Baseline Population Research Articles

Mitra-Clip results based on a single centre experience

Abstract Background/Introduction The uncertainty, whether TEER may improve clinical outcome was explored in two randomized trial targeting patients with symptomatic heart failure (HF), reduced left ventricular ejection fraction (LVEF) and moderate or severe mitral regurgitation (MR) – the MITRA-FR and COAPT trials. So far the COAPT trial is the only randomised trial that showed lower mortality in TEER group. Purpose The objective of this study is to compare the results of single Mitra-Clip centre with COAPT trial, with the focus on baseline population characteristic and 2-years overall and HF related mortality rates. Methods This study was designed as a retrospective cohort study that included 108 consecutively enrolled, sympomatic patients with moderate-to-severe and severe SMR and HF who underwent mitral valve repair with the MitraClip device (Abott) in John Paul II Hospital in Krakow, between 2014 and 2021. The exclusion criteria were cardiogenic shock, end-stage right or left heart failure or severe aortic valve disease. Results Among all patients 86 (79.6%) had fulfilled all Copat criteria. Initially one or two clips were implanted, and in over 90% of patients only mild and moderate (I or II degree) residual MR was observed in echocardiography at discharge and during follow up. In most most patients we also observed significant improvement in clinical status – before the procedure 86% patients were in NYHA class III and IV, and afterwards only 32% at discharge and 34% during follow-up. Death from any cause in the study population between 2016 and 2021 occurred in 16 % (n=31) and heart failure related death was observed in 10 % (n=16) patients. Conclusions Despite some differences between our study and COAPT trial, especially concerning patient selection, left ventricle structure and severity of MR, the overall 2 years mortality in our study was 16% vs. 29% in COAPT trial. This confirms that also some non-COAPT patients as well may contribute from TEER procedure, and beside the patients selection the procedural success significantly contributes to mortality benefit.

Estimated baseline density of a spotted hyaena population in a post-war landscape

Abstract The spotted hyaena Crocuta crocuta is relatively understudied across its range despite evidence of widespread declines. It is therefore essential that robust baseline population density assessments are conducted to inform current management and future conservation policy. In Mozambique this is urgent as decades of armed conflict followed by unchecked poaching have resulted in large-scale wildlife declines and extirpations. We conducted the first robust population density estimate for a spotted hyaena population in Mozambique using spatially explicit capture–recapture methodologies. We recorded a relatively low population density of 0.8–2.1 hyaenas/100 km2 in the wildlife management area Coutada 11 in the Zambezi Delta of central Mozambique in 2021. These densities are well below the estimated carrying capacity for the landscape and are comparable to published densities in high human-impact, miombo woodland-dominated and arid environments. The combination of historical armed conflict, marginal trophy hunting and bushmeat poaching using wire snares and gin traps (with physical injuries evident in 9% of identified individuals) presents persistent anthropogenic pressure, limiting the post-war recovery of this resident hyaena population. We provide insights into the dynamics of hyaena population status and recovery in such post-war landscapes, adding to mounting evidence that the species is less resilient to severe anthropogenic disturbances than previously believed. We recommend long-term monitoring of this and other carnivore populations in post-war landscapes to ascertain demographic trends and implement effective conservation interventions for population recovery.

Development of a health equity tool in resuscitation sciences and application to current research in extracorporeal cardiopulmonary resuscitation for cardiac arrest.

Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for adults with cardiac arrest (CA) refractory to Advanced Cardiovascular Life Support (ACLS). Concerns exist that adding ECPR could worsen health inequities, defined as differences in health outcomes that are unfair or unjust. Current guidelines do not explicitly address this issue. This study narratively reviews the latest evidence on ECPR, focusing on its implications for health equity and derives a health equity tool that may serve as a basis of comparison for resuscitation sciences. We searched the American Heart Association (AHA) and International Liaison Committee on Resuscitation (ILCOR) websites for the latest ACLS guidelines and scientific summaries on ECPR for CA and identified randomized controlled trials (RCTs) and observational studies. We identified population and individual characteristics associated with inequities based on the literature and expert opinion. These characteristics were used as a health equity tool to assess: differences in baseline risk, population exclusion and trial representation in studies, outcome analyses, and implementation barriers. We used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) Evidence to Decision (EtD) framework to evaluate ECPR's impact on health equity. Four RCTs involving 435 patients were conducted in the (2/4) USA, (1/4) Czech Republic, and (1/4) Netherlands. We identified thirteen characteristics associated with health inequities. All trials took place in urban, high-resourced hospitals and excluded older adults (60-75+ years). Across all RCTs, women were under-represented, and in the two USA-based trials, Black individuals were under-represented. There was no difference in baseline rate of survival with minimal or no neurologic impairment between sexes, but an observed trend favoring younger patients (<65). One trial's subgroup analysis showed no significant differences in ECPR effectiveness by sex or age. We noted that implementing ECPR for out-of-hospital CA faces challenges due to demographic variability, differences in emergency services, access to existing ECPR programs, and limited implementation outside urban areas. A health equity tool based on axes of health inequities for resuscitation identified that health equity is reduced with the use of ECPR for CA. Mitigation strategies should involve evaluating demographics, health equity measures, outcomes and ensuring equitable access to ECPR across catchment areas before and after implementation.

