Occupational Social Work: A Field of Practice in Need of Revival

The COVID-19 pandemic focused attention on the high levels of occupational stress experienced by frontline and essential workers. Occupational stress is also not unique to these workers as demonstrated by the consistently high rates of suicide within certain occupational groups. Occupational social work is the specialized field most suited to address the needs of workers under stress, yet it has been in decline in the United States since the 1990s. The factors contributing to this decline are put forward, including managed care, the dominance of the advanced clinical social work license, and the lack of a social work presence in occupational stress effectiveness research. The implications for practice regarding the actions that can be taken by the profession to revive this field and be more responsive to vulnerable workers are discussed. © The Author(s) 2023.

Multi-MedVit: a deep learning approach for the diagnosis of COVID-19 with the CT images

The grim situation of novel coronavirus pneumonia 2019 (COVID-19) and its terrible spreading speed have already constituted a severe risk to human life, so it is ultimately essential to rapidly and accurately diagnose for COVID-19 pneumonia. Based on this study's 746 lung CT images, we propose Multi-MedVit, a novel auxiliary COVID-19 diagnosis framework based on the multi-input Transformer. We compare Multi-MedVit with state-of-the-art deep learning methods, such as CNN, VGG16, and ResNet50. Multi-MedVit outperformed the other methods on the benchmark dataset and proved that multiscale data input for data augmentation helped enhance model stability. Based on an interpretable analysis of the input and output of Multi-MedVit, we found that with the support of the training set data, the model has been possible to accurately focus on the lesion area for diagnosis of COVID-19 without expert annotations, which can provide initial references containing more potential information to doctors more precisely and fleetly. © 2022 IEEE.

Which brands do consumers become attached to? The roles of brand concepts and brand positioning in the context of COVID-19

Purpose: The COVID-19 pandemic has dramatically disrupted everyday life, leading to a cascade of negative emotional responses such as death anxiety. Against this backdrop, the purpose of this paper is to focus on the buffering effect of brand attachment on death anxiety by exploring the roles of brand concepts and brand positioning on psychological compensation for security. Design/methodology/approach: This multi-method paper features four studies and shows how brands can offer emotional support under high-risk circumstances. Findings: Study 1 includes two surveys which offer preliminary evidence that death anxiety can enhance consumers' brand attachment. Study 2 reveals a causal effect wherein consumers experiencing death anxiety are more likely to attach to brands with a self-transcendence (vs self-enhancement) concept. Study 3 examines the mediating role of need for security in the relationship between death anxiety and attachment to brands with a self-transcendence concept. Further, Study 4 indicates the moderating role of brand positioning: self-transcendence brands adopting local (vs global) positioning strategies are more likely to satisfy consumers' need for security, thereby leading to strong brand attachment. Originality/value: The findings of this paper contribute to the brand attachment literature and to the global branding literature regarding consumers' emotional responses in the context of COVID-19. This paper innovatively frames brand concepts and brand positioning and provides actionable guidelines to help brands satisfy consumers' needs amid a worldwide crisis. © 2022, Emerald Publishing Limited.

Prophylactic and Therapeutic Activity of AZD7442 (Tixagevimab/ Cilgavimab) in SARS-CoV-2 Hamster Challenge Models

