Estimates Of Mortality Research Articles

Spatial modelling and estimation of mammals' mortalities by Pantanal 2020 megafires

Abstract Extreme wildfire events, such as the Pantanal 2020 megafires, are expected to become more common. Assessing the impacts of such extreme events on wildlife is imperative for conservation planning. Direct observation of carcasses can provide valuable information on how these impacts relate to spatial heterogeneity. Here, we use double‐observer carcass surveys to assess the numbers and spatial patterns of direct mortalities of medium‐ to large‐sized mammals resulting from the Pantanal 2020 megafires in a large reserve (1080 km2) in the northern Pantanal wetland. Accounting for imperfect detection, we model the spatial variation in mortality occurrence and abundance, testing the effects of habitat‐related variables and wildfire severity using multi‐species N‐mixture models. We found that 26 out of 27 species of medium and large‐sized mammals died from the fires with a mean estimate of around 49 thousand individuals. The most affected species included capuchin monkeys, agoutis, peccaries, tapirs, brocket deer, tamanduas, coatis and capybaras. Direct mortality of mammals by wildfires was affected by landscape factors related to species habitats, species traits (probably related to escape or refuge strategies), and the intensity of the wildfires. Mortalities presented a general positive relationship with non‐flooded forests (a fire‐sensitive habitat in Pantanal) and with the severity of wildfires. Artificial water bodies, a common landscape structure in Pantanal, had 7.5 times more deaths than other areas. Synthesis and applications: With the approach used, we were able to: (i) identify mortality hotspots associated with landscape features; (ii) simultaneously identify the most affected species and assess the average relationships for all the assemblage of medium‐ and large‐sized mammals. We discuss conservation and management actions in two contexts: species prioritization for rescuing and monitoring; and territory prioritization for fire prevention and fighting.

The Impact of the Approach to Accounting for Age and Sex in Economic Models on Predicted Quality-Adjusted Life-Years.

The method used to model general population mortality estimates in cohort models can make a meaningful difference in appraisals; particularly in scenarios involving potentially curative treatments where a prior National Institute for Health and Care Excellence (NICE) appraisal demonstrated that this assumption alone could make a difference of ~£10,000 to the incremental cost-effectiveness ratio. Our objective was to evaluate the impact of different methods for calculating general population mortality estimates on the predicted total quality-adjusted life expectancy (QALE) as well as absolute and proportional quality-adjusted life year (QALY) shortfall calculations. We employed three distinct methods for deriving general population mortality estimates: firstly, utilizing the population mean age at baseline; secondly, modelling the distribution of mean age at baseline by fitting a parametric distribution to patient-level data sourced from the Health Survey for England (HSE); and thirdly, modelling the empirical age distribution. Subsequently, we simulated patient age distributions to explore the effects of mean starting age and variance levels on the predicted QALE and applicable severity modifiers. Provided sample code in R and Visual Basic for Applications (VBA) facilitates the utilization of individual patient age and sex data to generate weighted average survival and health-related quality of life (utility) outputs. We observed differences of up to 10.4% (equivalent to a difference of 1.01 QALYs in quality-adjusted life-expectancy) between methods using the HSE dataset. In our simulation study, increasing variance in baseline age diminished the accuracy of predictions relying solely on mean age estimation. Differences of -0.30 to 2.24 QALYs were found at a standard deviation of 20%; commonly observed in trials. For potentially curative treatments this would represent a difference in economically justifiable price of -£4,500-+£33,600 at a cost-effectiveness threshold of £30,000 per QALY for a treatment with a 50% cure rate. For lower baseline ages, the population mean method tended to overestimate QALE, whereas for higher baseline ages, it tended to underestimate QALE compared with individual patient age-based approaches. The severity modifier assigned did not vary, however, apart from simulations with means at the extremes of the age distribution or with very high variance. Our analysis underscores the necessity of accounting for the distribution of mean age at baseline, as failure to do so can lead to inaccurate QALE estimates, thereby affecting calculations of incremental costs and QALYs in models, which base survival and quality of life predictions on general population expectations. We would recommend that patient age and sex distribution should be accounted for when incorporating general population mortality in economic models. Provided sufficient sample size, utilizing the observed empirical distribution for the expected population in clinical practice is likely to yield the most accurate results. However, in the absence of patient-level data, selecting a suitable parametric distribution is recommended.

