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Introduction: The interstitial space harbours two fluid compartments linked serially to the plasma. This study explores conditions that lead to fluid accumulation in the most secluded compartment, termed the "third space". Methods: Retrospective data was collected from 326 experiments in which intravenous crystalloid fluid was administered to conscious volunteers as well as a small group of anaesthetized patients. The urinary excretion and plasma dilution derived from haemoglobin served as input variables in nine population volume kinetic analyses representing subtly different settings. Results: An infusion of 250-500 mL of Ringer's solution expanded only the central fluid space (plasma), whereas the infusion of 500-1,000 mL extended into a rapidly exchanging interstitial fluid space. When more than 1 L was infused over 30 min, it was distributed across plasma and both interstitial fluid compartments. The remote space, characterized by slow turnover, abruptly accommodated fluid upon accumulation of 700-800 mL in the rapidly exchanging space, equivalent to an 11%-13% volume increase. However, larger expansion was necessary to trigger this event in a perioperative setting. The plasma half-life of crystalloid fluid was 25 times longer when 2,000-2,700 mL expanded all three fluid compartments compared to when only 250-500 mL expanded the central space (14 h versus 30 min). Conclusion: As the volume of crystalloid fluid increases, it apparently occupies a larger proportion of the interstitial space. When more than 1 L is administered at a high rate, there is expansion of a remote "third space", which considerably extends the intravascular half-life. [ABSTRACT FROM AUTHOR]

This investigation explores the effects of applying fuzzy time series (FTSs) based on neural network models for estimating a variety of spectral functions in integer time series models. The focus is particularly on the skew integer autoregressive of order one (NSINAR(1)) model. To support this estimation, a dataset consisting of NSINAR(1) realizations with a sample size of n = 1000 is created. These input values are then subjected to fuzzification via fuzzy logic. The prowess of artificial neural networks in pinpointing fuzzy relationships is harnessed to improve prediction accuracy by generating output values. The study meticulously analyzes the enhancement in smoothing of spectral function estimators for NSINAR(1) by utilizing both input and output values. The effectiveness of the output value estimates is evaluated by comparing them to input value estimates using a mean-squared error (MSE) analysis, which shows how much better the output value estimates perform. [ABSTRACT FROM AUTHOR]

Purpose/objectives: This research aimed to identify factors that affect dental students' attitudes toward participation in rural clinical outplacements (RCOP) in Australia, and to suggest strategies that will increase students' desire to attend RCOP in the future. Methods: Dental students from the nine dental schools in Australia were invited to an online survey on their willingness to participate in an RCOP and the factors that influence this willingness. These factors were grouped into themes of education, personal and health, social, financial, and information‐related. Results: The study had an estimated response rate of 10% with 202 responses. More than two‐thirds (68%) of students were willing to participate in an RCOP. Students who grew up in a rural area were significantly more likely to be willing to attend an RCOP, compared to those from urban settings. Attitudes toward the anticipated educational experience of RCOP were positive, while factors related to finances and pre‐existing information were of concern to students. Educational, personal/health‐related, and social factors had significant impacts on participants' willingness to attend RCOP. Conclusion: Overall, despite students holding negative opinions on certain social and financial factors, their positive attitudes toward other factors outweighed these. Universities should aim to further promote the educational benefits of RCOP to improve students' attitudes prior to attending RCOP. In‐depth qualitative analysis is required to explore students' concerns regarding RCOP and longitudinal research is warranted to monitor students' attitudes toward RCOP and rural work over time. [ABSTRACT FROM AUTHOR]

IntroductionThe interstitial space harbours two fluid compartments linked serially to the plasma. This study explores conditions that lead to fluid accumulation in the most secluded compartment, termed the “third space”.MethodsRetrospective data was collected from 326 experiments in which intravenous crystalloid fluid was administered to conscious volunteers as well as a small group of anaesthetized patients. The urinary excretion and plasma dilution derived from haemoglobin served as input variables in nine population volume kinetic analyses representing subtly different settings.ResultsAn infusion of 250–500 mL of Ringer’s solution expanded only the central fluid space (plasma), whereas the infusion of 500–1,000 mL extended into a rapidly exchanging interstitial fluid space. When more than 1 L was infused over 30 min, it was distributed across plasma and both interstitial fluid compartments. The remote space, characterized by slow turnover, abruptly accommodated fluid upon accumulation of 700–800 mL in the rapidly exchanging space, equivalent to an 11%–13% volume increase. However, larger expansion was necessary to trigger this event in a perioperative setting. The plasma half-life of crystalloid fluid was 25 times longer when 2,000–2,700 mL expanded all three fluid compartments compared to when only 250–500 mL expanded the central space (14 h versus 30 min).ConclusionAs the volume of crystalloid fluid increases, it apparently occupies a larger proportion of the interstitial space. When more than 1 L is administered at a high rate, there is expansion of a remote “third space”, which considerably extends the intravascular half-life.

Background: Actinic keratosis (AK) is a pre-cancerous skin condition caused by sun exposure. Number bias, a phenomenon that occurs when meaning other than numerical value is associated with numbers, may influence the reporting of AK removal. The present study aims to determine if number bias is affecting healthcare providers' documentation of patient-provider encounters. Methods: A single-center retrospective chart review of 1415 patients' charts was conducted at the University of Cincinnati Medical Center. To determine if there was a significant difference between even and odd-numbered AK removals reported, an exact binomial test was used. The frequency of removals per encounter was fitted to a zero-truncated negative binomial distribution to predict the number of removals expected. All data were analyzed with RStudio. Results: There were 741 odd and 549 even encounters. Odd removals were reported at a significantly greater frequency than even p < 0.001. Age may be contributing to the observed number bias (p < 0.001). One, two, and eight were reportedly removed more frequently, while nine, 13, and 14 were reportedly removed less frequently than expected, respectively. Conclusion: Number bias may be affecting clinicians' documentation of AK removal and should be investigated in other clinical settings. [ABSTRACT FROM AUTHOR]

Purpose Research pharmacy effort required to safely and compliantly manage investigational products (IP) varies between studies. No validated tool exists in the United States to evaluate these differences in effort. The Vizient Pharmacy Research Committee Investigational Drug Services (IDS) Subcommittee previously developed a systematic complexity scoring tool (CST) through expert consensus to assign a complexity score for pharmacy effort. This project seeks to develop and validate complexity categories based on CST scores. Methods Vizient member institutions in IDS assigned a CST complexity score and a perceived complexity category (low, medium, or high) for study initiation and maintenance. Receiver operating characteristic (ROC) curve analysis defined the best CST score cutoff points for each complexity category. Comparing the CST-assigned to the user-perceived complexity category determined whether the CST-assigned complexity category aligned with practitioner assignment. Results A total of 322 responses were used to determine complexity score categories. The AUC values for study initiation and maintenance were 0.79 (P < 0.001) for the low/medium boundary and 0.80 (P < 0.001) for the medium/high boundary, suggesting the performance of the CST is good. The agreement between CST-assigned and user-perceived complexity categories was 60% for study initiation and 58% for maintenance. The Kendall rank correlation coefficient between the raters and ROC categories was strong, with a value of 0.48 for study initiation and 0.47 for maintenance. Conclusion Development of the CST allows IDS pharmacies to objectively measure the complexity of clinical trials, which is a significant step towards assessing workload and guiding resource allocation. [ABSTRACT FROM AUTHOR]