The Heterogeneous Presentations of De Novo and Recurrent Ocular Inflammation following COVID-19 Vaccination: A Multi-Center Report and a Review of the Literature.

To describe the patterns of ocular inflammation following COVID-19 vaccination, assess underlying commonalities and understand outcomes. Retrospective, multicenter cohort study, conducted between 2020 and 2021. Patients with no previous uveitis history (de novo) or a known uveitis history (recurrent) who developed ocular inflammation within 42 days of COVID-19 vaccination were identified. Characteristics of the uveitis, treatment approaches and clinical outcomes were assessed. Fifty-five eyes of 39 patients with ocular inflammation temporally related to vaccination were identified. Twenty-two patients (36 eyes) were de novo, while 17 (19 eyes) were recurrent. Anterior uveitis was most common. HLA-B27 positivity was found in 6 (27.2%) de novo patients, and 5 (29.4%) recurrent patients. Most patients required only observation, topical or systemic corticosteroids. Amongst vaccinated patients, 12.3% of new uveitis referrals during the study period were related to COVID-19 vaccination. Among patients with a history of quiescent uveitis, only 0.85% experienced a flare following vaccination. The majority of inflammation thought to be secondary to COVID-19 vaccination achieved quiescence with observation or steroids, and the overall incidence is low. Anterior uveitis was the most common. HLA-B27 positivity occurred at a higher rate than reported in the baseline population.

Prevalence and predictors of Barrett's esophagus and esophageal cancer in patients with eosinophilic esophagitis.

Data on Barrett's esophagus (BE) and esophageal cancer (EC) outcomes in patients with eosinophilic esophagitis (EoE) are limited. We aimed to determine the risk of prevalent BE (<1year after endoscopy), incident BE (≥1year after endoscopy), and incident EC in patients with versus without EoE, and to identify predictors of BE/EC in EoE patients. We identified adult patients in the Merative MarketScan Database who underwent first-time upper endoscopy between 2008 and 2020. Chi-square analysis compared proportions of patients with versus without EoE who had BE or EC. Multivariate Cox regression determined associations between demographics/comorbidities and incident BE/EC in the EoE cohort, adjusting for established BE risk factors. Among 2,947,003 patients who underwent upper endoscopy, 20,588 patients (0.70%) had EoE (mean age 40.6years, 63.8% male, gastroesophageal reflux disease in 44.9%). Prevalent BE, incident BE, and incident EC was found in 1.03%, 0.57%, and 0.06% of patients with EoE versus 1.06%, 0.54%, and 0.05% of patients without EoE, respectively (P = 0.13, 0.21, and 0.36, respectively). Among individuals with EoE, older age, male sex, presence of a hiatal hernia, gastroesophageal reflux disease, and location in North Central or Southern USA were independently associated with incident BE. Older age and prevalent BE were independently associated with incident EC. BE/EC risk in EoE is comparable to that of the baseline population undergoing upper endoscopy. Our findings support current understanding that EoE is not associated with an increased risk of BE/EC and reinforce that conventional BE screening strategies can be applied in patients with EoE.

Investigation of brain volume changes associated with aging: Results from the fourth research on osteoarthritis/osteoporosis against disability survey.

