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Abstract Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient’s values and target the best outcome possible given the patient’s desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.

Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes. [ABSTRACT FROM AUTHOR]

Abstract Heart failure (HF) is a long‐term clinical syndrome, with increasing prevalence and considerable healthcare costs that are further expected to increase dramatically. Despite significant advances in therapy and prevention, mortality and morbidity remain high and quality of life poor. Epidemiological data, that is, prevalence, incidence, mortality, and morbidity, show geographical variations across the European countries, depending on differences in aetiology, clinical characteristics, and treatment. However, data on the prevalence of the disease are scarce, as are those on quality of life. For these reasons, the ESC‐HFA has developed a position paper to comprehensively assess our understanding of the burden of HF in Europe, in order to guide future policies for this syndrome. This manuscript will discuss the available epidemiological data on HF prevalence, outcomes, and human costs—in terms of quality of life—in European countries.

Sudden unexpected death of an individual with epilepsy can pose a challenge to death investigators, as most deaths are unwitnessed, and the individual is commonly found dead in bed. Anatomic findings (eg, tongue/lip bite) are commonly absent and of varying specificity, thereby limiting the evidence to implicate epilepsy as a cause of or contributor to death. Thus it is likely that death certificates significantly underrepresent the true number of deaths in which epilepsy was a factor. To address this, members of the National Association of Medical Examiners, North American SUDEP Registry, Epilepsy Foundation SUDEP Institute, American Epilepsy Society, and the Centers for Disease Control and Prevention constituted an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of autopsy and toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance of epilepsy-related deaths. The recommendations provided in this paper are intended to assist medical examiners, coroners, and death investigators when a sudden unexpected death in a person with epilepsy is encountered.

Abstract In light of the accumulating evidence on the negative predictive value of soluble urokinase plasminogen activator receptor (suPAR), a group of experts from the fields of intensive care medicine, emergency medicine, internal medicine and infectious diseases frame a position statement on the role of suPAR in the screening of patients admitted to the emergency department. The statement is framed taking into consideration existing publications and our own research experience. The main content of this statement is that sUPAR is a non-specific marker associated with a high negative predictive value for unfavourable outcomes; levels < 4 ng/ml indicate that it is safe to discharge the patient, whereas levels > 6 ng/ml are an alarming sign of risk for unfavourable outcomes. However, the suPAR levels should always be interpreted in light of the patient's history.

Poverty is an important social determinant of health that is associated with increased risk of death 1-5 . Cash transfer programmes provide non-contributory monetary transfers to individuals or households, with or without behavioural conditions such as children's school attendance 6,7 . Over recent decades, cash transfer programmes have emerged as central components of poverty reduction strategies of many governments in low- and middle-income countries 6,7 . The effects of these programmes on adult and child mortality rates remains an important gap in the literature, however, with existing evidence limited to a few specific conditional cash transfer programmes, primarily in Latin America 8-14 . Here we evaluated the effects of large-scale, government-led cash transfer programmes on all-cause adult and child mortality using individual-level longitudinal mortality datasets from many low- and middle-income countries. We found that cash transfer programmes were associated with significant reductions in mortality among children under five years of age and women. Secondary heterogeneity analyses suggested similar effects for conditional and unconditional programmes, and larger effects for programmes that covered a larger share of the population and provided larger transfer amounts, and in countries with lower health expenditures, lower baseline life expectancy, and higher perceived regulatory quality. Our findings support the use of anti-poverty programmes such as cash transfers, which many countries have introduced or expanded during the COVID-19 pandemic, to improve population health., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Odontotermes obesus (Blattodea: Termitidae) is a prevalent subterranean wood-eating termite species that causes damage to mature trees, saplings and seedlings. The efficacy of most synthetic insecticides against this notorious pest has been compromised primarily because of its enigmatic feeding behavior and development of resistance to a number of insecticides. It has therefore become necessary to explore other alternative biologically sound and low-impact termite control methods, particularly for use in forests. Hence, this study was designed to verify the efficacy of different indigenous EPN isolates (Steinernema carpocapsae, Heterorhabditis bacteriophora and Heterorhabditis indica) against workers of Odontotermes obesus. The pathogenicity of each nematode isolate was assessed in laboratory conditions using filter paper and sawdust bioassay at two different temperatures (16 ± 1 and 26 ± 1 °C). Additionally, the efficacy of the nematode species was also assessed in field conditions. The results of the experiments revealed that the mortality of termite workers was more pronounced in sawdust bioassay in comparison with filter paper bioassay at both the tested temperatures. The mortality response in both bioassays was more pronounced at the higher temperature. A significantly higher mortality was recorded at both tested temperatures for S. carpocapsae followed by H. bacteriophora and H. indica. A dose-dependent positive mortality response was also recorded at both tested temperatures. Similar to the laboratory trials, the field applications of the three tested nematode species showed that maximum mortality was recorded for S. carpocapsae followed by H. bacteriophora and H. indica. It was therefore concluded that indigenous EPNs can provide more effective control of termites, possibly because of their direct interaction with pest species in the soil and the possibility of causing secondary infection through infected cadavers. [ABSTRACT FROM AUTHOR]

