Background Spain is one of the European countries most affected by the COVID-19 pandemic. Serological surveys are a valuable tool to assess the extent of the epidemic, given the existence of asymptomatic cases and little access to diagnostic tests. This nationwide population-based study aims to estimate the seroprevalence of SARS-CoV-2 infection in Spain at national and regional level.Methods 35 883 households were selected from municipal rolls using two-stage random sampling stratified by province and municipality size, with all residents invited to participate. From April 27 to May 11, 2020, 61 075 participants (75•1% of all contacted individuals within selected households) answered a questionnaire on history of symptoms compatible with COVID-19 and risk factors, received a point-of-care antibody test, and, if agreed, donated a blood sample for additional testing with a chemiluminescent microparticle immunoassay. Prevalences of IgG antibodies were adjusted using sampling weights and post-stratification to allow for differences in non-response rates based on age group, sex, and census-tract income. Using results for both tests, we calculated a seroprevalence range maximising either specificity (positive for both tests) or sensitivity (positive for either test). FindingsSeroprevalence was 5•0% (95% CI 4•7-5•4) by the point-of-care test and 4•6% (4•3-5•0) by immunoassay, with a specificity-sensitivity range of 3•7% (3•3-4•0; both tests positive) to 6•2% (5•8-6•6; either test positive), with no differences by sex and lower seroprevalence in children younger than 10 years (<3•1% by the point-of-care test). There was substantial geographical variability, with higher prevalence around Madrid (>10%) and lower in coastal areas (<3%). Seroprevalence among 195 participants with positive PCR more than 14 days before the study visit ranged from 87•6% (81•1-92•1; both tests positive) to 91•8% (86•3-95•3; either test positive). In 7273 individuals with anosmia or at least three symptoms, seroprevalence ranged from 15•3% (13•8-16•8) to 19•3% (17•7-21•0). Around a third of seropositive participants were asymptomatic, ranging from 21•9% (19•1-24•9) to 35•8% (33•1-38•5). Only 19•5% (16•3-23•2) of symptomatic participants who were seropositive by both the point-of-care test and immunoassay reported a previous PCR test.Interpretation The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave.

SYNOPSISObjectives. This article describes the demographic and behavioral characteristics, human immunodeficiency virus (HIV) testing history, and results of HIV testing of transgender (TG) people recruited for rapid HIV testing by community-based organizations (CBOs) in three cities.Methods. CBOs in Miami Beach, Florida, New York City, and San Francisco offered TG people rapid HIV testing and prevention services, and conducted a brief survey. Participants were recruited in outreach settings using various strategies. The survey collected information on demographic characteristics, HIV risk behaviors, and HIV testing history.Results. Among 559 male-to-female (MTF) TG participants, 12% were newly diagnosed with HIV infection. None of the 42 female-to-male participants were newly diagnosed with HIV. A large proportion of MTF TG participants reported high-risk behaviors in the past year, including 37% who reported unprotected receptive anal intercourse and 44% who reported commercial sex work. Several factors were independently associated with increased likelihood of being newly diagnosed with HIV infection among MTF TG participants, including having a partner of unknown HIV status in the past year; being 20-29 or 40 years of age; having last been tested for HIV more than 12 months ago; and having been recruited at the New York City site.Conclusions. Based on the high proportion of undiagnosed HIV infection among those tested, TG people represent an important community for enhanced HIV testing and prevention efforts. MTF TG people should be encouraged to have an HIV test at least annually or more often if indicated, based upon clinical findings or risk behaviors. Efforts should continue for developing novel strategies to overcome barriers and provide HIV testing and prevention services to TG people.

Erectile dysfunction is a common disorder in patients treated in lipid units in Catalonia for cardiovascular risk factors. This condition is associated with age, obesity, ischaemic disease and unhealthy lifestyle habits.

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BackgroundAdverse events (AEs) epidemiology is the first step to improve practice in the healthcare system. Usually, the preferred method used to estimate the magnitude of the problem is the retrospective cohort study design, with retrospective reviews of the medical records. However this data collection involves a sophisticated sampling plan, and a process of intensive review of sometimes very heavy and complex medical records. Cross-sectional survey is also a valid and feasible methodology to study AEs.ObjectivesThe aim of this study is to compare AEs detection using two different methodologies: cross-sectional versus retrospective cohort design.SettingSecondary and tertiary hospitals in five countries: Argentina, Colombia, Costa Rica, Mexico and Peru.ParticipantsThe IBEAS Study is a cross-sectional survey with a sample size of 11 379 patients. The retrospective cohort study was obtained from a 10% random sample proportional to hospital size from the entire IBEAS Study population.MethodsThis study compares the 1-day prevalence of the AEs obtained in the IBEAS Study with the incidence obtained through the retrospective cohort study.ResultsThe prevalence of patients with AEs was 10.47% (95% CI 9.90 to 11.03) (1191/11 379), while the cumulative incidence of the retrospective cohort study was 19.76% (95% CI 17.35% to 22.17%) (215/1088). In both studies the highest risk of suffering AEs was seen in Intensive Care Unit (ICU) patients. Comorbid patients and patients with medical devices showed higher risk.ConclusionThe retrospective cohort design, although requires more resources, allows to detect more AEs than the cross-sectional design.

PAH patients undergoing diagnostic evaluation should be screened for a history of current or past methamphetamine use. Pharmacovigilance should be implemented to monitor patients being treated with methamphetamine for neuropsychiatric disorders (e.g., attention-deficit hyperactivity disorder). More studies will be needed to identify which susceptibility factors increase risk of PAH in methamphetamine users.

This paper presents a software-hardware based simulation approach to digital system simulation. Our approach provides better performance than a software only approach and also works with high-level system models. The approach uses an optimizing simulation compiler to transform a hardware description language system model into a high performance simulator. The target architecture for the simulation compiler is a tightly coupled processor and field-programmable gate array (FPGA). The components of the simulation compiler are a high performance compiled-code software simulator, an automatic partitioner that partitions the system model between the processor and FPGA, and a scheduler that maximizes concurrent execution within the FPGA and between the FPGA and processor. We describe these components and show how they can be used to improve the performance of synchronous digital system simulation by up to a factor of two when compared to a high performance all software simulator. IntroductionSimulation is used extensively to evaluate performance and to verify correctness of digital systems. As system designs become more complex, the level at which the system is initially specified is made more abstract in order to manage the complexity. Simulation techniques must keep up with these upward shifts in the abstraction level to ensure that systems designers can efficiently evaluate the performance and correctness of their ideas as early as possible in the design process. Recently, there has been a trend towards specifying systems using hardware description languages (HDLs). This trend is partly due to the widespread acceptance of logic synthesis tools and, to a lesser extent, high-level synthesis tools. This trend, coupled with the much greater demand for simulation performance resulting from the increase in system complexity, motivates the need for new simulation techniques that are optimized to simulate high-level system models as efficiently and as economically as possible.In this paper we describe and evaluate a simulation approach that converts an HDL model into a high-performance simulator consisting of tightly coupled software and hardware components that execute on processor and FPGA architecture. Our approach uses compiled-code software simulation, accurate performance estimation, logic synthesis, software-hardware partitioning, and software-hardware scheduling to generate these

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