Mortality Profiles Research Articles

Clinical Subtypes of Sepsis Survivors Predict Readmission and Mortality after Hospital Discharge.

Rationale: Sepsis survivors experience adverse outcomes including high rates of postdischarge mortality and rehospitalization. Given the heterogeneity of the condition, using a person-centered framework to identify subtypes within this population with different risks of postdischarge outcomes may optimize postsepsis care. Objectives: To classify individuals into subtypes and assess the association of subtypes with 30-day rehospitalization and mortality. Methods: We conducted a retrospective observational study between January 2014 and October 2017 among 20,745 patients admitted to one of 12 southeastern U.S. hospitals with a clinical definition of sepsis. We used latent class analysis to classify sepsis survivors into subtypes, which were evaluated against 30-day readmission and mortality rates using a specialized regression approach. A secondary analysis evaluated subtypes against readmission rate for ambulatory care-sensitive conditions. Results: Among 20,745 patients, latent class analysis identified five distinct subtypes as the optimal solution. Clinical subtype was associated with 30-day readmission, with the subtype existing poor health with severe illness and complex needs after discharge demonstrating highest risk (35%) and the subtype low risk, barriers to care demonstrating the lowest risk (9%). Forty-seven percent of readmissions in the subtype poor functional status were for ambulatory care-sensitive conditions, whereas 17% of readmissions in the subtype previously healthy with severe illness and complex needs after discharge, barriers to care were for ambulatory care-sensitive conditions. Subtype was significantly associated with 30-day mortality: highest in for existing poor health with severe illness and complex needs after discharge (8%) and lowest for low risk, barriers to care (0.1%). Conclusions: Sepsis survivors can be classified into subtypes representing nuanced constellations of characteristics, with differential 30-day mortality and readmission risk profiles. Predischarge classification may allow an individualized approach to postsepsis care.

Adaptions in subsistence strategy to environment changes across the Younger Dryas - Early Holocene boundary at Körtiktepe, Southeastern Turkey

The site of Körtiktepe in southeastern Turkey is one of few sites in the Upper Mesopotamia basin that attests continuous, permanent occupation across the boundary from end of the colder, drier Younger Dryas (YD) into the comparatively wetter and warmer Early Holocene (EH). This allows for the study of the degree of environmental change experienced on a local level over this boundary as well as for the study of the adaptations that the occupants of the site undertook in response to these changes. The mammal assemblage of Körtiktepe remains relatively stable across the YD – EH transition with the main contributors to diet being mouflon ( Ovis orientalis) and red deer ( Cervus elaphus) in approximately the same quantities, although the contribution of aurochs ( Bos primigenius) increases in the EH. The most significant changes can be seen in the shift in avifauna remains, with a sharp increase of waterbirds during the EH. It is proposed that these shifts reflect changes in the local environment with an increase in woodland cover as well as expansion of local waterways, which is generally consistent with previously published archaeobotanical studies. In terms of species exploited, mortality profiles as well as size distribution of mammals, a great deal of continuity is observed. This suggests that over this particular period the local impact of the beginning of the Early Holocene was not overly dramatic, allowing for cultural continuity of previously established subsistence strategies.

Profile of Patients With Symptomatic and Asymptomatic Aortic Stenosis in an Australian Clinical Cohort: A Retrospective Outcome Study

Current guidelines recommend aortic valve replacement (AVR) in patients with severe symptomatic aortic stenosis (AS). However, recent data suggest similar benefits of AVR in asymptomatic severe AS, with untreated severe and moderate AS patients having similar mortality profiles. We sought to determine the prevalence of symptoms in a large Australian cohort presenting with moderate and severe AS.

