Search

Summary: Background: People with diabetes are at increased risk of hospitalisation, morbidity, and mortality following SARS-CoV-2 infection. Long-term outcomes for people with diabetes previously hospitalised with COVID-19 are, however, unknown. This study aimed to determine the longer-term physical and mental health effects of COVID-19 in people with and without diabetes. Methods: The PHOSP-COVID study is a multicentre, long-term follow-up study of adults discharged from hospital between 1 February 2020 and 31 March 2021 in the UK following COVID-19, involving detailed assessment at 5 and 12 months after discharge. The association between diabetes status and outcomes were explored using multivariable linear and logistic regressions. Findings: People with diabetes who survived hospital admission with COVID-19 display worse physical outcomes compared to those without diabetes at 5- and 12-month follow-up. People with diabetes displayed higher fatigue (only at 5 months), frailty, lower physical performance, and health-related quality of life and poorer cognitive function. Differences in outcomes between diabetes status groups were largely consistent from 5 to 12-months. In regression models, differences at 5 and 12 months were attenuated after adjustment for BMI and presence of other long-term conditions. Interpretation: People with diabetes reported worse physical outcomes up to 12 months after hospital discharge with COVID-19 compared to those without diabetes. These data support the need to reduce inequalities in long-term physical and mental health effects of SARS-CoV-2 infection in people with diabetes. Funding: UK Research and Innovation and National Institute for Health Research. The study was approved by the Leeds West Research Ethics Committee (20/YH/0225) and is registered on the ISRCTN Registry (ISRCTN10980107).

Background The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown. Methods Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group. Results A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4% versus 33.2%, p

Background Pre-existing cardiovascular disease (CVD) or cardiovascular risk factors have been associated with an increased risk of complications following hospitalisation with COVID-19, but their impact on the rate of recovery following discharge is not known.Objectives To determine whether the rate of patient-perceived recovery following hospitalisation with COVID-19 was affected by the presence of CVD or cardiovascular risk factors.Methods In a multicentre prospective cohort study, patients were recruited following discharge from the hospital with COVID-19 undertaking two comprehensive assessments at 5 months and 12 months. Patients were stratified by the presence of either CVD or cardiovascular risk factors prior to hospitalisation with COVID-19 and compared with controls with neither. Full recovery was determined by the response to a patient-perceived evaluation of full recovery from COVID-19 in the context of physical, physiological and cognitive determinants of health.Results From a total population of 2545 patients (38.8% women), 472 (18.5%) and 1355 (53.2%) had CVD or cardiovascular risk factors, respectively. Compared with controls (n=718), patients with CVD and cardiovascular risk factors were older and more likely to have had severe COVID-19. Full recovery was significantly lower at 12 months in patients with CVD (adjusted OR (aOR) 0.62, 95% CI 0.43 to 0.89) and cardiovascular risk factors (aOR 0.66, 95% CI 0.50 to 0.86).Conclusion Patients with CVD or cardiovascular risk factors had a delayed recovery at 12 months following hospitalisation with COVID-19. Targeted interventions to reduce the impact of COVID-19 in patients with cardiovascular disease remain an unmet need.Trail registration number ISRCTN10980107.

Summary: Background: The scale of COVID-19 and its well documented long-term sequelae support a need to understand long-term outcomes including frailty. Methods: This prospective cohort study recruited adults who had survived hospitalisation with clinically diagnosed COVID-19 across 35 sites in the UK (PHOSP-COVID). The burden of frailty was objectively measured using Fried's Frailty Phenotype (FFP). The primary outcome was the prevalence of each FFP group—robust (no FFP criteria), pre-frail (one or two FFP criteria) and frail (three or more FFP criteria)—at 5 months and 1 year after discharge from hospital. For inclusion in the primary analysis, participants required complete outcome data for three of the five FFP criteria. Longitudinal changes across frailty domains are reported at 5 months and 1 year post-hospitalisation, along with risk factors for frailty status. Patient-perceived recovery and health-related quality of life (HRQoL) were retrospectively rated for pre-COVID-19 and prospectively rated at the 5 month and 1 year visits. This study is registered with ISRCTN, number ISRCTN10980107. Findings: Between March 5, 2020, and March 31, 2021, 2419 participants were enrolled with FFP data. Mean age was 57.9 (SD 12.6) years, 933 (38.6%) were female, and 429 (17.7%) had received invasive mechanical ventilation. 1785 had measures at both timepoints, of which 240 (13.4%), 1138 (63.8%) and 407 (22.8%) were frail, pre-frail and robust, respectively, at 5 months compared with 123 (6.9%), 1046 (58.6%) and 616 (34.5%) at 1 year. Factors associated with pre-frailty or frailty were invasive mechanical ventilation, older age, female sex, and greater social deprivation. Frail participants had a larger reduction in HRQoL compared with before their COVID-19 illness and were less likely to describe themselves as recovered. Interpretation: Physical frailty and pre-frailty are common following hospitalisation with COVID-19. Improvement in frailty was seen between 5 and 12 months although two-thirds of the population remained pre-frail or frail. This suggests comprehensive assessment and interventions targeting pre-frailty and frailty beyond the initial illness are required. Funding: UK Research and Innovation and National Institute for Health Research.

Purpose: Treatment of staghorn calculi in patients with neurogenic bladder is complex and requires special consideration. In this article, we explore the current literature on this topic and give insights from our own practice. Recent Findings: Stones appear to be more common in patients with neurogenic bladders for a variety of reasons including increased risk with urinary diversion, bladder augmentations, or other genitourinary (GU) reconstruction, higher spinal cord lesions, and presence of bacteriuria. Given high rates of bacteriuria, perioperative antimicrobial regimen should be determined by preoperative urine culture and stone culture while taking into account organisms which typically grow in these cultures including E. Coli and gram-negative rods, Enterobacter, Proteus, and Pseudomonas. One should be aware of the increased risk of funguria in this patient population as well and treat as indicated. Finally, rates of stone recurrence are higher in this patient population as well. Close follow up with identification and aggressive treatment of risk factors for stone recurrence is imperative. Summary: Although there are special considerations, PCNL is safe and effective in patients with neurogenic bladder and staghorn calculi and should be pursued to achieve stone free status when possible. [ABSTRACT FROM AUTHOR]

Background: People hospitalised for coronavirus disease 2019 (COVID-19) have elevated incidence of diabetes. However, it is unclear whether this is due to shared risk factors, confounding or stress hyperglycaemia in response to acute illness., Methods: We analysed a multicentre prospective cohort study (PHOSP-COVID) of people ≥18 years discharged from NHS hospitals across the United Kingdom following COVID-19. Individuals were included if they attended at least one research visit with a HbA1c measurement within 14 months of discharge and had no history of diabetes at baseline. The primary outcome was new onset diabetes (any type), as defined by a first glycated haemoglobin (HbA1c) measurement ≥6.5% (≥48 mmol/mol). Follow-up was censored at the last HbA1c measurement. Age-standardised incidence rates and incidence rate ratios (adjusted for age, sex, ethnicity, length of hospital stay, body mass index, smoking, physical activity, deprivation, hypertension, hyperlipidaemia/hypercholesterolaemia, intensive therapy unit admission, invasive mechanical ventilation, corticosteroid use and C-reactive protein score) were calculated using Poisson regression. Incidence rates were compared with the control groups of published clinical trials in the United Kingdom by applying the same inclusion and exclusion criteria, where possible., Results: Incidence of diabetes was 91.4 per 1000 person-years and was higher in South Asian (incidence rate ratios [IRR] = 3.60; 1.77, 7.32; p < 0.001) and Black ethnic groups (IRR = 2.36; 1.07, 5.21; p = 0.03) compared with White ethnic groups. When restricted to similar characteristics, the incidence rates were similar to those in UK clinical trials data., Conclusion: Diabetes incidence following hospitalisation for COVID-19 is high, but it remains uncertain whether it is disproportionately higher than pre-pandemic levels., (© 2024 The Author(s). Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.)

