Incremental Rise Research Articles

Association between lactate/albumin ratio and 28-day mortality in ICU critical patients with coronary heart disease: a retrospective analysis of the MIMIC-IV database.

The serum lactate/albumin ratio (LAR) is commonly employed for monitoring and evaluating the prognosis of critically ill patients. Both elevated lactate levels and decreased albumin levels may reflect the body's stress response and inflammatory reaction. Coronary heart disease (CHD), with common complications including myocardial infarction, arrhythmia, heart failure, is one of the leading causes of global death. Therefore, it is crucial to explore biomarkers that can predict the prognosis and mortality of CHD patients. This is a retrospective study in which the data is from the MIMIC-IV database. Our study assessed the association between LAR value and mortality within 28 days of admission in a total of 1,902 CHD patients from the Beth Israel Deaconess Medical Center. The results demonstrated a significant increase in 28-day mortality among individuals with higher LAR values. Multivariate analysis by Cox proportional hazard model revealed an incremental rise in mortality across each quartile with the increase of LAR value. Furthermore, restricted cubic spline (RCS) Cox regression analysis further revealed that higher LAR values were associated with increased 28-day mortality in the CHD patients. And subgroup analysis confirmed that the LAR level could serve as an independent predictor of 28-day mortality with CHD patients. Our study demonstrated that the LAR value can be an important risk predictor of 28-day mortality in patients with CHD, and a higher LAR associate with increased mortality rate.

Observation of doping-induced spin–orbit coupling in gold cluster assembly to carrier-tuneable semiconductors and Schottky behaviors

The doping influenced carrier dynamics to maneuvering n-type to p-type semiconducting gold cluster assembly have been assessed. The resonance photoemission spectroscopic measurements corroborate an incremental rise in the density of states at the valence edge, the overlap of valence states due to doping, and the presence of distinct spin–orbit splitting and coupling in manganese-doping (Au7Mn) compared to gold clusters (Au8), originating from the relativistic effect resulted in a semiconducting property. The work function dependent current–voltage characteristics in metal–semiconductor configuration show Ohmic and Schottky behaviors assorting p-type carriers in Au7Mn in contrast to the n-type Au8 and are presenting an atomic cluster based fast electronic device.

Study on the flow characteristics of double-cone in hypersonic flows

Reusable spacecraft is one of the hot topics in the field of aerospace, attracting wide attention from researchers. Due to the high-Mach-number flight of re-entry, the air near the wall exhibits significant thermochemical nonequilibrium effects. Besides, the existing shock wave/boundary layer interaction (SWBLI) leads to severe aerodynamic heating issues. This study utilizes the two-temperature model to conduct simulations of hypersonic laminar flows around a canonical 25°/55° double-cone with low and high enthalpy. By varying the wall temperature and the aft cone angle, the evolution mechanism of the flow under the high-enthalpy and hypersonic freestream is explored. Our findings illustrate that while the thermodynamic nonequilibrium model closely reflects the separation zone evidenced in the experiments, it habitually overpredicts the peak heat transfer, particularly under high-enthalpy conditions. For the thermochemical nonequilibrium model, the flow field structure appears more uniform, with a reduced standoff distance of the detached shock. An incremental rise in wall temperature correlates with a proportional augmentation of the separation bubble, though its impact on the overall flow field is negligible. Increasing the aft cone angle intensifies the shock/shock interaction (SSI), transitioning from a lower-intensity Type VI to a more intense Type IV shock interplay. The examination reveals that the increase in temperature and cone angle amplifies the interaction between the separation region and shock waves, drastically escalating the peak heat transfer and fostering a secondary peak. The hypersonic flow of the double-cone demonstrates a multifaceted interaction of phenomena, notably SWBLI and SSI, with our analyses providing pivotal insights for the aerodynamic and thermal protection design of the high-Mach-number spacecraft.