Early Pleistocene hominin subsistence behaviors in South Africa: Evidence from the hominin-bearing deposit of Cooper's D (Bloubank Valley, South Africa)

Evidence of the consumption of meat through hunting or scavenging by Early Pleistocene hominins is scarce, particularly in South Africa. Moreover, the interpretations of taphonomic evidence are subject to an important discussion commonly called the ‘hunting-vs-scavenging debate.’ Until today, only the Swartkrans Members 1–3 site has yielded a butchered bone assemblage large enough to permit reconstruction of carcass acquisition strategies by Early Pleistocene hominins in South Africa. This leaves an information gap between 1.4 and 1.0 Ma. Here, we provide the first evidence of meat consumption by hominins during this gap, based on the zooarchaeological study of the large mammal bone assemblage recovered from the Cooper's D site, South Africa. Based on skeletal part representation, our results show density-mediated attrition of bovid bones due to predepositional and postdepositional destruction. We argue that this attrition is the result of both abiotic (i.e., decalcification) and biotic (i.e., carnivore ravaging) processes. Bovid mortality profiles point out the involvement of ambush predators such as large felids. Bone surface modifications also indicate that the assemblage has been accumulated mostly by carnivores but with some hominin involvement as well. We observe all the stages of animal carcass processing (skinning, disarticulation, defleshing, marrow extraction) as well as the exploitation of a diversity of prey size classes at both Swartkrans Members 1–3 and Cooper's D. Thus, our study shows the importance of the Cooper's D bone assemblage for understanding Early Pleistocene hominin subsistence behaviors. Moreover, this article highlights the need for including long bone flake specimens in the analysis of large bone assemblages from South African caves to better understand the Early Pleistocene hominin bone damage record.

Chapter Two: Preliminary Findings from the Faunal Assemblage from Eleon

A relatively small, but well-preserved, assemblage of faunal remains centred on an apparent refuse heap in the southwest quadrant of Eleon has been analyzed to determine the relative representation of domesticated and wild taxa, as well as mortality profiles for sheep and goats. Although the total number of identified specimens is small, at 1059 fragments, several patterns that warrant further analysis have emerged in the data. The representation of deer among these remains is higher than at other sites on the Greek mainland. Lower-utility elements such as metapodials and tibiae are better represented than meatier portions of the skeleton, suggesting that entire carcasses were being processed on site. Mortality profiles developed from sheep and goat mandibles indicate a distinct management strategy for each species, with a large number of very young and juvenile goats, compared with many more mature sheep. Overall, the faunal remains from this deposit suggest a varied economy in the post-palatial period, exploiting a wide range of species for both primary and secondary animal products. Further faunal analysis at Eleon is warranted to allow comparisons across time periods and between locations at the site.

Age‐at‐death patterns and transition analysis trends for three Asian populations: Implications for [paleo]demography

AbstractObjectivesAge‐at‐death estimation provides biological anthropologists with fundamental biographic information to help resolve various theoretical and practical questions about both individual expression and populational trends in present and past contexts. Particularly, researchers interested in reconstructing past populations' mortality profiles have favored using Boldsen and colleagues' Transition Analysis (TA2), as the method provides both methodological and statistical solutions for optimally treating traditional ordinal, categorical score data from multiple age indicators. In this article, we present an assessment of TA2 to better understand its age estimation patterns and trends when applied to a large‐scale, documented Asian skeletal sample.Materials and methodsSpecifically, this study examines the patterns of error and bias of TA2 when applied to three Asian populations. We assess cumulative effects of the age estimates in mortality reconstruction, and TA2's ability to accurately characterize the effects of covariates (e.g., sex, stature) that are linked to inequal social status and differential access to resources and known to further cause mortality disparities.ResultsThe results show that age estimates of three age indicators (the pubic symphysis, auricular surface, and cranial sutures) combined with an informed prior produced the most accurate age estimates across all three Asian samples. Thus, the age composition of a target skeletal sample dictates the accuracy of TA2 estimates, and therefore demographic parameters.DiscussionAlthough the exact parameter values may differ from the true values and a consistent underestimation of female age‐at‐death and survivorship is evident, TA2 recovers a realistic approximation of a mortality pattern by revealing (previously hidden) elderly individuals.

