Death Classification Research Articles

Changing Trends in Sickle Cell Disease-Related Mortality in the United States over Four Decades

Introduction: Sickle cell disease (SCD) causes significant morbidity and early mortality. The Cooperative Study of Sickle Cell Disease estimated median life expectancy for individuals with SCD at 42 years for males and 48 years for females in the early 1990s. However, this calculation was made prior to now standards-of-care in SCD, including routine transcranial doppler screening, pneumococcal prophylaxis, and the introduction of the primary disease-modifying therapy hydroxyurea and the widespread use of chronic blood transfusion. Over the last thirty years, with expanded access to disease modifying therapies, increased evidence exists for the preservation of organ function and less frequent acute vaso-occlusive pain. It remains unclear whether the introduction of these therapies has affected overall SCD-related mortality or the specific causes of death of those with SCD in the United States, particularly in the last decade when the use of hydroxyurea has expanded most significantly. Methods: We used the US mortality statistics for 1979-2020 available publicly through the CDC WONDER database (http://wonder.cdc.gov), which is a compilation of county, state, and national-level mortality statistics derived from death certificates, including age category at death, sex, race, ethnicity, year of death, underlying cause of death, and additional contributing causes using ICD-9 codes for 1979-1998 (282.6 sickle cell anemia- all SCD genotypes were included under one code in ICD-9) and ICD-10 codes for 1999-2020 (D57.0 sickle cell anemia with crisis; D57.1 sickle cell anemia without crisis; D57.2 double heterozygous sickling disorders; D57.8 other sickle cell disorders). We searched the SCD ICD-10 codes listed as underlying cause of death by five-year age groups for Black individuals and all ethnicities, (from Hamideh and Alvarez, Pediatric Blood and Cancer 2013) and compared the crude death rates overall and for each age group to those of 1999-2009. We also searched using the SCD ICD-10 codes included in “the multiple causes of death” to determine the 15 most common ICD categories of death in each 10-year period. Results: For the period 2010-2020, 5272 Black (Hispanic & non-Hispanic) individuals died in the United States with the underlying cause of death listed as one of the ICD-10 SCD codes (see Figure 1A for a map of the crude mortality rate distribution). The crude mortality rate was 1.1 per 100,000 Black individuals, which was significantly lower than the period 1999-2009 (crude rate 1.2 per 100,000, p < 0.0001) (Figure 1B). Of note, similar to prior trends, there is a significant increase in mortality rate in the 15-19 year age group versus 20-24 years (0.9 per 100,000 to 1.4 per 100,000, p < 0.0001) corresponding with the age of transition to adult centers. The mean age at death for all genotypes for 2010-2020 was 43 years (females: 44 years, males: 41 years) versus 39 years for 1999-2009 (females: 40 years, males: 38 years). For the period 2010-2020, 61% of cases listed SCD as the primary cause of death without specificity or proximal cause; for the other 39% of cases when an underlying cause of death was noted, cardiovascular disease was the most common (28%), followed by accidents (7%), cerebrovascular disease (7%), malignancy (6%), septicemia (4.8%), and renal disease (3.8%). The fifteen most common causes of death accounted for 90% of underlying causes of death listed in the SCD population. Conclusion: The sickle cell disease-related mortality rate has significantly declined over the last 40 years, including in the period 1999-2020, corresponding with the introduction of disease modifying therapies, improved SCD care, and decreased infant mortality. This overall improvement, however, provides contrast to the enduring sharp increase in mortality in the young adult years. This demonstrates the critical need to improve the transition process from pediatric to adult care and to emphasize the need for additional support for young adults after they transition to adult SCD care.

Accident Severity Analysis On the North-South Expressway Using Binomial Logistic Regression

Accidents on Malaysian expressways must be monitored on a regular basis since severe accidents occur on expressways due to higher posted speeds than on other roadways. This study aims to analyse accident severities based on pavement conditions using binomial logistic regression. Data on accident severities and pavement conditions were gathered from the Malaysian Highway Authority (MHA) and the The Royal Malaysian Police (PDRM) respectively. Three binomial logistic regression models were constructed based on four accident severity categories of death, serious injury, minor injury and damage. The accident severity was grouped into different classifications in which Model 1, Model 2 and Model 3 were developed. To assess the model's predictive capabilities, predicted accident severity levels were distinguished with actual accident severity levels. Based on the results, Model 1 and Model 2 except Model 3 have significant pavement conditions and are viable for accident severity predictions whereby both models exhibited high prediction accuracy, has good fit and good in differentiating between two classifications. The model's classifier is better at classifying accident severity classes with more samples than categorizing accident severity classes with fewer data. The odds ratio of both Model 1 and Model 2 revealed that International Roughness Index (IRI) has greater influence in predicting accident severity compared to rut depth (RD) and mean texture depth (MTD) particularly on predicting death. This study suggested that a comparable study be conducted on other road classifications.

