The COVID‐19 pandemic changes citizens' visual aesthetic perceptions and attitudes toward restored landscape in the karst area in China

Landscape change caused by ecological restoration projects in the karst rocky desertification area of southwestern China has presented ecological benefits, yet the visual aesthetic perception of the restored landscape has received less attention. Meanwhile, given the unpredictable worldwide health emergency caused by the COVID‐19 pandemic, it inspired us to be concerned about will citizens' aesthetic perceptions and attitudes to the change of restored landscape from pre‐COVID‐19 to during the outbreak of the COVID‐19 pandemic. Organizing an online survey, we explored citizens' visual aesthetic perceptions and attitudes to natural restored landscape (NRL) and managed restored landscape (MRL) on 757 citizens in Shilin Geopark (in Kunming, China), as well as how citizens' sociocultural backgrounds influence visual aesthetic preference. The results indicated that before the COVID‐19 pandemic, the professionals preferred NRL, while the nonprofessionals presented a higher preference for MRL. However, during the COVID‐19 pandemic, both two groups showed a higher preference for NRL, which implied that the experience of lockdown during the COVID‐19 pandemic might awaken most citizens' preference for the NRL. Among different kinds of restored plant communities, the landscape dominated by shrubs was the most popular. Furthermore, gender, age, career type, education, region, and citizens' visit frequency were significantly correlated with visual aesthetic perceptions before the COVID‐19 pandemic. During the COVID‐19 pandemic, professional background, gender, and age did not show significant impacts on visual aesthetic perceptions anymore. These results highlight the necessity of understanding visual aesthetic perceptions in different sociodemographic groups to encourage natural succession and create a nature‐based restored landscape in the karst area. [ FROM AUTHOR] Copyright of Restoration Ecology is the property of Wiley-Blackwell 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.)

Nirmatrelvir/ritonavir use in patients with COVID-19 on hemodialysis: a case series

Patients undergoing hemodialysis (HD) are particularly vulnerable to coronavirus disease 2019 (COVID-19) and are at increased risk of developing severe infection. However, given the exclusion of such patients from clinical trials, there are limited data regarding the effectiveness of the antiviral drug nirmatrelvir/ritonavir (N/R) in patients on HD. We prescribed N/R to four patients on HD with COVID-19 after obtaining informed consent. Their clinical symptoms were improved at approximately 3 days after N/R administration. The viral load was reduced after approximately 10 days. The main adverse effects were nausea and vomiting. Rational dosage adjustment obtained good tolerance but did not influence the efficacy. These results suggest that N/R may be a promising agent for patients on HD with COVID-19.

Differences in Clinical and Imaging Features between Asymptomatic and Symptomatic COVID-19 Patients.

Objectives: The clinical and imaging features of asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 and symptomatic COVID-19 patients. Methods: The clinical and chest computed tomography imaging data of 47 asymptomatic carriers and 36 symptomatic COVID-19 patients were derived. All patients underwent 4-6 CT scans over a period of 2-5 days. Results: The bulk of asymptomatic carriers who developed symptoms and most of the COVID-19 patients were older than 18 years of age with a decreased lymphocyte count, abnormal hepatic and renal function, and increased D-dimer and C-reactive protein. In the early stage, the pulmonary lesion involved mostly 1-2 lobes at the peripheral area in asymptomatic carriers but more than three lobes at both the central and peripheral areas in COVID-19 patients. In the progression stage, the lesion of asymptomatic carriers extended from the peripheral to the central area, and no significant difference was found in the lesion range compared with the symptomatic control group. In early improvement stage, the lesion was rapidly absorbed, and lesions were located primarily at the peripheral area in asymptomatic carriers; contrastingly, lesions were primarily located at both the central and peripheral areas in symptomatic patients. Asymptomatic carriers reflected a significantly shorter duration from disease onset to peak progression stage compared with the symptomatic. Conclusions: Asymptomatic carriers are a potential source of transmission and may become symptomatic COVID-19 patients despite indicating less severe pulmonary damage, earlier improvement, and better prognosis. Early isolation and intervention can eliminate such carriers as potential sources of transmission and improve their prognosis.

