Background In the United States, Coronavirus Disease 2019 (COVID-19) deaths are captured through the National Notifiable Disease Surveillance System and death certificates reported to the National Vital Statistics System (NVSS). However, not all COVID-19 deaths are recognized and reported because of limitations in testing, exacerbation of chronic health conditions that are listed as the cause of death, or delays in reporting. Estimating deaths may provide a more comprehensive understanding of total COVID-19–attributable deaths. Methods We estimated COVID-19 unrecognized attributable deaths, from March 2020—April 2021, using all-cause deaths reported to NVSS by week and six age groups (0–17, 18–49, 50–64, 65–74, 75–84, and ≥85 years) for 50 states, New York City, and the District of Columbia using a linear time series regression model. Reported COVID-19 deaths were subtracted from all-cause deaths before applying the model. Weekly expected deaths, assuming no SARS-CoV-2 circulation and predicted all-cause deaths using SARS-CoV-2 weekly percent positive as a covariate were modelled by age group and including state as a random intercept. COVID-19–attributable unrecognized deaths were calculated for each state and age group by subtracting the expected all-cause deaths from the predicted deaths. Findings We estimated that 766,611 deaths attributable to COVID-19 occurred in the United States from March 8, 2020—May 29, 2021. Of these, 184,477 (24%) deaths were not documented on death certificates. Eighty-two percent of unrecognized deaths were among persons aged ≥65 years; the proportion of unrecognized deaths were 0•24–0•31 times lower among those 0–17 years relative to all other age groups. More COVID-19–attributable deaths were not captured during the early months of the pandemic (March–May 2020) and during increases in SARS-CoV-2 activity (July 2020, November 2020—February 2021). Discussion Estimating COVID-19–attributable unrecognized deaths provides a better understanding of the COVID-19 mortality burden and may better quantify the severity of the COVID-19 pandemic. Funding None

Background Influenza burden estimates help provide evidence to support influenza prevention and control programs at local and international levels. Methods Through a systematic review, we aimed to identify all published articles estimating rates of influenza-associated hospitalizations, describe methods and data sources used, and identify regions of the world where estimates are still lacking. We evaluated study heterogeneity to determine if we could pool published rates to generate global estimates of influenza-associated hospitalization. Results We identified 98 published articles estimating influenza-associated hospitalization rates from 2007-2018. Most articles (65%) identified were from high-income countries, with 34 of those (53%) presenting estimates from the United States. While we identified fewer publications (18%) from low- and lower-middle-income countries, 50% of those were published from 2015-2018, suggesting an increase in publications from lower-income countries in recent years. Eighty percent (n = 78) used a multiplier approach. Regression modelling techniques were only used with data from upper-middle or high-income countries where hospital administrative data was available. We identified variability in the methods, case definitions, and data sources used, including 91 different age groups and 11 different categories of case definitions. Due to the high observed heterogeneity across articles ( I 2 >99%), we were unable to pool published estimates. Conclusions The variety of methods, data sources, and case definitions adapted locally suggests that the current literature cannot be synthesized to generate global estimates of influenza-associated hospitalization burden.

of total injuries. When fractures occur, they tend to involve the midface, and to a lesser degree the nasal bones and mandible. The need for changes in golf practices along with increased technique and safety education are evident. The debate remains on how and where to implement changes to have the greatest impact on the sport while attempting to preserve its key elements.

Substance abuse is a rare but known cause of sensorineural hearing loss (SNHL). We report a case of acute SNHL in a 28-year-old man following an overdose of methamphetamine and incidental ingestion of fentanyl. On initial encounter, he had moderate-to-severe hearing loss in the right ear and severe-to-profound hearing loss in the left ear in addition to acute kidney injury, liver failure, and lactic acidosis. The patient was treated with a two-week course of high-dose steroids and expressed a subjective improvement in hearing. This case highlights the importance of auditory testing following a drug overdose and is one of the only documented cases of hearing loss following methamphetamine use in recent years. There is a paucity of literature regarding the mechanism causing acute SNHL secondary to methamphetamines. Proposed etiologies include neurotransmitter depletion or reduced cochlear blood flow as possible causes of ototoxicity.