Background. AZD7442-a combination of 2 human, extended-half-life, SARS-CoV-2-neutralizing monoclonal antibodies (mAbs) (tixagevimab/cilgavimab)-has received US Food and Drug Administration emergency use authorization for COVID-19 prevention in immunocompromised individuals. We evaluated the effect of AZD7442 in prevention and treatment settings in Syrian hamsters challenged with SARS-CoV-2. Methods. Hamsters received intraperitoneal isotype control mAb (2 mg) or AZD7442 (0.002-2 mg) 1 day before intranasal (IN) SARS-CoV-2 challenge (USA-WA1/2020;1x105 plaque-forming units) in prevention;OR control mAb (5 mg) or AZD7442 (0.5-5 mg) 1 day after IN SARS-CoV-2 challenge in treatment. The impact of AZD7442 on lung viral RNA and pathology and AZD7442 serum levels was assessed on Days 3 and 7 post infection. Body weight was recorded daily through Day 7. Results. With AZD7442 prevention, lower lung viral loads were observed compared to controls;at Day 3 post infection, lowest infectious virus titer and viral subgenomic mRNA (sgmRNA) levels were seen with doses >=0.2 mg AZD7442. Concomitantly, increased serum levels of AZD7442 were observed. By Day 7, infectious virus titer and sgmRNA fell below the level of detection (LOD) at all doses tested. Moreover, AZD7442 at doses >=0.2 mg protected hamsters from weight loss versus controls. Lung pathology scores (scale: 0 [normal] to 25 [most severe]) were generally dose dependent, with mean scores of < 2 for AZD7442 versus 10 for controls, indicating less SARS-CoV-2-induced inflammation and alveolar damage in hamsters given AZD7442. Lower AZD7442 doses were associated with mean pathology scores similar to controls. With AZD7442 treatment, infectious virus titers were below the LOD at Day 3 post infection and at Day 7 for sgmRNA, for all doses tested. Mean lung pathology score was <2 for AZD7442 versus 12 for controls. AZD7442 doses >=0.5 mg protected against weight loss relative to controls. Conclusion. In a SARS-CoV-2 challenge model, AZD7442 administered as prevention or treatment led to significantly lower lung viral loads and improved lung pathology, without weight loss. There was also no evidence that AZD7442 mediated antibody-dependent enhancement of disease or infection.

Low Serum Albumin at Admission Is Associated with Mortality among Inpatients with Cirrhosis: A Multi-National Experience

Background: MELD and Child-Pugh scores have traditionally been used as prognostic indicators in patients with cirrhosis. Albumin infusions in outpatients have been associated with improved outcomes, but not in transplant waitlisted patients or inpatients. This aim of this study was to assess whether low serum albumin (sAlb) on admission alone is a poor prognostic indicator among cirrhotic inpatients from a new multi-national cohort. Method(s): The CLEARED study is a global study that enrolled consecutive non-electively admitted inpatients without organ transplant or COVID-19 from 6 continents. Admission demographics, medical history, laboratory data, inpatient course, death/hospice transfer and mortality at 30 days post-discharge were recorded. Patients were divided into 3 groups: sAlb <28gm/L(A), sAlb >=28 but <35gm/L (B), and sAlb>=35gm/L (C) were compared. Multi-variable logistic regression was performed using inpatient mortality and overall 30-day mortality as outcomes. Result(s): 2429 patients were enrolled from 21 countries worldwide. The distribution was A:49%, B:39%, C:12%. Gp A patients were significantly younger (54yrs vs. 57yrs vs 58yrs p<0.0001) but with similar gender distribution, and higher MELD-Na score of 25 vs. 20 vs. 17 (p<0.0001). Gp A patients were more likely to have alcohol as etiology of cirrhosis (49% vs. 45% vs 38%, p=0.004), and were more likely to have either infection (27% vs. 18% vs. 13%, p<0.0001), HE (39% vs. 33% vs. 23%, p=0.005) or fluid related issues as a reason for admission (p<0.0001). More patients in Gp A received albumin infusion during their hospital stay (120gm vs. 100gm vs. 100gm p=0.0004), mostly for the indications of AKI (47% vs. 49% vs. 47%, p=0.79) and performance of large volume paracentesis (44% vs. 42% vs. 41%, p=0.80), followed by bacterial peritonitis indication (22% vs. 17% vs. 11%, p=0.01). Group A patients had longer hospital stays (9 days vs. 8 days vs. 7 days (p<0.001), but similar ICU transfer (23% vs. 22% vs. 20%, p=0.55). group A patients were more likely to die while inpatients (19% vs. 11% vs. 5%, p<0.0001), or by 30 days post-discharge (29% vs. 20% vs. 9%, p<0.0001). Table shows the admission variables associated with a poor outcome. Conclusion(s): Hypoalbuminemia is extremely common among admitted cirrhotic patients, with sAlb of <28gm/L occurring in almost half. Together with MELD-Na score and infection at admission, a low sAlb is associated with a poor outcome in these patients. Future studies will need to validate these findings and to assess whether albumin infusions will improve the outcome of these patients. (Figure Presented).

