Regional Variations Research Articles

Prevalence of Helicobacter pylori infection in China from 2014-2023: A systematic review and meta-analysis

BACKGROUND Helicobacter pylori (H. pylori) stands as the predominant infectious agent linked to the onset of gastritis, peptic ulcer diseases, and gastric cancer (GC). Identified as the exclusive bacterial factor associated with the onset of GC, it is classified as a group 1 carcinogen by the World Health Organization. The elimination of H. pylori plays a crucial role in the primary prevention of GC. While the prevalence has declined in recent decades, H. pylori infection is still highly prevalent in China, accounting for a significant part of the disease burden of GC. Therefore, updated prevalence information for H. pylori infection, especially regional and demographic variations in China, is an important basis for the design of targeted strategies that will be effective for the prevention of GC and application of policies for H. pylori control. AIM To methodically evaluate the occurrence of H. pylori infection throughout China and establish a reference point for subsequent investigations. METHODS A systematic review and meta-analysis was conducted following established guidelines, as detailed in our methodology section. RESULTS Our review synthesized data from 152 studies, covering a sample of 763827 individuals, 314423 of whom were infected with H. pylori . We evaluated infection rates in mainland China and the combined prevalence of H. pylori was 42.8% (95%CI: 40.7-44.9). Subgroup analysis indicated the highest prevalence in Northwest China at 51.3% (95%CI: 45.6-56.9), and in Qinghai Province, the prevalence reached 60.2% (95%CI: 46.5-73.9). The urea breath test, which recorded the highest infection rate, showed a prevalence of 43.7% (95%CI: 41.4-46.0). No notable differences in infection rates were observed between genders. Notably, the prevalence among the elderly was significantly higher at 44.5% (95%CI: 41.9-47.1), compared to children, who showed a prevalence of 27.5% (95%CI: 19.58-34.7). CONCLUSION Between 2014 and 2023, the prevalence of H. pylori infection in China decreased to 42.8%, down from the previous decade. However, the infection rates vary considerably across different geographical areas, among various populations, and by detection methods employed.

Systematic Review of Air Pollution in Ethiopia: Focusing on Indoor and Outdoor Sources, Health, Environment, Economy Impacts and Regulatory Frameworks

The varied geography (Bekele, 1996) and rapid economic growth of Ethiopia (World Bank, 2020) might have impact its air pollution patterns, with topography, elevation, and climate variability (Lemma Gonfa, 1996) playing significant roles. Environmental challenges, including deforestation and climate change, also affect air quality. This study offers a systematic review of air pollution research in Ethiopia, providing a thorough analysis of its health, environmental, and economic impacts, regional variations, and policy suggestions. It addresses both indoor and outdoor air pollution, assessing their wide-ranging effects. Data were gathered through an extensive search of peer-reviewed articles, policies, and guidelines using Google Scholar and reputable sources, following PRISMA guidelines. The review highlights critical sources of air pollution in Ethiopia, including indoor biomass fuel combustion and outdoor emissions from traffic and industries. Indoor air pollution, particularly from traditional biomass fuels like wood and dung, affects rural and peri-urban areas, leading to high levels of particulate matter and carbon monoxide. Outdoor pollution, driven by urbanization, industrial expansion, and vehicle emissions, worsens health issues and environmental damage. The study identifies severe health consequences, such as respiratory infections and cardiovascular diseases, with air pollution contributing to premature deaths and rising healthcare costs. Economic analysis highlights the significant costs related to healthcare, lost productivity, and infrastructure damage. Environmental impacts include harm to plant health, soil degradation, and contributions to climate change. Despite initiatives to improve air quality monitoring and regulation, challenges persist due to outdated policies, limited infrastructure, and insufficient data. The study emphasizes the need for more comprehensive research and regulations to tackle air pollution crisis.

Revascularization in frail patients with acute coronary syndromes: a retrospective longitudinal study.