The given text provides information on the Post-Hospitalisation COVID-19 (PHOSP-COVID) study, a national UK multicentre cohort study that aims to investigate the medium- and long-term effects of severe COVID-19 requiring hospitalization. The study collects data on physical measures, biological samples, and patient-reported outcome measures from participants who were hospitalized for COVID-19 and subsequently discharged. The study aims to understand the long-term health effects of COVID-19, evaluate the effects of treatments, and inform future clinical trials and care for patients with long COVID. The study has found that a significant number of participants continue to experience health impairments even 5 months after hospital discharge for COVID-19, including symptoms such as muscle aches, fatigue, impaired sleep quality, joint pain, breathlessness, and mental health issues. At 1 year after discharge, there was little improvement in symptoms and health impairments. The study has identified risk factors for lack of recovery and new or worse breathlessness. The study has strengths in its large sample size and multidimensional data collection, but there are limitations such as potential recall bias and selection bias. The data from the study can be accessed through the PHOSP-COVID study website. The study has various working groups covering different areas of research and involves multiple authors and affiliations. The research article focuses on the impact of COVID-19 on the respiratory system and the long-term effects it may have on patients. The research was conducted at the National Institute [Extracted from the article]

Background: The striking increase in COVID-19 severity in older adults provides a clear example of immunesenescence, the age-related remodelling of the immune system. To better characterise the association between convalescent immunesenescence and acute disease severity, we determined the immune phenotype of COVID-19 survivors and non-infected controls. Results: We performed detailed immune phenotyping of peripheral blood mononuclear cells isolated from 103 COVID-19 survivors 3–5 months post recovery who were classified as having had severe (n = 56; age 53.12 ± 11.30 years), moderate (n = 32; age 52.28 ± 11.43 years) or mild (n = 15; age 49.67 ± 7.30 years) disease and compared with age and sex-matched healthy adults (n = 59; age 50.49 ± 10.68 years). We assessed a broad range of immune cell phenotypes to generate a composite score, IMM-AGE, to determine the degree of immune senescence. We found increased immunesenescence features in severe COVID-19 survivors compared to controls including: a reduced frequency and number of naïve CD4 and CD8 T cells (p < 0.0001); increased frequency of EMRA CD4 (p < 0.003) and CD8 T cells (p < 0.001); a higher frequency (p < 0.0001) and absolute numbers (p < 0.001) of CD28−ve CD57+ve senescent CD4 and CD8 T cells; higher frequency (p < 0.003) and absolute numbers (p < 0.02) of PD-1 expressing exhausted CD8 T cells; a two-fold increase in Th17 polarisation (p < 0.0001); higher frequency of memory B cells (p < 0.001) and increased frequency (p < 0.0001) and numbers (p < 0.001) of CD57+ve senescent NK cells. As a result, the IMM-AGE score was significantly higher in severe COVID-19 survivors than in controls (p < 0.001). Few differences were seen for those with moderate disease and none for mild disease. Regression analysis revealed the only pre-existing variable influencing the IMM-AGE score was South Asian ethnicity (β = 0.174, p = 0.043), with a major influence being disease severity (β = 0.188, p = 0.01). Conclusions: Our analyses reveal a state of enhanced immune ageing in survivors of severe COVID-19 and suggest this could be related to SARS-Cov-2 infection. Our data support the rationale for trials of anti-immune ageing interventions for improving clinical outcomes in these patients with severe disease. [ABSTRACT FROM AUTHOR]

Purpose: To study what adult women with congenital adrenal hyperplasia (CAH) thought about the timing of genital surgery., Methods: As part of a larger follow-up study performed between the years 2002-2005 there were questionnaires concerning genital surgery, type of surgery, their thoughts about timing of genital surgery and experience of information about surgery. Early surgery was defined as ≤4 years of age and late ≥10 years. The medical and surgical files were reviewed., Results: 62 women with CAH due to 21-hydroxylase deficiency, mean age 28 years (18-63) were included. The age at first genital surgery was 3 years (0-28 years) in the 52 patients (84%) who had had genital surgery, with 60% had early surgery (≤4 years) and 29% late (≥10 years). Almost half of the cohort had a positive experience of the information about surgery, a third had no opinion and a fifth had a negative experience. Of the women 39% thought that early surgery was good, while 19% thought it should be done during or after puberty and 42% had no opinion. Of those preferring early surgery 70% had early surgery themselves. Vaginal surgery was less common among those favoring early surgery. Age, phenotype, genotype, decade of surgery and experience of the information about surgery did not differ significantly between the three groups., Conclusion: Equal numbers of women had no opinion regarding age at surgery or preferred early surgery while 19% thought it would be preferred to have surgery during or after puberty., (© 2024. The Author(s).)

