Epidemiological and etiological analysis of a case cluster caused by norovirus in a nursing home in Lanzhou

Objective: To understand the epidemiology and etiology of a cluster of cases with gastroenteritis in a nursing home in Anning district of Lanzhou, and to provide a scientific evidence for the prevention and control of norovirus diarrhea in community nursing centers. Methods: From January 28 to February 4 2021, an epidemiological investigation was conducted on all diarrhea cases, nursing staff and chefs in a nursing home in Anning district, Lanzhou city. Samples of patients' anal swabs, feces, vomitus were collected for norovirus detection by real-time fluorescent PCR. ORF1/ORF2 junction region of norovirus in some selected positive samples(Ct value 25) was sequenced. MEGA-X software was used to construct a phylogenetic tree for genetic evolution analysis using the neighboring method. Results: The first case was confirmed on January20,2021, and the number of cases peaked during January 25and 29.A total of 58 clinically diagnosed cases were reported,57were older people, with an incidence of(57/360,15.83%). Diarrhea(50/58,86.21%),vomiting(35/58,60.34%),nausea(13/58,22.41%)and abdominal pain(6/58,10.34%)were common symptoms, all cases were mild. Fifty-three asymptomatic cases were detected among chefs, housekeepers and nurses.A total of 163specimens were tested, the positive rate of norovirus GII was 49.08%(80/163). The positive rate of fecal samples collected from nurses, chefs and housekeepers was 48.62%(53/109), and was11.11%(2/18)in environmental surface swabs. The possibility of other pathogenic infections such as SARS-CoV-2was ruled out by further tests. Thirteen positive samples were selected for sequencing, and 9were successfully sequenced, they were all recombinant GII.4Sydney_2012 [P16]genotypes, forming an independent cluster, while in a large evolutionary branch with the 2020GII.10 [P16]and 2019GII.2 [P16]virus strains in Lanzhou city, showing a relative close genetic connection. Conclusions: GII .4Sydney_2012[P16]genotype of norovirus is found to be causative pathogen of this outbreak, and close contact is the main reason of the outbreak and persistence of the infection,so asymptomatic infections of norovirus play an important role in the disease spreading. Therefore, public health management in nursing homes and other centralized nursing facilities should be strengthened especially for asymptomatic workers in order to prevent virus transmission.

Transmission Mechanism of Post-COVID-19 Emergency Supply Chain Based on Complex Network: An Improved SIR Model

Since the COVID-19 epidemic swept the world, the emergency supply chain (ESC) has faced serious uncertainty risks. To maintain the stability of the emergency supply, risk prevention and contingency measures must be prepared. In this paper, the authors first obtain the initial risk value of 0.4 using the fuzzy comprehensive evaluation approach and then build an improved SIR model based on a complex network to investigate the risk propagation law of the ESC. The simulation results show that (1) the high number of nodes becomes the initial risk source, the risk propagates faster and the peak value arrives two days earlier on average;(2) the initial infection rate gradually increases from 0.2 to 0.4, 0.6, and 0.8, and the risk spread speed also accelerates;(3) the recovery rate of network nodes increases gradually from 0.1 to 0.2, 0.3, and 0.4, and the influence range of risk propagation decreases inversely;(4) appropriately increasing the deletion rate of network nodes is conducive to improving the stability of the ESC network. Given the above ESC risk propagation law, this paper proposes relevant risk prevention measures and suggests that a risk early warning system of node enterprises should be established in combination with the target immunization strategy. For ESC risk management, the result has significant theoretical and practical implications.

A deep ensemble learning-based automated detection of COVID-19 using lung CT images and Vision Transformer and ConvNeXt.