Frailty is increasingly prevalent in people presenting with acute coronary syndrome (ACS). This high-risk group is typically excluded from trials of interventions in ACS, and there is uncertainty about the risks and benefits of invasive management. Patients with an ACS diagnosis between 2010 and 2015 in England were identified from Hospital Episode Statistics, with linked Office for National Statistics mortality data. Frailty was defined by the Hospital Frailty Risk Score. Causal inference analysis used regional variation in revascularization as an instrumental variable to estimate average treatment effects of revascularization on cardiovascular mortality up to 5 years in people presenting with ACS and low-, intermediate-, or high-risk frailty. The analysis included 565 378 ACS patients, of whom 11.6% (n = 65 522) were at intermediate risk and 4.7% (n = 26 504) were at high risk of frailty. Intermediate and high frailty risks were associated with reduced likelihood of echocardiography, invasive angiography, or revascularization and increased likelihood of mortality and major adverse cardiovascular events compared with low frailty risk. Cardiovascular death at 5 years was 78.6%, 77.3%, and 75.7% in people at low, intermediate, and high frailty risk, respectively. Instrumental variable analysis suggested that revascularization resulted in a higher absolute reduction in cardiovascular mortality in high and intermediate frail risk patients compared with low risk at 1-year post-ACS. Frailty is common in people presenting with ACS, where cardiovascular causes are the principal mode of death. Revascularization is associated with short- and long-term survival benefits in people at intermediate and high risk of frailty after adjustment for measured and unmeasured confounders.

The Association of Drought with Different Precipitation Grades in the Inner Mongolia Region of Northern China

Drought has become an important factor affecting the environment and socio-economic sustainable development in northern China due to climate change. This study utilized the Standardized Precipitation Index (SPI) as a drought metric to investigate the correlation between drought characteristics and different grades of precipitation and rain days. The analysis was based on a long-term time series of precipitation data obtained from 116 meteorological stations located in Inner Mongolia, spanning 1960 to 2019. To achieve the objectives of the current research, the daily precipitation was categorized into four grades based on the “24-h Precipitation Classification Standard”, and the frequency of rain days for each grade was determined. Subsequently, the SPI was calculated for 1 and 12 months, enabling the identification of drought events. The results revealed pronounced spatiotemporal regional variations and complexities in the dry–wet climatic patterns of Inner Mongolia, with significant decreases in precipitation emerging as the primary driver of drought occurrences. Approximately 6% of the entire study period experienced short-term drought, while long-term drought periods ranged from 23% to 38%. Regarding multi-year trends, precipitation exhibited a weak increasing trend, while rain days exhibited a weak decreasing trend. Drought exhibited an alleviating trend, with 92% of stations displaying coefficients > 0 for SPI_Month and over 62% of stations displaying coefficients > 0 for SPI_Year. At the monthly scale, drought was most correlated with light rainfall trends and least correlated with moderate rainfall trends. At the annual scale, drought was relatively highly correlated with moderate and heavy rainfall distributions but poorly correlated with light rainfall. The results suggested that achieving the precise monitoring and mitigation of drought disasters in Inner Mongolia in the future will require a combined analysis of indicators, including agricultural drought, hydrological drought, and socio-economic drought. Such an approach will enable a comprehensive analysis of drought characteristics under different underlying surface conditions in Inner Mongolia.

Assessment of Tourism Development in Belarus: A Comprehensive Analysis of Infrastructure, Cultural Heritage and Natural Resources

