As of 6/1/2023, this data set is no longer being updated. Connecticut nursing homes are required by the Centers for Medicare and Medicaid Services (CMS) to report on the impact of COVID-19 on their residents and staff through CDC’s National Healthcare Safety Network (NHSN). This reporting is intended to reflect recent COVID-19 activity in nursing homes. Data presented here from NHSN reflect resident and staff COVID-19 cases and COVID-related deaths reported for Connecticut nursing homes for the previous week, Thursday–Wednesday. All nursing homes follow NHSN definitions and instructions when reporting to the NHSN COVID-19 module, ensuring data are reported in a systematic way. These data do not show where the resident or staff got infected. Detailed information about COVID-19 reporting for nursing homes and NHSN can be found here: https://www.cdc.gov/nhsn/ltc/covid19/index.html

The New York Times is releasing a series of data files with cumulative counts of coronavirus cases in the United States, at the state and county level, over time. We are compiling this time series data from state and local governments and health departments in an attempt to provide a complete record of the ongoing outbreak.

Since the first reported coronavirus case in Washington State on Jan. 21, 2020, The Times has tracked cases of coronavirus in real time as they were identified after testing. Because of the widespread shortage of testing, however, the data is necessarily limited in the picture it presents of the outbreak.

We have used this data to power our maps and reporting tracking the outbreak, and it is now being made available to the public in response to requests from researchers, scientists and government officials who would like access to the data to better understand the outbreak.

The data begins with the first reported coronavirus case in Washington State on Jan. 21, 2020. We will publish regular updates to the data in this repository.

As of March 10, 2023, the death rate from COVID-19 in the state of New York was 397 per 100,000 people. New York is one of the states with the highest number of COVID-19 cases.

Age-standardised mortality rates for deaths involving coronavirus (COVID-19), non-COVID-19 deaths and all deaths by vaccination status, broken down by age group.

This open data publication has moved to COVID-19 Statistical Data in Scotland (from 02/11/2022) Novel coronavirus (COVID-19) is a new strain of coronavirus first identified in Wuhan, China. Clinical presentation may range from mild-to-moderate illness to pneumonia or severe acute respiratory infection. This dataset provides information on demographic characteristics (age, sex, deprivation) of confirmed novel coronavirus (COVID-19) cases, as well as trend data regarding the wider impact of the virus on the healthcare system. Data includes information on primary care out of hours consultations, respiratory calls made to NHS24, contact with COVID-19 Hubs and Assessment Centres, incidents received by Scottish Ambulance Services (SAS), as well as COVID-19 related hospital admissions and admissions to ICU (Intensive Care Unit). Further data on the wider impact of the COVID-19 response, focusing on hospital admissions, unscheduled care and volume of calls to NHS24, is available on the COVID-19 Wider Impact Dashboard. There is a large amount of data being regularly published regarding COVID-19 (for example, Coronavirus in Scotland - Scottish Government and Deaths involving coronavirus in Scotland - National Records of Scotland. Additional data sources relating to this topic area are provided in the Links section of the Metadata below. Information on COVID-19, including stay at home advice for people who are self-isolating and their households, can be found on NHS Inform. All publications and supporting material to this topic area can be found in the weekly COVID-19 Statistical Report. The date of the next release can be found on our list of forthcoming publications. Data visualisation is available to view in the interactive dashboard accompanying the COVID-19 Statistical Report. Please note information on COVID-19 in children and young people of educational age, education staff and educational settings is presented in a new COVID-19 Education Surveillance dataset going forward.

OMOP dataset: Hospital COVID patients: severity, acuity, therapies, outcomes Dataset number 2.0

Coronavirus disease 2019 (COVID-19) was identified in January 2020. Currently, there have been more than 6 million cases & more than 1.5 million deaths worldwide. Some individuals experience severe manifestations of infection, including viral pneumonia, adult respiratory distress syndrome (ARDS) & death. There is a pressing need for tools to stratify patients, to identify those at greatest risk. Acuity scores are composite scores which help identify patients who are more unwell to support & prioritise clinical care. There are no validated acuity scores for COVID-19 & it is unclear whether standard tools are accurate enough to provide this support. This secondary care COVID OMOP dataset contains granular demographic, morbidity, serial acuity and outcome data to inform risk prediction tools in COVID-19.