This study aims to investigate the impact of aging on brain volume among community residents in Japan, focusing on trends over time and specific brain structures. We analyzed data from the fourth survey (2015-2016) of the Research on Osteoarthritis/Osteoporosis Against Disability project, encompassing 2146 community residents from Japan's mountainous and coastal regions. A total of 1755 participants (81.8% of the baseline population) underwent extensive data collection including lifestyle and health questionnaires, anthropometric measurements and brain magnetic resonance imaging. The imaging data were processed to examine correlations between total brain volume, gray matter volume (GMV), white matter volume (WMV), cerebrospinal fluid volume and participant age. Analysis showed significant sex differences in total brain volume, with GMV demonstrating a strong negative correlation with age - more pronounced than the moderate negative correlation seen in WMV. Cerebrospinal fluid volume exhibited a strong positive correlation with age. Notably, specific brain regions such as the bilateral amygdala, hippocampus, thalamus and primary motor cortex showed significant age-related volume reductions. This study confirms that GMV and WMV are smaller in older individuals in the Japanese population, with more pronounced differences in GMV. The amygdala, hippocampus, thalamus and primary motor cortex were particularly affected. Geriatr Gerontol Int 2025; 25: 279-286.

Cost-Effectiveness Analysis of Inclisiran for the Treatment of Primary Hypercholesterolemia or Mixed Dyslipidemia in Singapore

This analysis evaluated the cost-effectiveness of inclisiran plus standard of care (SoC; comprising statins, ezetimibe, and fenofibrate) in primary hypercholesterolemia or mixed dyslipidemia from a Singapore healthcare system perspective. Inclisiran+ SoC was separately compared with SoC, alirocumab+ SoC, and evolocumab+ SoC. A lifetime Markov model in the United Kingdom (UK) was adapted to the Singapore setting. The modeled population (comprising 4 separate subpopulations: "primary prevention heterozygous familial hypercholesterolemia [HeFH]," "secondary prevention HeFH," "atherosclerotic cardiovascular disease [ASCVD]," "primary prevention with elevated risk") and efficacy of inclisiran were informed by the ORION-9, ORION-10, and ORION-11 trials. Comparative efficacies of inclisiran versus comparators were informed by a network meta-analysis. Baseline cardiovascular event risks were obtained from a large UK real-world data set and the Netherlands, and UK-based utilities were applied. Baseline population characteristics, distribution of patients in the ASCVD subpopulation, and costs were sourced from local clinicians and published literature. A willingness-to-pay threshold of S$45 000/quality-adjusted life-year (QALY) was selected. Across all subpopulations, inclisiran+ SoC resulted in higher QALYs and total costs than SoC (incremental cost-effectiveness ratios, S$35 658-163 896/QALY) and dominated evolocumab+ SoC and alirocumab+ SoC. At the selected threshold, inclisiran+ SoC is cost-effective among patients with ASCVD and secondary prevention HeFH. The deterministic sensitivity analysis found that the model was most sensitive to inclisiran's acquisition cost and efficacy and rate ratios translating reductions in low-density lipoprotein cholesterol levels to the risk of cardiovascular death. Compared with SoC, evolocumab+ SoC, and alirocumab+ SoC, inclisiran+ SoC is cost-effective in patients with primary hypercholesterolemia or mixed dyslipidemia in Singapore at the selected threshold.

Association between maternal folic acid supplementation in pregnancy and abnormal fetal growth: Evidence from a birth cohort baseline survey.

The prevention of abnormal fetal growth can improve the health status of children during infancy and in the future. However, the effect of folic acid supplementation on fetal weight for gestational age is unclear. To investigate the effect of folic acid supplementation during pregnancy on abnormal fetal growth. This study was an observational study based on a baseline survey of the Jinan birth cohort. Multivariate logistic regression models were constructed to analyze the effects of folic acid supplementation on the risk of abnormal fetal growth and the stratified analyses were used to assess effects of folic acid supplementation in different subgroups. A total of 6501 pairs of mothers and single live births met inclusion and exclusion criteria in the 6640 pairs baseline population of a birth cohort. The proportion for appropriate-for-gestational-age (AGA), Small-for-gestational-age (SGA), and Large-for-gestational-age (LGA) were 73.0%, 5.2%, and 21.7% (1413/6501) among the study population. For the delivery of SGA, cumulative folic acid supplementation for more than 4 months was a protective factor in the mothers who were <35 years of age (OR=0.76, 95% CI: 0.58-0.99) or primiparas (OR=0.73, 95% CI: 0.54-0.98). While, for the delivery of LGA, folic acid supplementation during pregnancy was also a protective factor among the mothers who had 13 years of educational time or more (OR=0.69, 95% CI: 0.51-0.94). Cumulative supplementation of folic acid for more than 4 months may be appropriate to reduce the risk of SGA for mothers aged <35 years and primiparas. Continuing to take folic acid supplements after the first trimester may increase the risk of LGA for multiparas and women with lower education time.

