Effective prevention and management of COVID-19 in outpatient hemodialysis patients.

The authors introduce a mobile phone app that may effectively prevent and manage coronavirus disease 2019 (COVID-19) in outpatient hemodialysis patients in Sichuan Province, China.

Digital twin for healthy indoor environment: A vision for the post-pandemic era

Indoor environment has significant impacts on human health as people spend 90% of their time indoors. The COVID-19 pandemic and the increased public health awareness have further elevated the urgency for cultivating and maintaining a healthy indoor environment. The advancement in emerging digital twin technologies including building information modeling (BIM), Internet of Things (IoT), data analytics, and smart control have led to new opportunities for building design and operation. Despite the numerous studies on developing methods for creating digital twins and enabling new functionalities and services in smart building management, very few have focused on the health of indoor environment. There is a critical need for understanding and envisaging how digital twin paradigms can be geared towards healthy indoor environment. Therefore, this study reviews the techniques for developing digital twins and discusses how the techniques can be customized to contribute to public health. Specifically, the current applications of BIM, IoT sensing, data analytics, and smart building control technologies for building digital twins are reviewed, and the knowledge gaps and limitations are discussed to guide future research for improving environmental and occupant health. Moreover, this paper elaborates a vision for future research on integrated digital twins for a healthy indoor environment with special considerations of the above four emerging techniques and issues. This review contributes to the body of knowledge by advocating for the consideration of health in digital twin modeling and smart building services and presenting the research roadmap for digital twin-enabled healthy indoor environment.

Comparison of the prophylactic antithrombotic effect of indobufen and warfarin in patients with nephrotic syndrome: a randomized controlled trial.

PURPOSE: The risk of thromboembolic events is elevated in patients with nephrotic syndrome, and warfarin use has been associated with an increased risk of bleeding. Indobufen, a selective cyclooxygenase-1 inhibitor, is currently being evaluated for the prevention of thromboembolic events in nephrotic syndrome. This study aimed to compare the efficacy and safety of indobufen with that of warfarin in patients with nephrotic syndrome. MATERIALS AND METHODS: This multicenter, randomized, three-arm, open-label, parallel controlled trial involved a total of 180 adult patients with nephrotic syndrome from four centers in China. Patients were randomly assigned to receive 100 mg indobufen (bid), 200 mg indobufen (bid), and 3 mg warfarin (qd) daily for 12 weeks. The primary endpoints included thromboembolic and bleeding events, while laboratory results and adverse events constituted secondary endpoints. RESULTS: No thromboembolic events occurred in the high-/low-dose indobufen and warfarin groups. Moreover, the use of a low dose of indobufen significantly reduced the risk of minor bleeding events compared with warfarin use (2% versus 18%, p < .05). Finally, adverse events were more frequent in warfarin-treated patients. CONCLUSIONS: This study found that indobufen therapy provided equivalent effects in preventing thromboembolic events compared with warfarin therapy, while low dose of indobufen was associated with a reduced risk of bleeding events, thus it should be recommended for the prevention of thromboembolic events in clinical practice in patients with nephrotic syndrome. TRIAL REGISTRATION NUMBER: ChiCTR-IPR-17013428.

Effect of corticosteroids in patients with COVID-19: a Bayesian network meta-analysis.

OBJECTIVES: We sought to perform a network meta-analysis to compare the safety and efficacy of the systemic administration of corticosteroids for the treatment of COVID-19. METHODS: A Bayesian network meta-analysis was performed to combine the direct and indirect evidence. The surface under the cumulative ranking curve was obtained to estimate the ranking probability of the treatment agents for each outcome. The efficacy outcome was 28-day all-cause mortality. The safety outcome was serious adverse events. RESULTS: A total of 16 trials with 2992 patients comparing four treatments (dexamethasone, hydrocortisone, methylprednisolone, and placebo) were identified. Direct analysis showed that corticosteroids were associated with a reduced risk of 28-day mortality compared with usual care (risk ratio [RR] 0.83; 95% confidence interval [CrI] 0.70-0.99). Network analysis showed that the pooled RR was 0.63 (95% CrI 0.39-0.93) for all-cause mortality at 28 days comparing methylprednisolone with usual care or placebo (surface under the cumulative ranking curve: 91%). Our analysis demonstrated that patients who received a low dose of corticosteroids (RR 0.80; 95% CrI 0.70-0.91) and a long course of treatment (RR 0.81; 95% CrI 0.71-0.91) had higher survival rates than patients in the placebo group. CONCLUSION: Administration of corticosteroids was associated with a reduced all-cause mortality at 28 days compared with placebo or usual care. Our analysis also confirmed the mortality benefit associated with low-dose and long-term treatment with corticosteroids.