Monitoring life-testing trials for a product or substance often demands significant time and effort. To expedite this process, sometimes units are subjected to more severe conditions in what is known as accelerated life tests. This paper is dedicated to addressing the challenge of estimating the power hazard distribution, both in terms of point and interval estimations, during constant- stress partially accelerated life tests using progressive first failure censored samples. Three techniques are employed for this purpose: maximum likelihood, two parametric bootstraps, and Bayesian methods. These techniques yield point estimates for unknown parameters and the acceleration factor. Additionally, we construct approximate confidence intervals and highest posterior density credible intervals for both the parameters and acceleration factor. The former relies on the asymptotic distribution of maximum likelihood estimators, while the latter employs the Markov chain Monte Carlo technique and focuses on the squared error loss function. To assess the effectiveness of these estimation methods and compare the performance of their respective confidence intervals, a simulation study is conducted. Finally, we validate these inference techniques using real-life engineering data. [ABSTRACT FROM AUTHOR]

In this study, we introduce a novel estimation technique for assessing the reliability parameter R = P (Y < X) of the uniform truncated negative binomial distribution (UTNBD) in the context of stress–strength analysis. We base our inferences on the assumption that both the strength (X) and stress (Y) random variables follow a UTNBD with identical first shape and scale parameters. In the presence of a progressive type-II censoring scheme, we employ maximum likelihood, two parametric bootstrap methods, and Bayesian estimation approaches to derive the estimators. Due to the complexity introduced by censoring, the estimators are not available in explicit forms and are instead obtained through numerical approximation techniques. Furthermore, we compute the highest posterior density credible intervals and determine the asymptotic variance-covariance matrix. To assess the performance of our proposed estimators, we conduct a Monte Carlo simulation study and provide a comparative analysis. Finally, we illustrate the practical applicability of our study with an engineering application. [ABSTRACT FROM AUTHOR]

Objective: To examine the time trend of statistical inference, statistical reporting style of results, and effect measures from the abstracts of randomized controlled trials (RCTs). Study desgin and settings: We downloaded 385,867 PubMed abstracts of RCTs from 1975 to 2021. We used text-mining to detect reporting of statistical inference (p-values, confidence intervals, significance terminology), statistical reporting style of results, and effect measures for binary outcomes, including time-to-event measures. We validated the text mining algorithms by random samples of abstracts. Results: A total of 320 676 abstracts contained statistical inference. The percentage of abstracts including statistical inference increased from 65% (1975) to 87% (2006) and then decreased slightly. From 1975 to 1990, the sole reporting of language regarding statistical significance was predominant. Since 1990, reporting of p-values without confidence intervals has been the most common reporting style. Reporting of confidence intervals increased from 0.5% (1975) to 29% (2021). The two most common effect measures for binary outcomes were hazard ratios and odds ratios. Number needed to treat and number needed to harm are reported in less than 5% of abstracts with binary endpoints. Conclusions: Reporting of statistical inference in abstracts of RCTs has increased over time. Increasingly, p-values and confidence intervals are reported rather than just mentioning the presence of "statistical significance". The reporting of odds ratios comes with the liability that the untrained reader will interpret them as risk ratios, which is often not justified, especially in RCTs. [ABSTRACT FROM AUTHOR]

Aim: To investigate the causal impact of diet and sedentary behavior on Brazilian schoolchildren’s overweight/obesity using the data from observational studies. Methods: Annual cross-sectional nutritional surveys over the 2013–2015 period, with 26,712 children old 7–12 years in Florianópolis, Brazil, provided the data for this analysis. The surveys applied an online previous-day recall questionnaire on food intake and physical/sedentary activities. Outcome measures were overweight/obesity, whereas exposure variables were daily frequencies of consuming sugary drinks and ultra-processed foods, the total number of dietary items consumed and the total number of sedentary activities per day, and consuming breakfast, mid-morning snacks, lunch, afternoon snack, dinner, and evening snack. Control variables included child age, sex, family income, school shift, survey year, day of the week the questionnaire refers to, metabolic equivalents (METs) of physical activities (PAs), and the quality of dietary and PA reports. Causal effects were estimated by augmented inverse probability weighting. Results: Daily consumption of sugary drinks, eating ten or more foods, and engaging in three or more sedentary behaviors per day significantly increased the odds ratios (ORs) of being overweight/obese in the range of 3–24% compared to the reference, with 95% confidence intervals in the range of 1–32%. Among 19 ORs with P-value ≤ 0.05, only 3 exceeded 10%. Conclusions: Under certain conditions, not uncommon in large-scale monitoring and surveillance studies, it is possible to evaluate the causal effects of diet and sedentary activities on overweight/obesity. Daily consumption of sugar-sweetened beverages, eating ten or more foods, skipping breakfast, and engaging in three or more sedentary behaviors per day significantly increased the odds of being overweight/obese.

The aim of this paper is to introduce a discrete mixture model from the point of view of reliability and ordered statistics theoretically and practically for modeling extreme and outliers' observations. The base distribution can be expressed as a mixture of gamma and Lindley models. A wide range of the reported model structural properties are investigated. This includes the shape of the probability mass function, hazard rate function, reversed hazard rate function, min-max models, mean residual life, mean past life, moments, order statistics and L-moment statistics. These properties can be formulated as closed forms. It is found that the proposed model can be used effectively to evaluate over- and under-dispersed phenomena. Moreover, it can be applied to analyze asymmetric data under extreme and outliers' notes. To get the competent estimators for modeling observations, the maximum likelihood approach is utilized under conditions of the Newton-Raphson numerical technique. A simulation study is carried out to examine the bias and mean squared error of the estimators. Finally, the flexibility of the discrete mixture model is explained by discussing three COVID-19 data sets.

The autoregressive model is a representation of a certain kind of random process in statistics, insurance, signal processing, and econometrics; as such, it is used to describe some time-varying processes in nature, economics and insurance, etc. In this article, a novel version of the autoregressive model is proposed, in the so-called the partially autoregressive (PAR(1)) model. The results of the new approach depended on a new algorithm that we formulated to facilitate the process of statistical prediction in light of the rapid developments in time series models. The new algorithm is based on the values of the autocorrelation and partial autocorrelation functions. The new technique is assessed via re-estimating the actual time series values. Finally, the results of the PAR(1) model is compared with the Holt-Winters model under the Ljung-Box test and its corresponding p-value. A comprehensive analysis for the model residuals is presented. The matrix of the autocorrelation analysis for both points forecasting and interval forecasting are given with its relevant plots. [ABSTRACT FROM AUTHOR]

In this paper, we define a new generator to propose continuous as well as discrete families (or classes) of distributions. This generator is used for the DAL model (acronym of the last names of the authors, Dimitrakopoulou, Adamidis, and Loukas). This newly proposed family may be called the new odd DAL (NODAL) G-class or alternate odd DAL G-class of distributions. We developed both a continuous as well as discrete version of this new odd DAL G-class. Some mathematical and statistical properties of these new G-classes are listed. The estimation of the parameters is discussed. Some structural properties of two special models of these classes are described. The introduced generators can be effectively applied to discuss and analyze the different forms of failure rates including decreasing, increasing, bathtub, and J-shaped, among others. Moreover, the two generators can be used to discuss asymmetric and symmetric data under different forms of kurtosis. A Monte Carlo simulation study is reported to assess the performance of the maximum likelihood estimators of these new models. Some real-life data sets (air conditioning, flood discharges, kidney cysts) are analyzed to show that these newly proposed models perform better as compared to well-established competitive models. [ABSTRACT FROM AUTHOR]