Statistical investigation of climate and landfill age impacts on Kupferberg landfill leachate composition: one-way ANOVA analysis

This study investigated seasonal variations in the physico-chemical properties of leachate from the Kupferberg landfill site, examining the influence of landfill age and climatic factors. Data provided by the Windhoek Municipality during the years 2017 to 2022 facilitated the exploration of critical concerns related to groundwater protection and human health. Guided by two research questions and anchored in hypotheses tested at a 95% confidence level, the study employed Statistical Packages for Social Scientists (SPSS) for analysis.Significant temperature variations were observed across years [F (5, 21) = 4.493, p < 0.05], indicating a substantial relationship between landfill age and seasonal variations in leachate physico-chemical properties. Further ANOVA tests revealed temperature trends impacting leachate parameters, such as organic content and pH. While COD displayed a declining trend with landfill age, inorganic components like Cl- and alkalinity exhibited no distinct age-related pattern.Wet seasons demonstrated higher EC and Cl--mean values than dry seasons, correlating with elevated COD levels. The study underscored the incremental rise in parameter values over time and during the rainy season, attributed to solid waste degradation and rainwater percolation. Notably, climatic conditions significantly influenced seasonal variations in leachate physico-chemical properties (p < 0.05). Based on this outcome, null hypothesis 1 was rejected. The second null hypothesis was also rejected because climatic conditions do influence the seasonal variations in physico-chemical properties. These findings are crucial for emphasizing the need for effective leachate management strategies and providing valuable insights for arid regions. Future research can expand on a national scale, employing one-way ANOVA tests on other landfills in Namibia, and engaging local communities for comprehensive data collection on cross-contamination.

#1992 Triglyceride-glucose index and risk of cardiovascular events, graft loss and new onset diabetes after transplantation in renal transplant recipients

Abstract Background and Aims Insulin resistance is prevalent disorder, but its clinical significance remains undetermined in renal transplant recipients. We explored the clinical implication of triglyceride-glucose (TyG) index in renal transplant recipients, recognizing it as a valuable marker for insulin resistance. Method A total of 6354 renal transplant recipients were enrolled from a nationwide, prospective cohort between May 2014 and December 2022. The TyG index was assessed between 6- and 12-months post-transplantation. We evaluated the association between TyG index and the risk of composite of cardiovascular events and death, renal allograft loss, and new onset diabetes after transplantation (NODAT). Results During the mean follow-up period of 39.2 ± 26.1 months, a total of 106 composite events of cardiovascular events and death, 174 events of renal allograft loss, and 438 events of NODAT were observed. The cumulative rate for composite events, graft loss, and NODAT was greater in patients with higher TyG quartile (all P &amp;lt; 0.001). In multivariate analysis, higher quartile of TyG was associated with an increased risk of composite events (HR 1.81, 95% CI 1.14–2.86), renal allograft loss (HR 2.13, 95% CI 1.28–3.55), and NODAT (HR 2.52, 95% CI 1.90–3.34). Higher quartile of TyG was associated with future graft dysfunction (adjusted mean eGFR differences of −4.72, 95% CI −7.39 – −2.04). There was a linear escalation in the risk of composite events and graft loss with the incremental rise in the TyG index, concomitant with an exponential augmentation in the risk of NODAT. Conclusion Renal transplant recipients with higher TyG index are associated with higher risk of composite of cardiovascular event and death, renal allograft loss, and NODAT.

Research on shutdown purge characteristics of proton exchange membrane fuel cells: Purge parameters conspicuity and residual water

This paper comprehensively investigates the purge mechanism of proton exchange membrane fuel cells during the shutdown process, which qualitatively examines the effect of purge parameters (including current density, stoichiometric ratio, and relative humidity) on water content variation, and further quantitatively investigates the remaining water content post-purge. In contrast to previous studies, this paper offers a novel perspective on analyzing the purge process and conducts a thorough examination of residual water content. This study presents a transient, isothermal, two-phase flow model for proton exchange membrane fuel cells, which is subsequently validated experimentally. Results indicate that the significance of purge parameters follows the descending order: stoichiometric ratio, relative humidity, and current density. During the purge, the stoichiometric ratio should be rapidly increased to above 9. Each incremental rise in the stoichiometric ratio from 6 to 14 leads to a respective reduction in residual membrane water content after purge of 2.19 %, 1.57 %, 1.18 %, 0.93 %, 0.76 %, 0.63 %, 0.53 %, and 0.46 %. Similarly, it is recommended to swiftly decrease relative humidity to below 40 %. Elevating the purge current density from 20 to 200 mA/cm2 decreases the time required to completely remove liquid water from 20.24 s to 6.59 s. Hence, employing a higher current density at the onset of the purge facilitates quicker removal of liquid water, albeit resulting in an increase in residual membrane water content post-purge, from 3.17 to 3.70. In summary, optimizing the purge strategy requires adjusting purge current densities according to the specific purge stage.

