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• Open Dissertations (EBSCO) This link opens in a new window A database with records for more than 800,000 electronic theses and dissertations from around the world.
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The library collects theses from students who graduate from UTM with a masters degree. Search by topic or author name and limit to "Dissertation/Thesis". 

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Universiti Teknologi Malaysia Thesis Template

This utmthesis class was first created back in 2006. Since then, thanks to the various contributors over the years, it has matured into this.

List of major contributors (sorted alphabetically)

• Lim Lian Tze
• Muhammad Nadzir Marsono
• Ng Choon Ching
• Teo Hui Ming
• Vishnu P. Nambiar
• Yap Yung Szen
• Wan Zuki Azman

credits also to other contributors/testers whose names are not listed here

UTMthesis.cls v6.4 (2021/05/02) conforms with the 2018 UTM thesis manual.

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Templates for Research Study

Utm thesis manual and templates.

The UTM Thesis Manual and Templates are provided by School of Graduate Studies. All students are required to follow the guidelines in preparing the project report for the Research Study.

Abstract Guideline

The Faculty of Social Sciences and Humanities, Universiti Teknologi Malaysia has prepared an abstract guideline for easy reference in creating a good abstract for the Research Study report.

The thesis manual and templates are provided for all UTM students in preparing project report (for taught course students), dissertation (for mixed mode students), and thesis (for full research students). Therefore, please refer to the samples provided below in order to prepare report for Research Study. 

Samples for Research Study

English version, sample of title page.

English Version of Title Page, which is the first page of project report.

Sample of One Supervisor's Declaration Page

English version of One Supervisor’s Declaration Page that requires supervisor’s signature.

Sample of More than One Supervisors' Declaration Page

English version of more than one Supervisors Declaration Page that requires all supervisors’ signatures.

Sample of Student's Declaration Page

English version of Student’s Declaration Page that requires the student’s signature.

Malay Version

Malay Version of Title Page, which is the first page of project report.

Malay version of One Supervisor’s Declaration Page that requires supervisor’s signature.

Malay version of more than one Supervisors Declaration Page that requires all supervisors’ signatures.

Malay version of Student’s Declaration Page that requires the student’s signature.

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The LaTeX class for Universiti Teknologi Malaysia (UTM) thesis.

utmthesis/utmthesis

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Description.

The utmthesis project provides and maintains a LaTeX class, BibTeX styles (for both authordate and number citation styles) as well as a LyX layout to typeset your thesis according to the Universiti Teknologi Malaysia (UTM) thesis formatting rules. It is currently the most time saving and efficient way to write a UTM compliant thesis.

This is an ongoing project and it a free software project licensed under the New BSD License.

Even though you just spent 1-2 days writing the content of your thesis (because you are lazy), you can instantly generate the entire thesis in PDF with fully formatted table of contents, references, appendix, front cover, etc. This results in a beautifully written shiny magical thesis that will bedazzle your supervisors and examiners, guaranteeing you an A+.. or not.

There are tutorials, tips & examples on how to use LaTeX provided in the downloads and wiki section.

Download the latest version of utmthesis (both in LaTeX and LyX) here! Due to upload limitation imposed by Google, we could not upload new updates here. Temporarily, we provide download links from FKE Postgraduate Website while we are trying to resolve the upload restriction here.

Current stable release: version 6.4

Required Software

A good LaTeX compiler. For Windows users, you may try MikTeX or ProTeXt. For Linux users, install TeX Live. Note: If you install a minimal/basic version of a Latex compiler, you will face problems. Go for the full download. For Ubuntu (or Debian based distros) type the following command in your shell to auto-magically install all the above software like a boss:

sudo apt-get install texlive-full texmaker jabref

A text editor (an advance Notepad) such as TeXstudio or Texmaker or you may try LyX which is extremely user-friendly and provides a WYSWYG-like interface (What You See is What You Get).

Changes in version 6.4

• Corrected spacing depending on OS.

Changes in version 6.3

• Supervisor declaration page changed to use Roman numerals for multiple supervisors
• Tex to put list of publications to after Appendix.
• Ditto for *.lyx and *.layout

Changes in version 6.2

• Supports single-side printing
• Bug corrected for the p{length} was written as b{length}

Changes in version 6.1

• Fixed minor bugs with the declaration pages.

Changes in version 6.0

• Latest version that conforms to the UTM Thesis Format 2018

Changes in version 5.1

• The declaration and cover pages depends on the intake year. The new guideline applies to intake 2014 only.

Changes in version 5.0

• Supports two-side printing.

Changes in version 4.3

• Changed from "final year project report" to "report" based on 2015 manual.
• Solved the irregular spacing between title-author and author-degree type.
• Bold numbers for chapters in TOC.
• Removed one quote mark from Supervisor's Declaration

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• Dissertations & Theses Global Closed Collection This link opens in a new window ProQuest Digital Dissertations indexes theses from 1861 to the present, from American, Canadian, and selected international graduate schools. Abstracts are included for doctoral dissertations since July 1980, and for masters theses since 1988. Many titles are available full-text. Contains the full text of University of Toronto PhD dissertations from 1962 onwards and Masters theses from 1989 onwards. From ProQuest. Formerly known as Dissertation Abstracts International.
• Theses Canada Portal The Theses Canada Portal provides free access to the full text electronic versions of Canadian theses and dissertations that were published from the beginning of 1998 to August 31, 2002.
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• Introduction
• Conclusions
• Article Information

Postvaccine and post–COVID-19 myocarditis shown vs conventional myocarditis. Comparisons were standardized according to sociodemographic characteristics and comorbidities of conventional myocarditis (target group through a weighted generalized estimating equation model).

a β-blockers and/or drugs acting on the renin angiotensin system.

b Coronary angiography and/or computed tomographic scan.