Baseline Nutritional Status of Mother-Child Dyads in Urban Slums: Pre-Intervention Analysis for a Nutrition Informatics Intervention

Background: Urban slums are critical for public health intervention due to high population density, poor living conditions, and limited healthcare access. This study examines baseline nutritional and lifestyle patterns among mother-child dyads in the urban slums of Uttar Pradesh. The dyads were recruited for Nutritional Assessment and Intervention Kiosk (NAIK), a Population Health Informatics platform to address double burden of malnutrition. Methodology: This cross-sectional, pre-intervention study involved 406 mother-child dyads with children aged 2-5 years. Data on socio-demographic variables, anthropometric measurements, nutrient intake and lifestyle patterns were collected. Descriptive statistics summarized baseline characteristics. Results: The demographic profile showed predominantly low-income mothers with 43.34% without primary education. The mean ages of mothers and children were 33.98 ± 5.9 years and 46.91 ± 10.89 months, respectively. The waist-to-hip ratio was 0.92 ± 0.76 indicating cardiovascular risk factors with significant maternal obesity (47.78%). Education of the mother was found to be significantly associated with Mid Upper Arm Circumference (MUAC) of the child. The findings highlight the overnutrition in mothers and nutrient inadequacy in children, influenced by inadequate dietary intake and unhealthy lifestyle. Conclusions: This paper will comprehensively overview baseline population status, setting the stage for further analysis and evaluation of the intervention.

Estimating the potential health effects of cleaner air in the initial stages of the COVID-19 pandemic: a study in Malmö, Sweden

ABSTRACT Background During the initial phase of the COVID-19 pandemic, reductions in air pollution were globally observed owing to decreased human activities, underscoring the potential for cleaner air through shifts in human behaviour. Objectives The objective of the present study was to hypothetically estimate the resulting population health impacts in Malmö, Sweden, if these improvements in air quality were to become permanent. Methods We utilized air pollution data from two measurement campaigns conducted in the spring of 2019 and the spring of 2020 for our Health Impact Assessment, applying standard methods. This assessment involved making assumptions about baseline population risk and using established concentration-response functions. Results In the spring of 2020, the NO2 concentrations exhibited an average decrease of 6.6 μg/m3 (42%) decrease and PM2.5 concentrations a 1.9 μg/m3 (22%) decrease, compared to the spring of 2019. If sustained, such improvements could lead to an estimated 1–3% decrease in premature deaths, a 2% decrease in preeclampsia cases, a 6% decrease in low birthweight children, a 4% decrease in bronchitis cases among children, a 2% decrease in asthma cases, a 0.2% decrease in hospital admissions for respiratory diagnoses, and an estimated 11% decrease in dementia cases annually. Conclusion The findings illustrate the potential for enhanced health in Malmö due to improved air quality. Efforts to combat air pollution and implement long-term strategies, such as those targeting urban mobility and commuting patterns, are essential for the health and well-being of both local and global populations.

Status and ecology of forest antelopes and other large mammals in the Ngoyla Faunal Reserve, Cameroon

Abstract Ungulates have undergone major declines in Central and West African forests as a result of bushmeat trade and habitat loss. Monitoring forest ungulate status is a critical conservation need. We undertook a systematic camera-trap survey of the Ngoyla Faunal Reserve within the ∼11,000 km2 Dja-Ngoyla Complex, part of the critical TRIDOM forest landscape in Central Africa. We deployed cameras at 36 sites over 2,734 camera-trap days. We recorded 3,307 independent detections of 12 species of forest ungulates. The Peters’ duiker and blue duiker were the most abundant, accounting for 71 % of all ungulate detections, both with occupancy &gt;85 %. The black-fronted duiker and white-bellied duiker were relatively widespread but rare. There were very few detections of Bates’ pygmy antelope, sitatunga, forest buffalo, and bongo. These findings are similar to our baseline population estimates of ungulates in the neighbouring Dja World Heritage site. Our study provides further evidence of ecological partitioning among the more abundant duikers based on activity pattern and body size. The Dja-Ngoyla Complex is integral to the 178,000 km2 TRIDOM conservation landscape. The landscape is a global conservation priority for securing the future of great apes, forest elephant, a community of forest ungulates, and other threatened species in the region.

