True Mortality Research Articles

Beyond Early- and Late-onset Neonatal Sepsis Definitions: What are the Current Causes of Neonatal Sepsis Globally? A Systematic Review and Meta-analysis of the Evidence.

Sepsis remains a leading cause of neonatal mortality, particularly in low- and lower-middle-income countries (LLMIC). In the context of rising antimicrobial resistance, the etiology of neonatal sepsis is evolving, potentially making currently-recommended empirical treatment guidelines less effective. We performed a systematic review and meta-analysis to evaluate the contemporary bacterial pathogens responsible for early-onset sepsis (EOS) and late-onset neonatal sepsis (LOS) to ascertain if historical classifications-that guide empirical therapy recommendations based on assumptions around causative pathogens-may be outdated. We analyzed 48 articles incorporating 757,427 blood and cerebrospinal fluid samples collected from 311,359 neonates across 25 countries, to evaluate 4347 significant bacteria in a random-effects meta-analysis. This revealed gram-negative bacteria were now the predominant cause of both EOS (53%, 2301/4347) and LOS (71%, 2765/3894) globally. In LLMICs, the predominant cause of EOS was Klebsiella spp. (31.7%, 95% CI: 24.1-39.7%) followed by Staphylococcus aureus (17.5%, 95% CI: 8.5 to 28.4%), in marked contrast to the Streptococcus agalactiae burden seen in high-income healthcare settings. Our results reveal clear evidence that the current definitions of EOS and LOS sepsis are outdated, particularly in LLMICs. These outdated definitions may be guiding inappropriate empirical antibiotic prescribing that inadequately covers the causative pathogens responsible for neonatal sepsis globally. Harmonizing sepsis definitions across neonates, children and adults will enable a more acurate comparison of the epidemiology of sepsis in each age group and will enhance knowledge regarding the true morbidity and mortality burden of neonatal sepsis.

Conventional and frugal methods of estimating COVID-19-related excess deaths and undercount factors

Across the world, the officially reported number of COVID-19 deaths is likely an undercount. Establishing true mortality is key to improving data transparency and strengthening public health systems to tackle future disease outbreaks. In this study, we estimated excess deaths during the COVID-19 pandemic in the Pune region of India. Excess deaths are defined as the number of additional deaths relative to those expected from pre-COVID-19-pandemic trends. We integrated data from: (a) epidemiological modeling using pre-pandemic all-cause mortality data, (b) discrepancies between media-reported death compensation claims and official reported mortality, and (c) the “wisdom of crowds” public surveying. Our results point to an estimated 14,770 excess deaths [95% CI 9820–22,790] in Pune from March 2020 to December 2021, of which 9093 were officially counted as COVID-19 deaths. We further calculated the undercount factor—the ratio of excess deaths to officially reported COVID-19 deaths. Our results point to an estimated undercount factor of 1.6 [95% CI 1.1–2.5]. Besides providing similar conclusions about excess deaths estimates across different methods, our study demonstrates the utility of frugal methods such as the analysis of death compensation claims and the wisdom of crowds in estimating excess mortality.

Tracking Missing Deaths: An Exploratory Study on the Mortality Impact of COVID-19 in Kozhikode City, India.

The debate over the extent of the mortality impact of COVID-19 in India is still unsettled. This article contributes to the debate, seeking to explore the true mortality impact of the pandemic, by answering four interrelated questions. First, is there any discrepancy between recorded and actual death count? Second, if so, how large it is? Third, what is the extent of misclassification of COVID-19 mortality, and fourth, what is the magnitude of deaths that could be indirectly linked to COVID-19? To answer the questions, we explored three sources of data-all-cause mortality data from the civil registration system, records maintained at the burial grounds/cemeteries and crematoriums, and a household survey. The data collection period was between August 2021 and November 2021. The instrument used for data collection of verbal autopsies was built on the instrument proposed by the World Health Organization for adult mortality. The results revealed that deaths due to various causes including COVID-19 increased considerably at some points in 2020-2021 compared to the base year 2019 in the study setting. Notably, 5.5% of the noninstitutional deaths were unreported at the time of the survey and many deaths were plausibly misclassified, leading to undercounting of COVID-19 deaths. Overall, about half of our sampled deaths (48%) had either direct or indirect attribution to the pandemic. The extent of undercounting of pandemic-related deaths is likely to be either similar or worse in other states. To get reliable state and national estimates, policymakers should conduct a large-scale study.

Do we underestimate risk of cardiovascular mortality due to lead exposure?