Differences in Mortality Rates in Inpatients with Cirrhosis Depends on the Low, Middle or High Income Country Location: Multi-National Cleared Consortium Experience

Background: Although cirrhosis is a major cause of mortality worldwide, there could be disparities in outcomes. This needs a global consortium to study disparities in inpatient cirrhosis care Aim: Define the impact of location in prediction of outcomes in inpts with cirrhosis. Method(s): CLEARED prospectively enrolled non-electively admitted cirrhosis pts without COVID from all continents. To ensure equity, we allowed only 50 pts/site. Admission details, cirrhosis history, inpatient & 30-day course were recorded. World bank classification of low/low middle income (LMI), upper middle (UMI) & High income (HI) were used. Cirrhosis details, inpatient & 30-day outcomes were compared between groups. Multi-variable regression was performed using inpatient & 30-day mortality as outcomes. Result(s): 2758 pts from 21 countries from all continents, including Africa & Australia, were included.727 were L/LMI, 1050 UMI & 981 pts were from HICs. More men & younger pts were in LMI. Cirrhosis details: More pts in HI gp had 6M hospitalizations & infections, HE & ascites while prior variceal bleeding was higher in LMI . Prior HCC & transplant listings were lower in LMI but similar in UMI/HI. Alcohol & NASH was highest in HI. Viral hepatitis & cryptogenic were highest in UMI.Admissions: Admission MELD was highest in LMI. LMI pts were admitted more for GI Bleed, HE, & DILI, while anasarca & HBV flares were higher in UMI. Higher SBP (36% vs 24% vs 21% p<0.0001) & lowest skin/soft-tissue infections were in LMI (5% vs 5% vs 10% p=0.008);rest were similar. Nosocomial infections, driven by UTI were highest in LMI & HI pts (15% vs 14% vs 11% UMI, p=0.03). Admission diuretics, PPIs, Lactulose & statins were highest & antivirals lower in HI. SBP prophylaxis & rifaximin were highest in LMI pts. Outcome(s): More LMI pts needed ICU & had more organ failures (Fig B). Discharge MELD was highest in LMI. In-hospital mortality was highest & transplant lowest in LMI. This extended to 30-day mortality & transplant in LMI patients vs HI pts.Regression: In-hospital mortality was linked with age, infections, MELD & being in a LMI/UMI vs HIC while being on a transplant list, diabetes, & SBP prophylaxis were protective (Fig C). 30-day mortality predicted by age, ascites, HCC, discharge MELD, organ failures, LMI/UMI vs HIC but rifaximin was protective(Fig D). In-hospital transplant was higher with high MELD, admission rifaximin & listed pts &lower in LMI (OR 0.26) & UMI (OR 0.22) & age. 30-day transplant was higher in those with hyponatremia, ascites & HRS, on the list & on rifaximin and lower in LMI (OR 0.24) & UMI (OR 0.59) vs HI. Conclusion(s): In a global study of inpatients with cirrhosis, there were major differences in outcomes. Not being in a high-income country significantly increased the risk of inpatient and 30-day mortality independent of demographics, medications, in-hospital course, and cirrhosis severity likely due to disparities in access to transplant, which should be accounted for in global models. (Figure Presented).

