Impact of the COVID-19 pandemic on total, sex- and age-specific all-cause mortality in 20 countries worldwide during 2020: results from the C-MOR project.

BACKGROUND: To understand the impact of the COVID-19 pandemic on mortality, this study investigates overall, sex- and age-specific excess all-cause mortality in 20 countries, during 2020. METHODS: Total, sex- and age-specific weekly all-cause mortality for 2015-2020 was collected from national vital statistics databases. Excess mortality for 2020 was calculated by comparing weekly 2020 observed mortality against expected mortality, estimated from historical data (2015-2019) accounting for seasonality, long- and short-term trends. Crude and age-standardized rates were analysed for total and sex-specific mortality. RESULTS: Austria, Brazil, Cyprus, England and Wales, France, Georgia, Israel, Italy, Northern Ireland, Peru, Scotland, Slovenia, Sweden, and the USA displayed substantial excess age-standardized mortality of varying duration during 2020, while Australia, Denmark, Estonia, Mauritius, Norway, and Ukraine did not. In sex-specific analyses, excess mortality was higher in males than females, except for Slovenia (higher in females) and Cyprus (similar in both sexes). Lastly, for most countries substantial excess mortality was only detectable (Austria, Cyprus, Israel, and Slovenia) or was higher (Brazil, England and Wales, France, Georgia, Italy, Northern Ireland, Sweden, Peru and the USA) in the oldest age group investigated. Peru demonstrated substantial excess mortality even in the <45 age group. CONCLUSIONS: This study highlights that excess all-cause mortality during 2020 is context dependent, with specific countries, sex- and age-groups being most affected. As the pandemic continues, tracking excess mortality is important to accurately estimate the true toll of COVID-19, while at the same time investigating the effects of changing contexts, different variants, testing, quarantine, and vaccination strategies.

Age-based spatial disparities of COVID-19 incidence rates in the United States counties.

COVID-19 incidence disparities have been documented in the literature, but the different driving factors among age groups have yet to be explicitly explained. This study proposes a community-based COVID-19 spatial disparity model, considering different levels of geographic units (individual and community), various contextual variables, multiple COVID-19 outcomes, and different geographic contextual elements. The model assumes the existence of age nonstationarity effects on health determinants, suggesting that health effects of contextual variables vary among place and age groups. Based on this conceptual model and theory, the study selected 62 county-level variables for 1,748 U.S. counties during the pandemic, and created an Adjustable COVID-19 Potential Exposure Index (ACOVIDPEI) using principal component analysis (PCA). The validation was done with 71,521,009 COVID-19 patients in the U.S. from January 2020 through June 2022, with high incidence rates shifting from the Midwest, South Carolina, North Carolina, Arizona, and Tennessee to the West and East coasts. This study corroborates the age nonstationarity effect of health determinants on COVID-19 exposures. These results empirically identify the geographic disparities of COVID-19 incidence rates among age groups and provide the evidentiary guide for targeting pandemic recovery, mitigation, and preparedness in communities.

COVID-19 Information Overload Mediated the Effects of Cross-Channel Information Differences on Health Information Elaboration.

The COVID-19 pandemic has brought on an unprecedented amount of information about the virus and vaccination, varying significantly across information channels. While extant research shows that excessive information leads to overload and less elaboration, few studies have examined factors associated with information overload and elaboration. Considering the trend that we likely receive information on the same topics from different communication channels daily, this study sought to understand how cross-channel differences in the information were associated with information overload and subsequent elaboration. The survey assessed 471 participants' consumption of COVID-19 information across different channels (interpersonal communication vs. social media), concern about information quality, information overload, information elaboration, health literacy, and demographic characteristics in February 2021. Our findings confirmed that greater information overload was negatively associated with more information elaboration. Using a moderated mediation model, we found that people who received more information from social media, compared to those who received equal amounts of information from both social media and interpersonal communications, reported more information overload and less elaboration. Additionally, we found that people who experienced greater information overload and held greater concern about information quality tended to elaborate more information. All analyses were controlled for health literacy. Theoretical and practical implications were discussed.

