The Ethics of Implementing Emergency Resource Allocation Protocols.

AbstractWe explore the various ethical challenges that arise during the practical implementation of an emergency resource allocation protocol. We argue that to implement an allocation plan in a crisis, a hospital system must complete five tasks: (1) formulate a set of general principles for allocation, (2) apply those principles to the disease at hand to create a concrete protocol, (3) collect the data required to apply the protocol, (4) construct a system to implement triage decisions with those data, and (5) create a system for managing the consequences of implementing the protocol, including the effects on those who must carry out the plan, the medical staff, and the general public. Here we illustrate the complexities of each task and provide tentative solutions, by describing the experiences of the Coronavirus Ethics Response Group, an interdisciplinary team formed to address the ethical issues in pandemic resource planning at the University of Rochester Medical Center. While the plan was never put into operation, the process of preparing for emergency implementation exposed ethical issues that require attention.

On the peptide binding affinity changes in population-specific HLA repertoires to the SARS-CoV-2 variants Delta and Omicron.

OBJECTIVE: To investigate the changes of Spike protein-HLA binding affinity profiles between the Wuhan strain and two dominant variants, the Delta and the Omicron strains, among the Taiwanese, the British and the Russian populations. METHODS: The HLA frequencies and the HLA-peptide binding affinity profiles in the T-CoV database were combined to conduct the study. We focused on the public alleles in the three populations (HLA-A, HLA-B, HLA-C, HLA-DRB1, and/or HLA-DPA1/DPB1 alleles) and the altered peptides of the spike protein (compared to the Wuhan strain) in the Delta G/478K·V1 (B.1.617.2 + AY.1 + AY.2) and the Omicron (BA.1) strains. RESULTS: For the Delta strain, tight bindings of the altered peptides to the HLA alleles decrease in all three populations and almost vanish in the Taiwanese population. For the Omicron strain, tight bindings are mostly preserved for both HLA classes and in the Taiwanese and the British populations, with a slight reduction in HLA class II in the Taiwanese (1.4%), while the Russian population preserves a relatively high fraction of tight bindings for both HLA classes. CONCLUSION: We comprehensively reported the changes in the HLA-associated SARS-CoV-2 Spike protein peptide binding profiles among the Taiwanese, the British, and the Russian populations. Further studies are needed to understand the immunological mechanisms and the clinical value of our findings.

Effects of worries about hospital treatments or follow-up appointments during COVID-19 pandemic on supportive care needs in cancer patients (preprint)

Purpose With the basic characteristics of cancer patients as an independent variable and anxieties over hospital admission for medical treatment or follow-up appointments after the outbreak of COVID-19 as a moderator, this study explored how the two variables affected the supportive care needs of cancer patients.Methods In this cross-sectional study, 135 hospitalized patients in oncology wards were recruited from a teaching hospital in Taiwan from August 2021 to December 2021. Research tools used to complete our survey included general patient information sheets, patient characteristics, a survey on the impact of COVID-19, and the Supportive Care Needs Survey-short form.Results That 83 participants (61.5%) were worried about visiting hospitals for cancer treatment or follow-up appointments during the COVID-19 pandemic. Multiple regression results revealed that an interaction occurred depending on marital status when the health system and information needs of patients had an effect on their worries about visiting hospitals for cancer treatment or follow-up appointments (B = 4.45, p = .015). An interaction also occurred depending on marital status when the sexual needs of patients had an effect on their worries about hospital treatment or follow-up appointments (B = 11.95, p = .006). An interaction occurred depending on the stage of cancer when the physical and daily living needs of patients exerted an effect on their worries about going to hospital for cancer treatment or follow-up appointments (B = 7.80, p = .002).Conclusion The relationship between the basic characteristics and supportive care needs of patients can change owing to their worries about hospital treatments or follow-up appointments during the COVID-19 pandemic.

Teaching Evolution: The Use of Social Networking Sites

Online schooling has been adopted worldwide due to the COVID-19 pandemic. During quarantine, people go online for all kind of purposes, especially for amusement such as via social networking sites (SNSs). This study examined university physical education (PE) students’SNSs usage intention using the Unified Theory of Acceptance and Use of Technology model II (UTAUT2) in Taiwan. Research respondents were selected from PE departments of 19 universities through purposive sampling method. A total of 707 questionnaires were collected, with a returning rate of 93%. Using Warp PLS 7.0 as the main instrument for data analysis, this research finds that performance expectancy, facilitating conditions, hedonic motivation, price value, and habit within the UTAUT2 model have significant positive effects on students’intention to use social networking sites, and the model explains 63.4% of the variance in their intention to use SNSs. Among those variables, hedonic motivation had the highest impact (β= 0.24). Moreover, intention, facilitating conditions and habit have significant positive effects on students’use of social networking sites, and the model explains 13.4% of the variance in their use of social networking sites. The moderating effects of gender, age and experience are found in some path analyses. These findings provide future university instructors a with better understanding of students using SNSs. We thus recommend for university PE instructors to create interesting and pleasant classroom learning experiences to attract students’attention, and recommend that they may even manage a SNS as an aid for teaching to enhance students’interests in learning.

