Differences Research Articles

Alcohol-related injury hospitalisations in relation to alcohol policy changes, Northern Territory, Australia, 2007-2022: A joinpoint regression analysis.

The Northern Territory (NT) of Australia has the highest rates of alcohol consumption and injury in the country. We aimed to: (i) describe the epidemiology of alcohol-related injury (ARI) hospitalisations in the NT; (ii) estimate the proportion of alcohol involvement in injury hospitalisations; and (iii) consider the influence of alcohol policies on ARI hospitalisation trends. We conducted a retrospective time-series study using coded hospitalisation data from NT public hospitals between 2007 and 2022. ARI hospitalisation was defined combining indicators for injury and acute alcohol use. We undertook descriptive analyses and calculated alcohol involvement against all injury hospitalisations. Annual percent changes (APC) were computed using joinpoint regression to examine the influence of alcohol policies on ARI hospitalisation trends by NT geographical regions (Central Australia and Top End). Alcohol use was associated with 22.6% of all injury hospitalisations. The most common cause of ARI hospitalisations was assault (46%). In Central Australia, a significant trend decline (APC -12.2; p = 0.011) was observed after 2017 following alcohol policies implemented between 2017 and 2018 (Banned Drinkers Register v2; Minimum Unit Price; and Police Auxiliary Liquor Inspectors). Consecutive years with the greatest decrease in Central Australia were 2013-2014 (APC -25.8) and 2018-2019 (APC -35.1); likely influenced by alcohol policies in effect at the time. In the Top End, a non-significant trend decline (APC -26.1; p = 0.186) was observed after 2020. Alcohol policies implemented between 2017 and 2018 were associated with reduced ARI hospitalisations in Central Australia. Alcohol policies that demonstrated reduced harm should be sustained.

Telehealth and disparities in opioid use disorder treatment: Medicaid enrollees versus privately insured individuals.

To determine how the rise of telehealth during the COVID-19 pandemic impacted Medicaid enrollees' access to opioid use disorder (OUD) treatment. Electronic health records from Northwestern Medicine, a large midwestern academic health system, from January 1, 2019 to December 31, 2021. The exposure was the expansion of telehealth services during the COVID-19 pandemic. A difference-in-differences design was used to determine the impact of telehealth on the probability of receiving any OUD care, any in-person OUD care, and any telehealth OUD care in a month. The study included Medicaid and privately insured patients older than 18 years of age, diagnosed with OUD, who had any encounter with the Northwestern Medicine system. All outpatient visits with OUD as the primary diagnosis were included in the analysis. There were 486 individuals in the sample and 17,496 person-month observations. After the onset of the COVID-19 pandemic, Medicaid enrollees are 4.5 percentage points (percentage change, 43.7%; 95% confidence interval [CI] 8.7 to 0.3 percentage points; p = 0.035) less likely to receive any OUD care in a month, relative to privately insured patients. While no statistically significant differences in the likehood of receiving in-person OUD care were detected between the groups after exposure, we did observe that Medicaid enrollees are 3.6 percentage points (percentage change 64.2%; 95% CI 6.0 to 1.1 percentage points; p = 0.004) less likely to receive any telehealth OUD care in a month relative to privately insured patients. While those with private insurance were able to maintain OUD treatment during the pandemic by supplementing in-person care with telehealth, Medicaid enrollees experienced a drop in overall OUD treatment rates due to lower telehealth use. The rise of telehealth for OUD treatment might contribute to widening care gaps for Medicaid enrollees.

Detecting defects: low initial serum human chorionic gonadotropin (hCG) level may predict future fetal anomalies following frozen embryo transfer (FET).

