Characterizing long COVID in an international cohort: 7 months of symptoms and their impact

Background: A significant number of patients with COVID-19 experience prolonged symptoms, known as Long COVID. Few systematic studies have investigated this population, particularly in outpatient settings. Hence, relatively little is known about symptom makeup and severity, expected clinical course, impact on daily functioning, and return to baseline health. // Methods: We conducted an online survey of people with suspected and confirmed COVID-19, distributed via COVID-19 support groups (e.g. Body Politic, Long COVID Support Group, Long Haul COVID Fighters) and social media (e.g. Twitter, Facebook). Data were collected from September 6, 2020 to November 25, 2020. We analyzed responses from 3762 participants with confirmed (diagnostic/antibody positive; 1020) or suspected (diagnostic/antibody negative or untested; 2742) COVID-19, from 56 countries, with illness lasting over 28 days and onset prior to June 2020. We estimated the prevalence of 203 symptoms in 10 organ systems and traced 66 symptoms over seven months. We measured the impact on life, work, and return to baseline health. // Findings: For the majority of respondents (>91%), the time to recovery exceeded 35 weeks. During their illness, participants experienced an average of 55.9+/- 25.5 (mean+/-STD) symptoms, across an average of 9.1 organ systems. The most frequent symptoms after month 6 were fatigue, post-exertional malaise, and cognitive dysfunction. Symptoms varied in their prevalence over time, and we identified three symptom clusters, each with a characteristic temporal profile. 85.9% of participants (95% CI, 84.8% to 87.0%) experienced relapses, primarily triggered by exercise, physical or mental activity, and stress. 86.7% (85.6% to 92.5%) of unrecovered respondents were experiencing fatigue at the time of survey, compared to 44.7% (38.5% to 50.5%) of recovered respondents. 1700 respondents (45.2%) required a reduced work schedule compared to pre-illness, and an additional 839 (22.3%) were not working at the time of survey due to illness. Cognitive dysfunction or memory issues were common across all age groups (~88%). Except for loss of smell and taste, the prevalence and trajectory of all symptoms were similar between groups with confirmed and suspected COVID-19. // Interpretation: Patients with Long COVID report prolonged, multisystem involvement and significant disability. By seven months, many patients have not yet recovered (mainly from systemic and neurological/cognitive symptoms), have not returned to previous levels of work, and continue to experience significant symptom burden

Characterizing Long COVID in an International Cohort: 7 Months of Symptoms and Their Impact

Objective: To characterize the symptom profile and time course in patients with Long COVID, along with the impact on daily life, work, and return to baseline health. / Design: International web-based survey of suspected and confirmed COVID-19 cases with illness lasting over 28 days and onset prior to June 2020. / Setting: Survey distribution via online COVID-19 support groups and social media. / Participants: 3,762 respondents from 56 countries completed the survey. 1166 (33.7%) were 40-49 years old, 937 (27.1%) were 50-59 years old, and 905 (26.1%) were 30-39 years old. 2961 (78.9%) were women, 718 (19.1%) were men, and 63 (1.7%) were nonbinary. 8.4% reported being hospitalized. 27% reported receiving a laboratory-confirmed diagnosis of COVID-19. 96% reported symptoms beyond 90 days. / Results: Prevalence of 205 symptoms in 10 organ systems was estimated in this cohort, with 66 symptoms traced over seven months. Respondents experienced symptoms in an average of 9.08 (95% confidence interval 9.04 to 9.13) organ systems. The most frequent symptoms reported after month 6 were: fatigue (77.7%, 74.9% to 80.3%), post-exertional malaise (72.2%, 69.3% to 75.0%), and cognitive dysfunction (55.4%, 52.4% to 58.8%). These three symptoms were also the three most commonly reported overall. In those who recovered in less than 90 days, the average number of symptoms peaked at week 2 (11.4, 9.4 to 13.6), and in those who did not recover in 90 days, the average number of symptoms peaked at month 2 (17.2, 16.5 to 17.8). Respondents with symptoms over 6 months experienced an average of 13.8 (12.7 to 14.9) symptoms in month 7. 85.9% (84.8% to 87.0%) experienced relapses, with exercise, physical or mental activity, and stress as the main triggers. 86.7% (85.6% to 92.5%) of unrecovered respondents were experiencing fatigue at the time of survey, compared to 44.7% (38.5% to 50.5%) of recovered respondents. 45.2% (42.9% to 47.2%) reported requiring a reduced work schedule compared to pre-illness and 22.3% (20.5% to 24.3%) were not working at the time of survey due to their health conditions. / Conclusions: Patients with Long COVID report prolonged multisystem involvement and significant disability. Most had not returned to previous levels of work by 6 months. Many patients are not recovered by 7 months, and continue to experience significant symptom burden

