Long COVID describes new or persistent symptoms at least 4 weeks after onset of acute COVID-19. Clinical codes to describe this phenomenon were recently created.
To describe the use of long-COVID ...codes, and variation of use by general practice, demographic variables, and over time.
Population-based cohort study in English primary care.
Working on behalf of NHS England, OpenSAFELY data were used encompassing 96% of the English population between 1 February 2020 and 25 May 2021. The proportion of people with a recorded code for long COVID was measured overall and by demographic factors, electronic health record software system (EMIS or TPP), and week.
Long COVID was recorded for 23 273 people. Coding was unevenly distributed among practices, with 26.7% of practices having never used the codes. Regional variation ranged between 20.3 per 100 000 people for East of England (95% confidence interval CI = 19.3 to 21.4) and 55.6 per 100 000 people in London (95% CI = 54.1 to 57.1). Coding was higher among females (52.1, 95% CI = 51.3 to 52.9) than males (28.1, 95% CI = 27.5 to 28.7), and higher among practices using EMIS (53.7, 95% CI = 52.9 to 54.4) than those using TPP (20.9, 95% CI = 20.3 to 21.4).
Current recording of long COVID in primary care is very low, and variable between practices. This may reflect patients not presenting; clinicians and patients holding different diagnostic thresholds; or challenges with the design and communication of diagnostic codes. Increased awareness of diagnostic codes is recommended to facilitate research and planning of services, and also surveys with qualitative work to better evaluate clinicians' understanding of the diagnosis.
Abstract
Background
Noninfluenza respiratory viruses are responsible for a substantial burden of disease in the United States. Household transmission is thought to contribute significantly to ...subsequent transmission through the broader community. In the context of the coronavirus disease 2019 (COVID-19) pandemic, contactless surveillance methods are of particular importance.
Methods
From November 2019 to April 2020, 303 households in the Seattle area were remotely monitored in a prospective longitudinal study for symptoms of respiratory viral illness. Enrolled participants reported weekly symptoms and submitted respiratory samples by mail in the event of an acute respiratory illness (ARI). Specimens were tested for 14 viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), using reverse-transcription polymerase chain reaction. Participants completed all study procedures at home without physical contact with research staff.
Results
In total, 1171 unique participants in 303 households were monitored for ARI. Of participating households, 128 (42%) included a child aged <5 years and 202 (67%) included a child aged 5–12 years. Of the 678 swabs collected during the surveillance period, 237 (35%) tested positive for 1 or more noninfluenza respiratory viruses. Rhinovirus, common human coronaviruses, and respiratory syncytial virus were the most common. Four cases of SARS-CoV-2 were detected in 3 households.
Conclusions
This study highlights the circulation of respiratory viruses within households during the winter months during the emergence of the SARS-CoV-2 pandemic. Contactless methods of recruitment, enrollment, and sample collection were utilized throughout this study and demonstrate the feasibility of home-based, remote monitoring for respiratory infections.
A household study using online recruitment and home collection of respiratory specimens was conducted in 303 households during the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Of 678 samples collected, 237 tested positive for 1 or more noninfluenza viruses, and 4 tested positive for SARS-CoV-2.
β-LACTAM ANTIBIOTICS. I FERRES, HARRY; BASKER, MICHAEL J.; O'HANLON, PETER J.
Journal of antibiotics,
1974, Letnik:
27, Številka:
12
Journal Article
Recenzirano
Odprti dostop
Structure-activity relationships were compared for two series of penicillins containing a common acyl group. In series I, which included most of the penicillins in clinical use, the acyl moiety was ...linked directly to the amino group of the penicillin nucleus. For series II the acyl moiety was linked to the amino group of D-α-aminobenzylpenicillin (ampicillin). In the majority of cases a striking similarity between the two series was observed. The correlation provided both a valuable means of classifying and predicting the antibacterial properties of one series from a knowledge of the other.
β-LACTAM ANTIBIOTICS. II FERRES, HARRY; BASKER, MICHAEL J.; BEST, DESMOND J. ...
Journal of antibiotics,
1978, Letnik:
31, Številka:
10
Journal Article
Recenzirano
Odprti dostop
The influence on the structure-activity relationships (S. A. R.) of the stereochemistry and various alkyl, aryl, aralkyl and heterocyclic substituents at the two chiral centres in the dipeptide ...side-chain of a new series of penicillins was examined. In many cases the effects of these changes had a pronounced influence on the degree of activity against Gram-positive and especially Gram-negative bacteria. Several compounds indicated that the size, shape and spatial disposition of a substituent were the parameters of importance in influencing activity, rather than its lipophilic or electronic character. The most active homologues in the series provided broad-spectrum penicillins which in terms of their in vitro antibacterial properties showed improvements over certain of the marketed penicillins. Thus 6-D-α(α'-ureidoacylamino) acylaminopenicillanic acids were found which had a carbenicillin-like profile, with improvements against Pseudonionas aeruginosa, Klebsiella aerogenes, sensitive and β-lactamaseproducing Gram-positive cocci.