Biological Age Affecting Attrition and Tooth Loss in a Follow-up Study

In population-based longitudinal studies, bias caused by nonresponse among eligible participants and attrition during follow-up thwarts conclusions. As this issue is not commonly addressed in dental studies, it is the aim of this study to examine the consequences of attrition with respect to tooth loss and mortality in a 10-y follow-up study. From the Study of Health in Pomerania (SHIP-0), a biological age (BA) score was constructed from 10 systemic biomarkers and related to one’s actual chronological age (CA). The 3,417 dentate participants were stratified according to their BA-CA scores into tertiles: individuals with younger BA than their CA, those with concurrent BA and CA, and those with older BA than their CA. Baseline characteristics and propensity of leaving or remaining in the study were compared across these tertiles. We compared the characteristics within BA strata in the remainers of SHIP-2 (10-y follow-up) and their impact on tooth loss. Besides dropout by those who died, the attrition propensity of baseline study participants was dose dependent as related to BA-CA scores and socioeconomic factors. BA younger participants were underrepresented in dropouts but overrepresented in remaining follow-up participants. BA younger participants had a more favorable risk profile, better oral health, and a lower mortality rate than BA older participants. For the BA older participants, the opposite was observed. Remainers attaining the follow-up SHIP-2 were healthier and more health conscious. After 10 y, their tooth retention was still directed by BA constructed at baseline. The results support the assumption that individual risk profiles aggregated in BA constitute characteristic susceptibility patterns affecting perseverance or attrition in long-term follow-up studies. Attrition, which is common to follow-up studies, changes the study composition of participants depending on their BA and hence the transferability of results to the baseline population. The baseline BA gradient persists even after a long time.

Booster vaccination and post-COVID-19 condition during the Omicron variant-dominant wave: a large population-based study.

The effect of the COVID-19 booster vaccination and the long-term consequences concerning preventing post-COVID-19 condition (PCC) remains unclear. We aimed to investigate the association of COVID-19 booster vaccination dose and vaccination timing before infection with the risk of PCC during the Omicron variant-dominant wave. This population-based study included patients confirmed with COVID-19 (extracted from the Health Center Real-time Information-sharing System) aged 20-69years, who were infected between 1 July and 31 August 2022. We used a self-report questionnaire to evaluate PCC and extracted information on vaccination from the municipal vaccine registry system. We calculated multiple propensity scores for COVID-19 vaccination status (unvaccinated, 1-2 doses and ≥3 doses) to control for baseline population differences. We then used a logistic regression model with inverse probability weighting to analyse the associations between the number of vaccine doses and the risk of PCC. Additionally, we conducted stratified analysis by gender and subgroup analysis for respiratory and neurological symptoms. Multivariable logistic regression was used to analyse the association between vaccination timing and PCC risk, adjusting for vaccination doses. Of the 7936 participants with COVID-19 (mean age 42.9years, 4553 women), 940 (11.8%) had at least 1 PCC. Compared with people unvaccinated, those vaccinated ≥3 times before the infection had a lower probability of PCC with the OR of 0.69 (95% CI: 0.53-0.90), although we detected no association with one or two doses. This association was present in women (≥3 doses vs. unvaccinated OR: 0.70, 95% CI: 0.51-0.95) but not in men. Those vaccinated ≥3 times had fewer neurological symptoms compared with those unvaccinated (OR: 0.61, 95% CI: 0.45-0.83); however, no significant association was found for respiratory symptoms. This study suggests that booster vaccination could lower the risk of PCC.

Associations of motor and neuropsychiatric symptoms with comorbidities in prodromal Parkinson's disease.