A paper-based assay for the colorimetric detection of SARS-CoV-2 variants at single-nucleotide resolution.

The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted the need for versatile diagnostic assays that can discriminate among emerging variants of the virus. Here we report the development and performance benchmarking of an inexpensive (approximately US$0.30 per test) assay for the rapid (sample-to-answer time within 30 min) colorimetric detection of SARS-CoV-2 variants. The assay, which we integrated into foldable paper strips, leverages nucleic acid strand-displacement reactions, the thermodynamic energy penalty associated with single-base-pair mismatches and the metal-ion-controlled enzymatic cleavage of urea to amplify the recognition of viral RNAs for the colorimetric readout of changes in pH via a smartphone. For 50 throat swab samples, the assay simultaneously detected the presence of SARS-CoV-2 and mutations specific to the SARS-CoV-2 variants Alpha, Beta and Gamma, with 100% concordance with real-time quantitative polymerase chain reaction and RNA sequencing. Customizable and inexpensive paper-based assays for the detection of viruses and their variants may facilitate viral surveillance.

Reusable Cu2-xS-modified masks with infrared lamp-driven antibacterial and antiviral activity for real-time personal protection.

Disposable surgical masks are widely used by the general public since the onset of the coronavirus outbreak in 2019. However, current surgical masks cannot self-sterilize for reuse or recycling for other purposes, resulting in high economic and environmental costs. To solve these issue, herein we report a novel low-cost surgical mask decorated with copper sulfide (Cu2-xS) nanocrystals for photothermal sterilization in a short time (6 min). With the spun-bonded nonwoven fabrics (SNF) layer from surgical masks as the substrate, Cu2-xS nanocrystals are in-situ grown on their surface with the help of a commercial textile adhesion promoter. The SNF-Cu2-xS layer possesses good hydrophobicity and strong near infrared absorption. Under the irradiation with an infrared baking lamp (IR lamp, 50 mW cm-2), the surface temperature of SNF-Cu2-xS layer on masks can quickly increase to over 78 °C, resulting from the high photothermal effects of Cu2-xS nanocrystals. As a result, the polluted masks exhibit an outstanding antibacterial rate of 99.9999% and 85.4% for the Escherichia coli (E.coli) and Staphylococcus aureus (S. aureus) as well as the inactivation of human coronavirus OC43 (3.18-log10 decay) and influenza A virus A/PR/8/34 (H1N1) (3.93-log10 decay) after 6 min irradiation, and achieve rapid sterilization for reuse and recycling. Therefore, such Cu2-xS-modified masks with IR lamp-driven antibacterial and antiviral activity have great potential for real-time personal protection.

Preparation of hemodialysis centers in fighting against the novel coronavirus disease during the 2019-2020 epidemic: the experience in Sichuan province, China.

