Complete Information Research Articles

Mediation analysis using incomplete information from publicly available data sources.

Our work was motivated by the question whether, and to what extent, well-established risk factors mediate the racial disparity observed for colorectal cancer (CRC) incidence in the United States. Mediation analysis examines the relationships between an exposure, a mediator and an outcome. All available methods require access to a single complete data set with these three variables. However, because population-based studies usually include few non-White participants, these approaches have limited utility in answering our motivating question. Recently, we developed novel methods to integrate several data sets with incomplete information for mediation analysis. These methods have two limitations: (i) they only consider a single mediator and (ii) they require a data set containing individual-level data on the mediator and exposure (and possibly confounders) obtained by independent and identically distributed sampling from the target population. Here, we propose a new method for mediation analysis with several different data sets that accommodates complex survey and registry data, and allows for multiple mediators. The proposed approach yields unbiased causal effects estimates and confidence intervals with nominal coverage in simulations. We apply our method to data from U.S. cancer registries, a U.S.-population-representative survey and summary level odds-ratio estimates, to rigorously evaluate what proportion of the difference in CRC risk between non-Hispanic Whites and Blacks is mediated by three potentially modifiable risk factors (CRC screening history, body mass index, and regular aspirin use).

New-onset atrial fibrillation following arteriovenous fistula increases adverse clinical events in dialysis patients with end-stage renal disease.

End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance haemodialysis (MHD) patients. Arteriovenous fistula (AVF) is the preferred vascular access for MHD patients, but AVF significantly affects the haemodynamics of the cardiovascular system, leading to or exacerbating CVD, including atrial fibrillation (AF). This study aimed to evaluate the impact of AVF on cardiac function, especially of the left atrium (LA), in patients with ESRD and to further explore the relationship between AVF establishment and the occurrence of AF. We selected 1,107 ESRD patients on haemodialysis using AVF and 550 patients with tunneled-cuffed catheters (TCC) admitted between January 2016 and December 2022 for follow-up to compare the rate of AF between the two groups. A total of 153 patients in the AVF group with complete information (clinical data, echocardiographic and biochemical indices, and other data) were enrolled and retrospectively analysed for risk factors for the development of AF and were followed up for adverse clinical outcomes (including all-cause death, cardiac death, readmission due to heart failure, and stroke). The incidence of new-onset AF was higher in the AVF group than the TCC group after dialysis access was established (16.30% vs. 5.08%, P < 0.001). Echocardiography showed that the LA anteroposterior diameter increased (P < 0.001) and the incidence of AF increased from 11.76% to 26.14% (P = 0.001) after AVF establishment. Multivariate logistic regression analysis showed that age and LA enlargement were independent risk factors for new-onset AF after AVF establishment (P < 0.05). Adverse clinical outcomes were more common in patients with AF than in patients without AF (P < 0.001). Multivariate Cox risk regression analysis suggested that new-onset AF (HR = 4.08, 95% CI: 2.00-8.34, P < 0.001) and left ventricular systolic dysfunction (HR = 2.42, 95% CI: 1.20-4.88, P = 0.01) after AVF establishment were independent risk factors for adverse clinical outcomes. LA enlargement after AVF establishment is associated with a significant increase in the incidence of AF, in addition, AF which is as an important influential factor in patients with MHD combined other systemic diseases might increase adverse clinical events. (NCT06199609).

Chromatic Aberration Correction in Harmonic Diffractive Lenses Based on Compressed Sensing Encoding Imaging.

Large-aperture, lightweight, and high-resolution imaging are hallmarks of major optical systems. To eliminate aberrations, traditional systems are often bulky and complex, whereas the small volume and light weight of diffractive lenses position them as potential substitutes. However, their inherent diffraction mechanism leads to severe dispersion, which limits their application in wide spectral bands. Addressing the dispersion issue in diffractive lenses, we propose a chromatic aberration correction algorithm based on compressed sensing. Utilizing the diffractive lens's focusing ability at the reference wavelength and its degradation performance at other wavelengths, we employ compressed sensing to reconstruct images from incomplete image information. In this work, we design a harmonic diffractive lens with a diffractive order of M=150, an aperture of 40 mm, a focal length f0=320 mm, a reference wavelength λ0=550 nm, a wavelength range of 500-800 nm, and 7 annular zones. Through algorithmic recovery, we achieve clear imaging in the visible spectrum, with a peak signal-to-noise ratio (PSNR) of 22.85 dB, a correlation coefficient of 0.9596, and a root mean square error (RMSE) of 0.02, verifying the algorithm's effectiveness.