Prostate cancer is one of the most common cancers diagnosed in men in the United States and the second leading cause of cancer-related deaths worldwide. Since over 60% of prostate cancer cases occur in men over 65 years of age, and this population will increase steadily in the coming years, prostate cancer will be a major cancer-related burden in the foreseeable future. Accumulating data from more recent research suggest that the tumor microenvironment (TME) plays a previously unrecognized role in every stage of cancer development, including initiation, proliferation, and metastasis. Prostate cancer is not only diagnosed in the late stages of life, but also progresses relatively slowly. This makes prostate cancer an ideal model system for exploring the potential of natural products as cancer prevention and/or treatment reagents because they usually act relatively slowly compared to most synthetic drugs. Resveratrol (RSV) is a naturally occurring stilbenoid and possesses strong anti-cancer properties with few adverse effects. Accumulating data from both in vitro and in vivo experiments indicate that RSV can interfere with prostate cancer initiation and progression by targeting the TME. Therefore, this review is aimed to summarize the recent advancement in RSV-inhibited prostate cancer initiation, proliferation, and metastasis as well as the underlying molecular mechanisms, with particular emphasis on the effect of RSV on TME. This will not only better our understanding of prostate cancer TMEs, but also pave the way for the development of RSV as a potential reagent for prostate cancer prevention and/or therapy.

Background Brief assessments of functional status for community-dwelling older adults are needed given expanded interest in the measurement of functional decline. Methods As part of a 2015 prospective cohort study of older adults aged 60–89 years in Jiangsu Province, China, 1506 participants were randomly assigned to two groups; each group was administered one of two alternative 20-item versions of a scale to assess activities of daily living (ADL) and instrumental activities of daily living (IADL) drawn from multiple commonly-used scales. One version asked if they required help to perform activities (ADL-IADL-HELP-20), while the other version provided additional response options if activities could be done alone but with difficulty (ADL-IADL-DIFFICULTY-20). Item responses to both versions were compared using the binomial test for differences in proportion (with Wald 95% confidence interval [CI]). A brief 9-item scale (ADL-IADL-DIFFICULTY-9) was developed favoring items identified as difficult or requiring help by ≥4%, with low redundancy and/or residual correlations, and with significant correlations with age and other health indicators. We repeated assessment of the measurement properties of the brief scale in two subsequent samples of older adults in Hong Kong in 2016 (aged 70–79 years; n = 404) and 2017 (aged 65–82 years; n = 1854). Results Asking if an activity can be done alone but with difficulty increased the proportion of participants reporting restriction on 9 of 20 items, for which 95% CI for difference scores did not overlap with zero; the proportion with at least one limitation increased from 28.6% to 34.2% or an absolute increase of 5.6% (95% CI = 0.9–10.3%), which was a relative increase of 19.6%. The brief ADL-IADL-DIFFICULTY-9 maintained excellent internal consistency (α = 0.93) and had similar ceiling effect (68.1%), invariant item ordering (H trans = .41; medium), and correlations with age and other health measures compared with the 20-item version. The brief scale performed similarly when subsequently administered to older adults in Hong Kong. Conclusions Asking if tasks can be done alone but with difficulty can modestly reduce ceiling effects. It’s possible that the length of commonly-used scales can be reduced by over half if researchers are primarily interested in a summed indicator rather than an inventory of specific types of deficits.

Objectives: To describe volleyball-associated craniofacial injuries presenting to emergency departments (EDs) in the United States by patient demographics, injury type, anatomical location, and disposition. Design: An analysis of volleyball-related trauma was conducted using the National Electronic Injury Surveillance System (NEISS). Chi-squared testing (X2) was performed to compare categorical variables. Setting: The NEISS database collects information from approximately 100 EDs under the United States Consumer Product Safety Commission and provides data extrapolated to a nationally representative sample. Participants: The database was queried from years 2009-2018. Main outcome measures: Volleyball-related craniofacial injuries categorized by demographics (age, sex, and race), medical injury information (injury type and location), and patient disposition (observed and discharged, admitted, deceased). Results: A total of 235 volleyball-related facial traumas were recorded with an estimated 10,424 visits occurring nationally. The majority of injuries were among young adults aged 20-29 (52.3%) and was evenly distributed for men and women. Lacerations were the most frequent injury type (37.9%), while the face was the most common site of injury (41.7%). The majority of fractures involved the nose (71.4%) and amongst individuals aged 20 through 49 (90.5%). Males had significantly more lacerations than females (75.3% vs. 24.7%), whereas females had significantly more contusions/abrasions (64.5% vs. 35.5%) and concussions (72.9% vs. 27.1%). Conclusions: Volleyball-related craniofacial injuries can vary depending on patient demographics. This information can help with the development of safety and preventative measures for individuals participating in the sport. KEY POINTS Comparable studies on volleyball-related facial injuries are lacking despite 500 million people participating in the sport globally. The majority of volleyball-related facial injuries are incurred by young adults aged 20-29 years. Lacerations are the most common facial injury sustained while playing volleyball. Nasal bone fractures are the most common fracture type. New knowledge of volleyball-related craniofacial injuries can influence the development of safety measures (i.e. protective equipment).