PIONEER geography The West Midlands (WM) has a population of 5.9 million & includes a diverse ethnic & socio-economic mix. There is a higher than average percentage of minority ethnic groups. WM has a large number of elderly residents but is the youngest population in the UK. Each day >100,000 people are treated in hospital, see their GP or are cared for by the NHS. The West Midlands was one of the hardest hit regions for COVID admissions in both wave 1 & 2.

EHR. University Hospitals Birmingham NHS Foundation Trust (UHB) is one of the largest NHS Trusts in England, providing direct acute services & specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds & 100 ITU beds. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary & secondary care record (Your Care Connected) & a patient portal “My Health”. UHB has cared for >5000 COVID admissions to date. This is a subset of data in OMOP format.

Scope: All COVID swab confirmed hospitalised patients to UHB from January – August 2020. The dataset includes highly granular patient demographics & co-morbidities taken from ICD-10 & SNOMED-CT codes. Serial, structured data pertaining to care process (timings, staff grades, specialty review, wards), presenting complaint, acuity, all physiology readings (pulse, blood pressure, respiratory rate, oxygen saturations), all blood results, microbiology, all prescribed & administered treatments (fluids, antibiotics, inotropes, vasopressors, organ support), all outcomes.

Available supplementary data: Health data preceding & following admission event. Matched “non-COVID” controls; ambulance, 111, 999 data, synthetic data. Further OMOP data available as an additional service.

Available supplementary support: Analytics, Model build, validation & refinement; A.I.; Data partner support for ETL (extract, transform & load) process, Clinical expertise, Patient & end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.

PIONEER: Deeply-phenotyped hospital COVID patients: severity, acuity, therapies, outcomes Dataset number 4.0

Coronavirus disease 2019 (COVID-19) was identified in January 2020. Currently, there have been more than 6 million cases& more than 1.5 million deaths worldwide. Some individuals experience severe manifestations of infection, including viral pneumonia, adult respiratory distress syndrome (ARDS)& death. There is a pressing need for tools to stratify patients, to identify those at greatest risk. Acuity scores are composite scores which help identify patients who are more unwell to support & prioritise clinical care. There are no validated acuity scores for COVID-19 & it is unclear whether standard tools are accurate enough to provide this support. This secondary care COVID dataset contains granular demographic, morbidity, serial acuity and outcome data to inform risk prediction tools in COVID-19.

PIONEER geography The West Midlands (WM) has a population of 5.9 million & includes a diverse ethnic & socio-economic mix. There is a higher than average percentage of minority ethnic groups. WM has a large number of elderly residents but is the youngest population in the UK. Each day >100,000 people are treated in hospital, see their GP or are cared for by the NHS. The West Midlands was one of the hardest hit regions for COVID admissions in both wave 1 & 2.

EHR. University Hospitals Birmingham NHS Foundation Trust (UHB) is one of the largest NHS Trusts in England, providing direct acute services & specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds & 100 ITU beds. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary & secondary care record (Your Care Connected) & a patient portal “My Health”. UHB has cared for >5000 COVID admissions to date.

Scope: All COVID swab confirmed hospitalised patients to UHB from January – May 2020. The dataset includes highly granular patient demographics & co-morbidities taken from ICD-10 & SNOMED-CT codes but also primary care records& clinic letters. Serial, structured data pertaining to care process (timings, staff grades, specialty review, wards), presenting complaint, acuity, all physiology readings (pulse, blood pressure, respiratory rate, oxygen saturations), all blood results, microbiology, all prescribed & administered treatments (fluids, antibiotics, inotropes, vasopressors, organ support), all outcomes. Linked images available (radiographs, CT, MRI, ultrasound).

Available supplementary data: Health data preceding & following admission event. Matched “non-COVID” controls; ambulance, 111, 999 data, synthetic data.

Available supplementary support: Analytics, Model build, validation & refinement; A.I.; Data partner support for ETL (extract, transform & load) process, Clinical expertise, Patient & end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.

