Innovative angles from a youth epidemiological study: Data from the HK-YES in Hong Kong

There are few specific epidemiological studies focusing on youth mental health in a non-western population. In particular, studies which are designed to include a broad range of youth-relevant potential risk and protective factors during the COVID-19 period are scarce. Such data are important for formulating programs to enhance healthy coping, as well as to facilitate the screening of risk factors. We present data from a comprehensive youth epidemiological study in Hong Kong from innovative angles which extend beyond conventional prevalence reporting. For example we investigated the change in major depressive episode states in a cohort with longitudinal data, which provide us with insight into what determines the persistence of depression. We also look into suicidal ideation and the role of rumination in this population. We also report the use of a recently identified marker for brain inhibition/excitation balance (visual stress) as a predictor associated with mental health outcomes. Finally, we studied the role of personality in mediating mental health outcomes.

Analyse intermédiaire de l'efficacité et de la sécurité d'emploi de setmélanotide comme nouveau traitement chez des patients souffrant d'obésité hypothalamique

Les lésions de l'hypothalamus et l'altération de la signalisation de la voie du récepteur de type 4 aux mélanocortines (MC4R) résultant souvent d'une intervention chirurgicale ou de rayonnements reçus dans le cadre du traitement d'une tumeur bénigne, peuvent entraîner une obésité hypothalamique (OH). Suite à cette lésion, une prise de poids soudaine et des changements du comportement alimentaire ne répondant pas aux traitements existants apparaissent. Setmélanotide, un agoniste de MC4R, est approuvé pour le contrôle du poids et la régulation de la faim chez les patients présentant certains déficits génétiques associés à la voie de MC4R. Nous rapportons les résultats intermédiaires d'une étude de phase 2 évaluant setmélanotide dans le cadre du traitement de l'OH (NCT04725240). Des patients âgés de 6 à 40 ans ayant un indice de masse corporelle (IMC) ≥ 95e percentile (pour les enfants de 6 à < 18 ans) ou ≥ 35 kg/m2 (pour les adultes ≥ 18 ans) et une OH causée par une atteinte hypothalamique structurelle à la suite d'un crâniopharyngiome ou d'une autre tumeur cérébrale bénigne, d'une résection chirurgicale et/ou d'une chimiothérapie ont été inclus. La dose de setmélanotide a été déterminée en fonction de l'âge, avec 2 à 4 semaines d'escalade de doses, puis 12 à 14 semaines à la dose thérapeutique de 3 mg une fois par jour. Le critère d'évaluation principal était la proportion de patients obtenant une réduction ≥ 5 % de leur IMC à la semaine 16. L'un des critères d'évaluation secondaires clés était la proportion composite d'enfants présentant une réduction ≥ 0,2 point du score Z de l'IMC et d'adultes présentant une perte de poids ≥ 5 %. La faim a été évaluée quotidiennement à l'aide d'une échelle d'évaluation numérique, où 0 = aucune sensation de faim et 10 = sensation de faim la plus importante qui existe. Onze patients ont été inclus (âge moyen à l'inclusion [écart-type ;intervalle] : 14,6 [4,8 ;de 6 à 23] ans ;IMC moyen à l'inclusion [écart-type] : 38,7 [5,7] kg/m2). Tous les patients (IC à 90 % : [76,2 % ;100 %]) ont présenté une réduction ≥ 5 % de leur IMC (p < 0,0001) ;81,8 % (IC à 90 % : [53,0 % ;96,7 %]) ont présenté une réduction ≥ 10 % de leur IMC (p < 0,0001). La variation moyenne (intervalle) de l'IMC était de −17,2 % (de −37,2 % à −6,7 %). La variation moyenne (écart-type) de l'indice de faim était de −2,7 points (2,6). Les effets indésirables fréquents incluaient des nausées (63,6 %), des vomissements (45,5 %), des diarrhées (36,4 %) et la COVID-19 (36,4 %). Deux patients ont arrêté le traitement en raison d'événements indésirables. Ces premiers résultats justifient la poursuite de l'étude du setmélanotide dans cette population dont les besoins médicaux non satisfaits sont élevés et pour laquelle il n'existe aucun traitement approuvé. (French) [ FROM AUTHOR] Copyright of Nutrition Clinique et Métabolisme is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

CD4+ T cell calibration of antigen-presenting cells optimizes antiviral CD8+ T cell immunity.