Improved Survival with Rituximab-Based Chemoimmunotherapy in Patients with Primary Testicular Diffuse Large B-Cell Lymphoma

Background: Primary testicular lymphoma (PTL) accounts for 1% to 2% of non-Hodgkin's lymphomas. Diffuse large B-cell lymphoma (DLBCL) is the most common histological subtype of PTL, accounting for 80% to 98% of cases. The introduction of rituximab was a breakthrough in DLBCL treatment. However, the impact of rituximab on primary testicular DLBCL (PT-DLCBL) is controversial. A study by Gundrum et al (Gundrum JD, et al. J Clin Oncol 2009) found that PT-DLBCL survival did not improve in the rituximab era (i.e., after 2000). However, that study was based on a Surveillance, Epidemiology, and End Results (SEER) database cut-off of 2005. The follow-up period of PT-DLBCL patients in the rituximab era was relatively short, at only 4 years (from 2001 to 2005). Considering the wide use of rituximab in all kinds of DLCBL, we conducted a study based on the SEER database to evaluate the potential impact of the introduction of rituximab on PT-DLBCL. Methods: Data from the SEER 13 registries were analyzed in this study. Cases with PT-DLBCL diagnosed from 1992 to 2018 were included. Baseline characteristics, including age at diagnosis, laterality (left, right, bilateral), age, race, Ann Arbor stage, SEER cause-specific death classification, survival months, and vital status, were collected. Cancer-specific survival (CSS) was used as the study endpoint and defined as the time from diagnosis to death from DLBCL or last follow-up. The Kaplan-Meier method was used to build survival curves and the log-rank test used to compare groups. All p values were two-sided, and p-values < .05 considered statistically significant. All analyses were conducted using GraphPad PRISM 6. Results: A total of 961 patients were included in this analysis. Among them, 271 were diagnosed from 1992 through 2000 (pre-rituximab era) and 690 from 2001 through 2018 (rituximab era). In all, 435 patients showed unilateral left-side testicular involvement, 455 right-side, 63 bilateral, and 8 unknown. At last follow-up, 489 patients had died of PT-DLBCL. Patients diagnosed in the pre-rituximab era had more stage I disease than their counterparts in the rituximab era. No difference was found in age, race, or laterality across the two eras. For the entire cohort, there was a significant improvement in CSS in the rituximab era compared with the pre-rituximab era. The median CSS in the pre-rituximab era was 98 months compared to not reached in the rituximab era ( p = .001) (Figure 1A). We also compared the CSS of patients in different stages: early stage (I/II) or advanced stage (III/IV) in the pre-rituximab and rituximab eras. We found that CSS improved significantly in either early or advanced stage (early stage, p < .0017; advanced stage, p = .026; Figure 1B and 1C). We also explored the role of laterality in survival of PT-DLBCL. Compared with the pre-rituximab era, CSS of either left-side (Figure 1D) or right-side (Figure 1E) PT-DLBCL improved significantly (left-side, p < .001; right-side, p = .04) in the rituximab era. The introduction of rituximab decreased CSS by about 50% in patients with left-side PT-DLBCL but only about 30% in those with right-side disease, which indicated that patients with left-side (vs right-side) PT-DLBCL derived greater survival benefit from the introduction of rituximab. Conclusions: Survival of PT-DLBCL patients improved significantly in the rituximab era, with the survival curve reaching a plateau from the tenth year after treatment. Patients with left-side (vs right-side) PT-DLBCL derived greater survival benefit from the introduction of rituximab.

NEW PREDICTIVE BIOMARKERS FOR SCREENING COVID-19 PATIENTS WITH RHABDOMYOLYSIS IN COMBINATION WITH CYSTATIN C.