Objectives: There is a lack of prognostic information to guide the prediction of short-term all-cause mortality in patients with end-stage renal disease (ESRD). The aim was to review the risk factors that influenced the risk of short-term all-cause mortality in patients with ESRD. Methods: MEDLINE, Embase, PubMed, CINAHL, the Cochrane Library and Web of Science databases were searched for articles published between 2000 and 2020. Articles describing risk factors predicting short-term mortality (≤ 3 years) in patients with ESRD were included. Four reviewers independently performed title, abstract, full text screening and data extraction. Assessment of risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool checklist. Results: 20,840 articles were identified and 113 papers were included for this review. Of the 113 papers, 6.2% included only peritoneal dialysis (PD) patients, 67.3% included only hemodialysis (HD) patients, 20.4% included both PD and HD patients, with the remaining papers featuring patients on conservative management or awaiting renal transplant. Risk factors were categorised into 13 domains: 1)demographics/ lifestyle, 2) comorbidities 3)intradialytic blood pressure, 4)biomarkers, 5)cardiovascular measurements, 6)frailty status, 7)medications, 8)treatment related indicators, 9)renal related parameters, 10)health status, 11)cause of ESRD, 12)access to healthcare care/ information and, 13)proxy measures for poor health. C-reactive protein(CRP), age, and functional status were observed to have higher percentage of instances of being significantly associated with all-cause mortality. Conclusion: Commonly examined risk factors observed from this review may be used to build a general prognostic model for patients with ESRD, with specific treatment related risk factors added on to enhance the accuracy of the models. [ABSTRACT FROM AUTHOR]

Following decades of decline, maternal mortality began to rise in the United States around 1990-a significant departure from the world's other affluent countries. By 2018, the same could be seen with the maternal mortality rate in the United States at 17.4 maternal deaths per 100 000 live births. When factoring in race/ethnicity, this number was more than double among non-Hispanic Black women who experienced 37.1 maternal deaths per 100 000 live births. More than half of these deaths and near deaths were from preventable causes, with cardiovascular disease being the leading one. In an effort to amplify the magnitude of this epidemic in the United States that disproportionately plagues Black women, on June 13, 2020, the Association of Black Cardiologists hosted the Black Maternal Heart Health Roundtable-a collaborative task force to tackle the maternal health crisis in the Black community. The roundtable brought together diverse stakeholders and champions of maternal health equity to discuss how innovative ideas, solutions and opportunities could be implemented, while exploring additional ways attendees could address maternal health concerns within the health care system. The discussions were intended to lead the charge in reducing maternal morbidity and mortality through advocacy, education, research, and collaborative efforts. The goal of this roundtable was to identify current barriers at the community, patient, and clinician level and expand on the efforts required to coordinate an effective approach to reducing these statistics in the highest risk populations. Collectively, preventable maternal mortality can result from or reflect violations of a variety of human rights-the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. This is the first comprehensive statement on this important topic. This position paper will generate further research in disparities of care and promote the interest of others to pursue strategies to mitigate maternal mortality. [ABSTRACT FROM AUTHOR]

The concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.