Classical skyrmions in SU(N)/SO(N) cosets

We construct the skyrmion solutions appearing in the coset spaces SU(N)/SO(N) for N > 2 and compute their classical mass. For N = 3, the third homotopy group pi_3(SU(3)/SO(3)) = Z_4 implies the existence of two distinct solutions: the skyrmion of winding number two has spherical symmetry and is found to be the lightest non-trivial field configuration; the skyrmion and antiskyrmion of winding number plus and minus one are slightly heavier and of toroidal shape. For N >= 4, there is only one skyrmion since the third homotopy group is Z_2. It is found to have spherical symmetry and is significantly lighter than the N = 3 solutions.Comment: 14 pages, 3 figures; v2: discussion improve

New Sum Rules from Low Energy Compton Scattering on Arbitrary Spin Target

We derive two sum rules by studying the low energy Compton scattering on a target of arbitrary (nonzero) spin j. In the first sum rule, we consider the possibility that the intermediate state in the scattering can have spin |j \pm 1| and the same mass as the target. The second sum rule applies if the theory at hand possesses intermediate narrow resonances with masses different from the mass of the scatterer. These sum rules are generalizations of the Gerasimov-Drell-Hearn-Weinberg sum rule. Along with the requirement of tree level unitarity, they relate different low energy couplings in the theory. Using these sum rules, we show that in certain cases the gyromagnetic ratio can differ from the "natural" value g=2, even at tree level, without spoiling perturbative unitarity. These sum rules can be used as constraints applicable to all supergravity and higher-spin theories that contain particles charged under some U(1) gauge field. In particular, applied to four dimensional N=8 supergravity in a spontaneously broken phase, these sum rules suggest that for the theory to have a good ultraviolet behavior, additional massive states need to be present, such as those coming from the embedding of the N=8 supergravity in type II superstring theory. We also discuss the possible implications of the sum rules for QCD in the large-N_c limit.Comment: 18 pages, v2: discussion on black hole contribution is included, references added; v3: extended discussion in introduction, version to appear in JHE

Dangerous Skyrmions in Little Higgs Models

Skyrmions are present in many models of electroweak symmetry breaking where the Higgs is a pseudo-Goldstone boson of some strongly interacting sector. They are stable, composite objects whose mass lies in the range 10-100 TeV and can be naturally abundant in the universe due to their small annihilation cross-section. They represent therefore good dark matter candidates. We show however in this work that the lightest skyrmion states are electrically charged in most of the popular little Higgs models, and hence should have been directly or indirectly observed in nature already. The charge of the skyrmion under the electroweak gauge group is computed in a model-independent way and is related to the presence of anomalies in the underlying theory via the Wess-Zumino-Witten term.Comment: 31 pages, 4 figures; v2: minor changes, one reference added, version to appear in JHEP; v3: erratum added, conclusions unchange

Modulation of Wnt/β-catenin signaling and proliferation by a ferrous iron chelator with therapeutic efficacy in genetically engineered mouse models of cancer