Antiviral CD8+ T cell immunity depends on the integration of various contextual cues, but how antigen-presenting cells (APCs) consolidate these signals for decoding by T cells remains unclear. Here, we describe gradual interferon-α/interferon-ß (IFNα/ß)-induced transcriptional adaptations that endow APCs with the capacity to rapidly activate the transcriptional regulators p65, IRF1 and FOS after CD4+ T cell-mediated CD40 stimulation. While these responses operate through broadly used signaling components, they induce a unique set of co-stimulatory molecules and soluble mediators that cannot be elicited by IFNα/ß or CD40 alone. These responses are critical for the acquisition of antiviral CD8+ T cell effector function, and their activity in APCs from individuals infected with severe acute respiratory syndrome coronavirus 2 correlates with milder disease. These observations uncover a sequential integration process whereby APCs rely on CD4+ T cells to select the innate circuits that guide antiviral CD8+ T cell responses.

Zooming in or zoning out: examining undergraduate learning experiences with zoom and the role of mind-wandering

The COVID-19 pandemic necessitated a systematic change in course modalities due to the nationwide suspension of in-person instruction, resulting in the transition to emergency remote distance learning via Zoom. This transition certainly facilitated affordances of flexibility and continuity, but with it brought issues of unfamiliarity, lack of confidence, anxiety, distractions, and validity from both the instructors and the student perspectives. This in situ study aimed to better understand the students' learning experiences with Zoom by assessing the social, cognitive, and behavioral factors influencing learner's mind-wandering and its effect on online engagement. Undergraduate students from 14 classes across two research institutions in California (N = 633) were recruited to participate in an online survey while distance learning through a pandemic. Structural equation modeling was used to conduct a path analysis to explain the factors impacting students' online engagement mediated by students' frequency to mind-wander. Study findings revealed that (1) self-efficacy and trait anxiety had significant direct effects on students' mind-wandering;(2) self-efficacy, trait anxiety, task-value beliefs, and mind-wandering had significant direct effects on students' online engagement;and finally (3) the frequency of students' mind-wandering partially mediated the relationship between self-efficacy and engagement and between trait anxiety and engagement. Identifying these structural relationships further confirmed our hypotheses on sources contributing to students' mind-wandering while learning remotely, provided insights into potential mechanisms underpinning students' online engagement, and suggests practical pedagogical learning experience design recommendations for instructors to immediately implement while teaching and learning with Zoom..

Meaning in Life and Depression in Low-Income Families in Hong Kong during the COVID-19 Pandemic.

OBJECTIVE: To determine whether meaning in life (MIL) was associated with a lower risk of depression in people from low-income families during the COVID-19 pandemic. METHODS: Individuals from low-income families were recruited at a community centre during the fourth wave of the COVID-19 pandemic in Hong Kong. Levels of MIL were assessed using the Meaning in Life Questionnaire (MLQ). Severity of depressive symptoms was assessed using the Patient Health Questionnaire-9 (PHQ-9). Scores of ≥24 on the Presence of Meaning subscale (MLQ-P) and Search for Meaning subscale (MLQ-S) were considered high. A score of ≥10 on the PHQ-9 was indicative of clinical depression. Correlations between MLQ and PHQ-9 scores were examined, along with associations between presence of/search for meaning and risk of clinical depression. RESULTS: Among 102 participants, 64 (62.7%) had clinical depression; 14 (13.7%) had both high presence of meaning and high search for meaning. The MLQ score was correlated with the PHQ-9 score (r = -0.56, p < 0.001). The adjusted risk ratio for depression was 0.31 (p = 0.006) in participants with both high presence of meaning and high search for meaning. CONCLUSION: Among people with lower socioeconomic status, MIL may be important for protecting against depression during the COVID-19 pandemic.

Data-informed building energy management (DiBEM) towards ultra-low energy buildings