Since the outbreak of COVID-19, hundreds of millions of people have been infected, causing millions of deaths, and resulting in a heavy impact on the daily life of countless people. Accurately identifying patients and taking timely isolation measures are necessary ways to stop the spread of COVID-19. Besides the nucleic acid test, lung CT image detection is also a path to quickly identify COVID-19 patients. In this context, deep learning technology can help radiologists identify COVID-19 patients from CT images rapidly. In this paper, we propose a deep learning ensemble framework called VitCNX which combines Vision Transformer and ConvNeXt for COVID-19 CT image identification. We compared our proposed model VitCNX with EfficientNetV2, DenseNet, ResNet-50, and Swin-Transformer which are state-of-the-art deep learning models in the field of image classification, and two individual models which we used for the ensemble (Vision Transformer and ConvNeXt) in binary and three-classification experiments. In the binary classification experiment, VitCNX achieves the best recall of 0.9907, accuracy of 0.9821, F1-score of 0.9855, AUC of 0.9985, and AUPR of 0.9991, which outperforms the other six models. Equally, in the three-classification experiment, VitCNX computes the best precision of 0.9668, an accuracy of 0.9696, and an F1-score of 0.9631, further demonstrating its excellent image classification capability. We hope our proposed VitCNX model could contribute to the recognition of COVID-19 patients.

Impact of Environmental Factors on Short-Term Eye Strain Relief during COVID-19 Quarantine: A Pilot Study

Some policies implemented during the pandemic extended the time that students spend on electronic devices, increasing the risk of physical and eye strain. However, the role of different environments on eye strain recovery has not been determined. We recruited 20 undergraduate students (10 males and 10 females) from a university in eastern China and explored the restoration effects of their eye strain in different types of spaces (wayside greenspace, a playground, a square, and woodland) on campus through scale measurements. The results showed that the eye strain of the students accumulated by 15 min of e-learning was significantly relieved after 10 min of greenspace exposure compared to the indoor environment, and the recovery effect varied depending on the type of landscape. The effect of eye strain relief was found to be positively correlated with temperature, wind speed, visible sky ratio, canopy density, tree density, and solar radiation intensity, while it was negatively correlated with relative humidity. These findings enrich the research on the restoration benefits of greenspaces and provide a basis for predicting the effect of different environments on the relief of eye strain.

Effectiveness of a Brief Mindfulness-Based Intervention of "STOP touching your face" During the COVID-19 Pandemic: a Randomized Controlled Trial.

Objectives: Avoiding touching the eyes, nose, and mouth (T-zone) is a strategy to reduce the spread of COVID-19. This study evaluated the effectiveness of a brief mindfulness-based intervention (MBI) named "STOP (Stop, Take a Breath, Observe, Proceed) touching your face" for reducing face-touching behavior. Methods: In this online-based, two-arm, wait-list, randomized controlled trial, eligible participants were randomly assigned to the intervention (n = 545) or control group (n = 545). The results of 60-min self-monitoring of face-touching behavior were reported before and after the intervention. Reduction of the percentage of T-zone touching was the primary outcome, and reduction of face-touching frequency was a key secondary outcome. Outcomes were analyzed on an intention-to-treat (ITT) basis with a complete case analysis (CCA). Results: ITT analysis revealed that the percentage of T-zone touching was significantly reduced by 8.1% in the intervention group (from 81.1 to 73.0%, RR = 0.901, OR = 0.631, RD = - 0.081, p = 0.002), and insignificantly reduced by 0.6% in the control group (from 80.0 to 79.4%, p = 0.821). Fewer participants performed T-zone touching in the intervention group than in the control group (73.0% vs. 79.4%, RR = 0.919, OR = 0.700, RD = - 0.064, p = 0.015) after the intervention, and there was a greater reduction of T-zone touching frequency in the intervention group than in the control group [mean ± SD: 1.7 ± 5.13 vs. 0.7 ± 3.98, mean difference (95% CI): 1.03 (0.48 to 1.58), p < 0.001, Cohen's d = - 0.218]. The above results were further confirmed by CCA. Conclusions: This brief mindfulness-based intervention was potentially effective at reducing the spread of COVID-19 and could be further investigated as an intervention for preventing other infectious diseases spread by hand-to-face touching. Trial Registration: ClinicalTrials.gov NCT04330352. Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-022-02019-x.