Self-neglect among older adults with disabilities in Liaoning Province during the COVID-19 outbreak: A cross-sectional study.

Background: Self-neglect among older adults is a well-recognized public health issue. During the novel coronavirus disease 2019 (COVID-19), older adults with disabilities may be at increased risk for self-neglect. This study aimed to assess the prevalence of self-neglect and associated factors among older adults with disabilities in Liaoning Province during the COVID-19 outbreak. Methods: A cross-sectional study was conducted from January 2021 to April 2021. A convenience sample of 230 older adults with disabilities filled out questionnaires that collected data on socioeconomic and demographic characteristics alongside data using the Barthel Index (BI), the Elder Self-Neglect Assessment (ESNA), the Geriatric Depression Scale-Short Form (GDS-SF), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Mini-Mental State Examination (MMSE). Results: The overall self-neglect rate was 86%. The study revealed that self-neglect correlates positively with the degree of disability (p < 0.001) and depressive symptoms (p < 0.001). In contrast, monthly income (p = 0.002) and perceived social support (p = 0.001) were negatively associated with self-neglect. Conclusion: During the COVID-19 outbreak, self-neglect has been a serious public health problem among older adults with disabilities. Lower monthly income, decreased physical function, depressive symptoms, and perceptions of poor social support contributed to self-neglect among older adults with disabilities.

The

Landscape change caused by ecological restoration projects in the karst rocky desertification area of southwestern China has presented ecological benefits, yet the visual aesthetic perception of the restored landscape has received less attention. Meanwhile, given the unpredictable worldwide health emergency caused by the COVID-19 pandemic, it inspired us to be concerned about will citizens' aesthetic perceptions and attitudes to the change of restored landscape from pre-COVID-19 to during the outbreak of the COVID-19 pandemic. Organizing an online survey, we explored citizens' visual aesthetic perceptions and attitudes to natural restored landscape (NRL) and managed restored landscape (MRL) on 757 citizens in Shilin Geopark (in Kunming, China), as well as how citizens' sociocultural backgrounds influence visual aesthetic preference. The results indicated that before the COVID-19 pandemic, the professionals preferred NRL, while the nonprofessionals presented a higher preference for MRL. However, during the COVID-19 pandemic, both two groups showed a higher preference for NRL, which implied that the experience of lockdown during the COVID-19 pandemic might awaken most citizens' preference for the NRL. Among different kinds of restored plant communities, the landscape dominated by shrubs was the most popular. Furthermore, gender, age, career type, education, region, and citizens' visit frequency were significantly correlated with visual aesthetic perceptions before the COVID-19 pandemic. During the COVID-19 pandemic, professional background, gender, and age did not show significant impacts on visual aesthetic perceptions anymore. These results highlight the necessity of understanding visual aesthetic perceptions in different sociodemographic groups to encourage natural succession and create a nature-based restored landscape in the karst area.

The COVID‐19 pandemic changes citizens' visual aesthetic perceptions and attitudes toward restored landscape in the karst area in China

Landscape change caused by ecological restoration projects in the karst rocky desertification area of southwestern China has presented ecological benefits, yet the visual aesthetic perception of the restored landscape has received less attention. Meanwhile, given the unpredictable worldwide health emergency caused by the COVID‐19 pandemic, it inspired us to be concerned about will citizens' aesthetic perceptions and attitudes to the change of restored landscape from pre‐COVID‐19 to during the outbreak of the COVID‐19 pandemic. Organizing an online survey, we explored citizens' visual aesthetic perceptions and attitudes to natural restored landscape (NRL) and managed restored landscape (MRL) on 757 citizens in Shilin Geopark (in Kunming, China), as well as how citizens' sociocultural backgrounds influence visual aesthetic preference. The results indicated that before the COVID‐19 pandemic, the professionals preferred NRL, while the nonprofessionals presented a higher preference for MRL. However, during the COVID‐19 pandemic, both two groups showed a higher preference for NRL, which implied that the experience of lockdown during the COVID‐19 pandemic might awaken most citizens' preference for the NRL. Among different kinds of restored plant communities, the landscape dominated by shrubs was the most popular. Furthermore, gender, age, career type, education, region, and citizens' visit frequency were significantly correlated with visual aesthetic perceptions before the COVID‐19 pandemic. During the COVID‐19 pandemic, professional background, gender, and age did not show significant impacts on visual aesthetic perceptions anymore. These results highlight the necessity of understanding visual aesthetic perceptions in different sociodemographic groups to encourage natural succession and create a nature‐based restored landscape in the karst area. [ FROM AUTHOR]

[Analysis of the Characteristics of the Outcomes of Job-Transfer Subspecialty Training Program in Pediatrics in Sichuan].

