Studying the Long-term Impact of COVID-19 in Kids (SLICK). Healthcare use and costs in children and young people following community-acquired SARS-CoV-2 infection: protocol for an observational study using linked primary and secondary routinely collected healthcare data from England, Scotland and Wales

Introduction SARS-CoV-2 infection rarely causes hospitalisation in children and young people (CYP), but mild or asymptomatic infections are common. Persistent symptoms following infection have been reported in CYP but subsequent healthcare use is unclear. We aim to describe healthcare use in CYP following community-acquired SARS-CoV-2 infection and identify those at risk of ongoing healthcare needs.Methods and analysis We will use anonymised individual-level, population-scale national data linking demographics, comorbidities, primary and secondary care use and mortality between 1 January 2019 and 1 May 2022. SARS-CoV-2 test data will be linked from 1 January 2020 to 1 May 2022. Analyses will use Trusted Research Environments: OpenSAFELY in England, Secure Anonymised Information Linkage (SAIL) Databank in Wales and Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 in Scotland (EAVE-II). CYP aged ≥4 and <18 years who underwent SARS-CoV-2 reverse transcription PCR (RT-PCR) testing between 1 January 2020 and 1 May 2021 and those untested CYP will be examined.The primary outcome measure is cumulative healthcare cost over 12 months following SARS-CoV-2 testing, stratified into primary or secondary care, and physical or mental healthcare. We will estimate the burden of healthcare use attributable to SARS-CoV-2 infections in the 12 months after testing using a matched cohort study of RT-PCR positive, negative or untested CYP matched on testing date, with adjustment for confounders. We will identify factors associated with higher healthcare needs in the 12 months following SARS-CoV-2 infection using an unmatched cohort of RT-PCR positive CYP. Multivariable logistic regression and machine learning approaches will identify risk factors for high healthcare use and characterise patterns of healthcare use post infection.Ethics and dissemination This study was approved by the South-Central Oxford C Health Research Authority Ethics Committee (13/SC/0149). Findings will be preprinted and published in peer-reviewed journals. Analysis code and code lists will be available through public GitHub repositories and OpenCodelists with meta-data via HDR-UK Innovation Gateway

COVID-19 Infection Risk amongst 14,104 Vaccinated Care Home Residents: A national observational longitudinal cohort study in Wales, United Kingdom, December 2020 to March 2021

Backgroundvaccinations for COVID-19 have been prioritised for older people living in care homes. However, vaccination trials included limited numbers of older people.Aimwe aimed to study infection rates of SARS-CoV-2 for older care home residents following vaccination and identify factors associated with increased risk of infection.Study Design and Settingwe conducted an observational data-linkage study including 14,104 vaccinated older care home residents in Wales (UK) using anonymised electronic health records and administrative data.Methodswe used Cox proportional hazards models to estimate hazard ratios (HRs) for the risk of testing positive for SARS-CoV-2 infection following vaccination, after landmark times of either 7 or 21 days post-vaccination. We adjusted HRs for age, sex, frailty, prior SARS-CoV-2 infections and vaccination type.Resultswe observed a small proportion of care home residents with positive polymerase chain reaction (tests following vaccination 1.05% (N = 148), with 90% of infections occurring within 28 days. For the 7-day landmark analysis we found a reduced risk of SARS-CoV-2 infection for vaccinated individuals who had a previous infection; HR (95% confidence interval) 0.54 (0.30, 0.95). For the 21-day landmark analysis, we observed high HRs for individuals with low and intermediate frailty compared with those without; 4.59 (1.23, 17.12) and 4.85 (1.68, 14.04), respectively.Conclusionsincreased risk of infection after 21 days was associated with frailty. We found most infections occurred within 28 days of vaccination, suggesting extra precautions to reduce transmission risk should be taken in this time frame

2017 Scientific Consensus Statement: land use impacts on the Great Barrier Reef water quality and ecosystem condition, Chapter 1: the condition of coastal and marine ecosystems of the Great Barrioer Reef and their responses to water quality and disturbances

The condition of coastal and marine ecosystems on the Great Barrier Reef and their responses to water quality and disturbances. The Great Barrier Reef marine ecosystems and their associated catchments are part of a dynamic, interconnected system. This chapter provides an up-to-date review of the state of knowledge relating to the conditions and trends of key Great Barrier Reef coastal and marine ecosystems, including current knowledge on key drivers of change and activities leading to pressures and impacts on these ecosystems. Drivers include the impacts of land run-off, coastal development activities and other disturbances such as extreme weather events that influence Great Barrier Reef water quality and the health of marine and coastal ecosystems