The pandemic of COVID-19 led to a dramatic situation in hospitals, where staff had to deal with a huge number of patients in respiratory distress. To alleviate the workload of radiologists, we implemented an artificial intelligence (AI) - based analysis named CACOVID-CT, to automatically assess disease severity on chest CT scans obtained from those patients. We retrospectively studied CT scans obtained from 476 patients admitted at the University Hospital of Liege with a COVID-19 disease. We quantified the percentage of COVID-19 affected lung area (% AA) and the CT severity score (total CT-SS). These quantitative measurements were used to investigate the overall prognosis and patient outcome: hospital length of stay (LOS), ICU admission, ICU LOS, mechanical ventilation, and in-hospital death. Both CT-SS and % AA were highly correlated with the hospital LOS, the risk of ICU admission, the risk of mechanical ventilation and the risk of in-hospital death. Thus, CAD4COVID-CT analysis proved to be a useful tool in detecting patients with higher hospitalization severity risk. It will help for management of the patients flow. The software measured the extent of lung damage with great efficiency, thus relieving the workload of radiologists.

The COVID-19 dashboard includes data on city/town COVID-19 activity, confirmed and probable cases of COVID-19, confirmed and probable deaths related to COVID-19, and the demographic characteristics of cases and deaths.

Notes:

As of June 6, 2022, the novel coronavirus SARS-CoV-2 that originated in Wuhan, the capital of Hubei province in China, had infected over 2.1 million people and killed 14,612 in the country. Hong Kong is currently the region with the highest active cases in China.

From Wuhan to the rest of China

In late December 2019, health authorities in Wuhan detected several pneumonia cases of unknown cause. Most of these patients had links to the Huanan Seafood Market. With Chinese New Year approaching, millions of Chinese migrant workers travelled back to their hometowns for the celebration. Before the start of the travel ban on January 23, around five million people had left Wuhan. By the end of January, the number of infections had surged to over ten thousand. The death toll from the virus exceeded that of the SARS outbreak a few days later. On February 12, thousands more cases were confirmed in Wuhan after an improvement to the diagnosis method, resulting in another sudden surge of confirmed cases. On March 31, 2020, the National Health Commission (NHC) in China announced that it would begin reporting the infection number of symptom-free individuals who tested positive for coronavirus. On April 17, 2020, health authorities in Wuhan revised its death toll, adding 50 percent more fatalities. After quarantine measures were implemented, the country reported no new local coronavirus COVID-19 transmissions for the first time on March 18, 2020.

The overloaded healthcare system

In Wuhan, 28 hospitals were designated to treat coronavirus patients, but the outbreak continued to test China’s disease control system and most of the hospitals were soon fully occupied. To combat the virus, the government announced plans to build a new hospital swiftly. On February 3, 2020, Huoshenshan Hospital was opened to provide an additional 1,300 beds. Due to an extreme shortage of health-care professionals in Wuhan, thousands of medical staff from all over China came voluntarily to the epicenter to offer their support. After no new deaths reported for first time, China lifted ten-week lockdown on Wuhan on April 8, 2020. Daily life was returning slowly back to normal in the country.