BackgroundStudies using data from the National Health and Nutrition Examination Survey-III (NHANES-III) have demonstrated significant prospective associations between blood lead levels and increased mortality. Bone lead represents cumulative lead burden and thus is a better biomarker for assessing chronic impacts, but its in vivo assessment requires special K-x-ray fluorescence (KXRF) instrumentation. Our team recently developed an algorithm predicting bone lead levels from a combination of blood lead levels, age and other socioeconomic and behavioral variables. We examined the associations of our algorithm-estimated bone lead levels and mortality in NHANES-III. MethodsWe included 11,628 adults followed up to December 31, 2019. Estimated tibia lead and patella lead levels were calculated using our prediction algorithms. We used survey-weighted Cox proportional hazards models to compute hazard ratios (HRs) and 95 % confidence intervals (CIs). ResultsDuring the median follow-up of 26.8 years, 4900 participants died (mortality rate = 1398 per 100,000 adults/year). Geometric means (95 % CIs) of blood lead, predicted tibia lead, and predicted patella lead were 2.69 μg/dL (2.54, 2.84), 6.73 μg/g (6.22, 7.25), and 16.3 μg/g (15.9, 16.8), respectively. The associations for all-cause mortality were similar between blood lead and bone lead. However, the associations for cardiovascular mortality were much greater with predicted bone lead markers compared to blood lead: for comparing participants at the 90th vs. 10th percentiles of exposure, HR = 3.32 (95 % CI: 1.93–5.73) for tibia lead, 2.42 (1.56–3.76) for patella lead, 1.63 (1.25–2.14) for blood lead. The population attributable fractions for cardiovascular disease mortality if everyone's lead concentrations were declined to the 10th percentiles were 45.8 % (95 % CI: 28.1–59.4) for tibia lead, 33.1 % (18.1–45.8) for patella lead, and 22.8 % (10.4–33.8) for blood lead. ConclusionsThese findings suggest that risk assessment for cardiovascular mortality based on blood lead levels may underestimate the true mortality risk of lead exposure.

Risk factors for mortality in children with hemorrhagic cystitis after hematopoietic transplant

Hemorrhagic cystitis (HC) is a devastating complication of bone marrow (BMT) and stem cell transplant (SCT). Much of the literature has focused on exclusively adult patient populations, with limited evidence regarding risk factors for mortality and morbidity among pediatric HC patients. To examine factors associated with all-cause mortality in children with HC after BMT/SCT. The Pediatric Health Information System database was queried for patients with ICD-9/10 codes for hematopoietic transplant and gross hematuria, hematuria unspecified, or cystitis with hematuria. Multivariable logistic regression examined association of medical and surgical interventions frequently employed for hemorrhagic cystitis with mortality and genitourinary morbidity, defined as having received instillation of any bladder medication or having undergone any genitourinary procedure. A total of 811 patients, mean age of 12.4 years and 62% male, were included. Primary diagnosis included 388 (49%) leukemia/lymphoma, 182 (22%) blood dyscrasia, 99 (12%) solid organ tumor, 27 (3%) metabolic disease, 115 (14%) unknown. Transplant type included 377 (46%) bone marrow, 329 (41%) stem cell, 105, and (13%) unknown. Performing any bladder instillation (p<0.0001) or any type of GU procedure (p<0.0001) was significantly associated with mortality. On multivariate analysis, dialysis (OR=10.7, 95% CI=5.7-20.2), genitourinary morbidity (OR=4, 95% CI=2.2-6.8) and intravenous cidofovir (OR=2.0, 95% CI=1.2-3.3) were significantly associated with all cause mortality. Having an underlying diagnosis of blood dyscrasia was protective against mortality (OR=0.425, CI=0.205-0.88). In this large retrospective study evaluating factors associated with mortality in children with HC, all cause mortality was found to be 11%. This is probably an underrepresentation of true mortality in this population, as many patients discharged from the hospital likely die outside the hospital at home or hospice care. This study supports the current literature that invasive GU procedures are not associated with increased survival in patients with severe HC. This study is limited by retrospective use of a billing database that has the potential for errors in data entry and missing data. Patients who were discharged from the hospital were not captured by the PHIS which only collects data from inpatient stays. Patients with HC who received dialysis, intravenous cidofovir, or underwent GU intervention had significantly higher all-cause mortality. High grade HC is a marker of disease severity and efforts should be made by urologists and oncologists to maximize quality of life and limit futile treatments in this patient population.

Morbidity and mortality burden of COVID-19 in rural Madagascar: results from a longitudinal cohort and nested seroprevalence study.