Influenza-Associated Excess Mortality and Hospitalization in Germany from 1996 to 2018.

Influenza-associated excess mortality and morbidity is commonly estimated using statistical methods. In Germany, the Robert Koch Institute (RKI) uses the relative mortality distribution method (RMDM) to estimate influenza-associated excess mortality without reporting age-specific values. In order to better differentiate the distribution of the disease burden, a distinction by age is of high relevance. Therefore, we aimed to revise the existing excess mortality model and provide age-specific excess mortality estimates over multiple seasons. We also used the model to determine influenza-associated excess hospitalizations, since the RKI excess hospitalization model is currently based on another approach (i.e., combination of excess physician visits and hospitalized proportion). This study was a retrospective data analysis based on secondary data of the German population from 1996-2018. We adapted the RKI's method of estimating influenza-associated excess mortality with the RMDM and also applied this approach to excess hospitalizations. We calculated the number of excess deaths/hospitalizations using weekly and age-specific data. Data available in Germany are suitable for addressing the restrictions of the RKI's mortality model. In total, we estimated 175,858 (176,482 with age stratification) influenza-associated excess all cause deaths between 1995-1996 and 2017-2018 ranging from 0 (17 with age stratification) in 2005-2006 to 25,599 (25,527 with age stratification) in 2017-2018. Total influenza-associated excess deaths were comparable to RKI's estimates in most seasons. Most excess deaths/hospitalizations occurred in patients aged≥60 years (95.42%/57.49%) followed by those aged 35-59years (3,80%/24,98%). Compared with our model, the RKI hospitalization model implies a substantial underestimation of excess hospitalizations (828,090 vs. 374,200 over all seasons). This is the first study that provides age-specific estimates of influenza-associated excess mortality in Germany. The results clearly show that the main burden of influenza is in the elderly, for whom prevention and control measures should be prioritized.

Modelling time-temperature-dependent mortality of pest flies in cold storage to support the management of trade-related biosecurity risks

AbstractCold treatment with rigorous regulatory oversight is often mandated to manage horticultural trade-related biosecurity threats, such as invasive, cold-sensitive fruit flies (Diptera: Tephritidae). Cold treatment schedules, developed through rigorous laboratory experiments, require a set temperature and duration to ensure at least a probit 8.7 (99.99%) mortality rate, regardless of infestation likelihood. This threshold is costly to demonstrate for each pest and commodity combination and the resultant treatment may be harmful to fruit quality. Moreover, these stringent schedules do not account for cold-induced mortality already occurring in commercial supply chains. We developed a predictive temperature-dependent mortality function using 28 published cold treatment studies of pest fly species to support more flexible and proportionate use of cold treatment. The daily mortality rate was unaffected by the duration of cold exposure (0–20 days). The mortality rate varied primarily by pest species (10 species) and developmental stage (eggs and larval stages), and to a lesser extent by temperature (0–7 °C) and host (13 fruit types). Our model mostly predicted fewer days to meet probit 9.0 mortality compared to empirical results from large-scale studies, suggesting these studies can be overly conservative. By leveraging previous empirical studies, our model enables estimation of temperature-dependent daily mortality for unstudied pest developmental stage host–temperature combinations, which can then be empirically validated through targeted studies. It is hoped these results will shift cold treatment usage from highly regulated, fixed temperature treatments with a target mortality rate requirement to a more flexible approach that accounts for existing commercial supply chain practices and infestation likelihood in produce.

Global contribution of suicide to maternal mortality: a systematic review protocol

IntroductionMaternal suicide is a significant contributor to maternal mortality with devastating consequences for women, families and society. Maternal mortality reporting systems differ across countries and there is no up-to-date overview...