To investigate the associations between comorbidities and multimorbidity patterns with motor and neuropsychiatric symptoms in patients with Parkinson's disease (PD) in prodromal PD. Multimorbidity is defined as the coexistence of two or more long-term conditions (LTCs) (also known as multiple comorbidities). A total of 921 participants without PD were included in the Parkinson's Progression Markers Initiative (PPMI) database and were categorized according to the LTC count. Participants were evaluated on motor and psychiatric symptoms. Pearson correlation to examine relationship of comorbidities and target symptoms. The baseline population was analyzed using Multiple linear regression model, while mixed effects model was utilized for longitudinal analysis. Fuzzy C-means clustering analysis was conducted to identify comorbidity patterns, followed by multiple linear regression for further analysis. At baseline, a higher LTC count was significantly correlated with more severe motor (MDS-UPDRS I, II, ADL, all P < 0.05) and neuropsychiatric symptoms (QUIP, P < 0.001). Three multimorbidity patterns were identified. Among them, the cardiometabolic multimorbidity pattern (CAR) had the most significant correlation with the aforementioned symptoms. Our longitudinal analysis indicated that an increase in the LTC count was associated with the exacerbation of motor and neuropsychiatric symptoms. Comorbidities were cross-sectionally and longitudinally associated with the motor and neuropsychiatric symptoms of patients with prodromal PD. Among the three multimorbidity patterns, CAR posed the highest threat to the risk of more severe motor and neuropsychiatric symptoms.

Acute kidney injury stage 2/3 during acute heart failure admission - clinical contributors and outcomes

Abstract Introduction Acute Heart failure (AHF) may be complicated by acute kidney injury (AKI) as a result of cardiorenal syndrome.(1) However other factors may contribute to AKI. AKI stage 2 or 3 predicts negative inpatient outcomes in the general population.(2) We have reported data in a contemporary cohort on AKI in AHF. This study looks at a larger cohort in 5 previous years to test whether those findings were consistent. Better understanding of this clinical scenario may lead to improvements in care. Aim To assess the clinical factors associated with AKI 2/3 in AHF inpatients. Methods This study used retrospective data from a single teaching hospital collected for inclusion in the UK National Heart Failure National Audit. All AHF admissions over a 5-year period, from April 2017 – April 2022 inclusive, were analysed. Renal function on admission and discharge/death were assessed. AKI stage was defined according to KDIGO guidelines based on serum creatinine levels. Electronic patient records were reviewed and the clinical course leading up to and following AKI 2/3 was reviewed. Reported mode of death was also collected. Results 3219 AHF admissions (2360 unique patients) were assessed. 257 patients died during admission (8% admission mortality, 10.9% patients). 157 (4.9%) admissions had AKI 2/3 on admission/discharge. 85 (54.1%) AKI 2/3 died during their hospital admission vs 6.1% mortality in admissions without AKI 2/3. Baseline population characteristics are summarised in Table 1. Admissions with AKI 2/3 who died were older (77.6±11.5 vs 71.5 ±15.8) and had higher rates of atrial fibrillation (48.2% vs 39.9%), diabetes (40% vs 36%), ischaemic cardiomyopathy (56.5% vs 41.7%) and LVEF &amp;lt;35% (38.8% vs 27.7%). The most frequent contributors to AKI 2/3 were sepsis (55, 64.7%) and congestive cardiac failure/cardiorenal syndrome (48, 56.6%). Hypotension (25, 29.4%), over-diuresis (17, 20%), radioiodine contrast (10, 11.8%) and aminoglycosides (8, 9.4%) were less common factors in development of AKI 2/3. ≥2 contributors were present in 49, 57.6%. The dominant contributor for AKI 2/3 was adjudicated to be sepsis in 33 (38.8%) of admissions, followed by cardiorenal syndrome (congestive heart failure with AKI) in 29 (34.1%), and cardiogenic shock in 7 (8.2%). AKI 2/3 contributors are summarised in Table 2. In AKI 2/3 cases who died, 35 (41.2%) involved renal specialist input; 60 (70%) involved heart failure specialist review. Conclusion AKI in AHF is associated with high inpatient mortality. Despite this, specialist renal input was uncommon. AKI 2/3 was usually multifactorial. Cardiorenal syndrome accounted for one third of cases and may not be preventable. In keeping with our findings from a smaller contemporary cohort, sepsis was the most common dominant cause of severe AKI. Prevention, early identification, and treatment of infection could reduce this risk. Awareness of the high mortality of AKI in AHF and specialist review may improve outcomes in AHF.

Distribution and associated factors of choroidal thickness in highly myopic eyes-a real-world study based on a Chinese population.