The Impact of Multimodal Communication on Learners' Experience in a Synchronous Online Environment: A Mixed-Methods Study

During the COVID-19 pandemic, from early 2020 onwards, the adoption of synchronous online learning increased rapidly. It offers students a unique learning experience, utilizing communication modes from both in-person and asynchronous online classes. This mixed-methods study examined the impact of modes of communication (visual, bodily behaviors, spoken language, and written language) found in synchronous online contexts on students' learning experiences from the perspective of social presence and teaching presence, as well as their satisfaction with synchronous online learning experience. An online survey was distributed first to collect quantitative data. The survey results indicated that four different modes influenced students' communication to a different extent, with written and spoken language being the most effective modes of online communication. These modes were also significantly positively correlated with social presence, teaching presence, and student satisfaction;however, only spoken language was a significant predictor of student satisfaction. In the qualitative phase, semi-structured interviews were conducted to examine students' perceptions of how multimodality affects social presence, teaching presence, and satisfaction with online learning. This led to five major themes and highlighted how multiple modes of communication supports social presence, thereby helping teachers scaffold students. In addition, the online learning context impacts type of instruction, and the reduced distance between teachers and students improves teaching presence;however, the students felt a lack of affective belonging in their online classes. This study also provided implications for course instructors and designers to help them effectively adopt different modes in synchronous online environments and promote social and teaching presence. © 2022, The Online Learning Consortium. All rights reserved.

Neuroimaging Findings of SARS-CoV-2 Infection

This review article is a pictorial review of the wide variety of brain and spine CT and MR imaging findings related to coronavirus disease 2019 (COVID-19) in patients with neurologic deficits. By classifying CNS manifestations according to their pathogenesis, we provide different examples of vascular, immunologic, infectious, and miscellaneous complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We present cases encountered during the pandemic, retrieved from a large health system. Learning Objectives: To review the spectrum of common and uncommon brain and spine neuroimaging findings of COVID-19 and describe the key imaging features for each finding. © 2022, American Society of Neuroradiology. All rights reserved.

Differential Evolution Based Simulated Annealing Method for Vaccination Optimization Problem

Infectious diseases pose a severe threat to human health, especially the outbreak of COVID-19. After the infectious disease enters the stage of large-scale epidemics, vaccination is an effective way to control infectious diseases. However, when formulating a vaccination strategy, some restrictions still exist, such as insufficient vaccines or insufficient government funding to afford everyone's vaccination. Therefore, in this paper, we propose a vaccination optimization problem with the lowest total cost based on the susceptible-infected-recovered (SIR) model, which is called the Lowest Cost Of Vaccination Strategy (LCOVS) problem. We first establish a mathematical model of the LCOVS problem. Then we propose a practical Differential Evolution based Simulated Annealing (DESA) method to solve the mathematical optimization problem. We use the simulated annealing algorithm (SA) as a local optimizer for the results obtained by the differential evolution algorithm (DE) and optimized the mutation and crossover steps of DE. Finally, the experimental results on the six data sets demonstrate that our proposed DESA can achieve a more low-cost vaccination strategy than the baseline algorithms. IEEE

Three-way decision theory based on interval type-2 fuzzy linguistic term sets

This study examines decision theory based on interval type-2 fuzzy sets with linguistic information for the three-way decision approach by addressing the challenge of uncertainty for information analysis and fusion in subjective decision-making processes. First, the interval type-2 fuzzy linguistic term sets (IT2 FLTSs) are defined to represent and normalize the uncertain preference information in linguistic decision-making. Subsequently, perception computing based on computing with words paradigm is introduced to implement information fusion among different decision-makers in the linguistic information-based fuzzy logic reasoning process. Then, a three-way decision (3WD) theory based on IT2 FLTSs with fuzzy neighborhood covering is proposed, and the corresponded tri-partitioning strategies that satisfy Jaccard similarity of membership distributions are given. Finally, 3WD theory is applied to multi-criteria group decision-making with linguistic terms, and the algorithm steps are illustrated by a promising application under the background of coronavirus disease 2019 to reveal the feasibility and practicability of the proposed approach. © 2022 - IOS Press. All rights reserved.