Three years into the pandemic, there remains significant uncertainty about the true infection and mortality burden of COVID-19 in the World Health Organization Africa region. High quality, population-representative studies in Africa are rare and tend to be conducted in national capitals or large cities, leaving a substantial gap in our understanding of the impact of COVID-19 in rural, low-resource settings. Here, we estimated the spatio-temporal morbidity and mortality burden associated with COVID-19 in a rural health district of Madagascar until the first half of 2021. We integrated a nested seroprevalence study within a pre-existing longitudinal cohort conducted in a representative sample of 1600 households in Ifanadiana District, Madagascar. Socio-demographic and health information was collected in combination with dried blood spots for about 6500 individuals of all ages, which were analysed to detect IgG and IgM antibodies against four specific proteins of SARS-CoV-2 in a bead-based multiplex immunoassay. We evaluated spatio-temporal patterns in COVID-19 infection history and its associations with several geographic, socio-economic and demographic factors via logistic regressions. Eighteen percent of people had been infected by April-June 2021, with seroprevalence increasing with individuals' age. COVID-19 primarily spread along the only paved road and in major towns during the first epidemic wave, subsequently spreading along secondary roads during the second wave to more remote areas. Wealthier individuals and those with occupations such as commerce and formal employment were at higher risk of being infected in the first wave. Adult mortality increased in 2020, particularly for older men for whom it nearly doubled up to nearly 40 deaths per 1000. Less than 10% of mortality in this period would be directly attributed to COVID-19 deaths if known infection fatality ratios are applied to observed seroprevalence in the district. Our study provides a very granular understanding on COVID-19 transmission and mortality in a rural population of sub-Saharan Africa and suggests that the disease burden in these areas may have been substantially underestimated.

Perceptions, health seeking behavior and utilization of maternal and newborn health services among an indigenous tribal community in Northeast India-a community-based mixed methods study.

Evidence suggests that healthcare utilization among tribal communities in isolated regions can be influenced by social determinants of health, particularly cultural and geographical factors. The true mortality and morbidity due to these factors in remote tribal communities are often underestimated due to facility-dependent reporting systems often difficult to access. We studied the utilization of health services for maternal and newborn care and explored how cultural beliefs, perceptions, and practices influence the health-seeking behavior (HSB) of an indigenous tribal community in Northeast India. Within a concurrent triangulation design, the combined results from 7 focus group discussions and 19 in-depth interviews, and the 109 interviews of mothers from a community-based survey were interpreted in a complementary manner. The qualitative data were analyzed using a conceptual framework adapted from the socio-ecological and three-delays model, using a priori thematic coding. Multivariable logistic regression was carried out to identify factors associated with home delivery. Only 3.7% of the interviewed mothers received the four recommended antenatal check-ups in health centers, and 40.1% delivered at home. Mothers residing in the villages without a health center or one that was not operational were more likely to deliver at home. HSB was influenced significantly by available finances, the mother's education, low self-esteem, and a strong belief in traditional medicine favored by its availability and religious affiliation. The community sought health services in facilities only in emergency situations, determined primarily by the tribe's poor perception of the quality of health services provided in the irregularly open centers, locally available traditional medicine practitioners, and challenges in geographical access. National schemes intended to incentivize access to facilities failed to impact this community due to flawed program implementation that did not consider this region's cultural, social, and geographical differences. The health-seeking behavior of the tribe is a complex, interrelated, and interdependent process framed in a medical pluralistic context. The utilization of health centers and HSBs of indigenous communities may improve when policymakers adopt a "bottom-up approach," addressing structural barriers, tailoring programs to be culturally appropriate, and guaranteeing that the perceived needs of indigenous communities are met before national objectives.

The Accuracy of Nonstandardized MELD/PELD Score Exceptions in the Pediatric Liver Allocation System.

In the United States, over half of pediatric candidates receive exceptions and status upgrades that increase their allocation model of end-stage liver disease/pediatric end-stage liver disease (MELD/PELD) score above their laboratory MELD/PELD score. We determined whether these "nonstandardized" MELD/PELD exceptions accurately depict true pretransplant mortality risk. Using data from the Scientific Registry of Transplant Recipients, we identified pediatric candidates (<18 y of age) with chronic liver failure added to the waitlist between June 2016 and September 2021 and estimated all-cause pretransplant mortality with mixed-effects Cox proportional hazards models that treated allocation MELD/PELD and exception status as time-dependent covariates. We also estimated concordance statistics comparing the performance of laboratory MELD/PELD with allocation MELD/PELD. We then compared the proportion of candidates with exceptions before and after the establishment of the National Liver Review Board. Out of 2026 pediatric candidates listed during our study period, 403 (19.9%) received an exception within a week of listing and 1182 (58.3%) received an exception before delisting. Candidates prioritized by their laboratory MELD/PELD scores had an almost 9 times greater risk of pretransplant mortality compared with candidates who received the same allocation score from an exception (hazard ratio 8.69; 95% confidence interval, 4.71-16.03; P < 0.001). The laboratory MELD/PELD score without exceptions was more accurate than the allocation MELD/PELD score with exceptions (Harrell's c-index 0.843 versus 0.763). The proportion of patients with an active exception at the time of transplant decreased significantly after the National Liver Review Board was implemented (67.4% versus 43.4%, P < 0.001). Nonstandardized exceptions undermine the rank ordering of pediatric candidates with chronic liver failure.