Purpose: This study examines the development of tourism in Belarus, evaluating its infrastructure, cultural heritage potential, and natural resources. The research aims to identify key factors influencing tourism development and assess their relative impact on the sector's growth. Design/methodology/approach: The study employs a mixed-methods approach, primarily utilizing a quantitative survey (n=512) of local stakeholders across six regions of Belarus, supplemented by comprehensive statistical analysis. The research instrument included 17 structured questions measuring perceptions of tourism development across multiple dimensions. Data analysis was conducted using chi-square tests and Cramér's V coefficient to determine statistical significance and relationship strength. Findings: The results indicate moderate tourism development in Belarus (39% of respondents rated it as average, 42% as high). Infrastructure quality shows significant regional variation (χ2(4)=31.50, p<0.001, V=0.56). Cultural heritage emerged as a primary attraction (72% agreement), while natural resources received varied evaluations (57% highlighting landscape value). The study identified key development barriers: visa restrictions (74% of respondents), insufficient marketing (62%), and underdeveloped transport infrastructure (51%). Research limitations/implications: The study's cross-sectional nature and focus on domestic stakeholders may limit its generalizability. Future longitudinal studies incorporating international perspectives could provide additional insights. Conclusion: The study reveals that Belarus's tourism development exhibits a complex pattern of strengths and challenges. While the country possesses significant potential through its cultural heritage (72% positive evaluation) and natural resources (57% positive assessment), its tourism development is constrained by structural barriers. The research demonstrates that future tourism growth requires a three-pronged approach: (1) systematic infrastructure modernization, particularly in regional areas; (2) reform of visa policies to enhance accessibility; and (3) development of comprehensive marketing strategies. The statistical significance of these findings (p<0.001) supports the need for evidence-based policy interventions. This research contributes to both theoretical understanding of tourism development in transition economies and practical policy formulation, while establishing a methodological framework for future studies in similar contexts.

Revealing How Human Activity and Native Plants Outshine Climate in Shaping New Invasive Alien Plant Elevational Patterns in Nature Reserves

ABSTRACTAimWe aim to investigate whether invasive alien plants introduced at different times exhibit variations in elevational distribution patterns and to explore the correlations of these patterns with climate, native plants and human activity.LocationGuangxi, China.MethodsWe recorded plant richness and cover across elevational gradients at 25–34 sites within each reserve, utilising 84–134 roadside plots per site. Using generalised linear mixed model (GLMM), we assessed the impacts of climate, native plants and human activity on the distributions of all, old and new invasive alien plants across the region and within the nature reserves.ResultsAt regional scales, the cover of all, new and old invasive alien plants decreased with increasing elevation, while only the richness of old invasive alien plants exhibited a similar pattern. Contrasting patterns were observed in Dayao Mountain, where the cover of old invasive alien plants decreased while the cover of new invasive alien plants increased. The richness patterns of all and new invasive alien plants were opposite between Dayao Mountain and Yachang Orchid. Moreover, native plant richness was negatively correlated with the richness of invasive alien plants, while interference intensity positively affected new invasive alien plants at both regional and reserve scales. At the regional scale, native plant richness accounted for 78.27%, 91.94% and 60.9% of all, old and new invasive alien plants respectively. Interference intensity accounted for 33.85% of the variation in new invasive alien plants. Annual mean temperature positively influenced the cover of all and old invasive alien plants at both regional and reserve scales, explaining 36.91% and 74.28% of their regional variation. Additionally, interference intensity and distance to human settlements positively impacted the cover of new invasive alien plants, contributing to 50.95% and 31.92% of their variation at regional scales.Main ConclusionThe distinct distribution patterns of old and new invasive alien plants highlight the significance of residence time in understanding their dynamics. Climate factors constrain the cover distribution of all and old invasive alien plants, whereas interference intensity and distance to settlements determine the distribution of new invasive alien plants. Notably, native plants play a vital role in preventing the establishment and spread of invasive alien plants within nature reserves, and their effectiveness increases with longer residence times. Our findings highlight the critical importance of minimising human interference and conserving native species for the effective management of invasive alien plants in nature reserves.

Threshold effects of vegetation cover on production-living-ecological functions coordination in Xiangyang City, China.

Clarifying the nonlinear impacts of vegetation cover on production-living-ecological function (PLEF) coordination is essential to ecological restoration regulation and sustainable land use. However, the threshold effect of vegetation cover on PLEF coordination, particularly in major function-oriented zones (MFZs), has yet to receive attention. This study selected Xiangyang City, China, as the case area to identify the impact threshold of vegetation cover on PLEF coordination from the perspectives of the region as a whole and MFZ, respectively. The results showed that the PLEF coordination was high in the center and east while low in the west. For production-ecological function, 51.46% of the area was primarily coordinated and above, while for production-living function, 61.35% of the city area was severely uncoordinated. Vegetation cover was high in the west and low in the east. A negative correlation existed between vegetation cover and PLEF coordination. Urban built-up areas with lower vegetation cover showed higher levels of PLEF coordination, whereas western mountainous regions with higher vegetation cover demonstrated lower levels of PLEF coordination. Furthermore, vegetation cover exhibited a pronounced threshold effect on PLEF coordination, featuring conspicuous regional variations. The identified thresholds of vegetation cover for PLEF coordination in key development, agricultural production, and key ecological function zones were 0.3896, 0.2272, and 0.8161, respectively. Our study provides scientific references for the impact assessment of ecological restoration and the synergistic enhancement of land functions.

