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Background. The development path of a football player toward becoming a professional player involves four main aspects: physical, technical, tactical, and psychological ones. Objectives. This study aimed to examine the psychological characteristics of the environment that influence and contribute to the development of football players under 17 years old in Indonesia and Malaysia. Materials and methods. This study used a qualitative approach, namely evolved grounded theory, and the data collection process was conducted using three distinct methods: semi-structured interviews, observation, and document analysis. Twenty-five coaches participated in this study, comprising fifteen coaches from various football academies in Malaysia and ten coaches from Indonesia. All coaches involved in this study have a license and at least five years of experience as coaches under 17. The data collected and analyzed began with open coding, axial coding, and selective coding, and the analysis was assisted by using qualitative research software, namely N-Vivo 14. Results. The findings revealed that several aspects influenced player development, such as policy support, including structured and competitive age group competitions, a healthy football ecosystem; other results have been defined as relationships and cooperation supported by family, friendship between clubs, and teamwork. Finally, the study underscored the significance of involving coaching factors, including passion, patience, and coach psychological treatment abilities. These are the psychological characteristics of the environment that can influence the development of football players. Conclusions. It is hoped that the results of this study can be used as a reference for coaches, the Indonesian Football Association, and the Malaysian Football Association to create a policy that can support football players under 17 years from all aspects, including psychology.

Summary: Thousands of voltage-gated sodium (Nav) channel variants contribute to a variety of disorders, including epilepsy, cardiac arrhythmia, and pain disorders. Yet, the effects of more variants remain unclear. The conventional gain-of-function (GoF) or loss-of-function (LoF) classifications are frequently employed to interpret mutations’ effects and guide therapy for sodium channelopathies. Our study challenges this binary classification by analyzing 525 mutations associated with 34 diseases across 366 electrophysiology studies, revealing that diseases with similar GoF/LoF effects can stem from unique molecular mechanisms. Utilizing UniProt data, we mapped over 2,400 disease-associated missense mutations across Nav channels. This analysis pinpoints key mutation hotspots and maps patterns of gating-property impacts for the mutations, respectively, located around the selectivity filter, activation gate, fast inactivation region, and voltage-sensing domains. This study shows great potential to enhance prediction accuracy for mutational effects based on the structural context, paving the way for targeted drug design in precision medicine.

Football is the most popular sport in Indonesia and involves thousands of players and millions of spectators. As the sport continues to grow, it demands an accelerated development of players and adjustments to their needs. However, the Indonesian Football Association (PSSI) has created a curriculum that only focuses on the physical, tactical, and technical aspects, ignoring the psychological aspect. This study aimed to investigate the role of psychology in the development of football players in Indonesia, focusing on the weaknesses of the current curriculum. The study was concentrated on the development and psychological characteristics that soccer players under 17 years of age require to maintain their performance into adulthood. The study used a grounded theory approach and semi-structured open questions in data collection. The sample included youth player-coaches with a minimum of 5 years of experience, as well as football players under the age of 17. These players typically begin practicing football at the age of 6 and continue until they reach 17 years old in Indonesia. The results of this study can be a reference for the PSSI and football coaches in Indonesia to create a comprehensive training program that includes physical, technical, tactical, and psychological aspects, enabling them to develop successful football players in the future.

Masalah: Atlet yang berada dalam pusat pendidikan dan latihan olahraga pelajar (PPLP) Sumatera Barat sering dihadapkan dengan situasi yang menimbulkan tekanan maupun kecemasan, sehingga dapat mempengaruhi kepercayaan diri seorang atlet. Gangguan internal maupun eksternal yang dialami atlet tersebut dapat menyebabkan menurunnya kepercayaan diri seorang atlet yang berujung pada ketidakmampuan atlet menampilkan performa mereka dan yang akan bermuara pada prestasi atlet. Hal tersebut penting untuk diteliti karena seorang atlet yang memiliki kepercayaan diri yang tinggi mampu mengontrol pikiran negatif yang dapat menganggu performa atlet selama bertanding. Tujuan: Penelitian ini bertujuan untuk mengetahui kepercayaan diri atlet PPLP Sumbar sehingga menjadi landasan awal untuk tindakan selanjutnya Metode: Desain penelitian menggunakan pendekatan deskriptif kuantitatif. Instrumen yang digunakan adalah kuesioner yang telah melalui proses validitas dan reliabelitas. Sampel yang digunakan dalam penelitian ini merupakan siswa kelas XII PPLP Sumbar yang berjumlah 30 orang. Hasil: Hasil dari penelitian menunjukkan bahwa 10 orang atlet memiliki tingkat percaya diri tinggi dengan persentase (33,33 %), 12 orang atlet yang terdiri dari atlet memiliki tingkat percaya diri sedang dengan persentase (40%), dan 8 orang lainnya memiliki tingkat percaya diri yang rendah dengan persentase (26,66%). Adapun rata-rata tingkat percaya diri atlet PPLP Sumbar masuk dalam kategori sedang dengan persentase 70,34%. Kesimpulan: Kesimpulan peneltian ini menunjukkan bahwa tingkat kepercayaan diri atlet PPLP Sumbar dalam kategori sedang, melalui hasil penelitian ini diharapkan menjadi bahan evaluasi untuk mengetahui mental atlet khususnya masalah kepercayaan diri atlet karena akan berujung pada performa atlet.

Magneto-rheological dampers (MR-Dampers) are increasingly being used in construction applications to reduce the dynamic response of structures to seismic activities or severe wind loading. Sensors attached to the structure will signal the computer to supply the dampers with an electric charge that transfers the MR fluid to a near-solid material with different physical and mechanical properties (viscoelastic behavior). Control algorithms govern the fluid to near-solid conversion, which controls the behavior of the damper and the performance of the structure under the seismic or wind loading event. The successful optimization of control parameters minimizes the overall structural response to dynamic forces. The main objective of this research is to change the output behavior of specific floors within a building subjected to seismic excitation by optimizing the MR-Damper control parameters to impact the behavior of a specific floor or number of floors within the building. The adjustment of control parameters to attain this objective was validated in multiple case studies throughout this research. The successful implementation of the research outcome will result in optimized MR-damper design to meet the performance-based criteria of building projects.

