Outcome Of Study Research Articles

The influence of product availability and social media on green food product purchase intention

PurposeThe present research investigates the role of product availability, environmental concern, and social media concerning the intention to purchase green food products by utilising the extended theory of planned behaviour framework in a developing economy.Design/methodology/approachA self-administered questionnaire collected information from 412 adults and educated consumers from Vadodara city in India. The questionnaire items were used to collect data from previous studies and further validated using confirmatory factor analysis. The data were further analysed using partial least square-structural equation modelling.FindingsThe study findings indicated that attitude and perceived behavioural control impact the purchase intention regarding green food products, while subjective norms were found not supportive. At the same time, product availability influences perceived behavioural control and increases the volitional control amongst consumers. Moreover, social media positively impacts the theory of planned behaviour’s key constructs.Research limitations/implicationsThe outcomes of the present study provide marketing managers with enhanced insight into the relationship between consumers' perception and green food product consumption in the context of social media influence. The findings could help green food producers evaluate the extent of consumers' intentions to buy their products in developing countries.Originality/valueTo the best of the researchers’ knowledge, the present research is amongst the pioneers in India that focuses on the variables of the theory of planned behaviour, which led to knowing the role of green food availability and social media influence in green food products. At the same time, the focus on purchase intention concerning green food products adds to the study’s uniqueness.

Predicting schedule adherence of engineering changes – a case study on effectivity date adherence prediction using machine learning

Engineering changes (EC), redesigns of components, are common with complex products. Their realisation into production systems is a lengthy process and thorough control is imperative. As with most complex processes, however, this is a resource-intensive task and support is required to direct scarce resources. In other domains, predictive business process monitoring (PBPM) research has demonstrated that complex processes can be monitored using machine learning approaches. However, it is indicated that predictive performance is domain sensitive. Therefore, we investigate and show how PBPM can be applied to the EC process by predicting adherence to planned implementation dates. As the outcome of a case study comparing 30 predictive models, our research indicates that EC effectivity date adherence prediction, and thus pre-emptive EC schedule monitoring, is possible. However, performance comparison hints that shallow learning algorithms outperform deep learning algorithms. Furthermore, as the optimal algorithm depends on the deployment scenario, it is demonstrated how cost curves are better decision criteria for choosing models compared to threshold dependent metrics. Based on these findings, this article offers a blueprint for developing machine learning models for predicting the EC schedule adherence and lays the base for further research towards automatic EC scheduling and control.

A mindfulness-based, cognitive, social, digital relapse-prevention intervention for youth with depression in Australia: study protocol for a randomised controlled trial of Rebound

IntroductionMajor depressive disorder (MDD) causes significant disease burden and functional impairment during adolescence and young adulthood. While most young people recover from their first episode, around two-thirds will experience one...

Outcome of total hip arthroplasty versus hip hemiarthroplasty for femoral neck fractures in the elderly: a meta-analysis of randomized control trial

Background: Roughly 50% of all hip fractures are femoral neck fractures, these fractures are subtype of intracapsular hip fractures. Elderly patient's femoral neck fracture is typically the consequence of a straightforward fall from standing height with low energy. Total hip arthroplasty (THA) versus hip hemiarthroplasty (HHA) is a topic of controversy that sparked discussions over half century ago, between these two types technique have own advantages and disadvantages. Methods: A comprehensive search conducted across major electronic databases for relevant studies published from 2014-2024. Studies THA with HA for elderly patients with femoral neck fractures were included. Data regarding study characteristics, surgical techniques, outcomes, and garden classification were extracted and analyzed using appropriate statistical methods. Our primary outcomes were surgical duration, functional outcome and complications. Results: The initial search yielded total 825 studies, which 7 studies met the inclusion criteria, consisting of total 747 patients THA and HA for elderly patients with femoral neck fractures. THA had longer surgery duration compared with HA (MD=32.48, 95% CI:5.13 to 59.83, p=0.02). THA showed better ratings Harris hip score (HHS) during a year follow-up periods (MD=2.31, 95 CI:0.42 to 4.21, p=0.02). There was no significant difference in complications. Conclusions: THA advantageous over hemiarthroplasty in the terms of HHS but HA favoured in surgical duration. Ultimately, only large well-conducted studies will result in improvements in the outcomes of treatment and resolve the longstanding controversy of whether THA or HA is the preferred treatment modality for femoral neck fracture in elderly.