BACKGROUND: Dialysis patients are at high risk of being infected by the novel coronavirus. This article aimed to share our experience in preparing hemodialysis centers in fighting against the COVID-19 in Sichuan province. METHODS: To control COVID-19, the Sichuan Renal Disease Quality Control Center (SRDQCC) organized a multidisciplinary team to draft and distribute documents for dialysis centers. The SRDQCC also established an online education system and a registry. A survey was used to assess the resources and the preparation of the dialysis centers. Patients with infected COVID-19 were transferred to the referral hospitals and treated with continuous renal replacement therapy (CRRT) in isolated rooms. RESULTS: All 21 regions in Sichuan province had designated specific referral hospitals for COVID-19. The documents drafted by the SRDQCC were distributed to all dialysis centers. A total of 313 records from the survey showed that 96% (301/313) of the dialysis centers had set up an emergency program based on the relevant documents. Only 39% (121/313) of the centers had emergency isolated room(s) for COVID-19. Also, 22% (68/313) of the centers had their patient(s) moved to other centers. The online system educated medical staff in 87% (271/313) of the centers. The online registry received 329 records. Four cases of COVID-19-infected dialysis patients were reported until March 3rd, 2020. There were no outbreaks of COVID-19 in any dialysis center in Sichuan province. CONCLUSIONS: The experience of dialysis centers in Sichuan province in fighting against COVID-19 is worth sharing. Dialysis centers need to be prepared to cope with infectious epidemics guided by national as well as regional quality control centers or other similar organizations.

"An integrated system, three separated responsibilities", a new fever clinic management model, in prevention and control of novel coronavirus pneumonia.

BACKGROUND: Since December 2019, there have been many new cases of coronavirus pneumonia in Wuhan, Hubei Province, which has gradually spread throughout the country. AIM: To explore our hospital's innovative management system to ensure the efficient operation of fever clinics during the epidemic, since controlling the spread of disease is an important way to prevent and control the epidemic. METHODS: In total, 200 outpatients with fever at our hospital between November 2019 and July 2020 were selected and allocated into two groups. RESULTS: The fever clinic in our hospital operated smoothly, and infection with the novel coronavirus disease (COVID-19) has not been reported in our hospital. Additionally, we did not have any cases of missed diagnosis. The awareness regarding COVID-19 infection sources, transmission routes, early symptoms, and preventive measures was significantly higher in our fever clinic than in those of the pre-management group. CONCLUSION: "An integrated system, three separate responsibilities" ensured the efficient functioning of our fever outpatient clinic and early screening of COVID-19 cases, which effectively curbed the transmission of COVID-19 and hence prevented COVID-19 pneumonia epidemic in our hospital, ultimately achieving the maximum effect of epidemic prevention and control.

Nationwide assessment of energy costs and policies to limit airborne infection risks in U.S. schools

Practices such as improved ventilation and air filtration are being considered by schools to reduce the transmission of Severe Acute Respiratory Syndrome Coronavirus 2 that causes the pandemic of coronavirus disease 2019 (COVID-19). Improved ventilation may significantly increase the energy cost of heating, ventilation, and air conditioning (HVAC), exacerbating financial challenges schools face amidst the worst pandemic in decades. This study evaluated HVAC energy costs for reducing COVID-19 airborne infection risks in 111,485 public and private schools in the U.S. to support decision-making. The average annual HVAC energy cost to maintain the infection risk below 1% for the schools in the U.S. is estimated at $20.1 per square meter or $308.4 per capita with improved ventilation and air filtration, where the private schools have higher costs than the public schools on average. The cost could be reduced by adopting partial online learning. It is also found that additional cost to control infection risk with increased ventilation and air filtration is significantly lower for PK-5 schools than that for middle and high schools in all states, indicating the possibility of remaining in-person instruction for PK-5 schools with necessary governmental assistance. Analyses of school HVAC energy cost to reduce airborne infection risk under different intervention scenarios provide important operational guidelines, financial implications, and policy insights for schools, community stakeholders, and policymakers to keep schools safe during the ongoing pandemic and improve preparedness for epidemics projected in the future.

Impact of building closures during the COVID-19 pandemic on Legionella infection risks.

Prolonged building closures are prevalent during the COVID-19 pandemic, resulting in extreme stagnation in building water systems. High-throughput sequencing analysis revealed significantly increased presence of Legionella due to extreme water stagnation, highlighting elevated exposure risks to Legionella from building water systems during re-opening of previously closed buildings.

Airborne infection risks of SARS-CoV-2 in U.S. schools and impacts of different intervention strategies.