Background: COVID-19 is known to be associated with increased risks of cognitive and psychiatric outcomes after the acute phase of disease. We aimed to assess whether these symptoms can emerge or persist more than 1 year after hospitalisation for COVID-19, to identify which early aspects of COVID-19 illness predict longer-term symptoms, and to establish how these symptoms relate to occupational functioning., Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study of adults (aged ≥18 years) who were hospitalised with a clinical diagnosis of COVID-19 at participating National Health Service hospitals across the UK. In the C-Fog study, a subset of PHOSP-COVID participants who consented to be recontacted for other research were invited to complete a computerised cognitive assessment and clinical scales between 2 years and 3 years after hospital admission. Participants completed eight cognitive tasks, covering eight cognitive domains, from the Cognitron battery, in addition to the 9-item Patient Health Questionnaire for depression, the Generalised Anxiety Disorder 7-item scale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, and the 20-item Cognitive Change Index (CCI-20) questionnaire to assess subjective cognitive decline. We evaluated how the absolute risks of symptoms evolved between follow-ups at 6 months, 12 months, and 2-3 years, and whether symptoms at 2-3 years were predicted by earlier aspects of COVID-19 illness. Participants completed an occupation change questionnaire to establish whether their occupation or working status had changed and, if so, why. We assessed which symptoms at 2-3 years were associated with occupation change. People with lived experience were involved in the study., Findings: 2469 PHOSP-COVID participants were invited to participate in the C-Fog study, and 475 participants (191 [40·2%] females and 284 [59·8%] males; mean age 58·26 [SD 11·13] years) who were discharged from one of 83 hospitals provided data at the 2-3-year follow-up. Participants had worse cognitive scores than would be expected on the basis of their sociodemographic characteristics across all cognitive domains tested (average score 0·71 SD below the mean [IQR 0·16-1·04]; p<0·0001). Most participants reported at least mild depression (263 [74·5%] of 353), anxiety (189 [53·5%] of 353), fatigue (220 [62·3%] of 353), or subjective cognitive decline (184 [52·1%] of 353), and more than a fifth reported severe depression (79 [22·4%] of 353), fatigue (87 [24·6%] of 353), or subjective cognitive decline (88 [24·9%] of 353). Depression, anxiety, and fatigue were worse at 2-3 years than at 6 months or 12 months, with evidence of both worsening of existing symptoms and emergence of new symptoms. Symptoms at 2-3 years were not predicted by the severity of acute COVID-19 illness, but were strongly predicted by the degree of recovery at 6 months (explaining 35·0-48·8% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); by a biocognitive profile linking acutely raised D-dimer relative to C-reactive protein with subjective cognitive deficits at 6 months (explaining 7·0-17·2% of the variance in anxiety, depression, fatigue, and subjective cognitive decline); and by anxiety, depression, fatigue, and subjective cognitive deficit at 6 months. Objective cognitive deficits at 2-3 years were not predicted by any of the factors tested, except for cognitive deficits at 6 months, explaining 10·6% of their variance. 95 of 353 participants (26·9% [95% CI 22·6-31·8]) reported occupational change, with poor health being the most common reason for this change. Occupation change was strongly and specifically associated with objective cognitive deficits (odds ratio [OR] 1·51 [95% CI 1·04-2·22] for every SD decrease in overall cognitive score) and subjective cognitive decline (OR 1·54 [1·21-1·98] for every point increase in CCI-20)., Interpretation: Psychiatric and cognitive symptoms appear to increase over the first 2-3 years post-hospitalisation due to both worsening of symptoms already present at 6 months and emergence of new symptoms. New symptoms occur mostly in people with other symptoms already present at 6 months. Early identification and management of symptoms might therefore be an effective strategy to prevent later onset of a complex syndrome. Occupation change is common and associated mainly with objective and subjective cognitive deficits. Interventions to promote cognitive recovery or to prevent cognitive decline are therefore needed to limit the functional and economic impacts of COVID-19., Funding: National Institute for Health and Care Research Oxford Health Biomedical Research Centre, Wolfson Foundation, MQ Mental Health Research, MRC-UK Research and Innovation, and National Institute for Health and Care Research., Competing Interests: Declaration of interests AHa is co-director and owner of H2CD, and owner and director of Future Cognition, which support online studies and develop custom cognitive assessment software, respectively. PJHe is director and CEO of H2CD. JDC declares grants from AstraZeneca, Boehringer Ingelheim, Insmed, Novartis, Gilead Sciences, and Genentech; and consulting fees from AstraZeneca, Boehringer Ingelheim, Insmed, Novartis, Gilead Sciences, Chiesi, Zambon, and Genentech. L-PH declares grants to their institution from UK Research and Innovation (UKRI), Regenerative Medicine Platform, Celgene, British Lung Foundation, and Oxford Boehringer Ingleheim; the author is on the advisory board for the CATALYST trial and acts as chair of the Respiratory Translational Research Collaboration. AHo declares a grant to their institution from UKRI and the UK National Institute for Health Research (NIHR) to complete this work, funding from NIHR Manchester Clinical Research Facility to support study delivery, and personal funding from NIHR Manchester Biomedical Research Centre (BRC). AHo declares institutional payments to support grant-funded research from NIHR, UK Medical Research Council (MRC), Cystic Fibrosis Trust, Cystic Fibrosis Foundation, North West Lung Centre Charity, and Moulton Trust; consulting fees from Mylan Pharmaceuticals for advisory board participation; and payment from Vertex Pharmaceuticals for educational presentation, participation on a clinical trials advisory board, and writing of a review article. AHo's non-paid roles include chair of the Cystic Fibrosis Clinical Trials Accelerator Program, deputy chair of the NIHR Respiratory Translational Research Collaboration, and director of a university spin-out company (Mi-trial). BR declares payments from the British Heart Foundation Oxford Centre of Research Excellence, NIHR Oxford BRC, and UKRI for grants and contracts; and consulting fees from Axcella Therapeutics. ASh, ASi, and MM declare a grant to their institution from UKRI and NIHR to complete this work. ASh declares unremunerated participation on the AstraZeneca Thrombotic Thrombocytopenic Taskforce and Scottish and UK Governments COVID-19 advisory groups. LH-W declares a grant from NIHR unrelated to the submitted work; acting as independent chair of the NIHR Health Technology Assessment Committee for Colour COPD trial; and membership of the American Thoracic Society Pulmonary Rehabilitation Assembly Web and Planning Committees. NIL declares acting as director of research at the Intensive Care Society UK. CEB declares a grant to their institution from UKRI and NIHR to complete this work; the author reports grants from GSK, AstraZeneca, Sanofi, Boehringer Ingelheim, Chiesi, Novartis, Roche, Genentech, Mologic, and 4DPharma; and consultancy fees paid to their institution from GSK, AstraZeneca, Sanofi, Boehringer Ingelheim, Chiesi, Novartis, Roche, Genentech, Mologic, 4DPharma, and Teva. LVW declares research funding unrelated to the submitted work from GSK and Orion; consulting fees unrelated to the submitted work from Galapagos; a Wellcome Conference speaker honorarium; travel support from Genentech; advisory board participation for Galapagos; and an associate editor role for the European Respiratory Journal. RAE declares a grant to their institution from UKRI and NIHR to complete this work; the author declares speaker fees from Boehringer Ingelheim and unpaid roles as European Respiratory Society Assembly 01·02 Pulmonary Rehabilitation secretary and with the American Thoracic Society Pulmonary Rehabilitation Assembly programme committee. All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Foodborne illnesses are leading source of morbidity and mortality in both developed and developing nations. Escherichia coli O157 is one of the most reported foodborne pathogen that emerged in the past few decades. South East Asia region suffers the highest average burden of diarrhoeal mortality, especially when it comes to child mortality.Query Many studies were undertaken in the developed nations to evaluate the role of E. coli O157 as one of the etiological agent in foodborne outbreaks. In this article, we discuss the distribution of E. coli O157 serotype in the food chains of South East Asian countries, with a special focus on India where more than half a million child diarrhoeal deaths occurs every year and the reasons for which is often not ascertained to the fullest extent. The article also describes in detail about the various detection methods and control measures with respect to E. coli O157. The aim of this study is to document and highlight the extent of Foodborne infections of E. coli O157 origin and thereby taking effective and proactive preventive measures. [ABSTRACT FROM AUTHOR]