BackgroundIn the last 2 weeks of January 2021, Portugal was the worst country in the world in incidence of infections and deaths due to COVID-19. As a result, the pressure on the healthcare system increased exponentially, exceeding its capacities and leaving hospitals in near collapse. This scenario caused multiple constraints, particularly for hospital medical staff. Previous studies conducted at different moments during the pandemic reported that COVID-19 has had significant negative impacts on healthcare workers’ psychological health, including stress, anxiety, depression, burnout, post-traumatic stress symptoms, and sleep disturbances. However, there are many uncertainties regarding the professional quality of life of hospital nurses and physicians. To address gaps in previous research on secondary traumatic stress, we focused on healthcare workers working in hospitals affected by a major traumatic event: the third wave of COVID-19.ObjectivesThe aim of the present study was to identify the contribution of personal and work-related contextual variables (gender, age, parental status, occupation, years of experience, working with patients affected by COVID-19) on professional quality of life of healthcare workers.MethodsCross-sectional study with a web-based questionnaire given to physicians and nurses working in a hospital setting. A total of 853 healthcare professionals (276 physicians and 586 nurses; median age 37 years old) participated in the survey assessing professional quality of life compassion satisfaction, secondary traumatic stress, and burnout. Factors of professional quality of life were assessed using regression analysis.ResultsMost of the participants showed moderate (80%; n = 684) or high (18%; n = 155) levels of compassion satisfaction, whereas the majority of them experienced moderate levels of burnout (72%; n = 613) and secondary traumatic stress (69%; n = 592). The analyzed variables demonstrated no differences between professionals who were directly or not involved in the care of COVID-19 patients. Parental status was found to be a significant factor in compassion satisfaction. Female gender was significantly associated with more susceptibility to secondary traumatization. Factors that may potentially contribute to burnout include years of professional experience and the number of work hours per week.ConclusionThe COVID-19 pandemic has created a new challenge for the healthcare system. Burnout and secondary traumatic stress can lead to medical errors and impact standards of patient care, particularly compromising compassionate care. It is therefore recommended that hospitals develop psychoeducational initiatives to support professionals in dealing with barriers to compassion.

Background: Coronavirus disease 2019 (COVID-19) was identified in January 2020. Currently, there have been more than 125 million cases, and more than 2.7 million deaths worldwide. Some individuals experience severe manifestations of infection, including viral pneumonitis, adult respiratory distress syndrome (ARDS) and death. Many patients required ventilatory support including high flow oxygen, continuous positive airway pressure and intubated with or without tracheotomy. There was considerable learning on how to manage COVID-19 during the pandemic and new drugs became available during the different waves. This secondary care COVID dataset contains granular ventilatory, demographic, morbidity, serial acuity, medications and outcome data in COVID-19 across all waves and will be continuously refreshed.

PIONEER geography: The West Midlands (WM) has a population of 5.9 million and includes a diverse ethnic and socio-economic mix. There is a higher than average percentage of minority ethnic groups. WM has a large number of elderly residents but is the youngest population in the UK. Each day, more than 100,000 people are treated in hospital, see their GP or are cared for by the NHS. The West Midlands was one of the hardest hit regions for COVID admissions across all waves.

Electronic Health Records (EHR): University Hospitals Birmingham NHS Foundation Trust (UHB) is one of the largest NHS Trusts in England, providing direct acute services and specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds and 100 ITU beds. ITU capacity increased to 250 beds during the COVID pandemic. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary and secondary care record (Your Care Connected) and a patient portal “My Health”. UHB has cared for more than 10,000 COVID admissions to date.

Scope: All COVID swab confirmed hospitalised patients to UHB from January 2020 to the current date. The dataset includes highly granular patient demographics and co-morbidities taken from ICD-10 and SNOMED-CT codes. Serial, structured data pertaining to care process (timings, staff grades, specialty review, wards), severity, ventilatory requirements, acuity, all physiology readings (pulse, blood pressure, respiratory rate, oxygen saturations), all blood results, microbiology, all prescribed and administered treatments (fluids, antibiotics, inotropes, vasopressors, organ support, dexamethasone, remdesivir, tocilizumab), all outcomes.

Available supplementary data: Ambulance, 111, 999 data, synthetic data.

Available supplementary support: Analytics, Model build, validation and refinement; A.I.; Data partner support for ETL (extract, transform and load) process, Clinical expertise, Patient and end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.

PIONEER: The impact of ethnicity and multi-morbidity on COVID-related outcomes; a primary care supplemented hospitalised dataset Dataset number 3.0

Coronavirus disease 2019 (COVID-19) was identified in January 2020. Currently, there have been more than 65million cases and more than 1.5 million deaths worldwide. Some individuals experience severe manifestations of infection, including viral pneumonia, adult respiratory distress syndrome (ARDS) and death. Evidence suggests that older patients, those from some ethnic minority groups and those with multiple long-term health conditions have worse outcomes. This secondary care COVID dataset contains granular demographic and morbidity data, supplemented from primary care records, to add to the understanding of patient factors on disease outcomes.