Modeling the Spatial Distribution of Carcasses of Eagles Killed by Wind Turbines

ABSTRACT Currently, the US Fish and Wildlife Service makes eagle permitting and management decisions nationwide based on a limited understanding of the impacts of wind power generation on eagles, and the factors that influence risk at a given facility. Accurate estimates of eagle mortality at wind power facilities form the basis for comparing the magnitudes of mortality rates in different areas and for measuring the benefits of proposed methods of minimizing the collision-caused impacts to eagle populations. Simple counts of observed eagle carcasses at wind facilities are almost certainly underestimates of the true mortality because fatalities can be removed by scavengers, be missed by searchers, or fall outside searched areas. For the latter, models of relative carcass density as a function of distance from the turbine can be fit to observed carcass locations and used to estimate the proportion of carcasses expected to land within an area of any configuration beneath a turbine. In the USA, however, it has been difficult to estimate these models for large birds such as Bald Eagles (Haliaeetus leucocephalus) and Golden Eagles (Aquila chrysaetos) due to inadequate numbers of dead eagles found at any single facility. In this case, analysis of a surrogate species might be useful to inform carcass distributions. We chose to model the carcass distribution of White-tailed Eagles (Haliaeetus albicilla) in Norway as an informative surrogate for Bald Eagles and Golden Eagles in the USA. Our three best-fitting parametric models were very consistent in estimating that 50% (95% CI: 40–60%) of White-tailed Eagle carcasses land within approximately 42 m of the turbines that had 70-m hubs and approximately 40-m blades. Although our models were fit to data from White-tailed Eagles and not Bald or Golden Eagles, applying these models when calculating mortality impacts of wind developments on both eagle species will likely improve the accuracy of post-construction mortality estimates, particularly at sites where substantial areas may be unsearchable. Accurate post-construction mortality estimates can inform pre-construction fatality prediction models. Resource managers can determine whether their conditions are sufficiently similar to those we modeled to warrant the use of these models for Bald and Golden Eagle carcass distributions.

Rheumatic heart disease mortality in Indigenous and non-Indigenous Australians between 2013 and 2017

ObjectivesTo generate contemporary age-specific mortality rates for Indigenous and non-Indigenous Australians aged <65 years who died from rheumatic heart disease (RHD) between 2013 and 2017, and to ascertain the underlying...

Killing from Both Ends: A Re-Definition of Road Traffic Mortality

The metric of Road Traffic Mortality (RTM) is important: it is indicative of road safety, and is used to inform policy. Hitherto RTM is considered to be caused through collision or impact, or the “front” end of the vehicle. Mortality and morbidity arising from the “back” end of the vehicle, i.e., through tailpipe emissions, tends not to be included in the definition, or in the metric of RTM. Additionally, despite its widespread usage globally, RTM seems to lack a universal or standard definition. RTM is currently used interchangeably with about ten other acronyms. This lack of standard definition along with the exclusion of TRAP may underestimate the true mortality and morbidity arising from vehicular traffic. Further, the exclusion of mortality due to TRAP from RTM may relieve public policy from addressing this public health and climate change issue. A standardized definition of RTM is proposed in this paper. We are recommending the inclusion of exposure-related mortality and morbidity into RTM. To that end, the bifurcation of the definition of RTM into RTMi (Impact-related RTM) and RTMe (exposure-related RTM, such as through air or noise pollution) is proposed. This inclusion of RTMe into the metric of RTM might provide a legislative domicile for exposure-related mortality, advise policy change, and serve the dual purpose of strengthening climate policy efforts while bolstering public health.&#x0D; &#x0D; &#x0D;

Assessment of COVID-19 as the Underlying Cause of Death Among Children and Young People Aged 0 to 19 Years in the US