Cutaneous leishmaniasis (CL) is a parasitic disease caused by the bite of infectious female sand flies with high socioeconomic burdens. There is currently no non-invasive, point-of-care, diagnostic method with high sensitivity and specificity available for CL. We herein report the development of a non-invasive tape disc (TD) sampling method combined with a loop-mediated isothermal amplification (LAMP) assay using primer sets targeting kinetoplast DNA (kDNA) of Leishmania tropica (L. tropica) with a colorimetric readout for species-specific diagnosis of CL. We tested our Tape-Disc (TD)-LAMP method on a panel of skin samples collected by TD from 35 confirmed L. tropica patients, 35 healthy individuals and 35 patients with non-L. tropica infections. The detection limit of the TD-LAMP assay was determined as 1 fg (fg), and the assay sensitivity and specificity of 97 % and 100 % for L. tropica infection, respectively. This non-invasive, sensitive and rapid diagnostic method warrants further exploration of its use for differential diagnosis of CL in disease endemic settings.

Objective Performance and physiological responses of dairy calves may change by using extruded soybean meal (ESBM) instead of common soybean meal (SBM) in starter feed. The aims of the current study were i) to determine the effect of extrusion processing of SBM on protein electrophoretic size, fourier transform infrared spectroscopy (FTIR) structures and Cornell Net Carbohydrate and Protein System (CNCPS) protein sub-fractions and ii) to determine the effect of substitution of SBM with ESBM in starter feed of Holstein heifer calves during pre and post-weaning on performance, nutrient digestibility, and blood metabolites. Methods The SBM was substituted with ESBM at the level of 0%, 25%, 50%, 75%, and 100% (dry matter [DM] basis). Fifty heifer calves (initial body weight 40.3±0.63 kg) were used for the study. After birth, animals were fed colostrum for 3 days and then they were fed whole milk until weaning. Animals had free access to starter feed and water during the study. Results Extrusion of SBM decreased electrophoretic protein size and increased rapidly degradable true protein fraction, changed FTIR protein and amide II region. With increasing level of ESBM in the diet, starter intake increased quadratically during the pre-weaning period (p

Background: Stachys lavandulifolia Vahl is an herbaceous perennial plant which its flowering aerial parts are used traditionally as gastrotonic, spasmolytic, sedative and for the treatment of gastrointestinal disorders. In the present study the aerial parts of this medicinal plant was investigated for its flavonoid glycosides content. Methods: n-butanol fraction derived from hydroalcoholic extract of S. lavandulifolia was subjected to phytochemical analysis using chromatography on Sephadex LH-20 and RP-18 silica gel columns. The structures of isolated compounds were identified using 1H-NMR, 13C-NMR and UV spectral analysis. Results: Four flavone glycosides, chrysoeriol-7-O-β-D-glucopyranoside (1), apigenin-7-O-(6″-O-acetyl)-β-D-glucopyranoside (2), luteolin-7-O-β-D-glucopyranoside (3), apigenin-7-O-β-D-glucopyranoside (4), along with apigenin (5) and chlorogenic acid (6) were isolated from S. lavandulifolia aerial parts. Conclusion: Identification of these phenolic compounds with some known biological activities in S. lavandulifolia explains some medicinal properties reported for this species and make scientific rationale for its traditional uses.

Abstract We consider the Complexity=Action (CA) proposal in Einstein gravity and investigate new counterterms which are able to remove all the UV divergences of holographic complexity. We first show that the two different methods for regularizing the gravitational on-shell action proposed in ref. [1] are completely equivalent, provided that one considers the Gibbons-Hawking-York term as well as new counterterms inspired from holographic renormalization on timelike boundaries of the WDW patch. Next, we introduce new counterterms on the null boundaries of the WDW patch for four and five dimensional asymptotically AdS spacetimes which are able to remove all the UV divergences of the on-shell action. Moreover, they are covariant and do not change the equations of motion. At the end, by applying the null counterterms, we calculate the holographic complexity of an AdS-Schwarzschild black hole as well as the complexity of formation. We show that the null counterterms do not change the complexity of formation.

Abstract In this research, using the HRV approach and based on the growth diagnostics decision tree, we examined the limitations of Iran's economic growth during 1380 to 1395. The research methodology is grounded theory approach and benefited from open interview. According to the findings of this study, the weakness in financing is the main constraint for private sector investment and entrepreneurship in the country and determines the country's economic growth. The weakness in financing is due to a weakness in the banking system in Iran, which requires major reforms in the structure, laws and policies of the banks. Another weakness in the structure and functioning of the government which created this bottleneck. Strengthening foreign relations, reducing the risk of investment and developing advanced financing institutions can be very effective in this regard. The third factor of weakness in financing is also the flaws in the judicial system that should be monitored by a higher authority to resolve it. Introduction In 1355, Iran's economy experienced a high economic growth rate (16.2%). With the advent of revolutionary conditions in 1356 and after the outbreak of the war, the rate of economic growth declined sharply. Except for 1961-63, the economic growth rate was negative until the end of the war. During the post-war period, the rate of economic growth has been very fluctuating, from -9.6% to 14.3%. The most stable growth rate during the forty-year period of 1384 - 1386 was about 7%, and Iran's average economic growth for the forty years (1355-1375) was 2.9%. As long as the binding constraints for investment and production are not overcome, achieving economic stability and sustained growth of 8%, which is the target growth rate of the sixth plan, is not possible. Case Study Achieving a high economic growth rate is one of the most important goals of any economic system, which first needs to identify and resolve its binding constraint. This study examined the constraints of economic growth in the Islamic Republic of Iran. Materials and methods The research method is grounded theory. This method is carried out by deep interviews. According to the research question, first, the key points are collected and each point allocated a specific code. Then by comparing the codes, the codes which refer to a common aspect of the phenomenon take the title of a "concept". Then, few concepts establish a "category" and several categories are expressed in the form of a theory. In order to facilitate the movement in the evolutionary path of the researcher's theory, the data collection should move to the most relevant sources, in which case the data will be almost near the goal of the research. The result of the aggregation of coding is a general theory that could be generalized. Discussion and results According to the interviews, the most consensus is on funding constraints, which account for 46‌ % of interviews' votes. It means that this binding constraint has to be removed in order to speed up the country's economic growth. After funding 23 percent of marketers interviewed people as a country's binding constraints, 15 percent mentioned government failure, 8 percent pointed out human capital weakness, and 8 percent mentioned weak infrastructure. Meanwhile, none of the interviewed people considered the poor geography as the binding constraint to growth. Looking at the studies that have been mentioned in the background, it is observed that Vietnam and Pakistan are similar to Iran in funding constraints. Peru and Mongolia’s binding constraints are market failure, Georgia face government failure, Tunisia suffer from poor human capital, and Sri Lanka and Tajikistan, has weak Infrastructure like Iran. Conclusion According to the interviews, weakness in financing is due to weaknesses in the banking system of Iran, which requires major reforms in the structure, laws and policies of the banking system. Also, weakness in the structure and functioning of the government is another determinant of the bottleneck. Strengthening foreign relations, reducing the risk of investment and developing advanced financing institutions can be effective in removing it. The third factor of weakness in financing is also the flaws in the judicial system that should be monitored by a higher authority [1]-Hausman,Rodrik,Velasco (HRV)