Demystifying the association of center-level operative trauma volume and outcomes of emergency general surgery

BackgroundRecent studies have demonstrated a positive volume-outcome relationship in emergency general surgery. Some have advocated for the sub-specialization of emergency general surgery independent from trauma. We hypothesized inferior clinical outcomes of emergency general surgery with increasing center-level operative trauma volume, potentially attributable to overall hospital quality. MethodsAdults (≥18 years) undergoing complex emergency general surgery operations (large and small bowel resection, repair of perforated peptic ulcer, lysis of adhesions, laparotomy) were identified in the 2016 to 2020 Nationwide Readmissions Database. Multivariable risk-adjusted models were developed to evaluate the association of treatment at a high-volume trauma center (reference: low-volume trauma center) with clinical and financial outcomes after emergency general surgery. To evaluate hospital quality, mortality among adult hospitalizations for acute myocardial infarction was assessed by hospital trauma volume. ResultsOf an estimated 785,793 patients undergoing a complex emergency general surgery operation, 223,116 (28.4%) were treated at a high-volume trauma center. Treatment at a high-volume trauma center was linked to 1.19 odds of in-hospital mortality (95% confidence interval 1.12–1.27). Although emergency general surgery volume was associated with decreasing predicted risk of mortality, increasing trauma volume was linked to an incremental rise in the odds of mortality after emergency general surgery. Secondary analysis revealed increased mortality for admissions for acute myocardial infarction with greater trauma volume. ConclusionWe note increased mortality for emergency general surgery and acute myocardial infarction in patients receiving treatment at high-volume trauma centers, signifying underlying structural factors to broadly affect quality. Thus, decoupling trauma and emergency general surgery services may not meaningfully improve outcomes for emergency general surgery patients. Our findings have implications for the evolving specialty of emergency general surgery, especially for the safety and continued growth of the acute care surgery model.

Temperature exposure and health inequality

This paper analyzes the relationship among temperature exposure, health inequality, and adaptive behavior in China, a country with diverse climate zones ranging from the cold, arid northwest to the warm, humid south. Utilizing follow-up survey data spanning from 2000 to 2015, this paper constructs a measure of health inequality at the community level. Our findings reveal that extremely cold or hot days increase the health inequality at the community level. Specifically, with each incremental rise in the day’s extreme temperature, the Gini coefficient of community health rises by 0.0032, which constitutes approximately 0.4% of the community average. Furthermore, vulnerable communities, which are characterized by low average income, education levels, per capita electricity consumption, and urbanization, are highly susceptible to the effects of extreme temperatures on health equality. From the perspective of adaptive behavior, residents in high-income communities exhibit elevated electricity consumption and engage in frequent preventive health check-ups during extreme temperature exposure. This phenomenon may exacerbate social polarization because well-resourced individuals and communities are better equipped to withstand the challenges posed by climate change and extreme weather events compared with impoverished ones. Addressing this disparity requires local managers to implement comprehensive policies and interventions that can enhance the adaptability of low-income communities, improve public health facilities, and promote social equity.

Mortality rates in Norwegian HEMS—a retrospective analysis from Central Norway

BackgroundHelicopter Emergency Medical Services (HEMS) provide rapid and specialized care to critically ill or injured patients. Norwegian HEMS in Central Norway serves an important role in pre-hospital emergency medical care. To grade the severity of patients, HEMS uses the National Advisory Committee for Aeronautics’ (NACA) severity score. The objective of this study was to describe the short- and long term mortality overall and in each NACA-group for patients transported by HEMS Trondheim using linkage of HEMS and hospital data.MethodsThe study used a retrospective cohort design, aligning with the STROBE recommendations. Patient data from Trondheim HEMS between 01.01.2017 and 31.12.2019 was linked to mortality data from a hospital database and analyzed. Kaplan Meier plots and cumulative mortality rates were calculated for each NACA group at day one, day 30, and one year and three years after the incident.ResultsTrondheim HEMS responded to 2224 alarms in the included time period, with 1431 patients meeting inclusion criteria for the study. Overall mortality rates at respective time points were 10.1% at day one, 13.4% at 30 days, 18.5% at one year, and 22.3% at three years. The one-year cumulative mortality rates for each NACA group were as follows: 0% for NACA 1 and 2, 2.9% for NACA 3, 10.1% for NACA 4, 24.7% for NACA 5 and 49.5% for NACA 6. Statistical analysis with a global log-rank test indicated a significant difference in survival outcomes among the groups (p < 2⋅10− 16).ConclusionAmong patients transported by Trondheim HEMS, we observed an incremental rise in mortality rates with increasing NACA scores. The study further suggests that a one-year follow-up may be sufficient for future investigations into HEMS outcomes.