To investigate the relationship between early serum hCG levels after frozen embryo transfer and fetal anomalies. This was acase-control study at a single academic fertility center between 1/2010 and 12/2021, including all patients who underwent euploid frozen embryo transfers resulting in any fetal anomaly confirmed at the time of induced abortion > 10weeks or any anomaly reported at delivery. Controls included patients with healthy live births matched for age and day/grade of embryo after euploid FET. The primary outcome was fetal anomaly, with comparisons made using serum hCG levels from cycle day 28 to cycle day 35 and percent change between days 28 and 35. Both cycle day 28 serum hCG levels and day 35 serum hCG levels were significantly lower in the anomalous group (day 28: 152 vs 177.5 mIU/mL, p < 0.04; day 35: 3033 vs 3744 mIU/mL, p < 0.05). Patients with anomalous outcomes had a significantly lower hCG to start with 5/78 (6.4%) < 50mIU/mL, 16/78 (20.5%) 51-100mIU/mL, and 57/78 (73.1%) > 101mIU/mL, compared to controls 3/78 (3.8%) < 50mIU/mL, 8/77 (10.3%) 51-100mIU/mL, and 66/77 (85.7%) > 101mIU/mL (p < 0.02). However, the rate of rise between day 28 and day 35 was not statistically different (1758.0% vs 2097.0%, p = 0.23). Patients with anomalous fetal outcomes following frozen embryo transfer had lower early serum hCG levels than controls with healthy live births, highlighting the potential utility of this serum marker to identify high-risk pregnancies in the first trimester and expedite treatment as appropriate for this rare but devastating outcome.

The Interplay Between Muscular Activity and Pattern Recognition of Electro-Stimulated Haptic Cues During Normal Walking: A Pilot Study

This pilot study explored how muscle activation influences the pattern recognition of tactile cues delivered using electrical stimulation (ES) during each 10% window interval of the normal walking gait cycle (GC). Three healthy adults participated in the experiment. After identifying the appropriate threshold, ES as the haptic cue was applied to the gastrocnemius lateralis (GL) and biceps brachii (BB) of participants walking on a treadmill. Findings revealed variable recognition patterns across participants, with the BB showing more variability during walking due to its minimal activity compared to the actively engaged GL. Dynamic time warping (DTW) was used to assess the similarity between muscle activation and electro-stimulated haptic perception. The DTW distance between electromyography (EMG) signals and muscle recognition patterns was significantly smaller for the GL (4.87 ± 0.21, mean ± SD) than the BB (8.65 ± 1.36, mean ± SD), showing a 78.6% relative difference, indicating that higher muscle activation was generally associated with more consistent haptic perception. However, individual differences and variations in recognition patterns were observed, suggesting personal variability influenced the perception outcomes. The study underscores the complexity of human neuromuscular responses to artificial sensory stimuli and suggests a potential link between muscle activity and haptic perception.

The effects of dynamic stretching performed before and between the sets of exercises on vertical jump performance

The purpose of this study was to investigate the effects of dynamic stretching (DS) performed before and between the sets of exercises on vertical jump performance. Twelve healthy adult males performed DS on their lower limb muscles, with 10 repetitions on each side before and between four sets of three repetitions of vertical jumps. Vertical jump height was measured. Additionally, the percent change in jump height for each set was determined based on the baseline score from set 1. Heart rate was also measured at rest, before exercise, and before each set of vertical jumps. Vertical jump height was significantly higher in the latter half of the sets (p &lt; .05) compared to the condition in which DS was only performed before exercise and to the control condition in which the participants were refrained from performing DS throughout. In addition, when DS was only performed before exercise, vertical jump height was significantly lower in set 4 compared to set 1 (p = .001). These findings suggest that DS performed between sets, in addition to performing before the exercise, produces a higher power output in vertical jump performance in the latter half of multiple sets.

Single-Frequency Birdcage Coils for Deep Tissue Perfluorocarbon Magnetic Resonance Imaging in Mice.

