The K+/Na+ innate immune system is involved in the susceptibility to and severity of COVID-19: a systematic review and retrospective cohort study (preprint)

Abstract Background: From single-cellular to multicellular organisms, a natural nonspecific immune system, called the K+/Na+ innate immune system, has recently been proposed to play an important role in the process of fighting against viral infection, however, there is little direct research evidence. This study aimed to evaluate whether the changes in serum K+/Na+ concentrations are associated with susceptibility and severity of SARS-CoV-2 infection. Methods: We systematically searched PubMed, the Web of Science Core Collection, MedRxiv and BioRxiv databases for articles published between Jan 1, 2020 and Dec 14, 2022. We extracted the serum K+/Na+ concentration data of patients with COVID-19 from 112 published studies after removing inappropriate articles according to the defined criteria and analyzed the relationship between the serum k+/Na+ concentrations and the illness severity of patients. Then we used a cohort of 244 patients with COVID-19 for a retrospective analysis. Results: The mean serum k+/Na+ concentrations in patients with COVID-19 were 3.99 and 138.0 mmol/L, respectively, which were much lower than the mean levels in the population (4.40 and 142.0, respectively). The mean serum Na+ concentration in severe/critical patients (136.8) was significantly lower than those in mild and moderate patients (139.4 and 138.0, respectively). Such findings were confirmed in a retrospective cohort study, of which the mean serum k+/Na+ concentrations in all patients were 4.0 and 137.5 mmol/L, respectively. The significant differences in serum Na+ concentrations were found between the mild (139.2) and moderate (137.2) patients, and the mild and severe/critical (136.6) patients, which were correlated to the illness severity of patients. Conclusions: These findings may indicate the importance of a natural immune system constructed by intracellular potassium and extracellular sodium ions in the fight against viral infection and provide new ideas for the prevention and treatment of COVID-19.

The Effectiveness of a Blended Learning-Based Life Design Course: Implications of Instruction and Application of Technology

Purpose Due to the outbreak of the COVID-19 pandemic in 2021 in Taiwan, we have adapted the face-to-face Life Design course to a blended learning approach with educational technology to cope with the problem of cross-generational confusion and anxiety towards later life from learners. The objectives of this study are to. evaluate learners' reactions after attending the Life Design course including their level of satisfaction, engagement (Level 1), and the applicability of courses in their life. evaluate their learning outcomes after attending the Life Design course, such as their acquisition of knowledge, skills, attitudes, confidence, commitment (Level 2), and behavioral changes (Level 3). explore the factors that enable and prevent students from transferring their learning in this course to the action taking and making behavioral changes. explore how the application of educational technology can enhance the teaching and learning in the Life Design course. Methods This study used an action research method to solve two main problems we identified in practice: students' confusion about their future life and the shortcomings of traditional teaching methods, which cannot meet the learning needs of this type of course due to the requirement of intensive personal reflection and self-disclosure. Participants were 36 master's students who completed the Life Design course. Based on this course's design, implementation, and evaluation, we used the new Kirkpatrick Learning Assessment Model (Kirkpatrick J, Kirkpatrick WK. An introduction to the new world Kirkpatrick Model. Kirkpatrick Partners, 2021) to analyze the learning effectiveness on the Reaction, Learning, and Behavioral levels. Results To facilitate learners to overcome the cross-generational confusion of their life design and solve the shortage of face-to-face teaching methods, we took biographical learning as the core theme for this Life Design course and designed online and offline learning activities. The blended learning approach with educational technology allowed us to go beyond time and location constraints and provide a holistic and inseparable learning experience in both formats. The result of the evaluation shows that students who took the Life Design course were highly satisfied with the overall course design, topics, and the suitability of a blended learning approach, which motivated them to extend their learning outside the classroom and helped them benefit from a more trusted, personal and hybrid interaction with teachers and their peers both online and offline. On the learning level, students not only learned the correct knowledge of age perspectives, changed their views of career and personal development, and acquired skills for life design, but were also confident and committed to applying what they have learned in their future life. After the course, many students applied and integrated the learning into behavioral changes in their life. In terms of the difficulties and hindrances encountered in action taking, many students mentioned the lack of peers' support and constraints from their busy daily life. Many suggested providing extra support after the course with regular impulse, follow-ups, and individual feedback from teachers and peers in an online learning community. This indicates how educational technology can better support these elements in continuous learning and the transfer of learning. Conclusion Based on these results, we affirm that implementing this Life Design course with a blended learning approach is indeed better than a fully physical course. However, the focus of a blended learning approach should be on learners from a pedagogical perspective rather than technology.