The association between polychlorinated dibenzo-p-dioxin exposure and cancer mortality in the general population: a cohort study.

Earlier research has indicated that being exposed to polychlorinated dibenzo-p-dioxins (PCDDs) in the workplace can heighten the likelihood of cancer-related deaths. Nevertheless, there is limited information available regarding the connection between PCDD exposure and the risk of cancer mortality in the general population (i.e., individuals not exposed to these substances through their occupation). The National Health and Nutrition Examination Survey (NHANES) detected PCDDs in the general population, and the death data were recently updated as of December 31, 2019. We conducted Cox regression analysis and controlled for covariates including age, gender, ethnicity, educational attainment, physical activity, alcohol intake, NHANES survey period, BMI category, cotinine concentration, and household earnings. After accounting for confounding factors, the findings indicated that for each incremental rise of 1 log unit in 1,2,3,4,6,7,8,9-octachlorodibenzo-p-dioxin, there was a 76% rise in the likelihood of death from any cause, with a p value of 0.003. An increase of 1 log unit in the concentration of 1,2,3,4,6,7,8-heptachlorodibenzofuran could potentially lead to a 90% higher risk of cancer mortality, as indicated by a p value of 0.034 and a 95% confidence interval of 0.05-2.43. As the concentrations of 1,2,3,4,6,7,8-heptachlorodibenzofuran increased, the dose-response curve indicated a proportional rise in the risk of cancer mortality, accompanied by a linear p value of 0.044. The sensitivity analysis demonstrated that our findings were resilient. In the general population, an elevated risk of cancer mortality was observed in PCDDs due to the presence of 1,2,3,4,6,7,8-heptachlorodibenzofuran. Mechanistic research is required to further confirm it.

Research on the Passive Cooling System of Solar Photovoltaic Panel Based on Hybrid Solar Chimney and Ventilator

The efficiency of solar photovoltaic (PV) power generation is significantly impacted by factors such as ambient temperature, surrounding wind speed, and the temperature of the solar PV panels. The power generation efficiency of these panels diminishes by approximately 0.5% for each incremental rise in their temperature. To mitigate this effect, two primary methods for cooling solar photovoltaic panels are considered: active and passive cooling techniques. This review paper delves into an extensive body of literature on solar passive cooling systems, highlighting the vital role of passive cooling technology in enhancing the efficiency of solar PV power generation. We investigate the structure and cooling effect of diverse passive cooling systems, with a specific focus on the application of solar chimneys and ventilators in cooling systems for solar PV panels. Our study reveals that solar chimneys, using buoyancy, can decrease the temperature of solar PV panels by as much as 15 degrees, thereby augmenting power generation efficiency. Furthermore, the deployment of ventilator technology can boost the efficiency of solar PV power generation to an impressive 46.54%. In conclusion, this paper proposes the synergistic use of solar chimneys and ventilators to improve solar PV panel efficiency, extend their lifespan, and reduce the environmental impact resulting from inefficient solar PV panels. This comprehensive approach should inform future practices.

Factors Contributing to the Change in Overweight/Obesity Prevalence Among Indian Adults: A multivariate decomposition analysis of data from the National Family Health Surveys.

