included and their definitions. When multiple organ failure was a predetermined category, it was the most common cause of death recorded (~50% of deaths), followed by respiratory causes with proportions varying from 16% to 42% depending on nomenclature (e.g., refractory hypoxemia, pulmonary causes) and definitions. However, the largest observational study in non-COVID ARDS (964 deaths), did not include multiple organ failure as a predetermined category, and found that pulmonary failure (42%) and cardiac failure (37%) were the most common causes of death. In COVID-related ARDS observational studies, pulmonary reasons were the most reported cause of death (up to 88%). Few studies have reported cause of death in patients with ARDS. In those that do, cause of death categories and definitions used are heterogeneous. Further research is needed to see whether a more rigorous and unified approach to assigning and reporting cause of death in ARDS would help identify more relevant endpoints for the assessment of targeted treatments in clinical trials.

The Weight of Numbers: Counting Border Crossing Deaths and Policy Intent

Executive Summary This article explores how undocumented border crosser (UBC) deaths are counted as well as mis- and under-counted across the US southwest, and proposes a suite of policy remediations to standardize this process. An accurate count of UBC recovered remains is vital to understanding the scope of fatalities associated with border crossing, providing evidence accounting for the reciprocal relationship between US border enforcement and the incidence of migration-related death. To meaningfully intervene, it is insufficient to advocate only for more robust individual death investigations, though this is pivotal to forensically identify UBC decedents and unite them with their loved ones. Though identification and reunification of UBCs are the elements of forensic care most commonly attributed as humanitarian, the relationship between forensic investigation and international humanitarian principles is equally about accumulating primary evidence for policy intervention and justice claims on behalf of those who wrongfully die. Even if existing counting mechanisms do not provide the means for establishing this attribution between border-crossing deaths and border enforcement policy, this article lays out an argument for why they must do so and it makes recommendations for how this can take place. Necessarily, this article begins with a critique of existing mechanisms for counting UBC deaths, from the federal observation of such deaths by Customs and Border Protection, to the bureaucratic mechanisms for the collection of vital statistics authored at the local level. It then suggests means for improving accurate counting using the US Standard Certificate of Death. It particularly explores two aspects of the certificate, Manner of Death reporting and a section that asks death filers to describe how the death occurred, sections 37 and 43 respectively. Finally, it explores historical precedent for altering the standard death form at local and then national levels, positing that select amendments to the existing death certificate would be useful for standardizing how medicolegal death filers across the border and beyond can more accurately enumerate and characterize UBC deaths. Policy recommendations include the following, in order of immediacy: ● Jurisdictions across the US southwest must adopt standardized criteria for counting fatalities believed to be associated with undocumented border crossing. ● Despite some local formalization of UBC counting, current means of representing UBC status in vital records remains ad hoc across the US southwest and existing mechanisms for counting elude wider scale national recognition in vital statistics. The most straightforward and reliable method of standardization to ensure systematic representation of UBC deaths across the borderlands would be a UBC checkbox on the death certificate. This would require cooperation with state-level public health departments and legislatures. Precedent exists for changing the death form at the state level, facilitating, in some cases, for eventual inclusion of new components of the death certificate to be adopted on the US Standard Certificate of Death. This is recommended as a longer-term goal. ● Finally, there must be a means to characterize the deadly relationship between UBC fatalities and US border enforcement policy and practice in vital records where UBC Manners of Death are most often characterized as “Natural” or “Accidental.” Both are inaccurate. Unilaterally ensuring an accurate count leaves room for a trend already well underway in which agencies associated with border enforcement have cast UBC deaths as simply due to unfortunate heat-related accidents, resulting in legislation aimed to mitigate deaths that fails to address the role of border policy in causing deaths. This paper recommends that a new Manner of Death category could be useful beyond the border to represent non-capital crimes enforced by leveraging bodily harm.