Clustering-based simultaneous forecasting of life expectancy time series through Long-Short Term Memory Neural Networks

In this paper, we apply a functional clustering method to the multivariate time series of life expectancy at birth of the female populations collected in the Human Mortality Database. We reconstruct the functional form of life expectancy from the available discrete observations and derive the curves through non-parametric smoothing. Once the clustering is realized, we perform the life expectancy simultaneous forecasting of the countries inside each cluster implementing a multivariate Long-Short Term Memory neural network. Although functional clustering has already been used in the actuarial literature, in this work it is applied for the first time to the study of life expectancy. The originality of the work also lies in the combination of a functional clustering approach with simultaneous forecasting obtained through the Long-Short Term Memory. We point out that such a combination provides a more informative outlook of the evolution of life expectancy, allowing us to depict country-specific longevity consistently with acknowledged mortality profiles. The results show that the evolution of developed countries follows a homogeneous pattern and supports the persisting homogeneity within the high longevity cluster over time. Moreover, we find a remarkable cross-country heterogeneity in the medium-low longevity cluster. By exploiting the cluster information, we improve the simultaneous forecasting of life expectancy time series using Long Short Term Memory neural networks and compare the error forecast of our approach with those of the classical VAR model, showing a better performance of the former when considering the cluster average errors.

Investigating Middle Palaeolithic subsistence: zooarchaeological perspectives on the potential character of hominin climate refugia in Greece

ABSTRACTIt has long been proposed that during Pleistocene climatic perturbations the Balkan peninsula sustained refugial areas for fauna, flora, and potentially, hominins. In this study, we explore Middle Palaeolithic subsistence at the peninsula's southern end, Greece, and discuss how the evidence contributes to our understanding of the region's character as a refugium. We present new data from the recent reanalysis of the fauna from Asprochaliko rockshelter and the ongoing zooarchaeological investigations at Lakonis Cave 1 and compare them with published analyses from Klissoura Cave 1. We employ taxonomic abundance and diversity indices, as well as mortality profiles, to investigate hominin prey choice. Additional taphonomic observations provide further information on carcass exploitation. We examine changes in the faunal composition of the three sites in an attempt to identify the extent to which climate might have influenced resource availability and diversity in the region, stimulating resource intensification or diversification processes. Our results suggest that Middle Palaeolithic hominins consistently acquired high‐ranked prey through time. However, interregional differences in resource exploitation indicate that local topography and microclimate mediated prey choice and availability.

Seasonality and Oldowan behavioral variability in East Africa

The extent, nature, and temporality of early hominin food procurement strategies have been subject to extensive debate. In this article, we examine evidence for the seasonal scheduling of resource procurement and technological investment in the Oldowan, starting with an evaluation of the seasonal signature of underground storage organs, freshwater resources, and terrestrial animal resources in extant primates and modern human hunter-gatherer populations. Subsequently, we use the mortality profiles, taxonomic composition, and taphonomy of the bovid assemblages at Kanjera South (Homa Peninsula, Kenya) and FLK-Zinj (Olduvai Gorge, Tanzania) to illustrate the behavioral flexibility of Oldowan hominins, who were targeting different seasonally vulnerable demographics. In terms of the lithic assemblages, the specific opportunities and constraints afforded by dry season subsistence at FLK-Zinj may have disincentivized lithic investment, resulting in a more expedient toolkit for fast and effective carcass processing. This may have been reinforced by raw material site provisioning during a relatively prolonged seasonal occupation, reducing pressures on the reduction and curation of lithic implements. In contrast, wet season plant abundance would have offered a predictable set of high-quality resources associated with low levels of competition and reduced search times, in the context of perhaps greater seasonal mobility and consequently shorter occupations. These factors appear to have fostered technological investment to reduce resource handling costs at Kanjera South, facilitated by more consistent net returns and enhanced planning of lithic deployment throughout the landscape. We subsequently discuss the seasonality of freshwater resources in Oldowan procurement strategies, focusing on FwJj20 (Koobi Fora, Kenya). Although more analytical studies with representative sample sizes are needed, we argue that interassemblage differences evidence the ability of Oldowan hominins to adapt to seasonal constraints and opportunities in resource exploitation.

Office of Management and Budget Racial/Ethnic Categories in Mortality Research: A Framework for Including the Voices of Racialized Communities.

Since its founding, the US government has sorted people into racial/ethnic categories for the purpose of allowing or disallowing their access to social services and protections. The current Office of Management and Budget racial/ethnic categories originated in a dominant racial narrative that assumed a binary biological difference between Whites and non-Whites, with a hard-edged separation between them. There is debate about their continued use in researching group differences in mortality profiles and health outcomes: should we use them with modifications, cease using them entirely, or develop a new epistemology of human similarities and differences? This essay offers a research framework for including in these debates the daily lived experiences of the 110 million racialized non-White Americans whose lived experiences are the legacy of historically limited access to society's services and protections. The experience of Latinos in California is used to illustrate the major elements of this framework that may have an effect on mortality and health outcomes: a subaltern fuzzy-edged multivalent racial narrative, agency, voice, and community and cultural resilience.