Background: Extracorporeal life support (ECLS) has become an integral part of modern intensive therapy. The choice of support mode depends largely on the indication. Patients with respiratory failure are predominantly treated with a venovenous (VV) approach. We hypothesized that mortality in Germany in ECLS therapy did not differ from previously reported literature METHODS: Inpatient data from Germany from 2007 to 2018 provided by the Federal Statistical Office of Germany were analysed. The international statistical classification of diseases and related health problems codes (ICD) and process keys (OPS) for extracorporeal membrane oxygenation (ECMO) types, acute respiratory distress syndrome (ARDS) and hospital mortality were used., Results: In total, 45,647 hospitalized patients treated with ECLS were analysed. In Germany, 231 hospitals provided ECLS therapy, with a median of 4 VV-ECMO and 9 VA-ECMO in 2018. Overall hospital mortality remained higher than predicted in comparison to the values reported in the literature. The number of VV-ECMO cases increased by 236% from 825 in 2007 to 2768 in 2018. ARDS was the main indication for VV-ECMO in only 33% of the patients in the past, but that proportion increased to 60% in 2018. VA-ECMO support is of minor importance in the treatment of ARDS in Germany. The age distribution of patients undergoing ECLS has shifted towards an older population. In 2018, the hospital mortality decreased in VV-ECMO patients and VV-ECMO patients with ARDS to 53.9% (n = 1493) and 54.4% (n = 926), respectively., Conclusions: ARDS is a severe disease with a high mortality rate despite ECLS therapy. Although endpoints and timing of the evaluations differed from those of the CESAR and EOLIA studies and the Extracorporeal Life Support Organization (ELSO) Registry, the reported mortality in these studies was lower than in the present analysis. Further prospective analyses are necessary to evaluate outcomes in ECMO therapy at the centre volume level.

Background: Healthy life years have superseded life expectancy (LE) as the most important indicator for population health. The most common approach to separate the total number of life years into those spent in good and poor health is the Sullivan method which incorporates the health dimension to the classic period life table, thus transforming the LE indicator into the health expectancy (HE) indicator. However, life years derived from a period life table and health prevalence derived from survey data are based on different conceptual frameworks., Method: We modify the Sullivan method by combining the health prevalence data with the conceptually better fitting cross-sectional average length of life (CAL). We refer to this alternative HE indicator as the "cross-sectional average length of healthy life" (HCAL). We compare results from this alternative indicator with the conventional Sullivan approach for nine European countries. The analyses are based on EU-SILC data in three empirical applications, including the absolute and relative level of healthy life years, changes between 2008 and 2014, and the extent of the gender gap., Results: HCAL and conventional HE differ in each of these empirical applications. In general, HCAL provides larger gains in healthy life years in recent years, but at the same time greater declines in the proportion of healthy life years. Regarding the gender gap, HCAL provides a more favourable picture for women compared to conventional HE. Nonetheless, the extent of these differences between the indicators is only of minor extent., Conclusions: Albeit the differences between HE and HCAL are small, we found some empirical examples in which the two indicators led to different conclusions. It is important to note, however, that the measurement of health and the data quality are much more important for the healthy life years indicator than the choice of the variant of the Sullivan method. Nonetheless, we suggest to use HCAL in addition to HE whenever possible because it widens the spectrum of empirical analyses and serves for verification of results based on the highly sensitive HE indicator.

Oral squamous cell carcinoma (OSCC) is one of the most common epithelial malignancies of multifactorial etiology linked with considerable mortality and morbidity. Generally, OSCC arises from pre-existing oral lesions quoted as oral potentially malignant disorders. Early diagnosis of OSCC is an attractive strategy to increase the survival rate of patients. Despite the accessibility of prominent diagnostic tools, many factors restrain the successful application of these approaches. The discovery of novel alternative methods to diagnose cancer definitively with higher selectivity and sensitivity has aroused scientific interest. Metabolomics is an unbiased analytical approach for qualitative and quantitative analyses of different metabolites in cells, tissues, or biological fluids and their alterations in response to pathophysiological stimuli. Several coupled techniques, together with chromatographic platforms, have facilitated metabolic profiling and, at the same time, detected cancer biomarkers, which are crucial for an effective treatment process. This overview discusses some of the most recent technological advances in metabolomics and focuses on their application to reveal the underlying causes of OSCC and their potential implications for personalised medicine. [ABSTRACT FROM AUTHOR]

The introduction to the 2022 Special Issue presents the 20 articles that discuss the demographic aspects and the consequences of the COVID-19 pandemic. It synthesises the main findings from the contributions, emphasising the demographic, social and economic characteristics that influenced the spread of infections and determined the number of deaths. We highlight the specific focus on measurement issues, often with a comparative framework across several countries, and at the regional level as well, both within and beyond Europe. We also summarise the impact of the measures imposed to contain the spread of the virus, such as lockdowns. Moreover, we explore the impact of the pandemic on the quality of relationships, the intention and the motivation to have children, and realised fertility. In addition, we present the authors' broader reflections on the risks faced by different communities of individuals, and the potential consequences for their life trajectories, including in relation to other current risks that overlap with the pandemic (recent armed conflicts), and for the achievability of the Sustainable Development Goals themselves. [ABSTRACT FROM AUTHOR]

