Improvement In Mortality Research Articles

Assessing Longevity Inequality in the U.S.: What Can Be Said About the Future?

This paper investigates mortality inequality across U.S. states by modelling and forecasting mortality rates via a forecast reconciliation approach. Understanding the heterogeneity in state-level mortality experience is of fundamental importance, as it can assist decision making for policymakers, health authorities, as well as local communities who are seeking to reduce inequalities and disparities in life expectancy. A key challenge of multi-population mortality modeling is high dimensionality, and the resulting complex dependence structures across sub-populations. Moreover, when projecting future mortality rates, it is important to ensure that the state-level forecasts are coherent with the national-level forecasts. We address these issues by first obtaining independent state-level forecasts based on classical stochastic mortality models, and then incorporating the dependence structure in the forecast reconciliation process. Both traditional bottom-up reconciliation and the cutting-edge trace minimization reconciliation methods are considered. Based on the U.S. total mortality data for the period 1969{2017, we project the 10-year-ahead mortality rates at both national-level and state-level up to 2027. We find that the geographical inequality in the longevity levels is likely to continue in the future, and the mortality improvement rates will tend to slow down in the coming decades.

MORTALITY AND MEDICAL COMORBIDITY IN OLDER ADULTS WITH SCHIZOPHRENIA: A LITERATURE REVIEW

Introduction By 2025, the population of adults with schizophrenia over the age of 55 will reach 1.1?million. By 2050, this population may reach 10?million. Few studies have examined the physical comorbidities and mortality of Adults with (OAS). Recent national register studies have begun to yield compelling data on the medical issues facing this emerging demographic. These studies as well as other population based studies provide an opportunity to broadly assess whether this population's risk for specific medical disorders is increased compared to healthy peers and younger adults with schizophrenia. Methods Recent prominent register studies in the Netherlands, Denmark, Finland, United Kingdom, Sweden, Manitoba, Canada and Indiana, United States were reviewed in detail. The search term Older Adults with Schizophrenia was searched on PsycInfo, Google Scholar, Psychiatry Online with the following terms added: mortality, disease diabetes, utilization. antipsychotics. Approximately 112 journal articles, book chapters were selected for this review, prioritizing register studies, large population studies and journal articles focused on schizophrenic patients above the age of 55. . After removing redundant selections, approximately 93 articles were determined to be appropriate for this review. Results Recent register studies across nations and health care systems have demonstrated an approximate 2.0 to 2.5 increase in all-cause mortality in OAS compared to age peers. The all-cause mortality risk broadly appears to be improved compared to middle-aged and younger schizophrenics. The risk of suicide trends downward in OAS patients after the age of 60, further decreasing past the age of 70. Female OAS patients appear to have a higher suicide risk than males. OAS patients are still at significant risk of suicide compared to age peers without schizophrenia. Among OAS there is increased mortality for respiratory disease compared to the general population, but reduced compared to younger persons with schizophrenia. Increased prevalence of respiratory diseases in OAS has not been demonstrated consistently. There has been no demonstrated increase in mortality or prevalence of diabetes in the OAS population. OAS patients have a declining mortality from cardiovascular disease as they age compared to their younger counterparts, but still elevated compared to their age peers. Survival bias cannot be ruled out. Antipsychotic medication may play a role in increased cardiovascular mortality in OAS patients,(e.g., a U-shaped mortality curve pattern at no, low, and high doses) and suggests more research is needed to optimize dosing in this population. Population studies suggest a paradox where cancer incidence among persons with schizophrenia appears to be the same or lower than their age peers, but their mortality rate is higher; indeed, a screening and treatment gap exists in OAS patients with respect to cancer, which may account for lower incidence rates and higher mortality rates. A health care utilization gap for outpatient care exists for OAS patients across nations and health care systems. Integrated health care models show promise in bridging primary and psychiatric care. Conclusions Adults with is an emerging demographic in the schizophrenic population. Their healthcare outcomes appear to be unique when compared to younger individuals with schizophrenia and compared to their age peers without schizophrenia. This review evidences an increase in all-cause mortality for OAS patients compared to healthy age peers and this increase in mortality may extend to respiratory and cardiovascular diseases. OAS patients appear to have improved mortality rates for all-cause, respiratory disease, cardiovascular disease and suicide risk when compared to younger peers with schizophrenia; however, further study to understand what modifiable risk factors are influencing the mortality data is needed. This review also argues for a healthcare utilization gap in this population which may explain some of the modifiable risk affecting this population. This research was funded by: None