PIONEER geography The West Midlands (WM) has a population of 5.9 million & includes a diverse ethnic & socio-economic mix. There is a higher than average percentage of minority ethnic groups. WM has a large number of elderly residents but is the youngest population in the UK. Each day >100,000 people are treated in hospital, see their GP or are cared for by the NHS. The West Midlands was one of the hardest hit regions for COVID admissions in both wave 1 and 2.

EHR. University Hospitals Birmingham NHS Foundation Trust (UHB) is one of the largest NHS Trusts in England, providing direct acute services & specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds & 100 ITU beds. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary & secondary care record (Your Care Connected) & a patient portal “My Health”. UHB has cared for >5000 COVID admissions to date.

Scope: All COVID swab confirmed hospitalised patients to UHB from January – May 2020. The dataset includes highly granular patient demographics & co-morbidities taken from ICD-10 & SNOMED-CT codes but also primary care records and clinic letters. Serial, structured data pertaining to care process (timings, staff grades, specialty review, wards), presenting complaint, acuity, all physiology readings (pulse, blood pressure, respiratory rate, oxygen saturations), all blood results, microbiology, all prescribed & administered treatments (fluids, antibiotics, inotropes, vasopressors, organ support), all outcomes. Linked images available (radiographs, CT, MRI, ultrasound).

Available supplementary data: Health data preceding and following admission event. Matched “non-COVID” controls; ambulance, 111, 999 data, synthetic data.

Available supplementary support: Analytics, Model build, validation & refinement; A.I.; Data partner support for ETL (extract, transform & load) process, Clinical expertise, Patient & end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.

ObjectiveMaintaining provision and utilization of maternal healthcare services is susceptible to external influences. This study describes how maternity care was provided during the COVID-19 pandemic and assesses patterns of service utilization and perinatal health outcomes in 16 referral hospitals (four each) in Benin, Malawi, Tanzania and Uganda.MethodsWe used an embedded case-study design and two data sources. Responses to open-ended questions in a health-facility assessment survey were analyzed with content analysis. We described categories of adaptations and care provision modalities during the pandemic at the hospital and maternity ward levels. Aggregate monthly service statistics on antenatal care, delivery, caesarean section, maternal deaths, and stillbirths covering 24 months (2019 and 2020; pre-COVID-19 and COVID-19) were examined.ResultsDeclines in the number of antenatal care consultations were documented in Tanzania, Malawi, and Uganda in 2020 compared to 2019. Deliveries declined in 2020 compared to 2019 in Tanzania and Uganda. Caesarean section rates decreased in Benin and increased in Tanzania in 2020 compared to 2019. Increases in maternal mortality ratio and stillbirth rate were noted in some months of 2020 in Benin and Uganda, with variability noted between hospitals. At the hospital level, teams were assigned to respond to the COVID-19 pandemic, routine meetings were cancelled, and maternal death reviews and quality improvement initiatives were interrupted. In maternity wards, staff shortages were reported during lockdowns in Uganda. Clinical guidelines and protocols were not updated formally; the number of allowed companions and visitors was reduced.ConclusionVarying approaches within and between countries demonstrate the importance of a contextualized response to the COVID-19 pandemic. Maternal care utilization and the ability to provide quality care fluctuated with lockdowns and travel bans. Women's and maternal health workers' needs should be prioritized to avoid interruptions in the continuum of care and prevent the deterioration of perinatal health outcomes.