Data sharing statement

• Myocarditis and Pericarditis After Vaccination for COVID-19 JAMA Research Letter September 28, 2021 This study investigates the incidence of myocarditis and pericarditis emergency department or inpatient hospital encounters before COVID-19 vaccine availability (January 2019–January 2021) and during a COVID-19 vaccination period (February-May 2021) in a large US health care system. George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD
• Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021 JAMA Original Investigation January 25, 2022 This descriptive study compares the effect of mRNA-based COVID-19 vaccination with BNT162b2 (Pfizer-BioNTech) vs mRNA-1273 (Moderna) on the reported cases of myocarditis in the US after each vaccination dose. Matthew E. Oster, MD, MPH; David K. Shay, MD, MPH; John R. Su, MD, PhD, MPH; Julianne Gee, MPH; C. Buddy Creech, MD, MPH; Karen R. Broder, MD; Kathryn Edwards, MD; Jonathan H. Soslow, MD, MSCI; Jeffrey M. Dendy, MD; Elizabeth Schlaudecker, MD, MPH; Sean M. Lang, MD; Elizabeth D. Barnett, MD; Frederick L. Ruberg, MD; Michael J. Smith, MD, MSCE; M. Jay Campbell, MD, MHA; Renato D. Lopes, MD, PhD, MHS; Laurence S. Sperling, MD; Jane A. Baumblatt, MD; Deborah L. Thompson, MD, MSPH; Paige L. Marquez, MSPH; Penelope Strid, MPH; Jared Woo, MPH; River Pugsley, PhD, MPH; Sarah Reagan-Steiner, MD, MPH; Frank DeStefano, MD, MPH; Tom T. Shimabukuro, MD, MPH, MBA
• Diagnosis and Treatment of Acute Myocarditis—A Review JAMA Review April 4, 2023 This Review summarizes current evidence regarding the diagnosis and treatment of acute myocarditis. Enrico Ammirati, MD, PhD; Javid J. Moslehi, MD
• Patient Information: Acute Myocarditis JAMA JAMA Patient Page August 8, 2023 This JAMA Patient Page describes acute myocarditis and its symptoms, causes, diagnosis, and treatment. Kristin Walter, MD, MS
• Acute Myocarditis Following COVID-19 mRNA Vaccination in Adults Aged 18 Years or Older JAMA Internal Medicine Research Letter December 1, 2021 This cohort study examines the incidence and clinical outcomes of acute myocarditis among adults following mRNA vaccination in an integrated health care system in the US. Anthony Simone, MD; John Herald, MD; Aiyu Chen, MPH; Neil Gulati, MD; Albert Yuh-Jer Shen, MD; Bruno Lewin, MD; Ming-Sum Lee, MD, PhD

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Semenzato L , Le Vu S , Botton J, et al. Long-Term Prognosis of Patients With Myocarditis Attributed to COVID-19 mRNA Vaccination, SARS-CoV-2 Infection, or Conventional Etiologies. JAMA. Published online August 26, 2024. doi:10.1001/jama.2024.16380

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© 2024

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Long-Term Prognosis of Patients With Myocarditis Attributed to COVID-19 mRNA Vaccination, SARS-CoV-2 Infection, or Conventional Etiologies

• 1 EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance
• 2 University Paris-Saclay, Faculté de pharmacie, Orsay, France
• 3 Cardiologist, Specialized Medical Group, Strasbourg, France
• 4 Centre Ellipse, Strasbourg, France
• 5 University Paris-Saclay, UVSQ, University Paris-Sud, Inserm, Anti-infective evasion and Pharmacoepidemiology Unit/Team, CESP, Montigny le Bretonneux, France
• Research Letter Myocarditis and Pericarditis After Vaccination for COVID-19 George A. Diaz, MD; Guilford T. Parsons, MD, MS; Sara K. Gering, BS, BSN; Audrey R. Meier, MPH; Ian V. Hutchinson, PhD, DSc; Ari Robicsek, MD JAMA
• Original Investigation Myocarditis Cases Reported After mRNA-Based COVID-19 Vaccination in the US From December 2020 to August 2021 Matthew E. Oster, MD, MPH; David K. Shay, MD, MPH; John R. Su, MD, PhD, MPH; Julianne Gee, MPH; C. Buddy Creech, MD, MPH; Karen R. Broder, MD; Kathryn Edwards, MD; Jonathan H. Soslow, MD, MSCI; Jeffrey M. Dendy, MD; Elizabeth Schlaudecker, MD, MPH; Sean M. Lang, MD; Elizabeth D. Barnett, MD; Frederick L. Ruberg, MD; Michael J. Smith, MD, MSCE; M. Jay Campbell, MD, MHA; Renato D. Lopes, MD, PhD, MHS; Laurence S. Sperling, MD; Jane A. Baumblatt, MD; Deborah L. Thompson, MD, MSPH; Paige L. Marquez, MSPH; Penelope Strid, MPH; Jared Woo, MPH; River Pugsley, PhD, MPH; Sarah Reagan-Steiner, MD, MPH; Frank DeStefano, MD, MPH; Tom T. Shimabukuro, MD, MPH, MBA JAMA
• Review Diagnosis and Treatment of Acute Myocarditis—A Review Enrico Ammirati, MD, PhD; Javid J. Moslehi, MD JAMA
• JAMA Patient Page Patient Information: Acute Myocarditis Kristin Walter, MD, MS JAMA
• Research Letter Acute Myocarditis Following COVID-19 mRNA Vaccination in Adults Aged 18 Years or Older Anthony Simone, MD; John Herald, MD; Aiyu Chen, MPH; Neil Gulati, MD; Albert Yuh-Jer Shen, MD; Bruno Lewin, MD; Ming-Sum Lee, MD, PhD JAMA Internal Medicine

Question   What is the long-term prognosis of myocarditis after COVID-19 mRNA vaccination and do clinical outcomes and medical management differ from myocarditis of other origins?

Finding   In this nationwide cohort study including 4635 patients hospitalized for myocarditis in France during the first 1.5 years after COVID-19 vaccination, the 558 individuals with postvaccine myocarditis had less severe cardiovascular events than those with myocarditis of other origins at 18 months of follow-up. However, affected patients, mainly healthy young men, may require medical management up to several months after hospital discharge.

Meaning   These elements should be taken into account for ongoing and future mRNA vaccine recommendations.

Importance   Although patients with myocarditis after COVID-19 mRNA vaccination appear to have a good prognosis near hospital discharge, their longer-term prognosis and management remain unknown.

Objective   To study the cardiovascular complications of post–COVID-19 mRNA vaccination myocarditis and other types of myocarditis during an 18-month follow-up, as well as disease management based on a study of the frequency of medical procedures and drug prescriptions.

Design, Setting, and Participants   In this cohort study based on the French National Health Data System, all individuals aged 12 to 49 years hospitalized for myocarditis in France between December 27, 2020, and June 30, 2022, were identified.

Exposure   Individuals were categorized as having postvaccine myocarditis (within 7 days after COVID-19 mRNA vaccine), post–COVID-19 myocarditis (within 30 days of SARS-CoV-2 infection), or conventional myocarditis.

Main Outcomes and Measures   The occurrence of clinical outcomes (hospital readmission for myopericarditis, other cardiovascular events, all-cause death, and a composite outcome of these events) over the 18 months following hospital admission were analyzed using weighted Cox models to standardize the comparisons with the conventional myocarditis group. Also, medical management after hospital discharge was longitudinally assessed using generalized estimated equation models.