Background: The lack of background disease incidence rates in sub-Saharan countries where the RTS,S/AS01 E malaria vaccine is being implemented may hamper the assessment of vaccine safety and effectiveness. This study aimed to document baseline incidence rates of meningitis, malaria, mortality, and other health outcomes prior to vaccine introduction through the Malaria Vaccine Implementation Programme., Methods: An ongoing disease surveillance study is combining prospective cohort event monitoring and hospital-based disease surveillance in three study sites in Ghana and Kenya. An interim analysis was performed on the prospective cohort in which children were enrolled in two age-groups (the 5 to 17 months or 6 to 12 weeks age-group), capturing data in the framework of routine medical practice before the introduction of the malaria vaccine. Incidence and mortality rates were computed with 95% confidential intervals (CI) using an exact method for a Poisson variable., Results: This analysis includes 14,329 children; 7248 (50.6%) in the 6 to 12 weeks age-group and 7081 (49.4%) in the 5 to 17 months age-group. In the 5 to 17 months age-group (where the malaria vaccine was planned to be subsequently rolled out) the meningitis, malaria, severe malaria and cerebral malaria incidences were 92 (95% CI 25-236), 47,824 (95% CI 45,411-50,333), 1919 (95% CI 1461-2476) and 33 (95% CI 1-181) per 100,000 person-years, respectively. The all-cause mortality was 969 (95% CI 699-1310) per 100,000 person-years., Conclusion: Incidence estimates of multiple health outcomes are being generated to allow before-after vaccine introduction comparisons that will further characterize the benefit-risk profile of the RTS,S/AS01 E vaccine., Trial Registration: clinicaltrials.gov NCT02374450.

In recent years, demographers have parsed variation in survivorship into two distinct components: the shape and the pace of ageing. The pace of ageing is defined by measures of longevity such as mean life expectancy or maximum longevity, whereas measures of the shape of ageing attempt to classify different shapes of the survivorship curve. We recently published a paper pointing out that a commonly used discretization of a shape measure, Keyfitz' entropy, does not correctly classify survivorship curves into negatively and positively senescing curves (de Vries et al., 2023). In that paper, we also suggested an alternative, accurate discrete‐time version of Keyfitz' entropy. de Vries et al. (2023) ended with two open questions, both of which have been answered by Giaimo (2024) now: (1) Can a discrete‐time entropy measure of survivorship be generalized beyond age‐based population models? Giaimo (2024) introduce a new formula that achieves this. (2) Will a discretization of Keyfitz' derivation of his measure as the elasticity of lifespan to a uniform change in mortality lead to the same formula as a discretization of Keyfitz' result? Giaimo (2024) answers: no.Here, we briefly discuss the implications of the results obtained by Giaimo (2024), and the implementation of his new formula into the Rpackage Rage, which is widely used for comparative demographic studies.We showcase the strength of the new method by reanalysing a comparison of Keyfitz' entropy to another shape measure. We find that the comparison is significantly altered by using Giaimo's new Keyfitz' formula.This example strengthens Giaimo's (2004) words of warning in approaching discretizations with attentiveness. [ABSTRACT FROM AUTHOR]