Decentralized study of COVID Vaccine Antibody Response (STOPCoV): Results of a participant satisfaction survey.

The Covid-19 pandemic required many clinical trials to adopt a decentralized framework to continue research activities during lock down restrictions. The STOPCoV study was designed to assess the safety and efficacy of Covid-19 vaccines in those aged 70 and above compared to those aged 30-50 years of age. In this sub-study we aimed to determine participant satisfaction for the decentralized processes, accessing the study website and collecting and submitting study specimens. The satisfaction survey was based on a Likert scale developed by a team of three investigators. Overall, there were 42 questions for respondents to answer. The invitation to participate with a link to the survey was emailed to 1253 active participants near the mid-way point of the main STOPCoV trial (April 2022). The results were collated and answers were compared between the two age cohorts. Overall, 70% (83% older, 54% younger cohort, no difference by sex) responded to the survey. The overall feedback was positive with over 90% of respondents answering that the website was easy to use. Despite the age gap, both the older cohort and younger cohort reported ease of performing study activities through a personal electronic device. Only 30% of the participants had previously participated in a clinical trial, however over 90% agreed that they would be willing to participate in future clinical research. Some difficulties were noted in refreshing the browser whenever updates to the website were made. The feedback attained will be used to improve current processes and procedures of the STOPCoV trial as well as share learning experiences to inform future fully decentralized research studies.

Construction of SNP fingerprint and population genetic analysis of honeysuckle germplasm resources in China

Introduction The flower buds of Lonicera japonica Thunb. are widely used in Chinese medicine for their anti-inflammatory properties, and they have played an important role in the fight against SARS COVID-19 and other major epidemics. However, due to the lack of scientific and accurate variety identification methods and national unified standards, scattered and non-standardized management in flower bud production has led to mixed varieties that have caused significant difficulties in the cataloging and preservation of germplasm resources and the identification, promotion, and application of new L. japonica varieties. Methods In this study, we evaluated the population structure, genetic relationships, and genetic fingerprints of 39 germplasm resources of Lonicera in China using simplified genome sequencing technology. Results A total of 13,143,268 single nucleotide polymorphisms (SNPs) were identified. Thirty-nine samples of Lonicera were divided into four subgroups, and the population structure and genetic relationships among existing Lonicera germplasm resources were determined using principal component analysis, population structure analysis, and phylogenetic tree analysis. Through several stringent selection criteria, 15 additional streamlined, high-quality DNA fingerprints were filtered out of the validated 50 SNP loci and verified as being able to effectively identify the 39 Lonicera varieties. Discussion To our knowledge, this is the first comprehensive study measuring the diversity and population structure of a large collection of Lonicera varieties in China. These results have greatly broadened our understanding of the diversity, phylogeny, and population structure of Lonicera. The results may enhance the future analysis of genetic diversity, species identification, property rights disputes, and molecular breeding by providing a scientific basis and reference data for these efforts.

Getting Human Papillomavirus Vaccination Back on Track: A National Survey.

PURPOSE: Adolescent human papillomavirus (HPV) vaccine uptake in the United States dropped during the COVID-19 pandemic due to a decrease in well visits. This study sought to identify opportunities for primary care professionals (PCPs) to get adolescent vaccination back on track. METHODS: In early 2021, we recruited 1,047 PCPs (71% physicians) who provided adolescent vaccines in the United States from an existing panel. Participants completed an online survey about changes in adolescent HPV vaccine uptake and actions taken to promote vaccination during the pandemic, as well as intentions to engage in activities to increase adolescent vaccination in the next 3 months. RESULTS: A substantial proportion of PCPs (43%) reported that HPV vaccine uptake decreased in the first year of the pandemic; few (7%) PCPs reported an increase in uptake. PCPs reporting increased uptake were more likely to have used nurse-only vaccination visits, held drop-in and drive-through vaccination clinics, and used telehealth visits to recommend vaccination (all p < .05). Nearly two-thirds (62%) of all PCPs planned to promote adolescent vaccine uptake in the next 3 months. Planning was more common among PCPs who believed HPV vaccine uptake at their clinics increased during the pandemic, who saw more than 10 adolescent patients per week, who had ever reviewed their clinic's vaccination rates, and were nurses (all p < .05). DISCUSSION: Many PCPs saw HPV vaccination drop during the pandemic. Several interventions could help clinics get HPV vaccination back on track, including increasing the availability of nurse-only vaccination visits and vaccination-only clinics.