The Disparity of Culture Vicissitudes in Happiness, Mental Health and Parental Bonding During Coronavirus Disease 2019 between Changchun and Taiwan (preprint)

Background: The consequence of quarantine might have increased the emotional distress during the period of COVID-19 pandemic. Parental bonding plays an important role in the developing of emotional problems. Hence, this study tried to compare the difference of parental bonding in the developing of mental distress during the COVID-19 pandemic in Changchun of China and Taiwan.Methods: Total of 191 healthcare workers in Changchun area of China, and 458 healthcare workers in Taiwan, including 374 healthcare workers in two general hospitals and 84 in psychiatric center were recruited in this study.Findings: The findings showed that the healthcare workers tend to have more maternal affectionate constraint features in Changchun, compared to those with more maternal affectionless control features in Taiwan. Linear regression analysis showed the maternal affectionate constraint have contributed to the developing of mental health problems, and maternal affectionate constraint and maternal optimal bonding to developing of happiness in Changchun; comparing gender, hospital type and maternal optimal bonding have impact to the developing of mental health problems, and age, gender, hospital type, paternal optimal bonding and maternal affectionless control to the developing of happiness in Taiwan. SEM model also verified better mental health and maternal affectionate constraint have mainly contributed to the developing of happiness in Changchun.Interpretation: In conclusion, Changchun and Taiwan presented different kinds of parental bonding. Even in different culture vicissitudes, the maternal caring seems to be the unique contributing factor in developing of mental health problem and happiness, whether in Changchun or Taiwan, and, whether in 2003 SARS or 2020 COVID-19 pandemic. The results of the study may provide the references to policy-maker and prevention programs in the community. Further larger sample size with follow-up studies have to be considered to verify the role of parental bonding in the developing of resilience, emotional distress and suicidal ideation.Funding: None to declare. Declaration of Interest: None to declare. Ethical Approval: The Institutional Review Board of the Kaohsiung Armed Forces General Hospital in Taiwan approved the study (KAFGHIRB 108-037).

Seroprevalence of SARS-CoV-2 Infection in Cincinnati Ohio USA from August to December 2020 (preprint)

The world is currently in a pandemic of COVID-19 (Coronavirus disease-2019) caused by a novel positive-sense, single-stranded RNA {beta}-coronavirus referred to as SARS-CoV-2. Fortunately, most infected individuals recover and are then resistant to re-infection for a period, indicating that a vaccination approach can be successful. Elucidation of rates of past SARS-CoV-2 infection within select regions across the United States of America (USA) will help direct vaccination efforts and together will inform our approach towards achieving herd immunity. Here we investigated rates of SARS-CoV-2 infection in the greater Cincinnati, Ohio, USA metropolitan area from August to December 2020, just prior to initiation of the national vaccination program. Examination of 9,550 adult blood donor volunteers for serum IgG antibody positivity against the SARS-CoV-2 Spike protein showed an overall prevalence of 8.40%, measured as 7.56% in the first 58 days of this time frame, versus a significant increase to 9.24% in the last 58 days, and a final rate of 12.86% in December 2020. Approximately 56% of Spike seropositive individuals also had immunoreactivity against the receptor binding domain (RBD) within the Spike protein, which is associated with viral neutralization. Males and females in the Cincinnati area showed nearly identical rates of past infection, and rates among Hispanics, African Americans and Caucasians were not significantly different. Interestingly, donors under 30 years of age had the highest rates of past infection, while those over 60 had the lowest. Geographic analysis showed that the West side of Cincinnati had a rate of 9.63% versus 8.13% on the East side (demarcated by Interstate-75), while the adjoining area of Kentucky was 7.04% (as demarcated by the Ohio River). These results among healthy blood donors will be critical in calculating the time needed to achieve regional herd immunity in conjunction with the national vaccination campaign.

Transcriptome network analyses in human coronavirus infections suggest a rational use of immunomodulatory drugs for COVID-19 therapy.

The recent outbreak of coronavirus disease 2019 (COVID-19) by SARS-CoV-2 has led to uptodate 24.3 M cases and 0.8 M deaths. It is thus in urgent need to rationalize potential therapeutic targets against the progression of diseases. An effective, feasible way is to use the pre-existing ΔORF6 mutant of SARS-CoV as a surrogate for SARS-CoV-2, since both lack the moiety responsible for interferon antagonistic effects. By analyzing temporal profiles of upregulated genes in ΔORF6-infected Calu-3 cells, we prioritized 55 genes and 238 ligands to reposition currently available medications for COVID-19 therapy. Eight of them are already in clinical trials, including dexamethasone, ritonavir, baricitinib, tofacitinib, naproxen, budesonide, ciclesonide and formoterol. We also pinpointed 16 drug groups from the Anatomical Therapeutic Chemical classification system, with the potential to mitigate symptoms of SARS-CoV-2 infection and thus to be repositioned for COVID-19 therapy.

Federated Learning used for predicting outcomes in SARS-COV-2 patients (preprint)

‘Federated Learning’ (FL) is a method to train Artificial Intelligence (AI) models with data from multiple sources while maintaining anonymity of the data thus removing many barriers to data sharing. During the SARS-COV-2 pandemic, 20 institutes collaborated on a healthcare FL study to predict future oxygen requirements of infected patients using inputs of vital signs, laboratory data, and chest x-rays, constituting the “EXAM” (EMR CXR AI Model) model. EXAM achieved an average Area Under the Curve (AUC) of over 0.92, an average improvement of 16%, and a 38% increase in generalisability over local models. The FL paradigm was successfully applied to facilitate a rapid data science collaboration without data exchange, resulting in a model that generalised across heterogeneous, unharmonized datasets. This provided the broader healthcare community with a validated model to respond to COVID-19 challenges, as well as set the stage for broader use of FL in healthcare.