Low Voltage Electrohydraulic Actuators for Untethered Robotics

Rigid robots can be precise in repetitive tasks but struggle in unstructured environments. Nature's versatility in such environments inspires researchers to develop biomimetic robots that incorporate compliant and contracting artificial muscles. Among the recently proposed artificial muscle technologies, electrohydraulic actuators are promising since they offer comparable performance to mammalian muscles in terms of speed and power density. However, they require high driving voltages and have safety concerns due to exposed electrodes. These high voltages lead to either bulky or inefficient driving electronics that make untethered, high-degree-of-freedom bio-inspired robots difficult to realize. Here, we present low voltage electrohydraulic actuators (LEAs) that match mammalian skeletal muscles in average power density (50.5 W/kg) and peak strain rate (971 percent/s) at a driving voltage of just 1100 V. This driving voltage is approx. 5 - 7 times lower compared to other electrohydraulic actuators using paraelectric dielectrics. Furthermore, LEAs are safe to touch, waterproof, and self-clearing, which makes them easy to implement in wearables and robotics. We characterize, model, and physically validate key performance metrics of the actuator and compare its performance to state-of-the-art electrohydraulic designs. Finally, we demonstrate the utility of our actuators on two muscle-based electrohydraulic robots: an untethered soft robotic swimmer and a robotic gripper. We foresee that LEAs can become a key building block for future highly-biomimetic untethered robots and wearables with many independent artificial muscles such as biomimetic hands, faces, or exoskeletons.Comment: Stephan-Daniel Gravert and Elia Varini contributed equally to this wor

Obtaining structured clinical data from unstructured data using natural language processing software

ABSTRACT Background Free text documents in healthcare settings contain a wealth of information not captured in electronic healthcare records (EHRs). Epilepsy clinic letters are an example of an unstructured data source containing a large amount of intricate disease information. Extracting meaningful and contextually correct clinical information from free text sources, to enhance EHRs, remains a significant challenge. SCANR (Swansea University Collaborative in the Analysis of NLP Research) was set up to use natural language processing (NLP) technology to extract structured data from unstructured sources. IBM Watson Content Analytics software (ICA) uses NLP technology. It enables users to define annotations based on dictionaries and language characteristics to create parsing rules that highlight relevant items. These include clinical details such as symptoms and diagnoses, medication and test results, as well as personal identifiers.   Approach To use ICA to build a pipeline to accurately extract detailed epilepsy information from clinic letters. Methods We used ICA to retrieve important epilepsy information from 41 pseudo-anonymized unstructured epilepsy clinic letters. The 41 letters consisted of 13 ‘new’ and 28 ‘follow-up’ letters (for 15 different patients) written by 12 different doctors in different styles. We designed dictionaries and annotators to enable ICA to extract epilepsy type (focal, generalized or unclassified), epilepsy cause, age of onset, investigation results (EEG, CT and MRI), medication, and clinic date. Epilepsy clinicians assessed the accuracy of the pipeline. Results The accuracy (sensitivity, specificity) of each concept was: epilepsy diagnosis 98% (97%, 100%), focal epilepsy 100%, generalized epilepsy 98% (93%, 100%), medication 95% (93%, 100%), age of onset 100% and clinic date 95% (95%, 100%). Precision and recall for each concept were respectively, 98% and 97% for epilepsy diagnosis, 100% each for focal epilepsy, 100% and 93% for generalized epilepsy, 100% each for age of onset, 100% and 93% for medication, 100% and 96% for EEG results, 100% and 83% for MRI scan results, and 100% and 95% for clinic date. Conclusions ICA is capable of extracting detailed, structured epilepsy information from unstructured clinic letters to a high degree of accuracy. This data can be used to populate relational databases and be linked to EHRs. Researchers can build in custom rules to identify concepts of interest from letters and produce structured information. We plan to extend our work to hundreds and then thousands of clinic letters, to provide phenotypically rich epilepsy data to link with other anonymised, routinely collected data

2017 Scientific Consensus Statement: land use impacts on the Great Barrier Reef water quality and ecosystem condition

This report provides the 2017 Scientific Consensus Statement for the Great Barrier Reef – a review of the significant advances in scientific knowledge of water quality issues in the Great Barrier Reef to arrive at a consensus on the current understanding of the system. The consensus statement was produced by a multidisciplinary group of scientists, with oversight from the Reef Independent Science Panel, and supports the development of the Reef 2050 Water Quality Improvement Plan 2017–2022

2017 Scientific Consensus Statement: land use impacts on the Great Barrier Reef water quality and ecosystem condition, Chapter 5: overview of key findings, management implications and knowledge gaps