Comparison of complication profiles for femoral neck, intertrochanteric, and subtrochanteric geriatric hip fractures.

Most geriatric hip fractures occur in the femoral neck (FN) and intertrochanteric (IT) regions of the femur, while a minority occur in the subtrochanteric (ST) region. Relative outcomes based on the anatomical subtype of fracture are not well studied. This study characterizes postoperative complications and outcomes of hip fractures distinguished by anatomic region. The targeted hip fracture series of the American College of Surgeons National Surgical Quality Improvement Program database was queried to identify geriatric (≥ 65years) patients who sustained operative FN, IT, and ST hip fractures. Primary patient demographic and perioperative data were collected and correlated with 30-day postoperative complications and outcomes. Multivariate regression was used to calculate relative risks of adverse events (AEs) between groups. In total, 8220 geriatric hip fracture patients were identified. Risk-adjusted 30-day mortality was not significantly different between patients with ST (5.8%, p = 0.735) and IT (7.3%, p = 0.169) femur fractures relative to those with FN fractures (6.6%). The overall risk-adjusted rate of minor and major medical AEs within 30days and risk-adjusted rate of wound complications was not significantly different between FN, IT, and ST fractures. Patients with IT [34.4%, OR 2.35 (2.35-3.08), p < 0.001] and ST fractures [49.8%, OR 5.94 (4.58-7.70), p < 0.00] had higher risk-adjusted incidence of postoperative blood transfusion relative to FN fractures (18.5%). Furthermore, patients with IT fractures had a slightly lower risk-adjusted incidence of unplanned reoperation [2.1 vs. 2.7%, OR 0.69 (0.47-0.99), p = 0.046] and hospital readmission (7.8 vs. 9.2%, OR 0.76 [0.63-0.91], p = 0.003) than patients with FN fractures. With respect to anatomic region, geriatric hip fractures have similar short-term mortality and medical AE profiles with differences in transfusion, reoperation, and readmission rates. Knowledge of these short-term outcomes may guide surgeons in counseling hip fracture patients peri-operatively.

Trematodes coupled with neonicotinoids: effects on blood cell profiles of a model amphibian.

Habitat loss, climate change, environmental contaminants, and parasites and pathogens are among the main factors thought to act singly or together in causing amphibian declines. We tested for combined effects of neonicotinoid pesticides and parasites (versus parasites-only) on mortality, growth, and white blood cell profiles of a model amphibian: the northern leopard frog (Rana pipiens). We first exposed infectious stages of frog trematodes (cercariae of Echinostoma spp.) to low and high concentrations of thiamethoxam or clothianidin versus water-only controls. There were no differences in survival of trematode cercariae between treatments. For the main experiment, we exposed tadpoles to clean water versus high concentrations of clothianidin or thiamethoxam for 2 weeks and added trematode cercariae to all tanks after 1 week. Exposure of tadpoles and parasites to high concentrations of thiamethoxam or clothianidin did not affect parasite infection success. Tadpole survival was not different between treatments before or after parasite addition and there were no significant differences in tadpole snout-to-vent lengths or developmental stages between treatments. Tadpoles exposed to thiamethoxam + parasites had smaller widths than parasite-only tadpoles, whereas tadpoles exposed to clothianidin + parasites had higher eosinophil to leukocyte ratios compared to parasite-only tadpoles. Tadpoles of both neonicotinoid + parasite treatments had significantly lower monocyte to leukocyte ratios relative to parasite-only tadpoles. High concentrations of neonicotinoid combined with parasites appear to influence tadpole immune function important for further defense against parasites and pathogens. This work highlights the need for more holistic approaches to ecotoxicity studies, using multiple stressors.