Drivers of Mortality Dynamics: Identifying Age/Period/Cohort Components of Historical U.S. Mortality Improvements

The goal of this article is to obtain an age/period/cohort (A/P/C) decomposition of historical U.S. mortality improvement. Two different routes to achieving this goal are considered. In the first route, the desired components are obtained by fitting an A/P/C model directly to historical mortality improvement rates. In the second route, an A/P/C model is estimated to historical crude death rates and the desired components are then obtained by differencing the estimated model parameters. For each route, various possible A/P/C model structures are tested and evaluated on the basis of their robustness to several factors (e.g., changes in the calibration window) and their ability to explain historical changes in mortality improvement. Based on the evaluation results, an A/P/C decomposition for each gender is recommended. The decomposition will be examined in a follow-up project, in which the linkages between the A/P/C components and certain intrinsic factors will be identified.

Improving HMD Mortality Estimates with HFD Fertility Data

This article aims to improve mortality estimates using fertility data. Estimating the population exposed to risk, such as in the Human Mortality Database (HMD), can suffer from errors for cohorts born in years in which births fluctuate unevenly over the year. When comparing period and cohort mortality tables, we highlight the presence of anomalies in the period tables in the form of isolated cohort effects. Our investigation of the HMD methodology shows that it assumes a uniform distribution of births that is specific to the period tables, which is likely to lead to an asymmetry with the cohort tables. Building on the “Phantoms Never Die” study of Cairns et al. regarding the construction of a “data quality indicator,” we utilize the Human Fertility Database (HFD), which is the perfect counterpart to the HMD in terms of fertility. The indicator is then used to construct corrected period mortality tables for several countries, which are then analyzed from both historical and prospective points of view. The analysis has implications for the reduction of volatility of mortality improvement rates, the use of cohort parameters in stochastic mortality models, and the improved fit of corrected tables by classical mortality models.

1208: HIGH BURDEN OF ACQUIRED MORBIDITIES IN SURVIVORS OF PEDIATRIC ACUTE RESPIRATORY DISTRESS SYNDROME

Loh, Sin Wee1; Gan, Ming Ying2; Ong, Chengsi3; Wong, Judith Ju-Ming4; Lee, Jan Hau4 Author Information

Survival and Cause of Death among Extremely Preterm Infants Near the Limit of Viability

Although active perinatal management including delivery room resuscitation has been known to be the primary determinant of mortality for extremely preterm (EPT) infants near the limit of viability, wide institutional variations are evident in the Korean Neonatal Network data regarding the mortality of infants born at 23-24 weeks’ gestation. Most EPT infants near the limit of viability died within a few days of life. According to recent studies, improved mortality rate attributable to fewer deaths due to pulmonary and infectious causes in the infants with 23-24 weeks’ gestation was associated with antenatal steroid use and active delivery room resuscitation. Quality improvements that involve identifying and applying the best clinical care strategies, which include gentle meticulous respiratory care and infection control strategies, might be primarily responsible for the nationwide improvement in the outcomes of periviable EPT infants. There is also a need for the development of effective treatments to overcome deaths related to bronchopulmonary dysplasia and severe intraventricular hemorrhage.

Antimicrobial Therapy and Antimicrobial Stewardship in Sepsis.

Since sepsis was first defined, sepsis management has remained challenging. To improve mortality rates for sepsis and septic shock, an accurate diagnosis and prompt administration of appropriate antibiotics are essential. The goals of antimicrobial stewardship are to achieve optimal clinical outcomes and to ensure cost-effectiveness and minimal unintended consequences, such as toxic effects and development of resistant pathogens. A combination of inadequate diagnostic criteria for sepsis and time pressure to provide broad-spectrum antimicrobial therapy remains an obstacle for antimicrobial stewardship. Efforts such as selection of appropriate empirical antibiotics and de-escalation or determination of whether or not to stop antibiotics may help to improve a patient's clinical prognosis as well as the successful implementation of antimicrobial stewardship.

Inhibition of Dimethylarginine Dimethylaminohydrolase 1 Improves the Outcome of Sepsis in Pregnant Mice.