Purpose: Cystatin C (CysC) has been linked to the prognosis of corona virus disease 2019 (COVID-19). The study aims to investigate a predictor correlated with CysC screening for poor prognosis in COVID-19 patients combined with skeletal muscle (SKM) impairment and rhabdomyolysis (RM). Methods: A single-center retrospective cohort analysis was carried out. Demographic information, clinical data, laboratory test results, and clinical outcome data were gathered and analyzed. Results: According to the inclusion and exclusion criteria, 382 patients were included in this study. The subjects were divided into three groups based on CysC tertiles. Multivariate analysis revealed that SaO 2 (hazard ratio [HR], 0.946; 95% confidence interval [CI], 0.906-0.987; P = 0.011), CysC (HR, 2.124; 95% CI, 1.223-3.689; P = 0.008), aspartate aminotransferase (AST) (HR, 1.009; 95% CI, 1.000-1.018; P = 0.041), and hypersensitive C-reactive protein (HR, 1.005; 95% CI, 1.000-1.010; P = 0.045) were significantly associated with survivals. The area under curve (AUC) in the model characterized by RM incidence was 0.819 (0.698-0.941), as shown by CysC receiver operating characteristic curves. LDH*CysC and AST*CysC had better predictive values than CysC and the best prediction for RM, with an AUC of 0.880 (0.796,0.964) for LDH*CysC ( P < 0.05, vs CysC) and 0.925 (0.878,0.972) for AST*CysC ( P < 0.05, vs CysC). Conclusion: CysC is an essential evaluation indicator for COVID-19 patients' prognosis. AST*CysC and LDH*CysC have superior predictive value to CysC for SKM, RM, and death, and optimal classification for RM.

Abstract 14337: Identification of New Clinical Phenotypes of Sudden Cardiac Death Using Artificial Intelligence

Introduction: Current classifications of Sudden Cardiac Death (SCD) are based on cardiovascular (CV) conditions and risk factors, and frequently fail to explain numerous SCD cases. Hypothesis: a data-driven machine learning approach could identify new clinical phenotypes of SCD in the general population, using a wide range of CV and non-CV variables. Methods: All case of SCD over 18y that occurred between 2011-15 in Paris and suburbs were included in the Paris Sudden Death Expertise Center. Data from the French National Health Insurance database that occurred up to 10y before SCD were collected (drugs, examinations,diagnosis). We performed a non-supervised statistical approach to identify relevant clinical phenotypes of SCD, using clustering and dimension reduction methods. A validation was performed between 2016-20. Results: 12,651 SCD subjects were included. Mean age was 68y, and 61% were men. The clustering analysis identified 8 distinct clusters of SCD, with homogeneous characteristics. 3 clusters were already well known: a group mainly composed of aged women (3,307, 38% men, 81y), one with mainly CV diseases (3,638, 74% men, 74y) and one of young subjects with very few comorbidities (2,645, 65%men, 54 y). 4 non-CV clusters were identified: a group with psychiatric and/or neurologic disorders (862), a group with chronic or acute pulmonary diseases (688) and a group with malignant neoplasms of different sites and related drugs (518), and a group with kidney diseases (279). The last group was composed of subjects with characteristics related to social deprivation (alcohol related disorder, hepatitis, HIV, etc) (252).The same 8 clusters were identified in the validation cohort (11,485). Conclusions: By extending far beyond CV pathology, our approach provides for the first time a global picture of SCD, revealing the involvement of extra CV medical fields that might eventually lead to discover new pathways and help identifying high risk subjects.

Deaths of despair in England: an observational study of local authority mortality data