Prognostic impact of subepithelial Helicobacter pylori infection on clinical outcomes in patients with dyspepsia.

Several in vivo and in vitro studies have shown that Helicobacter pylori can invade epithelial cells and the lamina propria, potentially leading to underdiagnosis due to its subepithelial location. This retrospective study investigated H.pylori infection patterns and their impact on clinical improvement. Gastric tissue biopsies from 346 patients (August to December 2021) were studied using four commercially available immunohistochemical antibodies (TMDU, BioGenex, Cell Marque, and DAKO). The bacteria were graded based on their surface epithelial and subepithelial locations and then combined to establish an overall pattern. BioGenex, the antibody with the highest diagnostic performance due to its superior detection of surface and subepithelial cases, was selected as the gold standard for determining study outcomes. The isolated subepithelial H. pylori pattern was found to be an independent unfavorable prognostic feature. Patients with this pattern had the worst clinical outcomes compared to groups with isolated surface epithelial or other mixed patterns, which did not significantly differ. Subepithelial H. pylori should be included in pathological reports alongside the updated Sydney System. Further research should explore whether its eradication could improve treatment outcomes.

Possible misdiagnosis of pregnancy-associated stroke in the emergency department

ObjectivesPregnancy and the postpartum period are associated with an increased risk of ischemic and hemorrhagic stroke. The incidence of missed or delayed diagnosis of pregnancy-associated stroke (PAS) in the emergency setting is unknown. Materials and methodsWe conducted a retrospective cohort study of women hospitalized for labor and delivery identified through administrative claims data from all nonfederal EDs and hospitals in 11 states (New York 2006-2017, Florida 2005-2019, 3 states from 2016-2020, 6 states from 2016-2019). We then identified women hospitalized for stroke (ischemic or hemorrhagic) using validated ICD-9-CM or ICD-10-CM codes during a 270-day period extending from 6 months before through 3 months after delivery. The primary study outcome was possible ED misdiagnosis of PAS, defined as an ED treat-and-release visit for a neurological complaint within the 30 days preceding PAS hospitalization. Standard tests of comparison were used to compare differences in characteristics between PAS patients with a possible ED stroke misdiagnosis versus those without. ResultsAmong 5,308,962 women hospitalized for labor and delivery, 1,656 (0.03%) were hospitalized for a stroke during the study period. Of the pregnant or postpartum women hospitalized for stroke, 79 (4.8%; median age, 30 years) had at least one preceding ED visit for a neurological symptom (possible misdiagnosis). Demographics and vascular comorbidities were similar between those with versus without possible misdiagnosis. There were also no differences in the average length of stay (7.5 versus 9.6 days, p=0.43) or discharge to home (63.3% versus 56.6%, p=0.24) after stroke. ConclusionsPossible ED misdiagnosis occurred in nearly 1 of 20 cases of pregnancy-associated strokes in this multistate cohort though there were few of these strokes overall.

Association between stress hyperglycemia ratio and mortality in acute myocardial infarction patients with and without atrial fibrillation: a retrospective cohort study from the MIMIC-IV database

BackgroundThe stress hyperglycemia ratio (SHR) potently predicts adverse outcomes in patients with acute myocardial infarction (AMI), and previous studies reported U-shaped relationships between SHR and adverse prognosis. However, the relationship between SHR and mortality risk in AMI patients with or without atrial fibrillation (AF) remained unknown, and which factors affect the mortality in lower SHR patients were unclear. This study aims to research the relationship between SHR and mortality risk in AMI patients with or without AF, and whether AF affects the mortality in lower SHR patients.MethodsWe conducted a cohort study using data from 3233 patients with a first diagnosis of AMI from the MIMIC-IV (version 2.2) database. Patients were divided into two groups based on AF. The study outcome was 1-year all-cause mortality. SHR was defined as the index calculated by the formula: SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] – 2.59).ResultsU-shaped association between SHR and all-cause mortality was found only in AMI patients with AF, not in AMI patients without AF. For AMI patients with AF, the inflection point for the curve was found to be a SHR of 1.09, either lower (OR, 0.30; 95%CI, 0.10, 0.94) or higher (OR, 3.28; 95%CI, 2.01, 5.34) SHR is associated with increased mortality. However, a linear relationship was found in patients without AF, higher (OR, 1.95; 95%CI, 1.52, 2.51) SHR is associated with increased mortality. For patients with SHR ≤ 1.09, AF increased the risk of all-cause mortality(OR, 1.50; 95%CI, 1.10, 2.05), while this effect was not found in patients with SHR > 1.09.ConclusionThe association between SHR and mortality in AMI patients with or without AF is different: U-shaped association between SHR and all-cause mortality only in AMI patients with AF, not in AMI patients without AF. AF is a factor that make the difference by increasing the risk of mortality in AMI patients with low SHR. Lower SHR may increase mortality through the onset of AF. This study emphasizes avoiding “relative hypoglycemia”, SHR = 1.09 is the moderately tight glycemic control, which means glucose level is about (1.59 * HbA1c [%] – 2.59) * 1.09 mmol/L.Trial registrationClinical trial number: not applicable.