Dose specific effectiveness and safety of DOACs in patients with non-valvular atrial fibrillation: A Canadian retrospective cohort study

BackgroundDirect oral anticoagulants (DOACs) have been proven to be effective and safe for prevention of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation (NVAF). However, suboptimal adherence, variable dosing and use in patient populations that otherwise would have been excluded from clinical trials may impact the efficacy and safety profile of DOACs in a routine care setting. We compared stroke, bleeding, and mortality rates on and off therapy for standard and low-dose DOACs (apixaban, rivaroxaban, dabigatran) versus warfarin in a Canadian cohort. We also assessed persistence of DOACs compared to warfarin. MethodsWe conducted six 1-1 propensity-score matched retrospective cohort analyses using Quebec health administrative databases (2011–2017). NVAF patients (≥18 years) covered by the public medication insurance plan entered the cohort on the first OAC dispensation date. We excluded those with OAC use in the previous year or stroke or bleeding diagnoses in the previous two years. Follow-up ended at death, March 2017 or end of medication coverage by the public plan. Time-dependent Cox regression was applied. ResultsWe evaluated 10,893 patients initiated on apixaban (7206 standard, 3687 low-dose), 10,190 on rivaroxaban (7396 standard, 2794 low-dose), 5884 on dabigatran (2756 standard, 3128 low-dose), and propensity score-matched warfarin users. Across standard-dose DOACs, compared to warfarin, stroke risks were similar; bleeding risks were lower with apixaban (hazard ratio 0.63; 95% confidence interval 0.52–0.77) and dabigatran (0.47; 0.35–0.64) but not rivaroxaban (0.93; 0.79–1.10); death risks were lower with all DOACs. For low-dose DOACs, rivaroxaban demonstrated higher stroke (1.79; 1.21–2.64) and bleeding risks (1.37; 1.09–1.73); other agents had stroke risks similar to warfarin and bleeding risks lower than warfarin; only low-dose dabigatran had lower death risk (0.59; 0.52–0.68). Treatment discontinuation was lower with DOACs versus warfarin with the exception of low-dose rivaroxaban. The risks of stroke were 2–4 folds higher during time off any OAC versus time on warfarin. The risks of death were higher, while the risks of bleeding were generally lower during times off any OAC. ConclusionsStandard-dose DOACs had similar stroke, better persistence and mortality profiles than warfarin. Only standard dose apixaban and dabigatran had better bleeding profiles than warfarin. Low-dose rivaroxaban had worse persistence, stroke and bleeding profiles than warfarin, while low-dose apixaban and dabigatran had similar stroke and better bleeding profiles. Real-world use of DOACs may explain some of the differences observed in Canadian routine care versus the phase III clinical trials.

Global Neurosurgery Activities in the Latin American Region

Latin America comprises 33 countries and 15 dependencies of other countries, having a population of over 630 million inhabitants(Tables 1 and 2). As one of the most urbanized regions worldwide and with many diverse cities, there is a large variability i n lifeexpectancy and mortality profiles. A recent study on the life expectancy and mortality in 363 Latin American towns published in Naturefound that Life expectancy at birth ranges from 74–83 years and 63–77 years in women and men. Regarding mortality profiles, theyfound proportionate mortality by violent injury from near 0%, like Italy, to almost 20%, identical to Iraq (1)

Treatment with Bacterial Biologics Promotes Healthy Aging and Traumatic Brain Injury Responses in Adult Drosophila, Modeling the Gut-Brain Axis and Inflammation Responses.

Drosophila are widely used to study neural development, immunity, and inflammatory pathways and processes associated with the gut–brain axis. Here, we examine the response of adult Drosophila given an inactive bacteriologic (IAB; proprietary lysate preparation of Lactobacillus bulgaricus, ReseT®) and a probiotic (Lactobacillus rhamnosus, LGG). In vitro, the IAB activates a subset of conserved Toll-like receptor (TLR) and nucleotide-binding, oligomerization domain-containing protein (NOD) receptors in human cells, and oral administration slowed the age-related decline of adult Drosophila locomotor behaviors. On average, IAB-treated flies lived significantly longer (+23%) and had lower neural aggregate profiles. Different IAB dosages also improved locomotor function and longevity profiles after traumatic brain injury (TBI) exposure. Mechanistically, short-term IAB and LGG treatment altered baseline nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κβ) signaling profiles in neural and abdominal tissues. Overall, at select dosages, IAB and LGG exposure has a positive impact on Drosophila longevity, neural aging, and mild traumatic brain injury (TBI)-related responses, with IAB showing greater benefit. This includes severe TBI (sTBI) responses, where IAB treatment was protective and LGG increased acute mortality profiles. This work shows that Drosophila are an effective model for testing bacterial-based biologics, that IAB and probiotic treatments promote neuronal health and influence inflammatory pathways in neural and immune tissues. Therefore, targeted IAB treatments are a novel strategy to promote the appropriate function of the gut–brain axis.

Bones around town: Taphonomic patterns from civic feasting and residential dining contexts at Late Archaic Azoria, Crete

This paper evaluates the contextual taphonomy of faunal material from Azoria, Crete. The sudden abandonment of the settlement around 480 B.C.E., provides a rich archaeological record to understand the use of space across the site. In particular, the excavation of large civic dining complexes and smaller town houses enables a comparison of residential and civic dining practices. The standard set of evidence usually included in zooarchaeology reports – taxonomic composition and mortality profiles – are similar across the settlement, indicating that largely the same animals of similar ages were consumed in houses and at civic feasts. However, traces from taphonomic processes expose the differential use of space across the settlement. Bones with cleaver-chops found in the large Communal Dining Building reveal different cuts of meat were consumed at residential meals versus civic feasts. The scale of these feasts is also seen in an increased frequency of gnawed bones found in the kitchens of the same building, suggesting that even the local pets enjoyed the glut of meat from a civic feast. A final, ritual meal taken by the inhabitants of Azoria before abandoning the settlement is uncovered from structured deposits of burned bones.

Animal husbandry from the Middle Bronze Age through the Iron Age in the Shephelah\u2014faunal remains from the new excavations at Lachish

Lachish (Tell ed-Duweir) is located in the southern part of the Judean foothills, known as the Shephelah, and is one of the larger and most extensively excavated multi-period sites in the southern Levant. We present the faunal results of the first three seasons of the most recent excavations, the Austrian-Israeli Expedition to Tel Lachish. The expedition focusses on two areas of the tell encompassing the Middle Bronze Age III through the Iron Age II, area S (deep section) and area P (palace area). The aims for the faunal analysis are threefold: comparing the results between the two areas, seeing how our results compare to previous analyses, and comparing Lachish to other synchronous sites in the Shephelah. We observe differences in subsistence strategies between the areas in addition to diachronic differences. Ovicaprids dominate all assemblages, but we see shifts in the sheep to goat ratio and mortality profiles through time indicating changes in subsistence strategies. Our new results largely agree with the results from previous analyses, showing the value of previous studies and their potential compatibility with newer research. A synchronic comparison of Lachish within the Shephelah shows the occupants of the site were largely self-sufficient but possibly engaged in an exchange of resources in the vicinity.

The emergence and evolution of Neolithic cattle farming in southeastern Europe: New zooarchaeological and stable isotope data from Džuljunica-Smărdeš, in northeastern Bulgaria (ca. 6200–5500 cal. BCE)

Cattle were of great importance for the Neolithic farmers of southeastern Europe, in particular as farming expanded towards the well-watered regions of Džuljunica (ca. 6200–5500 cal. BCE), one of the earliest known Neolithic settlements in northeastern Bulgaria. The clear stratigraphy and the substantial Bos assemblage from Džuljunica Provided us with a great opportunity to investigate the beginning and evolution of cattle husbandry in the northern Balkans through stable isotope and zooarchaeological analyses. The relative abundance of Bos at Džuljunica leaves no doubt about the importance of beef and cattle herding. Mortality profiles suggest a transition in the early phases of the Neolithic from beef-oriented to mixed beef and milk production husbandry, enabled through intensified post-lactation culling. Stable carbon and oxygen isotope analysis of tooth enamel on a limited number of samples provides no evidence for an extended calving season for increasing milk availability or for vertical mobility. Stable carbon and nitrogen isotope values of bone collagen suggest that cattle were kept near the site, where C3 and C4 plants were available in summer, and that they were occasionally foddered with forest resources in the winter. Cattle experience a diachronic reduction in size on a regional scale, possibly due to farmers' choices aimed at more manageable herds consisting of smaller individuals. Restricting intermixing with local aurochs and the arrival of a new type of cattle may also have contributed to this change. Local factors or inter-regional influences may have influenced the ways cattle husbandry evolved at Džuljunica in particular and in northeastern Bulgaria more generally. More data from the region are necessary to flesh out the role of the interplay among environmental factors, local developments, and inter-regional contacts that facilitate the transfer of skills and traditions relating to the changing modes of cattle husbandry.