Frailty is an age-related clinical condition characterised by an increased susceptibility to stressors and an elevated risk of adverse outcomes such as mortality. In the light of global population ...ageing, the prevalence of frailty is expected to soar in coming decades. This narrative review provides critical insights into recent developments and emerging practices in frailty research regarding identification, management, risk factors, and prevention. We searched journals in the top two quartiles of geriatrics and gerontology (from Clarivate Journal Citation Reports) for articles published between 01 January 2018 and 20 December 2022. Several recent developments were identified, including new biomarkers and biomarker panels for frailty screening and diagnosis, using artificial intelligence to identify frailty, and investigating the altered response to medications by older adults with frailty. Other areas with novel developments included exercise (including technology-based exercise), multidimensional interventions, person-centred and integrated care, assistive technologies, analysis of frailty transitions, risk-factors, clinical guidelines, COVID-19, and potential future treatments. This review identified a strong need for the implementation and evaluation of cost-effective, community-based interventions to manage and prevent frailty. Our findings highlight the need to better identify and support older adults with frailty and involve those with frailty in shared decision-making regarding their care.
•This review provides insights into recent developments and emerging practices in frailty research.•Novelties in frailty identification, management, risk factors and prevention were identified.•New biomarkers and artificial intelligence provide promising directions for frailty screening.•Many recent articles were focused on factors delaying or driving frailty progression.•There is a strong need for high-quality intervention research to manage and prevent frailty.
Schizophrenia (SZ) and bipolar disorder (BD) share genetic risk factors, yet patients display differential levels of cognitive impairment. We hypothesized a genome-transcriptome-functional ...connectivity (frontoparietal)-cognition pathway linked to SZ-versus-BD differences, and conducted a multiscale study to delineate this pathway.
Large genome-wide studies provided single nucleotide polymorphisms (SNPs) conferring more risk for SZ than BD, and we identified their regulated genes, namely SZ-biased SNPs and genes. We then (a) computed the polygenic risk score for SZ (PRSSZ) of SZ-biased SNPs and examined its associations with imaging-based frontoparietal functional connectivity (FC) and cognitive performances; (b) examined the spatial correlation between ex vivo postmortem expressions of SZ-biased genes and in vivo, SZ-related FC disruptions across frontoparietal regions; (c) investigated SZ-versus-BD differences in frontoparietal FC; and (d) assessed the associations of frontoparietal FC with cognitive performances.
PRSSZ of SZ-biased SNPs was significantly associated with frontoparietal FC and working memory test scores. SZ-biased genes' expressions significantly correlated with SZ-versus-BD differences in FC across frontoparietal regions. SZ patients showed more reductions in frontoparietal FC than BD patients compared to controls. Frontoparietal FC was significantly associated with test scores of multiple cognitive domains including working memory, and with the composite scores of all cognitive domains.
Collectively, these multiscale findings support the hypothesis that SZ-biased genetic risk, through transcriptome regulation, is linked to frontoparietal dysconnectivity, which in turn contributes to differential cognitive deficits in SZ-versus BD, suggesting that potential biomarkers for more precise patient stratification and treatment.
Aims
The purpose of this study was to identify the number of pregnancies affected by pre‐gestational diabetes in the Republic of Ireland; to report on pregnancy outcomes and to identify areas for ...improvement in care delivery and clinical outcomes.
Methods
Healthcare professionals caring for women with pre‐gestational diabetes during pregnancy were invited to participate in this retrospective study. Data pertaining to 185 pregnancies in women attending 15 antenatal centres nationally were collected and analysed. Included pregnancies had an estimated date of delivery between 1 January and 31 December 2015.
Results
The cohort consisted of 122 (65.9%) women with Type 1 diabetes and 56 (30.3%) women with Type 2 diabetes. The remaining 7 (3.8%) pregnancies were to women with maturity‐onset diabetes of the young (MODY) (n = 6) and post‐transplant diabetes (n = 1). Overall women were poorly prepared for pregnancy and lapses in specific areas of service delivery including pre‐pregnancy care and retinal screening were identified. The majority of pregnancies 156 (84.3%) resulted in a live birth. A total of 103 (65.5%) women had a caesarean delivery and 58 (36.9%) infants were large for gestational age.
Conclusions
This audit identifies clear areas for improvement in delivery of care for women with diabetes in the Republic of Ireland before and during pregnancy.
What's new?
The National Pregnancy in Diabetes Audit was well received in the United Kingdom and outcome improvements have been observed since its initiation
Similar processes were not previously in place in Ireland
Few women attend a formal pre‐pregnancy care programme
Two‐thirds of women experience a caesarean delivery
Some 47% infants are admitted to a neonatal intensive care unit
The findings will encourage units to develop pre‐pregnancy care programmes for women with diabetes; streamline clinical care and review practices surrounding caesarean delivery
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