Scoping Review of Climate Change Adaptation Interventions for Health: Implications for Policy and Practice

Climate change is among the greatest threats to health in the 21st century, requiring the urgent scaling-up of adaptation interventions. We aim to summarise adaptation interventions that were funded by the Belmont Forum and the European Union, the largest global funders of climate change and health research. A systematic search was conducted (updated February 2023) to identify articles on adaptation interventions for health within this funding network. The data extracted included study characteristics, types of interventions, and study outcomes. The results were synthesised narratively within the PRISMA-ScR guidelines. A total of 197 articles were screened, with 37 reporting on adaptation interventions. The majority of interventions focused on the general population (n = 17), with few studies examining high-risk populations such as pregnant women and children (n = 4) or migrants (n = 0). Targeted interventions were mostly aimed at behavioural change (n = 8) and health system strengthening (n = 6), while interventions with mitigation co-benefits such as nature-based solutions (n = 1) or the built environment (n = 0) were limited. The most studied climate change hazard was extreme heat (n = 26). Several studies reported promising findings, principally regarding interventions to counter heat impacts on workers and pregnant women and improving risk awareness in communities. These findings provide a platform on which to expand research and public health interventions for safeguarding public health from the effects of climate change.

Multiomics approaches disclose very-early molecular and cellular switches during insect-venom allergen-specific immunotherapy: an observational study

Allergen-specific immunotherapy (AIT) induces immune tolerance, showing the highest success rate (>95%) for insect venom while a much lower chance for pollen allergy. However, the molecular switches leading to successful durable tolerance restoration remain elusive. The primary outcome of this observational study is the comprehensive immunological cellular characterization during the AIT initiation phase, whereas the secondary outcomes are the serological and Th2-cell-type-specific transcriptomic analyses. Here we apply a multilayer-omics approach to reveal dynamic peripheral immune landscapes during the AIT-initiation phase in venom allergy patients (VAP) versus pollen-allergic and healthy controls. Already at baseline, VAP exhibit altered abundances of several cell types, including classical monocytes (cMono), CD4+ hybrid type 1-type 17 cells (Th1-Th17 or Th1/17) and CD8+ counterparts (Tc1-Tc17 or Tc1/17). At 8-24 h following AIT launch in VAP, we identify a uniform AIT-elicited pulse of late-transitional/IL-10-producing B cells, IL-6 signaling within Th2 cells and non-inflammatory serum-IL-6 levels. Sequential induction of activation and survival protein markers also immediately occur. A disequilibrium between serum IL-6 and cMono in VAP baseline is restored at day seven following AIT launch. Our longitudinal analysis discovers molecular switches during initiation-phase insect-venom AIT that secure long-term outcomes. Trial number: NCT02931955.

Selective outcome reporting bias in randomized controlled trials on dental caries in children and adolescents: A meta-research study.