Abstract Motivated by T T ¯ $$ T\overline{T} $$ deformation of a conformal field theory we compute holographic complexity for a black brane solution with a cutoff using “complexity=action” proposal. In order to have a late time behavior consistent with Lloyd’s bound one is forced to have a cutoff behind the horizon whose value is fixed by the boundary cutoff. Using this result we compute holographic complexity for two dimensional AdS solutions where we get expected late times linear growth. It is in contrast with the naively computation which is done without assuming the cutoff where the complexity approaches a constant at the late time.

Quantitative fractal analysis of the microstructures of in situ Al–15%Mg2Si composite with and without Bismuth (Bi) has been performed. Fractal dimension of primary Mg2Si particles and eutectic Mg2Si network were calculated by box counting method. In this study, we attempt to show the modification effect of Bi addition (0–0.3%wt.) on fractal dimension of Al–15%Mg2Si microstructure. Also, efforts were made to establish a correlation between the fractal dimensions of Mg2Si (primary and eutectic) and ultimate tensile strength (UTS) and elongation (El.%) values. The results show that by addition of Bi, there is a linear correlation between UTS and the fractal dimensions of primary Mg2Si particles; however, no connection between fractal dimension of eutectic Mg2Si and UTS and El.% could be detected.

Since the penetration of fluids (water, oil and chemicals) into concrete, plays a major role in the durability of concrete, this paper describes the effect of compressive strength of concrete on its permeability. Having revised the existing methods developed so far, the results of investigations into the permeability of different mixtures of concrete are presented. The results of the new method (cylindrical chamber method) used for the estimation of the permeability of 5 different strength grades concrete samples after different curing periods were compared with the comparative results obtained using British standard method (BS EN 12390-8:2009). These experiments tend to indicate a very good correlation between the two sets of results. Based on the test results, higher water/cement ratio and shorter curing period result in decreased compressive strength and increased permeability. The correlations between compressive strength and permeability parameters (penetration depth, average penetration flow velocity, permeability coefficient and penetration volume) are also investigated using a regression approach. It is concluded that power and second-order polynomial approximations can predict these correlations with a desirable accuracy.

High-voltage direct-current (HVDC) power transmission is becoming increasingly important due to steadily rising need for bulk power delivery and interconnected power transmission and distribution systems. DC grids are vulnerable to dc faults, which lead to a rapid rise in dc fault currents. The dc faults must be cleared within the timeframe of milliseconds to avoid the collapse of the HVDC system. In the event of primary protection (PP) failure, back-up protection (BP) must be applied to clear the fault. In this paper, a novel algorithm based on a Naïve Bayes classifier is proposed to determine threshold levels and operational time frames for primary and back-up protection in multi-terminal voltage source converter-based HVDC. Local voltage and currents are measured to detect and identify the kind of fault. A four-terminal HVDC transmission system is developed in PSCAD/EMTDC and is subjected to line-line faults at different locations and time, to assess the designed protection schemes. Results show that a relaying algorithm effectively detects the fault and expedite the primary protection operation. On malfunctioning of PP, BP is accelerated in a short delay of 0.2 ms. Furthermore, the relaying algorithm provides faster protection compared with techniques available in the literature. The resulting reduced fault clearance time truncates the maximum fault current and, inevitably, leads to reduced power ratings required for dc grid equipment.

Background: Fast and reliable detection of Mycobacterium tuberculosis complex (MTBC) and drug resistance is crucial in establishing effective treatment and enforcing timely public health measures. Methods: The authors analysed the performance of a national U.K. molecular diagnostic service over a decade, based on the use of a line probe assay (Innolipa, LiPA) compared with conventional liquid and solid cultures with rapid molecular identification and culture-based drug resistance testing. Findings: Data were available for 7836 consecutive patient samples using LiPA and the reference microbiological technique (conventional liquid and solid cultures with rapid molecular identification and culture-based drug resistance testing). For all sputum specimens (n=3382) the sensitivity, specificity, positive predictive value, negative predictive value and accuracy for MTBC detection were 93.4%, 85.6%, 92.7%, 86.9% and 90.7%; the equivalent values for smear-positive sputum specimens (n=2606) were 94.7%, 80.9%, 93.9%, 83.3% and 91.3%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy for detection of rifampicin resistance in all sputum samples (n=1667) were 92.1%, 99.3%, 89.4%, 99.5% and 98.9%, respectively; the equivalent values for smear-positive sputum specimens (n=1477) were 93.3%, 99.3%, 87.5%, 99.6% and 99%. Between January 2006 and December 2008, LiPA saved 25.3 and 32.2 days for TB diagnosis and rifampicin resistance of smear-positive samples, respectively. Interpretation: A molecular diagnostic service, using a non-automated line probe assay approach, provides a rapid and reliable national service for diagnosing MTBC and rifampicin resistance. [ABSTRACT FROM AUTHOR]