The majority of approaches proposed in the past few decades to solve life test problems have differed markedly from those used for closely related, yet broader, issues. Due to the complexity of data that are generated each day in many practical domains, as a result of the development of scales for rating the success or failure of reliability, a new domain of reliability has been created. This domain is referred to as life classes, where specific probability distributions are presented. In this study, it is shown that the use of the quality-of-fit technique to solve problems involving life testing makes sense, and produces simpler processes that are roughly equivalent or superior to those used in traditional procedures. They may also behave better in limited samples. This work investigates a novel quality-of-fit test statistic; it is based on an exponential transform and is compared to the best renewal used Laplace test in increasing convex ordering (NBRULC). Evidence for approach normality is provided. The calculated variables include powers, Pitman asymptotic effectiveness, and critical points. Methods on how to handle censored data were also studied. Our experiments have real-world applications in the fields of medicine and engineering. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to show the impact of the pandemic on changes in guidelines for clinical work and the number of patients of the Clinic of Dentistry, University Hospital Centre (UHC) Zagreb, in the period of normal work before the pandemic and in subsequent years. Methods: From the data base of the hospital information system of UHC Zagreb data were retrospectively collected on the total number of cases at the Clinic of Dentistry in each period and the total number of cases at individual departments, for the period from January 1 to November 11, in 2018, 2019, 2020 and 2021. Results: During the pandemic period the most significant decrease in the number of patients in majority of organizational units was evident in 2020 compared to 2018, when a decrease in the number of patients of 30.27% was recorded, while in 2021, compared to 2018, the number of patients decreased by 9.73 %. The Department of Oral Surgery and the Department of Orthodontics had an almost unchanged number of patients in 2020 compared to 2018, while in 2021, compared to 2018, there was an increase in the number of patients. Rebro Dental Clinic and One-day surgery also recorded an increase in the number of patients. At the time of the epidemiological recommendations on the introduction of cold drive, these units of the Dental Clinic also treated other, less urgent diagnoses that would lead to bad consequences if delayed. During the collective annual leave of all other organizational units of the Dental Clinic, these units take over the provision of all necessary services of the Dental Clinic. Conclusion: COVID-19 pandemic has led to a reduction in the number of patients at the level of the Dental Clinic. The inability to treat teeth in a timely manner resulted in increased need for extractions and an increase in the number of patients at the Department of Oral Surgery. In 2021 there was a greater or lesser increase in the number of patients in individual departments, which, however, in the observed period has not yet reached the numbers from 2018. In the coming months, a further increase in the number of patients and elective dental procedures is expected.

Overcrowding of emergency departments all over the world has been recognised as one of the growing problems. The aim of our investigation was to determine the level of overcrowding in the neurological emergency room of the University Hospital Centre Split. This is a retrospective analysis of all patients that were examined in our emergency reception during the one-year period. We examined 8146 patients (around 22 patients per day). The main reason of their arrival was stroke (1,822 patients – 22%) but more than half of the patients were judged as non- urgent and they were sent to outpatient treatment. A total of 1,616 patients presented to the emergency department with (sub)acute complaints of cervical or lumbar spine. With this investigation we proved that there is a problem of overcrowding in our neurological emergency room and the existence of a very large number of non-urgent patients. We believe that better education of patients and doctors could be the solution of this problem.

In this article, a new family of bivariate discrete distributions is proposed based on the copula concept, in the so-called bivariate discrete odd generalized exponential-G family. Some distributional properties, including the joint probability mass function, joint survival function, joint failure rate function, median correlation coefficient, and conditional expectation, are derived. After proposing the general class, one special model of the new bivariate family is discussed in detail. The maximum likelihood approach is utilized to estimate the family parameters. A detailed simulation study is carried out to examine the bias and mean square error of maximum likelihood estimators. Finally, the importance of the new bivariate family is explained by means of two distinctive real data sets in various fields. [ABSTRACT FROM AUTHOR]

Due to the complexity of the data being generated day in and day out in many practical domains, as a result of the development of scales for rating the success or failure of reliability, a new domain of reliability called the classes of life and determinant probability distributions has been presented. This article introduces novel statistical probability models for the reliability class of life test under different reliability processes in the age range t ∘ . Several probabilistic properties and features were derived and rigorously screened to test the new reliability class. According to the U-statistic, a novel hypothesis test was created to evaluate the exponentiality property. The comparative efficiency of the test according to Pitman's asymptotic efficiency was examined and compared with other reliability classes. To prove the superiority of the new reliability class, some probability models were utilized, including the Weibull, Makeham, gamma, and linear failure rate models. Moreover, critical point simulations of the null Monte Carlo distribution and some applications of the censored and uncensored data were implemented to validate the class test listed by the reliability analysis. [ABSTRACT FROM AUTHOR]

It is agreed by industry experts that manufacturing processes are evaluated using quantitative indicators of units produced from this process. For example, the C p y process capability index is usually unknown and therefore estimated based on a sample drawn from the requested process. In this paper, C p y process capability index estimates were generated using two iterative methods and a Bayesian method of estimation based on stepwise controlled type II data from the Pareto model. In iterative methods, besides the traditional probability-based estimation, there are other competitive methods, known as bootstrap, which are alternative methods to the common probability method, especially in small samples. In the Bayesian method, we have applied the Gibbs sampling procedure with the help of the significant sampling technique. Moreover, the approximate and highest confidence intervals for the posterior intensity of C p y were also obtained. Massive simulation studies have been performed to evaluate the behavior of C p y . Ultimately, application to real-life data is seen to demonstrate the proposed methodology and its applicability. [ABSTRACT FROM AUTHOR]

Introduction: Health workforces around the world are characterized with geographic maldistribution, often leading to inequalities in rural health outcomes. Monetary incentives are frequently raised as a policy option to bolster recruitment of healthcare practitioners to rural and underserved communities; however, few rural health workforce studies focus on allied health professionals (AHPs), include urban comparators, integrate gender considerations, or measure rural diversity. This population-based observational study examines trends in the geographic and gender distribution and earnings of AHPs in Canada across the rural– urban continuum. Methods: Nationally representative data from the 2006 and 2016 Canadian population censuses were pooled and linked with the geocoded Index of Remoteness for all inhabited communities. Five groups of university-educated AHPs providing prevention, diagnostic evaluation, therapy, and rehabilitation services were identified by occupation. Multiple linear regression models were used to estimate the associations between relative remoteness and annual earnings of AHPs aged 25–54 years, controlling for gender and other personal and professional characteristics. Results: The density of AHPs was found to be 15 times higher in more urbanized and accessible parts of the country (23.6-25.6 per 10 000 population in 2016) compared to the most rural and remote areas (1.6 per 10 000 population), a pattern that changed little over the previous decade. A positive correlation was seen across occupations in terms of the degree of feminization and their geographic dispersion by relative remoteness. While pharmacists residing in more rural and remote communities earned 9% (95% confidence interval 4-15%) more than those in core urban centers, relative remoteness contributed little to wage differentials among dentists, physiotherapists and occupational therapists, or other AHPs in therapy and assessment (no significant difference at p<0.05). Women earned significantly less than men in dentistry, pharmacy, and physical or occupational therapy, after adjusting for remoteness and other characteristics. Conclusion: This study did not find consistent wage disparities by relative remoteness as characterizing allied health professions in Canada. The evidence base to support financial incentives to AHPs to reduce perceived opportunity costs associated with working and living in rural and underserved areas remains limited. More research is needed on the intersections of rurality, gender, and wage differentials among AHPs in different national contexts. [ABSTRACT FROM AUTHOR]