Exploring the role of Artificial Intelligence in Acute Kidney Injury management: a comprehensive review and future research agenda.

This study reviews the studies utilizing Artificial Intelligence (AI) and AI-driven tools and methods in managing Acute Kidney Injury (AKI). It categorizes the studies according to medical specialties, analyses the gaps in the existing research, and identifies opportunities for future research directions. PRISMA guidelines were adopted using the three most common databases (PubMed, Scopus, and EBSCO), which resulted in 27 eligible studies, published between 2012 and 2023. The study showed significant heterogeneity in the design of the models, with variations in clinical settings, patient characteristics, cohort regions, and statistical methods. Most models were developed for AKI in hospitalized patients, particularly those undergoing surgery or in intensive care units. Compact models with a subset of significant predictors were deemed more clinically applicable than full models with all predictors. The findings suggest that AI tools, such as machine learning (ML) algorithms, have high prediction capabilities despite the dynamic and complex association among the influencing factors and AKI. Based on these findings and the recognized need for broader inclusivity, future studies should consider adopting a more inclusive approach by incorporating diverse healthcare settings, including resource-limited or developing countries. This inclusivity will lead to a more holistic understanding of AKI management challenges and facilitate the development of adaptable and universally applicable AI-driven solutions. Additionally, further investigations should focus on refining AI models to enhance their accuracy and interpretability, promoting seamless integration and implementation of AI-based tools in real-world clinical practice. Addressing these key aspects will elevate the effectiveness and impact of AI-driven approaches in managing AKI.

Comprehensive Assessment of Soil Erosion using USLE and Sustainable Management Strategies

Continuous soil erosion from all parts of world through water and winds have become a severe concerns for soil scientists and geologists due to its adverse effect on soil productivity, water bodies siltation and deterioration of water quality. Therefore, it becomes most important to locate erosion-prone regions of any landscape and take the best measures to solve the issues of erosion. USLE and its modified models i.e. RUSLE (Revised Universal Soil Loss Equation) versions and MUSLE (Modified Universal Soil Loss Equation) are most commonly used for estimation of soil erosion. In India, soil erosion is a major serious concern which varies in its intensity depending on the country's different agro-climatic zones. USLE as well known model for evaluating soil deterioration is used in this review to provide an understanding of its parameters and how this approach is useful in soil erosion assessment. In addition, an overview of the current situation of erosion status in India which is being altered by regional variations like climate and land uses. Literature also dictates and discusses the potential advantages of better erosion control approaches, such as increased agricultural output and long-term land sustainability and looks at what might be possible in the future if the things get managed. The study also looks at crop selection and land use systems, emphasizing how crucial it is to choose crops that are suitable for the land vulnerability to erosion in order to prevent the further deterioration. Lastly, it emphasize on a thorough explanation of the USLE's parameters which are essential for precise erosion prediction including slope factors, soil erodibility, rainfall erosivity and conservation techniques. The study summarizes the knowledge on soil erosion in India and the necessity of customized, area-specific soil conservation plans to guarantee long-term agricultural outputs and sustainable agricultural goals.

Geometric Morphometric Analysis of Plastinated Brain Sections Using Computer-Based Methods: Evaluating Shrinkage and Shape Changes.