Hypoalbuminemia on admission in diabetic patients correlates with severity of illness in COVID-19: A retrospective clinical study and literature review

IntroductionTo elucidate factors associated with severe disease in patients with coronavirus disease 2019 (COVID-19) pneumonia complicated with diabetes mellitus. MethodsAmong patients with COVID-19 pneumonia hospitalized from January to September 2021, 100 patients with diabetes were included in the study. Patients in the intensive care unit admission or in-hospital death category were defined as the severe group (26 patients), and the other patients as the moderate group (74 patients). Comparisons were made between the two groups. Medical histories were extracted from the medical records, and statistical analysis was performed. ResultsPatients were 62.1 ± 13.0 years of age, 70 % male, 48 % aged 65 years and more, and HbA1c was 7.72 ± 1.51 %. The severe group had significantly higher blood glucose level, CRP, WBC, and LDH on admission. Serum albumin level was significantly lower in the severe group and was significantly negatively correlated with number of days on oxygen administration (r = 0.447) and maximal oxygen concentration (r = 0.561). Multiple logistic regression analysis with severity of illness as the objective variable showed that high CRP and low albumin levels on admission, and older age were independently associated. ConclusionsLow albumin levels on admission may be an indicator of severe disease in patients with diabetes.

군인의 죽음과 관련된 몇 가지 법적 과제

The death of a soldier signifies a profound sacrifice and dedication to the national community, and as such, it should be properly honored. It also reflects the values upheld by the nation. This article addresses various legal issues related to the death of soldiers, including distinctions between combat-related deaths, duty-related deaths, and other categories under the Military Personnel Act, as well as decisions regarding national merit and compensation under the National Merit Act and the Veterans' Compensation Act. Recently, the revision of the Military Court Act transferred the authority to investigate military deaths from the military to the National Police Agency, which is a positive development. However, considering that approximately 60-80% of recent military deaths are suicides, these cases often lack criminal allegations and are quickly concluded, potentially leading to inadequate investigations of significant unit-related factors. This highlights a limitation of the current system. The article also discusses issues such as the categorization of duty-related deaths, conflicts or inconsistencies between the National Merit Act and the Veterans' Compensation Act Enforcement Decree, among others. It is essential to establish a state agency independent of the military to investigate not only the deaths of soldiers but also the related unit-level factors. This is crucial to prevent the recurrence of similar incidents. The Military Human Rights Protection Officer, who also serves as a standing commissioner of the National Human Rights Commission, could fulfill this role. Additionally, this agency should have the authority to review decisions regarding death classifications if objections are raised by the bereaved families. Currently, the Central Military Merit Review Committee, which operates under the Ministry of National Defense, is responsible for re-investigating the causes of death. This could be seen as a conflict of interest, as it involves self-judgment. To address this, it may be beneficial for a newly established Military Human Rights Supervisory Body to assume the final responsibility for re-investigations and death classification judgments. In summary, this new body should be responsible for 1) the protection of and policy development regarding military human rights, 2) the investigation of military death cases based on complaints from bereaved families or ex officio, and 3) the re-investigation and review of death classifications upon objections from the bereaved.

Association of Disease Trajectory and Place of Care with End-of-Life Burdensome Transitions: A Retrospective Cohort Study

ObjectivesEnd-of-life (EOL) transitions to hospital can be burdensome for older adults and may contribute to poor outcomes. We investigated the association of disease trajectory and place of care with EOL burdensome transitions. DesignRetrospective cohort study using administrative data. Setting/ParticipantsOntarians aged ≥65 years who died between 2015 and 2018 and received long-term care (LTC) or home care 6 months before death. MethodsDisease trajectories were defined based on EOL functional decline: terminal illness, organ failure, frailty, sudden death, and other. Places of care included LTC, EOL home care, and non-EOL home care. Burdensome transitions were defined as early (≥3 hospitalizations for any reason or ≥2 hospitalizations due to pneumonia, urinary tract infection, sepsis, or dehydration in the last 90 days of life) or late (≥1 hospitalizations for any reason in the last 3 days of life). Multinomial logistic regression tested for effect modification between disease trajectory and places of care on burdensome transitions. ResultsOf 110,776 decedents, 40.7% had organ failure, 37.5% had frailty, and 12.8% had a terminal illness, with the remainder in sudden death or other categories. Most were in LTC (62.5%), and 37.5% received home care, with 6.8% receiving designated EOL home care and 30.7% non-EOL home care. There was a significant interaction (P < .001) between disease trajectory and care settings. Compared with terminal illness, organ failure was associated with increased odds of early transitions across all care settings [odds ratios (ORs) ranging 1.14-1.21]. Frailty was associated with increased odds of early transitions solely for non-EOL home care recipients (OR 1.17, 95% CI 1.06-1.28). Organ failure and frailty were associated with increased odds of late transitions across all settings, with organ failure having greater odds in LTC (organ failure OR 2.29, 95% CI 2.02-2.60, vs frailty OR 1.79, 95% CI 1.58-2.04). Conclusions and ImplicationsDisparities exist in burdensome transitions, notably for noncancer decedents with organ failure in LTC. Enhancing palliative care may help reduce burdensome transitions and improve patient outcomes.

Accuracy and validity of determined cause of death and manner of death following forensic autopsy prosection

AimsThe purpose of this study is to evaluate the accuracy and validity of the determination of cause of death (COD) and manner of death (MOD) at the completion of the...

Plasma n6 polyunsaturated fatty acid levels and risk for total and cause-specific mortality: A prospective observational study from the UK Biobank

BackgroundThe potential role of n-6 PUFAs in major health outcomes remains controversial. ObjectivesTo examine the relationship between the major plasma n6 PUFA, linoleic acid (LA), as well as the non-LA n6 PUFAs, and total and cause-specific mortality. MethodsThis was a prospective, observational, biomarker-based study in the UK Biobank. Individuals with complete information on baseline demographic, covariate and plasma PUFA levels (percent ot total fatty acids) and mortality outcomes were included (n=257,925). Multivariable-adjusted, Cox-proportional hazards models were used to predict risk of death from all-causes, and from cardiovascular disease (CVD), cancer, and other causes as a function of plasma LA and non-LA n6 levels, both continuously and by PUFA quintile (Q). ResultsComparing LA Q5 to Q1, the hazard ratio (HR, 95% CI) for total mortality was 0.80 (0.76, 0.84; p<0.001), and this was similar for all three cause-specific death categories. On the other hand, mortality HR for non-LA n6 was 1.12 (1.08,1.17; p<0.001), and this was primarily due to increased risk for non-CVD, noncancer deaths [HR 1.29 (1.19,1.40; p<0.001)]. Exploratory analyses among the eight next most common other causes of death suggested that both the decreased risk associated with higher LA and the increased risk associated with non-LA n6 were confined to deaths from respiratory and digestive diseases. ConclusionsThese findings highlight the profound differences in mortality risk related to LA and non-LA n6 PUFA levels and underscore the inappropriateness of treating n-6 PUFAs as a homogenous class with respect to health outcomes. They also support recommendations to maintain (if not increase) current LA intakes.

Impact of the COVID-19 Pandemic on Conduct and Results of CLEAR Outcomes Trial.