Epidemiological and etiological analysis of a case cluster caused by norovirus in a nursing home in Lanzhou

Objective To understand the epidemiology and etiology of a cluster of cases with gastroenteritis in a nursing home in Anning district of Lanzhou, and to provide a scientific evidence for the prevention and control of norovirus diarrhea in community nursing centers. Methods From January 28 to February 4 2021, an epidemiological investigation was conducted on all diarrhea cases, nursing staff and chefs in a nursing home in Anning district, Lanzhou city.Samples of patients′ anal swabs, feces, vomitus were collected for norovirus detection by real-time fluorescent PCR.ORF1/ORF2 junction region of norovirus in some selected positive samples（Ct value ≤ 25） was sequenced.MEGA-X software was used to construct a phylogenetic tree for genetic evolution analysis using the neighboring method. Results The first case was confirmed on January20,2021,and the number of cases peaked during January 25and 29.A total of 58clinically diagnosed cases were reported,57were older people,with an incidence of（57/360,15.83%）.Diarrhea（50/58,86.21%）,vomiting（35/58,60.34%）,nausea（13/58,22.41%）and abdominal pain（6/58,10.34%）were common symptoms,all cases were mild.Fifty-three asymptomatic cases were detected among chefs,housekeepers and nurses.A total of 163specimens were tested,the positive rate of norovirus GⅡwas 49.08%（80/163）.The positive rate of fecal samples collected from nurses,chefs and housekeepers was 48.62%（53/109）,and was11.11%（2/18）in environmental surface swabs.The possibility of other pathogenic infections such as SARS-CoV-2was ruled out by further tests.Thirteen positive samples were selected for sequencing,and 9were successfully sequenced,they were all recombinant GⅡ.4Sydney＿2012 [P16]genotypes,forming an independent cluster,while in a large evolutionary branch with the 2020GⅡ.10 [P16]and 2019GⅡ.2 [P16]virus strains in Lanzhou city,showing a relative close genetic connection. Conclusions GⅡ.4Sydney＿2012[P16]genotype of norovirus is found to be causative pathogen of this outbreak,and close contact is the main reason of the outbreak and persistence of the infection,so asymptomatic infections of norovirus play an important role in the disease spreading.Therefore,public health management in nursing homes and other centralized nursing facilities should be strengthened especially for asymptomatic workers in order to prevent virus transmission.

GC-MS combined with multivariate analysis for the determination of the geographical origin of Elsholtzia rugulosa Hemsl. in Yunnan province.

Elsholtzia rugulosa Hemsl., a Chinese herbal medicine, may have the potential to treat COVID-19. The geographical origin has a significant influence on the quality and application of E. rugulosa. In this paper, gas chromatography-mass spectrometry (GC-MS) combined with principal component analysis (PCA) and hierarchical cluster analysis (HCA) and other multivariate statistical analyses were performed for the identification of E. rugulosa. origins. The results showed that the volatile components of E. rugulosa. from different origins were significantly different. PCA and HCA can clearly distinguish the E. rugulosa of Lijiang and Fumin, and Dali and Yongsheng can be distinguished but with a certain overlap. The correlation of different components of was investigated by Pearson correlation. The results showed that E. rugulosa. characteristic component Elsholtzia ketone is regulated by terpenoid metabolism. The discriminant functions of different origins are constructed by Fisher stepwise discrimination, and its initial verification accuracy and leave-one-out cross-validation accuracy were 100% and 87.5%, respectively.

A review and update for registered clinical studies of stem cells for non-tumorous and non-hematological diseases.

