Endangered Apes—Can Their Behaviors Be Used to Index Fear and Disturbance in Anthropogenic Landscapes?

Behaviors exhibited by prey species towards predators (including humans) can reduce feeding time and increase time spent in vigilance, thereby impacting animal condition and ultimately limit populations, even when actual mortality from predation is low. Here, we test whether behavioral profiles in an endangered ape, Javan gibbons (Hylobates moloch), correspond to varying degrees of human disturbance in a human-impacted sacred forest, Cagar Alam Leuweung Sancang, West Java. Data were collected August 2010–July 2011. Although all groups reacted differently to human presence, overall, gibbons responded by reducing time spent on conspicuous behavior (e.g., vocalizing, feeding, traveling, and social interactions) as the number of humans in the area increased or distance to the nearest human decreased. In addition, gibbon responses to encountering humans were also more like their responses to encountering potential predators than they were to encountering monkeys or other gibbons. These results support the hypothesis that as human presence and encounter rates increase, gibbons alter their behavior in ways consistent with anti-predator behaviors. Assessing how this endangered species responds to human presence is a vital part of their ultimate conservation.

Impact of GERAADA Score in Patients With Acute Type A Aortic Dissection

Background Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors’ institutional results. MethodsAmong 101 acute type A aortic dissection patients treated at our hospital during August 2015–March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores.ResultsWhile the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1-77.6) %, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality.ConclusionsAlthough the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

How many lives do COVID vaccines save? Evidence from Israel.

Background: In December 2020, Israel began a mass vaccination program with the rapid rollout of the Pfizer-BioNTech COVID-19 BNT162b2 vaccine for adults in Israel. The campaign vaccinated fewer people than necessary for herd immunity. However, at the same time, government stringency measures in terms of closing public life were decreased. Real-world observational data were used to examine the effect of mass vaccination on Covid-19 mortality. Methods: The study period to examine the effect of vaccination on mortality was chosen to capture when at least 90% of the population over age 70 were vaccinated for less than seven months. Projected deaths as expected from vaccine efficacy and actual mortality data were compared for the study population with examination of potential confounding effects of government stringency. Average government stringency (Oxford Stringency Index) was calculated in the study period and the preceding period of the pandemic. Potential confounding effects of an age shift in the distribution of deaths were examined by analyzing the distributions of deaths and cases before and after the study period. Results: Confirmed deaths from COVID-19 in the population over 70 after mass vaccination were recorded as 370, versus 408 expected from applying person-days of vaccine efficacy, and 5,120 estimated without vaccinations. Conclusions: Vaccines against COVID-19 saved more lives than expected by simply applying individual vaccine efficacy to the vaccinated population in Israel, despite a loosening of government stringency.

Deaths and Injuries from Unintentional Falls: An Analysis of Nepal Police Records

Falls are a major cause of unintentional injury-related global mortality and morbidity. The actual mortality and morbidity from falls in Nepal have been overlooked and not systematically studied. This study, therefore, aims to present the national status of fall-related deaths and injuries. The study analyzed the fall incidents recorded by Nepal Police for five fiscal years (17 July 2014 to 16 July 2019). These incident recordings were in the form of narratives, and possible variables were extracted for the analysis. In five years, 4,714 people were injured or died from falls in Nepal. The average age of the fall victim was 35.6 years (SD=19.94); the mean age of the person who died from falls was slightly lower (30.9 years) than the injured person (40.4 years). The analysis showed that the fall cases were remarkably greater for males than females. This study found that Bagmati Province, where the capital city was located has the highest death and injury rates from falls, followed by Gandaki Province and Province 1. The study identified 11 different locations of falls. These findings revealed that Nepal has a considerable burden of fall deaths and injuries. However, the actual burden of fall injuries might be higher due to the under-reporting of the incidents through the Nepal Police data recording system.

The effectiveness of hepatosplanchnic ischemia treatment monitored with intramucosae pH in polytrauma

The study aimed to substantiate and introduce the empirical oxygenation of general and local action into intensive care for heptosplanchnic ischemia during polytrauma. The study included 85 patients with polytrauma with the brain injury of mild to moderate severity according to the modern clinical classification. The conditions for inclusion in the study were as follow: Injury Severity Score (ISS) more than 32 points, Acute Physio­logy and Chronic Health Evaluation (APACHE II) — 25 points or more. Clinical and biochemical studies were carried out at the following stages: upon admission (stage 1), 12–24 hours after the start of intensive care (stage 2), in 3, 5, 7 days (stages 3, 5, 7, respectively). The clinical observation was carried out up to 32 days from the time of the injury. The manifestations showed certain differences depending on the outcome of the disease. Victims with a subsequent fatal outcome had higher blood loss (by 27.65 %, p < 0.05), blood volume deficiency (by 33.42 %, p < 0.05), more severe hypotension, tachycardia; increased arterial hypoxemia; the indicator of venous blood shunting in the lungs significantly exceeded the normal values and those of the group of survivors. With sigmoidal gas tonometry in survivors, the intramucosal pH ranged 6.88–7.0; pCO2 from 85.6 to 118.38 mmHg. In the dead, the intramucosal pH ranged from 6.79 to 6.9 units; pCO2 from 95.61 to 121.71 mmHg. In 85 % of cases of endoscopic visuali­zation, erosive-ulcerative changes in the mucous membrane of the antrum were determined. Gastrointestinal insufficiency in patients with subsequent fatal outcome clinically corresponded to II–III stages; according to the manifestations of histological changes in the mucous membrane of the antrum of the stomach to the III–IV stages. The described features are based on the prevalence of 11.77 % ISS scales in deceased victims, APACHE II by 20.78 %, and SOFA by 71.52 %, which determines the severity of the damage, the condition of the victims, and the severity of organ damage. Starting from the 1st day of intensive care, the differences between the studied parameters in survivors and deceased victims continued to worsen. In surviving patients, oxygenation of arterial blood was restored from the first day to the physiological values due to the elimination of venous bypass blood in the lungs, and the transition to normodynamic blood circulation. Then on the 3rd day, the intramucosal pH was 99.59 % of the norm. In the dead, the restoration of the oxygenation index on the 1st day was combined with a decrease in tissue oxygen extraction, hypovolemic shock, refractory to vasopressor therapy from the 3rd day of the study. The pH values exceeded 7.35 only by the 5th day, while clinically the digestive function did not recover on the 7th day of the study. The data of the clinical evaluation of gastroenteric insufficiency were confirmed in the endoscopic picture, the data of histological and histochemical studies of the mucous membrane of the antrum. High, positive, reliable correlations between intramucosal pH and the outcome of the disease have been established. The actual mortality rate at the intermediate points was 20 %: 3 victims died on the 3rd day, 2 victims — on the 5th day. Before the 28th day of clinical observation, the actual mortality rate was 44 % (the rest 6 victims died from the 7th day to the 28th day). After 28 days to 32 days, death was not registered.