Plastination preserves biological specimens for long-term and geometric morphometry analyzes shape differences with advanced statistical methods. This study primarily aimed to statistically quantify shrinkage in brain sections following plastination. The secondary goal was to present the shrinkage occurring in both tissues and cavities of specific anatomical structures using geometric morphometry. Fourteen sections from each of nine male bovine brains underwent silicone plastination using the standard technique, which involves four stages: fixation, dehydration, forced impregnation, and curing. The shrinkage percentage in plastinated sections was measured using ImageJ, while geometric morphometry was used for shape analysis. Correlation analysis was performed to reveal the relationship between ventricle area and shrinkage percentage. Significant shrinkage was observed in each brain section. A positive correlation was observed between the shrinkage on the sections and ventricular area. However, with the exception of section number 9, this correlation was not statistically significant for the remaining sections. Furthermore, the strength of the correlation exhibited variability across different sections. Using geometric morphometric, shrinkage, and associated shape variations in specific anatomical regions within the serial brain sections were illustrated with visual graphics. Shape analysis revealed the most pronounced shrinkage in the sulcus coronalis, sulcus suprasylvius rostralis, ventral surface of the thalamus, and the third ventricle. Additionally, the cornu ammonis (hippocampus) exhibited the most significant shrinkage and shape variation. While morphometric analyses did not reveal significant shrinkage in cavity-like structures, geometric morphometric analyses demonstrated significant shrinkage in the third ventricle. This study is unique in that it is the first to comprehensively demonstrate, using geometric morphometry, the morphological changes that occur in brain tissue during plastination. The findings, when combined with graphical and statistical data analysis, emphasize the effectiveness of geometric morphometry as a powerful tool for elucidating shape changes in plastination research.

Water quality in the Chinese Qinling Mountains over the last 20 years

The Qinling Mountains, the so-called “central water tower,” are extremely important water resource hubs in China. The influence of the forest ecological environment on water quality is complicated. Therefore, to investigate the spatiotemporal variations in water quality, we employed a random forest model to integrate multiple key water quality indicators into one overall ranking value. Monthly monitoring data of surface runoff and atmospheric precipitation events (2003–2022) for the Huodigou stream in the Qinling Mountains were used. The results revealed that after atmospheric precipitation entered the forest ecosystem, the coefficients of variation of surface runoff for most of the selected indicators decreased, but there were significant differences among the six indicators (NO3−, Mg2+, Na+, pH, K+, Ca2+). Most of the indicators within surface runoff were positively correlated, such as those in atmospheric precipitation. However, some indices of surface runoff were negatively correlated with those of atmospheric precipitation, and there was a significant negative correlation between Ca2+ in atmospheric precipitation and Ca2+ in surface runoff and between NO3−in atmospheric precipitation and K+ and Na+ in surface runoff (p < 0.01). The water quality grade of the surface runoff generated by atmospheric precipitation through forest ecosystems was significantly improved (p < 0.001), among which the average water quality grade of surface runoff was approximately 3.6, that is, between Grade I-3 and Grade I-4, whereas the average water quality grade of atmospheric precipitation was approximately 4.5, that is, between Grade I-4 and Grade I-5. The order of improved water quality was NO3− > Mg2+ > Na+ > pH > K+ > Ca2+. Overall, our assessment revealed that from 2003 to 2022, the water quality grade in the Huodigou stream improved and was more stable. In summary, the forest ecosystem in the Huodigou stream has a significant water quality purification effect on the atmospheric precipitation it receives. Our novel criterion-based approach for categorizing the water quality of atmospheric precipitation and surface runoff offers a new tool for examining spatiotemporal stream water quality variations in the Qinling region and other mountainous areas.

Mortality after treatment of malignant pleural effusions with indwelling pleural catheters versus chemical pleurodesis: a population-based study.