To support building operations in reaching ultra-low energy targets, this paper proposes a data-informed building energy management (DiBEM) framework to improve energy efficiency systematically and continuously at the operation stage. Specifically, it has two key features including data-informed energy-saving potential identification and data-driven model-based energy savings evaluation. The paper demonstrates the proposed DiBEM with a detailed case study of an office and living laboratory building located in Cambridge, Massachusetts called HouseZero. It focuses on revealing the performance of the energy-efficient interventions from two-years' building performance monitoring data, as well as evaluating energy savings from the interventions based on the data-driven approach. With Year 1 as baseline, several interventions are proposed for Year 2 including improvements to controls and operation settings, encouragement of occupants' behavior for energy savings, and hardware retrofitting. These were deployed to heating/cooling, domestic hot water, lighting, plug and other loads, and photovoltaic (PV) systems. To quantify the impacts of different interventions on energy end uses, several data-driven models are developed. These models utilize linear regression, condition model, and machine learning techniques. Consequently, the heating/cooling energy consumption that was already ultra-low in Year 1 (12.8 kWh/m2) is further reduced to 9.7 kWh/m2 in Year 2, while the indoor thermal environment is well maintained. The domestic hot water energy is reduced from 2.3 kWh/m2 to 1.2 kWh/m2. The lighting energy is only increased from 0.3 kWh/m2 in pandemic operations without occupancy in Year 1 to 0.8 kWh/m2 in partial normal operations in Year 2, while the indoor illuminance level meets occupants' requirements. Combined with other relatively constant loads and the reduction of plug and other loads due to COVID building operation restrictions, the total energy use intensity is thereby reduced from 54.1 kWh/m2 to 42.8 kWh/m2, where 5.4 kWh/m2 of energy reduction for Year 2 is estimated to be contributed by the energy-efficient interventions. PV generation is 36.1 kWh/m2, with an increase of 1.4 kWh/m2 from a new inverter. In summary, this paper demonstrates the use of DiBEM through a detailed case study and long-term monitoring data as evidence to achieve ultra-low energy operations. © 2022 Elsevier B.V.

A COVID-19 Patient Discharged According to Strict Discharge Standards: Viral Negativity in Both Nasopharynx and Feces

Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) currently has spread all over the world. However, the dynamic characteristics of SARS-CoV-2 infections have not previously been described in detail. Here, we report a cured patient in West China Hospital, and describe the dynamic detection of SARS-CoV-2-RNA in different specimens and viral specific IgM and IgG antibodies in blood. The findings suggest that the fecal SARS-CoV-2-RNA negativity may be considered as a new standard for de isolation. Serum IgM and IgG antibodies detection were helpful for early diagnosis of SARS-CoV-2 infection and judgment of patients in recovery stage, respectively. © 2022 Journal of Bone and Joint Surgery Inc.. All rights reserved.

COLUMBIA-1: A phase Ib/II, open-label, randomized, multicenter study of durvalumab plus oleclumab in combination with chemotherapy and bevacizumab as first-line (1L) therapy in metastatic microsatellite-stable colorectal cancer (MSS-mCRC)