Objective: To discuss the characteristics of physician trainee outcomes after completion of the job-transfer subspecialty training in pediatrics, a program designed to increase the number of pediatricians, in Sichuan Province and to provide countermeasures for alleviating the shortage of pediatricians. Methods: We collected with questionnaire surveys information on changes in the workload and salaries experienced by physicians who completed the job-transfer subspecialty training program in pediatrics between February 2017 and May 2020 in Sichuan Province. Then, we compared the characteristics of physicians who successful became pediatricians and those who did no. Results: A total of 208 physicians completed the job-transfer subspecialty training program in pediatrics. Among them, 178, accounting for 85.6%, completed the questionnaire survey, and 120, accounting for 67.4%, had a background in other subspecialties than pediatrics. The majority (>90%) of physicians who participated in the training program came from secondary or lower levels of hospitals from the cities and prefectures all over Sichuan Province. In this study, we found that the rate of successful job transfer from being a physician to being a pediatrician in Sichuan Province in the past four years was 85.0% (102/120), with the year-by-year results being 88.2% (15/17) in 2017, 72.7% (16/22) in 2018, 86.7% (39/45) in 2019, and 94.% (32/34) in 2020. There was no significant difference between physicians who had successful job transfer and became pediatricians and those who failed to do so in terms of gender, age, hospital level, specialization prior to the job transfer, whether or not the hospital had a pediatrics department, amount of support for the pediatrics department, whether or not the physician was working at a new hospital after the job transfer, salaries, and changes of responsibilities during COVID-19 (all P>0.05). There was significant difference in the change of workload after completion of the training program between physicians who had successful job transfer and became pediatricians and those who failed to do so ( χ 2=9.037, P=0.003), and 78.4% of the trainees stated that their workload had increased after the job transfer. There was a moderate correlation between successful job transfer and changes in workload after the transfer (|Phi[ψ] |=0.729). Conclusions: The policy of government-supported job-transfer subspecialty training in pediatrics has played an active and important role in the swift resolution of the shortage of pediatricians. However, finding the root cause of and addressing the problem of the overwhelming workload of pediatricians remain challenging issues to be resolved.

Distinct gut microbiota and health outcomes in asymptomatic infection, viral nucleic acid test re-positive, and convalescent COVID-19 cases

Gut microbiota composition is suggested to associate with coronavirus disease 2019 (COVID-19) severity, but the impact of gut microbiota on health outcomes is largely unclear. We recruited 81 individuals from Wuhan, China, including 13 asymptomatic infection cases (Group A), 24 COVID-19 convalescents with adverse outcomes (Group C), 31 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) re-positive cases (Group D), and 13 non-COVID-19 healthy controls (Group H). The microbial features of Groups A and D were similar and exhibited higher gut microbial diversity and more abundant short-chain fatty acid (SCFA)-producing species than Group C. Group C was enriched with opportunistic pathogens and virulence factors related to adhesion and toxin production. The abundance of SCFA-producing species was negatively correlated, while Escherichia coli was positively correlated with adverse outcomes. All three groups (A, C, and D) were enriched with the mucus-degrading species Akkermansia muciniphila, but decreased with Bacteroides-encoded carbohydrate-active enzymes. The pathways of vitamin B6 metabolic and folate biosynthesis were decreased, while selenocompound metabolism was increased in the three groups. Specifically, the secondary bile acid (BA) metabolic pathway was enriched in Group A. Antibiotic resistance genes were common among the three groups. Conclusively, the gut microbiota was related to the health outcomes of COVID-19. Dietary supplementations (SCFAs, BA, selenium, folate, vitamin B6) may be beneficial to COVID-19 patients.