Gastrointestinal symptoms in 609 Japanese patients with COVID-19: a single-center retrospective study.

BACKGROUND: GI symptoms are common in acute COVID-19 patients. This study aimed to characterize the GI symptoms occurring in Japanese COVID-19 patients. METHODS: This retrospective single-center cohort study included 751 hospitalized acute COVID-19 patients. The primary outcomes were the frequency and severity of GI symptoms. The secondary outcomes included the association between COVID-19 severity and GI symptoms and the timing of GI symptom onset. RESULTS: After exclusion, the data of 609 patients were analyzed. The median age was 62 years, and 55% were male. The median time from initial symptom onset to admission was five days. On admission, 92% of the patients had fever, 35.1% had fatigue, 75% had respiratory symptoms, and 75% had pneumonia. The sample included patients with mild (19%), moderate (59%), and severe COVID-19 (22%). A total of 218 patients (36%) had GI symptoms, of which 93% were classified as grade 1/2; 170 patients had both respiratory and GI symptoms. Diarrhea was the most frequent GI symptom, occurring in 170 patients, followed by anorexia in 73 patients and nausea/vomiting in 36 patients, and abdominal pain in 8 patients. There was no significant relationship between COVID-19 severity and GI symptoms. Among COVID-19 patients with both GI and respiratory symptoms, 48% had respiratory symptoms preceding GI symptoms, 25% had GI symptoms preceding respiratory symptoms and 27% had a simultaneous onset of respiratory and GI symptoms. CONCLUSION: Thirty-six percent of the Japanese COVID-19 patients had GI symptoms; diarrhea was the most frequent GI symptom but did not predict severe COVID-19.

Online learning attributes on overall tourism and hospitality education learning satisfaction: Tourism Agenda 2030

PurposePromoting "Quality Education” as part of Sustainable Development Goal 4 requires educational stakeholders to understand the nature of online learning from the learners' perspective. This study aims to explore the asymmetric effects of online learning attributes on overall learning satisfaction in tourism and hospitality education.Design/methodology/approachThe authors adopt the three-factor satisfaction theory and the three analytical steps penalty–reward contrast analysis, impact range performance analysis (IRPA) and impact asymmetry analysis. The authors then juxtapose the results of such analytical approaches to the traditional importance–performance analysis (IPA) for further insights.FindingsTraditional IPA suggests nine high importance and performance online attributes. However, the IRPA reveals that only four attributes fall within high performance and high range of impact on satisfaction. The attribute "secure” had a low performance despite a significant impact on satisfaction.Research limitations/implicationsBy exploring asymmetric effects, scholars, service providers and participants of online education can have a deeper insight into the nature and dynamic effect of attributes on overall satisfaction.Originality/valueBy exploring the asymmetric impacts of online learning attributes on overall learning satisfaction, the findings provide a novel insight into the multidimensionality of online learning attributes.

Orthokeratology compliance, digital device use, and myopia control among children with myopia during COVID-19 home confinement in Taiwan.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic profoundly impacts lifestyle habits and myopia control in children worldwide. This study investigated the changes in eyecare habits, orthokeratology compliance, axial length, and time interval of follow-up visits during home confinement in the COVID-19 pandemic in Taiwan. Methods: This investigation was part of a prospective study undertaken to evaluate the effectiveness of a mobile application. A semi-structured telephone interview was conducted with parents retrospectively to document eyecare habits and myopia control during the COVID-19 home confinement. Results: Thirty-three children with myopia participated in the follow-up of orthokeratology lenses for 2 years. The children's time viewing digital devices such as tablets and televisions significantly increased during the COVID-19 pandemic (P < 0.05). An analysis using McNemar's test found that the proportional growth of axial length <0.2 mm in 2021 was significantly higher than that in 2020 (77.42% vs. 58.06%, P < 0.05). In the multivariate logistic regression analysis, onset <10 years of age (P = 0.001) and parents with high myopia (P < 0.001) were independent risk factors for the growth of axial length ≥0.2 mm in 2021. Conclusion: The suspension of face-to-face classes and after-school tutorials benefited myopic axial elongation in children during COVID-19 home confinement. The use of digital devices and staying indoors may not be the exclusive reasons for myopia progression. Educating parents about the influence of extra learning classes after school on myopia progression would be prudent.