Concerns over the escalating burden of non-communicable diseases call for the redressal of behavioral risk factors like increased body mass index. Most studies have failed to quantify the contribution of socio-demographic characteristics in a linear trend. The present study aims to estimate the current prevalence of overweight and obesity in Indian adults and the contribution of different socio-demographic factors to the increasing prevalence. We carried out a secondary data analysis of two National Family Health Survey (NFHS) rounds. The final sample includes 558,122 women and 84,477 men from round 4, and 574,099 women and 74,761 men were included from round 5, using a multi-stage stratified random sampling approach. Overweight/obesity was our primary dependent variable. Weighted bivariate analysis was used to ascertain the prevalence, and the adjusted odds ratios were computed to ascertain the potential predictors. The contribution of different factors towards rising burden over two time points was estimated using multivariate decomposition analysis for non-linear response models. Overall weighted prevalence of overweight and obesity in males and females per NFHS-5 was 44.02% and 41.16%, respectively, compared to 37.71% and 36.14% in NFHS-4. Decomposition analyses depict that the proportion of obesity increased by 6.37% and 5.10% points among men and women, respectively, over the two rounds. Compositional differences of participants (endowment) attributed to 16.54 and 49.90% differences, and the difference in coefficient or effect accounted for 83.46 and 50.10%, respectively, of the increase in the prevalence. The most significant factors contributing to increased prevalence were age, improving socio-economic status, smoking, unclean cooking fuel, and diabetes. The incremental rise in such a short period, mainly attributed to the effect of socio-demographic variables, is concerning. Policy interventions should prioritize health advocacy programs and aggressively target behavioral modifications while preparing the health systems to manage the people living with obesity.

Health assessment of converter transformer pressboard insulation based on FDS and digital image processing

The stable operation of the converter transformer is an essential task for power system operation reliability and security. Nowadays, Frequency domain spectroscopy (FDS) technology is prominently utilized for assessing oil-impregnated pressboard insulation. The present study examines the effect of the pressboard insulation material as a function of frequency and elevated temperature. The experimental analysis on oil-impregnated pressboard insulation is carried out at temperatures from 30 °C to 130 °C with an incremental rise of 20 °C intervals with frequency variation from 1 Hz to 10 MHz. The frequency-dependent permittivity, conductivity and loss tangent angle studies also confirm the deterioration of oil-impregnated pressboard insulation. The surface morphological changes inside the pressboard insulation are recorded with the help of scanning electron microscopy (SEM). The synergistic effect generated on pressboard insulation is examined by fiber width changeand image processing approach by randomly selecting the average of three local areas of SEM image. A canny operator is selected to extract the exact boundaries of images and more change is recorded in the edge detection count after 90 °C.The porosity and pore size distribution can be increased with elevated temperatures. A single-phase, 315 MVA valve side star winding with 60 discs of single-phase converter transformers model is developed in MATLAB Simulink. An impulse of 100 kV, 1.2/50μsec is applied across the star winding to identify the pressboard insulation degradation derived from FDS data with the help of mathematical morphology and wavelet transform technique. The energy of the wavelet coefficient on the neutral current capture during the impulse test adds a significant contribution to analyzing pressboard insulation degradation. The results presented are in good agreement with the published work.

Unveiling the relationship between MOF porosity, particle size, and polyethersulfone membranes properties for efficient decontamination of dye and organic matter

This work investigates the impact of reaction time on the textural properties and nanoparticles growth of metal organic framework (MOF) obtained from zinc substrate and their subsequent impact on the performance of polyether-sulfone (PES) ultrafiltration membranes. The MOF nanoparticles were synthesized at various reaction times between 2 and 8 h and then immersed in ascorbic acid to improve their hydrophilicity. A decline in the particle size with significant rise in the textural properties was noticed by decreasing the reaction time. Moreover, shifting of oxygen functional groups (–OH and C–O) was obtained after acid treatment. Next, 1.5 wt% of the acid treated MOFs were blended in the PES polymer for the formation of the hybrid membranes. The porosity, contact angle, water flux, surface morphology, and roughness were characterized for the resulting membranes. Moreover, the hybrid membranes were tested against the rejection of Eriochrome Black-T (EBT) and Humic acid (HA) pollutants. The characterization outcomes illustrated an incremental rise in hydrophilicity, porosity, and surface roughness of the hybrid membranes by decreasing the reaction time of the MOF nanoparticles. The water flux steadily improved by decreasing the reaction time of the MOFs. The maximum flux was 427.7 L m−2h−1 which was 2.2 times higher than the flux of the bare membrane. The elimination of EBT and HA, flux recover ratio and fouling resistance of both pollutants were improved by decreasing the particle size of MOFs. Overall, this study discloses that tuning the reaction time of MOF significantly influence the effectiveness of PES membranes in water treatment systems.