To measure the subfoveal choroidal thickness (SFCT) in highly myopic eyes at different locations using enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT). To identify the ocular and systemic risk factors associated with choroidal thinning in high myopia. Based on the Beijing Eye Study, a detailed ophthalmic examination was performed including EDI SD-OCT for the measurement of SFCT. OCT images were obtained from 103 highly myopic eyes (≥ -6.00 dioptres) and 227 normal eyes randomly selected from the baseline population, matched for age and sex. The mean SFCT was 110.6 ± 85.2 μm in highly myopic eyes (range, 3-395 μm). Mean regional choroidal thickness was lowest on the nasal and inferior sides of the macula, and slightly higher on the temporal and superior sides than at the fovea. On multivariate analysis, SFCT was associated with age (b = -0.48; P < 0.001), axial length (b = -0.44; P < 0.001), gender (b = -0.31; P < 0.05) and staphyloma (b = -0.26; P = 0.05). In highly myopic eyes, SFCT decreased by 5.1 μm/year of age, by 9.2 µm/D of myopia, and by 22.6 µm/mm of axial length. The SFCT decreases with age and increased axial length in highly myopic eyes. The formation of a posterior staphyloma has been identified as a major contributor to choroidal thinning and is therefore a reliable indicator for risk management. The involvement of choroidal abnormalities may be a significant factor in the development of myopic degeneration.

Semaglutide 2.4 mg in Participants With Metabolic Dysfunction-Associated Steatohepatitis: Baseline Characteristics and Design of the Phase 3 ESSENCE Trial.

Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated potential beneficial effects in metabolic dysfunction-associated steatohepatitis (MASH). To describe the trial design and baseline characteristics of the 'Effect of Semaglutide in Subjects with Non-cirrhotic Non-alcoholic Steatohepatitis' (ESSENCE) trial (NCT04822181). ESSENCE is a two-part, phase 3, randomised, multicentre trial evaluating the effect of subcutaneous semaglutide 2.4 mg in participants with biopsy-proven MASH and fibrosis stage 2 or 3. The primary objective of Part 1 is to demonstrate that semaglutide improves liver histology compared with placebo. The two primary endpoints are: resolution of steatohepatitis and no worsening of liver fibrosis, and improvement in liver fibrosis and no worsening of steatohepatitis. The Part 2 objective is based on clinical outcomes. The current work reports baseline characteristics of the first 800 randomised participants which includes demographics, laboratory parameters, liver histology, non-invasive tests and presence of metabolic dysfunction-associated steatotic liver disease (MASLD) cardiometabolic criteria. Of 800 participants, 250 (31.3%) had fibrosis stage 2 and 550 (68.8%) had fibrosis stage 3. In the overall population, mean (standard deviation [SD]) age was 56 (11.6) years, 57.1% were female, mean (SD) body mass index was 34.6 (7.2) kg/m2, 55.5% had type 2 diabetes and > 99% had at least one MASLD cardiometabolic criterion according to the published definition. The ESSENCE baseline population includes participants with clinically significant fibrosis stages 2 and 3. Although MASLD cardiometabolic criteria were not a requirement for study enrolment, almost all participants (> 99%) had at least one MASLD cardiometabolic criterion. NCT04822181.

Seasonal insights for integrative mosquito management from multi-year baseline entomological data on Aedes aegypti in Lee County, Florida.

The spread of arboviruses like yellow fever, dengue, chikungunya, and Zika, transmitted by the invasive mosquito Aedes aegypti has led to the development of many strategies to suppress mosquito populations. Given the rapid development of resistance to common chemical larvicides and adulticides in some Ae. aegypti populations, as well as the ever-shrinking chemical options for mosquito control, there is a pressing need for new tools and deployment of those innovative tools as a component of integrative mosquito management programs. Prior to the adoption of any mosquito population intervention, be it conventional or innovative, understanding the baseline population is essential to evaluate the efficacy of the control measure. The Lee County Mosquito Control District in Florida has collected a three-year-long period of baseline entomological surveillance data collection for Ae. aegypti on Captiva and Sanibel Islands as foundational information prior to implementation of a new integrative mosquito management approach. We identified 18 mosquito species and described their population dynamics during the rainy and dry seasons. The two islands had no significant differences in species richness, diversity, dominance, or evenness overall. Yet, there were clear differences between the high rain season and low rain season in the Shannon diversity index, Simpson dominance index, and Pielou species evenness index within each site. Our data suggest that any innovative intervention should begin before mid to late April when the mosquito population is at its lowest and certainly before populations build up to their summer peak between June and September. These data also show the spatial distribution of Ae. aegypti is dynamic in space and time, identifying hotspots of mosquito abundance to focus on for future interventions. Overall, our study emphasizes the importance of entomological data collection to understand the population dynamics of Ae. aegypti mosquitoes, including the impact of environmental factors such as temperature and precipitation.