Burnout and Mental Health and Well-Being of School Nurses After the First Wave of the COVID-19 Pandemic: A National Cross-Sectional Survey.

The aim of this study was to examine the associations between job stressors, COVID-19-related concerns, burnout, and mental health and well-being among school nurses, and whether any of these associations are mediated by burnout. Based on stratified proportional sampling, data collection was conducted by an online questionnaire distributed to 600 school nurses in Taiwan. A total of 256 participants aged between 27 and 62 years (mean = 47.08; standard deviation = 7.28) returned questionnaires. Results showed that burnout was the main mediating variable that fully mediated the relationship between COVID-19-related concerns and mental health and well-being. The effects of job stressors on mental health and well-being included direct negative effects (ß = -.29) and indirect negative effects (ß = -.67) through mediating factors. School health managers should be more aware of burnout and mental health and well-being among school nurses under the impact of COVID-19.

Adjusting intervention strategies for mental health of COVID-19 patients: A network analysis based on a survey in Omicron-infected patients

Background The COVID-19 pandemic had a major impact on people's mental health. As the SAS-Cov-2 evolves to become less virulent, the number of asymptomatic patients increases. It remains unclear if the mild symptoms are associated with mild perceived stress and mental illness, and the interventions to improve the mental health of the patients are rarely reported. Methods This cross-sectional study investigated the level of depression, anxiety and perceived stress of 1,305 COVID-19 patients who received treatment in the Fangcang shelter hospitals in Shanghai, China. Network analysis was used to explore the relationship among depression, anxiety and perceived stress. Results The prevalence of depression, anxiety and perceived stress in the patients with Omicron infection were 9.03, 4.60, and 17.03%, respectively, lower than the prevalence reported during the initial outbreak of COVID-19. “Restlessness (A5),” “Uncontrollable worry (A2),” “Trouble relaxing (A4)” and “Fatigue (D4)” had the highest expected influence values. “Irritability (A6)” and “Uncontrollable (S1)” were bridge symptoms in the network. Comparative analysis of the network identified differences in the network structures between symptomatic and asymptomatic patients. Conclusion This study investigated the prevalence of depression, anxiety and perceived stress and the correlation among them in Omicron-infected patients in Fangcang shelter hospital, in Shanghai, China. The core symptoms identified in the study provide insight into targeted clinical prevention and intervention of mental health in non-severe Omicron-infected patients.

The effect of COVID-19 restrictions on atmospheric new particle formation in Beijing

During the COVID-19 lockdown, the dramatic reduction of anthropogenic emissions provided a unique opportunity to investigate the effects of reduced anthropogenic activity and primary emissions on atmospheric chemical processes and the consequent formation of secondary pollutants. Here, we utilize comprehensive observations to examine the response of atmospheric new particle formation (NPF) to the changes in the atmospheric chemical cocktail. We find that the main clustering process was unaffected by the drastically reduced traffic emissions, and the formation rate of 1.5 nm particles remained unaltered. However, particle survival probability was enhanced due to an increased particle growth rate (GR) during the lockdown period, explaining the enhanced NPF activity in earlier studies. For GR at 1.5–3 nm, sulfuric acid (SA) was the main contributor at high temperatures, whilst there were unaccounted contributing vapors at low temperatures. For GR at 3–7 and 7–15 nm, oxygenated organic molecules (OOMs) played a major role. Surprisingly, OOM composition and volatility were insensitive to the large change of atmospheric NOx concentration;instead the associated high particle growth rates and high OOM concentration during the lockdown period were mostly caused by the enhanced atmospheric oxidative capacity. Overall, our findings suggest a limited role of traffic emissions in NPF.

