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

Effect of Freeze-Thaw Cycles on Soil Detachment Capacities of Three Loamy Soils on the Loess Plateau of China

Soil detachment is the initial phase of soil erosion and is of great significance to study in seasonal freeze-thaw regions. In order to elucidate the effects mechanism of freeze-thaw cycles on soil detachment capacity of different soils, a sandy loam, a silt loam, and a clay loam were subjected to 0, 1, 5, 10, 15, and 20 freeze-thaw cycles before they were scoured. The results revealed that with increased freeze-thaw cycles, soil bulk density and water-stable aggregates content decreased after the first few times and then kept nearly stable after about 10 cycles, especially for sandy loam. The shear strength of all soils gradually decreased as freeze-thaw cycles increased, except the values of clay loam increased subsequent to the 5th and 15th cycles. After the 20th cycle, the degree of decline of silt loam was the greatest (77.72%), followed by sandy loam (63.18%) and clay loam (39.77%). The soil organic matter of clay loam was much greater than silt loam and sandy loam and all significantly increased after freeze-thaw. Soil detachment capacity of silt loam and sandy loam was positively correlated with freeze-thaw cycle, which was contrary to findings for clay loam. The values of clay loam increased at first and then decreased during the cycles, reaching minimum values at about the 15–20th cycle. After the 20th cycle, the values of sandy loam and silt loam significantly increased 1.62 and 4.74 times over unfrozen, respectively, which was greater than clay loam (0.53 times). A nonlinear regression analysis indicated that the soil detachment capacity of silt loam could be estimated well by soil properties (R2 = 0.87, p < 0.05). This study can provide references for the study of the soil erosion mechanism in seasonal freeze-thaw regions

Anti-Tumor Activity of a Polysaccharide from Blueberry

Blueberries (Vaccinium spp.) are rich in bioactive compounds. However, the biological activity of polysaccharides from blueberry has not been reported so far. This study evaluated the anti-tumor and immunological activities of a polysaccharide (BBP3-1) from blueberry in S180-bearing mice. The experimental results indicated that BBP3-1 (100 mg·kg−1·d−1) inhibited the tumor growth rate by 73.4%. Moreover, this group, compared with the model control, had shown an effect of increasing both the spleen and thymus indices (p &lt; 0.05), increasing phagocytosis by macrophages (p &lt; 0.05), boosting the proliferation and transformation of lymphocytes (p &lt; 0.01), promoting the secretion of TNF-α, IFN-γ, and IL-2 (p &lt; 0.05) and improving NK cell activity (p &lt; 0.01). From this study, we could easily conclude that BBP3-1 has the ability to inhibit tumor progression and could act as a good immunomodulator

Effects of Bi³⁺ Doping on the Optical and Electric-Induced Light Scattering Performance of PLZT (8.0/69/31) Transparent Ceramics

Lanthanum modified lead zirconate titanate (abbreviated as PLZT) Electro-Optical ceramics with various Bi concentration were prepared by a hot-press process. The PLZT ceramic samples all present a single perovskite structure with no second phase detected. Bi3+ ion was considered to mainly enter the A-site of perovskite ABO3 structure of PLZT ceramics by the X-Ray Diffractionanalysis. The maximum permittivity (&#949;m) of the PLZT samples decreased obviously as Bi concentration increased, while their remnant polarization (Pr) decreased slightly. In particular, the PLZT sample with 0.14 wt% Bi doping presented a higher optical transmittance 61.8% (&#955; = 633 nm), and its electric-induced light scattering performance was found to be improved obviously, the maximum light deduction value of ~47.6% was obtained

Optimization of Conditions for a Freeze-Dried Restructured Strawberry Block by Adding Guar Gum, Pectin and Gelatin

With its high moisture content and tender texture, fresh strawberry is very susceptible to mechanical damage and microbial infection. Drying is one of the most frequently employed methods to extend its shelf life, and freeze-dried restructured strawberry block (FRSB) is an emerging popular food. Here, in order to enhance the quality of FRSB, edible gums of guar gum, pectin, and gelatin were added and the combination was optimized using response surface methodology (RSM) with chewiness, hardness, and organoleptic evaluations of the dried sample as the response indicators. The results showed that the combination addition of 0.10% guar gum, 0.22% pectin, and 0.30% gelatin contributed to the highest comprehensive quality of the dried sample. Compared with the untreated sample, the optimal combination addition of the three edible gums resulted in a higher moisture content for the dried sample (increased by 0.8%), and increased the chewiness, hardness, and porosity by 82.04%, 27.09%, and 3.01%, respectively, while maintaining more original color and forming a denser porous microstructure. The findings in the current work will be useful for the application of edible gums in freeze-dried restructured fruits and vegetables

Supramolecularly Assembled Nanocomposites as Biomimetic Chloroplasts for Enhancement of Photophosphorylation

Prototypes of natural biosystems provide opportunities for artificial biomimetic systems to break the limits of natural reactions and achieve output control. However, mimicking unique natural structures and ingenious functions remains a challenge. Now, multiple biochemical reactions were integrated into artificially designed compartments via molecular assembly. First, multicompartmental silica nanoparticles with hierarchical structures that mimic the chloroplasts were obtained by a templated synthesis. Then, photoacid generators and ATPase-liposomes were assembled inside and outside of silica compartments, respectively. Upon light illumination, protons produced by a photoacid generator in the confined space can drive the liposome-embedded enzyme ATPase towards ATP synthesis, which mimics the photophosphorylation process in vitro. The method enables fabrication of bioinspired nanoreactors for photobiocatalysis and provides insight for understanding sophisticated biochemical reactions