Background: Despite advances in the treatment of mCRC combining chemotherapy regimens with biologics, most patients (pts) still progress within 11 months of receiving 1L chemotherapy. Addition of novel therapies to the standard of care (SoC) to improve antitumor activity is urgently needed. The randomized part 2 of COLUMBIA-1 (NCT04068610) evaluated the safety and efficacy of combining SoC (bevacizumab [BEV] + FOLFOX) with the PD-L1 inhibitor durvalumab (D) and the anti-CD73 monoclonal antibody oleclumab (O). Method(s): Pts with previously untreated, MSS-mCRC and ECOG PS <=1 received either SoC alone or SoC + D (1500 mg, Q4W) + O (3000 mg Q2W x4 then Q4W) in the experimental arm (EXP). The primary endpoint was objective response rate (ORR) per investigator assessed RECIST v1.1. Result(s): As of 10 Dec 2021, 52 pts were enrolled, of whom 51 were response evaluable. The confirmed ORR with SoC was 44.0% (95% confidence interval [CI], 24.4-65.1%) compared to 61.5% (95% CI, 40.6-79.8%) in the EXP arm. Median OS was not reached (SoC) vs 19.1 mos (EXP);median PFS was 11.1 mos (SoC) vs 10.9 mos (EXP;Table). Grade >=3 treatment emergent adverse events (TEAEs) occurred in 76.9% of pts in SoC and 65.4% EXP. Fatal TEAEs (all unrelated) were observed in 3 pts in the EXP arm: 1 with sepsis and 2 with intestinal perforation. One pt with intestinal perforation deemed related to BEV experienced fatal peritonitis. In the SoC arm, there was a single fatal COVID-19 TEAE. The most frequent treatment-related AEs in the EXP arm were diarrhea (38.5%), peripheral sensory neuropathy (38.5%) and fatigue (26.9%). There was no identified association between CD73 expression and clinical benefit. Conclusion(s): Addition of D + O to FOLFOX + BEV SoC showed a moderate response increase without PFS benefit vs SoC alone. Safety was consistent with known safety profiles. [Formula presented] Clinical trial identification: NCT04068610. Editorial acknowledgement: Editing support for this , under the direction of the authors, was provided by Catherine Crookes of Ashfield MedComms (Macclesfield, UK), an Inizio company, and was funded by AstraZeneca. Legal entity responsible for the study: AstraZeneca. Funding(s): AstraZeneca. Disclosure: N.H. Segal: Financial Interests, Personal, Advisory Board: Immunocore, PsiOxus, Roche/Genentech, BI, Revitope, ABL Bio, Novartis, GSK, AstraZeneca, Numab;Financial Interests, Personal, Research Grant: Regeneron, Immunocore, PureTech, AstraZeneca, BMS, Merck, Pfizer, Roche/Genentech. J. Tie: Financial Interests, Personal, Invited Speaker, Honorarium: Novartis, Amgen, Merck Serono, Merck Sharp and Dohme, Pierre Fabre;Financial Interests, Personal, Advisory Board: Haystack Oncology, Amgen, Novartis, AstraZeneca, Merck Serono, Merck Sharp and Dohme, Pierre Fabre, BMS;Non-Financial Interests, Personal, Principal Investigator: AstraZeneca, Pfizer, Daiichi Sankyo, Novartis. S. Kopetz: Financial Interests, Personal, Ownership Interest: MolecularMatch, Lutris, Iylon;Financial Interests, Personal, Research Grant: Sanofi, Biocartis, Guardant Health, Array BioPharma, Genentech/Roche, EMD Serono, AstraZeneca, Novartis, Amgen, Lilly, Daiichi Sankyo;Financial Interests, Personal, Other: Genetech, EMD Serono, Merck, Holy Stone, Novartis, Lilly, BI, Boston Biomedical, AstraZeneca, Bayer Health, Pierre Fabre, Redx Pharma, Ipsen, Daiichi Sankyo, Natera, HalioDx, Lutris, Jacobio, Pfizer, Repare Therapeutics, Inivata, GSK, Jazz Pharmaceuticals, Iylon, Xilis, AbbVie, Amal Therapeutics, Gilead, Mirati, Flame Biosciences, Servier, Carina Biotechnology, Bicara Therapeutics, Endeavor BioMedicines, Numab Pharma, Johnson and Johnson/Janssen. M.P. Ducreux: Financial Interests, Personal, Invited Speaker: Roche, Beigene, MSD, Servier, Pierre Fabre, Amgen;Financial Interests, Personal, Advisory Board: Terumo, Roche, Merck Serono, Bayer, Daiichi Sankyo, Sotio;Financial Interests, Institutional, Research Grant: Keocyt, Roche, Bayer. E. Chen: Financial Interests, Personal, Advisory Board: AstraZeneca;Financial Interests, Personal, Princip l Investigator: AstraZeneca. R. Dienstmann: Financial Interests, Personal, Speaker's Bureau: Roche, BI, Ipsen, Amgen, Servier, Sanofi, Libbs, Merck Sharp and Dohme, Lilly, AstraZeneca;Financial Interests, Personal, Advisory Board: Roche, BI;Financial Interests, Personal, Research Grant: Merck, Pierre Fabre. A. Hollebecque: Financial Interests, Personal, Invited Speaker: Servier, Incyte, EISAI;Financial Interests, Personal, Advisory Board: Basilea, Tahio, Relay Theraeutics, QED Therapeutics, Debiopharm;Financial Interests, Institutional, Funding: Incyte;Financial Interests, Institutional, Research Grant: AstraZeneca;Non-Financial Interests, Personal, Principal Investigator, M19-345: AbbVie;Non-Financial Interests, Personal, Principal Investigator, CO42216: Roche;Non-Financial Interests, Personal, Principal Investigator, MCLA-158: Merus;Non-Financial Interests, Personal, Principal Investigator, SGNB6A: Seattle Genetics;Non-Financial Interests, Personal, Principal Investigator, TAS-120-202: Tahio;Non-Financial Interests, Personal, Principal Investigator, Krystal-10: Mirati;Non-Financial Interests, Personal, Principal Investigator, ADP-0033: Adaptimmune;Non-Financial Interests, Personal, Principal Investigator, ACT16902: Sanofi;Non-Financial Interests, Personal, Principal Investigator, C4201002: Pfizer;Non-Financial Interests, Personal, Principal Investigator, RLY-4008: Relay Therapeutics;Non-Financial Interests, Personal, Principal Investigator, CC-90011: Celgene/BMS;Non-Financial Interests, Personal, Principal Investigator, Loxo-IDH: Loxo/Lilly;Non-Financial Interests, Personal, Principal Investigator: AstraZeneca. M. Reilley: Financial Interests, Personal, Advisory Board: BMS, Helsinn, ZielBio. M.E. Elez Fernandez: Financial Interests, Personal, Invited Speaker: Novartis, Organon;Financial Interests, Personal, Advisory Board: Amgen, Bayer, F. Hoffman La Roche, Merck Serono, MSD, Pierre Fabre, Sanofi, Servier;Financial Interests, Institutional, Funding: Amgen, Array Biopharma, AstraZeneca, BeiGene, BI, BMS, Celgene, Debiopharm International SA, F. Hoffman La Roche, Genentech, HalioDX SAS, Hutchinson MediPharma International, Janssen-Cilag SA, Menarini, Merck ealth KgaA, MSD, Merus NV, Mirati, Novartis Farmaceutica SA, Pfizer, PharmaMar, Sanofi Aventis Recherche & Developpement, Servier, Taiho Pharma;Financial Interests, Personal, Other, ASCO Scientific Program Committee: Developmental Therapeutics - Immunotherapy: ASCO;Financial Interests, Personal, Other, Speaker of the ESMO Academy: ESMO;Financial Interests, Personal, Other, Coordinator of the SEOM +MIR Section of Residents and Young Assistants: SEOM;Financial Interests, Personal, Other, Travel, accommodations, expenses: Amgen, Array BioPharma, BMS, Merck Serono, Roche, Sanofi, Servier. J. Cosaert: Financial Interests, Personal, Full or part-time Employment: AstraZeneca;Financial Interests, Personal, Stocks/Shares: AstraZeneca;Financial Interests, Personal, Member: AstraZeneca. J. Cain: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. M. Hernandez: Financial Interests, Personal, Full or part-time Employment: AstraZeneca;Financial Interests, Personal, Stocks/Shares: AstraZeneca. N. Hewson: Financial Interests, Personal, Full or part-time Employment: AstraZeneca. Z.A. Cooper: Financial Interests, Personal, Full or part-time Employment: AstraZeneca;Financial Interests, Personal, Stocks/Shares: AstraZeneca. M. Dressman: Financial Interests, Personal, Full or part-time Employment: AstraZeneca;Financial Interests, Personal, Stocks/Shares: AstraZeneca. J. Tabernero: Financial Interests, Personal, Advisory Role: Array BioPharma, AstraZeneca, Bayer, BI, Chugai, Daiichi Sankyo, F. Hoffman-La Roche Ltd, Genentech, HalioDX SAS, Hutchison MediPharma International, Ikena Oncology, Inspirna Inc, IQVIA, Lilly, Menarini, Merck Serono, Merus, MSD, Mirati, Neophore, Novartis, Ona Therapeutics, Orion Biotechnology, Peptomyc, Pfizer, Pierre Fabre, Samsung Bioepis, Sanofi, Scandio Oncology, Scorpion Therapeutics, Seattle Genetics, Servier, Sotio Biotech, Taiho, Tessa Therapeutics, TheraMyc;Financial Interests, Personal, Stocks/Shares: Oniria Therapeutics;Financial Interests, Personal, Other, educational collaboration: Imedex/HMP, Medscape Education, MJH Life Sciences, PeerView Institute for Medical Education, Physicians Education Resource (PER). Copyright © 2022 European Society for Medical Oncology