This paper compares mortality transition in China and India in the period 1950-2021, highlighting similarities and differences. Mortality transition has been inconsistent in both countries, but differences remain. In China, the transition has been spread evenly across the age range, while in India, it has primarily been confined to younger ages, being markedly slow in ages 35-90. This difference in the older ages appears to explain the main difference between the respective mortality transition in the two countries. To address its ongoing mortality transition, the paper concludes, India needs to reinvigorate its health-care delivery system to meet the health care needs of the old people. The paper also emphasises using geometric mean of the age-specific probabilities of death as an appropriate measure to analyse mortality transition. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether delayed or no treatment was associated with increased mortality and morbidity risks in people with newly diagnosed epilepsy., Methods: We examined New Zealand hospitalization and antiseizure medication prescription data from 2007-2015. Mortality and hospital-diagnosed morbidities were compared between patients immediately treated after epilepsy diagnosis, treated after a delay, or untreated for the duration of follow-up, adjusted for age, sex, and ethnicity., Results: Three thousand three hundred sixty-six patients (54.7% male, median age = 37.5 years) were included and followed up for a median of 3.39 years. A total of 3123 (92.8%) patients were treated immediately, 125 (3.7%) had delayed treatment, and 118 (3.5%) were untreated. Compared to the general New Zealand population, the cohort had a standardized mortality ratio of 4.60 (95% confidence interval [CI] = 4.24-4.99). Maori patients were less likely to be treated (Holm-Bonferroni adjusted P = .024) and had higher mortality (hazard ratio [HR] = 1.41, 95% CI = 1.08-1.83). There was a trend of increased mortality in the untreated or delayed treatment group compared to the immediate treatment group (HR = 1.36, 95% CI = 0.99-1.87). Hospitalization risk was similar between untreated and immediately treated periods (P = .83). Untreated or delayed treatment patients had higher risk of acute myocardial infarction (HR = 9.64, 95% CI = 1.83-50.8). Maori patients were more likely to develop liver disease (HR = 4.67, 95% CI = 1.32-16.4) and alcohol or drug dependence (HR = 2.55, 95% CI = 1.44-4.51)., Significance: Most epilepsy patients were treated at diagnosis in New Zealand, but Maori patients had lower treatment rates and worse health outcomes. The apparent increased risk of acute myocardial infarction among the untreated or delayed treatment patients warrants further research., (Wiley Periodicals, Inc. © 2020 International League Against Epilepsy.)

Aims: Better management of heart failure (HF) over the past two decades has improved survival, mainly by reducing the incidence of death due to cardiovascular (CV) causes. Deaths due to non-CV causes, particularly cancer, may be increasing. This study explored the modes of death of consecutive patients who attended a HF clinic over 17 years., Methods and Results: A total of 935 deaths were ascertained from 2002 to 2018 among 1876 patients (mean age 65.8 ± 12.5 years, 75% men, left ventricular ejection fraction < 50%) admitted to our HF clinic. Median follow-up was 4.2 years [1.9-7.8]. Mode of death was curated from patient health records and verified by the Catalan and Spanish health system databases. Trends for every mode of death were assessed by polynomial regression. Two trends were observed: a significant reduction in sudden death (P = 0.03) without changes in HF progression as mode of death (P = 0.26), and a significant increase in non-CV modes of death (P < 0.001). Non-CV deaths accounted for 17.4% of deaths in 2002 and 65.8% of deaths in 2018. A total 138 deaths were due to cancer (37% of non-CV deaths). A significant trend was observed towards a progressive increase in cancer deaths over time (P = 0.002). The main mode of cancer mortality was lung cancer., Conclusions: The modes of death in HF have shifted over the last two decades. Patients with HF die less due to sudden death and more due to non-CV causes, mainly cancer. Whether HF triggers cancer, or cancer develops in HF survivors, deserves further insight., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)

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Background: Up to 40% of older women living in the community experience urinary incontinence. In community settings, urinary incontinence impacts the quality of life, morbidity, and mortality rates. However, little is known about urinary incontinence and its impact on older women admitted to hospitals. Objectives: This scoping review aims to establish the current knowledge of urinary incontinence during hospital admission for women (⩾ 55 years of age) with three key objectives: (a) What is the prevalence/incidence of urinary incontinence? (b) What health conditions are associated with urinary incontinence? (c) Is there an association between urinary incontinence and mortality? Eligibility criteria: Empirical studies were included in assessing the incidence/prevalence of urinary incontinence during hospital admissions and its related morbidities and mortality rates. Studies which only included men or younger women (< 55 years of age) were excluded. Only articles written in English and conducted between 2015 and 2021 were included. Sources of evidence: A search strategy was developed, and CINAHL, MEDLINE, and Cochrane databases were searched. Charting methods: Data from each article meeting the criteria were pulled into a table, including study design, study population, and setting, aims, methods, outcome measures, and significant findings. A second researcher then reviewed the populated data extraction table. Results: Overall, 383 papers were found: 7 met inclusion/exclusion criteria. Prevalence rates ranged from 22% to 80% depending on the study cohort. Several conditions were associated with urinary incontinence, including frailty, orthopaedics, stroke, palliative care, neurology, and cardiology. There was a potential positive association between mortality and urinary incontinence, although only two papers reviewed reported mortality. Conclusion: A dearth of literature determined the prevalence, incidence, and mortality rates for older women admitted to hospitals. Limited consensus on associated conditions was found. Further research is needed to fully explore urinary incontinence in older women during hospital admissions, particularly concerning prevalence/incidence and its association with mortality. [ABSTRACT FROM AUTHOR]