Date created: Data effective February 2020. Uploaded to Open Data on September 22, 2020.Update frequency: DailyAccuracy: Points of consideration for interpretation of the data: The data was extracted by Ottawa Public Health from The COVID-19 Ottawa Database (The COD). The COD is a dynamic disease reporting system that allows for ongoing updates to data previously entered. The data extracted from The COD represent a snapshot at the time of extraction and may differ in previous or subsequent reports. Data are for confirmed outbreaks and the number of staff, living in Ottawa, and residents/patients/students with laboratory confirmed COVID-19 associated to each outbreak is provided. Please note, individuals may be linked to multiple outbreaks. All the outbreaks reflect the outbreak definitions at the time they were declared open:Healthcare Institutions: From April 1st 2020, 1 staff or resident case of laboratory-confirmed COVID-19 is considered an outbreak in long-term care homes (LTCH), retirement homes (RH) and other healthcare institutions (e.g. group home, assisted living, group shelter) and declared facility wide. Starting May 10th 2020, 2 staff or patient cases of laboratory-confirmed COVID-19 within a specified hospital unit within a 14-day period where both cases could have reasonably acquired their infection in hospital is considered an outbreak in a public hospital. Childcare & Education: Starting July 2020, 1 child or staff (or household member) case of laboratory-confirmed COVID-19 is considered an outbreak in a childcare establishment. Starting August 26 2020, 2 student or staff (or visitor) cases of laboratory-confirmed COVID-19 within a specified class within a 14-day period where at least one case could have reasonably acquired their infection at school (including transportation and before/after school care) is considered an outbreak in an educational establishment.Attributes Data fields:Facility Name – text Type of Facility - textLocation in Facility – textReported Date – date the COVID-19 outbreak was openedEnd Date - date the COVID-19 outbreak was closedResident/Patient/Child/Student Cases – number of residents, patients, children, or students with confirmed COVID-19Resident/Patient/Child/Student Cases – number of residents, patients, children, or students with confirmed COVID-19 who diedStaff Cases – number of staff with confirmed COVID-19Staff Deaths – number of staff with confirmed COVID-19 who diedTotal Cases – total number of people with confirmed COVID-19 Total Deaths – total number of people with confirmed COVID-19 who died Author: OPH Epidemiology TeamAuthor email: OPH-Epidemiology@ottawa.caMaintainer Organization: Epidemiology & Evidence, Ottawa Public Health

Background. Chronic obstructive pulmonary disease (COPD) is a debilitating lung condition characterised by progressive lung function limitation. COPD is an umbrella term and encompasses a spectrum of pathophysiologies including chronic bronchitis, small airways disease and emphysema. COPD caused an estimated 3 million deaths worldwide in 2016, and is estimated to be the third leading cause of death worldwide. The British Lung Foundation (BLF) estimates that the disease costs the NHS around £1.9 billion per year. COPD is therefore a significant public health challenge. This dataset explores the impact of hospitalisation in patients with COPD during the COVID pandemic.

PIONEER geography The West Midlands (WM) has a population of 5.9 million & includes a diverse ethnic & socio-economic mix. There is a higher than average percentage of minority ethnic groups. WM has a large number of elderly residents but is the youngest population in the UK. There are particularly high rates of physical inactivity, obesity, smoking & diabetes. The West Midlands has a high prevalence of COPD, reflecting the high rates of smoking and industrial exposure. Each day >100,000 people are treated in hospital, see their GP or are cared for by the NHS.

EHR. University Hospitals Birmingham NHS Foundation Trust (UHB) is one of the largest NHS Trusts in England, providing direct acute services & specialist care across four hospital sites, with 2.2 million patient episodes per year, 2750 beds & 100 ITU beds. UHB runs a fully electronic healthcare record (EHR) (PICS; Birmingham Systems), a shared primary & secondary care record (Your Care Connected) & a patient portal “My Health”.

Scope: All hospitalised patients admitted to UHB during the COVID-19 pandemic first wave, curated to focus on COPD. Longitudinal & individually linked, so that the preceding & subsequent health journey can be mapped & healthcare utilisation prior to & after admission understood. The dataset includes ICD-10 & SNOMED-CT codes pertaining to COPD and COPD exacerbations, as well as all co-morbid conditions. Serial, structured data pertaining to process of care (timings, staff grades, specialty review, wards), presenting complaint, all physiology readings (pulse, blood pressure, respiratory rate, oxygen saturations), all blood results, microbiology, all prescribed & administered treatments (fluids, nebulisers, antibiotics, inotropes, vasopressors, organ support), all outcomes. Linked images available (radiographs, CT).

Available supplementary data: More extensive data including wave 2 patients in non-OMOP form. Ambulance, 111, 999 data, synthetic data.

Available supplementary support: Analytics, Model build, validation & refinement; A.I.; Data partner support for ETL (extract, transform & load) process, Clinical expertise, Patient & end-user access, Purchaser access, Regulatory requirements, Data-driven trials, “fast screen” services.