Harmonized-Multinational qEEG norms (HarMNqEEG).

This paper extends frequency domain quantitative electroencephalography (qEEG) methods pursuing higher sensitivity to detect Brain Developmental Disorders. Prior qEEG work lacked integration of cross-spectral information omitting important functional connectivity descriptors. Lack of geographical diversity precluded accounting for site-specific variance, increasing qEEG nuisance variance. We ameliorate these weaknesses. (i) Create lifespan Riemannian multinational qEEG norms for cross-spectral tensors. These norms result from the HarMNqEEG project fostered by the Global Brain Consortium. We calculate the norms with data from 9 countries, 12 devices, and 14 studies, including 1564 subjects. Instead of raw data, only anonymized metadata and EEG cross-spectral tensors were shared. After visual and automatic quality control, developmental equations for the mean and standard deviation of qEEG traditional and Riemannian DPs were calculated using additive mixed-effects models. We demonstrate qEEG "batch effects" and provide methods to calculate harmonized z-scores. (ii) We also show that harmonized Riemannian norms produce z-scores with increased diagnostic accuracy predicting brain dysfunction produced by malnutrition in the first year of life and detecting COVID induced brain dysfunction. (iii) We offer open code and data to calculate different individual z-scores from the HarMNqEEG dataset. These results contribute to developing bias-free, low-cost neuroimaging technologies applicable in various health settings.

Dynamic Imaging Changes of COVID-19 Pneumonia at Different Stages.

INTRODUCTION: To investigate the Computed Tomography (CT) imaging characteristics and dynamic changes of COVID-19 pneumonia at different stages. METHODS: Forty-six patients infected with COVID-19 who had chest CT scans were enrolled, and CT scans were performed 4-6 times with an interval of 2-5 days. RESULTS: At the early stage (n=25), ground glass opacity was presented in 11 patients (11/25 or 44.0 %) and ground glass opacity mixed with consolidation in 13 (13/25 or 52.0 %) in the lung CT images. At the progressive stage (n=38), ground glass opacity was presented in only one patient (1/38 or 2.6 %) and ground glass opacity mixed with consolidation in 33 (33/38 or 86.8 %). In the early improvement stage (n=38), the imaging presentation was ground glass opacity alone in three patients (3/38 or 7.9 %) and ground glass opacity mixed with consolidation in 34 (34/38 or 89.5 %). In the late improvement (absorption) stage (n=33), the primary imaging presentation was ground glass presentation in eight patients (8/33 or 24.2 %) and ground glass opacity mixed with consolidation in 23 (23/33 or 69.7 %). The lesion reached the peak at 4-16 days after disease onset, and 26 (26/38 or 68.4 %) patients reached the disease peak within ten days. Starting from 6 to 20 days after onset, the disease began to be improved, with 30 (30/38 or 78.9 %) patients being improved within 15 days. CONCLUSION: COVID-19 pneumonia will progress to the peak stage at a mediate time of seven days and enter the improvement stage at twelve days. Computed tomography imaging of the pulmonary lesion has a common pattern from disease onset to improvement and recovery and provides important information for evaluation of the disease course and treatment effect.

Evaluation of the quality of COVID-19 prevention and control by a novel comprehensive evaluation model in a tertiary general hospital: a prospective observational study.