Preoperative co-morbidities such as known coronary artery disease have commonly deemed a patient at 'high risk' for primary elective Total Hip Arthroplasty (THA). We prospectively collected data on 1744 patients who underwent primary elective THA between 1998 and 2004; 273 had a history of cardiac disease defined as a previous hospital admission with a diagnosis of angina pectoris or myocardial infarction; 594 patients had hypertension defined as that requiring treatment with antihypertensives. We also had data on preoperative age, sex and body mass index (BMI). There was no statistically significant increase in early mortality at three months with a history of cardiac disease or hypertension and this remained so when adjusting for the other factors in a multivariate analysis. Sex or BMI also did not have a statistically significant effect on the risk of death within three months. Increasing age was the only significant risk factor for early mortality (p<0.001). Longer-term mortality at two and five years in relation to these factors was also examined. Statistical analysis revealed that coronary history now showed a highly significant association (p<0.001) with long-term mortality in patients who survived more than three months. This remained significant (p=0.002) when adjusted for the other factors. Hypertension continued to have no effect, as did BMI. Age remained a significant risk factor and ASA was also a predictor of death, as has been previously shown. The overall long-term mortality following THAwas less than expected from the normal population, even in the subgroup with a coronary history. This study will assist clinicians when advising patients who have one of these common risk factors when seeking primary elective THA. [ABSTRACT FROM AUTHOR]

As the prevalence of obesity rises, the number of hip and knee replacements performed on obese patients will rise. This article reviews the correlation between obesity and the development of osteoarthritis in the hip and knee, and outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: Scientific and technological developments have promoted the status of organizational learning as a reasonable way to deal with the present changing circumstances. The development of organizational learning improves the performance of employees, and makes them feel satisfied. The aim of this study is to investigate the relationship between job satisfaction and organizational learning capabilities among the employees of Tehran hospitals. Materials and Methods This descriptive, analytical study was conducted among 290 employees in 2014 in Tehran hospitals. For data collection, a three-part questionnaire (including demographic characteristics, Gomez`s Organizational Learning Capability Questionnaire and Minnesota Job Satisfaction Questionnaire) was given to 290 employees. Data were analyzed using the SPSS-20 software with Spearman test. Results: Mean scores of organizational learning capability and job satisfaction were (3.03± 0.61) and (2.8± 0.61), respectively. Among the dimensions of organizational learning capability, the highest score pertained to systematic perspective (3.29± 0.78); regarding job satisfaction, the highest score was related to organizational climate (3.23± 0.1). The results showed that there was a significant correlation between the dimensions of organizational learning capability and job satisfaction. Also, a significant correlation was observed between organizational learning capabilities and job satisfaction. Conclusion: Organizational learning improves the performance of employees and is positively correlated with their satisfaction. Also, employee satisfaction is one of the factors affecting their performance. Therefore, managers can make employees satisfied and develop their organization through improving organizational learning.

Using Papadodimas and Raju construction of operators describing the interior of a black hole, we present a general relation between partition functions of operators describing inside and outside the black hole horizon. In particular for an eternal black hole the partition function of the interior modes may be given in terms those partition functions associated with the modes of left and right exteriors. By making use of this relation we observe that setting a finite UV cutoff will enforce us to have a cutoff behind the horizon whose value is fixed by the UV cutoff. The resultant cutoff is in agreement with what obtained in the context of holographic complexity.

Aim: Universities can overcome unstable funds as a result of changes or diminished governmental financial resources by relying on benevolent funding. However, the optimal use of this depends on recognition of their probable requirements and potential deviations that despite its evident nature is usually unnoticed. Methodology: Due to the relatively successful experience of Imam Sadiq (a.s.) University in enjoying this type of financing since its establishment, this research has tried to explore those requirements and potential deviations using GT methodology. Findings: After processing the data to reach theory, the model of benevolent university financing is proposed. Results: Based on the theoretical analysis of data obtained from interviews, the extra-university dimensions have been categorized as: first (public administration), second (private or corporate) and third (NGOs or cooperatives). The two main intra-university requirements, categorized as structural and content dimensions, are effective in the efficient utilization of benevolent funding.

It is felt to need wide investigation about financial and accounting subjects with developing of the privatization and tendency to exchange shares and increasing of the number of share holders. One of the important subjects is to studing about stock pricing modeles and determination of the variables that affect stock price. In recent decates, researchers have tried to find these variables and offer a model to pricing stocks based on it. This study empirically tests a number of stock pricing models that are based on fundamental variables in Tehran Stock Exchange. Using a cross-section of Tehran Stock Exchange listed firms over the 2002-2008, the study documents high explanatory power for stock pricing models based on the following models: Edwards-Bell-Ohlson (EBO), Economic Value Added (EVA), Price-to-Earnings (P/E), Price-to-Sales (P/S) and Price-to-Book value (P/B). Our finding indicated that P/B model has the highest adjusted coefficient of determination and hence is the best model of stock pricing among models of this research.

Background: The subcutaneous implantable cardioverter-defibrillator (ICD) is associated with fewer lead-related complications than a transvenous ICD; however, the subcutaneous ICD cannot provide bradycardia and antitachycardia pacing. Whether a modular pacing-defibrillator system comprising a leadless pacemaker in wireless communication with a subcutaneous ICD to provide antitachycardia and bradycardia pacing is safe remains unknown., Methods: We conducted a multinational, single-group study that enrolled patients at risk for sudden death from ventricular arrhythmias and followed them for 6 months after implantation of a modular pacemaker-defibrillator system. The safety end point was freedom from leadless pacemaker-related major complications, evaluated against a performance goal of 86%. The two primary performance end points were successful communication between the pacemaker and the ICD (performance goal, 88%) and a pacing threshold of up to 2.0 V at a 0.4-msec pulse width (performance goal, 80%)., Results: We enrolled 293 patients, 162 of whom were in the 6-month end-point cohort and 151 of whom completed the 6-month follow-up period. The mean age of the patients was 60 years, 16.7% were women, and the mean (±SD) left ventricular ejection fraction was 33.1±12.6%. The percentage of patients who were free from leadless pacemaker-related major complications was 97.5%, which exceeded the prespecified performance goal. Wireless-device communication was successful in 98.8% of communication tests, which exceeded the prespecified goal. Of 151 patients, 147 (97.4%) had pacing thresholds of 2.0 V or less, which exceeded the prespecified goal. The percentage of episodes of arrhythmia that were successfully terminated by antitachycardia pacing was 61.3%, and there were no episodes for which antitachycardia pacing was not delivered owing to communication failure. Of 162 patients, 8 died (4.9%); none of the deaths were deemed to be related to arrhythmias or the implantation procedure., Conclusions: The leadless pacemaker in wireless communication with a subcutaneous ICD exceeded performance goals for freedom from major complications related to the leadless pacemaker, for communication between the leadless pacemaker and subcutaneous ICD, and for the percentage of patients with a pacing threshold up to 2.0 V at a 0.4-msec pulse width at 6 months. (Funded by Boston Scientific; MODULAR ATP ClinicalTrials.gov NCT04798768.)., (Copyright © 2024 Massachusetts Medical Society.)