A Change in Presentation of Paraoesophageal Hiatus Hernia Requiring Surgical Intervention in a District General Hospital in the Northern Region of the United Kingdom

Aim: The incidence of paraoesphageal hiatus hernia (PEH) has changed over the last several years. This study aims to ascertain the difference in the presentation of PEH requiring operative intervention at our unit because of the COVID-19 pandemic Material&Methods:We conducted a retrospective review of procedures performed by a single surgeon for PEH in a district general hospital. We compared cases from 2016 to March 2020 and during the initial period of the COVID-19 pandemic in 2020. Result(s): 39 consecutive cases were identified undergoing PEH related procedures. The median age was 66 (IQR 26), with slight female predominance (M:F ratio of 5:6). 28 cases (71.8%) were performed as elective cases. After the 2020 March lockdown, there were 10 cases of PEH repair performed with 78% performed as emergency procedures, compared to 30 cases in the preceding 5 years and 10% performed as emergency cases. Chi-square test to examine the association between COVID-19 pandemic and emergency procedure, X2 (1, N=39)=14.199, p=0.000164. Pre-COVID19 the types of procedures included 76.7% were fundoplication with suture crural closure, 10% were fundoplication with mesh repair, 3.3% biological mesh repair, 3.3% with suture closure of the crural and 6.7% had suture gastropexy. During the COVID-19 period, 44.4% were gastropexy, 33.3% were gastrostomy tube insertion and 22.2% fundoplication performed. Conclusion(s): We have seen significantly more emergency PEH related procedures performed and using a variety of procedures. This leads to the consideration of whether current emergency general surgery training can equip trainees for future independent practice.