BackgroundDeaths of Despair (DoD) are socially patterned causes of death encompassing drug and alcohol misuse and suicide. DoDs are strongly associated with socioeconomic disadvantage. England has high levels of inequalities, so we hypothesised the existence of marked geographical variations in DoD. We aimed to yield new knowledge on the spatial distribution of DoD, and area-level socioeconomic factors that predict DoD risk in England. MethodsThis observational study was conducted using ICD-10 coded deaths for 307 local authorities in England during 2019–21. Deaths were grouped to non-overlapping categories of drug-related death, alcohol-specific death, and suicide. The mean contributions of each of these causes to the total number of DoD in England were calculated with Poisson exact confidence intervals. Standardised mortality ratios (SMRs) for DoD were generated for each local authority population. A multivariable regression model for DoD risk was developed using 25 socioeconomic variables. FindingsAn estimated 46 200 people lost their lives due to DoD between Jan 1, 2019, and Dec 31, 2021. Regional SMRs ranged from 57·4 (SD 16·1) in London to 144·1 (SD 26·8) in the northeast of England (p<0·0001). Alcohol-specific deaths were the largest contributor of DoD, accounting for 44·1% of DoD (95% CI 43·5–44·8), followed by drug-related death (28·1%, 27·7–28·6) and suicide (27·7%, 27·2–28·2). Living in the North, living alone, White British ethnicity, lower inward migration, economic inactivity, income deprivation in older people, employment in elementary occupations, unemployment, and education deprivation in adults were significantly associated with higher DoD rates in England. InterpretationDoD in England are spatially patterned, with northern regions experiencing a considerably higher burden of mortality from these avoidable causes. A key limitation is ecological bias. This study provides novel insights into area-level risk factors for DoD in England. FundingNational Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM).

Causes of stillbirth in ethnically diverse women in a Perth metropolitan hospital: A retrospective study.

Most published reports analysing the differences in causation of stillbirth between different ethnic groups focus on stillbirth risk factors, with a paucity of data comparing actual causes of stillbirth. To determine whether causes of stillbirth differ between Caucasian and non-Caucasian ethnic groups in an Australian context. Data from all stillbirths occurring at 20 or more completed weeks of gestation between 1 January 2010 and 31 December 2020 at a secondary level, outer metropolitan hospital, were analysed in this retrospective case series. Causes of stillbirth as determined by perinatal autopsy and placental histopathology were categorised using the Perinatal Society of Australia and New Zealand Perinatal Death Classification and compared between Caucasian and non-Caucasian groups. Ninety-two stillbirths (0.7% of all births) were identified during the study period. A greater proportion of non-Caucasian women had small for gestation age placentas compared to Caucasian women (n = 22/43 (51%) vs n = 12/49 (24%); P = 0.025). A greater proportion of stillbirths were caused by hypoxic peripartum death in non-Caucasian than in Caucasian women (n = 4/43 (9%) vs n = 0/49 (0%); P = 0.044), and a greater prevalence of placental dysfunction was seen in the non-Caucasian cohort compared to Caucasian women (n = 14/43 (33%) vs n = 8/49 (16%); P = 0.057). The differences observed in causes of stillbirth between Caucasian and non-Caucasian women are hypothesis generating and warrant further larger-scale, multi-centred studies using standardised definitions and classification systems to determine whether these differences persist in a more representative sample.

Talking about Death: the Thanatological Perspective of Polish Teachers’ Language and Literature

Research on thanatopedagogy a subdiscipline of pedagogy is constantly developing. In Polish educational research, the prevailing position is that the category of death is not present in education. The aim of the article is to present the results of the empirical research on the experiences of Polish language teachers in dealing with this subject. The survey method was chosen to achieve the goal, and the main research question was: what are the teachers' experiences in dealing with this subject? The research was conducted in July 2023 and covered over 145 teachers. Teachers' declarations were collected on the frequency of talking to students about the death or loss, the declared level of preparation for conducting this type of class, students' reactions, and the barrier in these conversations. Respondents were asked to assess the usefulness of talking about death, as well as the benefits of discussing this topic. The conclusions emphasized that although thanatopedagogical education is conducted on a large scale by Polish language teachers, further attempts should be made to assess its quality.

BEYOND CAUSAL EXPLANATIONS: the understanding of suicide from the perspective of existential phenomenological psychology

This article is about suicide on the Phenomenological Existential Psychology perspective. The question that guides this study is: how does the Phenomenological Existential Psychology understands and analyses the suicide subject? The general goal of the article is to discuss the matter of the suicide under the heideggerian Phenomenological Existential Psychology’s view. The specific goals are: contextualize the suicide matter; to understand the finitude, death and autonomy categories; and analyse the discussion of moralization, blaming and pathologizing of the suicide. This is a narrative literature review that attempts to describe the development of such theme, through the analysis of scientific production. Starting with a statistical analysis and the different ways of understanding of the suicide, this article attempted to reach a deeper reflection about the existential matters about the phenomenon. Going through reflections about the meaning of finitude, using some ideas, such as anguish, freedom and choice, and also aspects involving matters of cause and motive. Lastly, we attempted to deepen the interpretations of traditional labelers that that remains about the ways of understanding the behavior of putting an end to one’s own life. With an emphasis for the moralizing view, of blaming and pathologizing. We hope that the discussions made can favor a point of view that encompasses the subjectivity and complexity of each existence regarding suicide.