Structural analysis of reverse mortgages in Taiwan

This study investigated the framework of reverse mortgage (RM) programs in Taiwan, with a particular emphasis on the perspectives of both debtors and creditors. Employing the Lee–Carter model, the research estimated mortality rates in Taiwan while utilizing the theoretical framework to analyze various aspects of RM. House prices were assessed using the house price index as a foundational metric for estimating prices, along with lump-sum loanable amounts and RM considerations. Empirical analysis was conducted on debtors’ loans and incomes and financial institutions’ perspectives. The study delved into parameters such as maximum loanable amounts and income replacement ratios for debtors based on demographic factors such as sex, age, and occupation. Furthermore, the structure of RM programs was scrutinized from the viewpoint of financial institutions, considering factors such as rental income, remaining house value, creditor insurance protection, premium expenses, and creditor profitability. A series of simulations were performed to gauge the effects of different variables on the outcomes. The normal distribution of the house price index (HPI), as verified through the Anderson-Darling (AD) test and Kolmogorov–Smirnov (KS) test, bolstered the theoretical findings. This study’s primary contribution lies in its comprehensive exploration of the structure and advantages of RMs from the dual perspectives of debtors and creditors, a departure from insights from previous research predominantly focused on financial institutions. This research can aid debtors and creditors in evaluating RM programs and making informed decisions regarding asset allocation, thereby facilitating the selection of more suitable programs tailored to debtor characteristics.

Child Health and Mortality Prevention Surveillance (CHAMPS): Manhiça site description, Mozambique

The Manhiça Health Research Centre (Manhiça HDSS) was established in 1996 in Manhiça, a rural district at Maputo Province in the southern part of Mozambique with approximately 49,000 inhabited households, a total population of 209.000 individuals, and an annual estimated birth cohort of about 5000 babies. Since 2016, Manhiça HDSS is implementing the Child Health and Mortality Prevention Surveillance (CHAMPS) program aiming to investigate causes of death (CoD) in stillbirths and children under the age of 5 years using an innovative post-mortem technique known as Minimally Invasive Tissue sampling (MITS), comprehensive pathogen screening using molecular methods, clinical record abstraction and verbal autopsy. Both in-hospital and community pediatric deaths are investigated using MITS. For this, community-wide socio-demographic approaches (notification of community deaths by key informants, formative research involving several segments of the community, availability of free phone lines for notification of medical emergencies and deaths, etc.) are conducted alongside to foster community awareness, involvement and adherence as well as to compute mortality estimates and collect relevant information of health and mortality determinants. The main objective of this paper is to describe the Manhiça Health and Demographic Surveillance System (HDSS) site and the CHAMPS research environment in place including the local capacities among its reference hospital, laboratories, data center and other relevant areas involved in this ambitious surveillance and research project, whose ultimate aim is to improve child survival through public health actions derived from credible estimates and understanding of the major causes of childhood mortality in Mozambique.

Global burden of thyroid cancer in 2022: Incidence and mortality estimates from GLOBOCAN.

Thyroid cancer (TC) is the most common malignancy of the endocrine system. This study aimed to assess the global distribution of TC incidence and mortality in 2022, as well as to predict the burden for the year 2050. Data from the GLOBOCAN 2022database were used to analyze the age-standardized incidence and mortality rates of TC by sex, age group (<55 years and ≥55 years), country, world region, and level of Human Development Index (HDI) for 185 countries. The predicted incidence and mortality burden for 2050 was calculated based on demographic projections. In 2022, an estimated 821,214 new TC cases and 47,507 TC-related deaths occurred worldwide. The age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were higher in women (ASIR: 13.60 per 100,000; ASMR: 0.53 per 100,000) than in men (ASIR: 4.60 per 100,000; ASMR: 0.35 per 100,000). The ASIR in high HDI countries was approximately ten times higher than that in low HDI countries for both sexes, with relatively similar ASMR across regions. Among 185 countries, China had the largest number of TC cases (accounting for 56.77% of total cases) and TC-related deaths (accounting for 24.35% of global TC-related deaths), with the highest ASIR in men (13.30 per 100,000). Worldwide, approximately 64.63% of TC cases occurred in populations under 55 years old, while nearly 82.99% of TC-related deaths occurred in populations aged 55 years and above. If the rates stay the same as in 2022, it is projected that approximately 1,100,000 new TC cases and 91,000 TC-related deaths will occur in 2050, indicating a 34.15% and 89.58% increase, respectively. TC is a highly frequent cancer worldwide with disparities across regions, genders, and age groups. Our results provide light on the worldwide TC disease burden and facilitate regionally customized prevention measures.