Interdependent network restoration games with incomplete information and bounded rationality.

Communities face the challenge of finding restoration strategies in the aftermath of disasters. In particular, independent and self-interested utility managers devise such strategies for infrastructure through a heuristic decentralized process. This paper takes a game-theoretic approach to model the decentralized and strategic restoration decision making with application to interdependent infrastructure. Particularly, we model the decision process using simultaneous games to investigate decision makers' conflicting preferences. We employ Bayesian games to incorporate the realistic assumptions of poor interagent communication, resulting in incomplete information. Also, we account for behavioral biases such as bounded rationality, cooperative behavior or lack thereof, and equality-driven resource allocations. We test our models using ideal, synthetic interdependent networks, and the realistic infrastructure of Shelby County, TN. Results show that cooperation leads to the best-performing decisions even if others are not cooperative. The necessity of cooperation is even higher when there is a dominant player whose service is vital to other players. Our sensitivity results highlight the significant influence of resource availability and allocation on the performance of restoration plans. Our approach enhances the practicality of decision models for community resilience, and unravels novel policy strategies such as cooperationincentives.

[Associations of onset age, diabetes duration and glycated hemoglobin level with ischemic stroke risk in type 2 diabetes patients: a prospective cohort study].

Objective: To investigate the associations of onset age, diabetes duration, and glycated hemoglobin (HbA1c) levels with ischemic stroke risk in type 2 diabetes patients. Methods: The participants were from Comprehensive Research on the Prevention and Control of the Diabetes in Jiangsu Province. The study used data from baseline survey from December 2013 to January 2014 and follow-up until December 31, 2021. After excluding the participants who had been diagnosed with stroke at baseline survey and those with incomplete information on onset age, diabetes duration, and HbA1c level, a total of 17 576 type 2 diabetes patients were included. Cox proportional hazard model was used to calculate the hazard ratio (HR) and 95%CI of onset age, diabetes duration, and HbA1c level for ischemic stroke. Results: During the median follow-up time of 8.02 years, 2 622 ischemic stroke cases were registered. Multivariate Cox proportional risk regression model showed that a 5-year increase in type 2 diabetes onset age was significantly associated with a 5% decreased risk for ischemic stroke (HR=0.95, 95%CI: 0.92-0.99). A 5-year increase in diabetes duration was associated with a 5% increased risk for ischemic stroke (HR=1.05, 95%CI: 1.02-1.10). Higher HbA1c (per 1 standard deviation increase:HR=1.17, 95%CI: 1.13-1.21) was associated with an increased risk for ischemic stroke. Conclusion: The earlier onset age of diabetes, longer diabetes duration, and high levels of HbA1c are associated with an increased risk for ischemic stroke in type 2 diabetes patients.

Assessment of the efficiency of the skidding portage on the slopes with incomplete information on the technological properties of thawing soils of the cryolithozone

Assessment of the efficiency of the skidding portage on the slopes with incomplete information on the technological properties of thawing soils of the cryolithozone

Post-operative Patient Portal Messaging is Associated With Return to the Emergency Department After Lumbar Spine Surgery.

Retrospective study. To explore the association between patients undergoing lumbar spine surgery who message their care team via an electronic patient portal (EPP) post-operatively and emergency department (ED) visits within 90 days of surgery. Secure patient messaging through electronic patient portals has grown over recent years. Despite its frequent utilization by patients to engage with their care team, its association with clinical outcomes remains unknown in spine surgery. This study was approved by our Institutional Review Board. Inclusion criteria were adults who underwent single-stage lumbar spine surgery between January 2016-June 2023. Patients with incomplete information, multi-stage surgeries, and those who died within 90 days of surgery were excluded. Patient sociodemographic, surgical, hospital readmission, and patient-provider engagement data were collected. A total of 13,135 patients were included. A total of 1,711 patients (13%) had a post-operative ED visit, and 4,791 patients (36%) used the patient portal to send a message after surgery. Sending a post-operative patient message after undergoing lumbar spine surgery was associated with an increased likelihood of having an ED visit that does not lead to readmission (1.29 (1.10-1.53), P = 0.002). Patients with high school degrees were more likely to have an ED visit without readmission (1.33 (1.08-1.65), P = 0.008). Patients at a higher risk of presenting to the ED post-operatively should be identified and may benefit from additional counseling and access to the care team virtually to limit unnecessary healthcare utilization. Focusing on patients who reach out via EPP messaging post-operatively may be a good target patient group to address first. Future research is needed to investigate the possible health literacy and other socioeconomic barriers affecting these patients so that appropriate, more cost-effective resources can be utilized to avoid clinically unnecessary and costly ED visits.

Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study.

Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients' information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app.

Long-term night shift work, genetic predisposition, and risk of incident asthma: a prospective cohort study.

Evidence about a potential link between current and lifetime night shift work and risk of incident asthma is insufficient. To investigate the association of current and lifetime night shift work with risk of incident asthma, and the modified effect of genetic susceptibility on this association. We included 253,773 individuals with complete night shift work information in the UK biobank. We calculated the standard polygenetic risk score (PRS) for asthma. The Cox proportional hazard models were conducted to estimate hazard ratios (HRs) and 95% CIs. After multivariable adjustments, we found that current night shift work was associated with an increased risk of incident asthma in a dose-response fashion (P for trend<0.001). Compared with day workers, those working usual/permanent night shifts had a 17% (95% CI: 1.04-1.33) higher risk of asthma incidence. In addition, we observed significant dose-dependent relationships of longer lifetime duration or frequency of night shift work with elevated risk of asthma incidence (all P for trend<0.05). Compared with never night shift workers, those with a duration (≥5 years) or frequency (≥8 nights/month) of night shift work exhibited a 20% (95% CI: 1.03-1.39) or 22% (95% CI: 1.03-1.44) higher risk of incident asthma, respectively. Moreover, the elevated risk of incident asthma related to current and lifetime night shift work exposure was strengthened by high PRS, although no significant shift work-PRS interactions were detected. Both current and lifetime night shift work may increase the risk of incident asthma, regardless of genetic predisposition to asthma.

Analysis of automatic design systems

The process of designing and developing a control program begins after the previous stage of the product life cycle has been completed and it begins with the work of the design bureau. It develops new design solutions, and the technical specification for the required product is agreed with the customer. Based on this, a product drawing with technical requirements is created, which is usually transmitted to the department (technologists-programmers), which is directly involved in the design and development of process control for the product. At this stage, as a rule, the technologist consults with the developer of the drawing for the required product to obtain complete information about the product in order to eliminate any errors. Such cases are not excluded when, from this moment on, the drawing is returned for revision to the department of the design bureau due to the inability to sell the product in metal due to lack of industrial capacity or poor design solutions that make the description of the manufacturing technology impossible. After receiving the terms of reference, the next step is the development of the technological process. The technological process must be compiled technically competently in accordance with the internal standards of the enterprise (everyone may have their own, but the structure of the compilation is the same) and be informative enough at least to eliminate the high probability of defects during manufacture. As statistics show, in many enterprises, the overwhelming percentage of defects appears due to the negligent attitude of operators of CNC machines due to deviations from the technological process.

Modeling and optimization of networked evolutionary game based on incomplete information with switched topologies

AbstractIn the realm of evolutionary game theory, the majority of scenarios involve players with incomplete knowledge, specially regarding their opponents' actions and payoffs compounded by the ever‐shifting landscape of players' interactions. These dynamics present formidable challenges in both the analysis and optimization of game evolution. To address this, a novel model named the networked evolutionary game (NEG) is proposed based on incomplete information with switched topologies. This model captures situations where players possess limited insight into their opponents' benefits, yet make decisions based on their own payoffs while adapting to different networks and new players. To bridge the gap between incomplete and complete information games, R. Selten's transformation method is leveraged, a renowned approach that converts an incomplete information game into an interim agent game, thereby establishing the equivalence of pure Nash equilibria (NE) in both scenarios. Employing the semi‐tensor product (STP) of matrices, a powerful tool in logistic system, the evolution of the model is articulated through algebraic relationships. This enables to unravel the patterns of game evolution and identify the corresponding pure Nash equilibria. By introducing control players, strategically positioned within the game, optimized control is facilitated over the evolutionary trajectory, ultimately leading to convergence towards an optimal outcome. Finally, these concepts are illustrated with a practical example within the paper.