COVID-19 was the underlying cause of death for more than 940 000 individuals in the US, including at least 1289 children and young people (CYP) aged 0 to 19 years, with at least 821 CYP deaths occurring in the 1-year period from August 1, 2021, to July 31, 2022. Because deaths among US CYP are rare, the mortality burden of COVID-19 in CYP is best understood in the context of all other causes of CYP death. To determine whether COVID-19 is a leading (top 10) cause of death in CYP in the US. This national population-level cross-sectional epidemiological analysis for the years 2019 to 2022 used data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) database on underlying cause of death in the US to identify the ranking of COVID-19 relative to other causes of death among individuals aged 0 to 19 years. COVID-19 deaths were considered in 12-month periods between April 1, 2020, and August 31, 2022, compared with deaths from leading non-COVID-19 causes in 2019, 2020, and 2021. Cause of death rankings by total number of deaths, crude rates per 100 000 population, and percentage of all causes of death, using the National Center for Health Statistics 113 Selected Causes of Death, for ages 0 to 19 and by age groupings (<1 year, 1-4 years, 5-9 years, 10-14 years, 15-19 years). There were 821 COVID-19 deaths among individuals aged 0 to 19 years during the study period, resulting in a crude death rate of 1.0 per 100 000 population overall; 4.3 per 100 000 for those younger than 1 year; 0.6 per 100 000 for those aged 1 to 4 years; 0.4 per 100 000 for those aged 5 to 9 years; 0.5 per 100 000 for those aged 10 to 14 years; and 1.8 per 100 000 for those aged 15 to 19 years. COVID-19 mortality in the time period of August 1, 2021, to July 31, 2022, was among the 10 leading causes of death in CYP aged 0 to 19 years in the US, ranking eighth among all causes of deaths, fifth in disease-related causes of deaths (excluding unintentional injuries, assault, and suicide), and first in deaths caused by infectious or respiratory diseases when compared with 2019. COVID-19 deaths constituted 2% of all causes of death in this age group. The findings of this study suggest that COVID-19 was a leading cause of death in CYP. It caused substantially more deaths in CYP annually than any vaccine-preventable disease historically in the recent period before vaccines became available. Various factors, including underreporting and not accounting for COVID-19's role as a contributing cause of death from other diseases, mean that these estimates may understate the true mortality burden of COVID-19. The findings of this study underscore the public health relevance of COVID-19 to CYP. In the likely future context of sustained SARS-CoV-2 circulation, appropriate pharmaceutical and nonpharmaceutical interventions (eg, vaccines, ventilation, air cleaning) will continue to play an important role in limiting transmission of the virus and mitigating severe disease in CYP.

Abstract C112: Understanding and addressing cancer disparities among American Indians in North Carolina: The Southeastern cancer health equity partnership

Abstract North Carolina (NC) is home to the largest American Indian population in the Eastern United States (approximately 300,000 residents, about 2.8% of the total NC population), represented by eight state and federally recognized tribes (Eastern Band of Cherokee Indians, Sappony, Occaneechi Band of Saponi Nation, Meherrin, Haliwa Saponi, Coharie, Lumbee, Waccamaw Siouan) and four urban Indian organizations (Metrolina Native American Association, Guilford Native American Association, Triangle Native American Society, Cumberland County Association for Indian People). This population experiences significant health disparities largely related to adverse social determinants of health and limited access to health care. With regards to cancer, disparities exist for incidence and mortality for certain cancer, although there are limited data available with regards to cancer screening stage at diagnosis, treatment and survivorship. Furthermore, evidence suggests that racial misclassification contributes to a significant underestimation of the true cancer incidence and mortality in this population. To address the cancer care needs of NC American Indians, a unique collaboration was established in 2021 among the leadership of the Community Outreach and Engagement programs at the three NCI-designated Comprehensive Cancer Centers in North Carolina (Duke Cancer Institute, University of North Carolina Lineberger Cancer Center, Wake Forest Baptist Comprehensive Cancer Center). The collaboration, entitled, The Southeastern American Indian Cancer Health Equity Partnership (SAICEP), has as its mission to "understand and address the cancer-related health needs of American Indian communities in our catchment areas and beyond." SAICEP includes: (1) a quarterly speakers' series, featuring nationally recognized experts in the area of American Indian cancer research and care; (2) educational outreach and engagement activities at tribal and state cultural events; and, (3) cutting-edge culturally respectful research to understand and address cancer disparities at the tribal and state level. Partnerships have been established with tribal leaders across the state as well as researchers at the University of North Carolina at Pembroke in the traditional homeland of the Lumbee tribe (the largest tribe in the state). Future endeavors will include partnerships with tribes in other states in our catchment areas (Virginia, South Carolina). Citation Format: Ronny A. Bell, Tomi Akinyemiju, Stephanie B. Wheeler. Understanding and addressing cancer disparities among American Indians in North Carolina: The Southeastern cancer health equity partnership [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C112.