One in ten severe acute respiratory syndrome coronavirus 2 infections result in prolonged symptoms termed long coronavirus disease (COVID), yet disease phenotypes and mechanisms are poorly understood 1 . Here we profiled 368 plasma proteins in 657 participants ≥3 months following hospitalization. Of these, 426 had at least one long COVID symptom and 233 had fully recovered. Elevated markers of myeloid inflammation and complement activation were associated with long COVID. IL-1R2, MATN2 and COLEC12 were associated with cardiorespiratory symptoms, fatigue and anxiety/depression; MATN2, CSF3 and C1QA were elevated in gastrointestinal symptoms and C1QA was elevated in cognitive impairment. Additional markers of alterations in nerve tissue repair (SPON-1 and NFASC) were elevated in those with cognitive impairment and SCG3, suggestive of brain-gut axis disturbance, was elevated in gastrointestinal symptoms. Severe acute respiratory syndrome coronavirus 2-specific immunoglobulin G (IgG) was persistently elevated in some individuals with long COVID, but virus was not detected in sputum. Analysis of inflammatory markers in nasal fluids showed no association with symptoms. Our study aimed to understand inflammatory processes that underlie long COVID and was not designed for biomarker discovery. Our findings suggest that specific inflammatory pathways related to tissue damage are implicated in subtypes of long COVID, which might be targeted in future therapeutic trials., (© 2024. The Author(s).)

Recently, Escherichia albertii has been identified as a causative agent of diarrhea in humans and is often misidentified as diarrheagenic Escherichia coli (DEC), a lactose-nondegrading bacterium. In this study, we performed biochemical characterization, gene possession status, drug susceptibility testing, and sequencing analysis of the strains detected in urine samples. One urea-degrading strain was detected in terms of biochemical characteristics, but was found to be nonurea-degrading by another method, leading to conflicting results. All target strains possessed the E. albertii-specific gene, the DEC common gene eae, and the E. coli 16S rRNA gene. In the drug susceptibility test, all urine-derived strains were sensitive to tetracycline (TC), whereas the JCM 17328 strain was resistant to TC, suggesting that TC is effective against urine-derived E. albertii strains. In 16S rRNA sequencing analysis, the E. albertii strains were ranked at the top of homology, but not in the top one, making it difficult to differentiate them from other strains. In summary, if a suspected lactose-nondegrading E. coli strain was isolated from a urine sample, it could be differentiated from E. albertii by the presence of E. albertii-specific genes. [ABSTRACT FROM AUTHOR]

Scanning tunneling microscopy (STM) is a technique that can be used to directly observe individual biomolecules at near-molecular scale. Within this framework, STM is of crucial significance because of its role in the structural analysis, the understanding the imaging formation, and the development of relative techniques. Four decades after its invention, it is pertinent to ask how much of the early dream has come true. In this study, we aim to overview different analyses for DNA, lipids, proteins, and carbohydrates. The relevance of STM imaging is exhibited as an opportunity to assist measurements and biomolecular identification in nanobiotechnology, nanomedicine, biosensing, and other cutting-edge applications. We believe STM research is still an entire science research ecosystem for joining several areas of expertise towards a goal settlement that has been elusive for many years. [ABSTRACT FROM AUTHOR]

As educational institutions begin a school year following a year and a half of disruption from the COVID-19 pandemic, risk analysis can help to support decision-making for resuming in-person instructional operation by providing estimates of the relative risk reduction due to different interventions. In particular, a simulation-based risk analysis approach enables scenario evaluation and comparison to guide decision making and action prioritization under uncertainty. We develop a simulation model to characterize the risks and uncertainties associated with infections resulting from aerosol exposure in in-person classes. We demonstrate this approach by applying it to model a semester of courses in a real college with approximately 11,000 students embedded within a larger university. To have practical impact, risk cannot focus on only infections as the end point of interest, we estimate the risks of infection, hospitalizations, and deaths of students and faculty in the college. We incorporate uncertainties in disease transmission, the impact of policies such as masking and facility interventions, and variables outside of the college's control such as population-level disease and immunity prevalence. We show in our example application that universal use of masks that block 40% of aerosols and the installation of near-ceiling, fan-mounted UVC systems both have the potential to lead to substantial risk reductions and that these effects can be modeled at the individual room level. These results exemplify how such simulation-based risk analysis can inform decision making and prioritization under great uncertainty. [ABSTRACT FROM AUTHOR]