Little is known about patient outcomes following treatment of malignant pleural effusions (MPE) in the real-world setting. We aimed to compare post-procedure all-cause mortality between individuals who received indwelling pleural catheter (IPC) insertion versus chemical pleurodesis for managing MPEs. We performed a retrospective population-based study using provincial health administrative data (Ontario, Canada) of adults with a MPE who underwent IPC insertion or chemical pleurodesis between 2015 and 2019. Individuals were followed until death or March 31, 2021. Difference in post-procedure mortality was calculated using inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analysis to balance potential confounders at baseline. We identified 4,790 (77.3%) individuals who received an IPC and 1,407 (22.7%) who had chemical pleurodesis for MPE. IPC insertions are increasing and chemical pleurodesis procedures are decreasing. The majority of IPCs were inserted in outpatients (61%), by pulmonologists (64.2%) and at sites with higher annual IPC volume, while chemical pleurodesis procedures were generally done by thoracic surgeons (74%) and at sites with higher annual pleurodesis volumes. In unadjusted comparison median time from initial cancer diagnosis to intervention was significantly longer in the IPC group (244 days, interquartile range [IQR]:33-903) compared to pleurodesis group (81 days, IQR:10-737; p < 0.0001). Unadjusted median time from index procedure to death was significantly longer in the pleurodesis group (165[IQR:48-457] days vs. 81[IQR:29-256] days, p < 0.0001), however the difference between groups became insignificant after the IPTW was applied (HR 1.27, 95%CI 0.95-1.69). 35% of IPCs were removed prior to death or end of follow-up. After adjusting for differences in baseline characteristics there was no difference in post-procedure mortality between IPC and chemical pleurodesis groups. In the real world, there are significant differences in the characteristics of patients who receive these two procedures and notable regional practice variation between procedure use. Future research should evaluate these variations in care and their effect on patient outcomes.

Late Pleistocene scaphopod beads from Boodie Cave and deep time traditions of personal ornamentation in northwest Australia

Tubular segments of Scaphopoda (tusk shell) were traditionally used by Aboriginal peoples in the manufacture of ornate bead necklaces across northwest Australia. Twenty-seven scaphopod shell beads were recovered from Boodie Cave on Barrow Island dating to between 13,500 and 10,600 cal BP. We compare the Boodie Cave bead assemblage to historical necklace collections as well as experimental studies on scaphopod blanks to characterise bead manufacture, breakage, use-wear, and placement patterns. Results demonstrate that the Boodie Cave beads are larger than other northwest Australian collections; have been manufactured by an anvil-rested percussion technique; have signs of use-wear in the form of polish and rounding but are less curated than specimens from the inland Kimberley. The use-wear study identified that the Boodie Cave beads were strung in a series in a pattern not observed in historical scaphopod necklaces from northern Australia. This patterning may represent a regional variation in display and technological organisation and was likely part of wider ornamental practices documented in historical sources. In all, the Boodie Cave beads provide early and additional evidence for the trade, wearing, and loss of scaphopod beads by mobile hunter-gathers on a dynamic coastline.

Kin networks and quality of government: a regional analysis

AbstractThis paper examines the relationship between kin-based institutions and quality of government in the regions of Spain, France, and Italy. The results show that the rate of cousin marriage during the twentieth century is a strong predictor of the modern-day quality of government in the regions of these three countries. Regions characterized by a higher prevalence of cousin marriage tend to have on average worse governance outcomes. This finding holds after accounting for country fixed effects and different variables that may be correlated with both consanguinity and regional quality of government, including an extensive array of geographical, historical, and contemporary factors. The observed association between cousin marriage and quality of government persists when I utilize an instrumental variable approach that exploits regional variation in the degree of historical exposure to the marriage laws of the medieval Catholic Church to address potential endogeneity concerns. Furthermore, the paper also provides evidence consistent with the idea that the effect of cousin marriage on the quality of government operates through its impact on a series of cultural traits such as impersonal trust, fairness, and conformity-obedience.

Critical illness insurance and household consumption: evidence from rural China

ABSTRACT This paper explores the impact of the critical illness insurance (CII) on rural household consumption. We use data from the 2011–2018 China Health and Retirement Longitudinal Study (CHARLS), which covers 28 provinces, and apply a staggered difference-in-differences method to evaluate the effects of the CII over the entire policy period. This approach can provide nationally representative findings and address the limitations of previous studies. Our results indicate that the CII increases rural household consumption by approximately 8.5%. This effect is primarily driven by improved household expectations regarding reduced future medical expenses. Consequently, precautionary savings decrease, increasing consumption. The heterogeneity analysis reveals that the consumption-promoting effect of the CII is more pronounced in eastern regions and among middle-income rural households. These findings contribute to the literature by providing empirical evidence on the mechanisms and regional variations of the CII’s impact. They also offer policy implications for countries aiming to expand the CII coverage and enhance household consumption.