Sepsis is one of the most important causes of maternal mortality. In our previous work, we established a polymicrobial sepsis (cecal ligation and puncture [CLP]) model in murine pregnancy and found that pregnant mice had a greater susceptibility to septic shock. In this model, mortality seemed to be associated with the development of early hemodynamic dysfunction and although circulating cytokine levels were similar, "off target" lung inflammatory cell numbers were greater in pregnant mice.Here, we have used the same CLP model to test the hypothesis that inhibiting the metabolism of the endogenous inhibitor of nitric oxide synthase, asymmetric dimethylarginine would improve the outcome of sepsis in pregnancy. We used a dimethylarginine dimethylaminohydrolase 1-selective inhibitor (L-257), which reduces vascular nitric oxide synthesis without impairing immune cell function, in combination with a broad-spectrum antibiotic (Imipenem) and studied the outcome of septic shock in pregnant mice. Treatments were administered 3 h after CLP and samples were taken 3 h later. Both Imipenem and L-257 treatment alone slightly improved mortality rates from 13% (NaCl) to 20% (Imipenem) and 33% (L-257), whereas the combination of Imipenem and L-257 significantly improved survival to 50%. Imipenem and L-257 together prevented cardiovascular collapse and improved both organ function and bacterial killing, but did not reduce lung inflammatory cell numbers and actually increased lung cytokine levels.These data suggest that conventional management in combination with selective inhibition of DDAH1 may have therapeutic potential in the management of sepsis in pregnancy.

Childhood cancer, age at diagnosis and educational attainment: A meta-analysis

Despite improved mortality rates, cognitive and academic difficulties are evident in some childhood cancer survivor groups. This meta-analysis aims to determine whether: 1) survivors have lower educational attainment than non-cancer controls; 2) educational attainment varies according to cancer type (CNS versus non-CNS); and 3) whether an early age of diagnosis confers greater disadvantage. A systematic search utilising the terms "neoplasms", "childhood", "educational attainment" and other related terms retrieved 2256 records from Embase, Medline and PsycINFO. Eleven studies satisfied the inclusion criteria. Survivors were less likely than controls to graduate from high school (OR = 0.74, 95 % CI: [0.60; 0.92]) or university (OR = 0.74, 95 % CI: [0.58; 0.94]). Although educational attainment in survivors of CNS cancer is reduced, non-CNS cancer survivors tend to attain similar educational status to controls. Additionally, there is some evidence that a diagnosis prior to adolescence may reduce the likelihood of high school, but not university, graduation.

Study of clinical profile and outcomes of Percutaneous Coronary Intervention in ST Elevation Myocardial Infraction

Background and Aims: Percutaneous Coronary Intervention (PCI) is the preferred method of revascularization in Acute ST Elevation Myocardial Infarction (STEMI). Our aim was to study the clinical profile and outcomes of patients who underwent PCI for STEMI at tertiary cardiac centre of Nepal.
 Methods: It is a retrospective, single centre study, performed at Tribhuvan University, Manmohan Cardiothoracic Vascular and Transplant Centre, Kathmandu, Nepal. All patients who underwent PCI for STEMI from November 2015 to July 2018 were enrolled in this study. All the data were collected from hospital registry and cath lab records.
 Results: The Study showed that out of 232 patients who presented with STEMI, 74.5% were male with average age of 57.39 years. The mean time of presentation after onset of symptom/s was 17.5 hours. About 66% patients presented in less than 12 hours of symptoms onset, 21% presented at 12-24 hours of symptoms onset and 13% patients presented late. Primary PCI was done in 87% of patients. Almost all patients (98.2%) underwent coronary artery stenting with drug eluting stents. Multivessel PCI during index procedure was done in 7 patients. TIMI III flow following PCI was achieved in 97% cases. Average LVEF at discharge was 44.73%. There were 8 deaths, all after Primary PCI. In-hospital mortality rates for patients presenting with and without cardiogenic shock were 38.46% and 1.59% respectively. The overall mortality rate was 3.98%.
 Conclusion: This study has reemphasized that PCI is effective in the management of STEMI cases in Nepal with improving mortality rates and decreasing complications. Minimizing the delayed presentation after the onset of symptoms should be one of the prime focuses for effective management of STEMI.