A proportion of patients infected with severe acute respiratory syndrome coronavirus 2 experience a range of neuropsychiatric symptoms months after infection, including cognitive deficits, depression and anxiety. The mechanisms underpinning such symptoms remain elusive. Recent research has demonstrated that nervous system injury can occur during COVID-19. Whether ongoing neural injury in the months after COVID-19 accounts for the ongoing or emergent neuropsychiatric symptoms is unclear. Within a large prospective cohort study of adult survivors who were hospitalized for severe acute respiratory syndrome coronavirus 2 infection, we analysed plasma markers of nervous system injury and astrocytic activation, measured 6 months post-infection: neurofilament light, glial fibrillary acidic protein and total tau protein. We assessed whether these markers were associated with the severity of the acute COVID-19 illness and with post-acute neuropsychiatric symptoms (as measured by the Patient Health Questionnaire for depression, the General Anxiety Disorder assessment for anxiety, the Montreal Cognitive Assessment for objective cognitive deficit and the cognitive items of the Patient Symptom Questionnaire for subjective cognitive deficit) at 6 months and 1 year post-hospital discharge from COVID-19. No robust associations were found between markers of nervous system injury and severity of acute COVID-19 (except for an association of small effect size between duration of admission and neurofilament light) nor with post-acute neuropsychiatric symptoms. These results suggest that ongoing neuropsychiatric symptoms are not due to ongoing neural injury., Competing Interests: H.Z. has served at scientific advisory boards and/or as a consultant for Abbvie, Acumen, Alector, Alzinova, ALZPath, Annexon, Apellis, Artery Therapeutics, AZTherapies, CogRx, Denali, Eisai, Nervgen, Novo Nordisk, Passage Bio, Pinteon Therapeutics, Prothena, Red Abbey Labs, reMYND, Roche, Samumed, Siemens Healthineers, Triplet Therapeutics and Wave, has given lectures in symposia sponsored by Cellectricon, Fujirebio, Alzecure, Biogen and Roche, and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program (outside submitted work). I.K. declares grant fundind and speaker fees from Novo Nordisk., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Copyright of Revista Cientifica de la Facultade de Veterinaria is the property of Universidad del Zulia, Facultad de Ciencias Veterinarias and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures., Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025., Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; p adjusted =0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; p adjusted =0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; p adjusted =0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation., Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification., Funding: UK Research and Innovation and National Institute for Health Research., Competing Interests: Declaration of interests BR received funding support from the British Heart Foundation (BHF) Oxford Centre of Research Excellence (CRE) and National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Centre; and has received payment or honoraria for lectures, presentations, or educational events from Axcella Therapeutics. SN acknowledges grant support from the Oxford NIHR Biomedical Research Centre and the Oxford BHF CRE; and is a shareholder in Perspectum. PP has received grant funding from the NIHR (NIHR 132243) in the past 36 months. OMK has received partial funding from the Imperial NIHR Biomedical Research Centre; a grant from Cepheid; and speaker fees from Otsuka and Oxford Diagnostics. CEBo was supported by NIHR Nottingham Biomedical Research Centre. DGW received grant funding from NIHR; and payment or honoraria for lectures, presentations, or educational events from Biomerieux. TC has received grants on long COVID from NIHR and Guy's and Saint Thomas' Charity; carried out workshops on long COVID for NHS England and the European Association for Behavioural and Cognitive Therapies Conference; is an author of books related to fatigue and has received royalties in the past; and is the Director of the Persistent Physical Symptom Research and Treatment Service, which provides assessment and treatment to patients with long COVID. RA has received travel grant and lecture fees from Boehringer Ingelhem. ADS received grant funding from Bayer, Gilead, Pfizer, AstraZeneca, and Novartis; consulting fees from Boehringer Ingelheim, Bayer, Gilead, Pfizer, GSK, AstraZeneca, and Novartis; support for attending meetings or travel from AstraZeneca, Chiesi, and GSK; and has participated on a data safety monitoring board (DSMB) or advisory board for Bayer. LSH received fees for advisory boards or scientific steering committees from Janssen, Gossamer Bio, Bayer, Endotronix, Merck Sharp & Dohme, GSK, United Therapeutics, and LungRx; speaker fees from Janssen and Bayer; research support from Janssen; conference and travel support from Janssen; and has shareholdings in OneWelbeck Clinic, ATXA Therapeutics, iOWNA, and Circular. LGH received grant funding from GSK, Schering Plough, Synairgen, Novartis, Roche/Genentech, and MedImmune; consulting fees from AstraZeneca, Novartis, Roche/Genentech, Sanofi, Circassia, GSK, Chiesi, and Teva; support for attending meetings or travel from AstraZeneca, Chiesi, Novartis, Boehringer Ingelheim, Teva, and GSK; and has participated on a DSMB or advisory board for Novartis, Roche/Genentech, GSK, Evelo Biosciences, Teva, Theravance, and Vectura. GC received payment or honoraria for lectures, presentations, or educational events from GSK, Chiesi, AstraZeneca, and Boehringer Ingelheim; has participated on a DSMB or advisory board for AstraZeneca, acting as a chronic obstructive pulmonary disease group chair; and had a leadership role in the Scottish Government Respiratory Unscheduled Care Group and Lothian respiratory managed clinical network. DP received support for the present manuscript from the NIHR and UKRI. MGS has participated on a DSMB or advisory board for Pfizer; had a leadership or fiduciary role in Integrum Scientific and MedEx Solutions; has or had stocks or stock options in Integrum Scientific and MedEx Solutions; has received funding for equipment, material, or medical drugs from Chiesi; has been a non-remunerated independent member of the HMG UK Scientific Advisory Group for Emergencies, COVID-19 Response, and HMG UK New Emerging Respiratory Virus Threats Advisory Group; and received support for the present manuscript from the UKRI–MRC and Department of Health and Social Care NIHR. MGJ received grant funding from the Medical Research Council (MRC), British Lung Foundation, Royal Society, Boehringer Ingelheim, and the AAIR Charity. CMa was partly funded by the University College London (UCL) NIHR Biomedical Research Centre. SS is supported by grants from NIHR and Wellcome; and has received payment or honoraria for lectures, presentations, or educational events from GSK, Ministry of Justice, CIPLA, and Sherbourne Gibbs. SJS has participated on a DSMB or advisory board for the National Institute for Health and Care Excellence and on the Wales Long COVID advisory board; has or had a leadership or fiduciary role in the American Thoracic Society pulmonary rehabilitation assembly, Royal College of Physicians pulmonary rehabilitation accreditation scheme, and National Asthma and Chronic Obstructive Pulmonary Disease Audit Programme for pulmonary rehabilitation. SJS is also paid by the Royal College of Physicians for the audit and the Pulmonary Rehabilitation Services Accreditation Scheme. JKQ received grant funding from the MRC, HDR UK, GSK, Bayer, Boehringer Ingelheim, Asthma + Lung UK, Chiesi, and AstraZeneca; consulting fees from GSK and AstraZeneca; and payment or honoraria for lectures, presentations, or educational events from GSK, Boehringer Ingelheim, AstraZeneca, Chiesi, Teva, and Insmed. JDC received grant funding from AstraZeneca, Boehringer Ingelheim, Grifols, Insmed, Gilead Science, Genentech, and Novartis; and consulting fees from AstraZeneca, Boehringer Ingelheim, Janssen, Insmed, Chiesi, Grifols, Novartis, and Zambon. PJ received support for the present manuscript from the NIHR Oxford Biomedical Research Centre. MB and KM were supported by UKRI Project number 104688; National Consortium for Intelligent Medical Imaging. CAM was supported by an advanced Fellowship, NIHR301338, funded by the NIHR; acknowledges support from the University of Manchester BHF Accelerator Award (AA/18/4/34221) and the NIHR Manchester Biomedical Research Centre (NIHR203308); received support from the University of Manchester BHF Accelerator Award (AA/18/4/34221) and the NIHR Manchester Biomedical Research Centre (NIHR203308); received grant funding from NIHR Clinician scientist award, Roche Products, Univar Solutions, Amicus Therapeutics, Guerbet Laboratories, and Roche Diagnostics; received consulting fees from PureTech Health; received payment or honoraria for lectures, presentations, or educational events from Novo Nordisk and Boehringer Ingelheim; received support for attending meetings or travel from AstraZeneca; and has participated on a DSMB or advisory board for Boehringer Ingelheim and Lilly Alliance, AstraZeneca, and HAYA therapeutics. GJ received grant funding from AstraZeneca, Biogen, Galecto, GSK, Nordic Biosciences, RedX, Pliant; consulting fees from AstraZeneca, Brainomix, Bristol Myers Squibb, Chiesi, Cohbar, Daewoong, GSK, Veracyte, Resolution Therapeutics, and Pliant; payment or honoraria for lectures, presentations, or educational events from Boehringer Ingelheim, Chiesi, Roche, PatientMPower, and AstraZeneca; has participated on a DSMB or advisory board for Boehringer Ingelheim, Galapagos, and Vicore; and has or had a leadership or fiduciary role in NuMedii and Action for Pulmonary Fibrosis. VCH and AH received support for the present manuscript from the joint funding UKRI and NIHR (grant references: MR/V027859/1 and COV0319). AH reports funding support from NIHR Manchester Biomedical Research Centre; has received grants from the Engineering and Physical Sciences Research Council, Cystic Fibrosis Trust, NIHR, JP Moulton Charity, and Cystic Fibrosis Foundation; has received consulting fees from Roche Genentech and Vertex Pharmaceuticals; and has received payments for educational activities. SP is supported by a grant from BHF. JCP received support for the present manuscript from Breathing Matters, University College London Hospital Biomedical Research Centre NIHR; and has received payment or honoraria for lectures, presentations, or educational events from The Limbic. EMT holds a patent with Oxford University Innovation; and has or had stocks or stock options in Perspectum. She received grant funding from HDR UK BREATHE Hub; has participated on AstraZeneca's Thrombotic Thrombocytopenic Advisory Board; and had a leadership or fiduciary role in various UK and Scottish Government COVID-19 advisory bodies. MT has received consulting fees from Morphogen IX and Janssen; support for attending meetings or travel from GSK and Janssen; and has participated on a DSMB or advisory board for ComCov, FluCov. SRJ received grant funding from UKRI, European and Developing Countries Clinical Trials Partnership, MRC, Rosetrees Trust, and Global Challenges Research Fund; received payment or honoraria for lectures, presentations, or educational events from the Federation of European Academies of Medicine; has participated on a DSMB or advisory board for Bexero trial; and had a leadership or fiduciary role at the journal AIDS. VMF acknowledges support from the BHF (CH/16/1/32013). SKP acknowledges indirect support from the Oxford BHF CRE and NIHR Oxford Biomedical Research Centre. MK has or had stocks or stock options in Perspectum; and has financial or non-financial interests in Perspectum. CEBr received grant funding from GSK, AstraZeneca, Sanofi, Boehringer Ingelheim, Chiesi, Novartis, Roche, Genentech, Mologic, and 4D Pharma; and has received consulting fees from GSK, AstraZeneca, Sanofi, Boehringer Ingelheim, Chiesi, Novartis, Roche, Genentech, Mologic, 4D Pharma, and TEVA. In the past 3 years, GPM received grant funding from BHF and MRC; had a leadership or fiduciary role in the Wellcome Trust Early Career Committee and British Society of Cardiovascular Magnetic Resonance Research; and has received funding for equipment, material, or medical drugs from Circle Cvi42. RAE received grant funding from NIHR–UKRI–Wolfson Foundation; consulting fees from AstraZeneca for long COVID; payment or honoraria for lectures, presentations, or educational events from Boehringer Ingelheim; support for attending meetings or travel from Chiesi; and had a leadership or fiduciary role in the European Respiratory Society Pulmonary Rehabilitation Group. JRH received consulting fees from AstraZeneca, Boehringer Ingelheim, Chiesi, and GSK; support for attending meetings or travel from AstraZeneca; and participated on a DSMB or advisory board for the study called HEAL COVID. LVW received support for the present manuscript from the UKRI, NIHR, and GSK and Asthma + Lung UK; grant funding from Orion Pharma, GSK, Genentech, and AstraZeneca; consulting fees from Galapagos and Boehringer Ingelheim; support for attending meetings or travel from Genentech; has participated on a DSMB or advisory board for Galapagos; and had a leadership role (Associate Editor) for the European Respiratory Journal. JJ received consulting fees from Boehringer Ingelheim, Roche, GSK, and NHSX; payment or honoraria for lectures, presentations, or educational events from Boehringer Ingelheim, Roche, GSK, and Takeda; support for attending meetings or travel from Boehringer Ingelheim; holds a patent with UK patent application number 2113765.8; and has participated on a DSMB or advisory board for Boehringer Ingelheim and Roche. PJMO is supported by a NIHR Senior Investigator Award (award 201385); has consulted for Janssen, Moderna, Cephid, Seqirus, Pfizer, GSK, and Sanofi in relation to vaccine development; and receives funding from EMINENT, a joint programme award from the MRC UK and GSK. All other members of the writing committee declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: Caring for adults with prior paediatric genitourinary reconstruction remains a challenge for adult providers. Reconstructions typically have occurred decades before; surgical records are not always available and patients and families may be unable to convey procedures performed. Spina bifida (SB) patients are vulnerable to cognitive decline which may compound these challenges. Changes in patient body habitus and loss of function may contribute to problems with previous reconstructions. Methods: This is a non-systematic review of the literature and represents expert opinion where data are non-existent. This review focuses on the evaluation and management of complications arising from genitourinary reconstruction in congenital neurogenic bladder patients. Results: Common complications experienced by congenital neurogenic bladder patients include recurrent urinary tract infection, incontinence of catheterizable channel and urinary reservoir as well as malignancy as this population ages. Preservation of renal function and prevention of urinary tract infection while optimizing continence are essential guiding principles in the care of these patients. Many of the recommendations, however, are gleaned from available data in the adult spinal cord patient (a more commonly studied population) or the paediatric urologic literature due to limited studies in adult management of such patients. Conclusion: Close follow-up and vigilance is warranted to monitor for infectious, mechanical and malignant complications while optimizing preservation of the upper urinary tracts and patient quality of life. [ABSTRACT FROM AUTHOR]

