Modifiable lifestyle factors and severe COVID-19 risk: a Mendelian randomisation study.

BACKGROUND: Lifestyle factors including obesity and smoking are suggested to be correlated with increased risk of COVID-19 severe illness or related death. However, whether these relationships are causal is not well known; neither for the relationships between COVID-19 severe illness and other common lifestyle factors, such as physical activity and alcohol consumption. METHODS: Genome-wide significant genetic variants associated with body mass index (BMI), lifetime smoking, physical activity and alcohol consumption identified by large-scale genome-wide association studies (GWAS) of up to 941,280 individuals were selected as instrumental variables. Summary statistics of the genetic variants on severe illness of COVID-19 were obtained from GWAS analyses of up to 6492 cases and 1,012,809 controls. Two-sample Mendelian randomisation analyses were conducted. RESULTS: Both per-standard deviation (SD) increase in genetically predicted BMI and lifetime smoking were associated with about two-fold increased risks of severe respiratory COVID-19 and COVID-19 hospitalization (all P < 0.05). Per-SD increase in genetically predicted physical activity was associated with decreased risks of severe respiratory COVID-19 (odds ratio [OR] = 0.19; 95% confidence interval [CI], 0.05, 0.74; P = 0.02), but not with COVID-19 hospitalization (OR = 0.44; 95% CI 0.18, 1.07; P = 0.07). No evidence of association was found for genetically predicted alcohol consumption. Similar results were found across robust Mendelian randomisation methods. CONCLUSIONS: Evidence is found that BMI and smoking causally increase and physical activity might causally decrease the risk of COVID-19 severe illness. This study highlights the importance of maintaining a healthy lifestyle in protecting from COVID-19 severe illness and its public health value in fighting against COVID-19 pandemic

Long-term healthcare utilization and costs of babies born after assisted reproductive technologies (ART): a record linkage study with 10-years’ follow-up in England

STUDY QUESTION:Is the long-term health care utilization of children born after ART more costly to the healthcare system in England than children born to mothers with no fertility problems? SUMMARY ANSWER:Children born after ART had significantly more general practitioner (GP) consultations and higher primary care costs up to 10 years after birth, and significantly higher hospital admission costs in the first year after birth, compared to childrenborn to mothers with no fertility problems. WHAT IS KNOWN ALREADY:There is evidence that children born after ART are at an increased risk of adverse birth outcomes and a small increased risk of rare adverse outcomes in childhood. STUDY DESIGN, SIZE, DURATION: We conducted a longitudinal study of 368 088 mother and baby pairs in England using a bespoke linked dataset. Singleton babies born 1997–2018, and their mothers, who were registered at GP practices in England contributing data to the Clinical Practice Research Datalink (CPRD), were identified through the CPRD GOLD mother–baby dataset; this data was augmentedwith further linkage to the mothers’ Human Fertilisation and Embryology Authority (HFEA) Register data. Four groups of babies were identified through the mothers’ records: a ‘fertile’ comparison group, an ‘untreated sub-fertile’ group, an ‘ovulation induction’group, and an ART group. Babies were followed-up from birth to 28 February 2021, unless censored due to loss to follow-up (e.g. leaving GP practice, emigration) or death. PARTICIPANTS/MATERIALS, SETTING, METHODS: The CPRD collects anonymized coded patient electronic health records from a network of GPs in the UK. We estimated primary care costs and hospital admission costs for babies in the four fertility groups using the CPRD GOLD data and the linked Hospital Episode Statistics (HES) Admitted Patient Care (APC) data. Linear regression was used to compare the care costs in the different groups. Inverse probability weights were generated and applied to adjust for potential bias caused by attrition due to loss to follow-up. MAIN RESULTS AND THE ROLE OF CHANCE: Children born to mothers with no fertility problems had significantly fewer consultations and lower primary care costs compared to the other groups throughout the 10-years’ follow up. Regarding hospital costs, childrenborn after ART had significantly higher hospital admission costs in the first year after birth compared to those born to motherswith no fertility problems (difference = £307 (95% CI: 153, 477)). The same pattern was observed in children born after untreated subfertility and ovulation induction. LIMITATIONS, REASONS FOR CAUTION: HFEA linkage uses non-donor data cycles only, and the introduction of consent for data use reduced the availability of HFEA records after 2009. The fertility groups were derived by augmenting HFEA data with evidence from primary care records; however, there remains some potential misclassification of exposure groups. The cost of neonatal critical care is not captured in the HES APC data, which may cause underestimation of the cost differences between the comparison group and the infertility groups. WIDER IMPLICATIONS OF THE FINDINGS: The findings can help anticipate the financial impact on the healthcare system associatedwith subfertility and ART, particularly as the demand for these treatments grows. STUDY FUNDING/COMPETING INTEREST(S): C.C. and this work were funded by a UK Medical Research Council Career Development Award [MR/L019671/1] and a UK MRC Transition Support Award [MR/W029286/1]. X.H. is an Australia National Health and Medical Research Council (NHMRC) Emerging Leadership Fellow [grant number 2009253]. The authors declare no competing interest. TRIAL REGISTRATION NUMBER: N/A

Development and use of prediction models for classification of cardiovascular risk of remote Indigenous Australians