Newsvendor decisions under incomplete information: behavioural experiments on information uncertainty

Abstract Accepted by: Aris Syntetos Exploring the effects of information uncertainty presents an extensive challenge to decision makers. This study presents a set of behavioural experiments that examine the impact of incomplete information on newsvendor decisions. Findings show that orders deviate from normative benchmarks when decision makers have incomplete information and this tendency is stronger when the demand distribution is not known. Comparison of decisions under incomplete information against behavioural benchmarks with full and no information reveal that the availability of price and cost information brings decisions significantly closer to normative levels when the underlying demand distribution is unknown. On the opposite spectrum, when demand information is available, not knowing price or cost does not lead to worse decisions. Analysing newsvendor profits under various information conditions, we find participants capture at most 84% of earnings they could have generated if they ordered the normative quantity in high-profit margin settings; the corresponding percentage is 51% in low-profit margin settings. Our results suggest decreasing uncertainty on the demand distribution has a consistently positive impact on profits, while uncertainty about cost or price does not have a significant effect. Implications of our findings on the differential impact of incomplete information are discussed via the backdrop of the prevalence of newsvendor framework across a wide range of operational decisions.

Evaluation of the reliability and accuracy of YouTube™ and TikTok™ contents about storage media for avulsed teeth: A cross-sectional study.

The preservation of avulsed teeth is critical in dental trauma management, necessitating effective storage media to ensure viable tooth reimplantation. The urgent need for accurate information has led both professional and non-professional individuals to increasingly seek guidance from video-sharing platforms such as YouTube™ and TikTok™. These platforms have become key resources for advice on such dental emergencies, but the reliability and accuracy of this information have not yet been systematically evaluated. This study aimed to assess the quality, accuracy, and reliability YouTube™ and TikTok™ of videos regarding storage solutions for avulsion injuries. A search was conducted on YouTube™ and TikTok™ on February 4th, 2023, using terms related to traumatic dental injuries, and 53 videos were included. Video demographics such as platform, duration, type, upload date, likes, and comments were recorded. Video content quality, reliability, and accuracy were measured using the Global Quality Scale (GQS), Journal of the American Medical Association (JAMA) benchmarks, and Video Information and Quality Index (VIQI). Research data were analyzed using SPSS IBM 24.0 at a 95% confidence interval. In total, 53 videos were examined. The average scores were JAMA: 1.70/4.00, modified DISCERN: 54.3/80.00, GQS: 3.88/5.00, and VIQI: 13.8/20.00. According to the modified DISCERN index, there were no "very poor" or "poor" quality videos, 49.05% were "moderate," 22.6% were "good," and 28.3% were "very good." No difference was found between YouTube™ and TikTok™ videos in terms of the modified DISCERN index, JAMA scores, GQS, and VIQI scoring (p > .05). Traumatic dental injuries are a common problem among children, and evaluating the reliability of available contents is becoming crucial for appropriate intervention. The study reveals that despite being sourced mainly from dental professionals, the overall quality of videos on avulsed tooth management was mediocre, underscoring the risks associated with misleading or incomplete information in such critical situations.

Is Public Ignorance a Problem? An Epistemic Defense of Really Existing Democracies

Does good governance require citizens to be knowledgeable of basic facts and best policy ideas? Some scholars suggest that it does, and propose disenfranchising the most ‘ignorant’ voters. In contrast, we argue, political systems are complex systems inevitably exhibiting incomplete, imperfect and asymmetric information that is dynamically generated in society from actors with diverse life experiences, antagonistic interests and often profoundly dissonant views and values, generating radical uncertainty among political elites over the consequences of their decisions. Radical uncertainty, radical dissonance and power asymmetry are inescapable properties of politics. Good performance significantly depends on how political elites navigate through radical uncertainty to handle radical dissonance. Democracy, by offering citizens equal rights to participate in politics and talk freely, both enables and compels political actors to track social feedback regarding the effects of their decisions on a diverse public, and consider it in ways that mitigate these three problems.