BACKGROUND: Prevention and control (P&C) of Corona Virus Disease 2019 (COVID-19) is still a critical task in most countries and regions. However, there are many single evaluation indexes to assess the quality of COVID-19 P&C. It is necessary to synthesize the single evaluation indexes reasonably to obtain the overall evaluation results. METHODS: This study was divided into three steps. Step 1: In February 2020, the improved Delphi method was used to establish the quality evaluation indexes system for COVID-19 P&C. Step 2: in March 2020, the CRITIC method was used to adjust the Order Relation Analysis (G1) method to obtain the subjective and objective (S&O) combination weights. The comprehensive evaluation value was obtained using the weighted Efficacy Coefficient (EC) method, weighted TOPSIS method, weighted rank-sum ratio (RSR) method, and weighted Grey Relationship Analysis (GRA) method. Finally, the linear normalization method was used to synthesize the evaluation values of different evaluation methods. Step 3: From April 2020 to May 2021, this evaluation method was used to monitor and assess COVID-19 P&C quality in critical departments prospectively. The results were reported to the departments monthly. RESULT: A quality evaluation indexes system for COVID-19 P&C was established. Kendall's consistency test shows that the four evaluation method had good consistency (χ2 = 43.429, P<0.001, Kendall's consistency coefficient = 0.835). The Spearman correlation test showed that the correlation between the combined evaluation results and the original method was statistically significant(P < 0.001). According to the Mann-Kendall test, from March 2020 to May 2021, the mean value of COVID-19 P&C quality in all critical departments showed an upward trend (P < 0.01). CONCLUSIONS: The combined comprehensive evaluation method based on the S&O combined weight was more scientific and comprehensive than the single weighting and evaluation methods. In addition, monitoring and feedback of COVID-19 P&C quality were helpful for the improvement of P&C quality.

Physical and mental health outcomes including behavior and attitudes in people having social contacts with COVID-19 patients

The novel coronavirus (COVID-19) infection has spread worldwide since late 2019. People who have social contacts with COVID-19 patients might be at higher risk of physical or mental health problems. This study investigated whether people who had social contacts with COVID-19 patients would have poorer physical or mental outcomes, and different attitudes and behaviors. Chinese adults were recruited to fill in an online survey using snowball sampling during 21st-26nd February 2020. Physical symptoms, psychological outcomes, quality of life, COVID-19 related attitudes, and behaviors were measured. The differences in the outcomes between participants who had COVID-19 social contacts and those who had not were analyzed. The survey included 1,447 non-infected eligible participants. Among those, 173 (12.0%) reported at least one confirmed/suspected case in their social contacts. In the multiple regression adjusted for demographic data, the presence of confirmed/suspected infection cases in one's social contacts was significantly associated with poorer physical and mental outcomes, lower health-related quality of life, and different COVID-19 related attitudes and behaviors (p < 0.05). In conclusion, people who had social contacts with COVID-19 patients were at risk of adverse health outcomes. Future studies are needed to understand the long-term impacts. Similarly, strategies to improve health outcomes for these people are needed.

Self-Ensembling Co-Training Framework for Semi-Supervised COVID-19 CT Segmentation.

The coronavirus disease 2019 (COVID-19) has become a severe worldwide health emergency and is spreading at a rapid rate. Segmentation of COVID lesions from computed tomography (CT) scans is of great importance for supervising disease progression and further clinical treatment. As labeling COVID-19 CT scans is labor-intensive and time-consuming, it is essential to develop a segmentation method based on limited labeled data to conduct this task. In this paper, we propose a self-ensembled co-training framework, which is trained by limited labeled data and large-scale unlabeled data, to automatically extract COVID lesions from CT scans. Specifically, to enrich the diversity of unsupervised information, we build a co-training framework consisting of two collaborative models, in which the two models teach each other during training by using their respective predicted pseudo-labels of unlabeled data. Moreover, to alleviate the adverse impacts of noisy pseudo-labels for each model, we propose a self-ensembling strategy to perform consistency regularization for the up-to-date predictions of unlabeled data, in which the predictions of unlabeled data are gradually ensembled via moving average at the end of every training epoch. We evaluate our framework on a COVID-19 dataset containing 103 CT scans. Experimental results show that our proposed method achieves better performance in the case of only 4 labeled CT scans compared to the state-of-the-art semi-supervised segmentation networks.

Government Regulations to Mitigate the Shortage of Life-Saving Goods in the Face of a Pandemic (preprint)

During a pandemic, it is essential to secure a broad allocation of life-saving goods, such as medical and protective products, to save lives. However, these goods are often in short supply, due to consumer hoarding, insufficient manufacturing capacity and price gouging. Herein, we develop a game-theoretic supply chain model to evaluate the impact of government regulations on the shortage of life-saving goods and profit within the supply chain. Our model considers three types of regulation: (i) price regulation in the form of a price cap, (ii) purchase regulation or demand rationing and (iii) a combination thereof. The most distinguishing feature of our model is that it captures consumer panic buying, insufficient capacity, price surges and controls on the supply and demand side of the supply chain that are widely observed during a pandemic. The results establish reasonably simple prescriptions for policymakers to design effective and easy-to-implement regulations to mitigate shortages of critical supplies in the face of a pandemic.