The risk of dying or being injured as a result of traffic collisions is higher for medical emergency responders than for other professional drivers. This systematic review synthesizes the literature regarding the collisions of ambulances, focusing on the prevalence and characteristics surrounding such events. Keywords including paramedics and traffic collisions were searched in papers available in PubMed from January 1990 to July 2021. Two independent reviewers screened the abstracts of 2494 papers and ended up with 93 full-text articles to assess for eligibility, of which 26 papers were finally kept for this review. There was a total of 18 studies conducted in the United States, followed by 3 in Turkey, 2 in Taiwan, 1 in both the United States and Canada, 1 in France, and 1 in Poland. There is a high record of injury and fatal collisions for ambulances compared to other commercial or similarly sized vehicles. Drivers less than 35 years old with low experience and a history of citations are more likely to be involved in such collisions. Ambulance collisions are more likely to happen in urban areas and intersections are the riskiest locations. Most collisions occur when the ambulance is responding to an emergency call (i.e., going to the patient or the hospital) and using lights and sirens. Tailored preventive policies and programs for improving paramedics' safety should be sought to reduce the burden of these occupational collisions. [ABSTRACT FROM AUTHOR]

As people age they are at increased risk of cardiovascular disease, the leading cause of mortality and morbidity worldwide. Understanding cardiovascular ageing is essential to preserving healthy ageing and preventing serious health outcomes. This collection of papers published in Age and Ageing since 2011 cover key themes in cardiovascular ageing, with a separate collection on stroke and atrial fibrillation planned. Treating high blood pressure remains important as people age and reduces strokes and heart attacks. That said, a more personalised approach to blood pressure may be even more important as people age to lower blood pressure to tight targets where appropriate but avoid overtreatment in vulnerable groups. As people age, more people experience blood pressure drops on standing (orthostatic hypotension), particularly as they become frail. This can predispose them to falls. The papers in this collection provide an insight into blood pressure and orthostatic hypotension. They highlight areas for further research to understand blood pressure changes and management in the ageing population. Inpatient clinical care of older people with heart attacks differs from younger people in UK national audit data. People aged over 80 had improved outcomes in survival after heart attack over time, but had lower rates of specialist input from cardiology compared with younger people. This may partly reflect different clinical presentations, with heart attacks occurring in the context of other health conditions, frailty and multimorbidity. The care and outcomes of acute and chronic cardiovascular disease are impacted by the frailty and health status of an individual at baseline. The research included in this collection reinforces the wide variations in the ageing population and the necessity to focus on the individual needs and priorities, and provide a person-centred multidisciplinary approach to care. [ABSTRACT FROM AUTHOR]

This paper studies continuing optimal lockdowns (can also be interpreted as quarantines or self-isolation) in the long run if a disease (Covid-19) is endemic and immunity can fail, that is, the disease has SIRS dynamics. We model how disease related mortality affects the optimal choices in a dynamic general equilibrium neoclassical growth framework. An extended welfare function that incorporates loss from mortality is used. In a disease endemic steady state, without this welfare loss even if there is continuing mortality, it is not optimal to impose even a partial lockdown. We characterize how the optimal restriction and equilibrium outcomes vary with the effectiveness of the lockdown, the productivity of working from home, the rate of mortality from the disease, and failure of immunity. We provide the sufficiency conditions for economic models with SIRS dynamics with disease related mortality–a class of models which are non-convex and have endogenous discounting so that no existing results are applicable. [ABSTRACT FROM AUTHOR]

Peripartum cardiomyopathy is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified. Outcome varies from full recovery to residual left ventricular systolic dysfunction and even death. Many women return to their physician to acquire information on their long-term prognosis, to seek medical advice regarding contraception, or when planning a subsequent pregnancy. This position paper summarizes current evidence for long-term outcome, risk stratification of further pregnancies and overall management. Based on the best available evidence, as well as the clinical experience of the European Society of Cardiology Study Group on Peripartum Cardiomyopathy members, a consensus on pre- and postpartum management algorithms for women undergoing a subsequent pregnancy is presented. [ABSTRACT FROM AUTHOR]