Survival in Pandemic Times: Managing Energy Efficiency, Food Diversity, and Sustainable Practices of Nutrient Intake Amid COVID-19 Crisis

The COVID-19 pandemic led to an economic crisis and health emergency, threatening energy efficiency consumption, sustainable food diversity, and households’ nutrition security. The literature documented that environmental threats can divert attention from renewable energy and food security challenges that affect humans’ environmental behaviors. The COVID-19 crisis has consistently influenced environmental behaviors, as it primarily decreased income and disrupted food systems worldwide. This study investigated the COVID-19 consequences on household income, sustainable food diversity, sustainable energy consumption, and nutritional security challenges. The study used a self-structured online survey due to non-pharmaceutical restrictions and collected data from 728 households. The investigators applied t-test and logit regression to analyze the data for drawing results. Descriptive statistics show that COVID-19 has adversely affected the income of more than two-thirds (67%) of households. The pandemic has influenced households’ food consumption, energy, and dietary patterns to safeguard their income. The t-test analysis indicated that households’ food diversity and energy consumption significantly declined during the pandemic, and households consumed low-diversified food to meet their dietary needs more than twofold compared to pre-pandemic levels. The results showed that all nutrient consumption remained considerably lower in the COVID-19. Cereals are the primary source of daily dietary needs, accounting for over two-thirds of total energy and half of the nutrient consumption amid COVID-19. The share of vegetables and fruits in household energy consumption dropped by 40 and 30%. Results exhibited that increasing monthly income was inversely associated with worsening food diversity and intake with energy efficiency. Compared with farmers and salaried employment, wage earners were 0.15 and 0.28 times more likely to experience a decline in consuming food diversity. Medium and large households were 1.95 times and 2.64 times more likely than small, to experience decreased food diversity consumption. Launching a nutrition-sensitive program will help minimize the COVID-19 impacts on energy consumption, food diversity, and nutritional security for low-income individuals. This survey relied on the recall ability of the households for the consumed quantities of food commodities, which may lack accuracy. Longitudinal studies employing probability sampling with larger samples can verify this study’s insightful results. Copyright © 2022 Geng, Haq, Abbas, Ye, Shahbaz, Abbas and Cai.

Does bitcoin hedge against the economic policy uncertainty: based on the continuous wavelet analysis

This article aims to test a causal nexus between bitcoin market and economic policy uncertainty. We use the continuous wavelet analysis to investigate lead-lag relationship between bitcoin market and economic policy uncertainty in different time-frequency domains. Our findings show the negative relationship between bitcoin returns and economic policy uncertainty around the period of bitcoin’s currency recognition and COVIC-19 pandemic crisis both daily and monthly time series test. Furthermore, we find that the causality relationship between bitcoin and economic policy uncertainty is relatively indistinct around the period of bitcoin’s currency recognition, while bitcoin returns are leading economic policy uncertainty changes during COVID-19 pandemic crisis, indicating the economic policy uncertainty fluctuation trend can refer to the fluctuation of bitcoin, bitcoin can be viewed as a leading indicator, but it could not be employed as a safe-haven asset hedge against uncertainty during the period of COVID-19 pandemic. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Differential privacy preserving dynamic data release scheme based on Jensen-Shannon divergence

Health monitoring data or the data about infectious diseases such as COVID-19 may need to be constantly updated and dynamically released, but they may contain user's sensitive information. Thus, how to preserve the user's privacy before their release is critically important yet challenging. Differential Privacy (DP) is well-known to provide effective privacy protection, and thus the dynamic DP preserving data release was designed to publish a histogram to meet DP guarantee. Unfortunately, this scheme may result in high cumulative errors and lower the data availability. To address this problem, in this paper, we apply Jensen-Shannon (JS) divergence to design the OPTICS (Ordering Points To Identify The Clustering Structure) scheme. It uses JS divergence to measure the difference between the updated data set at the current release time and private data set at the previous release time. By comparing the difference with a threshold, only when the difference is greater than the threshold, can we apply OPTICS to publish DP protected data sets. Our experimental results show that the absolute errors and average relative errors are significantly lower than those existing works.