The potential airborne transmission of SARS-CoV-2 has triggered concerns as schools continue to reopen and resume in-person instruction during the current COVID-19 pandemic. It is critical to understand the risks of airborne SARS-CoV-2 transmission under different epidemiological scenarios and operation strategies for schools to make informed decisions to mitigate infection risk. Through scenario-based analysis, this study estimates the airborne infection risk of SARS-CoV-2 in 111,485 U.S. public and private schools and evaluates the impacts of different intervention strategies, including increased ventilation, air filtration, and hybrid learning. Schools in more than 90% of counties exhibit infection risk of higher than 1%, indicating the significance of implementing intervention strategies. Among the considered strategies, air filtration is found to be most effective: the school average infection risk when applying MERV 13 is over 30% less than the risk levels correlating with the use of increased ventilation and hybrid learning strategies, respectively. For most schools, it is necessary to adopt combined intervention strategies to ensure the infection risk below 1%. The results provide insights into airborne infection risk in schools under various scenarios and may guide schools and policymakers in developing effective operations strategies to maintain environmental health.

Role of Th22 Cells in Human Viral Diseases.

Naive CD4+ T cells can differentiate into different cell subsets after receiving antigen stimulation, which secrete corresponding characteristic cytokines and thereby exert biological effects in various diseases. Th22 cells, a novel subset of CD4+ T cells, are different from Th1, Th2, Th17, and Treg cell subsets, which have been discovered in recent years. They can express CCR4, CCR6, and CCR10 molecules and secrete IL-22, IL-13, and TNF-α. They are not able to secrete IL-17, IL-4, and interferon-γ (IFN-γ). IL-22 is considered as a major effector molecule of Th22 cells whose functions and mechanisms of regulating cell differentiation have been constantly improved. In this review, we provide an overview of the origin, differentiation of Th22 cells. Moreover, we also describe the interrelationships between Th22 cells and Th17, Th1, and Th2 cells. Additionally, the role of Th22 cells were discussed in human diseases with virus infection, which will provide novel insight for the prevention and treatment of viral infection in human.

Intention to COVID-19 vaccination and associated factors among health care workers: A systematic review and meta-analysis of cross-sectional studies.

OBJECTIVES: To gain insight into willingness and its influencing factors to vaccinate against COVID-19 among health care workers (HCWs), and provide a scientific basis for more reasonable epidemic prevention and control strategies. METHODS: A comprehensive literature search was conducted in 4 English databases (PubMed, EMBASE, Web of Science and the Cochrane Library) and 4 Chinese databases (Chinese National Knowledge Infrastructure (CNKI), the Chongqing VIP Chinese Science (VIP), Wanfang Database and China Biomedical Literature Database (CBM)) to collect the related studies. Quality evaluation was carried out for papers meeting the inclusion criteria using 6 items from the Downs and Black assessment checklist. The STATA statistical software version 15.1 was hired to perform meta-analysis. RESULTS: Nine records with a total of 24,952 subjects were included in this meta-analysis. The results of this meta-analysis revealed that the pooled effect value of COVID-19 vaccination willingness among HCWs using a random-effects model was 51% (95% confidence interval (CI) 0.41-0.62). Male, aged 30 years or older, having a history of prior influenza vaccination were facilitators for HCWs' intention to vaccinate against COVID-19 (odds ratio (OR) 1.82, 95% CI 1.37-2.41, P = .000, I2 = 59.4%; OR 1.32, 95% CI 1.16-1.51, P = .000, I2 = 31.7%; OR 2.97, 95% CI 1.82-4.84, P = .000, I2 = 88.1%). The impact of occupation on HCWs' intention to get vaccinated could not yet be definitively confirmed (OR 0.85, 95% CI 0.69-1.06, P = .160, I2 = 85.5%). CONCLUSION: COVID-19 vaccination acceptance of HCWs was at moderate level. Strengthening awareness of COVID-19 vaccine among HCWs, particularly female HCWs under 30 years who have no history of prior influenza vaccination, is crucial to eliminate concerns about vaccination and promote the application of COVID-19 vaccine in this population.