The toxigenic conversion of Escherichia coli strains by Shiga toxin-converting (Stx) bacteriophages were prominent and recurring events in the stepwise evolution of enterohemorrhagic E. coli (EHEC) O157:H7 from an enteropathogenic (EPEC) O55:H7 ancestor. Atypical, attenuated isolates have been described for both non-sorbitol fermenting (NSF) O157:H7 and SF O157:NM serotypes, which are distinguished by the absence of Stx, the characteristic virulence hallmark of Stx-producing E. coli (STEC). Such atypical isolates either never acquired Stx-phages or may have secondarily lost stx during the course of infection, isolation, or routine subculture; the latter are commonly referred to as LST (Lost Shiga Toxin)-isolates. In this study we analyzed the genomes of 15 NSF O157:H7 and SF O157:NM strains from North America, Europe, and Asia that are characterized by the absence of stx , the virulence hallmark of STEC. The individual genomic basis of the Stx (−) phenotype has remained largely undetermined as the majority of STEC genomes in public genome repositories were generated using short read technology and are in draft stage, posing a major obstacle for the high-resolution whole genome sequence typing (WGST). The application of LRT (long-read technology) sequencing provided us with closed genomes, which proved critical to put the atypical non-shigatoxigenic NSF O157:H7 and SF O157:NM strains into the phylogenomic context of the stepwise evolutionary model. Availability of closed chromosomes for representative Stx (−) NSF O157:H7 and SF O157:NM strains allowed to describe the genomic basis and individual evolutionary trajectories underlying the absence of Stx at high accuracy and resolution. The ability of LRT to recover and accurately assemble plasmids revealed a strong correlation between the strains' featured plasmid genotype and chromosomally inferred clade, which suggests the coevolution of the chromosome and accessory plasmids. The identified ancestral traits in the pSFO157 plasmid of NSF O157:H7 strain LSU-61 provided additional evidence for its intermediate status. Taken together, these observations highlight the utility of LRTs for advancing our understanding of EHEC O157:H7/NM pathogenome evolution. Insights into the genomic and phenotypic plasticity of STEC on a lineage- and genome-wide scale are foundational to improve and inform risk assessment, biosurveillance, and prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Group B Streptococcus (GBS) comprises the normal flora of the female urogenital tract and can be transferred to neonates during delivery, causing invasive diseases. This study was performed to investigate the colonization rate, antibiotic susceptibility, and serotype of GBS among Saudi pregnant women. Materials and Methods: In this cross-sectional study, vagino-rectal swabs from 400 pregnant women were collected over a period of one year. Identification of GBS isolates and determination of their antibiotic susceptibility were performed using the Microscan Walk Away system. The isolates were then typed using both latex agglutination and capsular genebased multiplex polymerase chain reaction assays. Results: Sixty (15.0%) subjects were colonized by GBS, with serotype Ia as the dominant type (30.0%) followed by serotype III and V (25.0%, each). Only 43 (71.7%) isolates were typed by latex agglutination, whereas the remaining isolates were not typable or were non-specifically typed as compared to the genotyping assay, which revealed the specific type of each GBS isolate. The highest resistance rates were observed for erythromycin and clindamycin (16.7%, each), which were mainly restricted to the prevalent serotypes. Conclusion: This study is the first to report the distribution of GBS serotypes based on molecular genotyping in Saudi Arabia. GBS colonization was evident among pregnant women, and resistance to erythromycin and clindamycin was predominant among serotypes Ia, III, and V. Molecular genotyping using capsular gene-based multiplex PCR provided reliable typing of the investigated GBS isolates in terms of sensitivity and specificity as compared to conventional serotyping using latex agglutination. [ABSTRACT FROM AUTHOR]