OBJECTIVE: To provide consultative information on selecting potential indications of stem cells in the treatment of non-tumorous and non-hematopoietic system conditions, we screened the clinical trials on website: http://www.clinicaltrials.gov. METHODS: A literature search was conducted using the National Institute of Health (NIH) website (http://www.clinicaltrials.gov) from May 10th, 2012 to Oct 13th, 2020 with stem cells as an intervention in human trials for non-tumorous and non-hematological conditions. There was no restriction for language, research location, and research race. RESULTS AND CONCLUSION: Search terms initially found a total of 3576 articles. Firstly, 138 terminated or suspended studies were excluded and further 24 repeated studies were excluded. Secondly, 987 tumorous and hematopoietic conditions-related studies were excluded. Lastly, 1218 studies were excluded without stem cell therapy as their primary purpose. A total of 1209 research studies were entered into the analysis and reviewed. The top 4 diseases were about motor system diseases 229 (19.28%). In addition, 206 (17.34%) studies were related to central nervous system (CNS) diseases. 140 (11.78%) were autoimmune diseases or graft-versus-host disease (GVHD) after organ transplantation. 129 (10.86%) were about respiratory system diseases, among them, 44.19% projects were about new coronary pneumonia (NCP). The main cell types used in various diseases are Mesenchymal Stem Cells (MSCs), bone marrow stem cells (BM-SCs), peripheral blood stem cells (PBSCs), hematopoietic stem cells (HSCs), adipose stem cell (ASCs) and precursor cells.

Autopsy results from a COVID-19 patient treated in a tropical area, and a review of the epidemiological history.

Since the start of the COVID-19 pandemic, there has been an urgent need to produce accurate and sensitive tests. However, there have been instances where a positive nucleic acid test turns negative after treatment, and then positive again. This case report describes such an instance from the tropical region of Hainan, China. The patient was a 61-year-old female who went to Hainan on vacation from Wuhan during the COVID-19 pandemic in 2020. Symptoms appeared 9 d after arriving in Hainan, and it was confirmed that the nucleic acid test was positive after 4 repeats. Her condition declined rapidly, her heart stopped beating, and she was admitted in a coma to the ICU. After treatment, the SARS-CoV-2 virus nucleic acid test of several nasopharyngeal swabs were negative, and tests on whole blood, anal swabs, and urine were also negative. Later, however, nucleic acid tests on a lower respiratory tract sputum swab and lower respiratory tract lavage fluid were positive. An autopsy examination was carried out 12 h after her death, and multi-organ secretions were extracted for nucleic acid testing. The SARS-CoV-2 virus nucleic acid was only detected in the swabs from the end of the bronchus, which was confirmed by the visualization of the coronavirus by electron microscopy. Autopsy confirmed that the damage was mainly concentrated in the lungs and immune organs and tissues throughout the body. Epidemiology indicated that none of the people she came into contact with after arriving in Hainan, including close contacts, were infected. This is in sharp contrast to the highly contagious virus in Wuhan in the temperate zone during the same period. This case report indicates: (1) The high temperatures in tropical areas may have an impact on the spread and harm of COVID-19, and (2) The reason why nucleic acid testing for COVID-19 was initially negative and then positive after treatment may be related to the survival of the SARS-CoV-2 virus in deep lung tissues.

Using soft X-ray tomography for rapid whole-cell quantitative imaging of SARS-CoV-2-infected cells.

High-resolution and rapid imaging of host cell ultrastructure can generate insights toward viral disease mechanism, for example for a severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Here, we employ full-rotation soft X-ray tomography (SXT) to examine organelle remodeling induced by SARS-CoV-2 at the whole-cell level with high spatial resolution and throughput. Most of the current SXT systems suffer from a restricted field of view due to use of flat sample supports and artifacts due to missing data. In this approach using cylindrical sample holders, a full-rotation tomogram of human lung epithelial cells is performed in less than 10 min. We demonstrate the potential of SXT imaging by visualizing aggregates of SARS-CoV-2 virions and virus-induced intracellular alterations. This rapid whole-cell imaging approach allows us to visualize the spatiotemporal changes of cellular organelles upon viral infection in a quantitative manner.

Acute psychological impact of coronavirus disease 2019 outbreak among psychiatric professionals in China: a multicentre, cross-sectional, web-based study.