Results   In total, 4635 individuals were hospitalized for myocarditis: 558 with postvaccine myocarditis, 298 with post–COVID-19 myocarditis, and 3779 with conventional myocarditis. Patients with postvaccine myocarditis were younger than those with post–COVID-19 and conventional myocarditis (mean [SD] age of 25.9 [8.6], 31.0 [10.9], and 28.3 [9.4] years, respectively) and were more frequently men (84%, 67%, and 79%). Patients with postvaccine myocarditis had a lower standardized incidence of the composite clinical outcome than those with conventional myocarditis (32/558 vs 497/3779 events; weighted hazard ratio, 0.55 [95% CI, 0.36-0.86]), whereas individuals with post–COVID-19 myocarditis had similar results (36/298 events; weighted hazard ratio, 1.04 [95% CI, 0.70-1.52]). The standardized frequency of medical procedures and drugs prescribed in patients with postvaccine myocarditis or post–COVID-19 myocarditis followed a similar trend in the 18 months following hospital discharge to that of patients with conventional myocarditis.

Conclusions and Relevance   Patients with post–COVID-19 mRNA vaccination myocarditis, contrary to those with post–COVID-19 myocarditis, show a lower frequency of cardiovascular complications than those with conventional myocarditis at 18 months. However, affected patients, mainly healthy young men, may require medical management up to several months after hospital discharge.

Cases of myocarditis have been broadly reported following vaccination with the COVID-19 mRNA BNT162b2 and mRNA-1273 vaccines. 1 Several epidemiological studies 2 confirmed an increased risk of myocarditis shortly after vaccination, predominantly in young adults and after the second dose. In a previous case-control study of individuals aged 12 to 50 years, 3 Le Vu et al reported an increased risk of myocarditis during the first week following vaccination compared with unvaccinated individuals, reaching a 30-fold–higher risk for the second dose of the mRNA-1273 vaccine. Also, SARS-CoV-2 infection occurring in the previous month was associated with a risk of myocarditis, 3 in accordance with the literature. 4 , 5

Although vaccination resulted in a significant decrease in hospitalization and mortality from COVID-19, 6 , 7 it is crucial to evaluate the consequences of postvaccine myocarditis, particularly in young people, who are less likely to have serious illness after SARS-CoV-2 infection and could thus be less inclined toward vaccination. Studies have shown that the prognosis at hospital discharge after postvaccine myocarditis was generally favorable, 8 - 11 with short hospital stays and seldom cases of death. Only 1 comparative study, based on the populations of 4 Nordic countries, had a large sample size and a 3-month posthospitalization follow-up. Results showed postvaccine myocarditis to be associated with a lower risk of heart failure within 90 days after hospital admission than myocarditis unrelated to COVID-19 vaccination or SARS-CoV-2 infection (ie, conventional myocarditis). 12 However, most of these studies had a short or no posthospitalization follow-up and did not address the management of myocarditis over time or its long-term complications.

This study aimed to examine the cardiovascular complications of postvaccine myocarditis and other types of myocarditis (ie, post–COVID-19 and conventional myocarditis) during an 18-month follow-up, as well as disease management at discharge based on a study of the frequency of medical procedures and drug prescriptions.

This cohort study used data from the French national hospital discharge database (PMSI), coupled with the French national COVID-19 vaccination database (VAC-SI), the SARS-COV-2 diagnosis testing database (SI-DEP), and the National Health Data System (SNDS), which covers the entire population of France (67 million residents). Each person is anonymously identified by a unique, lifelong number. Since 2006, the SNDS has recorded all reimbursement data for both outpatient care (including drugs, imaging, and laboratory tests) and inpatient care (including diagnoses and procedures performed) from the PMSI, as well as fully reimbursed health expenditures for patients with long-term diseases, such as cancer and diabetes. These data are pseudonymized. Therefore, no informed consent is required to perform this study, nor approval from an ethics committee/institutional review board. The SNDS has been extensively used to conduct real-life pharmacoepidemiological studies, including during the COVID-19 pandemic and vaccination periods. 3 , 13 - 16

Regulatory approval and ethical aspects are available in the eMethods in Supplement 1 ). The cohort included all individuals aged 12 to 49 years who had a main or related diagnosis of myocarditis (defined by International Classification of Diseases and Related Health Problems, 10th Revision codes) from inpatient hospital care from December 27, 2020, to June 30, 2022 (eMethods in Supplement 1 ).

Individuals admitted to the hospital for myocarditis within 7 days after receipt of any dose of a COVID-19 mRNA vaccine were categorized as having postvaccine myocarditis. 3 Individuals admitted to the hospital for myocarditis within 30 days of SARS-CoV-2 infection and who did not receive an mRNA vaccination within the preceding 7 days were categorized as having post–COVID-19 myocarditis 3 (eMethods in Supplement 1 ). Only 7 individuals, for whom there was a history of both COVID-19 mRNA vaccination within 7 days and COVID-19 within 30 days, were excluded because they could be classified in either group. The remaining cases of myocarditis were categorized as conventional myocarditis.

Clinical outcomes of hospital readmission for myopericarditis with at least 1 overnight stay, the occurrence of another cardiovascular event (code details in the eMethods in Supplement 1 ), all-cause hospitalization with at least 1 overnight stay, and all-cause death during the follow-up were identified. Two composite clinical outcomes were also defined: the first by the occurrence of rehospitalization for myopericarditis, another cardiovascular event, or death from any cause and the second by adding hospitalization for any reason to the first. All individuals were followed up for 18 months from the date of initial hospital admission (index date) for myocarditis. Time to event for individual cardiovascular outcomes was censored at the time of occurrence of the event of interest, death from any cause, or the end of the study on December 31, 2023, whichever occurred first. Time to event for the composite outcomes was censored at the first occurrence of any outcome of interest, death from any cause, or the end of the study on December 31, 2023, whichever occurred first.

Medical procedures and drugs administered at 3 months and between 3 and 6 months, 6 and 12 months, and 12 and 18 months were analyzed. Follow-up lasted 18 months from the date of initial hospital discharge for myocarditis and was complete for more than 99% of the population studied (eMethods in Supplement 1 ). Reimbursement for diagnostic procedures and specific drugs was also identified (eTable 9 in Supplement 1 ).

Details of sociodemographic characteristics, chronic diseases, and comorbidities at baseline are available in the eMethods in Supplement 1 .

The characteristics, clinical outcomes, medical procedures, and drugs prescribed for patients with postvaccine myocarditis are described overall and by the vaccine dose involved (first, second, or third dose).

Cox regression models were used to compare the incidence of each clinical outcome and the 2 composite outcomes during the 18-month follow-up between postvaccine myocarditis, post–COVID-19 myocarditis, and conventional myocarditis. These models were weighted after modeling the probability of the myocarditis type, as described below, to standardize incidences using the conventional myocarditis group as the target group based on sociodemographic characteristics and comorbidities presented in Table 1 and Table 2 . The individual probability of developing 1 of the 3 types of myocarditis was estimated using a multinomial multivariable logistic regression model 17 and was used to calculate the weights. This weighting was set at 1 for patients in the target group and calculated as a ratio between the probability of the target group and that of the actual group for the other groups. 18 We provided 95% CIs from 1000 bootstrap resamples, 19 except where the number of events was less than 5 due to instability of estimates.