Background: Cardiovascular disease (CVD) is the leading cause of death for Indigenous Australians. There is widespread belief that current tools have deficiencies for assessing CVD risk in this high-risk population. We sought to develop a 5-year CVD risk score using a wide range of known risk factors to further improve CVD risk prediction in this population. Methods: We used clinical and demographic information on Indigenous people aged between 30 and 74 years without a history of CVD events who participated in the Well Person’s Health Check (WPHC), a community-based survey. Baseline assessments were conducted between 1998 and 2000, and data were linked to administrative hospitalisation and death records for identification of CVD events. We used Cox proportional hazard models to estimate the 5-year CVD risk, and the Harrell’s c-statistic and the modified Hosmer-Lemeshow (mH-L) χ2 statistic to assess the model discrimination and calibration, respectively. Results: The study sample consisted of 1,583 individuals (48.1% male; mean age 45.0 year). The risk score consisted of sex, age, systolic blood pressure, diabetes mellitus, waist circumference, triglycerides, and albumin creatinine ratio. The bias-corrected c-statistic was 0.72 and the bias-corrected mH-L χ2 statistic was 12.01 (p-value, 0.212), indicating good discrimination and calibration, respectively. Using our risk score, the CVD risk of the Indigenous Australians could be stratified to a greater degree compared to a recalibrated Framingham risk score. Conclusions: A seven-factor risk score could satisfactorily stratify 5-year risk of CVD in an Indigenous Australian cohort. These findings inform future research targeting CVD risk in Indigenous Australians

Quasi-Solid-State Ion-Conducting Arrays Composite Electrolytes with Fast Ion Transport Vertical-Aligned Interfaces for All-Weather Practical Lithium-Metal Batteries

The rapid improvement in the gel polymer electrolytes (GPEs) with high ionic conductivity brought it closer to practical applications in solid-state Li-metal batteries. The combination of solvent and polymer enables quasi-liquid fast ion transport in the GPEs. However, different ion transport capacity between solvent and polymer will cause local nonuniform Li$^+$ distribution, leading to severe dendrite growth. In addition, the poor thermal stability of the solvent also limits the operating-temperature window of the electrolytes. Optimizing the ion transport environment and enhancing the thermal stability are two major challenges that hinder the application of GPEs. Here, a strategy by introducing ion-conducting arrays (ICA) is created by vertical-aligned montmorillonite into GPE. Rapid ion transport on the ICA was demonstrated by $^6$Li solid-state nuclear magnetic resonance and synchrotron X-ray diffraction, combined with computer simulations to visualize the transport process. Compared with conventional randomly dispersed fillers, ICA provides continuous interfaces to regulate the ion transport environment and enhances the tolerance of GPEs to extreme temperatures. Therefore, GPE/ICA exhibits high room-temperature ionic conductivity (1.08 mS cm$^{−1}$) and long-term stable Li deposition/stripping cycles (> 1000 h). As a final proof, Li||GPE/ICA||LiFePO$_4$ cells exhibit excellent cycle performance at wide temperature range (from 0 to 60 °C), which shows a promising path toward all-weather practical solid-state batteries

A method to prolong lithium-ion battery life during the full life cycle

Extended lifetime of lithium-ion batteries decreases economic costs and environmental burdens in achieving sustainable development. Cycle life tests are conducted on 18650-type commercial batteries, exhibiting nonlinear and inconsistent degradation. The accelerated fade dispersion is proposed to be triggered by the evolution of an additional potential of the anode during cycling as measured vs. Li$^+$/Li. A method to prolong the battery cycle lifetime is proposed, in which the lower cutoff voltage is raised to 3 V when the battery reaches a capacity degradation threshold. The results demonstrate a 38.1% increase in throughput at 70% of their beginning of life (BoL) capacity. The method is applied to two other types of lithium-ion batteries. A cycle lifetime extension of 16.7% and 33.7% is achieved at 70% of their BoL capacity, respectively. The proposed method enables lithium-ion batteries to provide long service time, cost savings, and environmental relief while facilitating suitable second-use applications

Phosphoric acid and thermal treatments reveal the peculiar role of surface oxygen anions in lithium and manganese-rich layered oxides

The interplay between cationic and anionic redox activity during electrochemical cycling makes layered Li-rich oxides appealing cathodes for state-of-the-art lithium-ion batteries. However, it remains challenging as the origin of lattice oxygen activity is not yet fully understood. Here we report on the effects of a lithium-deficient layer in the near-surface region of Co-free Li-rich Li[Li0.2Ni0.2Mn0.6]O-2 (LLNMO) achieved via a phosphoric acid surface treatment. Our results show that oxidized On- (0 < n < 2) species are formed on the surface of H3PO4-treated LLNMO resulting from Li ion deficiency and lattice distortion. The metastable On- could be easily released from the oxygen surface lattice forming O-2 via thermal treatment, accompanied by a surface reconstruction and a layered-to-rock-salt/spinel transition. The presented results demonstrate that the surface lattice structure plays a critical role in the electrochemical performance of LLNMO. This information provides new insights into the oxygen redox in LLNMO and opens up an opportunity for Li-rich cathodes to achieve long cycle life toward a broad range of applications in electrical energy storage devices

Validation and recalibration of the Framingham cardiovascular disease risk models in an Australian Indigenous cohort: Does the current Framingham risk calculator accurately estimate true CVD risk for Indigenous Australians?

In this study, we validated both the 1991 and 2008 Framingham CVD models using a cohort of Aboriginal and Torres Strait Islander adults drawn from remote Indigenous communities in Far North Queensland. Recalibration was also conducted to help generate more accurate CVD risk predictions for this population. Finally, we developed a CVD risk chart that could help improve the assessment and management of CVD in the Australian Indigenous population, particularly those in remote regions of Australia.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy