Prevalence and risk factors for long COVID among adults in Scotland using electronic health records: a national, retrospective, observational cohort study.

Background: Long COVID is a debilitating multisystem condition. The objective of this study was to estimate the prevalence of long COVID in the adult population of Scotland, and to identify risk factors associated with its development. Methods: In this national, retrospective, observational cohort study, we analysed electronic health records (EHRs) for all adults (≥18 years) registered with a general medical practice and resident in Scotland between March 1, 2020, and October 26, 2022 (98-99% of the population). We linked data from primary care, secondary care, laboratory testing and prescribing. Four outcome measures were used to identify long COVID: clinical codes, free text in primary care records, free text on sick notes, and a novel operational definition. The operational definition was developed using Poisson regression to identify clinical encounters indicative of long COVID from a sample of negative and positive COVID-19 cases matched on time-varying propensity to test positive for SARS-CoV-2. Possible risk factors for long COVID were identified by stratifying descriptive statistics by long COVID status. Findings: Of 4,676,390 participants, 81,219 (1.7%) were identified as having long COVID. Clinical codes identified the fewest cases (n = 1,092, 0.02%), followed by free text (n = 8,368, 0.2%), sick notes (n = 14,469, 0.3%), and the operational definition (n = 64,193, 1.4%). There was limited overlap in cases identified by the measures; however, temporal trends and patient characteristics were consistent across measures. Compared with the general population, a higher proportion of people with long COVID were female (65.1% versus 50.4%), aged 38-67 (63.7% versus 48.9%), overweight or obese (45.7% versus 29.4%), had one or more comorbidities (52.7% versus 36.0%), were immunosuppressed (6.9% versus 3.2%), shielding (7.9% versus 3.4%), or hospitalised within 28 days of testing positive (8.8% versus 3.3%%), and had tested positive before Omicron became the dominant variant (44.9% versus 35.9%). The operational definition identified long COVID cases with combinations of clinical encounters (from four symptoms, six investigation types, and seven management strategies) recorded in EHRs within 4-26 weeks of a positive SARS-CoV-2 test. These combinations were significantly (p < 0.0001) more prevalent in positive COVID-19 patients than in matched negative controls. In a case-crossover analysis, 16.4% of those identified by the operational definition had similar healthcare patterns recorded before testing positive. Interpretation: The prevalence of long COVID presenting in general practice was estimated to be 0.02-1.7%, depending on the measure used. Due to challenges in diagnosing long COVID and inconsistent recording of information in EHRs, the true prevalence of long COVID is likely to be higher. The operational definition provided a novel approach but relied on a restricted set of symptoms and may misclassify individuals with pre-existing health conditions. Further research is needed to refine and validate this approach. Funding: Chief Scientist Office (Scotland), Medical Research Council, and BREATHE.

Zero Threshold for Water Adsorption on MAPbBr3.

Hybrid organic-inorganic perovskites (HOIPs) have shown great promise in a wide range of optoelectronic applications. However, this performance is inhibited by the sensitivity of HOIPs to various environmental factors, particularly high levels of relative humidity. This study uses X-ray photoelectron spectroscopy (XPS) to determine that there is essentially no threshold to water adsorption on the in situ cleaved MAPbBr3 (001) single crystal surface. Using scanning tunneling microscopy (STM), it shows that the initial surface restructuring upon exposure to water vapor occurs in isolated regions, which grow in area with increasing exposure, providing insight into the initial degradation mechanism of HOIPs. The electronic structure evolution of the surface was also monitored via ultraviolet photoemission spectroscopy (UPS), evidencing an increased bandgap state density following water vapor exposure, which is attributed to surface defect formation due to lattice swelling. This study will help to inform the surface engineering and designs of future perovskite-based optoelectronic devices.

Chemical Modification of Polaronic States in Anatase TiO2(101).

Two polymorphs of TiO2, anatase and rutile, are employed in photocatalytic applications. It is broadly accepted that anatase is the more catalytically active and subsequently finds wider commercial use. In this work, we focus on the Ti3+ polaronic states of anatase TiO2(101), which lie at ∼1.0 eV binding energy and are known to increase catalytic performance. Using UV-photoemission and two-photon photoemission spectroscopies, we demonstrate the capability to tune the excited state resonance of polarons by controlling the chemical environment. Anatase TiO2(101) contains subsurface polarons which undergo sub-band-gap photoexcitation to states ∼2.0 eV above the Fermi level. Formic acid adsorption dramatically influences the polaronic states, increasing the binding energy by ∼0.3 eV. Moreover, the photoexcitation oscillator strength changes significantly, resonating with states ∼3.0 eV above the Fermi level. We show that this behavior is likely due to the surface migration of subsurface oxygen vacancies.

Telephone announcements encouraging common cold self-management reduce demand for general practice appointments.

BACKGROUND: Patients consulting with the common cold contribute to seasonal demand for general practice appointments. Seeing a community pharmacist or using self-management may have been more appropriate options. The study aimed to measure if the use of telephone announcements signposting appropriate patients with the common cold in the direction of community pharmacy or self-management reduced demand for general practice consultations. METHODS: Patients telephoning a UK general practice to request an appointment between December 2017 and March 2018 heard announcements regarding management of the common cold. The percentage of callers choosing to continue to speak to a receptionist was compared with baseline data prior to the intervention. The mean waiting time to the third available routine general practice appointment during the intervention was compared with the previous year. RESULTS: Routine calls continuing to reception reduced by 5.5 % (p<0.001) when the incidence of the common cold is at its highest and by 3.9% (p<0.001) throughout the intervention. The mean waiting time to the third available routine appointment reduced by 21%. CONCLUSION: This study has demonstrated that the use of telephone announcements signposting appropriate patients with the common cold in the direction of community pharmacy or self-management reduces calls to reception. This strongly infers that the telephone announcements reduce demand for general practice appointments and is supported by the reduced mean waiting time to the third available routine appointment. Implementation of this intervention could help general practitioners reduce seasonal demand in their own practices.

Shoes influence lower limb muscle activity and may predispose the wearer to lateral ankle ligament injury.

Lateral ankle ligaments are injured by hyperinversion of the foot. Foot position is controlled by the lower limb muscles. Awareness of foot position is impaired by wearing shoes. We aimed to determine the influence of wearing shoes upon muscle activity. Sixty-two healthy subjects underwent the same measurements, barefoot and with standardized shoes in a random order. Electromyography (EMG) was recorded from the peroneus longus muscle in response to sudden and unanticipated inversion of the ipsilateral foot. Following foot inversion, the EMG signal showed an initial peak muscle contraction followed by a sustained smaller contraction. Both changes were significantly greater in shoes compared to the barefoot condition for all tested degrees of inversion. Muscle contraction following sudden inversion of the foot was significantly greater when wearing shoes. This greater muscular contraction may be an intrinsic mechanism to oppose the increased moment created by the inverted foot/shoe condition, and hence, may counter balance the increased tendency to injure the lateral ankle ligaments created by wearing shoes.