Assessing excess mortality in times of pandemics based on principal component analysis of weekly mortality data—the case of COVID-19

The COVID-19 outbreak has called for renewed attention to the need for sound statistical analyses to monitor mortality patterns and trends over time. Excess mortality has been suggested as the most appropriate indicator to measure the overall burden of the pandemic in terms of mortality. As such, excess mortality has received considerable interest since the outbreak of COVID-19 began.Previous approaches to estimate excess mortality are somewhat limited, as they do not include sufficiently long-term trends, correlations among different demographic and geographic groups, or autocorrelations in the mortality time series. This might lead to biased estimates of excess mortality, as random mortality fluctuations may be misinterpreted as excess mortality.We propose a novel approach that overcomes the named limitations and draws a more realistic picture of excess mortality. Our approach is based on an established forecasting model that is used in demography, namely, the Lee-Carter model. We illustrate our approach by using the weekly age- and sex-specific mortality data for 19 countries and the current COVID-19 pandemic as a case study. Our findings show evidence of considerable excess mortality during 2020 in Europe, which affects different countries, age, and sex groups heterogeneously. Our proposed model can be applied to future pandemics as well as to monitor excess mortality from specific causes of death.

Excess Mortality Probably Attributable to COVID-19 in Tokyo, Japan During August and October 2020

Background: By March, 2021, the COVID-19 outbreak had reached its highest peak at the end of December, 2020. Nevertheless, no remarkable excess mortality attributable to COVID-19 has been observed. Object: We sought to quantify excess mortality in April using the National Institute of Infectious Diseases (NIID) model. Method: We applied the NIID model to deaths of all causes from 1987 through February, 2021 for all of Japan and through October for Tokyo. Results: Results obtained for Japan show very few excess mortality cases in August and October, 2020, estimated respectively as 12 and 104. However, in Tokyo, 595 cases of excess mortality were detected during August and October: they were, respectively, 3.1% and 1.7% of baseline numbers. Discussion and Conclusion: We detected considerable excess mortality in Tokyo but not throughout Japan. Continued careful monitoring of excess mortality of COVID-19 is expected to be important.

Potentially inappropriate medications (PIMs): frequency and extent of GP-related variation in PIMs: a register-based cohort study

ObjectivesPotentially inappropriate medications (PIMs) pose an increasing challenge in the ageing population. We aimed to assess the extent of PIMs and the prescriber-related variation in PIM prevalence.DesignNationwide register-based cohort study.SettingGeneral practice.ParticipantsThe 4.2 million adults listed with general practitioner (GP) clinics in Denmark (n=1906) in 2016.Main outcome measuresWe estimated the patients’ time with PIMs by using 29 register-operationalised STOPP criteria linking GP clinics and redeemed prescriptions. For each criterion and each GP clinic, we calculated ratios between the observed PIM time and that predicted by multivariate Poisson regressions on the patients. The observed variation was measured as the 90th/10th percentile ratios of these ratios. The extent of expectable random variation was assessed as the 90th/10th percentile ratios in randomly sampled GP populations (ie, the sampled variation). The GP-related excess variation was calculated as the ratio between the observed variation and sampled variation. The linear correlation between the observed/expected ratio for each of the criteria and the observed/expected ratio of total PIM time (for each clinic) was measured by Pearson’s rho.ResultsOverall, 294 542 individuals were exposed to 1 44 117 years of PIMs. The two most prevalent PIMs were long-term use (>3 months) of non-steroidal anti-inflammatory drugs (51 074 years of PIMs) or benzodiazepines (48 723 years of PIMs). These two criteria showed considerable excess variation of 2.33 and 3.05, respectively; for total PIMs, this figure was 1.65. For more than half of the criteria, we observed a positive correlation between the specific PIM and the sum of remaining PIMs.ConclusionsThis study documents considerable variations in the prescribing practice of GPs for certain PIMs. These findings highlight a need for exploring the causal explanations for such variations, which could be markers of suboptimal GP-prescribing strategies.

