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The Omicron variant of SARS-CoV-2 became the globally dominant variant in early 2022. A sub-lineage of the Omicron variant (BA.2) was identified in England in January 2022. Here, we investigated hospitalisation and mortality risks of COVID-19 cases with the Omicron sub-lineage BA.2 ( n  = 258,875) compared to BA.1 ( n  = 984,337) in a large cohort study in England. We estimated the risk of hospital attendance, hospital admission or death using multivariable stratified proportional hazards regression models. After adjustment for confounders, BA.2 cases had lower or similar risks of death (HR = 0.80, 95% CI 0.71–0.90), hospital admission (HR = 0.88, 95% CI 0.83–0.94) and any hospital attendance (HR = 0.98, 95% CI 0.95–1.01). These findings that the risk of severe outcomes following infection with BA.2 SARS-CoV-2 was slightly lower or equivalent to the BA.1 sub-lineage can inform public health strategies in countries where BA.2 is spreading. In this cohort study, the authors investigate the risk of severe outcomes following infection from Omicron BA.1 and BA.2 sub-lineages. Using whole genome sequencing and electronic health record data for ~980,000 BA.1 and ~250,000 BA.2 cases in England, they find a slightly lower risk of death and hospitalisation associated with BA.2.

Objective:To investigate the prevalence of 14 viruses in infants with bronchiolitis and to study demographic and clinical differences in those with respiratory syncytial virus (RSV), human bocavirus (hBoV) and rhinovirus (RV) infection.Methods:182 infants aged <12 months hospitalised for bronchiolitis were enrolled. Infants underwent nasal washing for the detection of RSV, influenza virus A and B, human coronavirus OC43, 229E, NL-63, HUK1, adenovirus, RV, parainfluenza 1–3, human metapneumovirus and hBoV. Demographic, clinical and laboratory data were obtained from parents and from patient medical files. Main outcome measurements were age, breastfeeding history, family smoking habits, family history for asthma and atopy, blood eosinophil count, chest radiological findings, clinical severity score and number of days of hospitalisation.Results:A virus was detected in 57.2% of the 182 infants. The most frequently detected viruses were RSV (41.2%), hBoV (12.2%) and RV (8.8%). Infants with dual infections (RSV and hBoV) had a higher clinical severity score and more days of hospitalisation than infants with RSV, RV and hBoV bronchiolitis (mean±SD: 4.7+2.4 vs 4.3±2.4 vs 3.0±2.0 vs 2.9±1.7, p<0.05; and 6.0±3.2 vs 5.3±2.4 vs 4.0±1.6 vs 3.9±1.1 days; p<0.05). Infants with RV infection had higher blood eosinophil counts than infants with bronchiolitis from RSV and hBoV (307±436 vs 138±168 vs 89±19 n/mm3; p<0.05).Conclusions:Although the major pathogen responsible for bronchiolitis remains RSV, the infection can also be caused by RV and hBoV. Demographic characteristics and clinical severity of the disease may depend on the number of viruses or on the specific virus detected.