Randomized controlled trial (RCT) of symptom screening with targeted early palliative care (STEP) versus usual care in patients with advanced cancer

Background: To direct limited specialized palliative care resources to patients in greatest need, we developed STEP (Symptom screening with Targeted Early Palliative care). STEP entails symptom screening (ESAS-r) at each oncology clinic visit and triggered alerts (for moderate-high physical and psychological symptoms) to a nurse who calls the patient to offer a palliative care clinic (PCC) visit. We conducted a phase III RCT to assess the impact of STEP versus usual care on quality of life and other patient-reported outcomes (PROs). Methods: Adults with advanced cancer were recruited from medical oncology clinics at the Princess Margaret Cancer Centre, Toronto, Canada. Consenting patients with oncologist-assessed ECOG 0-2 and estimated survival of 6-36 months were enrolled and block randomized (stratified by tumour site and symptom severity) to STEP or usual care. Participants completed measures of quality of life (FACT-G7), depression (PHQ-9), symptom control (ESASr-CS), and satisfaction with care (FAMCARE-P16) at baseline, 2, 4 and 6 months. The primary outcome was FACT-G7 at 6 months, with a planned sample size of 261/arm. Results: From 8/2019 to 3/2020, 69 patients were enrolled: 33 randomized to STEP and 36 to usual care. The trial was then halted permanently due to the COVID-19 pandemic, owing to substantial changes to elements of STEP (shift to virtual symptom screening and palliative care) and usual care (shift to virtual oncology care). Median age was 64 years (range 25-87) and 62% (43/69) were women;study arms were balanced at baseline except gender, with more women randomized to STEP. Within the STEP arm, 20 (61%) participants triggered a nurse's call to offer a PCC visit, of whom 13 attended the clinic at least once. All outcomes tended to be better in the STEP arm compared to usual care, particularly depression and satisfaction with care at 6 months;however, results were not statistically significant (Table). Conclusions: STEP holds promise for improving quality of life and other PROs in patients with advanced cancer and effectively directing early palliative care towards those who need it most. In response to the pandemic, an online version of STEP has been developed and a further trial is in progress.

[Exploration on risk management of infection prevention and control in COVID-19 makeshift hospitals].

In the current stage of prevention and control of the Omicron variant of the pandemic, makeshift hospitals played a key role in isolating and treating mild and asymptomatic patient, which helped to completely and quickly block the spread of the epidemic in the society. In order to reduce the risk of the spread of COVID-19 in makeshift hospital, prevent occupational exposure and nosocomial infections, it is necessary for all levels to actively identify risk sources, carry the risk assessment, implement comprehensive infection control risk treat, and supervise in a timely manner.

[Analysis on infectivity of COVID-19 patients before and after last negative nucleic acid test].

Objective: To investigate the infection rate in close contacts of COVID-19 patients before and after the last negative nucleic acid test, evaluate the effect of dynamic nucleic acid test in determining the infectivity of COVID-19 patients. Methods: Dynamic nucleic acid test results of COVID-19 cases were collected in a retrospective cohort study. COVID-19 cases with negative nucleic acid test results before their first positive nucleic acid tests were selected as study subjects. Close contacts of the index cases and the secondary close contacts were kept isolation for medical observation to assess their risk of infection. Results: This study included 89 confirmed cases from two local COVID-19 epidemics in Ningbo. A total of 5 609 close contacts were surveyed, the overall infection rate was 0.20%. No close contacts of the COVID-19 cases before the last negative nucleic acid test were infected, and the infection rate in the close contacts of the COVID-19 cases after the last negative nucleic acid test was 1.33%, all of these close contacts lived together with the index cases. No secondary close contacts were infected. Conclusion: COVID-19 patient becomes infectious after the last nucleic acid is negative, and has no infectivity before the last nucleic acid negative.