[Advances in clinical prediction scores for prognosis of coronavirus disease-2019].

Coronavirus Disease-2019 (COVID-19) has been a major public health issue all over the world, placing a significant burden on available healthcare resources. The most common types of COVID-19 are the mild and common forms. Although the proportion of the severe-critical types is smaller, the rate of death is significantly higher and the medical resources required tend to be greater. Thus, a variety of scores based on other disease and COVID-19 were used to assess the risk of poor prognosis on the COVID-19, including the common scores for community-acquired pneumonia, sepsis and viral pneumonia. Unfortunately, the above scores often lacked an adequate description of the applicable population or were at high risk of bias with unknown applicability. Therefore, the article summarized the existing scores, aiming to provide a reference for clinical prognostic risk assessment.

DID COVID-19 RESTRICTIONS IMPACT HIV TREATMENT among MSM in CHINA?

Background: Travel restrictions during the COVID-19 epidemic in China have impacted on the daily life and antiretroviral therapy (ART) of people living with HIV, including men who have sex with men (MSM). As China enters a state of routine COVID-19 prevention and control, it is necessary to understand the conditions of ART interruption (ATI) among HIV-infected MSM during and after the lockdown period (23 January to 7 April 2020) to summarize experience on HIV treatment. Methods: A nationwide cross-sectional online survey was conducted among HIV-infected MSM in China in February 2021, using convenience sampling on the WeChat platform called Li Hui Shi Kong. We collected information during and around lockdown period, including socio-demographics, health behaviors such as physical exercise and alcohol drinking, ART maintenance, CD4 and viral load testing. Pearson's Chi-squared test was performed to compare those characteristics between participants who experienced ATI during the lockdown period and did not. Logistic regression analysis was conducted to assess the correlates of ATI. Results: A total of 1296 participants were included in the analysis. The median age was 29.3 years (interquartile range [IQR] 25.2-34.0). 40.9% (n=530) of them did not exercise regularly in the second half of 2019 and 62.3% (n=808) had alcohol drinking. During the lockdown period, 6.8% (n=88) reported ATI experience, and 49.5% (n=629) performed CD4 cell test. Among the participants who took the last CD4 test after the lockdown, more people had not experienced ATI (66.8%) compared to those had experienced ATI (38.6%). HIV-infected MSM using other ART regimen as temporary substitution were more unlikely to experience ATI, including free ART (adjusted odds ratio [aOR] 0.05, 95% confidence interval [CI] 0.02-0.11) and out-of-pocket ART (aOR 0.11, 95% CI 0.01-0.89), which is different from their previous prescription. Conclusion: COVID-restrictions did not result in significantly negative effects on ART maintenance among HIV-infected MSM in China. In order to reduce the negative impact on HIV-infected MSM, attention should be paid to conducting health behavior education, maintaining ART service and encouraging CD4 and viral load testing during and after public emergencies.

Interactive Virtual Reality Game for Online Learning of Science Subject in Primary Schools

Education plays an important role in nurturing children. COVID-19 pandemic brings challenges or disruptions to school education, due to school closures in some countries. Science subject in primary schools is unique as hands-on experiments are important learning components. Its learning process may be affected, as a new norm of online learning or home-based learning. This research project creates a serious game on science subject for primary school students aging within 10 to 11 years old using virtual reality (VR) technology. It consists of three virtual learning phases. Phase 1 explains theories of science topics on electricity and electric circuits. Phase 2 provides interactive hands-on experiment exercises where students can practice theory knowledge learned in the previous phase. An interactive quiz session is offered to reinforce the learning in Phase 3. Interactive VR features enable primary school students learning science concepts in an interesting way compared to conventional classroom settings. Meticulous design attentions have been placed in the details such as visual instructions, voice instructions, speech tempo, animations, and colorful graphics to create a sense of realism and keep students actively engaged. Preliminary case study has been conducted with 10 students at primary schools in Singapore to evaluate learning effectiveness in this research. © 2021 IEEE.

