The Continuous Use Intention for the Online Learning of Chinese Vocational Students in the Post-Epidemic Era: The Extended Technology Acceptance Model and Expectation Confirmation Theory

In an attempt to prevent and control the outbreak of COVID-19, education systems worldwide have comprehensively implemented online courses to fulfill the educational goal of the suspension of classes without suspending school. Numerous online courses have been developed under these circumstances. From the perspective of sustainable development goals, these online courses should be continued. However, as the epidemic gradually eases, it is questionable whether or not students will still willingly participate in these courses. The method of teaching is a critical issue for schools to decide. Compared with other related educational research, the research on the vocational education system is still limited. To expand the understanding of this topic, this study adopted snowball sampling and invited students from Chinese vocational colleges to fill in a questionnaire to help understand the perceptions that affect students' expectations, attitudes, perceived effects, and satisfaction and the persistence of online learning. A total of 819 valid questionnaires were retrieved, with an effective questionnaire response rate of 81.9%. Meanwhile, under the framework of Expectation Confirmation Theory (ECT) and the Technology Acceptance Model (TAM), this study extended the theoretical model and proposed a sustainable model. The results of this study showed the following: 1. Expectancy belief and online learning attitudes had a positive impact on perceived ease of use and usefulness;2. Perceived ease of use had a negative impact on practical class satisfaction but a positive impact on theoretical class satisfaction and perceived usefulness;3. Perceived usefulness had a negative impact on practical course satisfaction but a positive impact on theoretical course satisfaction;and 4. Both types of course satisfaction had a positive impact on continuous use intentions for learning.

6 month serologic response to the Pfizer-BioNTech COVID-19 vaccine among healthcare workers.

AIM: Healthcare workers (HCWs) were among the first group of people vaccinated with the Pfizer-BioNTech Covid-19 vaccine (BNT162b2). Characterization of the kinetics of antibody response to vaccination is important to devise future vaccination strategies. To better characterize the antibody response to BNT162b2, we analyzed the kinetics of IgG and IgM antibody response to 5 different SARS-CoV-2 epitopes over a period of 6 months. METHODS AND RESULTS: An observational single-centered study was conducted to evaluate the temporal dynamics of anti-SARS-CoV-2 antibodies following immunization with two doses of BNT162b2. Anti-SARS-CoV-2 antibodies were assessed using the Maverick SARS-CoV-2 multi-antigen panel (Genalyte Inc.). Healthcare workers aged ≥18 receiving BNT162b2 vaccination who self-reported no prior symptoms of COVID-19 nor prior COVID-19 PCR test positivity, were included in this study. HCWs developed an IgG antibody response to SARS-CoV-2 Spike S1, Spike S1 receptor binding domain (RBD), Spike S1S2 and Spike S2 after vaccination. IgG response was observed at two weeks following immunization in most participant samples and continued to increase at week 4, but subsequently decreased significantly starting at 3 months and up to 6 months. In contrast, IgM response to respective epitopes was minimal. CONCLUSION: Multiplex results demonstrate that, contrary to natural infection, immunization with BNT162b2 produces minimal anti-Spike IgM response. Polyclonal IgG response to Spike declined at 3 months and continued to do so up to 6 months.

Enabling Blockchain Based SCM Systems with a Real Time Event Monitoring Function for Preemptive Risk Management

The risk of supply chain disruption is usually related to daily disturbances in supply chain operations (e.g., demand fluctuations) and some emergency risks, such as earthquakes and epidemic outbreaks. During a crisis, companies need agility to quickly find new suppliers and open auxiliary sales channels to meet customer needs and remain competitive. However, identifying “event” is one of the most difficult challenges of current decision support systems. If the system encounters an emergency, it is usually unable to promptly notify users of the warning to avoid risks. A sensible solution is to incorporate the real-time event-monitoring system into SCM (i.e., supply chain management) in order to share emergency information in the early stage for preemptive management in the supply chain. On the other hand, in order to process confidential supply chain data with other members, the SCM infrastructure requires secure data sharing. The blockchain-based SCM system can improve the transparency of traceability to ensure that the supply chain system provides high-quality products and protects data privacy and security. The view is taken;therefore, in this work, we combined a method of real-time event detection using collected Twitter data and blockchain technology for event monitoring to improve the visibility of the supply chain system and take preemptive measures for risk avoidance. The experiments show some interesting results and potentials for future work in the field of the agile supply chain.