Associated Co-Morbidities, Healthcare Utilization, and Mortality in Hospitalized Children and Adults with Hemophilia in the United States: Updated Nationally Representative Estimates and a Comparative Analysis

Introduction Hemophilia is one of the most common inherited bleeding disorders. This study aims to estimate associated diagnoses, healthcare utilization, and mortality in hospitalized pediatric and adult patients with hemophilia A and B and evaluate outcome improvement trends. Methods The 2016 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) was utilized for the analysis. The NIS uses a stratified probability sample of 20% of all inpatient discharges (representing more than 97% of the US population). We applied sampling weights to represent all hospital discharges for hemophilia identified using ICD-10 codes D66 and D67 and generate nationally representative estimates. For comparative historical data, we used 2007 data from a prior published study [Goel et al., Hemophilia (2012), 18, 688-692]. Results In 2016, there were n=10,840 hospital discharges with hemophilia A or B as one of all listed diagnoses (n=1600 as principal diagnosis). Of these, 2445 were children, and 8395 were adults. The median age (interquartile range) was 52 (33-68) years for adults and 5 (1-11) years for children. Associated Diagnoses (Table 1a) The most common associated diagnoses in adults with hemophilia were hypertension (34.7 ± 1.2%), Type 2 diabetes (21.1 ± 1.2%), and hyperlipidemia (18.8 ± 1.0%). Other noteworthy ones include hepatitis C (16.4 ± 1.1%), coronary artery disease (13.3 ± 0.9%), and congestive heart failure (11.1 ± 0.8%). In pediatric hemophilia cases, central line infection and fever (13.5 ± 1.5%), hemarthrosis (10.4 ± 1.3%), and anemia (8.6 ± 1.3%) were the most common discharge diagnoses. HIV/AIDS and hepatitis C were not reported in children and listed in 5.9 ± 0.6% and 16.4 ± 1.1% of adults, with the youngest age at reported diagnosis being 32 and 21 years, respectively. Mortality (Table 1b) The all-cause in-hospital mortality was 1.9% for hemophilia related admissions, which was comparable to all NIS hospitalizations at 1.9%. The median age at death in years (interquartile range) for hemophilia patients was 72 (57-78) and comparable to 73 (61-83) for all hospitalizations. The most common diagnoses associated with mortality included respiratory failure, "do not resuscitate" status, and sepsis. There was no inpatient mortality reported in children, and the youngest age for in-hospital death was 27 years. Health Care Utilization 96.0% of all hemophilia admissions had insurance coverage with the distribution as follows: Medicare: 33.4%, Medicaid: 28.8%, private insurance: 28.6%. For all NIS hospitalizations, 96.1% had coverage (Medicare: 39.6%, Medicaid: 23.1%, private insurance: 30.1%). The median hospital stay length per hemophilia admission was 3 days (2-6) and was similar to all hospital stays at 3 days (2-5). The median hospital charge per hemophilia admission was $50,662 as compared to $25,261 for all hospital admissions. 2007 Comparison When we compared our data to 2007, serving as a near-decade long follow-up, insurance distribution, inpatient mortality rate, and length of stay were relatively unchanged. Amongst the most common diagnoses for adults with hemophilia were hypertension (up from 28.1% to 34.7%), hepatitis C (down from 21.8% to 16.4%), congestive heart failure (up from 8.1% to 11.1%), and HIV/AIDS (stable at 5.6% and 5.9% respectively). In both 2007 and 2016, there were no HIV or hepatitis C cases amongst children with hemophilia. Notably, in 2007, there were more bleeding related diagnoses, such as hematuria and hemorrhages. There was no inpatient mortality for children in 2016, while there were 15 day of life zero deaths (7% mortality rate) in 2007. The median age at death was also greater in 2016 (72 and 68.3 years). Discussion/Conclusions Adult hemophilia hospitalizations were in large part related to non-bleeding complications and age-related co-morbidities. In contrast, catheter-related infections and bleeding remain the top reasons for pediatric admissions. Most hemophilia patients had insurance coverage. The median hospital charge for those with hemophilia was nearly twice that of all-cause hospitalizations. Advancements in hemophilia treatment and outcomes are continuing, as evidenced by the improved mortality rate and median survival range approaching those from all hospitalizations. These changes all cumulatively demonstrate significant treatment and health care advancements in hemophilia management. Disclosures Takemoto: Genetech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Other: DSMB for aplastic anemia trial.