The COVID-19 Question Answering System Based on Knowledge Graph

The COVID-19 that emerged at the end of 2019 is the biggest public health emergency encountered by human in the past 100 years. In the face of COVID-19, people need to get correct, comprehensive and clear information. However, traditional information retrieval methods only return a collection of related web pages, and users need to distinguish the authenticity from redundant and complicated information. Therefore, such information acquisition methods are inefficient and cannot serve users well. To meet the needs of users for related information, it is necessary to study the question answering system for the COVID-19. This paper studies and builds a COVID-19 question answering system based on knowledge graph. In the System, the question answering function is realized by template matching, which based on the Naive Bayes algorithm. For the input questions, the system firstly performs entity recognition, using entity type labeling combined with entity similarity matching to identify entities in the user's questions. Then the system predicts the user's question intention and use the trained question classifier to predict the category number. Finally Cypher is utilized to query graph database to generate and output the answer. The system implemented in this paper can help users quickly obtain the information they want and improve the user's information acquisition efficiency. The system can provide people convenient and fast ways of obtaining information about COVID-19, such as medical treatment, health, materials, prevention and control, scientific research, so as to help people take precautions against diseases and decrease the incidence of COVID-19. © 2021 IEEE.

Research on the Elastic Development of Spatial Layout of Hospitals Based on GIS Platform under COVID-19 Background: A Case Study of Wuhan

COVID-19 has become a major public health emergency in the world. At the beginning of the outbreak of the COVID-19 epidemic, a series of medical squeezes appeared in Wuhan, which exposed the problems existing in the implementation of the hierarchical diagnosis and treatment system. Based on GIS platform, this paper analyzes the spatial layout of medical facilities at all levels in Wuhan and compares and analyzes the usage of daily and epidemic periods. It is found that the interlevel gap in the development of daily medical resources leads to spatial differences in the reserved development flexibility, showing the characteristics of weak elastic coping ability and low reserved development flexibility in the surrounding urban areas, strong elastic coping ability and high-reserved development flexibility in the central old urban area. Therefore, to improve the resilience of medical institutions at all levels, we should promote the balanced layout of primary medical institutions and the "decentralization"of high-level medical institutions in spatial layout, coordinate the number and organizational structure of medical resources at different levels, and implement differentiated allocation strategies. © ASCE.

Clinical characteristics of coronavirus disease 2019 infected with Delta variant in Guangzhou:A real-world study