ОТДЕЛЬНЫЕ ПОКАЗАТЕЛИ ОБЩЕСТВЕННОГО ЗДОРОВЬЯ В СИБИРСКОМ ФЕДЕРАЛЬНОМ ОКРУГЕ, В УСЛОВИЯХ ПАНДЕМИИ COVID-19

Significance: This article is about assessing changes in selected indicators of public health against the background of the pandemic of a new coronavirus infection COVID-19 in adult population of the Siberian Federal District - a territory of the Russian Federation with a special climatic, geographical and ecological "portrait", characterized by a high prevalence of risk factors for chronic non-communicable diseases. The study of this issue creates prerequisites for a detailed analysis of the leading causes of death and peculiar features of their statistical coding in the Siberian Federal District for a given time interval, which helps to identify true mortality from diseases of the circulatory system (in particular, coronary artery disease and myocardial infarction. The purpose of the study was to assess dynamics in the indicators of total mortality and mortality from diseases of the circulatory system in adult population of the Siberian Federal District during the pandemic caused by a new coronavirus infection COVID-19. Material and methods. The study used data of the Federal State Statistics Service «Virtual statistical data mart» official website. The study analyzed non-standardized total mortality rates in adult population of the Siberian Federal District (per 100,000 population), and mortality from diseases of the circulatory system, coronary artery disease and myocardial infarction for the period from 2016 to 2021 and compared these indicators with the all-Russia data. The COVID-19 impact was assessed starting from January 2020, while the period preceding this date was conventionally designated as pre-COVID period. Ranks and econometric analysis of time series were used. Results. In the pre-COVID period, the total mortality rate in adult population was decreasing over time in the Russian Federation and most regions of the Siberian Federal District, with the exception of the Altai Republic. With the onset of the new coronavirus infection, total mortality increased in most regions of the Siberian Federal District, except for the Republic of Tyva. In the Siberian Federal District in the pre-COVID period, mortality from diseases of the circulatory system increased due to a rise in mortality from diseases of the circulatory system in the Altai Republic and Krasnoyarsk region, Irkutsk, Tomsk and Kemerovo regions; mortality from coronary artery disease increased due to a rise in mortality from diseases of the circulatory system in the Krasnoyarsk region, Altai Republic, Kemerovo, Novosibirsk and Tomsk regions; while increased mortality from myocardial infarction is associated with the increased mortality from diseases of the circulatory system in the Republic of Khakassia, Kemerovo, Novosibirsk and Irkutsk regions. With the beginning of the COVID-19 pandemic in 2020, there was an increase in mortality from diseases of the circulatory system and coronary artery disease in the Russian Federation and regions of the Siberian Federal District, including a rise in mortality from myocardial infarction, with the exception of the Altai Republic, and the Irkutsk region. In the Siberian Federal District in 2021, there was no increase in mortality from diseases of the circulatory system and coronary artery disease in the republics of Tyva and Khakassia, the Novosibirsk region and Krasnoyarsk Territory (only from coronary artery disease); mortality from myocardial infarction - in all regions of the Siberian Federal District, except the Tomsk region. Conclusion. The tendency towards lower total mortality in adult population in the pre-COVID period in the Russian Federation and the Siberian Federal District has changes towards increasing starting from official registration of COVID-19 cases. A similar trend is typical of diseases of the circulatory system (including coronary artery disease and myocardial infarction) in the Russian Federation and some regions of the Siberian Federal District. The COVID-19 pandemic is obviously associated with changes in public health indicators in the Russian Federation

Reimagining the SME failure phenomenon: incorporating regenerative effects and predicting enterprise regenerative capacity

PurposeExposure to a public health threat of significant proportions made current models inadequate to explain the failure phenomenon in small businesses. Hence, the need to reimagine the phenomenon. Borrowing from the principles of biology, this study extended theoretical and empirical perspectives on the failure phenomenon by unpacking its constituent elements and the measurement metrics using the regeneration lens.Design/methodology/approachBased on a cohort tracked over time, the study estimated the survival probabilities of small and medium-scale enterprises (SMEs) with and without regeneration using the Kaplan–Meier method. The study investigated the factors that predict enterprise regenerative capacity using the multivariate Cox proportional hazard ratios.FindingsRates of interruption in business activity, by month, ranged between 0% and 18% during the follow-up period. True mortality rates hovered between 0% and 4% over the same period. Over three in five SMEs that experienced interruption in business activity without ceasing operations regenerated at some point in time during the follow-up period. The survival probabilities beyond the follow-up period were 0.85 and 0.44 with and without regeneration effects, respectively. Fresh capital injection (+), the introduction of new/improved processes or products/services (+), perceived business outlook (+) and the presence of debt (−) influenced the capacity to regenerate.Research limitations/implicationsThe cohort was followed for only six months. There is a need to continue interrogating the failure phenomenon in other contexts over longer periods using the regeneration lens. Bringing on board academia, financial institutions and other SME-related ecosystem players will be strategic.Practical implicationsThe approach provides a more nuanced understanding of the life and well-being of enterprises under conditions of disruption. Improving the precision and validity of failure-related statistics enhances their utility in policy and remediation-related discussions.Social implicationsThe results did not show significant differences in SME mortality rates between male and female-owned enterprises. The results provide further evidence that the failure phenomenon is ungendered. As such, financial institutions and the SME ecosystem at large must eliminate perceptual gender biases in the financing and other support to SMEs.Originality/valueThe study used the principles of biology to reimagine the failure phenomenon in small businesses. The approach breathes life into entrepreneurship research and policy.