The COVID-19 pandemic disrupted clinical research. CLEAROutcomes investigated the effect of bempedoic acid (BA) versus placebo in 13 970 patients with statin intolerance and high cardiovascular (CV) risk. BA reduced the risk of the primary endpoint (composite of CV death, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization) by 13%. CLEAROutcomes began beforeand continued for 2.7 years afterthe start of the pandemic. The impact of the COVID-19 pandemic on patient disposition, adverse events, and major adverse CV events (MACE) in CLEAROutcomes was assessed. Rates of severe infection, hospitalization, or first MACE associated with a positive COVID-19 test were low and balanced between treatment groups. Rates of all-cause death, non-CV death, and undetermined death increased in the pandemic period compared with the pre-pandemic period, while rates of CV death with a known etiology remained stable. A sensitivity analysis excluding undetermined deaths occurring after the onset of the pandemic from the CV death designation yielded hazard ratios of 0.84 (95% CI, 0.76-0.93) for the primary endpoint and 0.94 (95% CI, 0.76-1.16) for the secondary endpoint of CV death, compared with 0.87 (95% CI, 0.79-0.96) and 1.04 (95% CI, 0.88-1.24), respectively, in the original analysis. The CLEAR Outcomes trial continued uninterrupted throughout the COVID-19 pandemic. Certain trial endpoints may have been impacted by the pandemic. Specifically, the classification of undetermined deaths as CV deaths may have attenuated the effect of BA on key efficacy endpoints.

Examining the trend of mortality of genitourinary system cancers in Babol, North Iran (2013–2021)

BackgroundCancers of the genitourinary system, particularly prostate, bladder, and kidney cancer, exhibit a high prevalence. Consequently, predicting the morbidity and mortality of genitourinary cancers holds great significance for future planning and implementation. This study aimed to examine the crude and age-standardized rates of mortality and the trend of genitourinary cancers over nine years in northern Iran.MethodsThis cross-sectional study used data on the number of deaths attributed to genitourinary cancers recorded in Babol City between 2013 and 2021 through the cause of death registration and classification system. Population estimates were derived from the latest census reports. Subsequently, crude and age-standardized rates, as well as trends for genitourinary cancers, were calculated.ResultsA total of 307 deaths occurred, with an average age of 75.6 ± 14.3 years due to genitourinary cancers. The crude and age-standardized rates of genitourinary cancers increased from 2.7 and 1.9 per hundred thousand people in 2013 to 7.7 and 5.9 per hundred thousand people in 2021, respectively. Over the study period, death rates significantly rose for men (P < 0.001) and remained constant for women (P = 0.444). Examination of genitourinary cancers revealed an upward trend for bladder (P = 0.012) and prostate (P = 0.012) cancers, while a stable trend was observed for kidney (P = 0.070) and testicular (P = 0.139) cancers.ConclusionsThe age-standardized rate and trend of genitourinary cancers are rising. Consequently, this study emphasizes the importance of prevention through screening programs, raising awareness, and utilizing appropriate diagnostic methods.

Trauma-related preventable death; data analysis and panel review at a level 1 trauma centre in Amsterdam, the Netherlands.

Trauma-related death is used as a parameter to evaluate the quality of trauma care and identify cases in which mortality could have been prevented under optimal trauma care conditions. The aim of this study was to identify trauma-related preventable death (TRPD) within our institute by an external expert panel and to evaluate inter-panel reliability. Trauma-related deaths between the 1st of January 2020 and the 1st of February 2022 at the Amsterdam University Medical Centre were identified. The severely injured patients (injury severity score ≥ 16) were enrolled for preventability analysis by an external multidisciplinary panel, consisting of a trauma surgeon, anaesthesiologist, emergency physician, neurosurgeon, and forensic physician. Case descriptions were provided, and panellists were asked to classify deaths as non-preventable, potentially preventable, and preventable. Agreements between the five observers were assessed by Fleiss kappa statistics. In total 95 trauma-related deaths were identified. Of which 36 fatalities were included for analysis, the mean age was 55.3 years (± 24.5), 69.4% were male and 88.9% suffered blunt trauma. The mean injury severity score was 35.3 (± 15.3). Interobserver agreement within the external panel was moderate for survivability (Fleiss kappa 0.474) but low for categorical preventable death classification (Fleiss kappa 0.298). Most of the disagreements were between non-preventable or potentially preventable with care that could have been improved. Multidisciplinary panel review has a moderate inter-observer agreement regarding survivability and low agreement regarding categorical preventable death classification. A valid definition and classification of TRPD is required to improve inter-observer agreement and quality of trauma care.