Mobility Response to COVID-19-related Restrictions in New York City

The first case of the 2019 novel coronavirus was detected in the United States in January 2020, and since then, efforts to contain the virus, such as stay-at-home policies, have greatly restricted human mobility. While stay-at-home policies and concern over the virus contributed to an increase in time spent at home, little is known as to how a change in home dwell time varied by population. The work presented in this paper seeks to understand the relationships between levels of mobility and socioeconomic and demographic characteristics of communities within New York City from February to April 2020. By analyzing the factors that contributed to changes in home dwell time, this work aims to support policymakers and inform future strategies for infection mitigation. Findings from this research reinforce the need for physical distancing policies that acknowledge the existence of socioeconomic and demographic diversity between not only geographic regions in the U.S. but also within a single city. © 2021 ACM.

Measuring subjective stress among young people in Hong Kong: validation and predictive utility of the single-item subjective level of stress (SLS-1) in epidemiological and longitudinal community samples

AimsBrief measurements of the subjective experience of stress with good predictive capability are important in a range of community mental health and research settings. The potential for large-scale implementation of such a measure for screening may facilitate early risk detection and intervention opportunities. Few such measures however have been developed and validated in epidemiological and longitudinal community samples. We designed a new single-item measure of the subjective level of stress (SLS-1) and tested its validity and ability to predict long-term mental health outcomes of up to 12 months through two separate studies.MethodsWe first examined the content and face validity of the SLS-1 with a panel consisting of mental health experts and laypersons. Two studies were conducted to examine its validity and predictive utility. In study 1, we tested the convergent and divergent validity as well as incremental validity of the SLS-1 in a large epidemiological sample of young people in Hong Kong (n = 1445). In study 2, in a consecutively recruited longitudinal community sample of young people (n = 258), we first performed the same procedures as in study 1 to ensure replicability of the findings. We then examined in this longitudinal sample the utility of the SLS-1 in predicting long-term depressive, anxiety and stress outcomes assessed at 3 months and 6 months (n = 182) and at 12 months (n = 84).ResultsThe SLS-1 demonstrated good content and face validity. Findings from the two studies showed that SLS-1 was moderately to strongly correlated with a range of mental health outcomes, including depressive, anxiety, stress and distress symptoms. We also demonstrated its ability to explain the variance explained in symptoms beyond other known personal and psychological factors. Using the longitudinal sample in study 2, we further showed the significant predictive capability of the SLS-1 for long-term symptom outcomes for up to 12 months even when accounting for demographic characteristics.ConclusionsThe findings altogether support the validity and predictive utility of the SLS-1 as a brief measure of stress with strong indications of both concurrent and long-term mental health outcomes. Given the value of brief measures of mental health risks at a population level, the SLS-1 may have potential for use as an early screening tool to inform early preventative intervention work.

The influence of universal face mask use on endophthalmitis risk after intravitreal antivascular endothelial growth factor injections during the COVID-19 pandemic

Purpose : Routine use of face masks for both patients and physicians during intravitreal anti-vascular endothelial growth factor (VEGF) injections has increased with the emergence of the COVID-19 pandemic. This study evaluates the impact of physician, ancillary staff, and patient face mask use on rates and outcomes of post-injection endophthalmitis. Methods : In this retrospective comparative cohort study, all eye receiving intravitreal antiVEGF factor injections from 10/1/2019 to 7/31/2020 were included from twelve centers. Cases were divided into a no face mask group if no face masks were worn by the physician or patient during intravitreal injections or a universal face mask group if face masks were worn by the physician, ancillary staff, and patient during intravitreal injections. The main outcome measures were rate of endophthalmitis, visual acuity, and microbial spectrum. Results : Of 505,968 intravitreal injections administered, 85 of 294,514 (0.0289%;1 in 3,464 injections) cases of endophthalmitis occurred in the no face mask group, and 45 of 211,454 (0.0213%;1 in 4,699 injections) cases occurred in the universal face mask group (odds ratio, 0.74;95%CI, 0.51-1.18;p=0.097;Table 1). In the no face mask group, there were 27 cases (0.0092%;1 in 10,908 injections) of culture-positive endophthalmitis compared to 9 cases (0.004%;1 in 23,494 injections) in the universal face mask group (OR, 0.46;95%CI, 0.22-0.99;p=0.041). Three cases of oral flora-associated endophthalmitis occurred in the no face mask group (0.001%;1 in 98,171 injections) compared to one (0.0005%;1 in 211,454) in the universal face mask group (p=0.645). At endophthalmitis presentation, mean logMAR visual acuity was 2.04 for no face mask group compared to 1.65 for the universal face mask group (p=0.022), although no difference was observed three months after treatment (p=0.764;Table 2). Conclusions : Universal face mask use during intravitreal anti-VEGF injections did not show a statistically significant reduction in presumed endophthalmitis, but there was a reduced rate of culture-positive endophthalmitis. Future studies are warranted to assess the role of face mask use to reduce endophthalmitis risk, particularly that due to oral flora.