Objective To summarize the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) infected with Delta variant, so as to provide further references for clinical diagnosis and treatment. Methods A real-world study was conducted to analyze the characteristics of 166 COVID-19 patients infected with Delta variant at Guangzhou Eighth People’s Hospital, Guangzhou Medical University. Results The study enrolled 5 asymptomatic cases, 123 non-severe cases (mild and moderate type), and 38 severe cases (severe and critical type). Among these patients, 69 (41.6%) were male and 97 (58.4%) were female, with a mean age of 47.0±23.5 years. Thirty-nine cases (23.5%) had received 1 or 2 doses of inactivated vaccine. The incidence of severe COVID-19 cases was 7.7% in 2-doses vaccinated patients, which was lower than that of 11.5% in 1-dose and 26.8% in unvaccinated patients. The proportion of severe cases in 2 dose-vaccinated patients was 7.7%, which was lower than that of 11.5% in 1-dose vaccinated patients and 26.8% in unvaccinated patients, but the difference was not significant (P>0.05). The most common clinical symptom was fever (134 cases, 83.2%), and 39.1% of cases presented with high-grade fever (≥ 39 °C);other symptoms were cough, sputum, fatigue, and xerostomia. The proportion of fever in severe cases was significantly higher than that of non-severe cases (97.4% vs. 76.4%, P<0.01). Similarly, the proportion of severe cases with high peak temperature (≥ 39 ℃) () was also higher than that of non-severe cases (65.8% vs. 30.9%, P<0.01). The median minimal Cycle threshold (Ct) values of viral nucleic acid N gene and ORFlab gene were 20.3 and 21.5, respectively, and the minimum Ct values were 11.9 and 13.5, respectively. Within 48 h of admission, 9.0% of cases presented with decreased white blood cell counts, and 52.4% with decreased lymphocyte counts. The proportions of increased C-reactive protein, serum amyloid A, interleukin 6, and interleukin 10 were 32.5%, 57.4%, 65.3%, and 35.7%, respectively. The proportions of elevated C-reactive protein, serum amyloid A and interleukin-6 in severe cases were significantly higher than those in non-severe cases (P<0.01). Logistic regression analysis showed that older age and higher peak temperature were associated with a higher likelihood of severe cases (OR>3, 95% CI: 2-7, P<0.01). In terms of treatment, traditional Chinese medicine (TCM) was used in 97.6% of non-severe cases and 100% in severe cases. Other treatments included respiratory and nutritional support, immunotherapy (such as neutralizing antibodies and plasma of recovered patients). The median times from admission to progression to severe cases, of fever clearance, and of nucleic acid conversion were 5 days, 6 days and 19 days, respectively. No deaths were reported within 28 days. Conclusions The symptoms of Delta variant infection in Guangzhou are characterized by a high proportion of fever, high peak temperature, long duration of fever, high viral load, a long time to nucleic acid conversion, and a high incidence of severe cases. The severe cases exhibit a higher percentage of elderly patients, a longer duration of fever and have a higher fever rate and a higher hyperthermia rate than non-severe cases. Age and hyperthermia are independent risk factors for progression to severe disease. The combination of TCM and Western medicine can control the progression of the disease effectively. © 2021 Chinese Medical Association. All rights reserved.

Impact of the COVID-19 pandemic on a tertiary care public hospital in Singapore: resources and economic costs.

BACKGROUND: The COVID-19 pandemic has prompted hospitals to respond with stringent measures. Accurate estimates of costs and resources used in outbreaks can guide evaluations of responses. We report on the financial expenditure associated with COVID-19, the bed-days used for COVID-19 patients and hospital services displaced due to COVID-19 in a Singapore tertiary hospital. METHODS: We conducted a retrospective cost analysis from January to December 2020 in the largest public hospital in Singapore. Costs were estimated from the hospital perspective. We examined financial expenditures made in direct response to COVID-19; hospital admissions data related to COVID-19 inpatients; and the number of outpatient and emergency department visits, non-emergency surgeries, inpatient days in 2020, compared with preceding years of 2018 and 2019. Bayesian time-series was used to estimate the magnitude of displaced services. RESULTS: USD $41.96 million was incurred in the hospital for COVID-19-related expenses. Facilities set-up and capital assets accounted for 51.6% of the expenditure; patient-care supplies comprised 35.1%. Of the 19,611 inpatients tested for COVID-19 in 2020, 727 (3.7%) had COVID-19. The total inpatient- and intensive care unit (ICU)-days for COVID-19 patients in 2020 were 8009 and 8 days, respectively. A decline in all hospital services was observed from February following a raised disease outbreak alert level; most services quickly resumed when the lockdown was lifted in June. CONCLUSION: COVID-19 led to an increase in healthcare expenses and a displacement in hospital services. Our findings are useful for informing economic evaluations of COVID-19 response and provide some information about the expected costs of future outbreaks.