Competing Interests: Disclosures The authors have no conflicts of interest to disclose.

Clinical outcomes of catheter ablation for atrial fibrillation (AF) are suboptimal due, in part, to challenges in achieving durable lesions. Although focal point-by-point ablation allows for the creation of any required lesion set, this strategy necessitates the generation of contiguous lesions without gaps. A large-tip catheter, capable of creating wide-footprint ablation lesions, may increase ablation effectiveness and efficiency. In a randomized, single-blind, non-inferiority trial, 420 patients with persistent AF underwent ablation using a large-tip catheter with dual pulsed field and radiofrequency energies versus ablation using a conventional radiofrequency ablation system. The primary composite effectiveness endpoint was evaluated through 1 year and included freedom from acute procedural failure and repeat ablation at any time, plus arrhythmia recurrence, drug initiation or escalation or cardioversion after a 3-month blanking period. The primary safety endpoint was freedom from a composite of serious procedure-related or device-related adverse events. The primary effectiveness endpoint was observed for 73.8% and 65.8% of patients in the investigational and control arms, respectively (P < 0.0001 for non-inferiority). Major procedural or device-related complications occurred in three patients in the investigational arm and in two patients in the control arm (P < 0.0001 for non-inferiority). In a secondary analysis, procedural times were shorter in the investigational arm as compared to the control arm (P < 0.0001). These results demonstrate non-inferior safety and effectiveness of the dual-energy catheter for the treatment of persistent AF. Future large-scale studies are needed to gather real-world evidence on the impact of the focal dual-energy lattice catheter on the broader population of patients with AF. ClinicalTrials.gov identifier: NCT05120193 ., (© 2024. The Author(s).)

Competing Interests: Dr Amin received EV-ICD Pivotal study participation support, from Medtronic; an institutional grant from Biosense Webster; consulting fees from Medtronic, Boston Scientific, Biosense Webster, Atricure, and Philips; and travel support from Boston Scientific, Medtronic, and Philips; advisory board participation at Boston Scientific, Medtronic, Atricure and Philips. Matthew Cline is an employee of Medtronic plc. During the preparation of this work the corresponding author used Canva.com to improve language and readability. After using this tool/service, the author(s) reviewed and edited the content as needed and take full responsibility for the content of the publication.

Background: Silver-Russel syndrome (SRS) is a congenital disorder which is mainly characterized by intrauterine and postnatal growth retardation, relative macrocephaly, and characteristic (facial) dysmorphisms. The majority of patients shows a hypomethylation of the imprinting center region 1 (IC1) in 11p15 and maternal uniparental disomy of chromosome 7 (upd(7)mat), but in addition a broad spectrum of copy number variations (CNVs) and monogenetic variants (SNVs) has been reported in this cohort. These heterogeneous findings reflect the clinical overlap of SRS with other congenital disorders, but some of the CNVs are recurrent and have therefore been suggested as SRS-associated loci. However, this molecular heterogeneity makes the decision on the diagnostic workup of patients with SRS features challenging., Case Presentation: A girl with clinical features of SRS but negatively tested for the IC1 hypomethylation and upd(7)mat was analyzed by whole genome sequencing in order to address both CNVs and SNVs in the same run. We identified a 11p13 microduplication affecting a region overlapping with a variant reported in a previously published patient with clinical features of Silver-Russel syndrome., Conclusions: The identification of a 11p13 microduplication in a patient with SRS features confirms the considerable contribution of CNVs to SRS-related phenotypes, and it strengthens the evidence for a 11p13 microduplication syndrome as a differential diagnosis SRS. Furthermore, we could confirm that WGS is a valuable diagnostic tool in patients with SRS and related disorders, as it allows CNVs and SNV detection in the same run, thereby avoiding a time-consuming diagnostic testing process., (© 2024. The Author(s).)

The transformation and gene editing of the woody species kiwifruit are difficult and time-consuming. The fast and marker-free genetic modification system for kiwifruit has not been developed yet. Here, we establish a rapid and efficient marker-free transformation and gene editing system mediated by Agrobacterium rhizogenes for kiwifruit. Moreover, a removing-root-tip method was developed to significantly increase the regeneration efficiency of transgenic hairy roots. Through A. rhizogenes-mediated CRISPR/Cas9 gene editing, the editing efficiencies of CEN4 and AeCBL3 achieved 55 and 50%, respectively. And several homozygous knockout lines for both genes were obtained. Our method has been successfully applied in the transformation of two different species of kiwifruit (Actinidia chinensis 'Hongyang' and A.eriantha 'White'). Next, we used the method to study the formation of calcium oxalate (CaOx) crystals in kiwifruit. To date, little is known about how CaOx crystal is formed in plants. Our results indicated that AeCBL3 overexpression enhanced CaOx crystal formation, but its knockout via CRISPR/Cas9 significantly impaired crystal formation in kiwifruit. Together, we developed a fast maker-free transformation and highly efficient CRISPR-Cas9 gene editing system for kiwifruit. Moreover, our work revealed a novel gene mediating CaOx crystal formation and provided a clue to elaborate the underlying mechanisms., (© 2024. The Author(s).)

A numerical approach based on shifted Jacobi-Gauss collocation method for solving mixed Volterra-Fredholm integral equations is introduced. The novel technique with shifted Jacobi-Gauss nodes is applied to reduce the mixed Volterra-Fredholm integral equations to a system of algebraic equations that has an easy solved. The present algorithm is extended to solve the one and two-dimensional mixed Volterra-Fredholm integral equations. Convergence analysis for the present method is discussed and confirmed the exponential convergence of the spectral algorithm. Various numerical examples are approached to demonstrate the powerful and accuracy of the technique., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Amin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