Selective Outcome Reporting (SOR) is a type of bias that potentially manifests in Randomized Controlled Trials (RCTs) and is defined as the change or omission of the primary outcome in the publication compared to the protocol. Researchers may alter outcomes to emphasize statistical significant results. We aimed to assess the prevalence of SOR in RCTs related to dental caries in Pediatric Dentistry. We conducted a search on the ClinicalTrials.gov and International Clinical Trials Registry Platform (ICTRP), using a comprehensive search strategy that included terms related to pediatric dentistry and dental caries, up to February 2023. Two independent reviewers included any trial that had two or more arms and focused on dental caries in pediatric dentistry. We excluded any registration that did not result in at least one published article. Data such as study characteristics and outcome data were extracted. The chi-square test was used with a significance level set at 5% to detect the association between SOR and the pre-specified variables. One hundred and forty-four protocols and their corresponding publications were included. SOR was observed in 58.9% (n=103), and 41.1% (n=72) having discrepancies in the primary outcome follow-up. Retrospectively registered studies accounted for 73.7%. SOR was significantly associated with discrepancies in the follow-up period (p<0.001) and with type of study design in paper (p=0.048). The high prevalence of SOR in dental caries RCTs in pediatric dentistry confirms that the issue deserves attention. Achieving transparency in the process requires the implementation of an appropriate pre-registered protocol, disclosure of deviations from it, and allowing stakeholders to compare the established protocol with the submitted documents Registration DOI: https://doi.org/10.17605/OSF.IO/5UVJ8.

Nurse-Led Mobile Phone Intervention to Promote Self-Management in Type 2 Diabetes in Ghana: A Randomized Controlled Trial.

The purpose of the study was to test the effectiveness of a nurse-led mobile phone intervention (NMPI) on glycemic variability and self-management among people living with type 2 diabetes (T2DM) in Ghana. In this randomized controlled trial, the intervention group received a 3-month NMPI program plus standard care, and the control group received standard care alone in a tertiary health care setting. Ninety-eight participants (baseline A1C > 7%) were randomized 1:1 to either NMPI or standard care group. The primary study outcomes were changes in A1C testing and self-management assessed using the Summary of Diabetes Self-Care Activities tool at baseline and end of the study. The intervention group had statistically significant improvement in their mean A1C level from baseline to the end of the study. In comparison, the control group also had improvement in their mean A1C level but was not statistically significant. Consistently, the intervention participants had better statistically significant improvements in self-management behaviors than the control group. There was a medium, negative correlation between A1C changes and overall self-care changes for the intervention group, whereas that of the control group was smaller. Study findings have shown that a tailored NMPI program in addition to standard care could improve glycemic variability and self-management among people living with poorly managed T2DM in Ghana better than standard care alone.

Phosphatidylethanol measures in patients with severe COVID-19-associated respiratory failure identify a subset with alcohol misuse.

Clinical trials in patients with COVID-19 have exclusively used self- or proxy-reporting to characterize alcohol consumption. The aim of this study was to measure an objective biomarker of recent alcohol use in patients hospitalized with severe COVID-19-associated respiratory failure who were enrolled in an investigational clinical trial to determine the prevalence of alcohol misuse, and to explore the relationship of alcohol use with outcomes. We conducted a substudy of patients enrolled in the multicenter, phase 2, adaptive platform design, Investigation of Serial Studies to Predict Your Therapeutic Response with Imaging And molecular Analysis in COVID-19 trial (ClinicalTrials.gov: NCT04488081), conducted at 20 hospital systems across the United States. Three hundred and fifty-five patients with available red blood cell (RBC) samples and 60-day follow-up assessments were included. RBCs were utilized to measure phosphatidylethanol (PEth). Prespecified thresholds of PEth were utilized to stratify patients into groups: low/no alcohol use (PEth < 20 ng/mL), significant alcohol use (PEth 20-200 ng/mL), and heavy alcohol use (PEth ≥ 200 ng/mL). In this cohort, 17% of patients met criteria for significant alcohol use, while 4% met criteria for heavy alcohol use. Alcohol misuse was associated with diminished odds for home discharge, though this finding did not achieve statistical significance. In a cohort of patients with severe COVID-19 enrolled in a clinical trial, alcohol consumption of two or more standard drinks per day was present among 21%, approximating the proportion of patients with diabetes, and raising the possibility that alcohol consumption alters risk for severe viral pneumonia. Undetected alcohol misuse among clinical trial participants has the potential to influence study outcomes or contribute to adverse events.