An observational study of hospitalized COVID-19 patients with cancer in San Diego county.

Aim: To delineate clinical correlates of COVID-19 infection severity in hospitalized patients with malignancy. Methods: The authors conducted a retrospective review of all hospitalized patients with a hematologic and/or solid tumor malignancy presenting to the authors' institution between 1 March 2020 and 5 January 2021, with a laboratory confirmed diagnosis of COVID-19. Univariate and multivariate logistic regression analyses were used to determine associations between specific severity outcomes and clinical characteristics. Results: Among 2771 hospitalized patients with COVID-19, 246 (8.88%) met inclusion criteria. Patients who were actively receiving treatment had an increased rate of death following admission (odds ratio [OR]: 2.7). After adjusting for significant covariates, the odds ratio increased to 4.4. Patients with cancer involvement of the lungs had a trend toward increased odds of death after adjusting for covariates (OR: 2.3). Conclusions: Among COVID-19 positive hospitalized cancer patients, systemic anti-cancer therapy was associated with significantly increased odds of mortality.

Plain language summary Though cancer is a biologically heterogenous disease with a wide spectrum of clinical features and behavior, accumulating evidence suggests that cancer patients are at greater susceptibility to COVID-19 infection and more likely to experience morbidity and mortality from COVID-19 infection than non-cancer patients. In this study, the authors reviewed the clinical characteristics of patients with a diagnosis of cancer hospitalized with COVID-19 to assess potential correlates of COVID-19 severity in this population. Notably, analysis of the hospital data revealed a statistically significant increased incidence of mortality in cancer patients who were receiving systemic anti-cancer treatment, including chemotherapy, immunotherapy or targeted therapy, than in those not on therapy. Likewise, there was a trend toward increased mortality in those with either primary or metastatic tumor involvement of the lung compared with those without lung involvement.

Evaluation of the Safety and Immunogenicity of Different COVID-19 Vaccine Combinations in Healthy Individuals: Study Protocol for a Randomized, Subject-blinded, Controlled Phase 3 Trial [PRIBIVAC] (preprint)

Trials guidance: The Abstract should not exceed 350 words. Please minimize the use of abbreviations and do not cite references in the abstract. The abstract must include the following separate sections:• Background: Over 2021, COVID-19 vaccination programs worldwide focused on raising population immunity through the primary COVID-19 vaccine series. In Singapore two mRNA vaccines (BNT162b2 and mRNA-1273) and the inactivated vaccine CoronaVac are currently authorized under the National Vaccination Programme for use as the primary vaccination series. More than 90% of the Singapore population has received at least one dose of a COVID-19 vaccine as of December 2021. With the demonstration that vaccine effectiveness wanes in the months after vaccination, and the emergence of Omicron which evades host immunity from prior infection and/or vaccination, attention in many countries has shifted to how best to maintain immunity through booster vaccinations. • Methods: The objectives of this phase 3, randomized, subject-blinded, controlled clinical trial are to assess the safety and immunogenicity of heterologous boost COVID-19 vaccine regimens (intervention groups 1-4) compared with a homologous boost regimen (control arm) in up to 600 adult volunteers. As non-mRNA vaccine candidates may enter the study at different time points depending on vaccine availability and local regulatory approval, participants will be randomized at equal probability to the available intervention arms at the time of randomization. Eligible participants will have received two doses of a homologous mRNA vaccine series with BNT162b2 or mRNA-1273 at least six months prior to enrolment. Participants will be excluded if they have a history of confirmed SARS or SARS-CoV-2 infection, are immunocompromised or pregnant. Participants will be monitored for adverse events and serious adverse events by physical examinations, laboratory tests and self-reporting. Blood samples will be collected at serial time points [Pre-vaccination/screening (Day -14 to Day 0), Day 7, Day 28, Day 180, Day 360 post-vaccination] for assessment of antibody and cellular immune parameters. Primary endpoint is the level of anti-SARS-CoV-2 spike immunoglobulins at Day 28 post-booster, and will be measured against wildtype SARS-CoV-2 and variants of concern. Comprehensive immune profiling of the humoral and cellular immune response to vaccination will be performed. • Discussion: This study will provide necessary data to understand the quantity, quality and persistence of the immune response to homologous and heterologous third booster dose of COVID-19 vaccines. This an important step in developing COVID-19 vaccination programs beyond the primary series. Trial registration: ClinicalTrials.gov NCT05142319, registered on 2 Dec 2021.