HIV status and survival of patients with pulmonary hypertension due to left heart disease: the Pan African Pulmonary Hypertension Cohort

In sub-Saharan Africa, little is known about pulmonary hypertension in left heart disease (PH-LHD). We used multivariate logistic and cox-hazard proportional regression models to examine factors associated with increased right ventricular systolic pressure (RVSP) and the effect of real-world HIV status scenarios on 6-month survival rate in the Pan African Pulmonary Hypertension Cohort (PAPUCO) study, a prospective cohort from four African countries. Exposure to biomass fuel smoke (aOR, 95%CI 3.07, 1.02–9.28), moderate to severe NYHA/FC III/IV (aOR, 95%CI 4.18, 1.01–17.38), and unknown HIV status (aOR, 95%CI 2.73, 0.96–7.73) predicted moderate to severe RVSP at the time of presentation. Six months later, HIV infection, moderate-to-severe NYHA/FC, and alcohol consumption were associated with decreased survival probabilities. Upon adjusting for HIV infection, it was observed that an incremental rise in RVSP (1 mmHg) and inter-ventricular septal thickness (1 mm) resulted in an 8% (aHR, 95%CI 1.08, 1.02–1.13) and 20% (aHR, 95%CI 1.2, 1.00–1.43) increase in the probability of mortality due to PH-LHD. In contrast, the risk of death from PH-LHD was reduced by 23% for each additional unit of BMI. (aHR, 95%CI 0.77, 0.59–1.00). In conclusion, the present study offers insights into the determinants that are notably linked to unfavorable survival outcomes in patients with pulmonary hypertension due to left heart disease. Certain factors identified in this study are readily evaluable and amenable to modification, even in settings with limited resources.

Effect of Periprocedural Myocardial Infarction After Initial Revascularization With Left Main PCI in Patients With Recent Myocardial Infarction.

Periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) for left main coronary artery disease (LMCAD) may be particularly deleterious in patients with recent myocardial infarction (MI). We sought to determine the rates and prognostic relevance of PMI using different definitions and biomarker thresholds after PCI for LMCAD in patients with recent MI. Between January 2004 and December 2016, 442 patients underwent PCI for LMCAD at a median of 3 days after presentation with MI. A total of 350 patients presented with elevated cardiac biomarker levels (349 with serial creatine kinase-myocardial band [CK-MB] and 219 with serial cardiac troponin I (cTnI) values) that were stable or falling before the PCI. In this cohort, PMI within 48 hours of PCI was adjudicated using Society for Cardiovascular Angiography & Interventions (SCAI), Academic Research Consortium 2 (ARC-2), and fourth Universal Definition of Myocardial Infarction (UDMI) criteria. The primary and secondary end points were 3-year rates of cardiovascular (CV) and all-cause death. An incremental post-PCI rise in CK-MB starting at ≥10× the upper reference limit from baseline was significantly associated with 3-year CV death (adjusted hazard ratio [aHR], 7.96; 95% confidence interval [CI], 2.89-21.90), whereas CV death was not associated with any threshold elevation of cTnI. The frequencies of PMI according to the fourth UDMI, ARC-2, and SCAI definitions were 19.4%, 12.3%, and 8.6%, respectively. PMI by all 3 definitions was significantly associated with 3-year CV death, with the SCAI definition having the strongest relationship (aHR, 6.34; 95% CI, 2.47-16.27) compared with those of ARC-2 (aHR, 2.82; 95% CI, 1.15-6.96) and fourth UDMI (aHR, 2.65; 95% CI, 1.14-6.14). In patients with recent MI undergoing PCI for LMCAD, an incremental elevation in postprocedural CK-MB of ≥10× the upper reference limit as a stand-alone measure was strongly predictive of 3-year CV and all-cause death, whereas no cTnI elevations of any level were prognostic. All 3 contemporary PMI definitions in widespread use were associated with 3-year mortality after PCI in this high-risk cohort, with the SCAI definition having the strongest relationship with subsequent death.

Healthy and Osteoarthritis-Affected Joints Facing the Cellular Crosstalk.