Categorising speakers’ language background: Theoretical assumptions and methodological challenges for learner corpus research

In this article, we investigate how speakers can be categorised based on their language background in the field of Learner Corpus Research (LCR). Specifically, we discuss three key aspects: first, the theoretical assumptions and methodological choices made in learner corpus design, second the integration of a holistic perspective for speaker categorisation in LCR and third the consequences that different categorisations might have on study outcomes. Through a comprehensive review of corpora used in the field, we identify the most common terms, definitions and criteria of categorisation used to describe a speaker's language background. Focusing on the most central metadata encoding language backgrounds, the L1 metadata, we inspect different operationalisations made and scrutinise the theoretical assumptions underlying them. Drawing on research on plurilingualism, we propose a holistic view of speaker's language background for Learner Corpus Research, combining various aspects of speaker's language use by methods inspired from the Dominant Language Constellation framework. We apply this methodology to re-evaluate the language categorisation system in LEONIDE, a multilingual corpus of Italian, German and English texts from secondary school students of diverse language backgrounds. We use the same corpus to evaluate the consequences of using different categorisations of the students on the outcome of possible linguistic studies. Despite a generally high overlap between study results across categorisations, we observe that variables combining multiple aspects of the speakers’ language backgrounds seem to explain group differences for more of the linguistic features investigated.

Two-year efficacy and safety outcomes of the pivotal OASIS Study using the Revi® System for treatment of urgency urinary incontinence.

The BlueWind Medical Device, Revi®, is a novel implantable tibial neuromodulation system powered by an external, battery-operated wearable that facilitates individually tailored stimulation to provide treatment for urgency urinary incontinence (i.e., overactive bladder wet). The Revi System is the first FDA-cleared implantable neuromodulation device which can be used without prior failure with more conservative treatment options. Two-year follow-up results of the OASIS Study are presented. The Revi System was implanted in 151 female participants. The primary efficacy and safety endpoints were assessed at 6- and 12-months, after which participants either consented to extend follow-up for long-term assessment of treatment durability and safety, or they chose to exit the study. Ninety-seven participants completed the 24-month assessment, and of these, 79% were therapy responders (≥ 50% reduction in urgency urinary incontinence episodes (UUIE), demonstrated on a 3-day voiding diary). Importantly, therapeutic response was durable, with comparable effectiveness at 6-, 12-, and 24-months (response rates of 78%, 82%, and 79%, respectively). Participants that completed both the 6- and 24-month assessment had similar demographics and treatment results at the 6-month visit, indicating that these results at 24-months are representative of the overall study population.In addition, high satisfaction and patient impression of improvement were reported, with 97% (88/91) of the participants satisfied with the therapy and 80% (78/97) feeling "much better" or "very much better". There were no serious adverse events related to the device or the procedure through 24 months. Two-year results demonstrate durable efficacy, high patient satisfaction, and a very favorable safety profile.

The Role of Organisational Culture and Situational Factors in Predicting Workplace Deviation Among Public Employees

Purpose – This study examined the influence of situational factors on organisational deviance and how organisational culture could mediate these factors among public employees. Aims(s) – The study aimed to identify predictors of workplace deviant behaviour in the public service and the mediatory roles of organisational cultures in these predictors. Design/methodology/approach – The study employed a quantitative approach using a cross-sectional survey design to collect data from 430 participants; the analysis included regression analysis and structural equation modelling to examine the mediating effect of organisational culture. Findings – The results of the structural equation modelling adopted in the data analysis revealed that injustice, stress, and lack of support were responsible for the increased observed organisational behaviour. The result also revealed that perceived organisational injustice and work stress levels significantly predict deviant behaviour among the studied group, while the organisation's culture mediated the influence of justice and stress predictor variables. Limitations of the study – The study outcome may not be free of sampling error and non-response error due to self-reported surveys that could be subject to bias. The sample may be limited to public service, thus limiting the generalisation of the findings to other sectors. Practical implications and Originality/value – The study contributes to the literature on the mediating role of organisational culture in deviant work behaviour. It also shows how the organisational culture could be used to control or prevent this cankerworm called workplace deviation among employees who implement policies within the organisation.

Educational gradients in the quality of mortality data: a nationwide, registry-based study on heart failure listed incorrectly as underlying cause of death in Norway.