Fluorine-19 (19F) MRI has become an established tool for invivo cell tracking following exvivo or invivo labelling of various cell types with 19F perfluorocarbons (PFCs). Here, we developed and evaluated novel mouse-specific radiofrequency (RF) hardware for improved dual 1H anatomical imaging and deep tissue 19F MR detection of PFCs. Three linearly polarized birdcage RF coils were constructed-a dual-frequency 1H/19F coil, and a pair of single-frequency 1H and 19F coils, designed to be used sequentially. RF coil quality factors (Q values), signal homogeneity and sensitivity were benchmarked against a commercially constructed dual-frequency 1H/19F surface coil. RF homogeneity was assessed using a phantom designed to mimic PFC localization at depth in a mouse. The single-frequency birdcage coils (1H and 19F) displayed more uniform coverage and enhanced signal-to-noise ratios (SNRs) compared to both the birdcage and surface dual-frequency coils for 19F detection. Bilateral injection of a perfluoropolyether nanoemulsion into the footpads of female athymic nude mice, resulting in drainage to various lymph nodes and subsequent accumulation in lymph node macrophages, provided a platform to assess differences in SNRs and contrast-to-noise ratios (CNR) between both coil configurations as a function of depth and location. The single-frequency 1H coil provided significantly increased CNR in anatomical images (p < 0.001) with increased anatomical coverage compared to the dual-frequency surface coil. The single-frequency 19F birdcage coil offered increased PFC detectability with significantly higher SNR in renal, lumbar, sciatic and popliteal lymph nodes (p < 0.01) compared to the dual-frequency surface coil. Interestingly, the percentage difference between SNR measurements in lymph nodes between the single-frequency 19F coil and the 1H/19F surface coil had a linear relationship with increasing distance from the surface coil (R2 = 0.6352; p < 0.0001), indicating a potential disagreement for imaging experiments that rely on 19F spin quantification at increasing depth within the mouse using surface RF coils.

Understanding Grandparent Caregiving in Korean and U.S. Culture: An Analysis Using Role Theory.

This study explored grandparent caregiving experiences in Korea and the United States. Using a phenomenological approach, semi-structured interviews were conducted with 20 custodial grandparents (10 in Korea, 10 in the United States) to understand their lived experiences. Under the guidance of role theory, the caregivers' experiences were explained by themes of role consensus, role conformity, and role conflict. Despite Korean and U.S. grandparent groups performing a similar role, relative differences were observed, including Korean grandparents with increased role conformity and the U.S. grandparents with increased role conflict. The distinction highlights the importance of understanding grandparent caregiving in cultural contexts and ensuring that interventions are culturally responsive. Regardless of cultural context, the grandparent caregivers disclosed relatively positive experiences of the pandemic, testifying to their resilience. Lastly, critical role supporters were identified at various levels, demonstrating that developing support systems can be a key in empowering grandparent caregivers.

MELD score predicts outcomes in patients with advanced heart failure: A longitudinal evaluation.

Advanced heart failure (AHF) is characterized by recurrent episodes of haemodynamic instability and frequent hospitalizations, leading to a progressive decline in quality of life and high mortality rates. The objectives of this study were to evaluate the effect of the model for end-stage liver disease (MELD) score and its variations in predicting adverse outcomes [death, urgent heart transplant, and left ventricular assist device (LVAD) implant] among patients with AHF to assess the clinical associations of the MELD score in this population and to compare the efficacy of this tool with other prognostic scores in AHF. In this longitudinal prospective study, 162 patients with advanced heart failure (AHF) were enrolled; all patients included in the study were receiving the maximum tolerated medical therapy according to guidelines. The MELD score was measured at baseline and every 6months during follow-up. All patients underwent echocardiographic assessment and cardiopulmonary testing, which included the evaluation of maximal oxygen uptake (VO2max) and the minute ventilation/carbon dioxide production (VE/VCO2) slope. The mean age of the study group was 57.7±11.6years. There were 26 deaths, 5 urgent transplants, and 1 LVAD implantation during a follow-up period of 31.4±15.6months. The mean New York Heart Association (NYHA) class was 2.8±0.5, ejection fraction (EF) was 26.3±6.5%, the mean VO2max was 11.7±3.5mL/kg/min. Multiple regression analysis revealed a positive correlation between the MELD score and NT-proBNP (β=0.215; P=0.041) and furosemide dosage (β=0.187; P=0.040). Conversely, a negative correlation was observed between the MELD score and TAPSE (β=-0.204; P=0.047). Multivariate Cox regression on combined outcome shows a HR of 1.094 (95% CI 1.003-1.196) for unit increase in MELD considered as a continuous variable. The predictive role is independent by the effect of covariates considered in the analysis such as age, sex, NYHA class, EF, TAPSE, PASP, VO2max, NT-proBNP, MELD score worsening, and NT-proBNP increase. Changes in MELD score percentage, considered as a dichotomous variable (≤100% and >100%), were found to be predictors of mortality, urgent heart transplant and LVAD implant. Receiver operating characteristic (ROC) curves showed an area under the curve (AUC) of 0.887 for MELD score and composite outcome of death, urgent transplant, and need for LVAD. The predictive performance of MELD was even superior compared with MELD-Na, MELD-XI, MAGGIC risk score, and MECKI. The MELD score and its longitudinal changes are effective predictors of adverse outcomes in AHF.