Low serum calcium and phosphorus and their clinical performance in detecting COVID-19 patients.

BACKGROUND: This study aimed to evaluate the clinical performance of low serum calcium and phosphorus in discriminative diagnosis of the severity of patients with coronavirus disease 2019 (COVID-19). We conducted a single-center hospital-based study and consecutively recruited 122 suspected and 104 confirmed patients with COVID-19 during January 24 to April 25, 2020. Clinical risk factors of COVID-19 were identified. The discriminative power of low calcium and phosphorus regarding the disease severity was evaluated. Low calcium and low phosphorus are more prevalent in severe or critical COVID-19 patients than moderate COVID-19 patients (odds ratio [OR], 15.07; 95% confidence interval [CI], 1.59-143.18 for calcium; OR, 6.90; 95% CI, 2.43-19.64 for phosphorus). The specificity in detecting the severe or critical patients among COVID-19 patients reached 98.5% (95% CI, 92.0%-99.7%) and 84.8% (95% CI, 74.3%-91.6%) by low calcium and low phosphorus, respectively, albeit with suboptimal sensitivity. Calcium and phosphorus combined with lymphocyte count could obtain the best discriminative performance for the severe COVID-19 patients (area under the curve [AUC] = 0.80), and combined with oxygenation index was promising (AUC = 0.71). Similar discriminative performances of low calcium and low phosphorus were found between suspected and confirmed COVID-19 patient. Low calcium and low phosphorus could indicate the severity of COVID-19 patients, and may be utilized as promising clinical biomarkers for discriminative diagnosis.

Federated deep learning for detecting COVID-19 lung abnormalities in CT: a privacy-preserving multinational validation study.

Data privacy mechanisms are essential for rapidly scaling medical training databases to capture the heterogeneity of patient data distributions toward robust and generalizable machine learning systems. In the current COVID-19 pandemic, a major focus of artificial intelligence (AI) is interpreting chest CT, which can be readily used in the assessment and management of the disease. This paper demonstrates the feasibility of a federated learning method for detecting COVID-19 related CT abnormalities with external validation on patients from a multinational study. We recruited 132 patients from seven multinational different centers, with three internal hospitals from Hong Kong for training and testing, and four external, independent datasets from Mainland China and Germany, for validating model generalizability. We also conducted case studies on longitudinal scans for automated estimation of lesion burden for hospitalized COVID-19 patients. We explore the federated learning algorithms to develop a privacy-preserving AI model for COVID-19 medical image diagnosis with good generalization capability on unseen multinational datasets. Federated learning could provide an effective mechanism during pandemics to rapidly develop clinically useful AI across institutions and countries overcoming the burden of central aggregation of large amounts of sensitive data.

Neutralizing and binding antibody kinetics of COVID-19 patients during hospital and convalescent phases (preprint)

Background: Knowledge of host immune response after natural SARS-CoV-2 infection is essential for the direction of vaccination and epidemiological control strategies against COVID-19. Methods: : Thirty-four COVID-19 patients were enrolled with 244 serial blood specimens (38.1% after hospital discharge) collected to explore the chronological evolution of neutralizing (NAb), total (TAb), IgM, IgG and IgA antibody in parallel. Results: : IgG titers reached a peak later (35 days postonset) than those of Nab, Ab, IgM and IgA (25 days postonset). IgM levels declined with an estimated half-life of 35 days postonset, which was more rapid than those of IgA and IgG (73-76 days postonset). All patients remained positive for NAb, IgG and IgA up to 3 months after illness onset. The relative contribution of IgM to NAb was higher than that of IgG (standardized β regression coefficient: 0.53 vs 0.48). However, the relative contribution of IgG to NAb increased and that of IgM further decreased after 6 weeks postonset. Conclusions: : This study suggests that SARS-CoV-2 infection induces robust neutralizing and binding antibody responses in patients. Humoral immunity against SARS-CoV-2 acquired by infection may persist for a relatively long time.