Medical procedures and drugs administered during the 18-month follow-up period after hospital discharge for each myocarditis group were reported using generalized estimating equations to account for multiple observations per patient using an exchangeable covariance matrix, which assumes the same correlation between the 4 periods (before 3 months, 3 to 6 months, 6 to 12 months, and 12 to 18 months). Generalized estimating equation models were weighted with the same weight calculation method as described above.

Sensitivity analyses were performed to compare the standardized incidence of clinical outcomes between the myocarditis groups by excluding patients with a history of myocarditis, starting follow-up from hospital discharge, defining postvaccine myocarditis within 30 days (instead of 7 days) of vaccine receipt, and using myocarditis identified in 2018 as the target group (details in the eMethods in Supplement 1 ).

All calculations were performed using SAS Enterprise Guide software, version 8.3 (SAS Institute).

The cohort included 4635 individuals hospitalized for myocarditis during the pandemic period from December 27, 2020, to June 30, 2022: 558 (12%) were categorized as having postvaccine myocarditis, 298 (6%) as having post–COVID-19 myocarditis, and 3779 (82%) as having conventional myocarditis (eFigure in Supplement 1 ).

Most cases of postvaccine myocarditis (n = 376 [67%]) occurred after a second vaccine dose ( Table 1 ). During the initial hospital stay for myocarditis, 1 patient received extracorporeal membrane oxygenation and none of them received a heart transplant. No death occurred during hospitalization. A comparison of the clinical outcomes during the follow-up according to the vaccine dose administered showed no significant differences between doses (eTable 1 in Supplement 1 ).

Individuals with postvaccine myocarditis, compared with conventional myocarditis, were younger (mean [SD] age, 25.9 [8.6] vs 28.3 [9.4] years), more frequently male (84% vs 79%), and had a lower frequency of history of cardiometabolic diseases, whereas individuals with post–COVID-19 myocarditis, compared with those with conventional myocarditis, were hospitalized slightly longer (median [IQR] length of stay, 5 [3-8] vs 4 [3-6] days), were older (mean age [SD], 31.0 [10.9] years), were less frequently male (67%), and had more comorbidities ( Table 2 ). Among those with postvaccine myocarditis, 97.5% had no history of myocarditis in the previous 5 years vs 97.0% of those with post–COVID-19 myocarditis and 93.5% of those with conventional myocarditis.

In the 18 months following hospitalization, 18 of 558 individuals (3.2%) with postvaccine myocarditis, 12 of 298 (4.0%) with post–COVID-19 myocarditis, and 220 of 3779 (5.8%) with conventional myocarditis were rehospitalized for myopericarditis ( Table 3 ). Hospitalization for other cardiovascular events occurred for 15 individuals (2.7%) with postvaccine myocarditis, 22 (7.4%) with post–COVID-19 myocarditis, and 277(7.3%) with conventional myocarditis cases. Death occurred for 1 patient (0.2%) followed-up after postvaccine myocarditis, 4 (1.3%) after post–COVID-19 myocarditis, and 49 (1.3%) after conventional myocarditis, including 0, 4, and 17 deaths, respectively, occurring during the initial hospital stay defining the cohorts.

After standardization on the characteristics of conventional myocarditis cases, postvaccine myocarditis cases presented a lower standardized incidence of rehospitalization for myopericarditis, other cardiovascular events, or all-cause death as a composite outcome (weighted hazard ratio [wHR], 0.55 [95% CI, 0.36-0.86]), while no differences were observed with post–COVID-19 myocarditis (wHR, 1.04 [95% CI, 0.70-1.52]).

Patients with postvaccine myocarditis were less frequently hospitalized for any cause (wHR, 0.69 [95% CI, 0.50-0.94]) than those with conventional myocarditis, while no difference was observed with post–COVID-19 myocarditis. Similar results were found when hospitalization for any cause was added to the composite criterion (wHR for postvaccine myocarditis, 0.64 [95% CI, 0.48-0.85]; wHR for post–COVID-19 myocarditis, 1.03 [95% CI, 0.75-1.40]).

Clinical outcomes by vaccine type for postvaccine myocarditis compared with conventional myocarditis are shown in Table 4 . Compared with the conventional myocarditis group, the association observed with the first composite outcome seemed to be stronger in the mRNA-1273 postvaccine myocarditis group than in the BNT162b2 postvaccine group (wHR of 0.24 [95% CI, 0.05-1.18] and 0.68 [95% CI, 0.38-1.22], respectively), but uncertainty on these estimates (ie, large CIs) prevented drawing any firm conclusion.

In the sensitivity analyses limited to patients without a history of myocarditis (eTable 2 in Supplement 1 ) or starting follow-up from hospital discharge (eTable 3 in Supplement 1 ), similar results to those obtained in the main analysis were found. An age-stratified analysis distinguishing those aged 12 to 29 years from those aged 30 to 49 years also produced similar results (results not shown).

When the definition of postvaccine myocarditis was extended to include patients who received a dose of mRNA vaccine within the previous 30 days (rather than 7), a larger wHR was observed (wHR, 0.84 [95% CI, 0.64-1.09]) for the composite clinical outcome in the postvaccine myocarditis group (eTable 4 in Supplement 1 ).

A total of 2191 individuals hospitalized for myocarditis were identified in 2018 (during the prepandemic period), categorized as historical control, with similar characteristics at baseline (eTable 5 in Supplement 1 ) and clinical outcomes during follow-up as those with conventional myocarditis (eTable 6 in Supplement 1 ). Consistent with the main analysis, patients with postvaccine myocarditis appeared to have a lower standardized incidence of the first composite outcome (wHR, 0.65 [95% CI, 0.40-1.05]) than those with historical myocarditis.

The standardized incidences of the first composite outcome for unvaccinated and vaccinated individuals with post–COVID-19 myocarditis (wHR of 1.06 [95% CI, 0.29-3.86] and 1.23 [95% CI, 0.64-2.39]) did not differ substantially from conventional myocarditis (eTables 7 and 8 in Supplement 1 ).

The evolution of the medical procedures and drugs administered according to myocarditis group in the 18 months following hospital discharge is presented in the Figure , with additional outcomes presented in eTable 9 in Supplement 1 . After standardization, the frequency of medical procedures (cardiac imaging, troponin assay, stress test) and drug prescriptions followed a similar trend for patients with postvaccine or conventional myocarditis.

This nationwide population-based study is the first to describe the evolution of postvaccine myocarditis with an 18-month follow-up after hospitalization. Unlike patients with post–COVID-19 myocarditis, those with postvaccine myocarditis had fewer hospital readmissions for myopericarditis, other cardiovascular events, or all-cause death as a composite outcome than those with conventional myocarditis. The differences in clinical outcomes observed between the groups cannot be interpreted as causal effects, because the type of myocarditis is not modifiable.