Modeling long-term, stage-structured dynamics of Tribolium castaneum (Coleoptera: Tenebrionidae) at food facilities with and without two types of long-lasting insecticide-incorporated netting.

The red flour beetle, Tribolium castaneum (Herbst) (Coleoptera: Tenebrionidae), is a cosmopolitan and destructive external-infesting pest at many food facilities. The use of deltamethrin- and α-cypermethrin-incorporated long-lasting insecticide-incorporated netting (LLIN) has shown incredible promise for the management of stored product insects. However, it is unknown how LLIN deployed within food facilities may affect the long-term population dynamics of T. castaneum compared to populations where no LLIN is present. Exposure to LLIN has been shown to affect mortality in the current generation and decrease progeny production in the subsequent generation. Thus, we modeled the long-term population dynamics of T. castaneum at food facilities over 15 generations by incorporating realistic estimates for mortality and progeny reduction after contact with LLIN compared to baseline growth by the species. We parameterized the model with estimates from the literature and used a four-stage structured population (eggs, larvae, pupae, and adults). The model was implemented using the package popbio in R. Our models suggest that deploying LLIN led to significant population reductions based on the estimates of mortality and progeny reduction from prior work, whereas the baseline model exhibited exponential population growth. In addition, there were differences in the frequencies of each life stage under each scenario modeled. As a result, it appears deploying LLIN may contribute to the local extirpation of T. castaneum within as few as 15 generations. Our work contributes to a growing literature about the effectiveness of incorporating LLIN into existing pest management programs for managing stored product insects in food facilities.

Short-term primary and revision modular dual-mobility cup total hip arthroplasty outcomes in high-risk dislocation patients: a retrospective study

PurposeModular dual-mobility cups (MDMCs) have a lower risk for dislocation after total hip arthroplasty (THA). The primary aims of our study were to analyze implant survivorship and to determine complications, especially dislocation, and revision rates of primary THAs used for hip fracture patients and for revision THAs. Secondary aims were to evaluate mortality after MDMC surgery and to find out if introduction of MDMC at our institution (Kuopio University Hospital, Finland) have decreased dislocation rate.MethodsThis retrospective cohort study consisted of 101 MDMC patients who were consecutively operated at our institution between April 1, 2018 and June 30, 2020. The implant survival rate, complications and mortality were evaluated with minimum of 2-year follow-up. Finnish Hospital Discharge Register was used to find out yearly dislocation rates following THA at our institution.ResultsThe cumulative estimate implant survival after MDMC in the primary THA group was 97% at 2 years, and in the revision THA group, it was 90% at 2 years. Dislocation was a rare complication in the primary THA group (1.4%), while it was common in revision THA group (12.9%). The cumulative estimate for mortality after MDMC in the primary THA group was 13% at 2 years, and in the revision group, it was also 13% at 2 years. The yearly number of patients who had re-hospitalization period due to THA dislocation decreased 46% after implementation of MDMC.ConclusionShort-term survival and complication rates after MDMC were excellent after primary THA and moderate after revision THA. Implementation of MDMC THA for hip fracture patients seems to have effectively decrease dislocation rate during a short follow-up.

Differences between sexes in STEMI treatment and outcomes with contemporary primary PCI.

Historically, differences in timely reperfusion and outcomes have been described in females who suffer ST-segment elevation myocardial infarction (STEMI). However, there have been improvements in the treatment of STEMI patients with contemporary Percutaneous Coronary Intervention (PCI) strategies. Comparisons between sexes were performed on STEMI patients treated with primary PCI over a 4-year period (January 1, 2017-December 31, 2020) from the Queensland Cardiac Outcomes Registry. Primary outcomes were 30-day and 1-year cardiovascular mortality. Secondary outcomes were STEMI performance measures. The total and direct effects of gender on mortality outcomes were estimated using logistic and multinomial logistic regression models. Overall, 2747 (76% male) were included. Females were on average older (65.9 vs. 61.9 years; p < 0.001), had longer total ischemic time (69 min vs. 52 min; p < 0.001) and less achievement of STEMI performance targets (<90 min) (50% vs. 58%; p < 0.001). There was no evidence for a total (odds ratio [OR] 1.3 (95% confidence interval [CI]: 0.8-2.2; p = 0.35) or direct (adjusted OR 1.2 (95% CI: 0.7-2.1; p = 0.58) effect of female sex on 30-day mortality. One-year mortality was higher in females (6.9% vs. 4.4%; p = 0.014) with total effect estimates consistent with increased risk of cardiovascular mortality (Incidence rate ratio [IRR]: 1.5; 95% CI: 1.0-2.3; p = 0.059) and noncardiovascular mortality (IRR: 2.1; 95% CI: 0.9-4.7; p = 0.077) in females. However, direct (adjusted) effect estimates of cardiovascular mortality (IRR: 1.0; 95% CI: 0.6-1.6; p = 0.94) indicated sex differences were explained by confounders and mediators. Small sex differences in STEMI performance measures still exist; however, with contemporary primary PCI strategies, sex is not associated with cardiovascular mortality at 30 days or 1 year.