In the context of mortality, heart failure (HF) represents an intermediate factor and should not be used to describe underlying cause of death (UCoD). We explored the potential educational gradients in use of HF to describe UCoD using national data spanning more than 30 years from Norway. Using a cross-sectional design, we linked data from the Cause of Death Registry and the National Education Database. Logistic regression models were used to analyze the association between highest attained education and the odds of HF being listed as the UCoD: odds ratios (ORs) and corresponding 95% confidence intervals (CIs) are reported. HF was listed as UCoD in 46,331 (3.7%) of 1,254,249 deaths analyzed. Compared to primary education, secondary and tertiary education were associated with 10% (OR = 0.90, 95% CI: 0.88-0.92) and 17% (OR = 0.83, 95% CI: 0.80-0.86) lower odds of HF incorrectly listed as UCoD, respectively. We observed no significant differences for the association between education and study outcomes between men and women and across place of death categories. However, educational gradients were greater among younger compared to older individuals (pinteraction, = 0.002). Similar educational gradients were observed in the analyses restricted to cardiovascular deaths (OR = 0.93; 95% CI: 0.91-0.94 for secondary vs. primary education, and OR = 0.91; 95% CI: 0.88-0.95 for tertiary vs. primary education). Education was inversely associated with the use of HF to incorrectly describe UCoD. Addressing the observed educational gradients, would improve the quality of mortality data and allow for less biased descriptions of cause-specific mortality.

Post hoc analysis of ADAMANT, a phase 2 clinical trial of active tau immunotherapy with AADvac1 in patients with Alzheimer’s disease, positive for plasma p-tau217

BackgroundThe spread of tau pathology closely correlates with the disease course and cognitive decline in Alzheimer’s disease (AD). Tau-targeting immunotherapies are being developed to stop the spread of tau pathology and thus halt disease progression. In this post hoc analysis of the ADAMANT clinical trial, we examined the performance of AADvac1, an active immunotherapy targeting the microtubule-binding region (MTBR) of tau, in a subgroup of participants with elevated plasma p-tau217, indicating AD-related neuropathological changes.MethodsADAMANT was a 24-month, randomized, placebo-controlled, parallel-group, double-blinded, multicenter, phase 2 clinical trial in subjects with mild AD. The trial participants were randomized 3:2 to receive six doses of AADvac1 or placebo at 4-week intervals, followed by five booster doses at 14-week intervals. The primary outcome was safety. The secondary outcomes were the Clinical Dementia Rating-Sum of Boxes (CDR-SB), the Alzheimer’s Disease Cooperative Study – Activities of Daily Living score for Mild Cognitive Impairment 18-item version (ADCS-ADL-MCI-18), and immunogenicity. Volumetric MRI, plasma neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) were exploratory outcomes. The inclusion criterion for this post-hoc analysis was a baseline plasma p-tau217 level above the cutoff for AD.ResultsAmong 196 ADAMANT participants, 137 were positive for plasma p-tau217 (mean age 71.4 years, 59% women). AADvac1 was safe and well tolerated in this subgroup. AADvac1 reduced the rate of accumulation of log-plasma NfL by 56% and that of GFAP by 73%. The treatment differences in the CDR-SB and ADCS-ADL-MCI-18 scores favored AADvac1 but were not statistically significant. AADvac1 had no effect on whole-brain volume but nonsignificantly reduced the loss of brain cortical tissue in several regions. Importantly, the impact on the study outcomes was more pronounced in participants with higher anti-tau antibody levels.ConclusionsThese results suggest that AADvac1 tau immunotherapy can reduce plasma biomarkers of neurodegeneration and neuroinflammation. These findings and possible observations on brain atrophy and cognition are hypothesis-generating and warrant further evaluation in a larger clinical trial.Trial registrationEudraCT 2015–000630-30 (primary) and NCT02579252.

Epidemiology and outcomes of severe injury patients related to suicide attempt or self-harm in Korea: Nationwide community-based study, 2016–2020