OBJECTIVES: To assess the magnitude of mental health outcomes and associated factors among psychiatric professionals in mental health services during COVID-19 in China. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from psychiatric professionals in 34 hospitals between 29 January and 7 February 2020, in China. Hospitals equipped with fever clinics or deployed on wards for patients with COVID-19 were eligible. PRIMARY OUTCOME AND MEASURES: The severity of symptoms of depression, anxiety, insomnia and distress were assessed by the Chinese versions of 9-item Patient Health Questionnaire, 7-item Generalised Anxiety Disorder, 7-item Insomnia Severity Index and 22-item Impact of Event Scale-Revised, respectively. Multivariable logistic regression and structural equation modelling was performed to identify factors associated with mental health outcomes. RESULTS: A total of 610 psychiatric professionals were included. 29.8% were employed in Wuhan, and 22.5% were frontline workers. A considerable proportion of participants reported symptoms of depression (461 (75.6%)), anxiety (282 (46.2%)), insomnia (336 (55.1%)) and mental stress (481 (78.9%)). Psychiatric symptoms were associated with worrying about infection (eg, OR 2.36 (95% CI 1.27 to 4.39) for anxiety), risks of exposure to COVID-19 (eg, having inadequate personal protection equipment, OR 2.43 (1.32 to 4.47) for depression) and self-perceived physical health (eg, OR 3.22 (2.24 to 4.64) for mental stress). Information sources of COVID-19 were also found to be both positively (eg, information from relatives, OR 2.16 (1.46 to 3.21) for mental stress) and negatively (eg, information from TV, OR 0.52 (0.35 to 0.77) for mental stress) associated with mental stress. There is preliminary evidence that mental health might benefit from greater availability of mental healthcare services. The structural equation model analysis indicated that worrying about infection may be the primary mediator via which risk of exposure to COVID-19 pandemic affects the mental health of psychiatric professionals. CONCLUSIONS: The current findings demonstrate several pathways via which the COVID-19 pandemic may have negatively affected the mental health of psychiatric professionals in China.

Workplace factors associated with mental health of healthcare workers during the COVID-19 pandemic: an international cross-sectional study.

BACKGROUND: The association of workplace factors on mental health of healthcare workers (HCWs) during the COVID-19 pandemic needs to be urgently established. This will enable governments and policy-makers to make evidence-based decisions. This international study reports the association between workplace factors and the mental health of HCWs during the pandemic. METHODS: An international, cross-sectional study was conducted in 41 countries. The primary outcome was depressive symptoms, derived from the validated Patient Health Questionnaire-2 (PHQ-2). Multivariable logistic regression identified factors associated with mental health outcomes. Inter-country differences were also evaluated. RESULTS: A total of 2527 responses were received, from 41 countries, including China (n = 1213; 48.0%), UK (n = 891; 35.3%), and USA (n = 252; 10.0%). Of all participants, 1343 (57.1%) were aged 26 to 40 years, and 2021 (80.0%) were female; 874 (34.6%) were doctors, and 1367 (54.1%) were nurses. Factors associated with an increased likelihood of depressive symptoms were: working in the UK (OR = 3.63; CI = [2.90-4.54]; p < 0.001) and USA (OR = 4.10; CI = [3.03-5.54]), p < 0.001); being female (OR = 1.74; CI = [1.42-2.13]; p < 0.001); being a nurse (OR = 1.64; CI = [1.34-2.01]; p < 0.001); and caring for a COVID-19 positive patient who subsequently died (OR = 1.20; CI = [1.01-1.43]; p = 0.040). Workplace factors associated with depressive symptoms were: redeployment to Intensive Care Unit (ICU) (OR = 1.67; CI = [1.14-2.46]; p = 0.009); redeployment with perceived unsatisfactory training (OR = 1.67; CI = [1.32-2.11]; p < 0.001); not being issued with appropriate personal protective equipment (PPE) (OR = 2.49; CI = [2.03-3.04]; p < 0.001); perceived poor workplace support within area/specialty (OR = 2.49; CI = [2.03-3.04]; p < 0.001); and perceived poor mental health support (OR = 1.63; CI = [1.38-1.92]; p < 0.001). CONCLUSION: This is the first international study, demonstrating that workplace factors, including PPE availability, staff training pre-redeployment, and provision of mental health support, are significantly associated with mental health during COVID-19. Governments, policy-makers and other stakeholders need to ensure provision of these to safeguard HCWs' mental health, for future waves and other pandemics.