Autopsy rates and the misclassification of suicide and accident deaths.

Mortality statistics are critical to determine the burden of disease. Certain causes of death are prone to being misclassified on cause of death certificates. This poses a serious risk for public health and safety, as accurate death certificates form the basis for mortality statistics, which in turn are crucial for research, funding allocation and health interventions. This study uses generalised estimating equations and regression modelling to investigate for which cause of death categories suicide and accident deaths are misclassified as. National mortality statistics and autopsy rates from North America and Europe covering the past forty years were analysed to determine the associations between the different causes of death in cross-sectional and longitudinal models. We find that suicides and deaths by accidents are frequently mutually misclassified. We also find that suicides are frequently misclassified as drug use disorder deaths, in contrast to accident deaths, which are not misclassified as drug use disorder deaths. Furthermore, suicides do not seem to be misclassified as undetermined deaths or ill-defined deaths. The frequency of misclassification shows that the quality of death certificates should be improved, and autopsies may be used systematically to control the quality of death certificates.

Call for attention to the prevention of perinatal death attributed to birth defect

Birth defect and perinatal death are major public issues threatening the health of women and children in China. However, perinatal death attributed to birth defects has not yet received sufficient attention. To minimize the occurrence of perinatal death caused by birth defects, this review article deeply analyzed the current status of epidemiology, clinical, and basic research on perinatal death attributed to birth defects both domestically and internationally, and proposed to encourage the conduct of national research on perinatal causes. We should also pay attention to the application of the perinatal cause of death classification system, and focus on accurate diagnosis and the three-level prevention and control of perinatal death attributed to birth defect.

Monitoring emergency and urgent surgery: an improvement in a Healthcare Management Unit at a third-level hospital in Italy.

At San Martino IRCCS Hospital in Genoa, Italy, emergency and urgent surgery is classified according to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) classification, whereby cases are divided into two categories and colour-coded accordingly: - EMERGENCY - (Colour-code: RED) "Surgery to be performed within minutes"; - URGENCY - (colour-code: YELLOW) "Surgery to be performed within hours". In this context, it is essential that the emergency surgical team gets clear and complete information from the proposing surgeon, in order to complete the surgical list. Between 14th April 2023 and 23th July 2023, a new method of requesting urgent and emergency surgery by filling out an online form was tested. A total of 406 online requests were made, resulting in 367 E/U surgeries. The greatest number of emergency operations concerned thoracic-abdominal surgery (45%), followed by urology (19%). The requests analysed classified 18% of cases as red and 71% as yellow. The remaining 11% contained compilation errors. Moreover, 11% of the interventions were not performed within the time limits defined according to the severity code. By means of this new tool, San Martino IRCCS Hospital's Healthcare Management Unit can monitor requests for surgery in real time, thereby achieving greater efficiency and implementing corrective measures in the use of Operating Room resources.

Analyzing the trend of mortality due to traffic and nontraffic accidents: a study in the north of Iran

Background: Examining the raw and standardized mortality rates is the primary strategy for improving life expectancy and human health in society through identifying risk factors and dealing with the factors that cause them. Objectives: This study examined the trend of mortalities due to traffic and nontraffic accidents. Methods: This cross-sectional study examines the registered mortalities during the years 2016–2022 in the form of a census in the health department’s death registration and classification system. Mortality was analyzed as raw and standardized mortality in each 100 000 population. Results: Out of 18 265 deaths during 2016–2022, 1305 (7.15%) were related to accidents and incidents. The age-standardized total mortality rate in the first year was 32.9, and in the final year of the study, it was 33.3 per 100 000 people; although there are fluctuations, this trend is upward (P.trend=0.021). Also, the age-standardized traffic death rate in the first year is 19, and in the final year is 12 per 100 000 people; this decreasing trend was not statistically significant (P.trend=0.061). The incidence of age-standardized intentional nontraffic deaths was 1.7 in the first year of the study interval and 9.8 in the last year in 100 000 people, which showed an upward trend (P.trend&lt;0.001). Conclusion: In light of the generally increasing trend of accidents, especially nontraffic accidents, universal and well-rounded measures are necessary for safety matters and reducing mortality.