Optimal Blood Sampling Time for Area under the Concentration-Time Curve Estimation of Vancomycin by Assessing the Accuracy of Four Bayesian Software.

Effective blood sampling times, beyond trough and peak levels, have not been determined for estimating vancomycin's area under the concentration-time curve (AUC) using the Bayesian software. The aim of this study was to evaluate the accuracy of AUC estimation at different blood sampling times during the same dosing interval at steady state utilizing data from a prior phase I trial of vancomycin. Six healthy adult participants were sampled following intravenous administration of 1 g vancomycin for 1.5 h every 12 h. The AUC was estimated using four software packages and four population pharmacokinetic models. Accuracy was assessed using bias (difference between the estimated and reference AUC) and imprecision (absolute percentage difference between the estimated and reference AUC). The accuracy varied with the sampling time. The optimal two-point sampling times were determined to be 2.5 and 5.5 h post-injection using software packages for EasyTDM, Practical AUC-guided therapeutic drug monitoring (TDM), and Anti-MRSA Agents TDM Analysis Software (incorporating Rodvold, Yamamoto, and Yasuhara models). In these estimations, the mean bias (range, -1.7 to 9.5 µg·h/mL) was unbiased and the mean imprecision (range, -3.0% to 5.0%) was precise. The optimal one-point sampling time was 5.5 h post-injection for Anti-MRSA Agents TDM Analysis Software, which incorporated the Yamamoto and Yasuhara models. In conclusion, optimal blood sampling times may vary depending on the software and model used. Our findings suggest that identifying specific sampling times could improve the efficacy of TDM in clinical practice.

Serum symmetric dimethylarginine concentrations in enalapril- or telmisartan-treated dogs with proteinuric chronic kidney disease

IntroductionRenin-angiotensin-aldosterone system inhibition (RAASi) reduces intraglomerular pressure and is a standard therapy for dogs with proteinuric chronic kidney disease (CKD). RAASi can acutely decrease glomerular filtration rate (GFR); however, its effects on the marker of GFR serum symmetric dimethylarginine (SDMA) concentration in dogs have not been specifically evaluated. The objective of this study was to evaluate changes, relative to pretreatment values, in serum SDMA concentrations in dogs with proteinuric CKD receiving RAASi therapy.MethodsThis retrospective study used banked samples from 29 dogs with proteinuric CKD treated with enalapril (0.5 mg/kg PO q12h; n = 16) or telmisartan (1 mg/kg PO q24h; n = 13) alone (n = 22) or in combination with amlodipine if severely hypertensive (n = 7). Serum SDMA, creatinine, and urea nitrogen (SUN) concentrations were measured before and 7 and 30 days after starting RAASi. Percentage and absolute changes in these biomarkers were calculated for each dog and time point. A linear mixed model was used to test whether changes significantly differed from zero (α &amp;lt; 0.05).ResultsOverall, mean ± SEM Day 7 and 30 percentage change in SDMA were − 4.8 ± 3.6% and − 3.2 ± 3.4%, respectively; in creatinine were 7.4 ± 3.3% and 3.0 ± 3.1%, respectively; and in SUN were 22.1 ± 6.8% and 16.7 ± 6.2%, respectively. Mean changes varied according to whether all dogs, those on RAASi alone, or those co-treated with amlodipine were evaluated. In dogs receiving RAASi alone, at day 7, there were significant mean percentual increases in creatinine (9%; p = 0.023) and SUN (23%; p = 0.005), but SDMA was unchanged. In dogs co-treated with amlodipine, a significant absolute decrease in mean SDMA (−2.29 μg/dL; p = 0.026) occurred at days 7 and 30, while mean creatinine was unchanged and mean SUN increased.DiscussionProteinuric dogs receiving RAASi had low-magnitude changes in serum SDMA and creatinine, and moderate-magnitude changes in SUN concentrations. The direction of change in SDMA did not consistently match that of creatinine and SUN.