COVID-19 mortality according to civilian records

In this short report, we bring some data-driven analyses of COVID-19 mortality in Brazil. The impact of COVID-19 is evaluated by comparing the 2019 and 2020 civilian death records. There is evidence of a considerable excess of deaths since the pandemic started with respect to the previous year. In some states, it is clear that not all excess of deaths in 2020 is due to COVID-19, but to other respiratory causes that did not present the same prevalence in the previous year. Because of this unusual behavior of respiratory deaths, we may infer the evidence of a huge amount of under-reporting deaths due to the COVID-19. The data also shows that COVID-19 has produced an excess death in all ages besides people above 90 and below 10 years. In addition, when separates by sex, data indicate a larger increase in the deaths among males than females.

The Impact of Utilizing Silica Fume as a Filler on Asphalt Concrete Mixes

This study evaluates the influence of utilizing silica fume as a stabilizer to the filler on the behavior of asphalt mixes. The investigation of the properties of asphalt mixes was conducted by using different percentages of Silica Fume (0, 3, 6, and 9% by filler weight). Results indicate that, the OAC is 4.7% and it achieves the best results in the Marshall tests. Marshall Stability is increased by about 27.5% and the flow is decreased by about 20.2 %. In this study the implementation of 9% of silica fume in the asphalt concrete mix showed a considerable excess in the resistance to moisture damage of 28% when compared to the original mix. A great decrease in the tensile strength of asphalt concrete mixes, in a range from (4-15)% could be noticed following the moisture damage process for both the reference and silica fume adjusted mixes. Six percent of it was the optimum percent that had developed the tensile characteristics of the hot asphalt concrete mixes. The moisture sensibility of the asphalt concrete was reduced with an increase in the silica fume content. Following the moisture damage process, Silica fume of 9% was the optimum percent that had developed the punching shear characteristics of asphalt concrete. It exhibited a positive effect of 20%, while 6-9% of silica fume exhibited a positive effect of 5-9% on the development of the tensile characteristics of asphalt concrete.

Evidence for significant protein-like dissolved organic matter accumulation in Sea of Okhotsk sea ice

Absorption and fluorescence of chromophoric dissolved organic matter (CDOM) in sea ice and surface waters in the southern Sea of Okhotsk was examined. Sea-water CDOM had featureless absorption increasing exponentially with shorter wavelengths. Sea ice showed distinct absorption peaks in the ultraviolet, especially in younger ice. Older first-year sea ice had relatively flat absorption spectra in the ultraviolet range. Parallel factor analysis (PARAFAC) identified five fluorescent CDOM components, two humic-like and three protein-like. Sea water was largely governed by humic-like fluorescence. In sea ice, protein-like fluorescence was found in considerable excess relative to sea water. The accumulation of protein-like CDOM fluorescence in sea ice is likely a result of biological activity within the ice. Nevertheless, sea ice does not contribute excess CDOM during melt, but the material released will be of different composition than that present in the underlying waters. Thus, at least transiently, the CDOM introduced during sea-ice melt might provide a more labile source of fresher protein-like DOM to surface waters in the southern Sea of Okhotsk.

Disulfide Bond Formation in Secreton Component PulK Provides a Possible Explanation for the Role of DsbA in Pullulanase Secretion

ABSTRACT When expressed in Escherichia coli, the 15Klebsiella oxytoca pul genes that encode the so-called Pul secreton or type II secretion machinery promote pullulanase secretion and the assembly of one of the secreton components, PulG, into pili. Besides these pul genes, efficient pullulanase secretion also requires the host dsbA gene, encoding a periplasmic disulfide oxidoreductase, independently of disulfide bond formation in pullulanase itself. Two secreton components, the secretin pilot protein PulS and the minor pseudopilin PulK, were each shown to posses an intramolecular disulfide bond whose formation was catalyzed by DsbA. PulS was apparently destabilized by the absence of its disulfide bond, whereas PulK stability was not dramatically affected either by adsbA mutation or by the removal of one of its cysteines. The pullulanase secretion defect in a dsbA mutant was rectified by overproduction of PulK, indicating reduced disulfide bond formation in PulK as the major cause of the secretion defect under the conditions tested (in which PulS is probably present in considerable excess of requirements). PulG pilus formation was independent of DsbA, probably because PulK is not needed for piliation.