Population size and survival of the Brazilian Torrent Frog Hylodes heyeri (Anura, Hylodidae)

AbstractPopulation dynamics are influenced by environmental variability and understanding the abundance and persistence of individuals and populations is a fundamental goal of population ecology. Thus, estimating demographic parameters to identify the factors important for population variability is required to understand temporal and spatial dynamics. The stream‐living diurnal frog Hylodes heyeri is endemic to the Atlantic Forest of Brazil in the states of Paraná, São Paulo and Santa Catarina. Here we use capture‐mark‐recapture methods to estimate survival rates and population size of this Brazilian Torrent Frog in Pico do Marumbi State Park, Paraná. We used CJS models for an open population to estimate apparent survival, capturability and population size in two streams. The number of captures during each session was positively correlated with the minimum weekly temperature. Despite that correlation, the most parsimonious model of survival and capturability was the constant model for both parameters, resulting in a monthly survival rate of 0.38 (95% CI = 0.30–0.46). Thus, only the abundance of the frog differed in the two streams (79 vs. 36), with the population size estimate of 187 individuals. Reproduction is seasonal in the Brazilian Torrent Frog and so the low monthly survival rate suggests that animals move over time rather than die, because 38% month−1 survival should result in &lt;1% of the population remaining after 5 months. Thus, researchers must recognize that populations are labile and individuals often move or are washed downstream during heavy rainfall, generating apparently rapid local turnover that is unlikely to reflect true mortality.

Mutliple Myeloma Increases the Mortality Rate in Patients Admitted for Upper GI Bleed: An Analysis of National Inpatient Database

Introduction Multiple myeloma is a malignant disease of terminally differentiated B cells presenting with bone lesions, renal abnormalities, electrolyte changes and infections. It can occasionally leave the bone medullary space and involve other systems like respiratory and gastrointestinal (GI) tract to form plasmacytomas. The extramedullary spread into the GI tract results in typical presentation of hematemesis and melena. There have been a few cases that have reported the same, but the true prevalence and mortality of these patients is not well known. The aim of the study was to evaluate role of multiple myeloma on the in-hospital outcomes in patients admitted for Upper GI bleed in the United States. Methodology We conducted retrospective analysis utilizing Nationwide Inpatient Database (NIS) from year 2016-2019. Patients with age 18 years or more admitted to the hospital due to non-variceal Upper GI bleed were included in our study and it was further divided based on presence (study group) or absence (control group) of underlying Multiple Myeloma. ICD-10 CM codes were used to identify patient population. Chi-square test was used to compare categorical variables and Wilcoxon rank sum test for continuous variables. Impact of multiple myeloma on the in-hospital outcomes and healthcare utilization was evaluated using multivariate logistic regression analysis. Results The sample size included 1,007,765 patients admitted for upper GI bleed, of which 0.31% had underlying multiple myeloma. Patients with underlying multiple myeloma were relatively older with mean age of 72 years compared to 65 years in group with no multiple myeloma (p<0.001). Females constituted 40.36% of the multiple myeloma group compared to 44.63% of patients without it. There was a higher mortality rate (5.03%) in those with multiple myeloma compared to those without it (1.9%) (adjusted OR=2.53, p<0.001). They also had a higher rate of blood transfusion (45.22% vs 33.91%) compared to those with no underlying multiple myeloma (adjusted OR=1.42, p<0.001). The adjusted mean total hospitalization charge was $14,531 higher and adjusted mean length of stay was 1.1 day more in those with underlying multiple myeloma compared to those without it, with p<0.001. Conclusion Our study showed that Multiple Myeloma increases the mortality rate by more than two and half fold in patients presenting with upper GI bleed. It also poses a significant burden on the healthcare and therefore, physicians should be more vigilant when encountered with such challenges. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Windfarm collisions in medium‐sized raptors: even increasing populations can suffer strong demographic impacts