Risk Factors of Marginal Cord Insertion in Singleton Pregnancies: A Systematic Review and Meta-Analysis

Background: Marginal cord insertion (MCI) is increasingly recognized as a pathological variation that necessitates early diagnosis. Identifying the risk factors associated with MCI is essential for improving prenatal screening and optimizing management strategies. Our meta-analysis systematically and quantitatively synthesizes the current evidence on various potential risk factors for MCI. Methods: This systematic review and meta-analysis adhered to the PRISMA and MOOSE guidelines. Comprehensive searches were performed in three databases up until 6 May 2024, identifying observational cohort and case–control studies that examined risk factors for MCI in singleton pregnancies compared with central or eccentric cord insertion. Quality and risk of bias assessment were performed using the Newcastle–Ottawa Scale and the Quality In Prognosis Studies tool, respectively. Statistical analyses employed random-effects models to calculate relative risks (RR) and mean differences with their 95% confidence intervals (95% CI). Heterogeneity was assessed via Cochran’s Q and I2 statistics. Results: A total of 18 studies (14 cohort and 4 case–control), encompassing 51,463 MCI cases and 901,020 control cases, were included. The meta-analysis revealed a prevalence of MCI at 5.71% among singleton pregnancies. Significant risk factors for MCI included the use of assisted reproductive technology (RR = 1.55; 95% CI: 1.34–1.78), chronic hypertension (RR = 1.47; 95% CI: 1.11–1.95), placenta previa (RR = 1.83; 95% CI: 1.62–2.08), and nulliparity (RR = 1.18; 95% CI: 1.08–1.30). No significant associations were found for smoking, maternal age, prior Cesarean section, preexisting diabetes, or Caucasian ethnicity. Sensitivity analyses corroborated the robustness of these findings. Conclusions: This meta-analysis identified assisted reproductive technology, chronic hypertension, placenta previa, and nulliparity as significant risk factors for marginal cord insertion in singleton pregnancies. These findings can inform the development of prenatal screening protocols and enable targeted screenings for high-risk populations.

The Effect of Adding Generation Bus to the Short Circuit Current Level in Electrical Power System

The need for electrical energy is changing and increasing, requiring system flexibility always to be changed and developed. On the other hand, changes in the configuration of the electric power system due to the addition of components or sub-systems also change system parameters such as impedance or level of fault current (short circuit current). This paper presents a study of changes in the fault current caused by adding a new generating bus to an electric power system. This paper aims to determine the change in short-circuit current due to the addition of generators on new buses connected to existing buses to identify the most suitable location for adding these generators based on short-circuit current levels. Three-phase short circuit faults are simulated and analyzed on the IEEE 14 bus standard system using ETAP software with a base MVA 615 MVA. The addition of generators was carried out at five locations with varying generating capacities. The research results show that the short circuit current will change significantly when adding a generator bus to bus 13, with an average percentage change of 5,656%. The smallest change occurs when adding a generator to bus 2, with an average percentage change of 2,417%. The research results conclude that connecting a generator to a new bus linked to an existing generator bus (PV bus) is more effective than connecting it to a new bus associated with a load bus (PQ bus).

A Narrative Exploration of Family Members' Perspectives of Life Story Phases Following Transition of an Older Family Relative Into Long-Term Care.

The transition of an older person from a home environment into long-term care is frequently unplanned and complex. Little is known about how relatives make sense of supporting the transition of their relatives to long-term care. This study explored family members' narratives of the process of supporting the transition of their older relative into long-term care. Life stories of six relatives who supported transitioning their older family relatives into a nursing home were collected using open narrative questioning in accordance with the Biographical Narrative Interpretive Method. Data was analysed using a dialogic/performance analysis narrative analytic method. Four key life story phases were identified: before transition, crisis event, transition and after transition. These phases varied in time duration and involvement of healthcare providers. The longest phase was 'before transition' where a process of slow deterioration became more apparent to the participants retrospectively. This was followed by the shortest period 'crisis event' where the older person was admitted to tertiary care. Two permeating themes: family dynamics and knowledge/understanding underpinned all life story phases. Relatives' knowledge, family dynamics and positioning of self-informed the duration of the life story phases of participants as they navigated the transition. Understanding nuanced differences in relatives' life story phases highlights how timing of information provision can affect the emotional adjustment of relatives experiencing this challenging process. Both community and gerontological nurses' offer real potential to provide tailored and effective responses to relatives depending on each life phase. Sequencing of information appropriate to the life phase could potentially ease the stress associated with transitioning to nursing home care, possibly preventing a crisis event from occurring. Anticipatory conversations also offer potential to alleviate relatives' concerns through life story phases.