Abstract P428: The Intracerebral Hemorrhage Score Overestimates Mortality in Young Adults

Introduction: The intracerebral hemorrhage (ICH) score is a widely used scoring system for predicting mortality in patients with ICH. This score has been validated for use in adults of all ages with ICH, but not specifically for use in populations of young adults (age 18-45). We aimed to determine the validity of the ICH score when applied to young adults with ICH. Methods: This was a retrospective analysis of all patients aged 18-45 with spontaneous ICH consecutively admitted to our institution from 2009-2019. We calculated the ICH score for each patient, recording the individual subcomponents, and analyzed the scores for prediction of mortality at 30 days. We also analyzed the individual subcomponents of the score for effect on mortality. Results: We identified 156 patients (mean age 35 +/- 7.8; 67 were female, 103 were white) to include in our study. The 30-day mortality rate was 15% (n=24); these patients had a mean age of 34.9 +/- 7.8, compared to survivors who had mean age 35.4 +/- 7.8 (p=0.797). ICH scores were predictive of mortality (p=0.036 for trend); however, the actual mortality rates in our population were substantially lower than those predicted by the ICH score. Specifically, patients in our population with scores of 1, 2, or 3 had 30-day mortality rates of 0%, 3%, and 41%, compared to the current ICH score mortality predictions of 13%, 26%, and 72%, respectively. Scores of 4 and 5 in our population were more closely aligned to current ICH predictions (85% and 100% compared to 97% and 100%, respectively). Of the ICH score subcomponents, ICH volume >30mL (p=0.007) and Glasgow Coma Scale (GCS) scores of 3 or 4 (p=0.014) were the strongest predictors of mortality at 30 days. Conclusion: The ICH score is predictive of mortality for adults of all ages, but the specific mortality rates associated with this scoring system vary considerably when applied to young adults (age 18-45). This over-estimation should be taken into consideration when applying the predictions of the ICH score to young adults with ICH; additionally, special attention should be given to ICH volume >30mL and very low GCS scores, as these were the strongest predictors of early mortality.

Survival among patients with severe high cervical spine injuries – a TraumaRegister DGU® database study

Background Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group. Methods In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group. Results Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 h. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%. Conclusions An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected.

Three unpublished Caesarean Sections, done by John Wysor

Prof. Ayers says that the generally accepted 1O% of mortality from caesar section in medical statistics does not really represent actual mortality; the latter, in his opinion, should be much more, up to 30%. In view of this, he publishes 3 cases that have remained so far unknown.

Survival among patients with severe high cervical spine injuries – A TraumaRegister DGU® database study

BackgroundTrauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group.MethodsIn a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group.ResultsSix hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 hours. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%.ConclusionsAn AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected.

Mortality from COVID in Colombia and Peru: Analyses of Mortality Data and Statistical Forecasts

National predictions of the course of COVID mortality can be used to plan for effective healthcare responses as well as to support COVID policymaking. We developed the Global COVID Assessment of Mortality (GCAM), a statistical model with continually improving precision that combines actual mortality counts with Bayesian inference, to predict COVID trends, currently until December 1, 2020. In Colombia, the GCAM analysis found the peak of COVID mortality around August 12 and an expected total of COVID deaths of 24,000-31,000, or 48%-92% over the total through August 21. In Peru, a first mortality peak occurred around May 24, and given the current trajectory, a second peak is predicted around September 6. Peru can expect 29,000-43,000 COVID deaths, representing an increase of 7%-55% over COVID deaths through August 21. GCAM projections are also used to estimate medical surge capacity needs. To gauge the reliability of COVID mortality forecasts, we compared all-cause mortality from January through June 2020 with average all-cause mortality in previous years in Colombia and Peru, and found that the excesses were consistent with GCAM forecast, most notably a doubling of overall mortality from May 25-June 7th of weeks in Peru. The GCAM results predict that as a percentage of all adult deaths in previous years, Colombia can expect about 13% excess from COVID deaths, whereas Peru can expect 34% excess. Comparisons of GCAM analyses of several other countries with Colombia and Peru demonstrate the extreme variability that characterizes COVID mortality around the world, emphasizing the need for country-specific analyses and ongoing monitoring as more mortality data become available.