Incorporation of Thiotepa in a Reduced Intensity Conditioning Regimen Leads to Improved Engraftment after Stem Cell Transplant for Patients with Hemophagocytic Lymphohistiocytosis

Introduction: Hematopoietic stem cell transplantation (HSCT) for patients with hemophagocytic lymphohistiocytosis (HLH) following myeloablative conditioning regimens (MAC) is associated with high rates of non-relapse mortality. A previously reported prospective, phase 2 multi-center trial (RICHI) using using RIC strategy of fludarabine, melphalan and alemtuzumab (day -14) for HLH and primary immune deficiency syndromes (PIDS) demonstrated improved mortality rates but fewer than half the patients with HLH (41%) successfully engrafted without secondary graft failure, need for donor lymphocyte infusion (DLI) or second transplant. Incorporation of thiotepa during conditioning has been to shown to be safe and improve engraftment. We report the results of a retrospective analysis of nine consecutive patient treated with the inclusion of thiotepa into the RICHI backbone (RICHI+TT). Methods: Patients received a single additional dose of thiotepa 10mg/kg on day -3 added to the fludarabine/melphalan/alemtuzumab backbone (RICHI+TT) with the same graft-versus-host disease prophylaxis of methyprednisolone through day +28 and cyclosporine through day 180. To determine sustained engraftment, we used the same parameters the RICHI study defined as > 5 % donor chimerism without any intervention and alive at 1 year post-transplant. Results: Our cohort consisted of 8 males and 1 female with a median age of 7 years (range 1-18 years). Seven patients had HLH with proven pathogenic genetic mutations (biallelic PRF1 - 2, UNC13D - 2, STXBP1- 1, RAB27A-1, STAT3 gain of function-1), while the other 2 patients had HLH without identified pathogenic mutations (1- chronic active EBV, 1- juvenile idiopathic arthritis with refractory macrophage activation syndrome).The majority of patients received a bone marrow product (n = 8), one patient received a peripheral blood stem cell product; 6 patients received a graft from a matched related donor , two from a mismatched unrelated donor, and one from a matched unrelated donor. All patients engrafted at a median of 15 days post-transplant (8 patients at 100% donor chimera; 1 patient at 99% donor chimera at initial engraftment). Six of the 9 patients were evaluable to assess donor chimerism at 1 year as per study definitions with a median follow up of 875 days (range: 366 -1000 days). All 6 patients had > 5% donor chimerism and were alive at 1 year. Five of the 6 evaluable patients met criteria for sustained donor engraftment without need for intervention and all maintained 100% donor chimerism at last follow-up (Table 1). Only one of the six patients had evidence of falling donor chimerism; this stabilized at 40% donor chimerism after DLI. No patients had primary or secondary graft failure. Three patients were not evaluable for long-term assessment due to death prior to 1 year. Six of the 9 patients described here are alive and disease-free with stable long-term engraftment. The incorporation of Thiotepa to the RICHI backbone improved on previously reported sustained donor engraftment (Table 2). Conclusions: The RICHI+TT approach had better long-term donor engraftment with a decreased need for DLI or second transplant without increased rates of non-relapse mortality. Prospective studies are needed to determine the optimal treatment strategies for patients with HLH who require HSCT for cure. Disclosures Heslop: Cell Medica: Research Funding; Tessa Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Marker Therapeutics: Equity Ownership, Membership on an entity's Board of Directors or advisory committees; Kiadis: Membership on an entity's Board of Directors or advisory committees; Allovir: Equity Ownership; Gilead Biosciences: Membership on an entity's Board of Directors or advisory committees.

Pediatric Trauma System Evaluation before and after Level II Verification

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study (P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group (P = 0.0002); motorized recreational vehicle (P = 0.028), violent (P = 0.009), and other (P = 0.0374) mechanism of injury categories; ambulance (P = 0.0124), fixed wing (P = 0.0028), and personal-owned vehicle (P = 0.0112) modes of transportation. Decreased public injuries (P = 0.0071) and advanced life support ambulance transportation (P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.

MORTALITY TRENDS IN THE POPULATION OF THE IRKUTSK REGION IN THE PROCESS OF SOCIAL AND ENVIRONMENTAL TRANSFORMATIONS (1989-2017)

Introduction. The policy in the field of public health care should take into account the peculiarities of regional development, due to the influence of socio-environmental factors and processes. Mortality indices are the most important medico-demographic index of the state of the regional socio-ecological system. The aim of the study is to characterize the mortality trends of various age groups of the population of the Irkutsk region in the context of social and environmental transformations of the post-Soviet period. Material and methods. A retrospective longitudinal study of the mortality characteristics of the population of the Irkutsk region, the Siberian Federal District (SFD) and the Russian Federation (RF) in the dynamics from the late 1980s to 2017 was carried out. Statistical materials were obtained from the databases of the Federal State Statistics Service, the Center for Demographic Studies of the New Economic School and Demographic Yearbooks of Russia. The analysis of trends in mortality rates and their socio-ecological interpretation is carried out. Results. Dynamics of the total mortality rate in the period 1989-2017 consisted of two stages (1991-1998 and 1999-2017). Each of these stages was characterized by a marked increase in the mortality rate and its subsequent decrease. The values of this index in the Irkutsk region during the entire observation period were higher than the values of the same indicator for the SFD by 6.5-10.0% and higher than the figure for the Russian Federation by 12.9-21.5%. The dynamic changes in the mortality rates of the working-age population are similar to the corresponding characteristics of total mortality. The trends in child and infant mortality rates were characterized by a consistent decrease. The dynamics of the mortality rate of the adolescent-youth contingent (15-19 years) was similar to the dynamics of the total mortality rate. Conclusion. The phenomena of a systemic transformational crisis led to the adverse dynamics of mortality characteristics from 1992 to 2006. A major positive shift in improving mortality rates occurred in 2007-2017. It was due to positive changes in the socio-economic sphere. Only the mortality levels of the working-age population did the lag behind the figures for 1989-1990 continue. The Irkutsk region should be characterized as a region of relative socio-ecological disadvantage in the mortality rates of all age groups of the population.

Mortality-Culling Rates of Dairy Calves and Replacement Heifers and Its Risk Factors in Holstein Cattle.

Simple SummaryHigh mortality and involuntary culling rates cause great economic losses to the dairy industry around the world, and the survival of dairy calves and replacement heifers is paramount in modern dairy breeding. However, little has been done to genetically improve mortality rates of dairy calves and replacement heifers in Chinese Holstein cattle. In this study, we investigated population parameters (descriptive statistics) of mortality rates of dairy calves and replacement heifers and risk factors affecting mortality and involuntary culling rates in Chinese Holstein cattle. The mortality rate of dairy calves and replacement heifers from day 3 to 60, 61 to 365, and 366 to first calving was 5.5%, 7.4%, and 8.7%, and an unfavorable increasing trend has been observed in the Chinese Holstein population. Health events associated with digestive and respiratory or circulatory systems were the main reasons for deaths. Herd-birth year, birth season, and dam parity had significant effects on survival. Our findings will help farmers to better manage dairy calves and replacement heifers and highlight the need to include these survival traits as part of the national genetic evaluation schemes.The rates of mortality and involuntary culling of dairy calves and replacement heifers have great economic implications on the dairy cattle industry around the world. The main objectives of this study were: (1) to obtain population parameters of mortality and involuntary culling rates of dairy calves and replacement heifers; and, (2) to investigate the factors affecting mortality and involuntary culling rates in Chinese Holstein cattle. Two datasets containing records of birth, calving, and culling events from 142,833 Holstein cattle born between 1991 and 2018 were used in this study. The population parameters were obtained using dataset 1, which consisted of dairy calves and replacement heifers that died or were involuntarily culled. Three survival traits were defined in dataset 2, which consisted of females born from 1999 to 2018. A binomial logistic regression was used to analyze the risk factors on the survival traits. The mortality rate of dairy calves and replacement heifers from day 3 to 60, 61 to 365, and 366 to first calving was 5.5%, 7.4%, and 8.7%, and an unfavorable increasing trend was observed. Health events associated with digestive and respiratory or circulatory systems were the main death reasons. Herd-birth year, birth season, and dam parity had significant effects on survival traits. The results from this study will help farmers to better manage calves and replacement heifers and highlight the need to include survival traits in dairy calves and replacement heifers as part of national genetic evaluation schemes.

Influence of Time to Transport to a Higher Level Facility on the Clinical Outcomes of US Combat Casualties with TBI: A Multicenter 7-Year Study.