Estimating the stochastic uncertainty underlying sample-based estimates of infant mortality in the Philippines: a first-time application to a country in the Southeast Asia/Pacific Basin region

ABSTRACT Infant mortality is an important population health statistic that is often used to make health policy decisions. Unfortunately, these data are not available for all populations. A newly developed method is presented for accounting for the stochastic uncertainty found in infant mortality rates (IMRs) estimated from sample surveys and for the first time applied to a country in the Southeast Asian/Pacific Basin area, the Philippines. The method is founded on the fact that there are two sources of variation in sample-based estimates of IMRs: (1) sample size; and (2) variation of infant deaths. The approach is aimed at taking into account stochastic uncertainty while preserving information concerning the uncertainty due to sampling. In applying the method to the Philippines, the sample-based IMR estimates appear to perform well in terms of accounting for stochastic uncertainty. This finding is consistent with previous research assessing this approach in Africa and with variations, in Canada, Europe and the United States, which suggests that in the form presented here or in one of its variants, it could successfully be employed not only elsewhere in the Southeast Asia/Pacific Basin region but also in East Asia, North Asia, South Asia, and West Asia.

Monitoring monthly mortality of maricultured Atlantic salmon (Salmo salar L.) in Scotland I. Dynamic linear models at production cycle level

The mortality of Atlantic salmon is one of the main challenges to achieving its sustainable production. This sector benefits from generating many data, some of which are collated in a standardized way, on a monthly basis at site level, and are accessible to the public. This continuously updated resource might provide opportunities to monitor mortality and prompt producers and inspectors to further investigate when mortality is higher than expected. This study aimed to use the available open-source data to develop production cycle level dynamic linear models (DLMs) for monitoring monthly mortality of maricultured Atlantic salmon in Scotland. To achieve this, several production cycle level DLMs were created: one univariate DLM that includes just mortality; and various multivariate DLMs that include mortality and different combinations of environmental variables. While environmental information is not collated in a standardized way across all sites, open-source remote-sensed satellite resources provide continuous, standardized estimates. By combining environmental and mortality data, we seek to investigate whether adding environmental variables enhanced the estimates of mortality, and if so, which variables were most informative in this respect. The multivariate model performed better than the univariate DLM (P = .004), with salinity as the only significant contributor out of 12 environmental variables. Both models exhibited uncertainty related to the mortality estimates. Warnings were generated when any observation fell above the 95% credible interval. Approximately 30% of production cycles and more than 50% of sites experienced at least one warning between 2015 and 2020. Occurrences of these warnings were non-uniformly distributed across space and time, with the majority happening in the summer and autumn months. Recommendations for model improvement include employing shorter time periods for data aggregation, such as weekly instead of on a monthly basis. Furthermore, developing a model that takes hierarchical relationships into account could offer a promising approach.