The primary objective of this article was to introduce a new probabilistic model for the discussion and analysis of random covariates. The introduced model was derived based on the Marshall–Olkin shock model. After proposing the mathematical form of the new bivariate model, some of its distributional properties, including joint probability distribution, joint reliability distribution, joint reversed (hazard) rate distribution, marginal probability density function, conditional probability density function, moments, and distributions for both Y = max { X 1 , X 2 } and W = min { X 1 , X 2 } , were investigated. This novel model can be applied to discuss and evaluate symmetric and asymmetric data under various kinds of dispersion. Moreover, it can be used as a probability approach to analyze different shapes of hazard rates. The maximum likelihood approach was utilized for estimating the parameters of the bivariate model. A simulation study was carried out to assess the performance of the parameters, and it was noted that the maximum likelihood technique can be used to generate consistent estimators. Finally, two real datasets were analyzed to illustrate the notability of the novel bivariate distribution, and it was found that the suggested distribution provided a better fit than the competitive bivariate models. [ABSTRACT FROM AUTHOR]

Introduction. Deflazacort (DFZ) is a synthetic ozaxolinic glucocorticoid derived from prednisolone, it has anti-inflammatory properties and acts as an immunosuppressant, is the raw material used as the active ingredient of products marketed in pharmaceutical forms such as tablets and oral suspensions. Objective. Validate the methodology analytical by high performance liquid chromatography (HPLC), for the identification and assessment of (1-(1β,16α)-21-(acetyloxy)-11-hydroxy-2´-methyl-5´H-pregna-1,4 -dieno[17,16-d] oxazol-3,20-diona) in Deflazacort raw material under tropical climate conditions. Methodology. Using as mobile phase an isocratic mixture of methanol and water in a ratio of 80:20 with a f low of 1, 1mL/min, the column used was Luna® 5µm C8 100A 250 x 4.6mm, diode array detector at a wavelength of 245nm. Results. For linearity, a correlation coefficient R ≥ 0.999 was obtained, the coefficient of variation did not exceed the RS D of 2.0% in the repeatability of the system and in intermediate precision between analysts, an RSD value <3.0% was identified, in accuracy a recovery percentage of 98.9% was found. Conclusions. The method is linear, precise, exact, robust for a flow of 1.21mL/min and not for a flow of 0.99mL/min since it does not meet retention time. In the performance tests, Deflazacort showed low stability when exposed to degradation by basic hydrolysis with 1.0 N and 0.1 N NaOH solutions. The sample and the standard in solution showed to be stable at room temperature for two hours and refrigerated for three hours. [ABSTRACT FROM AUTHOR]

Objective: Quad bike riders in Dubai (UAE) constitute a highly diverse group with varying driving skills and familiarity with the desert environment. In the absence of evidence on the quad bike riders in the region, we attempted to describe the most vulnerable risk groups using routinely collected injury data. This may hopefully inform the most effective injury prevention strategies for the region., Methods: Four-year injury incident reports of 226 patients rescued by Dubai ambulance were grouped into three clusters using two-step cluster analysis in SPSS., Result: The three clusters that emerged were 'Older Tourist-Expatriates' (n=86), 'Prompt Young Emiratis' (n=76) and 'Tightlipped Young Colliders' (n=60). Older tourists were more likely to ride during the daytime and sustained milder injuries due to rollover. Prompt Young Emirati riders who experienced severe head, neck and spine injuries from nighttime rollovers were more likely to call for an ambulance without delay. Tightlipped Young Colliders were very young riders who experienced quad bike collisions or did not report their crash history. One in five riders in Clusters 1 and 3 delayed calling the ambulance by more than 6 hours., Conclusion: Young nationals with severe injuries due to night collisions and rollovers during winter would benefit from increased guardianship, vehicle modification and crowd control interventions. In addition, emergency first aid services for tourists and nationals should be allocated to the major quad biking desert locations in Dubai to relieve the burden on emergency ambulatory care services., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. Published by BMJ Group.)

Background: Gendered challenges have been shown to persist among health practitioners in countries at all levels of development. Less is known about non-clinical professionals, that is, those who do not deliver services directly but are essential to health systems performance, such as health policy researchers. This national observational study examined gender occupational segregation and wage gaps in the Canadian health policy research workforce using a cross-domain comparative labour market analysis approach.Methods: Sourcing data from the 2016 population census, we applied linear regression and Oaxaca-Blinder decomposition techniques to assess wage differentials by sex, traditional human capital measures (e.g., age, education, place of work), and social identity variables intersecting with gender (household head, childcare, migrant status) among health policy researchers aged 25-54. We compared the gender composition and wage gap with seven non-health policy and programme domains, as mapped under the national occupational classification by similarity in the types of work performed.Results: The health policy research workforce (N = 19 955) was characterized by gender segregation: 74% women, compared with 58% women among non-health policy research occupations (N = 102 555). Women health policy researchers earned on average 4.8% (95% CI 1.5‒8.0%) less than men after adjusting for other professional and personal variables. This gap was wider than among education policy researchers with similar gender composition (75% women; adjusted wage gap of 2.6%). Wages among health policy researchers were 21.1% (95% CI 19.4‒22.8%) lower than their counterparts in the male-dominated economics policy domain, all else being equal. Overall, women's earnings averaged 3.2% lower than men's due to factors that remained unexplained by policy domain or other measured predictors.Conclusions: This investigation found that the gender inequalities already widely seen among clinical practitioners are replicated among health policy researchers, potentially hindering the competitiveness of the health sector for attracting and retaining talent. Our findings suggest intersectoral actions are necessary to tackle wage gaps and devaluation of female-dominated health professions. Accountability for gender equity in health must extend to the professionals tasked with conducting equity-informative health policy research. [ABSTRACT FROM AUTHOR]

To estimate the degree of concordance and consistency in the radiographic and tomographic evaluation of the periapical area. A study of diagnostic tests was designed. Three blind evaluators analyzed radiographic images, which were selected at two different points in time. An oral radiologist and an endodontist determined the second observation moment. The degree of similarity and variability, concordance and consistency for each radiograph was set at 95% confidence. A Kappa coefficient (κ), for radiographic findings and a correlation coefficient of Lin (CCC) for tomographic measurements was established. 12 radiographies and 19 tomographs were evaluated. The intraobserver consistency determined a k= 1 (Almost Perfect) and a CCC from 0.42 to 0.95 (Poor to Substantial) for both observation times. For radiographies, the interobserver concordance did not show changes between the first and second observation. Values include a k= 0.56-0.80 (Moderate to Good) and a CCC with greater degree of agreement, after training, as follows: axial view: CCC 0.86, 95% of Confidence Interval (CI) 0.69-0.94, coronal view: CCC 0.90 95%CI 0.75-0.96, and sagittal view: CCC 0.96, 95%CI 0.90-0.98. The statistical tests estimated the consistency and concordance to observe radiographically and tomographically the periapical tissue in endodontics.