Highlighted Prospects of an IgM/IgG Antibodies Test in Identifying Individuals With Asymptomatic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.

CONTEXT.­: Covert severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections could be seeding new outbreaks. How to identify asymptomatic SARS-CoV-2 infections early has become a global focus. OBJECTIVE.­: To explore the roles of immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies detection, nucleic acid tests, and computed tomography (CT) scanning to identify asymptomatic SARS-CoV-2 infection. DESIGN.­: The clinical data of 389 individuals with close contacts, including in general characteristics, SARS-CoV-2 etiology, serum-specific IgM and IgG antibody detection and CT imaging results, were systematically analyzed. RESULTS.­: The present study showed that only 89 of 389 individuals with close contacts were positive after the first nucleic acid test, while 300 individuals were still negative after 2 nucleic acid tests. Among the 300 individuals, 75 did not have pneumonia, and the other 225 individuals had pulmonary imaging changes. A total of 143 individuals were eventually diagnosed as having asymptomatic infection through IgM antibody and IgG antibody detection. The sensitivity, specificity, and false-negative rate of IgM and IgG antibody detection were approximately 97.1% (347 of 357), 95.3% (204 of 214), and 4.67% (10 of 214), respectively. It also indicated that during approximately 2 weeks, most individuals were both IgM positive and IgG positive, accounting for 68.57% (72 of 105). During approximately 3 weeks, the proportion of IgM-positive and IgG-positive individuals decreased to 8.57% (9 of 105), and the proportion of IgM-negative and IgG-positive individuals increased to 76.19% (80 of 105). CONCLUSIONS.­: There are highlighted prospects of IgM/IgG antibody detection as a preferred method in identifying the individuals with asymptomatic SARS-CoV-2 infection, especially combined with nucleic acid tests and pulmonary CT scanning.

Mortality in chronic kidney disease patients with COVID-19: a systematic review and meta-analysis.

At the beginning of 2020, the outbreak of coronavirus disease 2019 (COVID-19) led to a worldwide pandemic and mass panic. The number of infected people has been increasing exponentially since, and the mortality rate has also been concomitantly increasing. At present, no study has summarized the mortality risk of COVID-19 in patients with chronic kidney disease (CKD). Therefore, the aim of the present study was to conduct a literature review and meta-analysis to understand the frequency of mortality among CKD patients infected with COVID-19. A comprehensive systematic search was conducted on the PubMed, Embase, and Cochrane databases to find articles published until May 15, 2020. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. After careful screening based on the inclusion and exclusion criteria, 3,867,367 patients from 12 studies were included. The mortality rate was significantly higher among CKD patients with COVID-19 infection than among CKD patients without COVID-19 infection, as indicated by a pooled OR of 5.81 (95% CI 3.78-8.94, P < 0.00001, I2 = 30%). The patients were then stratified into ≥ 70 and < 70 years, and subgroup analysis revealed that among CKD patients with COVID-19 infection, the mortality rate was higher in the < 70 years group (OR 8.69, 95% CI 7.56-9.97, P < 0.0001) than in the ≥ 70 years group (OR 2.44, 95% CI 0.75-6.63, P = 0.15). Thus, COVID-19 patients with CKD have a high mortality risk and require a comprehensive multidisciplinary management strategy.

Understanding building-occupant-microbiome interactions toward healthy built environments: A review.

Built environments, occupants, and microbiomes constitute a system of ecosystems with extensive interactions that impact one another. Understanding the interactions between these systems is essential to develop strategies for effective management of the built environment and its inhabitants to enhance public health and well-being. Numerous studies have been conducted to characterize the microbiomes of the built environment. This review summarizes current progress in understanding the interactions between attributes of built environments and occupant behaviors that shape the structure and dynamics of indoor microbial communities. In addition, this review also discusses the challenges and future research needs in the field of microbiomes of the built environment that necessitate research beyond the basic characterization of microbiomes in order to gain an understanding of the causal mechanisms between the built environment, occupants, and microbiomes, which will provide a knowledge base for the development of transformative intervention strategies toward healthy built environments. The pressing need to control the transmission of SARS-CoV-2 in indoor environments highlights the urgency and significance of understanding the complex interactions between the built environment, occupants, and microbiomes, which is the focus of this review.