»: There is a spectrum of midtarsal injuries, ranging from mild midfoot sprains to complex Lisfranc fracture-dislocations., »: Use of appropriate imaging can reduce patient morbidity, by reducing the number of missed diagnoses and, conversely, avoiding overtreatment. Weight-bearing radiographs are of great value when investigating the so-called subtle Lisfranc injury., »: Regardless of the operative strategy, anatomical reduction and stable fixation is a prerequisite for a satisfactory outcome in the management of displaced injuries., »: Fixation device removal is less frequently reported after primary arthrodesis compared with open reduction and internal fixation based on 6 published meta-analyses. However, the indications for further surgery are often unclear, and the evidence of the included studies is of typically low quality. Further high-quality prospective randomized trials with robust cost-effectiveness analyses are required in this area., »: We have proposed an investigation and treatment algorithm based on the current literature and clinical experience of our trauma center., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A930)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Outcomes following catheter ablation (CA) for atrial fibrillation (AF) improve as the diagnosis-to-ablation time (DAT) shortens. Use of a protocol-based integrated care model through a dedicated atrial fibrillation clinic (AFC) may serve to standardize treatment pathways and decrease DAT., Objective: To evaluate the DAT and clinical characteristics of patients with AF referred from an AFC vs a conventional electrophysiology clinic (EC)., Methods: Retrospective analysis was completed in consecutive patients undergoing index AF ablation at Riverside Methodist Hospital in 2019 with minimum 1 year follow-up. Patients were categorized based off their CA referral source (AFC vs EC) and where the initial visit following index diagnosis of AF occurred (AFC vs EC)., Results: A total of 182 patients (mean age 65 years, 64% male) were reviewed. Patients referred from an AFC (21%) had a median DAT of 342 days (interquartile range [IQR], 125-855 days) compared to patients referred from EC (79%) with a median DAT of 813 days (IQR, 241-1444 days; P = .01). Patients with their index visit following AF diagnosis occurring in the AFC (9%) had significantly shorter median DAT (127 days [IQR, 95-188 days]) compared to EC (91%) (789 days [IQR, 253-1503 days]; P = .002). Patients with DAT <1 year had lower AF recurrence than patients with DAT >1 year (P = .04, hazard ratio = 0.58, 95% confidence interval 0.3418-1.000)., Conclusion: DAT is a modifiable factor that may affect CA outcomes. Significant reductions in DAT were observed in patients evaluated through a dedicated AF clinic., (© 2022 Heart Rhythm Society. Published by Elsevier Inc.)

Introduction: Dofetilide suppresses atrial fibrillation (AF) in a dose-dependent fashion. The protective effect of AF against QT c prolongation induced torsades de pointe and transient post-cardioversion QT c prolongation may result in dofetilide under-dosing during initiation. Thus, the optimal timing of cardioversion for AF patients undergoing dofetilide initiation to optimize discharge dose remains unknown as does the longitudinal stability of QT c . The purpose of this study was to evaluate the impact of baseline rhythm on dofetilide dosing during initiation and assess the longitudinal stability of QT c-all (Bazzett, Fridericia, Framingham, and Hodges) over time., Methods: Medical records of patients who underwent preplanned dofetilide loading at a tertiary care center between January 2016 and 2019 were reviewed., Results: A total of 198 patients (66 ± 10 years, 32% female, CHADS 2 -Vasc 3 [2-4]) presented for dofetilide loading in either AF (59%) or sinus rhythm (SR) (41%). Neither presenting rhythm, nor spontaneous conversion to SR impacted discharge dose. The cumulative dofetilide dose before cardioversion moderately correlated (r = .36; p = .0001) with discharge dose. Postcardioversion QT c-all prolongation (p < .0001) prompted discharge dose reduction (890 ± 224 mcg vs. 552 ± 199 mcg; p < .0001) in 30% patients. QT c-all in SR prolonged significantly during loading (p < .0001). All patients displayed QT c-all reduction (p < .0001) from discharge to short-term (46 [34-65] days) that continued at long-term (360 [296-414] days) follow-ups. The extent of QT c-all reduction over time moderately correlated with discharge QT c-all (r = .54-0.65; p < .0001)., Conclusion: Dofetilide initiation before cardioversion is equivalent to initiation during SR. Significant QT c reduction proportional to discharge QT c is seen over time in all dofetilide-treated patients. QT c returns to preloading baseline during follow-up in patients initiated in SR., (© 2022 Wiley Periodicals LLC.)

Background: Decisions to isolate patients at risk of having coronavirus disease 2019 (COVID-19) in the emergency department (ED) must be rapid and accurate to ensure prompt treatment and maintain patient flow whilst minimising nosocomial spread. Reverse transcription polymerase chain reaction (RT-PCR) assays are too slow to achieve this, and near-patient testing is being used increasingly to facilitate triage. The ID NOW severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) assay is an isothermal nucleic acid amplification near-patient test which targets the RNA-dependent RNA-polymerase gene., Aim: To assess the diagnostic performance of ID NOW as a COVID-19 triage tool for medical admissions from the ED of a large acute hospital., Methods: All adult acute medical admissions from the ED between 31 st March and 31 st July 2021 with valid ID NOW and RT-PCR results were included. The diagnostic accuracy of ID NOW [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] was calculated against the laboratory reference standard. Discrepant results were explored further using cycle threshold values and clinical data., Findings: Two percent (124/6050) of medical admissions were SARS-CoV-2 positive on RT-PCR. Compared with PCR, ID NOW had sensitivity and specificity of 83.1% [95% confidence interval (CI) 75.4-88.7] and 99.5% (95% CI 99.3-99.6), respectively. PPV and NPV were 76.9% (95% CI 69.0-83.2) and 99.6% (95% CI 99.5-99.8), respectively. The median time from arrival in the ED to ID NOW result was 59 min., Conclusion: ID NOW provides a rapid and reliable adjunct for the safe triage of patients with COVID-19, and can work effectively when integrated into an ED triage algorithm., (Copyright © 2022 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: An RFA lesion quality indicator, Surpoint Tag Index ® (TI) incorporates key factors: power, time, and contact force, impacting lesion quality. TI accurately estimates lesion depth in animal studies. However, the relationship between TI and in-vivo atrial wall thickness in patients exhibiting bidirectional block remains unknown., Objective: To describe the relationship between atrial wall thickness and TI in CTI exhibiting bidirectional block., Methods: Data from 492 RFA lesions from 25 patients undergoing PVI and CTI ablations in SR with point-by-point RF lesions (<45 W) utilizing a Thermocool Smarttouch ®  SF ablation catheter and CARTO-3 mapping were retrospectively analyzed. Operators were blinded to TI data and CTI thickness. CTI thickness was obtained using ICE images on Cartosound pre-ablation. Durable lesions were defined as part of a lesion set exhibiting bidirectional block of >30 min., Results: In lesions exhibiting bidirectional block, the thinnest (1-2 mm; 5% lesions) and thickest (8-10 mm; 6% lesions) portions of the CTI correlated with the lowest (429 ± 75) and highest (516 ± 64) TI. The bulk of thickness (2-6 mm; 80%) correlated with a TI of 455 ± 72 ( p  = 0.001). There was a weak but positive correlation between TI and CTI thickness ( r  = 0.2; p  ≤ 0.01). Examined in sectors, the anterior 1/3 rd CTI was the thickest (4.8 ± 1.9 mm) but correlated with a similar TI value (479 ± 75 vs. 471 ± 70; p  = 0.34) as the thinner middle 1/3 rd (3.8 ± 1.7 mm; p  ≤ 0.0001)., Conclusion: A mean TI value of 455 correlates with bidirectional block across the bulk of CTI with lower and higher values needed for the thinner and thicker portions, respectively. Tissue composition, aside from wall thickness, influences TI values for the creation of the bidirectional block., Competing Interests: None., (© 2021 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.)