The derivation and interpretation of P values derived from inferential testing remain somewhat vague and ambiguous in the minds of some researchers/editors/reviewers/readers. The British polymath Fisher famously averred: “the value for which P = 0.05, or 1 in 20, is 1.96 or nearly 2; it is convenient to take this point as a limit in judging whether a deviation is to be considered significant or not. Deviations exceeding twice the standard deviation are thus formally regarded as significant.” This sometimes leads to an almost reductio ad absurdum mindset with an automatic discardment of studies with results where P > 0.05. It must be remembered that results may be negatively impacted by myriad factors that may be out of the researcher/s control, such as small sample sizes, small effects, bias, and random error. This paper briefly reviews the historical events leading to the acceptance of P ≤ 0.05 for statistical significance, the rationale behind the null hypothesis (H0 ), the meaning of P (and the potential for Type 1 and 2 Errors), α, β, the possibility of using non‑0.05 cut‑offs when studies are “trending toward statistical significance,” and the importance of including confidence intervals (CIs) in results. P values are vital but must be tempered by judicial consideration of CI and study design. P is a probability spectrum and not simply a binary significant/non‑significant statistical metric. MeSH: 95% confidence interval, biostatistics, P value. [ABSTRACT FROM AUTHOR]

Introduction: Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repetitive head impacts (RHI) typically sustained by contact sport athletes. Post‐translation modifications to tau in CTE have not been well delineated or compared to Alzheimer's disease (AD). Methods: We measured phosphorylated tau epitopes within dorsolateral frontal cortex from post mortem brains with neither CTE nor AD (n = 108), CTE (n = 109), AD (n = 223), and both CTE and AD (n = 33). Results: Levels of hyperphosphorylated tau (p‐tau)202, p‐tau231, and p‐tau396 were significantly increased in CTE. Total years of RHI exposure was significantly associated with increased p‐tau202 levels (P =.001), but not p‐tau396. Instead, p‐tau396 was most closely related to amyloid beta (Aβ)1‐42 levels (P <.001). The p‐tau202:p‐tau396 ratio was significantly increased in early and late CTE compared to AD. Discussion: In frontal cortex, p‐tau202 is the most upregulated p‐tau species in CTE, while p‐tau396 is most increased in AD. p‐tau202 and p‐tau396 measurements may aid in developing biomarkers for disease. [ABSTRACT FROM AUTHOR]

Introduction: Our goal was to investigate trends in computed tomography (CT) utilization in emergency departments (EDs) and its association with hospitalization. Methods: We conducted an analysis of an administrative claims database of U.S. privately insured and Medicare Advantage enrollees. We identified ED visits from 2005 through 2013 and assessed for CT use, associated factors, and hospitalization after CT, along with patient demographics. We used both descriptive methods and regression models adjusted for year, age, sex, race, geographic region, and Hwang comorbidity score to explore associations among CT use, year, demographic characteristics, and hospitalization. Results: We identified 33,144,233 ED visits; 5,901,603 (17.8%) involved CT. Over time, CT use during ED visits increased 59.9%. CT use increased in all age groups but decreased in children since 2010. In propensity-matching analysis, odds of hospitalization increased with age, comorbidities, male sex, and CT use (odds ratio, 2.38). Odds of hospitalization over time decreased more quickly for patients with CT. Conclusion: CT utilization in the ED has increased significantly from 2005 through 2013. For children, CT use after 2010 decreased, indicating caution about CT use. Male sex, older age, and higher number of comorbidities were predictors of CT in the ED. Over time, odds of hospitalization decreased more quickly for patients with CT.

Introduction: Understanding the determinants of disease burden is imperative in enhancing population health outcomes. This study uses data from the Iganga-Mayuge Health and Demographic Surveillance Site, to understand demographic and socioeconomic factors influencing morbidity., Methods: We analysed secondary data from 2018 to 2023. We employed graphs and tables to present morbidity patterns across different sociodemographic factors and applied mixed-effects multinomial multivariate logistic regression model to understand the correlates of morbidity., Results: The findings reveal a predominant prevalence of malaria, lower respiratory tract infections, coryza, gastric acid-related and urinary tract infections, collectively constituting 83% of diagnosed diseases. Noteworthy demographic variations, particularly gender and age, significantly impact disease distribution, revealing higher diagnosis rates among females. Additionally, socioeconomic factors, including education and wealth status, contribute to discernible differences in disease burden., Conclusion: This research provides crucial insights into the implications of demographic and socioeconomic factors on disease burden in Uganda. The results contribute to evidence-based policy-making, highlighting the necessity for targeted interventions addressing specific health challenges encountered by diverse populations. The study advocates for continuous assessment of the epidemiological landscape to inform more tailored and effective health strategies, ultimately enhancing resilience in disease control efforts., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: To analyse the relationship between diabetes, its severity (including blood glucose levels, disease duration, antidiabetic drug use and number of comorbidities) and preserved ratio impaired spirometry (PRISm) using data from the National Health and Nutrition Examination Survey (NHANES)., Methods: This cross-sectional study collected data from the NHANES database from 2007 to 2012. PRISm was defined as having a forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio ≥0.7 and an FEV1 predicted value <80%. We examined the relationship between diabetes duration, fasting plasma glucose (FPG), glycated haemoglobin (HbA1c), log-transformed homeostasis model assessment for insulin resistance, C reactive protein and the number of comorbidities with PRISm in the entire population. We analysed the relationship between antidiabetic drug use and PRISm, specifically in the diabetes population. Logistic regression models were used, and results were reported as OR., Results: A total of 5783 participants with normal spirometry or PRISm were included in the analysis. Diabetes was associated with 2.19 times higher odds of PRISm compared with non-diabetic participants. Longer disease duration increased PRISm odds by 2% per year. Each 1-unit increase in HbA1c and each 10 mg/dL increase in FPG were associated with 24% and 6% higher odds of PRISm, respectively. No relationship was found between insulin resistance and PRISm after adjusting for covariates. An increase of 1 mg/dL in CRP was associated with 18% higher odds of PRISm. A higher number of diabetes-related comorbidities was strongly associated with PRISm. No significant relationship was found between antidiabetic drug use and PRISm., Conclusions: Severe diabetes status, such as higher blood glucose levels, longer disease duration and a greater number of comorbidities, is associated with an increased risk of PRISm. Effective blood glucose control, self-management and regular monitoring of lung function are crucial for diabetes management., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Background: Increasing numbers of children in the UK are being taken into care, with adverse consequences for children and unsustainable costs for local government. It is crucial that local authorities better understand which children are most at risk to target preventative interventions., Objectives: To identify predictors of children becoming 'looked after' (taken into care by the state) among children known to a local authority., Methods: Secondary analysis of routinely collected Children's Social Care data including all children who first became known to social care in Liverpool between April 2019 and March 2022, (excluding unaccompanied asylum seeker children). Outcome was time (in months) between first contact with social care and either becoming looked after or reaching the censoring date (March 2022). Survival analysis was undertaken using a discrete time hazard model., Results: 5808 children under 19 became known to Children's Social Care during the study, 377 of whom subsequently became looked after. Black and Asian children were more likely to become looked after, as were those known to social care services pre-birth or in the first year. Key risk factors that increased hazard of becoming looked after were neglect, sexual abuse, emotional abuse, drug and/or alcohol use in the household or the child and mental ill health in the household. Children who had a Child in Need intervention were less likely to become looked after. Children who had a Child Protection Plan were more likely to become looked after., Conclusion: In our study of routinely collected Children's Social Care data, we have identified the key factors that increased the hazard of a child becoming looked after. These findings highlight potential areas for service change and can be used to inform risk prediction and preventative action, however, the local context may influence the generalisability of our findings to other settings.  ., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