COVID-19 increased existing gender mortality gaps in high-income more than middle-income countries

ObjectiveTo analyze how patterns of excess mortality varied by sex and age groups across countries during the COVID-19 pandemic and their association with country income level. MethodsWe used World Health Organization excess mortality estimates by sex and age groups for 75 countries in 2020 and 62 countries in 2021, restricting the sample to estimates based on recorded all-cause mortality data. We examined patterns across countries using country-specific Poisson regressions with observations consisting of the number of excess deaths by groups defined by sex and age. FindingsMen die at higher rates in nearly all places and at all ages beyond age 45. In 2020, the pandemic amplified this gender mortality gap for the world, but with variation across countries and by country income level. In high-income countries, rates of excess mortality were much higher for men than women. In contrast, in middle-income countries, the sex ratio of excess mortality was similar to the sex ratio of expected all-cause mortality. The exacerbation of the sex ratio of excess mortality observed in 2020 in high-income countries, however, declined in 2021. ConclusionThe COVID-19 pandemic has killed men at much higher rates than women, as has been well documented, but these gender differences have varied by country income. These differences were the result of some combination of variation in gender patterns of infection rates and infection fatality rates across countries. The gender gap in mortality declined in high-income countries in 2021, likely as a result of the faster rollout of vaccination against COVID-19.

Unveiling the hidden impact: Wildlife roadkill assessment in the Paraguayan Chaco

AbstractThe incidence of wildlife roadkill significantly threatens the persistence of wildlife populations and disrupts the ecological functionality of ecosystems. This study investigates the impact of roadkills on wildlife in the Paraguayan Chaco, focusing on a 250‐km segment of Route 9 ‘Dr. Carlos Antonio López’ between Villa Hayes and Pozo Colorado. We conducted a road survey for 15 months and recorded 2338 carcasses, identifying 87 species, with mammals (41.3%), reptiles (32.3%) and birds (19.8%) being the most observed groups. The species most frequently killed included Cerdocyon thous, Caracara plancus, Thamnodynastes hypoconia and Procyon cancrivorus. We also recorded species with conservation concern. Additionally, we estimated mortality rates by accounting for sampling errors such as carcass removal and searcher efficiency, revealing annual roadkill rates of 5183 mammals, 19 402 birds and 5020 reptiles on the 250 km per year. Spatial analysis using Ripley's K statistic and HotSpot Identification highlighted significant variation in roadkill distribution across different taxonomic groups and seasons, with 51 km of road identified as hotspots when analysing all groups together. Notably, there was minimal overlap in hotspot locations between seasons and taxonomic groups, emphasizing the need for targeted mitigation strategies. Our findings challenge previous macroecological assessments suggesting low roadkill rates in Paraguay, underscoring the importance of local studies in accurately assessing ecological impacts. This study provides critical baseline data for conservation efforts and calls for further research to develop and implement effective roadkill mitigation strategies in Latin America, especially in Chaco region.

Wild bird mass mortalities in eastern Canada associated with the Highly Pathogenic Avian Influenza A(H5N1) virus, 2022

AbstractIn 2022, a severe outbreak of disease caused by clade 2.3.4.4b Highly Pathogenic Avian Influenza (HPAI) H5N1 virus resulted in unprecedented mortality among wild birds in eastern Canada. Tens of thousands of birds were reported sick or dead, prompting a comprehensive assessment of mortality spanning the breeding season between April 1 and September 30, 2022. Mortality reports were collated from federal, Indigenous, provincial, and municipal agencies, the Canadian Wildlife Health Cooperative, and other nongovernmental organizations, universities, and citizen science platforms. A scenario analysis was conducted to refine mortality estimates, accounting for potential double counts from multiple sources under a range of spatial and temporal overlaps. Correcting for double counting, HPAI is estimated to have caused 40,391 wild bird mortalities in eastern Canada during the spring and summer of 2022; however, this figure underestimates total mortality as it excludes unreported deaths on land and at sea. Seabirds and sea ducks, long‐lived species that are slow to recover from perturbations, accounted for 98.7% of estimated mortalities. Our study provides estimates of bird mortality, with Northern Gannets (Morus bassanus; 25,669), Common Murres (Uria aalge; 8133), and American Common Eiders (Somateria mollissima dresseri; 1894) exhibiting the highest mortality figures. We then compare these mortality estimates with recent population estimates and trends and make an initial assessment of whether biologically meaningful population‐level impacts are possible. Specifically, we focus on the Northern Gannet, a species that has suffered significant global mortality, and two harvested species, Common Murre and American Common Eider, to inform management decisions. Our analysis suggests population‐level impacts in eastern Canada are possible for Northern Gannets and American Common Eiders, but are unlikely for Common Murres. This study demonstrates a comprehensive approach to assessing mortality and underscores the urgent need for further research to understand the broader ecological ramifications of the HPAI outbreak on wild bird populations.