What was Killing Babies in Amsterdam? A Study of Infant Mortality Patterns Using Individual-Level Cause of Death Data, 1856–1904

Based on unique individual-level cause of death data, this article presents an analysis of the development of infant mortality and the underlying cause of death pattern in the city of Amsterdam in the period 1856–1904. We contribute to the discussion on the development of infant mortality and its determinants and test the newly-constructed ICD10h coding system. First, our results demonstrate that the ICD10h and groupings of causes worked quite well for our period and city data. Second, Amsterdam moved from being one of the most lethal cities in the country to one of the healthiest for infants. These improvements in the fate of infants were brought about despite faltering progress in the provision of piped water, and an absence of modern sewerage throughout the period. For the entire period air-borne diseases were a prominent cause of death category, peaking in the 1880s and still making up the major group of diseases by 1904. Water- and food related ailments were also dominating the epidemiological pattern after the 1870s. Vague or ill-defined disease terms were frequent at the start of the study period. These observations suggest that physicians were increasingly better able and more prepared to formulate more precise disease terms by the 1900s. The seasonality analysis of the different disease groups demonstrates strong summer effects on the group of water- and food related causes of death. It testifies to the shortcomings in the city’s hygienic situation and limited breastfeeding.

A NOVEL MULTIFRACTAL-BASED METHOD FOR PREDICTION OF SUDDEN CARDIAC DEATH BY DIFFERENTIATING CARDIAC SIGNALS IN TWO ABNORMAL HEART CONDITIONS

Many of the used features in sudden cardiac death (SCD) classification algorithms are based on features present in the autonomic system. However, changes in the autonomic system occur in both SCD subjects and patients with congestive heart failure (CHF). Therefore, many overlaps are observed in the features extracted from the cardiac signals of these two groups. To solve this challenge, this paper studies the changes in the multifractal dimension in patients with SCD and compares it with the subjects with CHF using the heart rate variability (HRV) signal processing. For this purpose, HRV signals are initially extracted, and their four sub-signals are determined using the empirical mode decomposition (EMD) method. Afterward, the instant amplitude of each sub-signal obtained in the previous step is calculated using the Teager energy method; thus, new signals are generated through the utilization of these instant amplitudes. Subsequently, modifications in each new signal’s fractal dimensions are obtained using the multifractal detrended fluctuation analysis (MF-DFA) method. The appropriate features are selected using the t-test method and are applied to the support vector machine algorithm as input data. The proposed algorithm can differentiate the signal of SCD subjects with an average accuracy of 84.08% in 26[Formula: see text]min prior to the event.

Estimating alcohol-attributable injury deaths: A comparison of epidemiological methods.

Injuries often involve alcohol, but determining the proportion caused by alcohol is difficult. Several approaches have been used to determine the causal role of alcohol, but these methods have not been compared directly with one another. Such a comparison would be useful for understanding the strengths and comparability of different approaches. This study compared estimates of average annual alcohol-attributable deaths in the United States from injuries during 2015-19 using a blood alcohol concentration (BAC) method compared with a population attributable fraction (PAF) approach. For the BAC method, we used a direct method involving the proportion of decedents with a high blood alcohol concentration (BAC; e.g. ≥ 0.10%). For the PAF approach, we compared the use of unadjusted survey data with average consumption data adjusted using alcohol sales data to account for underreporting and also accounting for the underreporting of binge drinking. Survey data were from the Behavioral Risk Factor Surveillance System and mortality data were from the National Vital Statistics System. The number of alcohol-attributable injury deaths using the direct method (48 516 deaths annually) was similar to that using PAF methods (47 879 deaths annually), but only when alcohol use measures were adjusted using alcohol sales data. Furthermore, estimates were similar for cause-specific categories of deaths, including non-motor vehicle unintentional injuries and motor vehicle crashes. Among PAF methods, excessive drinking accounted for 38.3% of injury deaths using unadjusted survey data, but 64.8% of injury deaths using adjusted data. Estimates of alcohol-attributable injury deaths from a direct method and from a population attributable fraction method that adjusts for alcohol use based on alcohol sales data appear to be comparable.