To examine the healthcare costs associated with colorectal cancer (CRC) screening and the frequency and costs of events potentially related to colonoscopy among average-risk adults. In this cohort study, adults (ages 50–75 years) with CRC screening between 1/1/2014 and 6/30/2019 (index = earliest test) were selected from the IBM MarketScan Research databases. Individuals at above-average risk for CRC or with prior CRC screening were excluded. Frequency of utilization was reported by screening type: colonoscopy, fecal immunochemical test (FIT), fecal occult blood test (FOBT), multi-target stool DNA (mt-sDNA). For colonoscopy, frequency and costs of potential events were reported overall, by event type, and by an individual event in the 30 days after colonoscopy. Among the 333,306 average-risk adults, colonoscopy was the most common CRC screening modality (70.6%), followed by FIT (17.7%), FOBT (8.1%), and mt-sDNA (3.2%). The mean cost of a colonoscopy procedure was $2,125 and the mean out-of-pocket costs were $79. Serious gastrointestinal (GI) events were observed in 1.3% of individuals with colonoscopy, 1.9% had other GI events, and 1.2% had an incident cardiovascular event. Mean event-related costs were $2,631 among individuals with a serious GI event, $1,774 among individuals with any other GI event, and $4,234 among individuals with a cardiovascular event. This study provides updated and more detailed information regarding the costs of CRC screening and potential colonoscopy events based on a comprehensive review of a robust claims dataset. [ABSTRACT FROM AUTHOR]

This study aims to measure the association between deprivation, health care accessibility and health care system with the likelihood of receiving non-restorative rectal cancer surgery (NRRCS). All adult patients who had rectal resection for invasive adenocarcinoma diagnosed between 2007 and 2016 in four French specialised cancer registries were included. A multilevel logistic regression with random effect was used to assess the link between patient and health care structure characteristics on the probability of NRRCS. 2997 patients underwent rectal cancer resection in 68 health care structures: 708 (23.63%) had NRRCS. The likelihood of receiving NRCCS was associated with patients' characteristics (97%): age, sub peritoneal rectal tumors, neoadjuvant therapy, residual tumour and stage III. There was no impact of European Deprivation Index or remoteness on NRRCS. Inter-health care structure variability was modest (3%), of which 50% was explained by the high group volume of colorectal procedures and the type of health care structure which were associated with less NRRCS (p <0.01). There is an influence of operating volume and type of structure on the probability of NRRCS, but it has truly little importance in explaining differences in performances. The probability of NRRCS is mainly affected by clinical determinant. [ABSTRACT FROM AUTHOR]

Background: Numbers of GP locums in the NHS have grown in recent years, yet evidence on the scale and scope of the locum workforce in general practice is sparse.Aim: To identify characteristics, geographical patterns, and drivers of GP locum use.Design and Setting: Observational study of routine data from general practices in England.Method: Descriptive analyses of national GP workforce data between December 2017 and September 2020 were conducted to determine the volume and geographical distribution of locum use and examine the characteristics of locums compared with other GP types. Locum full-time equivalent (FTE) was modelled using negative binomial regression and estimated incidence rate ratios (IRRs) for associations between outcome and characteristics of practices and population.Results: In December 2019, total locum FTE was 1217.9 compared with 33 996.6 for total GP FTE. Locums represented 3.3% of total GP FTE, which was fewer than other GP types. Median locum age was 42 years (interquartile range [IQR] 36 to 51) FTE and the majority were UK qualified (660 of 1034 [63.8%] total locum FTE), were male (642.6 of 1178.9 [54.5%] total locum FTE), and had long-term employment (834.1 of 1127.9 [74.0%]) total locum FTE. Rurality (IRR 1.250 [95% CI = 1.095 to 1.428]), inadequate Care Quality Commission ratings (IRR 2.108 [95% CI = 1.370 to 3.246), and single-handed practice (IRR 4.611 [95% CI = 4.101 to 5.184) were strong predictors of locum use. There was substantial variation in locum use between regions.Conclusion: GP locum use remained stable over time. Compared with other GPs, locums were younger male GPs, a substantial percentage of whom did not qualify in the UK, and those who served underperforming practices in rural areas. This is likely to reflect recruitment or high turnover challenges in these practices/areas and can provide a greater understanding of general practice workforce challenges in England. [ABSTRACT FROM AUTHOR]

Background The Hospital Frailty Risk Score (HFRS) has made it possible internationally to identify subgroups of patients with characteristics of frailty from routinely collected hospital data. Objective To externally validate the HFRS in France. Design A retrospective analysis of the French medical information database. Setting 743 hospitals in Metropolitan France. Subjects All patients aged 75 years or older hospitalised as an emergency in 2017 (n  = 1,042,234). Methods The HFRS was calculated for each patient based on the index stay and hospitalisations over the preceding 2 years. Main outcome measures were 30-day in-patient mortality, length of stay (LOS) >10 days and 30-day readmissions. Mixed logistic regression models were used to investigate the association between outcomes and HFRS score. Results Patients with high HFRS risk were associated with increased risk of mortality and prolonged LOS (adjusted odds ratio [aOR] = 1.38 [1.35–1.42] and 3.27 [3.22–3.32], c-statistics = 0.676 and 0.684, respectively), while it appeared less predictive of readmissions (aOR = 1.00 [0.98–1.02], c-statistic = 0.600). Model calibration was excellent. Restricting the score to data prior to index admission reduced discrimination of HFRS substantially. Conclusions HFRS can be used in France to determine risks of 30-day in-patient mortality and prolonged LOS, but not 30-day readmissions. Trial registration: Reference ID on clinicaltrials.gov: ID: NCT03905629. [ABSTRACT FROM AUTHOR]

To estimate the degree of concordance and consistency in the radiographic and tomographic evaluation of the periapical area. A study of diagnostic tests was designed. Three blind evaluators analyzed radiographic images, which were selected at two different points in time. An oral radiologist and an endodontist determined the second observation moment. The degree of similarity and variability, concordance and consistency for each radiograph was set at 95% confidence. A Kappa coefficient (κ), for radiographic findings and a correlation coefficient of Lin (CCC) for tomographic measurements was established. 12 radiographies and 19 tomographs were evaluated. The intraobserver consistency determined a k= 1 (Almost Perfect) and a CCC from 0.42 to 0.95 (Poor to Substantial) for both observation times. For radiographies, the interobserver concordance did not show changes between the first and second observation. Values include a k= 0.56-0.80 (Moderate to Good) and a CCC with greater degree of agreement, after training, as follows: axial view: CCC 0.86, 95% of Confidence Interval (CI) 0.69-0.94, coronal view: CCC 0.90 95%CI 0.75-0.96, and sagittal view: CCC 0.96, 95%CI 0.90-0.98. The statistical tests estimated the consistency and concordance to observe radiographically and tomographically the periapical tissue in endodontics. Se diseñó un estudio de pruebas diagnósticas para estimar el grado de concordancia y consistencia en la evaluación radiográfica y tomográfica del área periapical. Tres evaluadores ciegos analizaron imágenes radiográficas, que fueron seleccionadas en dos momentos diferentes. El grado de similitud y variabilidad, concordancia y consistencia para cada radiografía se estableció en un 95% de confianza. Se estableció un coeficiente Kappa (κ), para los hallazgos radiográficos y un coeficiente de correlación de Lin (CCC) para las mediciones tomográficas. Se evaluaron 12 radiografías y 19 tomografías. La consistencia intraobservador determinó un k = 1 (casi perfecto) y un CCC de 0,42 a 0,95 (deficiente a sustancial) para ambos tiempos de observación. Para las radiografías, la concordancia entre observadores no mostró cambios entre la primera y la segunda observación. Los valores incluyen un k = 0.56-0.80 (moderado a bueno) y un CCC con mayor grado de acuerdo, después del entrenamiento, de la siguiente manera: vista axial: CCC 0.86, 95% del intervalo de confianza (IC) 0.69-0.94, vista coronal: CCC 0.90 IC del 95% 0,75-0,96 y sagital view: CCC 0,96, IC del 95% 0,90-0,98. Las pruebas estadísticas estimaron la consistencia y concordancia para observar radiográfica y tomográficamente. [ABSTRACT FROM AUTHOR]

Abstract Background Mortality rates due to coronary heart disease (CHD) have decreased in most countries, but increased in low and middle-income countries. Few studies have analyzed the trends of coronary heart disease mortality in Latin America, specifically the trends in young-adults and the effect of correcting these comparisons for nonspecific causes of death (garbage codes). The objective of this study was to describe and compare standardized, age-specific, and garbage-code corrected mortality trends for coronary heart disease from 1985 to 2015 in Argentina, Colombia, and Mexico. Methods Deaths from coronary heart disease were grouped by country, year of registration, sex, and 10-year age bands to calculate age-adjusted and age and sex-specific rates for adults aged ≥25. We corrected for garbage-codes using the methodology proposed by the Global Burden of Disease. Finally, we fitted Joinpoint regression models. Results In 1985, age-standardized mortality rates per 100,000 population were 136.6 in Argentina, 160.6 in Colombia, and 87.51 in Mexico; by 2015 rates decreased 51% in Argentina and 6.5% in Colombia, yet increased by 61% in Mexico, where an upward trend in mortality was observed in young adults. Garbage-code corrections produced increases in mortality rates, particularly in Argentina with approximately 80 additional deaths per 100,000, 14 in Colombia and 13 in Mexico. Conclusions Latin American countries are at different stages of the cardiovascular disease epidemic. Garbage code correction produce large changes in the mortality rates in Argentina, yet smaller in Mexico and Colombia, suggesting garbage code corrections may be needed for specific countries. While coronary heart disease (CHD) mortality is falling in Argentina, modest falls in Colombia and substantial increases in Mexico highlight the need for the region to propose and implement population-wide prevention policies.

Introduction: the aim was to conduct a bibliometric study regarding the scientific production on dental caries in the period 2014–2018. Methods: a bibliometric study in a five-year period including 2,291 publications from the Web of Science database. The following variables were included: annual production of articles, journals, authors, cooperation, and citation analysis. Results: a sustained production of information has been conducted throughout the study years. Paiva, from Brazil, is the author with the largest number of publications (n = 33); the journal with the highest number of articles is Caries Research (n = 176). The United States and Brazil are the countries with the most publications on this topic. Conclusions: there is a sustained production of publications on dental caries, validating this topic and showing the importance of scientific groups conducting research in the fields of diagnosis, prevention, and public health mainly.

We analysed all proven cases of SARS-CoV-2 on sea-going vessels entering or present in the Port of Rotterdam to illustrate the burden of the corona pandemic on commercial shipping. We calculated the notification rate (NR) per arrival and attack rate per vessel and correlated outbreak sizes by vessel type over time during the pandemic using routinely gathered data from the port and public health (PH) authorities.

Existing quantitative imaging biomarkers (QIBs) are associated with known biological tissue characteristics and follow a well-understood path of technical, biological and clinical validation before incorporation into clinical trials. In radiomics, novel data-driven processes extract numerous visually imperceptible statistical features from the imaging data with no a priori assumptions on their correlation with biological processes. The selection of relevant features (radiomic signature) and incorporation into clinical trials therefore requires additional considerations to ensure meaningful imaging endpoints. Also, the number of radiomic features tested means that power calculations would result in sample sizes impossible to achieve within clinical trials. This article examines how the process of standardising and validating data-driven imaging biomarkers differs from those based on biological associations. Radiomic signatures are best developed initially on datasets that represent diversity of acquisition protocols as well as diversity of disease and of normal findings, rather than within clinical trials with standardised and optimised protocols as this would risk the selection of radiomic features being linked to the imaging process rather than the pathology. Normalisation through discretisation and feature harmonisation are essential pre-processing steps. Biological correlation may be performed after the technical and clinical validity of a radiomic signature is established, but is not mandatory. Feature selection may be part of discovery within a radiomics-specific trial or represent exploratory endpoints within an established trial; a previously validated radiomic signature may even be used as a primary/secondary endpoint, particularly if associations are demonstrated with specific biological processes and pathways being targeted within clinical trials. Key Points: • Data-driven processes like radiomics risk false discoveries due to high-dimensionality of the dataset compared to sample size, making adequate diversity of the data, cross-validation and external validation essential to mitigate the risks of spurious associations and overfitting. • Use of radiomic signatures within clinical trials requires multistep standardisation of image acquisition, image analysis and data mining processes. • Biological correlation may be established after clinical validation but is not mandatory. [ABSTRACT FROM AUTHOR]

Optimizing the utilization of radiology departments is one of the primary objectives for many hospitals. To support this, a solution has been developed, which at first transforms the export of different Radiological Information Systems (RIS) into the data format of a clinical data warehouse (CDW). Additional features, like for example the time between the creation of a radiologic request and the finalization of the diagnosis for the created images, can then be defined using a simple interface and are calculated and saved in the CDW as well. Finally, the query language of the CDW can be used to create custom reports with all the RIS data including the calculated features and export them into the standard formats Excel and CSV. The solution has been successfully tested with data from two German hospitals. [ABSTRACT FROM AUTHOR]