Changes in psychiatric disorder incidence patterns during the COVID-19 pandemic in Korea: a study using the nationwide universal health insurance data

BackgroundFew studies have evaluated the incidence of various psychiatric disorders during the coronavirus disease (COVID-19) pandemic using hospital visit data for the entire population of a nation. We used Korea’s universal compulsory health insurance data to conduct a descriptive analysis to evaluate changes in psychiatric disorder incidence during the COVID-19 pandemic.MethodsHospital visit data related to psychiatric disorders were retrieved from the National Health Insurance Database. First-ever diagnosis for specific psychiatric disorders for each Korean was identified (from January 2015 to February 2023) and monthly age-standardized incidence rates were calculated. An interrupted time-series analysis was used to estimate counterfactual disease incidence rates and observed and counterfactual rates were compared using difference-in-difference framework.ResultsCompared to pre-pandemic period, there was a decrease in the incidence [percentage changes in monthly rate (95% confidence intervals)] of organic mental disorders [-14.6% (-18.4, -10.9)] and psychoactive substance related disorders [-12.9% (-17.5, -8.3)] during the pandemic. However, anxiety disorders [8.8% (3.1, 14.6)], behavioral syndromes associated with physiological disturbances [8.1% (4.2, 11.9)], mental retardation [8.6% (3.0, 14.2)], psychological developmental disorders [19.6% (11.5, 27.7)], childhood- and adolescent-onset behavioral and emotional disorders [45.1% (28.4, 61.8)], and unspecified mental diseases [51.8% (39.8, 63.8)] increased.ConclusionsPsychological disease incidence patterns changed substantially during the pandemic in South Korea. Various pandemic-related stressors, such as disrupted lifestyles and hospital accessibility, may have influenced these changes. The causes and public health consequences of these changes require further evaluation.

Early adoption of telehealth/remote patient monitoring and hospital revenue changes during COVID-19.

The COVID-19 pandemic dramatically affected the financial performance of hospitals across the U.S. The prompt availability of telehealth options likely impacted both a hospital's healthcare options and opportunities for revenue in the short-term. The aim of this study was to explore the association between early adoption of telehealth and changes in revenue during the early phase of the pandemic, and to compare whether the results differed between rural and urban hospitals. We performed first-difference regressions on a cross-sectional dataset of 1,742 U.S. hospitals. Our dependent variables were percent changes in four categories of revenue between 2019 and 2020: inpatient, outpatient, gross, and net. The adoption of telehealth and remote patient monitoring as of 2019 served as the primary independent variables of interest. We controlled for changes in hospital characteristics from 2019 to 2020, including case mix index and number of employees. Our results suggest that telehealth adoption prior to the COVID-19 pandemic was associated with significant increases in all four revenue categories from 2019 to 2020, ranging from 1.79% (net patient revenue) to 2.92% (outpatient revenue). However, RPM implementation in 2019 was associated with significant declines in gross patient (0.08%) and outpatient revenue (1.50%). The results were largely similar across rural and urban locations. Adopting telehealth before the onset of COVID-19 helped hospitals increase revenue during the initial phase of the pandemic. Alternatively, implementation of remote patient monitoring was associated with revenue declines, likely due to limited ability for monetization. Whether these relationships have persisted needs further investigation.

