Objectives To compare the incidence and severity of invasive pneumococcal diseases (IPDs), pneumococcal pneumonia and all-cause pneumonia during the COVID-19 pandemic period with universal masking and social distancing with that of previous 5 years. Design Retrospective observational study on incidence of IPDs, pneumococcal pneumonia and all-cause pneumonia between January 2015–December 2019 and March 2020–March 2021. January–February 2020 was excluded from analysis as it was treated as a transitional period between normal time and pandemic. Setting Episode-based data by retrieval of hospitalisation records from the Hospital Authority’s territory-wide electronic medical record database in Hong Kong. Participants Hospitalised patients with IPD (n=742), pneumococcal pneumonia (n=2163) and all-cause pneumonia (including COVID-19 pneumonia, n=453 999) aged 18 years or above. Control diagnoses were included to assess confounding from health-seeking behaviours. Primary and secondary outcomes Primary outcome is the incidence of diseases between two periods. Secondary outcomes include disease severity surrogated by length of stay and mortality. Results Monthly average number of IPD, pneumococcal pneumonia and all-cause pneumonia hospitalisation significantly decreased by 88.9% (95% CI 79.8% to 98.0%, p<0.0005), 72.5% (95% CI 65.9% to 79.1%, p<0.0005) and 17.5% (95% CI 16.8% to 18.2%, p<0.0005), respectively. Changes in trend from January 2015–December 2019 to March 2020–March 2021 were −70% (95% CI −87% to −35%, p=0.0025), –43% (95% CI −59% to −19%, p=0.0014) and −11% (95% CI −13% to −10%, p<0.0005), respectively. Length of stay for IPD and pneumococcal pneumonia episodes were insignificantly different in the two periods. No reductions in hospitalisations for control diagnoses were observed. Conclusions Incidence of IPD, pneumococcal pneumonia and all-cause pneumonia decreased during the COVID-19 pandemic. This was observed with universal masking and social distancing. We postulated this is related to reduced transmission of respiratory viruses and bacteria.

Healthcare-seeking behavior changed during the COVID-19 pandemic and might alter the epidemiology of pleural empyema. In this study, the incidence, etiology and outcomes of patients admitted for pleural empyema in Hong Kong in the pre-COVID-19 (January 2015–December 2019) and post-COVID-19 (January 2020–June 2022) periods were compared. Overall, Streptococcus pneumoniae was the predominant organism in <18-year-old patients, while Streptococcus anginosus, anaerobes and polymicrobial infections were more frequent in adults. In the post-COVID-19 period, a marked decline in the incidence of pleural empyema in children was observed (pre-COVID-19, 18.4 ± 4.8 vs. post-COVID-19, 2.0 ± 2.9 cases per year, p = 0.036), while the incidence in adults remained similar (pre-COVID-19, 189.0 ± 17.2 vs. post-COVID-19, 198.4 ± 5.0 cases per year; p = 0.23). In the post-COVID-19 period, polymicrobial etiology increased (OR 11.37, p < 0.0001), while S. pneumoniae etiology decreased (OR 0.073, p < 0.001). In multivariate analysis, clinical outcomes (length of stay, ICU admission, use of intrapleural fibrinolytic therapy, surgical intervention, death) were not significantly different in pre- and post-COVID-19 periods. In conclusion, an increase in polymicrobial pleural empyema was observed during the pandemic. We postulate that this is related to the delayed presentation of pneumonia to hospitals.

The American Dream-the perception that upward social mobility depends on effort-is a central cultural ethos in the United States. The belief in upward social mobility is not unique to Americans, and cultural groups across the world endorse it to varying degrees. The current study aims to examine cross-cultural trends in perceived mobility and to test possible mechanisms that may explain changes in perceived mobility. Using a dataset of over 1.4 million participants across 167 countries from 2005 to 2019, we comprehensively document cultural variations in perceived mobility. Citizens in Bhutan, Qatar, and Uzbekistan reported the highest levels of perceived mobility, and the United States ranked 107. We further examined the trajectories of perceived mobility across a 15-year timespan and found rapid declines in perceived mobility in countries experiencing sociopolitical crises (e.g., in Syria and Hong Kong). Multilevel analyses revealed high-income individuals are 32% (95% confidence interval, CI [24%, 39%]) more likely to perceive mobility than low-income individuals, and the level of disparity did not decrease over time. Preregistered time-series analyses showed education privatization and economic condition Granger-cause perceived mobility, but these temporal associations showed heterogeneity across countries. Overall, we performed the world's largest global monitor of perceived mobility and discussed how the cultural value of perceived mobility unfolds in social, economic, and political contexts. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

There are a range of approaches to compare differences between or among optimum nitrogen (N) fertilizer rates resulting from different management practices; however, this goal lacks statistical standardization. To provide the statistical rigor needed to give clear recommendations for greater or less N need based on specific management practices, we propose a bootstrapping approach that resamples residuals with replacement. While bootstrapping is not new to data processing in agronomic fields, we provide an example of how to conduct residual‐resampled bootstrapping with nonlinear regression to identify differences in response curves, optimum N rates, and maximum yields using the FertBoot package in R. Our example dataset provides clear evidence of the value of the bootstrapping approach, as it can aid in determining significant differences between even relatively small differences in optimum N rate. We encourage adoption of this approach as a way to accurately evaluate differences in optimum fertilizer levels between or among treatments to better inform future agronomic decision making.

Background: The incidence of pneumococcal pneumonia in the context of the Coronavirus Disease 2019 (COVID-19) pandemic, along with the real-world data on the ratio of non-invasive to invasive pneumococcal pneumonia, is an area that has not been thoroughly studied. The outcomes associated with coinfection of influenza and COVID-19 remain unknown. This study examined the incidence, demographics, coinfection with influenza and/or COVID-19, and clinical outcomes of pneumococcal hospitalizations in Hong Kong during the baseline, pandemic, and post-pandemic periods. Methods: Hospitalization records of individuals aged 18 years and above with pneumococcal disease from January 2015 to August 2024 were extracted from the territory-wide electronic medical record database. Pneumococcal disease was categorized into invasive pneumococcal pneumonia (IPP), invasive pneumococcal disease without pneumonia (IPDWP), and non-invasive pneumococcal pneumonia (NIPP), followed by univariate and multivariate analyses. Effects of coinfection with influenza and COVID-19 were analyzed. Results: The incidence of pneumococcal disease decreased during the COVID-19 pandemic but rebounded in the post-pandemic period. There were no significant changes in the distribution of pneumococcal serotypes across the three periods. The study revealed a strong positive correlation between monthly pneumococcal hospitalizations and the indicator of influenza activity, while the correlation with the COVID-19 indicator was weak. Additionally, strong positive correlations were observed between the indicator of influenza activity and influenza coinfections, as well as between the indicator of COVID-19 activity and COVID-19 coinfections. Multivariate analyses identified male gender, a higher comorbidity index, older age, invasive pneumococcal disease (IPP and IPDWP), coinfection with influenza and COVID-19, and hospitalization during the pandemic period as factors associated with adverse outcomes. Conclusions: The study showcases changes in the epidemiology of pneumococcal disease during and after the COVID-19 pandemic. It highlights the adverse effects of influenza and COVID-19 coinfections on the outcomes of patients with pneumococcal disease and emphasizes the need to vaccinate vulnerable populations against these infections.