Several studies have reported reassuring results for the prognosis of patients with postvaccine myocarditis at discharge, with a low likelihood of cardiac dysfunction at presentation and generally rapid recovery. However, residual symptoms 20 , 21 and diagnostic abnormalities, such as altered myocardial deformation or the persistence of late gadolinium enhancement, 9 , 20 , 22 - 26 were observed on cardiac magnetic resonance imaging after up to 1 year of follow-up. Although the presence of late gadolinium enhancement is an indicator of cardiac injury and fibrosis and is associated with a worse form for patients with classic acute myocarditis, 24 , 27 its persistence over time and its prognostic value are less well established.

The current results are consistent with those of Husby et al. 12 Their study outcome was limited to heart failure occurring during the first 3 months after discharge. 25 The current study was able to extend the analysis to other cardiovascular complications and to benefit from a much longer follow-up period and standardization for multiple patient characteristics.

Part of the lower incidence of all-cause hospitalization observed in postvaccine myocarditis compared with conventional myocarditis might be explained by the more varied etiology of conventional myocarditis cases. For example, cases linked to inflammatory disease may require more hospital follow-up due to the underlying pathology and have more frequent cardiovascular comorbidities and risk factors. In the current study, no patient with postvaccine myocarditis received a heart transplant and 2 (0.4%) required extracorporeal membrane oxygenation, which is consistent with other studies. 28 - 30

The American Heart Association and the American College of Cardiology guidelines advise that patients with myocarditis be instructed to refrain from competitive sports for 3 to 6 months and to have their health condition assessed prior to the resumption of sports. 8 , 10 Myocarditis in athletes is receiving increasing attention, mainly because of the particular risk of sudden cardiac death it presents. 31 In the current study, 1 patient with postvaccine myocarditis died during the follow-up after receiving extracorporeal membrane oxygenation, with myocarditis being the most likely cause of death. Although rare, this unfavorable outcome has already been reported in the literature. 32 , 33

The mechanisms producing myocardial injury after administration of a COVID-19 mRNA vaccine are not well understood, 34 with various hypotheses such as an altered gene expression, direct immune activation by mRNA, molecular mimicry, immune dysregulation, or aberrant cytokine expression. The current analyses might suggest a difference in the strength of the association with clinical outcomes by type of mRNA vaccine. Considering the small number per subgroup, with relatively rare events, further specific studies on this subject are required.

Although the main strength of this study lies in the large sample size, its population-based nature and the assessment of cases and vaccine exposure in comprehensive, high-quality databases, this study has other strengths. First, the data enabled the longest follow-up to date, with most patients having had time to recover without developing complications, although medical follow-up still appears necessary for some and a small proportion experienced a cardiovascular event. Second, although misclassification of cases as myocarditis might occur, which would result in an over- or underestimation of the severity of prognosis, analysis of the drugs dispensed was reassuring concerning the specificity of the cases. 35 In addition, several reports 36 , 37 have shown good International Classification of Diseases and Related Health Problems, 10th Revision coding accuracy for other cardiovascular diseases in the database used in this study whose diagnosis could be confused with that of myocarditis.

This study also has several limitations. First, it focused on cases of myocarditis requiring hospitalization. Patients who did not seek medical attention for an acute illness, such as simple chest pain, were not included. Due to the particular attention paid to this adverse event since the COVID-19 pandemic, an overdiagnosis bias is also possible, particularly when suspecting postvaccine or post–COVID-19 myocarditis, leading to the hospitalization of patients with less severe cases. Second, the potential misclassification of myocarditis may have occurred. Vaccine-induced myocarditis was defined as hospitalization for myocarditis within 7 days of vaccination with an mRNA vaccine. In a previous study by Le Vu et al, 3 associations between the risk of myocarditis and vaccination were found, reaching a 30-fold–higher risk for the second dose of the mRNA-1273 vaccine and an 8-fold–higher risk for the second dose of the BNT162b2 vaccine. Furthermore, although some studies defined postvaccine myocarditis as hospitalization for myocarditis within 21 days of vaccination with an mRNA vaccine, the study found no association between vaccination with either the BNT162b2 or mRNA-1273 vaccine and a risk of myocarditis in the 8 to 21 days after vaccination. 3 When repeating the main analysis with a less restrictive definition of postvaccine myocarditis (ie, mRNA vaccine within the previous 30 days), a higher wHR was observed for postvaccine myocarditis, which suggests a less specific definition of this group. Third, the effect of the COVID-19 pandemic may have had an impact on the constitution of the conventional myocarditis group. However, similar results were obtained whether the target group was conventional myocarditis or historical myocarditis. Fourth, standardization was performed on the characteristics observed in the conventional myocarditis group, but the groups may still differ according to unmeasured characteristics. Fifth, although information on the frequency of medical procedures performed over time was available, the results of these examinations in the databases were not available, which would have provided more information on the evolution of the clinical severity of the myocarditis.

Patients with post–COVID-19 mRNA vaccination myocarditis, contrary to patients with post–COVID-19 myocarditis, have a lower frequency of cardiovascular complications than those with conventional myocarditis at 18 months. However, affected patients, mainly healthy young men, may require medical disease management for up to several months after hospital discharge. These elements should all be taken into account for ongoing and future mRNA vaccine recommendations.

Accepted for Publication: July 26, 2024.

Published Online: August 26, 2024. doi:10.1001/jama.2024.16380

Corresponding Authors: Laura Semenzato, MSc, PI-PHARE, 143/147 Bd Anatole, France 93285 Saint-Denis Cedex France ( [email protected] ); Mahmoud Zureik, MD, PhD, EPI-PHARE, 143/147 Bd Anatole, France 93285 Saint-Denis Cedex France ( [email protected] ).

Author Contributions: Ms Semenzato had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Semenzato, Le Vu, Botton, Jabagi, Dray-Spira, Zureik.

Acquisition, analysis, or interpretation of data: Semenzato, Le Vu, Botton, Bertrand, Drouin, Cuenot, Zores, Weill, Zureik.

Drafting of the manuscript: Semenzato, Cuenot, Zureik.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Semenzato, Le Vu, Botton, Zureik.

Administrative, technical, or material support: Bertrand, Cuenot.

Supervision: Le Vu, Botton, Jabagi, Dray-Spira, Zureik.

Conflict of Interest Disclosures: Dr Zores reported receiving nonfinancial support from the French Society of Cardiology outside the submitted work. No other disclosures were reported.

Data Sharing Statement: See Supplement 2 .