Mortality trends in suicide among pediatric and adolescent patients aged 15–24 years in Mississippi, 2012–2022

AbstractDue to the lack of studies examining suicide trends and its implications on pediatric populations, this study aimed to address the gap in research and to identify the magnitude and the impact of suicide by exploring trends in suicide among Mississippians from 2012 to 2022. The study uses data from the Mississippi Statistically Automated Health Resource System, which is an online database with data collected from vital statistics. Joinpoint regression models were used to calculate annual percentage change (APC) and average annual percentage change (AAPC) as an indicator of trends. The overall age‐adjusted suicide rate increased from 9.4 deaths per 100,000 in 2012 to 10.8 deaths per 100,000 in 2022 for pediatric and adolescent patients aged 15–24 years (14.9% increase). There are upward trends for females (AAPC, 6.33%, 95% CI, −0.82%–16.82%), Blacks (AAPC, 7.72%, 95% CI, 2.19%–16.47%), and other races (AAPC, 7.59%, 95% CI, −0.83%–21.47%). Males had a downward trend from 2015 to 2022 (APC, −1.46%, 95 CI, −14.05%–1.35%). Whites also had a downward trend from 2017 to 2022 (APC, 4.74%, 95% CI, −15.42% to −0.96%). This study identified an overall increase in suicide. However, trends varied by gender, race, and age. Based on the findings, Mississippi needs more initiatives aimed toward equitable prevention of suicide among youth and the implementation of gun control policies. By implementing these measures, Mississippi could tremendously benefit and improve mental health outcomes and reduce suicide within the state.

Developing a nearly automated open-source pipeline for conducting computational fluid dynamics simulations in anterior brain vasculature: a feasibility study

Intracranial aneurysms (IA) pose significant health risks and are often challenging to manage. Computational fluid dynamics (CFD) simulation has emerged as a powerful tool for understanding lesion-specific hemodynamics in and around IAs, aiding in the clinical management of patients with an IA. However, the current workflow of CFD simulations is time-consuming, complex, and labor-intensive and, thus, does not fit the clinical environment. To address these challenges, we have developed a semi-automated pipeline integrating multiple open-source software packages to streamline the CFD simulation process. Specifically, the study utilized medical angiography data from 18 patients. An in-house open-source DL image segmentation model (ARU-Net) was employed to generate 3D computer models of the anterior circulation. The segmented intracranial vasculature models, including IAs, were further refined using the Vascular Modeling Toolkit (VMTK), an open-source Python package. This step involved smoothing the surface of the models and extending the inlet and outlet regions to ensure a realistic representation of the vascular geometry. The refined vascular models were then converted into computational meshes using an open-source mesh generator known as TetGen. This process was nearly automated and required minimal user interaction(s). Blood flow simulations of the cerebral vascular models were performed using established SimVascular solvers (an open-source finite element platform for vascular applications) through an application programming interface (API). The CFD simulation process was also conducted using the manual workflow for comparative purposes. The initial assessment compared the geometries derived from manual and DL-based segmentation. The DL-based segmentation demonstrated reliable performance, closely aligning with manually segmented results, evidenced by excellent Pearson correlation coefficient (PCC) values and low relative difference (RD) values ranging from 3% to 10% between the computed geometrical variables derived from both methods. The statistical analysis of the computed hemodynamic variables, including velocity informatics and WSS-related variables, indicated good to excellent reliability for most parameters (e.g., ICC of 0.85–0.95). Given the data investigated, the proposed automated workflow streamlines the process of conducting CFD simulations. It generates results consistent with the current standard manual CFD protocol while minimizing dependence on user input.

Iodinated contrast dye-diluent combination exhibits longer time to full dye saturation compared to lidocaine, bupivacaine, and water in porcine cadaveric nervous tissue.

Dye-diluent combinations have different nerve-staining behavior, making locoregional cadaveric dye study findings difficult to compare. The objective of this study was to quantify the effect of 4 diluents on nerve color saturation when used in combination with commercial food dye. 48 unpreserved brachial plexus nerves were randomized into 4 diluent groups. Lidocaine, bupivacaine, iodinated contrast, and sterile water were combined with commercial food dye (10:1), and prosected nerves were immersed in one of these groups for 1, 15, 30, or 60 minutes. Images at baseline and at each timepoint were processed using ImageJ. Color saturation was divided into quartiles (dark, medium dark, medium light, or light). The percentage of nerve area stained in each quartile was compared using a 2-way ANOVA and post hoc Tukey test. At 1 minute, water and bupivacaine had a higher percentage of area of dark saturation compared to contrast. At 15 and 30 minutes, dark and medium-dark saturation percentages of area were also larger in lidocaine, bupivacaine, and water compared to contrast. There were no differences in saturation percentages of areas between groups at 60 minutes. Within groups, all diluents had darker percentages of area saturation at 15, 30, and 60 minutes compared to minute 1. In porcine nerves, the staining profiles of 2% lidocaine, 0.5% bupivacaine, and sterile water combined withcommercial food dye appear similar and may be used interchangeably after 15 minutes of exposure. When using iodinated contrast, exposures over 60 minutes yield comparable results to other diluents. Diluents contribute to heterogeneous nerve-staining behavior and should be considered when comparing study outcomes. If contrast is used as the diluent in cadaveric studies with postoperative imaging, researchers should be aware of the significant delay to reach a saturation level comparable to other diluent combinations.