BENTUK DAN STRUKTUR SUPERSTISI KATEGORI KEMATIAN DAN ADAT PEMAKAMAN PADA MASYARAKAT MELAYU RUMBAI TIMUR

Superstition is a belief that cannot be proven logically and does not necessarily occur. In this study the authors took one village among the villages in East Rumbai District, namely the village of Tebing Tinggi Okura. This research is also motivated by the researcher's desire to find out the structure and meaning contained in the superstitious East Rumbai Malay community which is formed by the relationship between different life values ​​and beliefs. The purpose of this study is to describe the form and structure of the superstitious categories of death and burial customs in the Malay community in Tebing Tinggi Okura Rumbai Timur Village, Pekanbaru City. The approach to this study uses a qualitative approach while the research method is a qualitative descriptive method with a type of field research. The analysis in this study was carried out in three stages, namely data reduction, data presentation and conclusion. Based on the results of the analysis in this study, there were 27 superstitious forms of death category data and funeral customs. Of the 27 data that has been obtained, 23 data are classified into a two-part structure, namely cause and effect, while the other 4 data include a three-part structure, namely a sign, a change from one state to another (conversion), and a result. The East Rumbai Malay community, especially the village of Tebing Tinggi Okura, has instilled superstitious values ​​in their daily lives, because the use of this superstition can regulate the order of norms in their collective society, especially in death and funeral customs in the East Rumbai Malay community.

Maintaining the Utility of Coronavirus Disease 2019 Pandemic Severity Surveillance: Evaluation of Trends in Attributable Deaths and Development and Validation of a Measurement Tool.

Death within a specified time window following a positive SARS-CoV-2 test is used by some agencies for attributing death to COVID-19. With Omicron variants, widespread immunity, and asymptomatic screening, there is cause to re-evaluate COVID-19 death attribution methods and develop tools to improve case ascertainment. All patients who died following microbiologically confirmed SARS-CoV-2 in the Veterans Health Administration (VA) and at Tufts Medical Center (TMC) were identified. Records of selected vaccinated VA patients with positive tests in 2022, and of all TMC patients with positive tests in 2021-2022, were manually reviewed to classify deaths as COVID-19-related (either directly caused by or contributed to), focused on deaths within 30 days. Logistic regression was used to develop and validate a surveillance model for identifying deaths in which COVID-19 was causal or contributory. Among vaccinated VA patients who died ≤30 days after a positive test in January-February 2022, death was COVID-19-related in 103/150 cases (69%) (55% causal, 14% contributory). In June-August 2022, death was COVID-19-related in 70/150 cases (47%) (22% causal, 25% contributory). Similar results were seen among the 71 patients who died at TMC. A model including hypoxemia, remdesivir, and anti-inflammatory drugs had positive and negative predictive values of 0.82-0.95 and 0.64-0.83, respectively. By mid-2022, "death within 30 days" did not provide an accurate estimate of COVID-19-related death in 2 US healthcare systems with routine admission screening. Hypoxemia and use of antiviral and anti-inflammatory drugs-variables feasible for reporting to public health agencies-would improve classification of death as COVID-19-related.

Curriculum Innovation: Teaching Neuroethics Through a Case-Based Undergraduate Medical Education Workshop: Implementation and Evaluation.