Background: No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge., Methods: The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing., Findings: 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters., Interpretation: The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials., Funding: UK Research and Innovation and National Institute for Health Research., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Climate change can drive population declines for many species, often through changes to their food supply. These changes can involve a mis-timing between periods of high food demand and peak food availability, typically from advances in breeding phenology, and/or an overall reduction in food availability. Aerial insectivores, birds that feed on insects caught in flight, are experiencing steep population declines possibly because of shifts in the timing and/or abundance of aerial insects. We determined whether changes in breeding performance over time could account for declines in Bank Riparia riparia, Barn Hirundo rustica, Cliff Petrochelidon pyrrhonota, and Tree Tachycineta bicolor Swallows, and if so, whether changes were related to shifts in breeding phenology and/or climate change. We compared breeding performance and phenology in Maritime Canada before (1962-1972) and after (2006-2016) the onset of steep population declines during the mid-1980s, to determine whether breeding performance was reduced or phenology was advanced. Then, we modeled relationships between temperature, precipitation, breeding phenology, and performance for Barn and Tree Swallows, the only species with sufficient data, from 1960 to 2016, to determine whether phenology and performance were related to climatic conditions. Between the two time periods, we found significantly lower performance in Bank Swallows, higher performance in Barn and Tree Swallows, and unchanged performance in Cliff Swallows. We also found clutch initiation dates advanced by 8-10 d for all species except Bank Swallows. On the breeding grounds, warmer winter temperatures for Tree Swallows and less winter precipitation for Barn and Tree Swallows in a given year were associated with earlier breeding, and for Tree Swallows, changes in nestling survival. Otherwise, Barn and Tree Swallow breeding performance was unaffected by winter temperature and precipitation. Our results suggest that in this region poorer breeding performance could contribute to population declines for Bank Swallows but not for the other three species. [ABSTRACT FROM AUTHOR]

Group BStreptococcus(GBS), a leading cause of neonatal sepsis and meningitis, asymptomatically colonizes up to 30% of women and can persistently colonize even after antibiotic treatment. Previous studies have shown that GBS resides inside macrophages, but the mechanism by which it survives remains unknown. Here, we examined the ability of 4 GBS strains to survive inside macrophages and then focused on 2 strains belonging to sequence type (ST)-17 and ST-12, to examine persistence in the presence of antibiotics. A multiple stress medium was also developed using several stressors found in the phagosome to assess the ability of 30 GBS strains to withstand phagosomal stress. The ST-17 strain was more readily phagocytosed and survived intracellularly longer than the ST-12 strain, but the ST-12 strain was tolerant to ampicillin unlike the ST-17 strain. Exposure to sub-inhibitory concentrations of ampicillin and erythromycin increased the level of phagocytosis of the ST-17 strain, but had no effect on the ST-12 strain. In addition, blocking acidification of the phagosome decreased the survival of the ST-17 strain indicating a pH-dependent survival mechanism for the ST-17 strain. Congruent with the macrophage experiments, the ST-17 strain had a higher survival rate in the multiple stress medium than the ST-12 strain, and overall, serotype III isolates survived significantly better than other serotypes. These results indicate that diverse GBS strains may use differing mechanisms to persist and that serotype III strains are better able to survive specific stressors inside the phagosome relative to other serotypes. [ABSTRACT FROM AUTHOR]

Bacteria prevalence has increased in health centers and hospitals. Infection control can decrease the number of bacteria. Bacteria cause 90% of nosocomial infections and fungi, viruses, or protozoa are less involved. Bacteria control can decrease the number of diseases. The Simultaneous titanium oxide (SMTiO) is a new method of disinfection. This process degrades bacteria by producing hydroxyl radical. The present study was conducted with the aim of analyzing the bactericidal effect of simultaneous titanium oxide on common hospital bacteria. In this study, SMTiO system was placed under a laminar hood. Escherichia coli, Klebsiella pneumonia, Staphylococcus aureus, Pseudomonas aeruginosa, and Citrobacter freundii were selected as common hospital bacteria. Treatment operations were conducted at the bacteria concentration 10 cells/mL and the exposure times of 1 to 48 h. Then, the bacteria colonies were counted and removal rate calculated separately each of the bacteria. Finally, data analysis was conducted by using one-way ANOVA. Results showed that E. coli and C. freundii had the highest removal rate (40%) and the lowest removal (14%), respectively. Results confirmed that SMTiO can degrade Gram-positive and Gram-negative bacteria, but its effects were lower on Gram-positive bacteria. Results showed that removal efficiency increased gradually during exposure periods. We recommend that future studies should analyze the structure of bacteria after the treatment with SMTiO. [ABSTRACT FROM AUTHOR]