A state estimation method based on CNN-LSTM for ball screw

Ball screw is widely used in the engineering field, and accurate estimation of their state is crucial for the reliability of system operation. However, existing methods often overlook the time series characteristics and spatial correlation of vibration signals, unable to provide complete degradation information and divide the degradation process, resulting in limited prediction accuracy. Therefore, a state estimation method for ball screw based on Convolutional Neural Networks (CNN) and Long Short-Term Memory Neural Networks (LSTM) is proposed. An experiment of ball screw transmission equipment was conducted to collect vibration signals throughout the entire life cycle and verify the proposed method. Firstly, the frequency domain amplitude signal of the transformed ball screw is normalized to eliminate scale differences, which serves as the input for CNN feature extraction. Then, these deep features are input into the LSTM network to capture the fault evolution patterns that reveal the degradation of ball screw performance, and achieve accurate estimation of ball screw state. The final prediction accuracy was 97.87%, verifying the effectiveness of the proposed method.

A comparative study on physicochemical properties of rice and starch of white rice, black rice and black glutinous rice

Rice is a staple food for Indonesians and Asians in general. It is rich in starch, a component that can be developed as a texture agent, filler, or raw material for edible films, encapsulation, or other products. The characteristics of the starch produced will determine its functional properties. This study aimed to characterize the physicochemical properties of rice and starch of white rice, black rice, and black glutinous rice. In this study, rice was extracted using an alkaline method to obtain rice starch. The processing of rice into starch can change some of its characteristics. A comparative study was also conducted on rice starch. The results showed that the starch contents of white, black, and black glutinous rice were 85.48; 86.67; and 83.56% (db). Black glutinous rice contains more amylopectin than black and white rice. Resistant starch in the rice fractions was greater than the amount of resistant starch in the starch fractions. Black rice contained anthocyanins of 323.85 mg/100 g, while the anthocyanins in black glutinous rice reached 219.35 mg/100 g. Although in very small amounts, anthocyanins were detected in black rice and black glutinous rice starch fractions. The starch fraction has much lower antioxidant activity compared to that in the form of rice. It appears on all types of rice. The peak viscosities of the starch of white rice, black rice, and black glutinous rice were 3627, 5448, and 5001 cP with pasting temperatures of 79.10°C, 80.60°C, and 80.90°C. Physicochemical and pasting properties of the rice fraction and the starch fraction from white, black, and black glutinous rice provide complete information to be used as a basis for the manufacture of food products.

Socioeconomic Impacts of Climate Mitigation Actions in Greece: Quantitative Assessment and Public Perception

Appropriately designed and implemented climate mitigation actions have multiple co-benefits (yet some trade-offs cannot be excluded) that result in substantial social and economic value beyond their direct impact on reducing energy consumption and GHG emissions. Despite their wider acknowledgement by the research community, decision makers and the public have incomplete information on these multiple effects. This paper has a twofold objective: First, through analytical bottom-up approaches, it assesses, in quantitative terms, the macroeconomic effects and the public health benefits attributed to a variety of mitigation actions under consideration in the context of the Greek Energy and Climate Plan. Second, it investigates, through a social survey, how citizens perceive climate change and value these multiple impacts of mitigation actions, and to what extent they are willing to pay for them and support the adoption of policy measures aiming at the green transition of the Greek economy. We show that mitigation actions bring about significant health benefits, particularly in cities, and generate significant positive macroeconomic effects, particularly if mitigation actions focus on the decarbonization of the building sector and on the exploitation of local renewable sources. We also argue that most people do not realize that climate mitigation actions can have wider benefits for society, such as tackling energy poverty, improving public health, and creating new jobs. Unwillingness to pay tends to be the prominent attitude. People who are more reluctant to cover a part of the cost of environmental protection are less likely to perceive that climate change is one of the main challenges at global and national level and support the adoption of climate mitigation policies. In this context, the national strategy for climate change should focus on effectively informing and engaging the public in climate mitigation strategies, strengthening the public trust in government institutions, promoting mutually acceptable solutions with the local communities, and providing incentives for changing citizens’ behavior towards climate-related actions.

Higher ratio of plasma omega-6/omega-3 fatty acids is associated with greater risk of all-cause, cancer, and cardiovascular mortality: A population-based cohort study in UK Biobank.