Medical students on their clinical neurology clerkship often encounter ethically challenging situations, yet formal neuroethics training is limited. This study sought to evaluate a case-based small-group workshop that was implemented to introduce students to important neuroethics concepts and resources. (1) To define decision-making capacity and describe how it is assessed in neurologic illness; (2) to define the legal category of brain death and its evolution over time; (3) to describe the legal process for surrogate decision making in the state of Maryland; (4) to identify barriers to goals-of-care conversations; and (5) to reflect on how personal beliefs of patients and physicians influence delivery of care and medical decision making. A 1.5-hour interactive curriculum for medical students on the neurology clerkship covering ethical considerations in brain death, surrogate decision making, and navigating conversations surrounding these topics (with reference to lesbian, gay, bisexual, transgender, queer/questioning, and others' health and health disparities) was designed and implemented over 2 years. Curriculum outcomes were measured by preworkshop and postworkshop self-assessment surveys. Learner reactions were measured by self-reported interest in ethics and perceived utility of the curriculum. Content knowledge was measured through multiple-choice questions on brain death and capacity assessment, which were scored for correctness by the study team, and self-reported confidence in ethical reasoning. Changes in these metrics were analyzed for paired precourse and postcourse responses to determine the effectiveness of the session. The study recruited 234 of 356 rotating students (65.7% response rate). Presurvey data revealed that 36% had encountered a challenging clinical scenario before the intervention. Preintervention and postintervention paired data were available for 184 (79%) respondents. Of these, 66% reported increased confidence in their knowledge of ethics, and 42% reported increased interest in ethics. Presession performance on content questions did not differ significantly based on prior clinical ethics experience. Performance on neuroethics content questions improved significantly after the session as demonstrated by the increase in the percentage of students providing correct answers to content questions between the presurvey and postsurvey (17% increase for capacity assessment, 19% increase for brain death, and 22% increase for surrogate decision making, p < 0.0001). An interactive neuroethics workshop using a case-based discussion format integrates ethics and health disparity education into the clinical neurology curriculum and enhanced knowledge and confidence in medical ethics. This curriculum increases student interest in ethics, confidence in their ability to perform ethical reasoning tasks, and content knowledge of brain death and surrogate decision making.

Incidence, causes, and risk factors of stillbirth in an Amazonian context: Saint Laurent du Maroni maternity ward 2016–2021

We aimed to describe the epidemiology of intrauterine fetal deaths in multiethnic western French Guiana and to assess its main causes and risk factors. A retrospective descriptive study was conducted based on data from January 2016 to December 2021. All information on stillbirth with a gestational age ≥20 weeks in the Western French Guiana Hospital Center was extracted. Terminations of pregnancy were excluded. We focused on medical history, clinical investigation, biological findings, placental histology, and autopsy examination to elucidate the cause of death. We used the Initial Cause of Fetal Death (INCODE) classification system for assessment. Univariable and multivariable logistic regression analyses were performed. Overall, 331 fetuses in 318 stillbirth deliveries were reviewed and compared to live births that occurred during the same period. The rate of fetal death varied between 1.3 % and 2.1 %, with an average of 1.8 % over the 6-year period. Poor antenatal care (104/318, 32.7 %), obesity ≥30kg/m2 (88/318, 31.7 %), and preeclampsia (59/318, 18.5 %) were the main risk factors associated with fetal death in this group. Four hypertensive crises were reported. According to the INCODE classification, the main causes of fetal death were obstetric complications (112/331, 33.8 %), particularly intrapartum fetal death with labor-associated asphyxia under 26 weeks (64/112, 57.1 %), and placental abruption (29/112, 25.9 %). Maternal-fetal infections were common, particularly mosquito-borne diseases (e.g., Zika virus, dengue, and malaria), re-emerging infectious agents such as syphilis, and severe maternal infections (8/331, 2.4 %). 19.3 % of fetal deaths (64/331) remained unexplained. Change in lifestyle as well as social deprivation and isolation adversely affect pregnancy in western French Guiana, in the context of a poor health care system that is similar to what is found in the Amazonian basin. Particular attention must be paid to emerging infectious agents in pregnant women and travelers returning from the Amazon region.

Validation of a tool for determining the clinical utility of stillbirth investigations.

Up to 20% of all stillbirths and 45% of term stillbirths are currently classified as unexplained. Many of these stillbirths do not undergo currently recommended investigations. This may leave questions unanswered and not identify stillbirths with a recurrence risk in subsequent pregnancies. To validate a new tool (Stillbirth Investigation Utility Tool) to identify the clinical utility of investigations in stillbirth and the inter-rater agreement on cause of stillbirth using the Perinatal Society of Australia and New Zealand-Perinatal Death Classification (PSANZ-PDC). Thirty-four stillbirths were randomly selected for inclusion, each assessed independently by five blinded assessors. The investigations were grouped into three categories: clinical and laboratory; placental pathology; and autopsy examination. The cause of death was assigned at the end of each group. Outcome measures were clinical utility of investigations measured by assessor rated usefulness and inter-rater agreement on the assigned cause of death. Comprehensive maternal history, maternal full blood count, maternal blood group and screen and placenta histopathology were useful in all cases. Clinical photographs were not performed and should have been performed in 50% of cases. The inter-rater agreement on cause of death assigned after all investigation results was 0.93 (95% CI 0.87-1.0). The new Stillbirth Investigation Utility Tool showed very good agreement in assigning the cause of death using PSANZ-PDC. Four investigations were useful in all cases. Minor refinements will be made based on feedback to enhance usability for wider implementation in research studies to assess the yield of investigations in stillbirths.

