COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records

BACKGROUND: Updatable estimates of COVID-19 onset, progression, and trajectories underpin pandemic mitigation efforts. To identify and characterise disease trajectories, we aimed to define and validate ten COVID-19 phenotypes from nationwide linked electronic health records (EHR) using an extensible framework. METHODS: In this cohort study, we used eight linked National Health Service (NHS) datasets for people in England alive on Jan 23, 2020. Data on COVID-19 testing, vaccination, primary and secondary care records, and death registrations were collected until Nov 30, 2021. We defined ten COVID-19 phenotypes reflecting clinically relevant stages of disease severity and encompassing five categories: positive SARS-CoV-2 test, primary care diagnosis, hospital admission, ventilation modality (four phenotypes), and death (three phenotypes). We constructed patient trajectories illustrating transition frequency and duration between phenotypes. Analyses were stratified by pandemic waves and vaccination status. FINDINGS: Among 57 032 174 individuals included in the cohort, 13 990 423 COVID-19 events were identified in 7 244 925 individuals, equating to an infection rate of 12·7% during the study period. Of 7 244 925 individuals, 460 737 (6·4%) were admitted to hospital and 158 020 (2·2%) died. Of 460 737 individuals who were admitted to hospital, 48 847 (10·6%) were admitted to the intensive care unit (ICU), 69 090 (15·0%) received non-invasive ventilation, and 25 928 (5·6%) received invasive ventilation. Among 384 135 patients who were admitted to hospital but did not require ventilation, mortality was higher in wave 1 (23 485 [30·4%] of 77 202 patients) than wave 2 (44 220 [23·1%] of 191 528 patients), but remained unchanged for patients admitted to the ICU. Mortality was highest among patients who received ventilatory support outside of the ICU in wave 1 (2569 [50·7%] of 5063 patients). 15 486 (9·8%) of 158 020 COVID-19-related deaths occurred within 28 days of the first COVID-19 event without a COVID-19 diagnoses on the death certificate. 10 884 (6·9%) of 158 020 deaths were identified exclusively from mortality data with no previous COVID-19 phenotype recorded. We observed longer patient trajectories in wave 2 than wave 1. INTERPRETATION: Our analyses illustrate the wide spectrum of disease trajectories as shown by differences in incidence, survival, and clinical pathways. We have provided a modular analytical framework that can be used to monitor the impact of the pandemic and generate evidence of clinical and policy relevance using multiple EHR sources. FUNDING: British Heart Foundation Data Science Centre, led by Health Data Research UK

Biowaste-based biochar: A new strategy for fermentative bioethanol overproduction via whole-cell immobilization

This work explores the potential use of biochar as a microbial cell carrier enhancing the efficiency of alcoholic fermentations. Olive kernels, vineyard prunings, sewage sludge and seagrass residues were applied as biowaste for biochar production through pyrolysis at two different temperatures (250 °C and 500 °C), while a commercial type of non-biomass char was also employed for benchmarking purposes. Apart from vineyard prunings pyrolyzed at 250 °C, all other carbonaceous materials presented crystalline phases including halite, calcite, sylvite and/or silicon. Moreover, increase in pyrolysis temperature enhanced biochar's porosity and BET-specific surface area, which reached 41.7 m 2 g −1 for VP-based biochar remaining at lower levels (0.15–5.3 m 2 g −1 ) in other specimens tested. Elemental analysis demonstrated reduction in oxygen and increase in the carbon content of biochars produced at elevated temperatures, while biochar from seagrass included residues of chloride (0.3–5.14%). Three major yeasts were immobilized on materials exhibiting the highest surface areas and applied in repeated batch fermentations using Valencia orange peel hydrolyzates as feedstock. The biocatalysts developed using S. cerevisiae and K. marxianus immobilized on vineyard prunings-based biochar exhibited exceptional ethanol productivities as compared to the relevant literature, which reached 7.2 g L −1 h −1 and 7.3 g L −1 h −1 respectively. Although the aforementioned strains improved biofuel production by 36–52% compared to the conventional process, P. kudriavzevii KVMP10 was not efficient following immobilization on biochar. The approach constitutes an innovative method for bioenergy production, demonstrating a novel application of biochar in industrial biotechnology which incorporates important technological advances such as enhanced biofuel production and biomass recycling

Discharges to prison from medium secure psychiatric units in England and Wales

BackgroundEarly findings from a national study of discharges from 32 National Health Service medium secure units revealed that nearly twice as many patients than expected were discharged back to prison.AimsTo compare the characteristics of those discharged back to prison with those discharged to the community, and consider the implications for ongoing care and risk.MethodProspective cohort follow-up design. All forensic patients discharged from 32 medium secure units across England and Wales over a 12-month period were identified. Those discharged to prison were compared with those who were discharged to the community.ResultsNearly half of the individuals discharged to prison were diagnosed with a serious mental illness and over a third with schizophrenia. They were a higher risk, more likely to have a personality disorder, more symptomatic and less motivated than those discharged to the community.ConclusionsFindings suggest that alternative models of prison mental healthcare should be considered to reduce risks to the patient and the public.</jats:sec

Fully integrated modelling for sustainability assessment of resource recovery from waste

This paper presents an integrated modelling approach for value assessments, focusing on resource recovery from waste. The method tracks and forecasts a range of values across environmental, social, economic and technical domains by attaching these to material-flows, thus building upon and integrating unidimensional models such as material flow analysis (MFA) and lifecycle assessment (LCA). We argue that the usual classification of metrics into these separate domains is useful for interpreting the outputs of multidimensional assessments, but unnecessary for modelling. We thus suggest that multidimensional assessments can be better performed by integrating the calculation methods of unidimensional models rather than their outputs. To achieve this, we propose a new metric typology that forms the foundation of a multidimensional model. This enables dynamic simulations to be performed with material-flows (or values in any domain) driven by changes in value in other domains. We then apply the model in an illustrative case highlighting links between the UK coal-based electricity-production and concrete/cement industries, investigating potential impacts that may follow the increased use of low-carbon fuels (biomass and solid recovered fuels; SRF) in the former. We explore synergies and trade-offs in value across domains and regions, e.g. how changes in carbon emissions in one part of the system may affect mortality elsewhere. This highlights the advantages of recognising complex system dynamics and making high-level inferences of their effects, even when rigorous analysis is not possible. We also indicate how changes in social, environmental and economic ‘values’ can be understood as being driven by changes in the technical value of resources. Our work thus emphasises the advantages of building fully integrated models to inform conventional sustainability assessments, rather than applying hybrid approaches that integrate outputs from parallel models. The approach we present demonstrates that this is feasible and lays the foundations for such an integrated model.UK's Natural Environment Research Council (NERC); Department for Environment; Food and Rural Affairs (DEFRA);Economic and Social Research Council (ESRC