Distinct Cause of Death Profiles of Hospitalized Non-alcoholic Fatty Liver Disease: A 10 Years' Cross-Sectional Multicenter Study in China.

Background: The clinical burden and natural history of non-alcoholic fatty liver disease (NAFLD) vary globally. We aimed to investigate NAFLD-related mortality profiles in hospitalized patients in southern China.Methods: A multicenter retrospective investigation with a 10-year study period (2009–2018) analyzed 10,071 deaths during hospitalization (NAFLD: 2,015; other liver diseases: 1,140; without liver diseases: 6,916) was performed using a multiple cause of death analysis. Medical histories and biochemistry and imaging findings were extracted from the electronic medical record system. The underlying causes of death were classified by 10th Revision of the International Classification of Diseases (ICD-10) codes.Results: The distribution of death causes in patients with NAFLD has stabilized over time, with cardio- and cerebral vascular disease (CVD) ranked first (35.6%), followed by extrahepatic malignancies (22.6%), infection (11.0%), kidney disease (7.5%), liver-related diseases (5.2%), respiratory diseases (3.9%), digestive diseases (3.5%), endocrine diseases (3.5%), and other diseases (7.2%). NAFLD patients had more deaths attributable to CVD, extrahepatic malignancies, liver-related diseases (all P < 0.001) and multiorgan failure than the deceased controls. The severity of steatosis was independently associated with these relationships (liver-related diseases: OR = 1.37, 95% CI: 1.20–1.59, cardio- and cerebrovascular diseases: OR = 1.23, 95% CI: 1.19–1.31, infectious diseases: OR = 1.14, 95% CI: 1.04–1.26, and renal diseases: OR = 1.21, 95% CI: 1.02–1.47, all P < 0.05) after adjustment for sex, body mass index (BMI), fasting blood glucose, low-density lipoprotein cholesterol, uric acid, metabolic syndromes and fibrosis index based on the 4 factors.Conclusion : NAFLD patients had higher proportions of death due to underlying CVD and liver-related diseases than the general population in China; these proportions positively correlated with steatosis degree.

Comparative prevalence of COVID–19 in european countries: a time window at second wave

Introduction: The pandemic generated by COVID–19 completely changed people's daily lives, their relationship with family and friends, unexpectedly disrupted their working conditions and enhanced the need for an enduring resilience to face yet a second wave of the disease. It is crucial to keep continuously updating our knowledge about COVID–19 prevalence and incidence evolutions over large connected territories, where the disease is striking in alarming proportions. Objective: The main objective of this research is to identify and describe COVID–19 prevalence, incidence and mortality profiles in EU and EEE/EFTA countries, seven months after the start of the pandemic in Europe, and more recent tendencies, probably associated to the beginning of a second wave. Methods: This COVID–19 study covers thirty–one European countries. Six epidemiological variables where analyzed per 100 000 inhabitants on October 25 2020, two of them evaluated over the seven previous days. A multivariate statistical exploratory analysis based on rank principal components and cluster analysis was applied. Results: A COVID–19 prevalence typology of six country clusters was identified regarding 31 countries (EU, UK and three EEE/EFTA countries). The five epidemiological variables and number of tests revealed a wider dispersion with outlier observations. The rank transformation of data and their multivariate statistical analysis allowed us to construct a rational to better discriminate and describe these clusters, identifying specific behaviours related to the global prevalence from March until the end of October or highlight recent evolutions of COVID–19 incidence in the context of a second wave of pandemic. In fact we pinpointed country clusters where COVID–19 reached alarming levels which persist, or have even worsen, at the beginning of the second wave. Additionally, two other clusters were identified: one with countries that seems to be evolving into a situation under control, and another cluster of countries very weakly struck on the first wave, but are now facing a very complex surge, that will test their health systems capacity and timely response regarding covid and non–covid patients. Finally, the worst and more dramatic situation occurred in countries where the number of deaths per 100 000 inhabitants attained an impressive cumulative score.