Integrated environment-occupant-pathogen information modeling to assess and communicate room-level outbreak risks of infectious diseases.

Microbial pathogen transmission within built environments is a main public health concern. The pandemic of coronavirus disease 2019 (COVID-19) adds to the urgency of developing effective means to reduce pathogen transmission in mass-gathering public buildings such as schools, hospitals, and airports. To inform occupants and guide facility managers to prevent and respond to infectious disease outbreaks, this study proposed a framework to assess room-level outbreak risks in buildings by modeling built environment characteristics, occupancy information, and pathogen transmission. Building information modeling (BIM) is exploited to automatically retrieve building parameters and possible occupant interactions that are relevant to pathogen transmission. The extracted information is fed into an environment pathogen transmission model to derive the basic reproduction numbers for different pathogens, which serve as proxies of outbreak potentials in rooms. A web-based system is developed to provide timely information regarding outbreak risks to occupants and facility managers. The efficacy of the proposed method was demonstrated by a case study, in which building characteristics, occupancy schedules, pathogen parameters, as well as hygiene and cleaning practices are considered for outbreak risk assessment. This study contributes to the body of knowledge by computationally integrating building, occupant, and pathogen information modeling for infectious disease outbreak assessment, and communicating actionable information for built environment management.

Impacts of carbon-based nanomaterials on nutrient removal in constructed wetlands: Microbial community structure, enzyme activities, and metabolism process

The increasing use of raw carbon-based nanomaterials (CBNs) will inevitably affect wastewater treatment systems. Constructed wetlands (CWs) are ecological wastewater treatment facilities and can intercept the vast particles pollutant, including CBNs. However, the impacts of CBNs on the treatment performance of CWs have no available knowledge. Therefore, we systematically inspected the effects of single-walled and multi-walled carbon nanotubes (SWCNTs and MWCNTs) and fullerene nanoparticles (C60) on CW performance under 180-day exposure to 0, 10 and 1000 µg/L concentrations. The results showed that CBNs had marginally adverse impacts on chemical oxygen demand (COD) and total phosphorus (TP) removal, whereas nitrogen removal declined by 24.1 %-42.7 % following long-term exposure to CBNs. MWCNTs had the greatest inhibition effect on nitrogen removal, followed by SWCNTs and C60. The CBNs also induced reactive oxygen species (ROS) overproduction as the increasing concentration, which confirmed that CBNs have biotoxic effects in CWs. The variation of functional microbial community and the inhibition of enzyme activities were the dominant reasons for the decline in nitrogen removal efficiency. Furthermore, predictive functional profiling showed that CBNs affected functional gene abundance, and caused a decline in the enzymes abundance connected to nitrogen removal by the end of the 180-day exposure period.

Segmenting areas of potential contamination for adaptive robotic disinfection in built environments.

Mass-gathering built environments such as hospitals, schools, and airports can become hot spots for pathogen transmission and exposure. Disinfection is critical for reducing infection risks and preventing outbreaks of infectious diseases. However, cleaning and disinfection are labor-intensive, time-consuming, and health-undermining, particularly during the pandemic of the coronavirus disease in 2019. To address the challenge, a novel framework is proposed in this study to enable robotic disinfection in built environments to reduce pathogen transmission and exposure. First, a simultaneous localization and mapping technique is exploited for robot navigation in built environments. Second, a deep-learning method is developed to segment and map areas of potential contamination in three dimensions based on the object affordance concept. Third, with short-wavelength ultraviolet light, the trajectories of robotic disinfection are generated to adapt to the geometries of areas of potential contamination to ensure complete and safe disinfection. Both simulations and physical experiments were conducted to validate the proposed methods, which demonstrated the feasibility of intelligent robotic disinfection and highlighted the applicability in mass-gathering built environments.