To support the development of the Reef 2050 Water Quality Improvement Plan 2017-2022, a multidisciplinary group of scientists, with oversight from the Reef Independent Science Panel, was established to review and synthesise the significant advances in scientific knowledge of water quality issues in the Great Barrier Reef to arrive at a consensus on the current understanding of the system. For the 2017 Scientific Consensus Statement, the information and findings in these assessments and in other scientific publications were reviewed and synthesised in four supporting chapters. This fifth and final chapter provides a synthesis of the key findings of these four chapters and, based on this evidence, makes recommendations for future management of water quality in the Great Barrier Reef. The overarching consensus is that: Key Great Barrier Reef ecosystems continue to be in poor condition. This is largely due to the collective impact of land run-off associated with past and ongoing catchment development, coastal development activities, extreme weather events and climate change impacts such as the 2016 and 2017 coral bleaching events. Current initiatives will not meet the water quality targets. To accelerate the change in on-ground management, improvements to governance, program design, delivery and evaluation systems are urgently needed. This will require greater incorporation of social and economic factors, better targeting and prioritisation, exploration of alternative management options and increased support and resources

Impact of COVID-19 pandemic on community medication dispensing: a national cohort analysis in Wales, UK

BackgroundPopulation-level information on dispensed medication provides insight on the distribution of treated morbidities, particularly if linked to other population-scale data at an individual-level.ObjectiveTo evaluate the impact of COVID-19 on dispensing patterns of medications.MethodsRetrospective observational study using population-scale, individual-level dispensing records in Wales, UK. Total dispensed drug items for the population between 1st January 2016 and 31st December 2019 (3-years, pre-COVID-19) were compared to 2020 with follow up until 27th July 2021 (COVID-19 period). We compared trends across all years and British National Formulary (BNF) chapters and highlighted the trends in three major chapters for 2019-21: 1-Cardiovascular system (CVD); 2-Central Nervous System (CNS); 3-Immunological & Vaccine. We developed an interactive dashboard to enable monitoring of changes as the pandemic evolves.ResultAmongst all BNF chapters, 73,410,543 items were dispensed in 2020 compared to 74,121,180 items in 2019 demonstrating -0.96% relative decrease in 2020. Comparison of monthly patterns showed average difference (D) of -59,220 and average Relative Change (RC) of -0.74% between the number of dispensed items in 2020 and 2019. Maximum RC was observed in March 2020 (D= +1,224,909 and RC= +20.62%), followed by second peak in June 2020 (D= +257,920, RC= +4.50%). A third peak was observed in September 2020 (D= +264,138, RC= +4.35%). Large increases in March 2020 were observed for CVD and CNS medications across all age groups. The Immunological and Vaccine products dropped to very low levels across all age groups and all months (including the March dispensing peak).ConclusionsReconfiguration of routine clinical services during COVID-19 led to substantial changes in community pharmacy drug dispensing. This change may contribute to a long-term burden of COVID-19, raising the importance of a comprehensive and timely monitoring of changes for evaluation of the potential impact on clinical care and outcomes

Viscospora peruviscosa, a new fungus in the Glomeraceae from a plantation of Theobroma cacao in Peru

A new fungus, Viscospora peruviscosa, was detected in a Theobroma cacao plantation in the Huallaga province of San Martín State in Peru.The fungus was propagated in the greenhouse on Sorghum vulgare and Brachiaria brizantha. The fungus is similar to V. viscosa as it has two spore wall layers and also a viscose outer spore surface, but its spores are smaller ((30-) 44-56 (-65) × (25-) 44-54 μm) and the subtending hyphae generally are more pronounced funnel-shaped. Also, the walls of the spores and subtending hyphae are thinner than in V. viscosa. Phylogenetically, both species form two well separated sister clades in the genus Viscospora. Based on the partial nrDNA gene, the two species have 90-91% maximum identity (MI). So far, the fungus is only known from the cacao plantation in Huallaga. No environmental sequences in the public data bases suggest that the fungus has already been found elsewhere in the neotropics or worldwide. This is the second species in the genus Viscospora (Glomeraceae) described, hence Viscospora is no longer monospecific

The Green Bank Ammonia Survey: A Virial Analysis of Gould Belt Clouds in Data Release 1

We perform a virial analysis of starless dense cores in three nearby star-forming regions : L1688 in Ophiuchus, NGC 1333 in Perseus, and B18 in Taurus. Our analysis takes advantage of comprehensive kinematic information for the dense gas in all of these regions made publicly available through the Green Bank Ammonia Survey Data Release 1, which used to estimate internal support against collapse. We combine this information with ancillary data used to estimate other important properties of the cores, including continuum data from the James Clerk Maxwell Telescope Gould Belt Survey for core identification, core masses, and core sizes. Additionally, we used \textit{Planck} and \textit{Herschel}-based column density maps for external cloud weight pressure, and Five College Radio Astronomy Observatory $^{13}$CO observations for external turbulent pressure. Our self-consistent analysis suggests that many dense cores in all three star-forming regions are not bound by gravity alone, but rather require additional pressure confinement to remain bound. Unlike a recent, similar study in Orion~A, we find that turbulent pressure represents a significant portion of the external pressure budget. Our broad conclusion emphasizing the importance of pressure confinement in dense core evolution, however, agrees with earlier work.Comment: 35 pages, 8 tables, and 14 figures consisting of 16 .pdf files. Accepted for publication in the Astrophysical Journa