Methods used for suicide by farmers in England and Wales

BackgroundFarmers in the UK have an elevated risk of suicide. It has been suggested that this may be related to their ease of access to dangerous means for suicidal behaviour. The extent to which farmers use these means and changes in their use may be relevant to suicide prevention.MethodData on 719 deaths in farmers of both genders in England and Wales between 1981 and 1993 in which a verdict of suicide or undetermined cause (open verdict) was recorded were analysed.ResultsOf 702 deaths in male farmers, farms were involved in 40.0%, hanging in 29.6%, carbon monoxide in 16.4%, poisoning in 8.0% (over half of which involved agricultural or horticultural poisons) and other methods in 6.1%. There was a considerable excess of deaths due to firearms compared with the distribution of methods of suicide and open verdict deaths in males in the general population. Hanging was also somewhat more frequent. During the study period there was a reduction in firearm death rates, particularly after 1989 when there was national legislation on firearm ownership, registration and storage. There were also fewer farming suicides after this date. By the end of the study period hanging was more frequent than deaths involving firearms.ConclusionsFarmers who commit suicide tend to use methods to which they have easy access. Restriction of the ready availability of such methods, particularly in farmers known to be depressed or otherwise at risk, might prevent some suicides.

Marriage, Bargaining, and Intrahousehold Resource Allocation: Excess Female Mortality among Adults during Early German Development, 1740–1860

This article investigates sex-specific mortality rates in eighteenth- and nineteenthcentury rural Germany to determine whether there was any gender bias in the allocation of household resources. Family reconstitution data from 60 villages provide evidence of considerable excess female mortality among married adults. The empirical findings are consistent with a bargaining approach to understanding intrahousehold resource allocation and suggest that women's survival disadvantage is related to their positions in the remarriage market, the perceived value of their work, as well as differences in altruism. Agricultural change appears to be one factor responsible for the emergence of this disadvantage.

A translocated erythropoietin receptor gene in a human erythroleukemia cell line (TF-1) expresses an abnormal transcript and a truncated protein

We previously identified a translocation breakpoint in exon 8 of the erythropoietin receptor (EpoR) gene in TF-1 cells, a cell line derived from a human erythroleukemia. To investigate the potential pathogenetic significance of this abnormality, we more precisely mapped the breakpoint within exon 8 and studied the expression of the translocated gene by S1 nuclease mapping of EpoR transcripts and chemical crosslinking of labeled erythropoietin (Epo) to TF-1 cell surface receptors. Transcripts from the abnormal gene were found to be highly expressed in relation to normal EpoR transcripts in TF-1 cells. The breakpoint predicted by S1 mapping of abnormal EpoR transcripts agreed closely with that determined by Southern analysis. Chemical cross- linking of 125I-Epo to TF-1 cells showed an abnormal, low-molecular- weight cross-linked species directly recognized by anti-EpoR antibodies and present in considerable excess over the normal EpoR. Karyotype analysis showed that each of 10 TF-1 cell metaphases had, in addition to multiple other alterations, one chromosome 19 with additional chromosomal material translocated onto the short arm at 19p13.3, the location of the EpoR gene. We conclude that the structurally abnormal EpoR gene in TF-1 cells is highly expressed and produces an abnormal protein. We speculate that the chromosomal material brought into the EpoR locus by translocation is responsible for the high level of expression. We hypothesize that this translocation participated in the evolution of the erythroleukemia from which TF-1 cells were derived.