Osteoarthritis (OA) is a chronic, progressive, severely debilitating, and multifactorial joint disease that is recognized as the most common type of arthritis. During the last decade, it shows an incremental global rise in prevalence and incidence. The interaction between etiologic factors that mediate joint degradation has been explored in numerous studies. However, the underlying processes that induce OA remain obscure, largely due to the variety and complexity of these mechanisms. During synovial joint dysfunction, the osteochondral unit undergoes cellular phenotypic and functional alterations. At the cellular level, the synovial membrane is influenced by cartilage and subchondral bone cleavage fragments and extracellular matrix (ECM) degradation products from apoptotic and necrotic cells. These "foreign bodies" serve as danger-associated molecular patterns (DAMPs) that trigger innate immunity, eliciting and sustaining low-grade inflammation in the synovium. In this review, we explore the cellular and molecular communication networks established between the major joint compartments-the synovial membrane, cartilage, and subchondral bone of normal and OA-affected joints.

A Systematic Review of the Risk and Protective Factors of Tobacco Use among South Indian Adults

Background: India is facing a crucial health burden due to the incremental rise in the prevalence of tobacco use and associated diseases. Sociocultural factors largely influence tobacco use behaviour. Hence, documenting the risk and protective factors associated with tobacco use among the South Indian population helps develop context-based interventions and policies to reduce tobacco-related issues. Objective: This systematic review aims to synthesise the available literature evidence on the risk factors contributing to tobacco use and the protective factors safeguarding against this health risk behaviour among South Indian adults. Methods: The primary author conducted a PRISMA-compliant systematic search using five databases: PubMed, Scopus, Web of Science, Wiley Online Library, and Science Direct from the inception to June 23, 2021. A manual search was also done in Google Scholar to find pertinent publications. 13 articles that met the review's inclusion criteria were selected from the 5063 articles that were initially found after a thorough screening process and suitable quality assessment. According to the socio-ecological model, the risk and protective factors identified were divided into five levels: intrapersonal, interpersonal, organisational, community, and public. Results: From the included studies, the major risk factors found were stress, low perceived health effect, low income, peer influence, nature of the occupation, lack of awareness about health effects due to community marginalization, community misconception of positive aspects of tobacco use and ease of availability in the market. The major protective factors identified were awareness, perceived harm to social image, familial support, community-based health education, exposure to tobacco warning labels and government initiatives of tobacco control. Conclusion: The multi-level factors identified from the current review findings reveal the need for population and context-specific interventions as well as the tobacco control policies to be developed in the near future. Interventions tailored to address the risk factors and incorporate the protective factors identified would benefit the South Indian community in tackling this health burden.

The impact of urbanisation on the cardiometabolic health of Indigenous Brazilian peoples: a systematic review and meta-analysis, and data from the Brazilian Health registry