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide and is associated with mortality rates as high as 30%. Patients with TBI are at high risk for secondary injury and need to be transported to definitive care expeditiously. However, the physiologic effects of aeromedical evacuation are not well understood and may compound these risks. Combat TBI patients may benefit from delayed aeromedical evacuation. The goal of this study was to evaluate the impact of transport timing out of theater via Critical Care Air Transport Teams (CCATT) to a higher level facility on the clinical outcomes of combat casualties with TBI. We performed a retrospective review of patients with TBI who were evacuated out of theater by CCATT from January 2007 to May 2014. Data abstractors collected flight information, vital signs, procedures, in-flight assessments, and outcomes. Time to transport was defined as the time from injury to CCATT evacuation out of combat theater. We calculated descriptive statistics and constructed regression models to determine the association between time to transport and clinical outcomes. This study was approved by the U.S. Air Force 59th Medical Wing Institutional Review Board. We analyzed the records of 438 patients evacuated out of theater via CCATT and categorized them into three groups: patients who were transported in one day or less (n = 165), two days (n = 163), and three or more days (n = 110). We used logistic regression models to compare outcomes among patients who were evacuated in two days or three or more days to those who were transported within one day while adjusting for demographics, injury severity, and injury type. Patients who were evacuated in two days or three or more days had 50% lower odds of being discharged on a ventilator and were twice as likely to return to duty or be discharged home than those who were evacuated within one day. Additionally, patients transported in three or more days were 70% less likely to be ventilated at discharge with a GCS of 8 or lower and had 30% lower odds of mortality than those transported within one day. In patients with moderate to severe TBI, a delay in aeromedical evacuation out of the combat theater was associated with improved mortality rates and a higher likelihood of discharge to home and return to duty dispositions. This study is correlational in nature and focused on CCATT transports from Role III to Role IV facilities; as such, care must be taken in interpreting our findings and future studies are needed to establish a causal link between delayed evacuation and improved discharge disposition. Our study suggests that delaying aeromedical evacuation of TBI patients when feasible may confer benefit.

MON-298 ANEMIA PREVALENCE AND ITS IMPACT ON HEALTH-RELATED QUALITY OF LIFE IN DIABETIC KIDNEY DISEASE PATIENTS: EVIDENCE FROM A CROSS-SECTIONAL STUDY

Anaemia is one of the burdening complications of diabetes and chronic kidney disease (CKD). Early identification and treatment may enhance the quality of life, delay renal replacement therapy and improve mortality rates. The dearth of evidence is available from Indian settings regarding anaemia prevalence in Diabetic Kidney Disease (DKD) patients. Thus, this study was undertaken to determine the prevalence, predictors of anaemia and its impact on quality of life among DKD patients.

Rotation of the age pattern of mortality improvements in the European Union

Human mortality tends to decline in the long run, which is fortunate for humans, but less so for pension and health insurance schemes and annuity providers. Empirical studies have shown that rates of mortality improvement depend heavily on the age, gender and country in question, and additionally, they also tend to change in time. More specifically, the historical acceleration of mortality decreases among the elderly and a simultaneous slowdown of improvement at younger ages, which are sometimes jointly referred to as the rotation of the age pattern of mortality decline, have been observed in several populations. After a concise summary of the most relevant literature, this paper suggests a simple, largely data-driven methodology with few assumptions for the empirical examination of the rotation phenomenon in historical mortality datasets. These techniques are then applied on United Nations data from the period between 1950 and 2015 for both genders and all 28 countries of the European Union. The results indicate that rotation has indeed taken place in numerous member states, but its presence is far from universal, and it appears to have been notably more prevalent in populations of women than among men. Life expectancies seem to predict degrees of rotation only in the former Eastern bloc despite prominent literature that suggests otherwise, while increments of life expectancies over the observed period are better predictors of the degrees of rotation in the case of Western European women.