Objective To assess the impact of the 2009 A/H1N1 influenza pandemic in England during the two waves of activity up to end of February 2010 by estimating the probabilities of cases leading to severe events and the proportion of the population infected.Design A Bayesian evidence synthesis of all available relevant surveillance data in England to estimate severity of the pandemic. Data sources All available surveillance systems relevant to the pandemic 2009 A/H1N1 influenza outbreak in England from June 2009 to February 2010. Pre-existing influenza surveillance systems, including estimated numbers of symptomatic cases based on consultations to the health service for influenza-like illness and cross sectional population serological surveys, as well as systems set up in response to the pandemic, including follow-up of laboratory confirmed cases up to end of June 2009 (FF100 and Fluzone databases), retrospective and prospective follow-up of confirmed hospitalised cases, and reported deaths associated with pandemic 2009 A/H1N1 influenza.Main outcome measures Age specific and wave specific probabilities of infection and symptomatic infection resulting in hospitalisation, intensive care admission, and death, as well as infection attack rates (both symptomatic and total). The probabilities of intensive care admission and death given hospitalisation over time are also estimated to evaluate potential changes in severity across waves.Results In the summer wave of A/H1N1 influenza, 0.54% (95% credible interval 0.33% to 0.82%) of the estimated 606 100 (419 300 to 886 300) symptomatic cases were hospitalised, 0.05% (0.03% to 0.08%) entered intensive care, and 0.015% (0.010% to 0.022%) died. These correspond to 3200 (2300 to 4700) hospital admissions, 310 (200 to 480) intensive care admissions, and 90 (80 to 110) deaths in the summer wave. In the second wave, 0.55% (0.28% to 0.89%) of the 1 352 000 (829 900 to 2 806 000) estimated symptomatic cases were hospitalised, 0.10% (0.05% to 0.16%) were admitted to intensive care, and 0.025% (0.013% to 0.040%) died. These correspond to 7500 (5900 to 9700) hospitalisations, 1340 (1030 to 1790) admissions to intensive care, and 240 (310 to 380) deaths. Just over a third (35% (26% to 45%)) of infections were estimated to be symptomatic. The estimated probabilities of infections resulting in severe events were therefore 0.19% (0.12% to 0.29%), 0.02% (0.01% to 0.03%), and 0.005% (0.004% to 0.008%) in the summer wave for hospitalisation, intensive care admission, and death respectively. The corresponding second wave probabilities are 0.19% (0.10% to 0.32%), 0.03% (0.02% to 0.06%), and 0.009% (0.004% to 0.014%). An estimated 30% (20% to 43%) of hospitalisations were detected in surveillance systems in the summer, compared with 20% (15% to 25%) in the second wave. Across the two waves, a mid-estimate of 11.2% (7.4% to 18.9%) of the population of England were infected, rising to 29.5% (16.9% to 64.1%) in 5-14 year olds. Sensitivity analyses to the evidence included suggest this infection attack rate could be as low as 5.9% (4.2% to 8.7%) or as high as 28.4% (26.0% to 30.8%). In terms of the probability that an infection leads to death in the second wave, these correspond, respectively, to a high estimate of 0.017% (0.011% to 0.024%) and a low estimate of 0.0027% (0.0024% to 0.0031%).Conclusions This study suggests a mild pandemic, characterised by case and infection severity ratios increasing between waves. Results suggest low ascertainment rates, highlighting the importance of systems enabling early robust estimation of severity, to inform optimal public health responses, particularly in light of the apparent resurgence of the 2009 A/H1N1 strain in the 2010-11 influenza season.

In September 2004, the members of the International Committee of Medical Journal Editors (ICMJE) published a joint editorial aimed at promoting registration of all clinical trials. 1 We stated that we will consider a trial for publication only if it has been registered before the enrollment of the first patient. This policy applies to trials that start recruiting on or after July 1, 2005. Because many ongoing trials were not registered at inception, we will consider for publication ongoing trials that are registered before September 13, 2005. Our goal then and now is to foster a comprehensive, publicly available database of . . .

In neural systems, information is often carried by ensembles of cells rather than by individual units. Optical indicators 1 provide a powerful means to reveal such distributed activity, particularly when protein-based and encodable in DNA 2 , 3 , 4 : encodable probes can be introduced into cells, tissues, or transgenic organisms by genetic manipulation, selectively expressed in anatomically or functionally defined groups of cells, and, ideally, recorded in situ , without a requirement for exogenous cofactors. Here we describe sensors for secretion and neurotransmission that fulfil these criteria. We have developed pH-sensitive mutants of green fluorescent protein (‘pHluorins’) by structure-directed combinatorial mutagenesis, with the aim of exploiting the acidic pH inside secretory vesicles 5 , 6 to monitor vesicle exocytosis and recycling. When linked to a vesicle membrane protein, pHluorins were sorted to secretory and synaptic vesicles and reported transmission at individual synaptic boutons, as well as secretion and fusion pore ‘flicker’ of single secretory granules.

The use of fossil fuels as energy source is unsustainable in the long term and net‐zero carbon processes need to be implemented to maintain environmental balance. One could make use of assisted water electrolysis to produce clean hydrogen and avoid high overpotentials observed for the oxygen evolution reaction by switching to the SO2 oxidation reaction (SO2OR). This process exhibits a complex mechanism on Au electrodes, which is strongly affected by convection, exhibiting an anti‐Levich behavior, in which the limiting current linearly decreases with the square root of the rotation rate. Likewise, the bi‐stability region observed in the j/E profiles narrows in a sigmoidal profile with the rotation rate, leading to a non‐linear phenomenon with two controlling parameters, mass transport and potential applied. These events were understood to be related to the changing in the reaction mechanism by controlling the electrode rotation, much related to the decrease in the current aforementioned. Mass transport effects: The use of fossil fuels led to the production of unwanted chemicals, such as sulfur dioxide, which could be oxidized to sulfuric acid while facilitating hydrogen generation. This reaction presents a complex mechanism dependent of convection and electrolyte chaotropicity, being attributed to the reaction pathway alteration and generation of catalytic poison.