Deep learning has recently demonstrated the ability to predict long-term patient risk and its stratification when trained on imaging data such as chest radiographs. However, existing methods formulate estimating patient risk as a binary classification, typically ignoring or limiting the use of temporal information, and not accounting for the loss of patient follow-up, which reduces the fidelity of estimation and limits the prediction to a certain time horizon. In this paper, we demonstrate that deep survival and time-to-event prediction models can outperform binary classifiers at predicting mortality and risk of adverse health events. In our study, deep survival models were trained to predict risk scores from chest radiographs and patient demographic information in the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial (25,433 patient data points used in this paper) for 2-, 5-, and 10-year time horizons. Binary classification models that predict mortality at these time horizons were built as baselines. Compared to the considered alternative, deep survival models improve the Brier score (5-year: 0.0455 [95% CI, 0.0427–0.0482] vs. 0.0555 [95% CI, (0.0535–0.0575)], p < 0.05) and expected calibration error (ECE) (5-year: 0.0110 [95% CI, 0.0080–0.0141] vs. 0.0747 [95% CI, 0.0718–0.0776], p < 0.05) for those fixed time horizons and are able to generate predictions for any time horizon, without the need to retrain the models. Our study suggests that deep survival analysis tools can outperform binary classification in terms of both discriminative performance and calibration, offering a potentially plausible solution for forecasting risk in clinical practice. [ABSTRACT FROM AUTHOR]

The early detection of colorectal polyps is crucial for the reduction of mortality rates. However, manually identifying polyps is time-consuming and expensive, increasing the risk of missing them. Our paper aims to address this issue by presenting an automated segmentation approach for colorectal polyps. This paper proposes a method that combines a skip connection with hybrid attention guidance (AG) using attention guidance (AG) and residual path frameworks to identify salient features. Furthermore, we augment test samples using original, horizontal flip, and vertical flip transformations to enhance model robustness through Test Time Augmentation (TTA). The model was trained with Kvasir-seg samples and evaluated on Kvasir-seg and CVC-ClinicDB datasets to gauge generalizability. A significant accuracy (0.9546), a Dice Similarity Coefficient (DSC) of 0.8557, a Cross-section over Union (IoU) of 0.8824, a Recall (0.8221), a Precision (0.8922), an area under Receiver Operating Characteristics (ROC-AUC) of 0.9454, and an area under Precision-Recall (AUC-PR) of 0.8717 were achieved without TTA. Through TTA integration, accuracy (0.9993), DSC (0.8663), IoU (0.8277), Recall (0.8060), Precision (0.9364), and ROC-AUC (0.9587) have been improved. A comparison of our framework with state-of-the-art models demonstrated its effectiveness and segmentation capabilities. Additionally, the proposed model contains only 0.47 million parameters and a weight size of 6.71 MB, illustrating its potential for clinical diagnostics. A computer-aided diagnosis (CAD) system improves patient outcomes by detecting colorectal polyps early and improving segmentation accuracy. [ABSTRACT FROM AUTHOR]

Tricuspid valve repair (TVR) combined with mitral valve surgery (MVS) has been a controversial issue. It is not clear whether the combined surgery has any influence on the occurrence of postoperative complications. The aim of this study was to compare the occurrence of complications including wound infection, wound bleeding, and mortality after MVS combined with or without TVR. By meta‐analysis, a total of 1576 papers were collected from 3 databases, and 7 of them were included. We provided the necessary data of 7 included studies such as the authors, publication date, country, surgical approach and case number, patient age, and so on. Statistical analysis was carried out with RevMan 5.3 software. We found that patients with heart failure accepting MVS combined with or without TVR, performed no statistically significant difference in postoperative wound infection (OR: 0.88; 95% CI: 0.29, 2.62; P = 0.81), wound bleeding (OR: 0.74; 95% CI: 0.3, 1.48; P = 0.39), and mortality (OR: 1.05; 95% CI: 0.42, 2.61; P = 0.92). In conclusion, current evidence indicated that the combined surgery had no additional risk of postoperative complications, and might be an effective alternative surgical approach to mitral valve diseases accompany with tricuspid regurgitation. However, for the limited case size, it was required to support the findings with a large number of cases in further studies. [ABSTRACT FROM AUTHOR]