Transcatheter arterial embolization versus surgery for refractory non-variceal upper gastrointestinal bleeding: a meta-analysis

BackgroundNowadays, very few patients with non-variceal upper gastrointestinal bleeding fail endoscopic hemostasis (refractory NVUGIB). This subset of patients poses a clinical dilemma: should they be operated on or referred to transcatheter arterial embolization (TAE)?ObjectivesTo carry out a systematic review of the literature and to perform a meta-analysis of studies that directly compare TAE and surgery in patients with refractory NVUGIB.Materials and methodsWe searched PubMed, Ovid MEDLINE, and Embase. A combination of the MeSH terms “gastrointestinal bleeding”; “gastrointestinal hemorrhage”; “embolization”; “embolization, therapeutic”; and “surgery” were used ((“gastrointestinal bleeding” or “gastrointestinal hemorrhage”) and (“embolization” or “embolization, therapeutic”) and “surgery”)). The search was performed in June 2018. Studies were retrieved and relevant studies were identified after reading the study title and abstract. Bibliographies of the selected studies were also examined. Statistical analysis was performed using RevMan software. Outcomes considered were all-cause mortality, rebleeding rate, complication rate, and the need for further intervention.ResultsEight hundred fifty-six abstracts were found. Only 13 studies were included for a total of 1077 patients (TAE group 427, surgery group 650). All selected papers were non-randomized studies: ten were single-center and two were double-center retrospective comparative studies, while only one was a multicenter prospective cohort study. No comparative randomized clinical trial is reported in the literature.Mortality. Pooled data (1077 patients) showed a tendency toward improved mortality rates after TAE, but this trend was not statistically significant (OD = 0.77; 95% CI 0.50, 1.18; P = 0.05; I2 = 43% [random effects]). Significant heterogeneity was found among the studies.Rebleeding rate. Pooled data (865 patients, 211 events) showed that the incidence of rebleeding was significantly higher for patients undergoing TAE (OD = 2.44; 95% CI 1.77, 3.36; P = 0.41; I2 = 4% [fixed effects]).Complication rate. Pooling of the data (487 patients, 206 events) showed a sharp reduction of complications after TAE when compared with surgery (OD = 0.45; 95% CI 0.30, 0.47; P = 0.24; I2 = 26% [fixed effects]).Need for further intervention. Pooled data (698 patients, 165 events) revealed a significant reduction of further intervention in the surgery group (OD = 2.13; 95% CI 1.21, 3.77; P = 0.02; I2 = 56% [random effects]). A great degree of heterogeneity was found among the studies.ConclusionsThe present study shows that TAE is a safe and effective procedure; when compared to surgery, TAE exhibits a higher rebleeding rate, but this tendency does not affect the clinical outcome as shown by the comparison of mortality rates (slight drift toward lower mortality for patients undergoing TAE). The present study suggests that TAE could be a viable option for the first-line therapy of refractory NVUGIB and sets the foundation for the design of future randomized clinical trials.LimitationsThe retrospective nature of the majority of included studies leads to selection bias. Furthermore, the decision of whether to proceed with surgery or refer to TAE was made on a case-by-case basis by each attending surgeon. Thus, external validity is low. Another limitation involves the variability in etiology of the refractory bleeding. TAE techniques and surgical procedure also differ consistently between different studies. Frame time for mortality detection differs between the studies. These limitations do not impair the power of the present study that represents the largest and most recent meta-analysis currently available.

Closing the Disparity in Pancreatic Cancer Outcomes: A Closer Look at Nonmodifiable Factors and Their Potential Use in Treatment.

African Americans (AAs) have disproportionately higher incidence and lower survival rates from pancreatic cancer compared with whites. Historically, this disparity has been attributed to modifiable risk factors. Recent studies suggest that nonmodifiable aspects may also play an important role. We review these new contributions as potential targets for closing the disparity. A PubMed search was conducted to review studies of nonmodifiable elements contributing to pancreatic cancer disparities in AAs. Several nonmodifiable risks are associated with the racial disparity in pancreatic cancer. SSTR5 P335L, Kaiso, and KDM4/JMJD2A demonstrate differential racial expression, increasing their potential as therapeutic targets. Many social determinants of health and their associations with diabetes, obesity, and the microbiome are partially modifiable risk factors that significantly contribute to outcomes in minorities. Barriers to progress include the low minority inclusion in research studies. Genomics, epigenetics, the microbiome, and social determinants of health are components that contribute to the pancreatic cancer disparity in AAs. These factors can be researched, targeted, and modified to improve mortality rates. Closing the disparity in pancreatic cancer will require an integrated approach of personalized medicine, increased minority recruitment to studies, and advanced health care/education access.