Cluster analysis of clinical phenotypes in idiopathic inflammatory myopathy patients complicated with cardiac involvement.

This study aimed to classify idiopathic inflammatory myopathy (IIM) patients with cardiac involvement (IIM-CI) into different categories based on their clinical phenotypes via cluster analysis and to explore their differences in outcomes. IIM-CI patients admitted to Peking Union Medical College Hospital from January 2015 to June 2021 were retrieved. The clinical data, laboratory examinations, and treatment were retrospectively reviewed, and the outcome was traced. A second-order clustering method was employed for categorization. A total of 88 IIM-CI patients were enrolled in this study and were classified into two categories through cluster analysis. Category I consisted of patients who exhibited distinct cardiac structural and functional changes, such as enlargement of atriums and/or ventricles, along with the remarkable heart insufficiency biomarkers, whereas patients of category II displayed more widely systemic injuries and intensive skeletal muscle weakness. In comparison, pulmonary hypertension (58.8% vs 16.7%, p < 0.01), arrhythmia (82.4% vs 27.8%, p < 0.01), and positive serum anti-mitochondrial-M2 antibody (52.9% vs 5.6%, p < 0.01) were more prevalent in category I than in category II, and serum N-terminal pro-B-type natriuretic peptide levels (1703.5 pg/L vs 364.0 pg/L, p = 0.02) were significantly elevated in category I, whereas skeletal muscle weakness (50.0% vs 74.1%, p = 0.02), interstitial lung disease (20.6% vs 63.0%, p < 0.01), skin rash (11.8% vs 48.1%, p < 0.01), arthralgia (2.9% vs 27.8%, p < 0.01), fever (2.9% vs 27.8%, p < 0.01), and dysphagia (2.9% vs 22.2%, p < 0.01) were more common in category II patients. Heart failure was the primary cause of death in category I, but severe pneumonia was predominantly responsible for deaths in category II. Two categories of IIM-CI were identified based on clinical features with distinctive characteristics. Two categories exhibited differences in clinical manifestations, autoantibody profiles, and the primary cause of death.

Advanced medical imaging for forensic triage: A study of the added value of combining PMCT and PMMR of the head

BackgroundApproximately 170,000 individuals die annually in the Netherlands. Dutch law mandates examinations to distinguish between natural death and unnatural death. Traditionally, this involves external examinations and an inspection of medical records; however, medical imaging has emerged as a tool for investigating deaths. ObjectiveThe objective of the study was to investigate whether the addition of post-mortem magnetic resonance (PMMR) to post-mortem computed tomography (PMCT) could assist in the categorisation of deaths as natural or unnatural and augment confidence in those classifications. MethodsIn this retrospective study, the PMCT and PMMR head images of 50 individuals were evaluated by a forensic radiologist. The impact of PMMR on lesion detection, the cause of death (COD), the differentiation between natural death and unnatural death, and confidence levels were assessed. All available case information was used as the reference standard. ResultsThe addition of the PMMR led to a statistically significant increase in lesion detection (48%), changes in the classification of COD in four cases, and an increased level of confidence in the classification. Differentiation between natural death and unnatural death reversed in 10 cases, altering the overall manner of death (MOD) classification in 20% of cases. ConclusionWhen PMCT indicates a natural or unnatural death, PMMR is unnecessary. PMMR of the head is recommended in situations in which the MOD is uncertain based on PMCT findings. The ultimate determination of a natural death and unnatural death should always take into account the results of external examinations, police investigations, and other available information.