IntroductionSuicide is a major social issue in Korea. Suicide attempt or self-harm (SA/SH)—a risk factor for suicides—is in itself a major public health problem. Investigating vulnerable populations is the first step for designing an effective prevention program. This study aimed to investigate the epidemiology and outcomes of patients with severe injuries related to suicide attempts or self-harm (SA/SH) by age groups, using a nationwide database. Materials and MethodsThis retrospective observational study was conducted in Korea between 2016 and 2020. Its participants were patients with severe injuries, who were treated by emergency medical service (EMS). From among injured patients who met the criteria for a field-based injury triage scheme or had a prehospital physiological abnormality, those with SA/SH were included. Exposure was based on age groups: adolescents (10–18 years), adults (19–64 years), and older adults (≥65 years). The study's outcomes were in-hospital mortality. Patients’ characteristics and outcomes were compared by age groups and SA/SH mechanisms. Predictors of mortality were investigated using multivariable logistic regression analysis. ResultsAmong the 204,211 patients with severe injuries transferred by EMS, 43,945 (21.5 %) were SA/SH-related. Their median (interquartile) age was 48 (35–61) years, and 52.9 % were female patients. The common SA/SH mechanisms were: poisoning (67.6 %), hanging (16.3 %), and jumping (8.1 %). Overall, the mortality was 21.9 %, but it was higher for hanging (69.2 %) and jumping (62.0 %), than for common poisoning (6.5 %). Among adolescents, poisoning (46.1 %), followed by jumping (34.0 %) was common, and the mortality was 23.3 %. In the older adults, poisoning (68.6 %), followed by hanging (20.2 %) was common, and the mortality was 34.9 %. Older adults compared to adults, males compared to females, and hanging and jumping compared to poisoning, were associated with higher mortality. ConclusionsMore than 20 % of EMS treated patients with severe injury were SA/SH-related, and the mortality was over 20 %. Although poisoning was the most common mechanism, the high proportions of jumping and hanging with high mortality, resulted in adolescents and the older adults groups having high mortality. Therefore, designing target-specific SA/SH prevention programs based on age, sex, and common SA/SH mechanisms are necessary.

Distribution, assessment, and causality analysis of soil heavy metals pollution in complex contaminated sites: a case study of a chemical plant.

To effectively prevent and control pollution from heavy metals (HMs) in urban soils, it is essential to thoroughly understand the contamination status of contaminated sites. In this study, the contamination status and sources of six HMs (As, Cu, Cr, Ni, Pb, Cd) in the soil of a decommissioned chemical plant in southern China were comprehensively analyzed. The results indicated that the average concentration of HMs followed the sequence: Cr > Pb > Cu > Ni > As > Cd. Heavy metal accumulation in the upper soil layer was predominantly observed in industrial zones and low-lying areas, with notable variations in concentration along the vertical profile. Certain sections of the site exhibited severe HM contamination, particularly with Cu levels exceeding the background value by 46.77times. Cd presented significant ecological risks in specific areas, with an average Ecological Index of 96.09. Carcinogenic and non-carcinogenic risks were identified at three and six sampling points, respectively, with sampling point S103 demonstrating both types of risks. The causes of HM contamination were primarily attributed to anthropogenic activities. Horizontal dispersion was mainly influenced by production operations and topographical features, while vertical distribution was predominantly affected by the permeability characteristics of the strata. The causality analysis incorporating production activities and topographical factors provides novel perspectives for understanding sources of contamination at contaminated sites. The study outcomes can offer guidance for the assessment and surveying of urban industrial pollution sites.

Mediation Analysis of Serum Fibroblast Growth Factor 20 and Poor Prognosis After Ischemic Stroke.

We aimed to examine the relationship between serum FGF20 (fibroblast growth factor 20) levels and stroke prognosis in a multicenter cohort study. Patients with ischemic stroke/transient ischemic attack were prospectively recruited from 5 participating centers and followed up at 3 months and 1 year. FGF20 levels were measured using the ELISA method. The primary outcome was poor stroke functional outcome (modified Rankin Scale score of 3-6), and secondary outcomes included death and composite vascular events. Multivariable logistic regression analysis or Cox proportional hazards regression analysis was employed to estimate the relationship between FGF20 and study outcomes. Mediation analysis was conducted to examine the mediating effects of traditional risk factors on the association between FGF20 and stroke outcomes. A total of 1011 patients with ischemic stroke were included in the study. After adjusting for potential confounding factors, an elevated serum FGF20 level was associated with a reduced risk of the poor outcome and death. Multivariable adjusted spline regression analysis demonstrated a linear correlation between serum FGF20 levels and the stroke outcomes. The incorporation of FGF20 alongside conventional risk factors marginally enhanced the reclassification of adverse outcomes. Renal function and white blood cell count partially mediated the relationship between FGF20 and the prognosis of ischemic stroke. Elevated FGF20 level is associated with decreased risks of adverse outcomes after ischemic stroke, which was partially mediated by renal function and white blood cells with a modest amount, indicating that serum FGF20 might serve as a promising biomarker for predicting stroke prognosis. URL: https://www.chictr.org.cn; Unique identifier: ChiCTR2100051104.