Alcohol Consumption in China Before and During COVID-19: Preliminary Results From an Online Retrospective Survey.

Background: Alcohol is an important aspect of Chinese culture, and alcohol use has been traditionally accepted in China. People with stress, anxiety, and depression may use more alcohol. More people reported symptoms of anxiety and depression during the outbreak of COVID-19. Thus, people may drink more alcohol during the outbreak of COVID-19 than before COVID-19. Methods: An online retrospective survey was conducted on a total sample of 2,229 participants. Drinking behaviors before and during COVID-19, current risky drinking and hazardous drinking, and the association between high-risk drinking and mental health problems (depression, anxiety, and stress) were assessed via self-reported measures on the Alcohol Use Disorders Identification Test (AUDIT) and the 21-item Depression Anxiety Stress Scales (DASS-21). Results: This study found that, compared with before COVID-19, alcohol consumption was slightly decreased during COVID-19 (from 3.5 drinks to 3.4 drinks, p = 0.035) in the overall sample. Most (78.7%) alcohol drinkers were males. Before and during COVID-19, males consumed more drinks per week (4.2 and 4.0 vs. 1.3 and 1.2 drinks), had a higher percentage of heavy drinking (8.1 and 7.7% vs. 4.4 and 2.7%), and more drinking days per week (2.1 and 2.1 vs. 1.0 and 0.9 days). Males also had more risky drinking (43.2 vs. 9.3%) and hazardous drinking (70.2 vs. 46.6%) than female counterparts. This study also found that high-risk drinking predicted anxiety in females. Conclusions: This study suggests a slight reduction in alcohol consumption during COVID-19. However, hazardous drinking is common, especially among male alcohol drinkers. Males consumed more alcohol, had more risky and hazardous drinking than female counterparts both before and during COVID-19. Public health policy makers should pay more attention to developing effective, population-based strategies to prevent harmful alcohol consumption.

Brief mindfulness-based intervention of 'STOP (Stop, Take a Breath, Observe, Proceed) touching your face': a study protocol of a randomised controlled trial.

INTRODUCTION: Face-touching behaviour often happens frequently and automatically, and poses potential risk for spreading infectious disease. Mindfulness-based interventions (MBIs) have shown its efficacy in the treatment of behaviour disorders. This study aims to evaluate an online mindfulness-based brief intervention skill named 'STOP (Stop, Take a Breath, Observe, Proceed) touching your face' in reducing face-touching behaviour. METHODS AND ANALYSIS: This will be an online-based, randomised, controlled, trial. We will recruit 1000 participants, and will randomise and allocate participants 1:1 to the 'STOP touching your face' (both 750-word text and 5 min audio description by online) intervention group (n=500) and the wait-list control group (n=500). All participants will be asked to monitor and record their face-touching behaviour during a 60 min period before and after the intervention. Primary outcome will be the efficacy of short-term mindfulness-based 'STOP touching your face' intervention for reducing the frequency of face-touching. The secondary outcomes will be percentage of participants touching their faces; the correlation between the psychological traits of mindfulness and face-touching behaviour; and the differences of face-touching behaviour between left-handers and right-handers. Analysis of covariance, regression analysis, χ2 test, t-test, Pearson's correlations will be applied in data analysis. We will recruit 1000 participants from April to July 2020 or until the recruitment process is complete. The follow-up will be completed in July 2020. We expect all trial results to be available by the end of July 2020. ETHICS AND DISSEMINATION: The study protocol has been approved by the Ethics Committee of Sir Run Run Shaw Hospital, an affiliate of Zhejiang University, Medical College (No. 20200401-32). Study results will be disseminated via social media and peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT04330352.