The current and future cancer burden in the Gulf Cooperation Council (GCC) countries.

Cancer is a leading cause of morbidity and mortality in the Gulf Cooperation Council (GCC) countries. This study aims to provide cancer incidence and mortality estimates in 2020 in the GCC countries alongside future projections for 2040 to shape cancer control policy in the region. The estimated numbers of new cancer cases and deaths were extracted from the GLOBOCAN database developed by the International Agency for Research on Cancer; new cancer cases, cancer deaths, and corresponding age-standardized incidence and mortality rates for the year 2020 are presented. An estimated 42,475 new cancer cases and 19,895 deaths occurred in the GCC countries in 2020, with corresponding age-standardized incidence and mortality rates of 96.5 and 52.3 per 100,000, respectively. Female breast (16%), colorectal (13%), and thyroid (9%) were the most common types of cancer in the GCC countries, accounting for almost 40% of all cancer incidence. Colorectal (14%) followed by breast cancer (9%) were the leading causes of cancer death, though the magnitude of rates of the major cancer types varied substantially across the GCC countries. Even if we assume rates in the region will remain unchanged over the next two decades, the cancer burden in the GCC will increase by 116% (Saudi Arabia) to 270% (Qatar), reaching nearly 104,000 cancer cases by the year 2040. The sharp increase in the estimated cancer incidence and mortality predicted over the next decades in the region requires workforce and financial planning for the healthcare systems in the constituent countries, alongside broader strengthening of national cancer prevention and control efforts.

First Results From a Calibrated Network of Low-Cost PM2.5 Monitors in Mombasa, Kenya Show Exceedance of Healthy Guidelines.

The paucity of fine particulate matter (PM2.5) measurements limits estimates of air pollution mortality in Sub-Saharan Africa. Well calibrated low-cost sensors can provide reliable data especially where reference monitors are unavailable. We evaluate the performance of Clarity Node-S PM monitors against a Tapered element oscillating microbalance (TEOM) 1400a and develop a calibration model in Mombasa, Kenya's second largest city. As-reported Clarity Node-S data from January 2023 through April 2023 was moderately correlated with the TEOM-1400a measurements (R 2=0.61) and exhibited a mean absolute error (MAE) of 7.03μgm-3. Employing three calibration models, namely, multiple linear regression (MLR), Gaussian mixture regression and random forest (RF) decreased the MAE to 4.28, 3.93, and 4.40μgm-3 respectively. The R 2 value improved to 0.63 for the MLR model but all other models registered a decrease (R 2=0.44 and 0.60 respectively). Applying the correction factor to a five-sensor network in Mombasa that was operated between July 2021 and July 2022 gave insights to the air quality in the city. The average daily concentrations of PM2.5 within the city ranged from 12 to 18μgm-3. The concentrations exceeded the WHO daily PM2.5 limits more than 50% of the time, in particular at the sites nearby frequent industrial activity. Higher averages were observed during the dry and cold seasons and during early morning and evening periods of high activity. These results represent some of the first air quality monitoring measurements in Mombasa and highlight the need for more study.

Risk of early clinical deterioration and 30-day mortality in pulmonary embolism intermediate-high-risk patients with patent foramen ovale.

We assess the prognostic role of patent foramen ovale (PFO) for the estimation of 30-day mortality and risk of 48-h clinical deterioration since admission, in intermediate-high-risk pulmonary embolism (PE) patients. A post-hoc analysis of intermediate-high-risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (Trial registry: ClinicalTrials.gov; No.: NCT01604538) was performed. The entire cohort was divided according to the presence or absence of PFO after transthoracic echocardiography (TTE) evaluation. Among 450 intermediate-high-risk PE patients (mean age 71.4 ± 13.8years, 298 males), PFO was diagnosed in 68 (15.1%) cases. A higher mortality rate (29.4% vs. 3.1%, p < 0.001) as well as occurrence of clinical deterioration within 48h from admission (38.2% vs. 3.6%, p < 0.001) were observed in intermediate-high-risk PE patients with PFO compared to those without multivariate Cox regression analysis showed that the presence of a PFO predicts 30-day mortality (HR: 3.21, 95% CI 3.16-3.27, p < 0.001) and was also associated with a significantly higher risk of 48-h clinical deterioration [HR: 2.24 (95% CI 2.20-2.29), p < 0.0001] in intermediate-high-risk PE patients. The presence of a PFO in intermediate-high-risk PE patients is associated with a higher risk of clinical deterioration within 48h from admission and 30-day mortality.