Hereditary Hemorrhagic Telangiectasia: Pregnancy and Delivery-Specific Considerations and Outcomes.

Prior studies have evaluated maternal outcomes in patients with hereditary hemorrhagic telangiectasia (HHT), yet pregnancy- and delivery-specific data remain limited. This study aims to evaluate pregnancy and delivery outcomes in patients with HHT. This retrospective cohort study used the Nationwide Readmissions Database to identify patients with HHT diagnosis on delivery between 2010 and 2021. The primary outcome was severe maternal morbidity (SMM). Secondary outcomes included nontransfusion SMM, preterm birth, stillbirth, prelabor rupture of membranes or preterm prelabor rupture of membranes, cesarean delivery, respiratory bleeding, cerebrovascular complications, patient disposition, and length of stay. Trends in the prevalence of HHT at delivery were assessed with logistic regression. Logistic regression analyses, adjusting for age, payer, zip code income, hospital size, and teaching status, were also used to produce adjusted relationships between HHT status and outcomes. The cohort of 21,698,861 delivered pregnancies corresponded to a national estimate of 44,325,599. Of those, 612 (national estimate: 1,265; 2.8 per 100,000) had a diagnosis of HHT. A steady rise in the HHT diagnosis rate during pregnancy from 2010 to 2021 (1.7 per 100,000 in 2010, 3.8 per 100,000 in 2021, p < 0.001 for trend) was seen. Patients with HHT were significantly more likely to experience SMM compared with patients without HHT (7.8 vs. 1.7%, adjusted relative risk [aRR]: 4.49 [95% confidence interval, CI: 3.06, 6.58]). Rates of preterm birth (14.2 vs. 8.5%, aRR: 1.57 [95% CI: 1.22, 2.03]), cesarean delivery (41.0 vs. 32.9%, aRR: 1.23 [95% CI: 1.07, 1.41]), respiratory bleeding (2.1 vs. <0.1%, aRR: 94.44 [56.64, 157.46]), and cerebrovascular complications (0.9 vs. <0.1%, aRR: 22.89 [9.89, 52.96]) were higher in patients with HHT than non-HHT patients. There was no difference in stillbirth rates between groups. Patients with HHT have higher rates of SMM and adverse delivery outcomes when compared with the baseline population. · There was a steady rise in the rates of HHT during pregnancy from 2010 to 2021.. · Patients with HHT are more likely to experience SMM.. · Patients with HHT are more likely to have a preterm delivery and cesarean delivery..

Leveraging publicly available data to evaluate health reform: establishing a methodology to assess the future impact of over-the-counter hearing aids

Health systems are complex and health reform is uncertain. With an aging global population, chronic health conditions are increasing and have become a priority for policymakers. Hearing loss is the third most common chronic condition among older adults and if left untreated, is associated with poor health and social outcomes. In the US, accessibility and affordability have been significant barriers to hearing aid utilization. Through new reform, over-the-counter (OTC) hearing aids are now available. This study demonstrates how publicly available health data was used to establish a methodology to define, characterize, and analyze the target population of this reform. In this retrospective cross-sectional cohort analysis, data from the National Health Interview Survey (NHIS) was utilized, with a sample that included respondents from the 2021 NHIS Sample Adult Interview. Three hearing aid groups (Active, Potential, General) were defined using questions from the NHIS annual core questionnaire and a baseline population health framework was developed. Binary logistic regression confirmed that the framework sufficiently described two group comparisons (Active-Potential, Active General) and also identified the key determinants of hearing aid utilization. Classification and regression tree (CART) classification amply predicted active hearing aid users and verified the key determinants as important predictors. These findings aligned nicely with literature published before OTC hearing aids were made available, confirming the NHIS to be consistent and representative. Our methodology can be repeated to examine the impact of OTC hearing aids in the post-implementation period and similar approaches should be taken to examine other emerging health reforms.