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Top Biden-Harris Climate Official Gets Off Easy After Conflict-of-Interest Violations

Vermont Health Department Discourages Saying 'Son' and 'Daughter' in Classrooms

Barack obama's monument to himself is a hideous eyesore, official dem platform backs plan to give amnesty to already-deported aliens, a tale of two interviews: dana bash with j.d. vance vs. kamala harris, watch: veep thoughts with kamala harris (vol. 20), robin diangelo plagiarized minority scholars, complaint alleges.

Robin DiAngelo, the best-selling author of White Fragility , is a big believer in citing minorities.

In an " accountability " statement on her website, which makes repeated reference to her Ph.D., DiAngelo, 67, tells "fellow white people" that they should "always cite and give credit to the work of BIPOC people who have informed your thinking."

It doesn't matter if their contribution is just a few words. "When you use a phrase or idea you got from a BIPOC person," DiAngelo says, referring to black, indigenous, and other people of color, "credit them."

But the white diversity trainer has not always taken her own advice. According to a complaint filed last week with the University of Washington, where DiAngelo received her Ph.D. in multicultural education, she plagiarized several scholars—including two minorities—in her doctoral thesis.

The 2004 dissertation , "Whiteness in Racial Dialogue: A Discourse Analysis," lifts two paragraphs from an Asian-American professor, Northeastern University's Thomas Nakayama, and his coauthor, Robert Krizek, without proper attribution, omitting quotation marks and in-text citations.

DiAngelo also lifts material from Stacey Lee, an Asian-American professor of education at the University of Wisconsin-Madison, in which Lee summarizes the work of a third scholar, David Theo Goldberg.

The passage creates the impression that DiAngelo is providing her own summary of Goldberg rather than using Lee's language—a misleading move that Peter Wood, the president of the National Association of Scholars, likened to "forgery."

"It is never appropriate to use the secondary source without acknowledging it, and even worse to present it as one's own words," said Wood, a former Boston University provost who led several research misconduct probes. "That's plagiarism."

The complaint describes dozens of cases in which DiAngelo, who rakes in almost $1 million a year in speaking fees, passed off the work of others as her own. It calls into question the key credential on which DiAngelo built her career, which has relied on the notion that her therapeutic workshops—which can cost up to $40,000 and insist that all white people are racist—are backed by scholarly expertise.

"No one who respected the basic expectations of scholarship would do this," said Steve McGuire, a member of the American Council of Trustees and Alumni and former professor of political theory at Villanova University. "The amount of copying of verbatim language without quotation marks or clear and consistent citations in these examples is appalling."

The doctorate has become a centerpiece of DiAngelo's marketing. Her website, "Robin DiAngelo, PhD," refers to her as "Dr. DiAngelo," notes that she is a professor at the University of Washington, and states that she coined the term "white fragility" in an "academic article" in 2011.

The first use of that phrase actually came in her dissertation, on page 184, where she formulated the concept that would define her career.

"White fragility," DiAngelo wrote, "is a state in which even a minimum amount of racial stress becomes intolerable, triggering a range of defensive moves."

The complaint suggests that the paper responsible for these ideas violated bedrock scholarly norms. Several passages appear to meet the University of Washington's definition of plagiarism , which includes "borrowing the structure of another author's phrases or sentences without crediting the author from whom it came."

DiAngelo, for example, copies a page of material from Kristin Gates Cloyes—her classmate in the university's Ph.D. program—and frames it as original language.

She lifts another page from Debian Marty, an emerita professor of communication at California State University, Monterey Bay, keeping the structure of the passage the same while swapping out synonyms and details.

Turnitin.com defines this sort of splicing as "mosaic plagiarism," in which a source's phrases are interspersed, uncredited, with one's own. "Plagiarism need not be intentional," the University of Washington states , "and 'I didn't know' is not a defense."

DiAngelo did not respond to a request for comment. The University of Washington did not respond to a request for comment.

Once an obscure professor at Westfield State University, DiAngelo emerged in 2020 as the high priestess of progressive racialism. Her most famous book, White Fragility , published in 2018, flew off the shelves following George Floyd's death, beating out How to Be An Antiracist by Ibram X. Kendi—a black man—on USA Today 's best-seller list.

DiAngelo has become a staple of teacher trainings, corporate affinity groups, fundraisers, and "antiracist" book clubs. She even addressed 184 members of Congress, including then-House speaker Nancy Pelosi (D., Calif.), about what it "mean[s] to be white," telling the Democratic caucus in 2020 that its members would continue to "hurt" black people until they reckoned with the question.

The talk was one of myriad speaking engagements that launched DiAngelo into the top 1 percent of American earners and helped her afford three houses worth $1.6 million . At one of those houses, a cabin in rural Washington State, DiAngelo has been photographed relaxing with a group of friends who, by all outward appearances, are exclusively white.

Last week's complaint is part of a wave of plagiarism allegations unleashed by the resignation of former Harvard University president Claudine Gay, who stepped down in January after half of her published works were found to contain plagiarized material. Subsequent complaints targeted diversity officials at Harvard , Columbia , the Massachusetts Institute of Technology , the University of California, Los Angeles , and the University of Wisconsin-Madison .

The allegations ranged from mild sloppiness to copying huge chunks of text from other sources, including Wikipedia , without attribution. DiAngelo falls on the severer half of that continuum, lifting longer chunks of text than some officials, including Gay, and displaying telltale signs of deliberate plagiarism.

Though she cites all of her sources in her bibliography, DiAngelo omits quotation marks, footnotes, and other forms of attribution that would mark off her words from those of her sources. And while a verbatim quote could have been copied accidentally, she often tweaks her sources' prose—suggesting she is aware of what she is doing and intentionally misleading readers.

In a sentence taken from Queen's University's Cynthia Levine-Rasky, for example, DiAngelo changes just one word.

"It could be one of those signatures of the habitual plagiarist in which a minor change is meant either to throw people off or to justify the pretense of taking someone else's words for oneself," Wood said. "In any case, it shows that DiAngelo was fully conscious of what she was doing."

A similar case involves two sentences from Bronwyn Davies, a professorial fellow at the University of Melbourne, and Rom Harré, a deceased philosopher and psychologist. DiAngelo copies the sentences almost verbatim, tweaking a word here or there to avoid an exact reproduction.

"It does look like plagiarism," Davies told the Washington Free Beacon . Other scholars named in the complaint did not respond to requests for comment.

Published under: Anti-Racism , claudine gay , Ethics , Hypocrisy , plagiarism , Professors , Racism , Robin DiAngelo , Universities , woke

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Police raid Andrew Tate’s home in Romania as new allegations emerge involving minors

Masked police officers in Romania carried out fresh raids early Wednesday at the home of divisive internet influencer Andrew Tate.

Divisive internet influencer Andrew Tate and his brother Tristan were detained on Wednesday in Romania following a police raid at their house earlier in the day. While being ushered into a police van Andrew Tate complained to reporters that he didn’t know what he had done wrong.