Abstract 4147639: Trends in Atherosclerosis-related mortality in the United States from 1999 to 2020; A Retrospective Analysis

Background and Aims: Atherosclerotic diseases, including but not limited to myocardial infarction and stroke, are the leading cause of morbidity and mortality worldwide. Here we aim to identify and quantify temporal trends of atherosclerotic disease mortality among adults in the United States from 1999 to 2020, and pinpoint racial, local, regional, age and gender-wise variations in this trend. Methods: Data was sourced from the CDC WONDER database, with atherosclerosis identification based on ICD-10 Codes I70. We determined the crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals from 1999-2020. JointPoint regression was employed to examine the changes in AAMR across the years through annual percent change (APC) and the average annual percent change (AAPC). Results: The AAMR for atherosclerosis shows a uniformly declining trend from 1999 to 2020 with AAPC= -7.25; 95% CI -6.34 to -8.14. The analysis revealed significant disparities in mortality rates among different demographic groups. Mortality was significantly higher among female patients (AAPC=-7.09%; 95% CI -6.48 to -8.58), American Indian patients (AAPC=-7.88%; 95% CI -.6.58 to -9.11), and rural populations (AAPC=-7.62%; 95% CI -6.53 to -8.70). Most deaths occurred in the southern region of the US (AAPC: -7.62%; 95% CI -7.45 to -9.19). A notable exception to this was California which accounted for the highest mortality in the US. Conclusion: Our nationwide analysis showed an overall decreasing mortality trend due to atherosclerosis among adults in the US. However, the higher mortality rate among females, American Indians, and rural populations is concerning and requires further investigation that can explain and expand on the findings of our study and explain this variation in mortality rates.

Abstract 4136412: Quantitative Cardiac Magnetic Resonance Standardized Signal Intensity Comparison in Dilated Cardiomyopathy versus Cardiac Sarcoidosis

Introduction/Background: Dilated cardiomyopathy (DCM) and cardiac sarcoidosis (CS) manifest unique late gadolinium enhancement (LGE) patterns on cardiac magnetic resonance (CMR), indicative of differing distributions of myocardial scar tissue. Nevertheless, these LGE patterns lack specificity, leading to significant overlap between the two conditions. Goals/Aims: This study seeks to introduce a novel quantitative method employing z-score analysis of LGE-CMR signal intensity to objectively evaluate and compare the spatial distribution of LGE intensity between DCM and CS. Methods/Approach: The retrospective cohort included 22 NICM patients (13 DCM, 9 CS) that underwent pre-procedural CMR prior to ventricular tachycardia (VT) ablation between November 2018 to May 2023. LGE images were delineated into sub-endocardial, mid-myocardial, and sub-epicardial layers, categorized into anterior, lateral, inferior, and septal walls based on the AHA 17 segment model for LV myocardial segmentation. CMR signal intensities were standardized as z-scores: z = (x−μ)/σ, where x is the MRI signal intensity for a specific myocardial segment and layer, and μ and σ are the mean and standard deviation across all myocardial segments and layers of the LV, to characterize regional intensity variations. Results/Data: Compared to patients with DCM, those with CS exhibited significantly higher CMR signal intensity z-scores in the septum (β=0.32, p=0.009), particularly in the endocardial third of the right ventricular side (β=0.56, p=0.001). A z-score greater than 0.40 in this area was associated with a CS diagnosis, with an area under the ROC curve of 0.692 in 5-fold cross-validation. Conclusions: Patients with CS exhibit higher affinity for contrast in the septum, particularly on the RV endocardium. Standardized analysis of CMR signal intensities provides a novel, quantitative method for distinguishing CS from DCM, with the former exhibiting higher CMR signal intensity z-scores in the septum.