Using a screen for Wnt/β-catenin inhibitors, a family of 8-hydroxyquinolone derivatives with in vivo anti-cancer properties was identified. Analysis of microarray data for the lead compound N-((8-hydroxy-7-quinolinyl) (4-methylphenyl)methyl)benzamide (HQBA) using the Connectivity Map database suggested that it is an iron chelator that mimics the hypoxic response. HQBA chelates Fe2+ with a dissociation constant of ∼10−19 , with much weaker binding to Fe3+ and other transition metals. HQBA inhibited proliferation of multiple cell lines in culture, and blocked the progression of established spontaneous cancers in two distinct genetically engineered mouse models of mammary cancer, MMTV-Wnt1 and MMTV-PyMT mice, without overt toxicity. HQBA may inhibit an iron-dependent factor that regulates cell-type-specific β-catenin-driven transcription. It inhibits cancer cell proliferation independently of its effect on β-catenin signaling, as it works equally well in MMTV-PyMT tumors and diverse β-catenin-independent cell lines. HQBA is a promising specific intracellular Fe2+ chelator with activity against spontaneous mouse mammary cancers

Feasibility Study of a Wearable Exoskeleton for Children: Is the Gait Altered by Adding Masses on Lower Limbs?

We are designing a pediatric exoskeletal ankle robot (pediatric Anklebot) to promote gait habilitation in children with Cerebral Palsy (CP). Few studies have evaluated how much or whether the unilateral loading of a wearable exoskeleton may have the unwanted effect of altering significantly the gait. The purpose of this study was to evaluate whether adding masses up to 2.5 kg, the estimated overall added mass of the mentioned device, at the knee level alters the gait kinematics. Ten healthy children and eight children with CP, with light or mild gait impairment, walked wearing a knee brace with several masses. Gait parameters and lower-limb joint kinematics were analyzed with an optoelectronic system under six conditions: without brace (natural gait) and with masses placed at the knee level (0.5, 1.0, 1.5, 2.0, 2.5 kg). T-tests and repeated measures ANOVA tests were conducted in order to find noteworthy differences among the trial conditions and between loaded and unloaded legs. No statistically significant differences in gait parameters for both healthy children and children with CP were observed in the five “with added mass” conditions. We found significant differences among “natural gait” and “with added masses” conditions in knee flexion and hip extension angles for healthy children and in knee flexion angle for children with CP. This result can be interpreted as an effect of the mechanical constraint induced by the knee brace rather than the effect associated with load increase. The study demonstrates that the mechanical constraint induced by the brace has a measurable effect on the gait of healthy children and children with CP and that the added mass up to 2.5 kg does not alter the lower limb kinematics. This suggests that wearable devices weighing 25 N or less will not noticeably modify the gait patterns of the population examined here.Cerebral Palsy International Research FoundationStavros S. Niarchos Foundatio

Educational Homogamy Lowers the Odds of Reproductive Failure

Assortative mating based on education is a common phenomenon. We investigated whether it affected parameters of reproductive performance such as childlessness, offspring number and age at first marriage. On the basis of the US census from 1980 (n = 670,631 married US couples), we find that the proportion of childless individuals is usually minimal in women married to a husband of the same educational level. This holds particularly true in the highest and the lowest educated women. Educational homogamy is also associated with a lower average age at first marriage. No obvious effect of educational homogamy on a woman's average offspring number is found, where mean offspring number generally increases both with decreasing woman's and decreasing husband's educational attainment. We conclude that educational homogamy reduces the likelihood of reproductive failure

Reaction rates and transport in neutron stars

Understanding signals from neutron stars requires knowledge about the transport inside the star. We review the transport properties and the underlying reaction rates of dense hadronic and quark matter in the crust and the core of neutron stars and point out open problems and future directions.Comment: 74 pages; commissioned for the book "Physics and Astrophysics of Neutron Stars", NewCompStar COST Action MP1304; version 3: minor changes, references updated, overview graphic added in the introduction, improvements in Sec IV.A.

Epidemiological risk factors for adult dengue in Singapore: an 8-year nested test negative case control study

10.1186/s12879-016-1662-4BMC Infectious Diseases16132