Armed gendarmes wearing balaclavas walk outside the residence of Andrew Tate during a police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. (AP Photo/Vadim Ghirda)

Andrew Tate is convoyed from his residence by armed gendarmes for questioning after a police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. Masked police officers in Romania carried out fresh raids early Wednesday at the home of divisive internet influencer Andrew Tate, who is awaiting trial on charges of human trafficking, rape and forming a criminal gang to sexually exploit women. (AP Photo/ Vadim Ghirda)

Tristan Tate exits his residence convoyed by a masked gendarme for questioning after a police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21 2024. Masked police officers in Romania carried out fresh raids early Wednesday at the home of divisive internet influencer Andrew Tate, who is awaiting trial on charges of human trafficking, rape and forming a criminal gang to sexually exploit women.(AP Photo/ Vadim Ghirda)

Gendarmes wearing balaclavas walk outside the residence of Andrew Tate during a police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. (AP Photo/Vadim Ghirda)

A masked gendarme patrols the courtyard of the residence of internet influencer Andrew Tate during an early morning police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. (AP Photo/ Vadim Ghirda)

Internet influencer Andrew Tate’s lawyer Eugen Vidineac exits the residence of Andrew Tate during an early morning search raid by the police, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. (AP Photo/ Vadim Ghirda)

A police officer stands outside the residence of internet influencer Andrew Tate during an early morning police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. (AP Photo/ Vadim Ghirda)

A masked gendarme patrols the courtyard of the residence of social media personality Andrew Tate during an early morning police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21 2024. (AP Photo/ Vadim Ghirda)

Gendarmes wearing balaclavas exit the residence of internet influencer Andrew Tate during an early morning police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. (AP Photo/ Vadim Ghirda)

Gendarmes wearing balaclavas hold a battering ram used to break down a door outside the residence of internet influencer Andrew Tate during an early morning police search raid, on the outskirts of Bucharest, Romania, Wednesday, Aug. 21, 2024. (AP Photo/ Vadim Ghirda)

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BUCHAREST, Romania (AP) — Masked police officers in Romania carried out fresh raids early Wednesday at the home of divisive internet influencer Andrew Tate , who is awaiting trial on charges of human trafficking, rape and forming a criminal gang to sexually exploit women.

Romania’s anti-organized crime agency, DIICOT, said it was searching four homes in Bucharest and nearby Ilfov county, investigating allegations of human trafficking, the trafficking of minors, sexual intercourse with a minor, influencing statements and money laundering. The agency added that hearings will later be held at its headquarters.

Tate’s spokesperson, Mateea Petrescu, said in response to the raids that “although the charges in the search warrant are not yet fully clarified, they include suspicions of human trafficking and money laundering” and added that his legal team is present. Petrescu did not address the allegations involving minors.

Dozens of police officers and forensic personnel were scouring Tate’s large property on the edge of the capital Bucharest. “During the entire criminal process, the investigated persons benefit from the procedural rights and guarantees provided by the Code of Criminal Procedure, as well as the presumption of innocence,” DIICOT noted in its statement.

The 37-year-old Andrew Tate and his brother Tristan, 36, both former kickboxers and dual British-U.S. citizens who have amassed millions of social media followers, were arrested in 2022 near Bucharest along with two Romanian women. Romanian prosecutors formally indicted all four last year. They have denied the allegations.

Petrescu said late Wednesday that the Tate brothers have been detained for 24 hours, which is the maximum DIICOT can hold them without a judge approving a request by prosecutors for a longer period. “As of yet, no proposal has been submitted by the prosecution,” she said.

As the brothers were ushered from their home into a police van outside, Andrew Tate complained to reporters that the case was progressing too slowly. “What I’ve done wrong, who knows,” he claimed.

Andrew Tate is known for expressing misogynistic views online and has amassed 9.9 million followers on the social media platform X, and has repeatedly claimed that prosecutors have no evidence against him and that there is a political conspiracy to silence him. He was previously banned from various social media platforms for misogynistic views and hate speech.

In April, the Bucharest Tribunal ruled that the prosecutors’ case file against the four met the legal criteria and that a trial could start but did not set a date for it to begin. That ruling came after the legal case had been discussed for months in the preliminary chamber stages, a process in which the defendants can challenge prosecutors’ evidence and case file.

After the Tate brothers’ arrest in 2022, they were held for three months in police detention before being moved to house arrest. They were later restricted to the Bucharest and Ilfov counties, and later to all of Romania.

Last month, a court overturned an earlier decision that allowed the Tate brothers to leave Romania as they await trial. The earlier court ruled on July 5 that they could leave the country as long as they remained within the 27-member European Union. The decision was final.

In March, the Tate brothers also appeared at the Bucharest Court of Appeal in a separate case, after British authorities issued arrest warrants over allegations of sexual aggression in a U.K. case dating back to 2012-2015. The appeals court granted the British request to extradite the the Tates to the U.K., but only after legal proceedings in Romania have concluded.

McGrath reported from Sibiu, Romania.

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Trump Shares AI-Generated Images Claiming Swifties Are Supporting Him

Former president Donald Trump has shared AI-generated images that falsely claim Taylor Swift fans are supporting his campaign.

In a post on Truth Social , Trump shared screenshots of four posts on X that purport to show a number of young women all wearing “Swifties for Trump” T-shirts in a variety of styles. One of the screenshots claimed that Swifties are supporting Trump now after Taylor Swift canceled her concert in Vienna due to security concerns. Another image included the phrase “Taylor wants you to vote for Donald Trump.”

“I accept!” Trump captioned his post.

However, Trump’s post appears to contain a mixture of real and AI-generated images that falsely suggest a widespread and coordinated movement of Swifties for Trump. Using a tool created by nonprofit True Media to detect the spread of election-related deepfakes, WIRED found that many of the images shared by Trump show “substantial evidence of manipulation.”

One of the screenshots Trump shared was from an anonymous pro-Trump account with over 300,000 followers that regularly posts AI-generated images. Following its post about Swifties for Trump, this account shared a follow-up post that said the original Swifties for Trump post was “satire.”

While there doesn’t appear to be an active Swifties for Trump campaign initiative, there is an active Swifties4Kamala group. “We do not represent every Swiftie, but I think there is a reason we don’t need AI to show our support for Kamala,” Irene Kim, cofounder of Swifties4Harris , tells WIRED.

There is at least one public Swiftie for Trump. Among the images shared by Trump on Sunday on Truth Social was a real picture of Jenna Piwowarczyk, who wore a homemade T-shirt to a Racine, Wisconsin, Trump rally in June, emblazoned with the words “Swifties for Trump.” Piwowarczyk is now selling her homemade T-shirts on Etsy.