Maxillary Intercanine Width in a South Sumatran Population: Implications for Maxillofacial Reconstruction

Introduction: The maxilla is a crucial bone in the facial skeleton, contributing significantly to both aesthetics and function. Understanding the morphometric variations of the maxilla, particularly the intercanine width (ICW), is vital for successful maxillofacial reconstruction procedures. This study aimed to investigate the ICW in a South Sumatran population, considering its implications for reconstructive surgeries. Methods: This retrospective study analyzed computed tomography (CT) scans of 96 adult patients (60 males, 36 females) from South Sumatra. The ICW was measured using 3D reconstruction software, and the data were analyzed for gender-based differences. The findings were compared with existing literature to understand regional variations in maxillary morphology. Results: The mean ICW for males was 3.58 ± 0.27 cm and for females was 3.44 ± 0.18 cm. Males exhibited a significantly larger ICW than females (p &amp;lt; 0.05). These findings are consistent with previous studies indicating sexual dimorphism in maxillary morphology. Conclusion: This study provides valuable data on maxillary intercanine width in a South Sumatran population. The observed gender-based differences highlight the importance of considering patient demographics in maxillofacial reconstruction. This information can aid surgeons in achieving optimal functional and aesthetic outcomes.

Trends of antiseizure medication utilization among pregnant people in four Canadian provinces from 1998 to 2023; a study from the Canadian mother-child cohort active surveillance initiative (CAMCCO)

BackgroundEpilepsy management during pregnancy is crucial for both the mother and fetus. The use of antiseizure medications (ASMs) during pregnancy requires careful consideration due to their potential effects on maternal and fetal health.MethodsThis study analyzed trends in ASMs use among pregnant people in four Canadian provinces over 20 years (Manitoba, Saskatchewan, Alberta, and Quebec). Descriptive statistics were utilized to examine the characteristics of the population, with the frequency and patterns of ASM use estimated throughout each trimester. Linear regression models were developed to analyze yearly patterns of ASM utilization for the overall study population, as well as for people with and without epilepsy.ResultsAmong 1,317,141 pregnant individuals across four provinces, 0.7% had epilepsy. Of the total pregnancies, 1.7% (n = 22,783) were exposed to ASMs, comprising 4,392 from pregnant people with epilepsy (PPWE) and 18,391 from those without epilepsy (PPWOE). Results demonstrated varying trends in ASM usage between provinces, with an overall increase in usage among people without epilepsy in Manitoba, Saskatchewan, and Alberta. ASM use among PPWOE surged significantly in Manitoba (24.2–149.1 per 10,000 pregnant people), Saskatchewan (29.4–107.0 per 10,000), and Alberta (65.7–241.7 per 10,000) (p &amp;lt; 0.05). In Alberta, PPWE’s ASM exposure also rose, from 23.6 in 2008 to 43.0 per 10,000 pregnant people in 2021, while Quebec witnessed a decrease from 59.2 in 1998 to 45.5 per 10,000 pregnancies in 2015. Analysis of ASM use by trimester illustrated a substantial decline among PPWOE from 365 days pre-pregnancy to the third trimester in all provinces. ASM utilization by drug class showcased significant shifts, with second-generation ASMs experiencing a notable rise. Carbamazepine, once prominent, declined, making way for lamotrigine. Regional variations underscore diverse preferences, such as clonazepam’s sustained popularity in Manitoba and Quebec.ConclusionThe study identified increasing trends in ASM use, particularly the increased use of second-generation ASMs, and differences in prescription patterns for pregnant individuals with and without epilepsy. These findings reveal changing ASM use patterns, including increased second-generation ASM use and regional disparities, providing valuable insights into real-world prescription practices.

Textbooks, hunger, and humanitarian narratives: representations of U.S. food policies to Germany on a regional scale (1949–89)

AbstractThis article investigates the significance of United States (U.S.) post-WWII food aid to Germany in West German textbooks from a regional angle during the Cold War period. Previous studies have predominantly focused on interpreting the significance of U.S. aid in West Germany from a national standpoint, overlooking regional variations in humanitarian narratives. This study challenges the national scale as the exclusive basis of collective meaning. By exploring educational materials from three different German regions—Berlin, Bavaria and North Rhine-Westphalia, it examines the different afterlives of U.S. aid in West German humanitarian narratives. Further attention for nuances in reconstructing humanitarian narratives not only does justice to the distinct regional histories and memory cultures, but also gives scope to reassessments of dominant narratives.