'I'm being forced to make decisions I have never had to make before': Oncologists and the conundrums created by COVID-19

Background: The COVID-19 pandemic has created conundrums for physicians. This study examines the experiences of oncologists who engage in complex decision-making regarding the use of chemotherapy in seriously ill persons in the context of the COVID-19 pandemic. Methods: Between January 2020 and August 2020, the authors conducted semistructured, in-depth individual interviews with 22 purposefully sampled oncologists from practices enrolled in the Michigan Oncology Quality Consortium. Transcripts were double-coded and reconciled by consensus using qualitative data analysis software for thematic analysis. Results: Among the thematic clusters we identified, one was related to conundrums created by the COVID-19 pandemic. In this presentation, we report the results pertaining to three themes within this cluster: (1) the ethical dilemmas faced by oncologists due to the COVID-19 pandemic, (2) the need for both patients and oncologists to manage uncertainty and emotions, and (3) the importance and complexity of integrating technology and communication for seriously ill persons. Oncologists grappled with several conundrums including resource scarcity, resource allocation, delays in care, a duty to promote equity and non-abandonment, high levels of uncertainty and fear, and the importance of advanced care directives and end-of-life care planning. Nonabandonment featured as a coping mechanism for increased stress, and integration of communication with telemedicine was frequent and necessary. Conclusions: This study offers an indepth exploration of the conundrums faced by oncologists due to the COVID-19 pandemic and how they navigated them. Optimal decision-making for seriously ill persons with cancer during the COVID-19 pandemic must include open acknowledgement of the ethical dilemmas faced, the heightened emotions experienced by both patients and their oncologists, and the urgent need for integrating technology with compassionate communication in determining patient preferences.

Enteral methadone for iatrogenic opioid withdrawal in patients with COVID-19 acute respiratory distress syndrome: A case series

Rationale: Patients with severe acute respiratory distress syndrome (ARDS) often require deep sedation for extended periods of time to facilitate mechanical ventilation. The emergence of COVID-19 resulted in high volume of patients admitted to our tertiary care center with severe ARDS. Many developed withdrawal symptoms upon tapering of continuous sedation and were unable to be safely extubated despite improved ventilator requirements. A protocol using enteral methadone was developed to facilitate tapering of continuous sedation and mitigate the severity of iatrogenic withdrawal. Methods: Data was collected through retrospective chart review of patients treated with protocolized methadone for IWS during 04/2020-08/2020. Inclusion criteria were FiO2 ≤ 60%, PEEP ≤ 12cmH220, ≥ 5 days of continuous fentanyl or hydromorphone (≥100 mcg/hr or 1.5 mg/hr respectively), and approval by the toxicology and addiction medicine service. Those receiving high dose vasopressors, paralytics, or QTc ≥500ms were excluded. Descriptive statistics after initiation of methadone are presented in the following case series. Results: There were 32 patients treated with methadone for IWS during the study period. Of these participants, 90% were male (N=29) with median age of 59 (IQR 52-63.5). Opioid infusions were successfully weaned in 75% of patients (N=24) treated with methadone. Median time to wean continuous opioids after starting methadone was 2.5 days (mean 4.08, IQR 1-5). At the end of the study period, 40% (N=13) of patients died from complications of COVID-19. Of the patients who survived, 7 required tracheostomy placement and 16 were successfully extubated. One patient developed prolonged QT with ectopy and was switched to IV Buprenorphine. She was subsequently weaned off continuous sedation after 5 days. Another patient developed prolonged QT but was able to resume after holding for 48 hours. Conclusion: IWS is a barrier to de-escalation of care in patients with COVID-19 ARDS. IWS is associated with longer ICU stay and duration of mechanical ventilation. Protocolized methadone use can be an effective tool for mitigating IWS as suggested by the findings in this study. This study is limited by the lack of a control group. Future directions include comparison to a matched cohort of patients not treated with methadone. Continued investigation with prospective studies in the context of changing practice guidelines for COVID-19 are also warranted. If methadone is found to be safe and effective in future studies, widespread use could help reduce the strain on ICU resources by COVID-19.