Trump has consistently shared AI-generated images. Last week, Trump falsely claimed that the Harris campaign was using AI to artificially inflate crowd sizes at her rallies. Over the weekend, Trump also posted an AI-generated image on X of Harris speaking at the Democratic National Convention in Chicago with a Soviet Union flag hanging over the crowd.

Disinformation experts have warned about the threat posed to the integrity of elections by generative AI tools. Already this year, WIRED has tracked dozens of examples of content created using generative AI in elections across the globe.

Swift has not publicly endorsed any candidate for president, but she did endorse President Joe Biden in 2020. She has also strongly criticized Trump: After Trump made his infamous “ when the looting starts, the shooting starts ” comment in 2020 following Black Lives Matter protests in support of George Floyd, the pop superstar slammed the then-president for having “the nerve to feign moral superiority” after “stoking the fires of white supremacy and racism your entire presidency.”

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Behind the arrest of Telegram boss, a small Paris cybercrime unit with big ambitions

The investigation into Telegram boss Pavel Durov that has fired a warning shot to global tech titans was started by a small cybercrime unit within the Paris prosecutor's office, led by 38-year-old Johanna Brousse.

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Billionaire Bill Gates Has 83% of His $48 Billion Portfolio in Just 4 Stocks

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While he has more than two dozen stocks in his portfolio, four make up the vast majority of his holdings.

Most investors have probably heard of Bill Gates, best known as a billionaire philanthropist and co-founder of Microsoft ( MSFT 0.97% ) .

After heading up the technology company he founded for more than 25 years, the former CEO stepped down to focus on his charity work. Gates is worth an estimated $132.6 billion (as of this writing), according to Forbes, making him the ninth richest person in the world. However, the fabled billionaire has pledged that "the vast majority of my wealth would go toward helping as many people as possible."

The vehicle he uses to support that goal is the Bill & Melinda Gates Foundation Trust. "Our mission is to create a world where every person has the opportunity to live a healthy, productive life," the Gates Foundation website declares. The foundation has made grant payments of $77.6 billion since its inception, "taking on the toughest, most important problems." As a result, holdings of the Trust tend to vary from quarter to quarter.

While the Trust continues to own stakes in more than two dozen companies, 83% of its portfolio was comprised of just four stocks at the close of the second quarter.

Image source: Getty Images.

1. Microsoft: 33%

Of all the holdings in the Gates Trust, Microsoft is by far the largest. This shouldn't be a surprise, given that Gates set up the foundation with his own holdings. The Trust owns roughly 35 million shares of Microsoft stock valued at $14.7 billion.

Yet this isn't the Microsoft of old. The company has expanded beyond its browser and operating system software, with Azure Cloud becoming the fastest-growing cloud infrastructure provider. It's up 29% year over year in the most recent quarter, outpacing both Amazon Web Services (AWS) and Alphabet 's Google Cloud.

However, it was Microsoft's early move into generative AI that has investors most excited. Management noted that Azure's cloud growth included "eight points from AI services," helping illustrate the upside. The company's AI-powered digital assistant -- Copilot -- and other AI tools could generate incremental revenue of $143 billion by 2027, according to analysts at Evercore ISI.

The Trust also benefits from Microsoft's quarterly dividend, which the company has paid out consistently since 2004 and increased every year since 2011. The current yield of 0.7% might seem inconsequential, but that's a function of the impressive stock price gains of more than 200% over the past five years. Furthermore, with a payout ratio of less than 25%, there are likely many more dividend increases on the horizon.

2. Berkshire Hathaway: 21%

Fellow billionaire Warren Buffett, CEO of Berkshire Hathaway ( BRK.A 1.85% ) ( BRK.B 1.61% ) , has similar plans to donate the bulk of his wealth to charity. He joined Gates in the "Giving Pledge" in 2006 and has since donated roughly $43 billion to the Trust, including a bequest of $4 billion in June. As a result, the Gates Foundation currently holds nearly 25 million Berkshire Hathaway Class B shares worth $11 billion.

Given Berkshire's portfolio of profitable businesses and successful stock holdings, it isn't surprising that the Trust continues to keep so much of the stock on hand. The portfolio provides built-in diversification and is expected to rake in billions in dividend income over the coming year. Furthermore, Berkshire just pared down its stock holdings and boosted its cash pile to a record high. It's now holding roughly $277 billion in cash .

Given the company's history of success and massive cash pile, it isn't surprising that it's still one of the Trust's largest holdings.

3. Waste Management: 16%

Gates has a soft spot for boring companies with strong recurring revenue, which is the very definition of Waste Management ( WM 1.03% ) . If you have any doubt, consider this: The Gates Trust has a stake of more than 35 million shares of Waste Management stock worth $7.3 billion.

Beyond just trash collection, Waste Management owns a number of reclamation stations that recover glass, paper, metal, and plastics and redirect them for recycling. The company also operates a number of landfills where it collects landfill gases to generate electricity and power vehicles.

In the second quarter, revenue grew 5.5% year over year, while its adjusted operating EBITDA increased 10%.

Let's not forget the dividend. Waste Management has increased its payout for 15 consecutive years, with a current yield of 1.43%. And with a payout ratio of 46%, there's plenty more where that came from.

4. Canadian National Railway: 13%

Another area where Gates and Buffett share common ground is enduring faith in railroads. Buffett was clear when he bought out Burlington Northern Santa Fe in 2009, saying that railroads transported goods "in a very cost-effective way... they do it in an extraordinarily environmentally friendly way... [releasing] far fewer pollutants into the atmosphere." Gates clearly shares this mindset, as the Trust holds nearly 55 million shares of Canadian National Railway ( CNI 0.74% ) worth $6.2 billion.

What sets Canadian National apart is that it's the only transcontinental railroad in North America, connecting the Atlantic coast, the Pacific coast, and the Gulf of Mexico. Regarding Buffett's point, railroads reduce greenhouse gas emissions by 75%. This is primarily because they're four times more efficient than long-haul trucks, making railroads a more cost-effective option. Add to that their high barriers to entry and significant economic moat, and it's easy to understand the appeal.

Canadian National has a solid track record of dividend payments, with consecutive increases every year since it was initiated in 1996, and a current yield of 2.1%. The current payout ratio of 38% suggests there's plenty of opportunity for future increases.

John Mackey, former CEO of Whole Foods Market, an Amazon subsidiary, is a member of The Motley Fool's board of directors. Suzanne Frey, an executive at Alphabet, is a member of The Motley Fool's board of directors. Danny Vena has positions in Alphabet, Amazon, Canadian National Railway, and Microsoft. The Motley Fool has positions in and recommends Alphabet, Amazon, Berkshire Hathaway, and Microsoft. The Motley Fool recommends Canadian National Railway and Waste Management and recommends the following options: long January 2026 $395 calls on Microsoft and short January 2026 $405 calls on Microsoft. The Motley Fool has a disclosure policy .

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