Efficacy And Feasibility of Telephone-Delivered Educational Intervention in Knowledge Transfer of COVID-19 Related Information to Elderly in Hong Kong: A Pilot Study (preprint)

Background: Educational interventions were necessary to clarify COVID-19 related misconceptions among Hong Kong older adults. Yet, face-to-face interventions were infeasible under the pandemic. The primary objective of the present study was to evaluate the efficacy of a healthcare student-led, telephone-delivered intervention in educating older adults on COVID-19 related health topics. Feasibility, satisfaction level in subjects and impacts on volunteer students of the intervention were also explored. Methods: Subjects aged 65 or above were recruited from a community center in Yuen Long, Hong Kong. The telephone-delivered intervention consisted of 5 phone call sessions conducted by student volunteers. The first four sessions included pre-tests covering three COVID-19 related health topics. Standardized explanations were offered to all subjects during phone call. In the last session, post-tests on all themes were conducted. Paired t-test and McNemar’s test were used to measure the efficacy of intervention based on the differences in pre-tests and post-tests scores. The level of significance was 0.05. Subject satisfaction surveys and student feedback surveys were analyzed. This was a longitudinal study with no control group. Results: Twenty-five subjects were recruited. Paired t-test results showed statistically significant improvement in test scores for all themes: from 76.0% to 95.3% (p<0.01) on Medication Safety, from 64.0% to 88.9% (p<0.01) on Healthcare Voucher, and from 78.0% to 93.0% (p<0.01) on COVID-19 Myth busting. McNemar’s test results showed an increase in correct rate for all questions. However, the improvement was not statistically significant in 65% of the questions due to small sample size and ceiling effect. Most subjects were satisfied with the program and improvement in mood after the program were reported. Student feedback survey suggested that the intervention enhanced students’ communication skills and understanding about older adults in Hong Kong. Conclusion: Our pilot study offered initial evidence to suggest the efficacy and feasibility of telephone-delivered educational intervention in educating Hong Kong older adults and its benefits on student volunteers. Future studies should include a larger sample size and evaluate the ability of phone calls in improving subjects’ mental well-being.

Clinical and Virological Features of SARS-CoV-2 Variants of Concern: A Retrospective Cohort Study Comparing B.1.1.7 (Alpha), B.1.315 (Beta), and B.1.617.2 (Delta) (preprint)