Circulating omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) have been associated with various chronic diseases and mortality, but results are conflicting. Few studies examined the role of omega-6/omega-3 ratio in mortality. We investigated plasma omega-3 and omega-6 PUFAs and their ratio in relation to all-cause and cause-specific mortality in a large prospective cohort, the UK Biobank. Of 85,425 participants who had complete information on circulating PUFAs, 6461 died during follow-up, including 2794 from cancer and 1668 from cardiovascular disease (CVD). Associations were estimated by multivariable Cox proportional hazards regression with adjustment for relevant risk factors. Risk for all three mortality outcomes increased as the ratio of omega-6/omega-3 PUFAs increased (all Ptrend <0.05). Comparing the highest to the lowest quintiles, individuals had 26% (95% CI, 15-38%) higher total mortality, 14% (95% CI, 0-31%) higher cancer mortality, and 31% (95% CI, 10-55%) higher CVD mortality. Moreover, omega-3 and omega-6 PUFAs in plasma were all inversely associated with all-cause, cancer, and CVD mortality, with omega-3 showing stronger effects. Using a population-based cohort in UK Biobank, our study revealed a strong association between the ratio of circulating omega-6/omega-3 PUFAs and the risk of all-cause, cancer, and CVD mortality. Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institute of Health under the award number R35GM143060 (KY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Higher ratio of plasma omega-6/omega-3 fatty acids is associated with greater risk of all-cause, cancer, and cardiovascular mortality: A population-based cohort study in UK Biobank

Background:Circulating omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) have been associated with various chronic diseases and mortality, but results are conflicting. Few studies examined the role of omega-6/omega-3 ratio in mortality.Methods:We investigated plasma omega-3 and omega-6 PUFAs and their ratio in relation to all-cause and cause-specific mortality in a large prospective cohort, the UK Biobank. Of 85,425 participants who had complete information on circulating PUFAs, 6461 died during follow-up, including 2794 from cancer and 1668 from cardiovascular disease (CVD). Associations were estimated by multivariable Cox proportional hazards regression with adjustment for relevant risk factors.Results:Risk for all three mortality outcomes increased as the ratio of omega-6/omega-3 PUFAs increased (all Ptrend &lt;0.05). Comparing the highest to the lowest quintiles, individuals had 26% (95% CI, 15–38%) higher total mortality, 14% (95% CI, 0–31%) higher cancer mortality, and 31% (95% CI, 10–55%) higher CVD mortality. Moreover, omega-3 and omega-6 PUFAs in plasma were all inversely associated with all-cause, cancer, and CVD mortality, with omega-3 showing stronger effects.Conclusions:Using a population-based cohort in UK Biobank, our study revealed a strong association between the ratio of circulating omega-6/omega-3 PUFAs and the risk of all-cause, cancer, and CVD mortality.Funding:Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institute of Health under the award number R35GM143060 (KY). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Informational continuity of medication management in transitions of care: Qualitative interviews with stakeholders from the HYPERION-TransCare study.

The transition of patients between inpatient and outpatient care can lead to adverse events and medication-related problems due to medication and communication errors, such as medication discontinuation, the frequency of (re-)hospitalizations, and increased morbidity and mortality. Older patients with multimorbidity and polypharmacy are particularly at high risk during transitions of care. Previous research highlighted the need for interventions to improve transitions of care in order to support information continuity, coordination, and communication. The HYPERION-TransCare project aims to improve the continuity of medication management for older patients during transitions of care. Using a qualitative design, 32 expert interviews were conducted to explore the perspectives of key stakeholders, which included healthcare professionals, patients and one informal caregiver, on transitions of care. Interviews were conducted between October 2020 and January 2021, transcribed verbatim and analyzed using content analysis. We narratively summarized four main topics (stakeholders' tasks, challenges, ideas for solutions and best practice examples, and patient-related factors) and mapped them in a patient journey map. Lacking or incomplete information on patients' medication and health conditions, inappropriate communication and collaboration between healthcare providers within and across settings, and insufficient digital support limit the continuity of medication management. The study confirms that medication management during transitions of care is a complex process that can be compromised by a variety of factors. Legal requirements and standardized processes are urgently needed to ensure adequate exchange of information and organization of medication management before, during and after hospital admissions. Despite the numerous barriers identified, the findings indicate that involved healthcare professionals from both the inpatient and outpatient care settings have a common understanding.