Lung cancer incidence and mortality in trend and prediction between 2012-2030 in Shandong Province, using a Bayesian age-period-cohort model

ObjectivesLung cancer is one of the most common cancers in Shandong Province, China. Projecting future cancer trend is crucial for planning cancer control. We aimed to examine the trend of lung cancer incidence and mortality from 2012 to 2023, and predict the lung cancer burden to 2030 in Shandong.MethodsData of lung cancer incidence and mortality from 2012 to 2023 were obtained from the Shandong Cancer Registries. The average annual percentage change (AAPC) was used to quantify the trend of the lung cancer age-standardised rate using Joinpoint software. Bayesian age-period-cohort model was used to predict lung cancer incidence and mortality from 2024 to 2030.ResultsThe age-standardised incidence rate (ASIR) remained stable from 2012 to 2023. The ASIR in males decreased with an AAPC of -1.350%, while the ASIR in females increased with an AAPC of 2.429%. The age-standardised mortality rate (ASMR) decreased with an AAPC of -2.911%. This trend was also observed in males (AAPC=-2.513%), females (AAPC=-3.632%), urban areas (AAPC=-3.267%) and rural areas (AAPC=-2.603%). For our predictions, the ASIR will increase to 49.21 per 100,000 until 2030, with an AAPC of 1.873%. This upward trend is expected for females and urban areas, with an AAPC of 4.496% and 4.176%, while it is not observed for males and rural areas. The ASMR is expected to remain stable up to 2030, and this trend will maintain both in males and females. The ASMR will exhibit an upward trend (AAPC=1.100%) in urban areas and a downward trend (AAPC=-0.915%) in rural areas.ConclusionThe ASIR of lung cancer will increase until 2030, while the ASMR of lung cancer is expected to remain stable in Shandong. It is necessary to take further preventive measures such as strengthening tobacco control, enhancing health education and expanding screening efforts.

Trends in hospital readmissions among adults with and without HIV in the US, 2010-2020

Background: Although 30-day hospital readmission is a widely followed quality measure, there are limited US nationwide data to evaluate its trends among people with HIV (PWH) and the sex disparity over time. We describe the 30-day all-cause unplanned readmission trends among PWH and people without HIV (PWoH) in the US. Setting: Adult participants in the 2010-2020 Nationwide Readmissions Database(NRD), which weighted represents all US hospitalizations each year. Methods: We defined index admission and unplanned readmission using the US Centers for Medicare &amp; Medicaid Services criteria. Overall and sex-specific readmission risk were tabulated among the index admissions from adult PWH and PWoH each year in the 2010-2020 NRD. Random effect linear and Poisson regressions were used to estimate risk difference (RD) and annual percent change of the trend. We added a spline in 2015 and additionally stratified the analysis by age and patient’s zip code median household income. All analyses were weighted to generate national estimates. Results: Approximately 140,000 index admissions from PWH and 25 million from PWoH were included each year. For PWoH between 2010-2020, annual readmission risk was stable at ∼12%. For PWH, readmission risk was stable at ∼22% during 2010-2015 and decreased from 22.0% in 2016 to 20.1% in 2020(RD= -1.60[-2.24,-0.95]). Non-pregnant female PWH continued to have higher readmission risk than male PWH for all subgroups and all years. Female PWH &lt;40 years had no reduction in readmission risk between 2016-2020(RD= -0.45[-2.43,1.53]). Conclusion: There remains strong need for readmission reduction interventions focusing on PWH, especially for young female PWH.