Introduction: To assess opinions of females with CAH, and parents of females with CAH, about designating this population "intersex," particularly in legislation about genital surgery during childhood., Methods: We conducted a mixed-methods (quantitative and qualitative) anonymous cross-sectional online survey of females with CAH (46XX, 16+years old) and independently recruited parents of girls with CAH (2019-2020) diagnosed in first year of life from the United States. A multidisciplinary CAH team drafted the survey in collaboration with women with CAH and parents. Fisher's exact test was used to compare female and parent responses. A qualitative thematic approach was used to analyze open-ended answers for emergent categories of reasons why CAH females should or should not be considered as intersex., Results: Of 57 females with CAH participating (median age: 39 years, 75.5% of ≥25year olds had post-secondary degree), all had classical CAH and 93.0% underwent genital surgery at median 1-2 years old. While 89.5% did not endorse the intersex designation for CAH, the remaining 5.3% did (5.3% provided no answer, Summary Figure). Most CAH females (63.2%) believed CAH females should be considered separately in "any laws banning or allowing surgery of children's genitals" (19.3% disagreed, 17.5% neutral, 0.0% no answer). Most common themes identified by females with CAH not endorsing an intersex designation were: normal female internal organs, sex chromosomes, personal identity, genital appearance, issues with language, hormones, and those endorsing it: genital appearance, community/group experiences, topic complexity. Overall, 132 parents of females with CAH participated (parent/child median ages: 40/11 years, 81.7% of ≥25year olds had post-secondary degree). All children had classical CAH and 78.8% underwent surgery at median <1 year old. While 95.5% of parents did not endorse the intersex designation for CAH, 2.3% did (2.3% no answer), similar to females (p = 0.29). Most parents (81.1%) believed CAH females should be considered separately in legislation (9.1% disagreed, 6.1% neutral, 3.8% no answer), a slightly higher percentage than females (p = 0.01)., Discussion: Echoing previously published disagreement with clinically designating CAH females as intersex, majority of CAH females and parents oppose a legal intersex designation. Differing opinions among females and parents strengthen concern about a one-size-fits-all approach to legislation about childhood genital surgery. Differences in opinions between female and parent responses, while statistically significant, were relatively small., Conclusion: Majority of females with CAH and parents believe CAH should be excluded from the intersex designation, and should be considered separately in legislation pertaining to childhood genital surgery., Competing Interests: Conflicts of interest Authors: none. Study group members: Louise Fleming, PhD RN: Chair of the CARES Foundation (volunteer position); Mitchell E. Gaffner, MD: consulted/consults for Adrenas, Millendo, Neurocrine Biosciences, Pfizer, and Spruce Biosciences, served on data safety monitoring board for Millendo, receives royalties from McGraw-Hill and UpToDate; Karen Lin-Su, MD: Medical Director of CARES Foundation; Dix P. Poppas, MD: Member of CARES Foundation Scientific Advisory Board (volunteer position); Phyllis W. Speiser, MD: Medical Advisor for National Adrenal Diseases Foundation (volunteer position) and Member of CARES Foundation Scientific Advisory Board (volunteer position); others: none., (Copyright © 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Populations of most North American aerial insectivores have undergone steep population declines over the past 40 years but the relative importance of factors operating on breeding, wintering, or stopover sites remains unknown. We used archival light-level geolocators to track the phenology, movements and winter locations of barn swallows (Hirdundo rustica; n = 27) from populations across North America to determine their migratory connectivity. We identified an east-west continental migratory divide for barn swallows with birds from western regions (Washington State, USA (n = 8) and Saskatchewan, Canada (n = 5)) traveling shorter distances to wintering areas ranging from Oregon to northern Colombia than eastern populations (Ontario (n = 3) and New Brunswick (n = 10), Canada) which wintered in South America south of the Amazon basin. A single swallow from a stable population in Alabama shared a similar migration route to eastern barn swallows but wintered farther north in northeast Brazil indicating a potential leap frog pattern migratory among eastern birds. Six of 9 (67%) birds from the two eastern populations and Alabama underwent a loop migration west of fall migration routes including around the Gulf of Mexico travelling a mean of 2,224 km and 722 km longer on spring migration, respectively. Longer migration distances, including the requirement to cross the Caribbean Sea and Gulf of Mexico and subsequent shorter sedentary wintering periods, may exacerbate declines for populations breeding in northeastern North America. [ABSTRACT FROM AUTHOR]

Bladder augmentation remains the final step in the management of refractory neurogenic bladder (NGB) for many children who have failed medical management. The long-term risks and benefits of augmentation surgery are important to understand when counseling patients about management options and when following augmented patients postoperatively. Benefits of bladder augmentation include improved continence, decreased risk of upper tract deterioration, possibly improved quality of life, and even reduced risk of renal-related mortality. However, risks are not trivial and include the potential need for further surgery, calculi formation, bladder perforation, acid-base disturbances, vitamin B deficiency, and possibly malignancy. Therefore, patients considered for augmentation should be well counseled and selected and subsequently must be followed closely by an experienced urologist for the duration of their lives. [ABSTRACT FROM AUTHOR]

The purpose of this work is to study the existence and stability of stationary waves for viscous traffic flow models. From the viewpoint of dynamical systems, the steady-state problem of the systems can be formulated as a singularly perturbed problem. Using the geometric singular perturbation method, we establish the existence of stationary waves for both the inviscid and viscous systems. The inviscid stationary waves contain smooth waves and discontinuous transonic waves. Both waves admit viscous profiles for the viscous systems. Then we consider the linearized eigenvalue problem of the systems along smooth stationary waves. Applying the technique of center manifold reduction, we show that any one of the supersonic smooth stationary waves is spectrally unstable. [ABSTRACT FROM AUTHOR]

As North American species' ranges shift northward in response to climate change, populations isolated in high-elevation habitat 'islands' at the southern edge of distributions are predicted to decrease in size or be extirpated. Levels of genetic structure and gene flow and the number of private alleles held within these peripheral populations can be used as a measure of the potential loss of genetic diversity due to climate change. We use GIS-based climate niche models to project geographic distributions of 15 boreal forest bird species for the year 2080 under two carbon emissions scenarios to predict the extent to which ranges will shift, leading to the extirpation of isolated populations at the southern periphery of the boreal forest. Breeding distributions of nearly all boreal bird species are predicted to expand as they shift northward, but will dramatically decrease or be completely lost from mountain populations in New York, Vermont, and New Hampshire by 2080. To examine the effect of these shifts on gene pools of migratory bird species we genotyped 178 blackpoll warblers ( Setophaga striata) at nine microsatellite loci, sampling four imperiled high-elevation populations and four northern populations. In S. striata 10.4 % of microsatellite alleles were confined to populations expected to be lost due to climate change. However, these accounted for a nonsignificant percent of the genetic structure, and loss of these alleles would not significantly erode species heterozygosity or allelic richness. Our results indicate that isolated southern populations of S. striata, and possibly other migratory species with high gene flow, do not represent genetically isolated, independently evolving units. Efforts to mitigate the effect of climate change on boreal forest birds should focus on species in which peripheral populations harbor significant genetic diversity. [ABSTRACT FROM AUTHOR]

With the popularity of wind energy increasing globally, concerns surfaced in the 1980s as to the potential adverse effects of wind turbines on migrating birds. Understanding how weather conditions influence passage rates can help determine the potential for increased avian-turbine collisions. Using vertical and horizontal mounted marine radars, raptor stand watch observations, and portable handheld weather stations, we studied how temperature, cloud cover, barometric pressure, wind direction, and wind speed affected avian passage rates and height of migrants over 3 ridges (Wartenbe, North Dokie, and South Dokie) being developed for wind energy in northern British Columbia. Using an Akaike's Information Criterion (AIC), we determined that a reduced model combining wind speed, barometric pressure, and cloud cover was best at explaining and predicting higher passage rates (expressed as no. birds/hr) in the fall migration for both diurnal and nocturnal migrants. Wind speed proved the most important predictor of passage rates for spring nocturnal migrants and a combination of cloud cover, temperature, and wind direction for diurnal spring migrants. Wind speed also predicted decreases in flight altitude among nocturnal migrants but increased altitude in diurnal migrants. This information coupled with migration timing and topographical areas of higher migrant activity can be useful to wind energy proponents who wish to mitigate collision risk with migrating birds. [ABSTRACT FROM AUTHOR]