Objective: Articular cartilage is incapable of effective repair following injury or during osteoarthritis. While there have been developments in cartilage repair technologies, there is a need to advance biologically relevant models for preclinical testing of biomaterial and regenerative therapies. This study describes conditions for the effective ex vivo culture of the whole human femoral head., Design: Fresh, viable femoral heads were obtained from femoral neck fractures and cultured for up to 10 weeks in (a) Dulbecco's modified Eagle's medium (DMEM); (b) DMEM + mixing; (c) DMEM + 10% human serum (HS); (d) DMEM + 10% HS + mixing. The viability, morphology, volume, and density of fluorescently labelled in situ chondrocytes and cartilage surface roughness were assessed by confocal microscopy. Cartilage histology was studied for glycosaminoglycan content using Alcian blue and collagen content using picrosirius red., Results: Chondrocyte viability remained at >95% in DMEM + 10% HS. In DMEM alone, viability remained high for ~4 weeks and then declined. For the other conditions, superficial zone chondrocyte viability fell to <35% at 10 weeks with deeper zones being relatively unaffected. In DMEM + 10% HS at 10 weeks, the number of chondrocytes possessing cytoplasmic processes increased compared with DMEM ( P = 0.017). Alcian blue labeling decreased ( P = 0.02) and cartilage thinned ( P ≤ 0.05); however, there was no change to surface roughness, chondrocyte density, chondrocyte volume, or picrosirius red labeling ( P > 0.05)., Conclusions: In this ex vivo model, chondrocyte viability was maintained in human femoral heads for up to 10 weeks in culture, a novel finding not previously reported. This human model could prove invaluable for the exploration, development, and assessment of preclinical cartilage repair and regenerative therapies.

Chondrocytes with abnormal morphology are present in nondegenerate human cartilage suggesting dedifferentiation to a fibroblastic phenotype and production of a mechanically-weakened matrix of unknown composition. We determined the relationship between in situ chondrocyte morphology, chondrocyte clusters, and levels of cell-associated collagen type I. Chondrocyte morphology in fresh femoral head cartilage from 19 patients with femoral neck fracture and collagen type I labelling was identified with Cell Tracker TM fluorescence and immunofluorescence, respectively, in axial/coronal orientations using confocal microscopy with images analysed by Imaris TM . In axial images of grade 0 cartilage, 87 ± 8% were normal chondrocytes with a small (10 ± 6%) abnormal population possessing ≥1 cytoplasmic process. More normal chondrocytes (78 ± 11%) were collagen type I negative than those labelling positively (p < 0.001). For abnormal chondrocytes, 81 ± 14% labelled negatively for collagen type I compared to those labelling positively (19 ± 3%; p = 0.007; N(n)=11(3)). Overall, approximately 9% of the cells in normal cartilage labelled for collagen type I. With degeneration, the percentage of normal chondrocytes decreased (p < 0.001) but increased for abnormal cells (p = 0.036) and clusters (p = 0.003). A larger percentage of normal, abnormal and clustered chondrocytes now demonstrated collagen type I labelling (p = 0.004; p = 0.009; p = 0.001 respectively). Coronal images exhibited increased (p = 0.001) collagen type I labelling in the superficial zone of mildly degenerate cartilage with none in the mid or deep zones. These results show that collagen type I was identified around normal and abnormal chondrocytes in nondegenerate cartilage, which increased with degeneration. This suggested the presence of mechanically weak fibro-cartilaginous repair tissue in otherwise macroscopically nondegenerate human cartilage which progressed with degeneration as occurs in osteoarthritis., (© 2021 The Authors. Journal of Cellular Physiology Published by Wiley Periodicals LLC.)

Both Legionella pneumophila and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pneumonia. L. pneumophila is acquired from water sources, sometimes in healthcare settings. We report 2 fatal cases of L. pneumophila and SARS-CoV-2 co-infection in England. Clinicians should be aware of possible L. pneumophila infections among SARS-CoV-2 patients.