The UK resuscitative endovascular balloon occlusion of the aorta in trauma patients with life-threatening torso haemorrhage: the (UK-REBOA) multicentre RCT.

The most common cause of preventable death after injury is haemorrhage. Resuscitative endovascular balloon occlusion of the aorta is intended to provide earlier, temporary haemorrhage control, to facilitate transfer to an operating theatre or interventional radiology suite for definitive haemostasis. To compare standard care plus resuscitative endovascular balloon occlusion of the aorta versus standard care in patients with exsanguinating haemorrhage in the emergency department. Pragmatic, multicentre, Bayesian, group-sequential, registry-enabled, open-label, parallel-group randomised controlled trial to determine the clinical and cost-effectiveness of standard care plus resuscitative endovascular balloon occlusion of the aorta, compared to standard care alone. United Kingdom Major Trauma Centres. Trauma patients aged 16 years or older with confirmed or suspected life-threatening torso haemorrhage deemed amenable to adjunctive treatment with resuscitative endovascular balloon occlusion of the aorta. Participants were randomly assigned 1 : 1 to: standard care, as expected in a major trauma centre standard care plus resuscitative endovascular balloon occlusion of the aorta. Primary: Mortality at 90 days. Secondary: Mortality at 6 months, while in hospital, and within 24, 6 and 3 hours; need for haemorrhage control procedures, time to commencement of haemorrhage procedure, complications, length of stay (hospital and intensive care unit-free days), blood product use. Health economic: Expected United Kingdom National Health Service perspective costs, life-years and quality-adjusted life-years, modelled over a lifetime horizon. Case report forms, Trauma Audit and Research Network registry, NHS Digital (Hospital Episode Statistics and Office of National Statistics data). Ninety patients were enrolled: 46 were randomised to standard care plus resuscitative endovascular balloon occlusion of the aorta and 44 to standard care. Mortality at 90 days was higher in the standard care plus resuscitative endovascular balloon occlusion of the aorta group (54%) compared to the standard care group (42%). The odds ratio was 1.58 (95% credible interval 0.72 to 3.52). The posterior probability of an odds ratio > 1 (indicating increased odds of death with resuscitative endovascular balloon occlusion of the aorta) was 86.9%. The overall effect did not change when an enthusiastic prior was used or when the estimate was adjusted for baseline characteristics. For the secondary outcomes (3, 6 and 24 hours mortality), the posterior probability that standard care plus resuscitative endovascular balloon occlusion of the aorta was harmful was higher than for the primary outcome. Additional analyses to account for intercurrent events did not change the direction of the estimate for mortality at any time point. Death due to haemorrhage was more common in the standard care plus resuscitative endovascular balloon occlusion of the aorta group than in the standard care group. There were no serious adverse device effects. Resuscitative endovascular balloon occlusion of the aorta is less costly (probability 99%), due to the competing mortality risk but also substantially less effective in terms of lifetime quality-adjusted life-years (probability 91%). The size of the study reflects the relative infrequency of exsanguinating traumatic haemorrhage in the United Kingdom. There were some baseline imbalances between groups, but adjusted analyses had little effect on the estimates. This is the first randomised trial of the addition of resuscitative endovascular balloon occlusion of the aorta to standard care in the management of exsanguinating haemorrhage. All the analyses suggest that a strategy of standard care plus resuscitative endovascular balloon occlusion of the aorta is potentially harmful. The role (if any) of resuscitative endovascular balloon occlusion of the aorta in the pre-hospital setting remains unclear. Further research to clarify its potential (or not) may be required. This trial is registered as ISRCTN16184981. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 14/199/09) and is published in full in Health Technology Assessment; Vol. 28, No. 54. See the NIHR Funding and Awards website for further award information.