Mortality rates and proximal causes of death in patients with Lewy body dementia versus Alzheimer's disease: Alongitudinal study using secondary care mental health records.

Previous studies have shown reduced survival in Lewy body dementia (LBD) compared to Alzheimer's disease (AD), but the reasons for this are not known. We identified cause of death categories accounting for the reduced survival in LBD. We linked cohorts of patients with dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD) and AD, with proximal cause of death data. We examined mortality by dementia group and hazard ratios for each death category by dementia group in males and females separately. In a specific focus on the dementia group with the highest mortality rate versus reference, we examined cumulative incidence to identify the main causes of death accounting for the excess deaths. Hazard ratios for death were higher in PDD and DLB compared to AD, for both males and females. PDD males had the highest hazard ratio for death across the dementia comparison groups (HR 2.7, 95% CI 2.2-3.3). Compared with AD, hazard ratios for "nervous system" causes of death were significantly elevated in all LBD groups. Additional significant cause-of-death categories included aspiration pneumonia, genitourinary causes, other respiratory causes, circulatory and a "symptoms and signs" category in PDD males; other respiratory causes in DLB males; mental disorders in PDD females; and aspiration pneumonia, genitourinary and other respiratory causes in DLB females. Further research and cohort development is required to investigate differences by age group, to extend cohort follow-up to the whole population and to investigate the risk-balance of interventions which may differ by dementia group.

Risk factors for deaths associated with COVID-19 according to the cause of death classification in Republic of Korea.

This study aimed to classify coronavirus disease 2019 (COVID-19)-related deaths according to whether COVID-19 was listed as the cause of death, and to investigate the differences in demographic characteristics and risk factors for COVID-19 death classifications. A total of 5,625 deaths in South Korea among patients with confirmed COVID-19 from January 20, 2020 to December 31, 2021 were selected. Excluding false reports and unnatural deaths, 5,597 deaths were analyzed. Based on death report data, deaths were classified according to whether the cause of death was listed as COVID-19 (CD) or not (NCD). The epidemiological characteristics and causes of deaths were investigated using descriptive, univariate, and multivariate statistical analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to analyze the risk factors. The case fatality ratio was 0.89% and increased with age. Additionally, 96.4% of the subjects had an underlying disease, and 53.4% died in winter. The proportion of NCDs was 9.3%, of whom 19.1% died at home and 39.0% were confirmed to have COVID-19 after death. Malignant neoplasms (102/416 vs. 637/4,442; OR, 1.71; 95% CI, 1.36-2.16; p<0.001) were significantly associated with NCD. This is the first study to analyze risk factors by cause of death using COVID-19 death report data in South Korea. These results are expected to be used as evidence for establishing a death monitoring system that can collect timely information in a new infectious disease pandemic.

Machine Learning-Assisted High-Throughput SERS Classification of Cell Secretomes.

During the response to different stress conditions, damaged cells react in multiple ways, including the release of a diverse cocktail of metabolites. Moreover, secretomes from dying cells can contribute to the effectiveness of anticancer therapies and can be exploited as predictive biomarkers. The nature of the stress and the resulting intracellular responses are key determinants of the secretome composition, but monitoring such processes remains technically arduous. Hence, there is growing interest in developing tools for noninvasive secretome screening. In this regard, it has been previously shown that the relative concentrations of relevant metabolites can be traced by surface-enhanced Raman scattering (SERS), thereby allowing label-free biofluid interrogation. However, conventional SERS approaches are insufficient to tackle the requirements imposed by high-throughput modalities, namely fast data acquisition and automatized analysis. Therefore, machine learning methodswereimplemented to identify cell secretome variations while extracting standard features for cell death classification. To this end, ad hoc microfluidic chipsweredevised, to readily conduct SERS measurements through a prototype relying on capillary pumps made of filter paper, which eventually would function as the SERS substrates. The developed strategy may pave the way toward a faster implementation of SERS into cell secretome classification, which can be extended even to laboratories lacking highly specialized facilities.