Objective: To evaluate a triage algorithm used to identify and isolate patients with suspected COVID-19 among medical patients needing admission to hospital using simple clinical criteria and the FebriDx assay., Design: Retrospective observational cohort., Setting: Large acute National Health Service hospital in London, UK., Participants: All medical admissions from the emergency department between 10 August 2020 and 4 November 2020 with a valid SARS-CoV-2 RT-PCR result., Interventions: Medical admissions were triaged as likely, possible or unlikely COVID-19 based on clinical criteria. Patients triaged as possible COVID-19 underwent FebriDx lateral flow assay on capillary blood, and those positive for myxovirus resistance protein A (a host response protein) were managed as likely COVID-19., Primary Outcome Measures: Diagnostic accuracy (sensitivity, specificity and predictive values) of the algorithm and the FebriDx assay using SARS-CoV-2 RT-PCR from nasopharyngeal swabs as the reference standard., Results: 4.0% (136) of 3443 medical admissions had RT-PCR confirmed COVID-19. Prevalence of COVID-19 was 46% (80/175) in those triaged as likely, 4.1% (50/1225) in possible and 0.3% (6/2033) in unlikely COVID-19. Using a SARS-CoV-2 RT-PCR reference standard, clinical triage had sensitivity of 96% (95% CI 91% to 98%) and specificity of 61.5% (95% CI 59.8% to 63.1%), while the triage algorithm including FebriDx had sensitivity of 93% (95% CI 87% to 96%) and specificity of 86.4% (95% CI 85.2% to 87.5%). While 2033 patients were deemed not to require isolation using clinical criteria alone, the addition of FebriDx to clinical triage allowed a further 826 patients to be released from isolation, reducing the need for isolation rooms by 9.5 per day, 95% CI 8.9 to 10.2. Ten patients missed by the algorithm had mild or asymptomatic COVID-19., Conclusions: A triage algorithm including the FebriDx assay had good sensitivity and was useful to 'rule-out' COVID-19 among medical admissions to hospital., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The chloroplast is the main organelle for stress-induced production of reactive oxygen species (ROS). However, how chloroplastic ROS homeostasis is maintained under salt stress is largely unknown. We show that EGY3, a gene encoding a chloroplast-localized protein, is induced by salt and oxidative stresses. The loss of EGY3 function causes stress hypersensitivity while EGY3 overexpression increases the tolerance to both salt and chloroplastic oxidative stresses. EGY3 interacts with chloroplastic Cu/Zn-SOD2 (CSD2) and promotes CSD2 stability under stress conditions. In egy3-1 mutant plants, the stress-induced CSD2 degradation limits H 2 O 2 production in chloroplasts and impairs H 2 O 2 -mediated retrograde signaling, as indicated by the decreased expression of retrograde-signal-responsive genes required for stress tolerance. Both exogenous application of H 2 O 2 (or APX inhibitor) and CSD2 overexpression can rescue the salt-stress hypersensitivity of egy3-1 mutants. Our findings reveal that EGY3 enhances the tolerance to salt stress by promoting the CSD2 stability and H 2 O 2 -mediated chloroplastic retrograde signaling., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Percutaneous fixation of Lisfranc injuries is potentially less invasive to traditional open techniques but evidence of any clinical benefit is lacking. The aim of this study is to compare the clinical outcomes of percutaneous reduction and internal fixation (PRIF) of low energy Lisfranc injuries with a matched, control group of patients treated with ORIF., Methods: Over a seven-year period (2012-2019), 16 consecutive patients with a low energy Lisfranc injury (Myerson B2-type) were treated with PRIF. Patient demographics, injury mechanism and radiological outcomes were recorded within a prospectively maintained database at the institution. This study sample was matched for age, sex and mechanism of injury to a control group of 16 patients with similar low energy Lisfranc injuries (Myerson B2-type) treated with ORIF. Clinical outcome was compared using the American Orthopaedic Foot and Ankle Society (AOFAS) midfoot score and Manchester Oxford Foot Questionnaire (MOXFQ)., Results: At a mean follow up of 43 months (95% CI 35.6 - 50.4), both the AOFAS and MOXFQ scores were significantly higher in the PRIF group compared to the control ORIF group (AOFAS 89.1vs 76.4, p=0.03; MOXFQ 10.0 vs 27.6, p=0.03). There were no immediate postoperative complications in either group. There was no radiological evidence of midfoot osteoarthritis in the PRIF group, three patients in the ORIF group developed midfoot osteoarthritis (p=0.2)., Conclusions: PRIF of low energy Lisfranc injures is a safe, minimally invasive technique and is associated with better mid-term clinical outcomes compared to ORIF., Competing Interests: Conflict of interests We declare that this manuscript is original, has not been published before., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

At the time of medial opening wedge high tibial osteotomy (HTO) to realign the lower limb and offload medial compartment knee osteoarthritis, unwanted fractures can propagate from the osteotomy apex. The aim of this study was to use finite element (FE) analysis to determine the effect of hinge location and apical drill holes on cortical stresses and strains in HTO. A monoplanar medial opening wedge HTO was created above the tibial tuberosity in a composite tibia. Using the FE method, intact lateral hinges of different widths were considered (5, 7.5, and 10 mm). Additional apical drill holes (2, 4, and 6 mm diameters) were then incorporated into the 10 mm hinge model. The primary outcome measure was the maximum principal strain in the cortical bone surrounding the hinge axis. Secondary outcomes included the force required for osteotomy opening, minimum principal strain, and mean cortical bone stresses (maximum principal/minimum principal/von Mises). Larger intact hinges (10 mm) were associated with higher cortical bone maximum principal strain and stress, lower minimum principal strain/stress, and required greater force to open. Lateral cortex strain concentrations were present in all scenarios, but extended to the joint surface with the 10 mm hinge. Apical drill holes reduced the mean cortical bone maximum principal strain adjacent to the hinge axis: 2 mm hole 6% reduction; 4 mm 35% reduction; and 6 mm 55% reduction. Incorporating a 4-mm apical drill hole centered 10 mm from the intact lateral cortex maintains a cortical bone hinge, minimizes cortical bone strains and reduces the force required to open the HTO; thus improving control., (© 2020 Orthopaedic Research Society. Published by Wiley Periodicals LLC.)

Objectives: To describe the prevalence and nature of bacterial co-infections in COVID-19 patients within 48 hours of hospital admission and assess the appropriateness of empirical antibiotic treatment they received., Methods: In this retrospective observational cohort study, we included all adult non-pregnant patients who were admitted to two acute hospitals in North West London in March and April 2020 and confirmed to have COVID-19 infection within 2 days of admission. Results of microbiological specimens taken within 48 hours of admission were reviewed and their clinical significance was assessed. Empirical antibiotic treatment of representative patients was reviewed. Patient age, gender, co-morbidities, inflammatory markers at admission, admission to ICU and 30 day all-cause in-hospital mortality were collected and compared between patients with and without bacterial co-infections., Results: Of the 1396 COVID-19 patients included, 37 patients (2.7%) had clinically important bacterial co-infection within 48 hours of admission. The majority of patients (36/37 in those with co-infection and 98/100 in selected patients without co-infection) received empirical antibiotic treatment. There was no significant difference in age, gender, pre-existing illnesses, ICU admission or 30 day all-cause mortality in those with and without bacterial co-infection. However, white cell count, neutrophil count and CRP on admission were significantly higher in patients with bacterial co-infections., Conclusions: We found that bacterial co-infection was infrequent in hospitalized COVID-19 patients within 48 hours of admission. These results suggest that empirical antimicrobial treatment may not be necessary in all patients presenting with COVID-19 infection, although the decision could be guided by high inflammatory markers., (© The Author(s) 2020. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)