Setting up a three-stage pre-endoscopy triage during the coronavirus disease 2019 pandemic: A multicenter observational study

Objectives Between May and July 2021, the coronavirus disease 2019 (COVID-19) pandemic led to a sharp surge in community transmission in Taiwan. We present a three-stage restructuring process of pre-endoscopy triage at the beginning of the pandemic, which can support urgent endoscopic procedures while protecting endoscopy staff. Methods The pre-endoscopy triage framework was set up with three checkpoints at the hospital entrance, outpatient department, and endoscopy unit, with a specific target patient population and screening methods. Relevant data included the number of endoscopic procedures performed, outpatient department visits, and performing screening methods such as temperature measurement, travel, occupation, contact, and clustering history checking, polymerase chain reaction assay, and rapid antigen test. Results Forehead temperature measurement and verification of travel, occupation, contact, and clustering history provided rapid, easy, and early mass screening of symptomatic patients at the hospital entrance. During the pandemic, outpatient department visits and endoscopic procedures decreased by 37% and 64%, respectively. The pre-endoscopy screening methods used displayed regional variations in COVID-19 prevalence. Among 16 endoscopy units with a community prevalence of ≥ 31.04 cases per 100,000 residents, 12 (75%) used polymerase chain reaction assay and four (25%) used rapid antigen test to identify asymptomatic patients before endoscopy. Of 6540 pre-endoscopy screening patients, 15 (0.23%) tested positive by laboratory testing. No endoscopy-related nosocomial COVID-19 infections were reported during the pandemic. Conclusions We present a three-stage pre-endoscopy triage based on the local laboratory capacity, medical resources, and community prevalence. These measures could be useful during the COVID-19 pandemic.

Myopia related impacts and responses among school children during Covid-19

The Covid-19 pandemic has affected lifestyles and health worldwide, forcing countries to adopt different levels of epidemic prevention. In addition to restricting outdoor activities, some governments have suspended in-person classes, switching to online learning. Multiple scholars have conducted studies confirming that the prevalence of myopia among school children has worsened due to the implementation of pandemic restrictions. Since May 2020, the Taiwanese government has suspended all in-person classes, club activities, after-school tutoring, and parenting classes at schools, further escalating health experts' concerns about myopia. A literature review suggests that since the beginning of the pandemic, the prevalence of myopia increased considerably among school children, as they spent less than 1 hour in outdoor activities and at least 1 hour in online classes per day, often relying on mobile phones to complete coursework. Children also spent substantially more time engaged in close visual work and other screenrelated activities. During the pandemic, annual growth of diopter and axial length in school children were approximately >0.5-0.98 D and >0.2 mm, respectively. However, neither foreign nor domestic studies have proposed specific strategies for myopia prevention in the postpandemic era. Therefore, based on the literature review, this study proposes the following solutions: (1) strengthen life skills of children and parents in limiting close visual work;(2) assist teachers in adapting curriculum for online learning;(3) implement guidelines for the use and management of 3C products;and (4) introduce technological monitoring and tracking products. These 4 responses may prevent eyesight deterioration in school children due to pandemic restrictions. (Taiwan J Public Health. 2022;41(3):276-285)

SARS-CoV-2: The Monster Causes COVID-19

Coronaviruses are viruses whose particles look like crowns. SARS-CoV-2 is the seventh member of the human coronavirus family to cause COVID-19 which is regarded as a once-in-a-century pandemic worldwide. It holds has the characteristics of a pandemic, which has broy -55ught many serious negative impacts to human beings. It may take time for humans to fight the pandemic. In addition to humans, SARS-CoV-2 also infects animals such as cats. This review introduces the origins, structures, pathogenic mechanisms, characteristics of transmission, detection and diagnosis, evolution and variation of SARS-CoV-2. We summarized the clinical characteristics, the strategies for treatment and prevention of COVID-19, and analyzed the problems and challenges we face.

NSP16 2'-O-MTase in Coronavirus Pathogenesis: Possible Prevention and Treatments Strategies.