AbstractThe impact of bird mortality by collision on windfarms has often been evaluated at the individual level, but rarely at the population level. The Lesser kestrel Falco naumanni is an endangered short‐lived migratory raptor, susceptible to collision with wind turbines. We evaluated the impacts of windfarm turbine collisions on the demography of the largest lesser kestrel population in France. Using data from local monitoring of reproduction and windfarm mortality surveys, combined with capture‐recapture ringing data at a nearby population, we quantified vital parameters of fecundity and survival in order to parameterize a matrix population model to study the viability of this population. The breeding success was high and varied in synchrony with survival probabilities. Between 2013 and 2020, 43 carcasses were found below wind turbines, and when accounting for carcass detection and persistence rates, the true mortality should approach 154 individuals in that period, i.e. 3% of the studied population was affected by collisions each year. The matrix model showed that the population growth observed was only possible if there was a constant recruitment of 26 immigrant individuals each year into the population. Without the excess mortality by the windfarm, we predict that this population would have 22% more breeding pairs than what was observed in 2020. Simulations over 30 years showed that, under the current immigration rate, the population should decline if the excess mortality exceeds 11%. If immigration ceases, the population would decline above 5% excess mortality per year. It is urgent to monitor and reduce the excess mortality by windfarm collisions that threatens this lesser kestrel population. More generally, we advocate the use of population matrix demographic models in impact assessment studies to avoid placing new windfarms close to rare species that could not sustain additional mortality by collisions.

Two Chemical Engineers Look at the COVID-19 Pandemic.

Chemical engineering involves a skill set that is transferrable to a broad range of other areas. A case in point is the work that is being done by chemical engineers to better understand and fight the COVID‐19 epidemic. In this study, we consider a problem that has eluded the COVID‐19 research community, which is nevertheless very tractable with a chemical engineering mindset: the true or intrinsic mortality rate of COVID‐19, that is, the fraction or percentage of COVID‐19‐infected people that die of the disease. We solve this problem in two locations (Spain and the state of New York) for the epidemic's first wave using a combination of daily death data, a fit of a computer simulation of an epidemiological model with adjustable parameters, and independent results of immunological blood testing on a random sample of the population. Parallels are drawn with the problem of determining the turnover frequency of a catalyst based on a similar combination of data and approaches. It is concluded from the study that the intrinsic mortality rate of COVID‐19 was 1.45 ± 0.45% during the first wave, a number that reflects OECD countries. By incorporating data on the age dependence of the mortality rate, a relationship f mort = (3.0 ± 0.7) × 10−5 exp(0.1a), where a is the age in years, is tentatively put forward for the mortality rate as a fraction.

All-cause excess mortality across 90 municipalities in Gujarat, India, during the COVID-19 pandemic (March 2020-April 2021).

Official COVID-19 mortality statistics are strongly influenced by local diagnostic capacity, strength of the healthcare and vital registration systems, and death certification criteria and capacity, often resulting in significant undercounting of COVID-19 attributable deaths. Excess mortality, which is defined as the increase in observed death counts compared to a baseline expectation, provides an alternate measure of the mortality shock-both direct and indirect-of the COVID-19 pandemic. Here, we use data from civil death registers from a convenience sample of 90 (of 162) municipalities across the state of Gujarat, India, to estimate the impact of the COVID-19 pandemic on all-cause mortality. Using a model fit to weekly data from January 2019 to February 2020, we estimated excess mortality over the course of the pandemic from March 2020 to April 2021. During this period, the official government data reported 10,098 deaths attributable to COVID-19 for the entire state of Gujarat. We estimated 21,300 [95% CI: 20, 700, 22, 000] excess deaths across these 90 municipalities in this period, representing a 44% [95% CI: 43%, 45%] increase over the expected baseline. The sharpest increase in deaths in our sample was observed in late April 2021, with an estimated 678% [95% CI: 649%, 707%] increase in mortality from expected counts. The 40 to 65 age group experienced the highest increase in mortality relative to the other age groups. We found substantial increases in mortality for males and females. Our excess mortality estimate for these 90 municipalities, representing approximately at least 8% of the population, based on the 2011 census, exceeds the official COVID-19 death count for the entire state of Gujarat, even before the delta wave of the pandemic in India peaked in May 2021. Prior studies have concluded that true pandemic-related mortality in India greatly exceeds official counts. This study, using data directly from the first point of official death registration data recording, provides incontrovertible evidence of the high excess mortality in Gujarat from March 2020 to April 2021.