Background: The impact of SARS-CoV-2 variants of concern (VOCs) on disease severity is unclear. In this retrospective cohort study, we compared outcomes of patients infected with B.1.1.7, B.1.351, and B.1.617.2 with those with wild-type strains from early 2020.Methods: National surveillance data from 1-January-2021 to 22-May-2021 were obtained from the Ministry of Health, and outcomes in relation to VOC were explored. Detailed patient level data from all SARS-CoV-2 patients with VOC infection admitted to our centre between 20-December-2020 and 12-May-2021 were analysed. Outcomes were compared with a cohort of 846 patients admitted January-April 2020.Findings: There were 838 VOC infections in Singapore in the study period. After adjusting for age and gender, B.1.617.2 infection was associated with higher odds of oxygen requirement, ICU admission, or death (adjusted odds ratio (aOR) 4·90, [95% CI 1·43-30·78]. 157 patients with VOCs were admitted to our centre. After adjusting for age, gender, comorbidities, and vaccination, aOR for pneumonia with B.1.617.2 was 1·88 [95% CI 0·95-3·76]) compared with wild-type. B.1.617.2 was associated with significantly lower PCR Ct values and significantly longer duration of Ct value ≤30 (estimated median duration 18 days for B.1.617.2, 13 days for wild-type). Vaccine breakthrough cases were less severe.Interpretation: There was a signal toward increased severity associated with B.1.617.2. The association of B.1.617.2 with lower Ct value and longer viral shedding provides a potential mechanism for increased transmissibility. These findings provide a strong impetus for the rapid implementation of vaccination programmes.Funding Information: National Medical Research Council grants COVID19RF-001 and COVID19RF-008.Declaration of Interests: BEY reports personal fees from Roche and Sanofi, outside the submitted work. All other authors declare no competing interests.Ethics Approval Statement: Informed consent for retrospective data collection was waived as approved by the institutional review board (NHG-DSRB reference number 2020/01122).

Recommendations for COVID-19 Vaccination in People with Rheumatic Disease: Developed by the Singapore Chapter of Rheumatologists (preprint)

AimPeople with rheumatic diseases (PRD) remain vulnerable in the era of the COVID-19 pandemic. We formulated recommendations to meet the urgent need for a consensus for vaccination against SARS-CoV-2 in PRD. MethodsSystematic literature reviews were performed to evaluate (1) outcomes in PRD with COVID-19; (2) efficacy, immunogenicity and safety of COVID-19 vaccination; and (3) published guidelines/recommendations for non-live, non-COVID-19 vaccinations in PRD. Recommendations were formulated based on the evidence and expert opinion according to the Grading of Recommendations Assessment, Development and Evaluation methodology. ResultsThe consensus comprises two overarching principles and seven recommendations. Vaccination against SARS-CoV-2 in PRD should be aligned with prevailing national policy and should be individualized through shared decision between the healthcare provider and patient. We strongly recommended that eligible PRD and household contacts be vaccinated against SARS-CoV-2. We conditionally recommended that the COVID-19 vaccine be administered during quiescent disease if possible. Immunomodulatory drugs, other than rituximab, can be continued alongside vaccination. We conditionally recommended that the COVID-19 vaccine be administered prior to commencing rituximab if possible. For patients on rituximab, the vaccine should be administered a minimum of 6 months after the last dose and/or 4 weeks prior to the next dose of rituximab. Post-vaccination antibody titres against SARS-CoV-2 need not be measured. Any of the approved COVID-19 vaccines may be used, with no particular preference. ConclusionThese recommendations provide guidance for COVID-19 vaccination in PRD. Most recommendations in this consensus are conditional, reflecting a lack of evidence or low-level evidence. (words 247)

Utility of a high-definition 3D digital exoscope for spinal surgery during the COVID-19 pandemic.

The COVID-19 pandemic creates unique challenges in the practice of spinal surgery. We aim to show how the use of a high-definition 3D digital exoscope can help streamline workflows, and protect both patients and healthcare staff.

Effects of Coronavirus Disease 2019 (COVID-19) Pandemic on Antimicrobial Prevalence and Prescribing in a Tertiary Hospital in Singapore (preprint)

Background: The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing and resistance. Methods: : One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017-2019. Results: : The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p =0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p <0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p =0.08). Conclusion: AMS efforts over the years paid dividends during the COVID-19 pandemic to sustain the control of antimicrobial prevalence and quality of AMU in non-COVID-19 wards and plausibly also in COVID-19 wards.