Several life-threatening viruses have recently appeared, including the coronavirus, infecting a variety of human and animal hosts and causing a range of diseases like human upper respiratory tract infections. They not only cause serious human and animal deaths, but also cause serious public health problems worldwide. Currently, seven species are known to infect humans, namely SARS-CoV-2, MERS-CoV, SARS-CoV, HCoV-229E, HCoV-NL63, HCoV-OC43, and HCoV-HKU1. The coronavirus nonstructural protein 16 (NSP16) structure is similar to the 5'-end capping system of mRNA used by eukaryotic hosts and plays a vital role in evading host immunity response and protects the nascent viral mRNA from degradation. NSP16 is also well-conserved among related coronaviruses and requires its binding partner NSP10 to activate its enzymatic activity. With the continued threat of viral emergence highlighted by human coronaviruses and SARS-CoV-2, mutant strains continue to appear, affecting the highly conserved NSP16: this provides a possible therapeutic approach applicable to any novel coronavirus. To this end, current information on the 2'-O-MTase activity mechanism, the differences between NSP16 and NSP10 in human coronaviruses, and the current potential prevention and treatment strategies related to NSP16 are summarized in this review.

Impact of COVID-19 pandemic on fecal immunochemical test screening uptake and compliance to diagnostic colonoscopy.

BACKGROUND AND AIM: During this COVID-19 pandemic, Taiwan is one of the few countries where fecal immunochemical test and endoscopic activity for colorectal cancer screening keeps ongoing. We aimed to investigate how screening uptake and colonoscopy rate were affected in one of the biggest screening hubs in Northern Taiwan. METHODS: We conducted a prospective observational study tracing and analyzing the screening uptake and the trend of compliance to diagnostic colonoscopy in fecal immunochemical test-positive subjects in the National Taiwan University Hospital screening hub since the outbreak of COVID-19 and compared it with that of the corresponding periods in the past 3 years. Cancellation and rescheduling rates of colonoscopy and related reasons were also explored. RESULTS: Screening uptake during December 2019 to April 2020 was 88.8%, which was significantly lower than that in the corresponding period of the past 3 years (91.2-92.7%, P for trend < 0.0001). Colonoscopy rate in this period was 66.1%, which was also significantly lower than that in the past 3 years (70.2-77.5%, P for trend = 0.017). Rescheduling or cancellation rate was up to 10.9%, which was significantly higher than that in the past 3 years (P for trend = 0.023), and half of them was due to the fear of being infected. CONCLUSION: Fecal immunochemical test screening was significantly affected by COVID-19 pandemic. In order to resume the practice in COVID-19 era, screening organizers should consider various approaches to secure timely diagnosis of colorectal cancer.

Diabetes patients with comorbidities had unfavorable outcomes following COVID-19: a retrospective study (preprint)

BackgroundPrevious studies have shown that diabetes mellitus is a common comorbidity of Coronavirus Disease 2019 (COVID-19), but the effects of diabetes or antidiabetic medication on the mortality of COVID-19 have not been well described. To investigate the outcome of different statuses (with or without comorbidity) and antidiabetic medication use before admission of patients with diabetes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, we collected clinical data of patients with COVID-19 and compared those with diabetes versus nondiabetics.MethodsIn this multicenter and retrospective study, we enrolled 1,422 consecutive hospitalized patients from January 21 to March 25, 2020, at six hospitals in Hubei Province, China. The primary endpoint was in-hospital mortality.ResultsPatients with diabetes were 10 years older than nondiabetic patients (p<0.001) and had a higher prevalence of comorbidities such as hypertension (p<0.001), coronary heart disease (CHD) (p<0.001), cerebrovascular disease (CVD) (p<0.001), and chronic kidney disease (CKD) (p=0.007). Mortality (p=0.003) was more prevalent among the diabetes group. Further analysis revealed that patients with diabetes who took acarbose had a lower mortality rate (p<0.01). Multivariable Cox regression showed that male sex (hazard ratio [HR] 2.59 [1.68-3.99]), hypertension (HR 1.75 [1.18-2.60]), CKD (HR 4.55 [2.52-8.20]), CVD (HR 2.35 [1.27-4.33]), and age were risk factors for the COVID-19 mortality. Higher HRs were noted in those aged ≥65 (HR 11.8 [4.6- 30.2]) versus 50-64 years (HR 5.86 [2.27-15.12]). The survival curve revealed that, compared with the diabetes only group, the mortality was increased in the diabetes with comorbidities group (p=0.009) but had was not significantly different from the noncomorbidity group (p=0.59).ConclusionPatients with diabetes had worse outcomes when suffering from COVID-19; however, the outcome was not associated with diabetes itself but with comorbidities. Furthermore, the administration of acarbose could reduce the risk of death in patients with diabetes.