Background: Reducing disparities in men with prostate cancer (PCa) that may be caused by racial and socioeconomic differences is a major public health priority. Few reports have studied whether these disparities have changed over time. Methods: Men diagnosed with PCa from January 1, 2000 to December 31, 2015 were identified from the Massachusetts and Pennsylvania cancer registries. All‐cause mortality and PCa and cardiovascular cause‐specific mortality were assessed. To estimate neighborhood socioeconomic position (nSEP), a summary score was generated using census tract‐level measures of income, wealth, educational attainment, and racial and income segregation. Participants were grouped by diagnosis year (2000‐2003, 2004‐2007, 2008‐2011, or 2012‐2015), and changing trends in the mortality rate ratio by race and nSEP were estimated using covariate‐adjusted Cox models with follow‐up for up to 10 years, until death, or until censoring on January 1, 2018. Results: There were 193,883 patients with PCa and 43,661 deaths over 1,404,131 person‐years of follow‐up. The Black‐White adjusted hazard ratio (aHR) from 2000 to 2003 through 2012 to 2015 was stable for all‐cause mortality (aHR, 1.14 to 0.97; P for heterogeneity =.42), decreased for PCa‐specific mortality (aHR, 1.38 to 0.93; P for heterogeneity =.005), and increased for cardiovascular mortality (aHR, 1.09 to 1.28; P for heterogeneity =.034). The aHR comparing those in the lowest versus the highest nSEP quintile increased significantly for all‐cause mortality (aHR, 1.54 to 1.79; P for heterogeneity =.008), but not for PCa‐specific mortality (aHR, 1.60 to 1.72; P for heterogeneity =.40) or cardiovascular mortality (aHR, 1.72 to 1.89; P for heterogeneity =.085). conclusions: Although Black‐White disparities in prostate mortality declined in Massachusetts and Pennsylvania over the study period, nSEP mortality disparity trends were stagnant or increased, warranting further attention. Lay Summary: Few reports have examined whether racial and socioeconomic disparities in prostate cancer mortality have widened or narrowed in recent years.Using data from 2 state registries (Massachusetts and Pennsylvania) with differing intensities of government‐mandated health insurance, trends in racial and neighborhood socioeconomic disparities were studied among Black and White men diagnosed from 2000 to 2015.Overall, trends in racial disparities were stagnant for all‐cause mortality, shrank for prostate mortality, and widened for cardiovascular mortality.Disparities associated with neighborhood socioeconomic status either were stagnant or widened across all mortality end points.In general, disparities were more pronounced in Pennsylvania than in Massachusetts. Trends in racial disparities among Black men and White men in Pennsylvania and Massachusetts diagnosed with prostate cancer from 2000 to 2015 are stagnant for all‐cause mortality, shrink for prostate mortality, and widen for cardiovascular mortality. Disparities associated with neighborhood socioeconomic status either are stagnant or widen across all mortality endpoints. [ABSTRACT FROM AUTHOR]

The polymorphism of its concept, as well as the complexity of its multiple spatial dimensions, make the measurement of segregation a challenging subject. Which is why, over the years, methodological approaches have been developed, which have produced different indicators to quantify the phenomenon. On the one hand, there are the traditional indicators, which have been criticized for the flaws attributed to them, among which their inability to reveal the way in which the phenomenon is spatially distributed stands out. On the other hand, there are spatial indicators, created from the development of spatial statistics and the availability of Geographic Information System (GIS) software, which are believed to be conceptually and operationally superior. This has led some Latin American researchers to propose abandoning the use of traditional indicators altogether, and to exclusively use the indicators considered as spatial. However, this article shows how, from a complementary approach, spatial and aspatial indicators can be articulated to reveal the different spatial dimensions of residential segregation, and thus reduce arbitrariness in their measurement, representation, and interpretation. While, at the same time, it addresses the limited availability of individual spatial data that characterizes Latin America. The results of the study of socioeconomic residential segregation in Managua, through the Dissimilarity Index and the Global Moran's Index, show that the city exhibits small-scale segregation, and that the most segregated group in terms of concentration and grouping is the population with a college degree. It also reveals that although spatial indicators seek to capture the inherently geographical nature of residential segregation, their exclusive use fails to address the spatial multidimensionality of the phenomenon and can lead to gaps in its quantification. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes is a leading contributor to cardiovascular disease and mortality; social determinants of health (SDOH) are associated with disparities in diabetes risk. Quantifying the cumulative impact of SDOH and identifying the SDOH most associated with diabetes prevalence at the neighbourhood level can help policy-makers design and target local interventions to mitigate these disparities. Machine learning (ML) methods can provide novel insights and help inform public health intervention strategies in a place-based manner., Methods: In a cross-sectional study, we used gradient boosting ML models to estimate the cumulative contribution of a set of SDOH variables to diabetes prevalence (%) at the census tract level within New York City (NYC); Shapley Additive Explanations were used to assess the magnitude and shape of relationships between our SDOH variables and model-predicted NYC diabetes prevalence. SDOH measures included socioeconomic position, educational attainment, food access, air quality, neighbourhood environment, housing conditions and insurance coverage., Results: Across 2096 NYC census tracts (population 8 170 505), mean diabetes prevalence was 11.5% (SD 3.7%; range 1.9%-42.8%). A set of 16 SDOH variables representing a framework of 16 distinct SDOH concepts accounted for 67% of the between-tract variance in model-derived NYC diabetes prevalence estimates (95% CI 66% to 68%); a set of 81 variables representing these 16 concepts accounted for 80% of variance (95% CI 78% to 81%). Models showed excellent across-location generalisation. The most important variables driving model predictions within NYC were measures of low educational attainment and poverty., Conclusions: SDOH accounted for a substantial proportion of neighbourhood-level variation in diabetes prevalence within NYC, independent of the demographics and health behaviours associated with those SDOH. Our place-based findings suggest that, within NYC, where approximately one million residents have diabetes and there are legislative requirements to reduce the impacts from diabetes, policies reducing socioeconomic and educational inequality could have the greatest potential to equitably achieve this., Competing Interests: None declared., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)

Objective: Obesity is associated with a significant clinical and economic burden and its prevalence has reached epidemic proportions worldwide. An ethnicity-specific impact of excess weight has been demonstrated, with Asian individuals exhibiting weight-related health problems at lower body mass indexes (BMIs) than Caucasians. We aimed to adapt the core obesity model (COM) to predict incidences of weight-associated diseases, including type 2 diabetes, acute coronary syndrome (ACS), stroke, cancers, sleep apnoea, hyperuricaemia/gout, total knee replacement (TKR) and non-alcoholic fatty liver disease (NAFLD) in a Japanese population., Methods and Analysis: Literature was searched to identify studies reporting the association between risk factors and comorbidities in Japanese populations. Data were extracted to update the COM risk prediction equations. Internal and external validation were performed., Results: Overall, good internal validity was achieved, with mild underestimation for diabetes, cardiovascular and all-cause death taken together (ordinary least squares linear regression [OLS-LRL] 0.8844), moderate overestimation of TKR and cancers (OLS-LRL 1.267) and a slight underestimation for NAFLD and hyperuricaemia (OLS-LRL 0.934). External validation results were aligned with known geographical patterns: complications occurred at lower BMI in Japanese individuals, with a threefold higher incidence of diabetes and twofold higher obstructive sleep apnoea, gout prevalence and colorectal cancer at equal BMI. Conversely, the 10-year cumulative ACS incidences predicted in a Japanese population were less than half of those in a Western population., Conclusion: The Japanese COM adaptation addresses ethnicity-specific patterns of overweight/obesity, with better sensitivity to lower BMIs for several associated complications. It may support regional public health policy and research., Competing Interests: IT received lecture fees from Takeda Pharmaceutical Co., Ltd., and received research grants from Takeda Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd. and Bayer Yakuhin, Ltd., (Copyright © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. Published by BMJ.)