Indigenous Brazilian peoples have faced an unparalleled increase in the rate of cardiovascular diseases following rapid nutritional transition to more urban diets. We aimed to conduct a systematic review and meta-analysis to evaluate the association between urbanisation (including data from Amazon rainforest deforestation) and cardiometabolic risk factors and outcomes. In this systematic review and meta-analysis, we searched Pubmed, Embase, Web of Science, and Scopus for articles published in any language between the year 1950 and March 10, 2022. Studies conducted in Indigenous Brazilian adults that evaluated metabolic health were included. Data for deforestation was obtained by the Amazon Deforestation Monitoring Project. Cardiovascular mortality was obtained from the Brazilian Health registry. Two independent reviewers evaluated studies for risk of bias, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. The main outcomes assessed were the prevalence of obesity and related cardiometabolic risk factors among Indigenous Brazilian peoples and its association with urbanisation. Summary data were extracted from published reports for the meta-analyses. We calculated pooled estimates of the prevalence of each cardiometabolic outcome by using a random-effects model (DerSimonian-Laird method). This study is registered with the International Prospective Register of Systematic Reviews, CRD42021285480. 46 studies were identified, including a total of 20 574 adults from at least 33 Indigenous Brazilian ethnicities. Meta-analyses of the prevalence of obesity showed that there were higher rates of obesity (midwest region: 23% [95% CI 17-29]; and south region 23% [13-34]) and hypertension (south region: 30% [10-50]) in Indigenous peoples living in urban regions of Brazil, while the lowest rates of obesity (11% [95% CI 8-15]) and hypertension (1% [1-2]) were observed in those in the less urbanised (north) regions of Brazil. The prevalence of obesity was 3·5 times higher in participants living in urbanised Indigenous territories (28%) than in those living in lands with >80% native Amazon rainforest (8%). In meta-analyses that evaluated blood pressure level, there was no incremental change in blood pressure with ageing in Indigenous peoples who lived according to traditional lifestyle, in contrast to those living in urbanised regions. For Indigenous men with traditional lifestyles, systolic blood pressure changed from 109·8 mm Hg to 104·4 mm Hg between the youngest (<30 years) and the oldest (>60 years) age groups, and diastolic blood pressure changed from 69·8 mm Hg to 66·1 mm Hg. For Indigenous women with traditional lifestyles, systolic blood pressure was 100·0 mm Hg for the youngest age group with no changes for older age groups, and diastolic blood pressure was 62 mm Hg for the youngest age group with no changes for older age groups. For Indigenous men with urbanised lifestyles, systolic blood pressure changed from 117·3 mm Hg to 124·9 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 72·7 mm Hg to 76·4 mm Hg. For Indigenous women with urbanised lifestyles, systolic blood pressure changed from 110·0 mm Hg to 116·0 mm Hg between the youngest and the oldest age groups, and diastolic blood pressure changed from 68·3 mm Hg to 74·0 mm Hg. For the years 1997 and 2019, the cardiovascular mortality rate in individuals living in the southeast region (the most urbanised) was 2·5 times greater than that observed in the north. Conversely, the incremental rise in cardiovascular mortality in the past two decades among Indigenous Brazilians living in the north or northeast (2·7 times increase) stands in stark contrast to the stable rates in those living in already urbanised regions. The macrosocial changes of Indigenous peoples' traditional ways of living consequent to urbanisation are associated with an increased prevalence of adverse cardiometabolic outcomes. These data highlight the urgent need for environmental policies to ensure the conservation of the natural ecosystem within Indigenous territories, as well as the development of socio-health policies to improve the cardiovascular health of Indigenous Brazilians peoples living in urban areas. None.

Abstract 12769: Association of Lung Protective Ventilation and Outcomes in Patients With Cardiogenic Shock on ECLS

Background: In Acute Respiratory Distress Syndrome, lung protective ventilation (LPV) improves patient outcomes by minimizing the risk of ventilator-associated lung injury. For patients with cardiogenic shock (CS) requiring VA-ECLS, the extracorporeal heart-lung circuit provides a unique opportunity to provide LPV. At present, there are limited data regarding optimal ventilator strategies for patients in CS on VA-ECLS. We hypothesized that CS patients on VA-ECLS who require ventilator support will have better outcomes with LPV. Methods: We queried Extracorporeal Life Support Organization (ELSO) registry for hospital admissions between 2009 and 2019 for CS patients on VA-ECLS and mechanical ventilation. Patients with multiple ECLS runs, congenital heart disease, pre-ECLS cardiac arrest, and durable mechanical circulatory support were excluded. We defined LPV as peak inspiratory pressure (PIP24)&lt;30 cm H 2 O at 24 hours on ECLS. ELSO registry does not report tidal volume, hence, PIP24 was used as surrogate for plateau pressure. PIP24 and driving pressure (PIP24 minus PEEP24) at 24 hours (DP24) were also studied as continuous variables. Our primary outcome was survival to discharge. Multivariable analysis adjusted for baseline SAVE score, age, race, BMI, etiology of CS, intubation hours prior to ECMO and history of chronic lung disease. Results: A total of 2,226 CS patients on VA-ECLS were included of which 1904 received LPV. LPV patients had a significantly lower BMI (median 28.28 vs 31.14, p&lt;0.001), and were less sick, as assessed by their baseline SAVE score (-1.79 vs -2.79, p=0.002). The primary outcome of survival to discharge was significantly greater in LPV cohort (47.4% vs 32.6%, p&lt;0.001). Median PIP24 (22 vs 24, p&lt;0.001) as well as DP24 (14.5 vs 16, p&lt;0.001) were significantly lower in those surviving to discharge. Adjusted OR for primary outcome with LPV was 1.69 (p=0.0023). Adjusted OR for primary outcome with incremental rise in PIP24 (0.78, p=0.0003) and DP24 (0.75, p&lt;0.0001) were also statistically significant. Conclusions: In VA-ECLS patients requiring mechanical ventilation, LPV and lower PIP and DP at 24 hours is associated with improved survival to discharge.