Estimates of the number of prevalent human immunodeficiency virus infections are used in England and Wales to monitor development of the human immunodeficiency virus-acquired immune deficiency syndrome epidemic and for planning purposes. The population is split into risk groups, and estimates of risk group size and of risk group prevalence and diagnosis rates are combined to derive estimates of the number of undiagnosed infections and of the overall number of infected individuals. In traditional approaches, each risk group size, prevalence or diagnosis rate parameter must be informed by just one summary statistic. Yet a rich array of surveillance and other data is available, providing information on parameters and on functions of parameters, and raising the possibility of inconsistency between sources of evidence in some parts of the parameter space. We develop a Bayesian framework for synthesis of surveillance and other information, implemented through Markov chain Monte Carlo methods. The sources of data are found to be inconsistent under their accepted interpretation, but the inconsistencies can be resolved by introducing additional 'bias adjustment' parameters. The best-fitting model incorporates a hierarchical structure to spread information more evenly over the parameter space. We suggest that multiparameter evidence synthesis opens new avenues in epidemiology based on the coherent summary of available data, assessment of consistency and bias modelling.

In the present-day situation, the clinical forensic documentation of an asylum seeker’s narrative and his or her examination, together with the physical and psychological findings, may have very important effects on the outcome of the request for political asylum. Since 2012, the Municipality of Milan, the University Institute of Legal Medicine, and other institutions have assembled a team with the task of examining vulnerable asylum seekers and preparing a medical report for the Territorial Commission for International Protection (Prefecture, Ministry of Interiors), who will assess the application. We compared medico-legal reports and outcomes of 57 cases which were evaluated by the Commission after having undergone a medico-legal evaluation through the Istanbul Protocol criteria and examined, in particular, which medico-legal variables seem associated to the outcome. The results show that forensic assessment seems to have a significant and interesting correlation with the final assessment given by the Commission. For example, the higher the level of consistency, according to the Istanbul Protocol, the more frequently protection is granted. These data show how important clinical forensic medicine can be in such scenarios and how the presence of clinical forensic experts should be encouraged in such evaluations, as has been recently enshrined in Italy in the guidelines of a Ministerial Decree of April 3rd, 2017 for the assistance and the rehabilitation as well as the treatment of psychiatric disorders in refugees and asylum seekers who have undergone torture, rape, and other severe forms of psychological, physical, or sexual violence.

This paper concerns a method for assessing adult age based on the relationship between age and the third molar maturity index (I 3M ), which is related to the measurement of the open apices of the third molar. Furthermore, this method was compared to those based on Demirjian’s stages G and H. The sample consisted of 906 Caucasian individuals aged between 14 and 23 years (53.6% females and 46.4% males). Orthopantomographs were analyzed by two observers and calibrated by means of the concordance correlation coefficient for the reproducibility of the third molar maturity index (I 3M ) and κ statistics for reproducibility of the Demirjian stages. Probabilities for an individual to be older than 18 years of age (adult age) were derived using the measurements of the third molar maturity index (I 3M ). These results were exploited to set out a threshold value to assign an individual to juvenile or adult age. A cutoff value of I 3M  = 0.08 was taken. The sensitivity of this test was 70% and specificity was 98%. Furthermore, the proportion of individuals with a correct classification was 83%. The results of the test showed a better specificity when compared to the choice of stage G and a better sensitivity when compared to the choice of stage H for adult age.

Nowadays, due to the global increase in migration movements, forensic age estimation of living young adults has become an important focus of interest. Minors often have no identification documents providing their correct birth dates. Establishing the age of majority is therefore fundamental in order to determine whether juvenile penal systems or penal systems in force for adults are to be applied. Radiological examination of the clavicles is one of the methods recommended by the Study Group on Forensic Age Diagnostics. In this retrospective study, a sample of chest radiographs of 274 subjects, aged between 12 and 25 years, was studied according to Schmeling’s method in order to examine the ossification of both medial clavicular epiphyses. All stage classifications were evaluated by five examiners. Intra- and inter-examiner reliability was analysed by Cohen’s K statistic. Intra-examiner agreement was insufficient for two of the experts. Inter-examiner agreement, among the other three operators, was moderate ( K  = 0.509). Study of reliability highlighted difficulties in interpretation, the need to select qualified personnel and choice of the best radiographic image in order to reduce any anatomic overlaps. Although ossification of the medial clavicular epiphyses is recommended to assess whether an individual has already reached the age of majority or not, these results suggested that it is very difficult to clearly identify the five stages of ossification by using conventional chest radiography.