Behavioral and Social Drivers of COVID-19 Vaccination in the United States, August-November 2021.

INTRODUCTION: COVID-19 vaccines are safe, effective, and widely available, but many adults in the U.S. have not been vaccinated for COVID-19. This study examined the associations between behavioral and social drivers of vaccination with COVID-19 vaccine uptake in the U.S. adults and their prevalence by region. METHODS: A nationally representative sample of U.S. adults participated in a cross-sectional telephone survey in August-November 2021; the analysis was conducted in January 2022. Survey questions assessed self-reported COVID-19 vaccine initiation, demographics, and behavioral and social drivers of vaccination. RESULTS: Among the 255,763 respondents, 76% received their first dose of COVID-19 vaccine. Vaccine uptake was higher among respondents aged ≥75 years (94%), females (78%), and Asian non-Hispanic people (94%). The drivers of vaccination most strongly associated with uptake included higher anticipated regret from nonvaccination, risk perception, and confidence in vaccine safety and importance, followed by work- or school-related vaccination requirements, social norms, and provider recommendation (all p<0.05). The direction of association with uptake varied by reported level of difficulty in accessing vaccines. The prevalence of all of these behavioral and social drivers of vaccination was highest in the Northeast region and lowest in the Midwest and South. CONCLUSIONS: This nationally representative survey found that COVID-19 vaccine uptake was most strongly associated with greater anticipated regret, risk perception, and confidence in vaccine safety and importance, followed by vaccination requirements and social norms. Interventions that leverage these social and behavioral drivers of vaccination have the potential to increase COVID-19 vaccine uptake and could be considered for other vaccine introductions.

A qualitative study of behavioral and social drivers of COVID-19 vaccine confidence and uptake among unvaccinated Americans in the US April-May 2021.

INTRODUCTION: Around one-third of Americans reported they were unwilling to get a COVID-19 vaccine in April 2021. This focus group study aimed to provide insights on the factors contributing to unvaccinated adults' hesitancy or refusal to get vaccinated with COVID-19 vaccines. METHOD: Ipsos recruited 59 unvaccinated US adults who were vaccine hesitant (i.e., conflicted about or opposed to receiving a COVID-19 vaccination) using the Ipsos KnowledgePanel. Trained facilitators led a total of 10 focus groups via video-conference in March and April 2021. Two coders manually coded the data from each group using a coding frame based on the focus group discussion guide. The coding team collaborated in analyzing the data for key themes. RESULTS: Data analysis of transcripts from the focus groups illuminated four main themes associated with COVID-19 vaccine hesitancy: lack of trust in experts and institutions; concern about the safety of COVID-19 vaccines; resistance towards prescriptive guidance and restrictions; and, despite personal reluctance or unwillingness to get vaccinated, acceptance of others getting vaccinated. DISCUSSION: Vaccine confidence communication strategies should address individual concerns, describe the benefits of COVID-19 vaccination, and highlight evolving science using factural and neutral presentations of information to foster trust.

Explaining demographic differences in COVID-19 vaccination stage in the United States - April-May 2021.

COVID-19 vaccine coverage in the US has marked demographic and geographical disparities, but few explanations exist for them. Our paper aimed to identify behavioral and social drivers that explain these vaccination disparities. Participants were a national sample of 3562 American adults, recruited from the Ipsos KnowledgePanel. Participants completed an online survey in spring 2021, when COVD-19 vaccination was available for higher-risk groups but not yet available to all US adults. The survey assessed COVID-19 vaccination stage (intentions and vaccine uptake), constructs from the Increasing Vaccination Model (IVM) domains (thinking and feeling, social processes, and direct behavior change), self-reported exposure to COVID-19 vaccine information, and demographic characteristics. Analyses used multiple imputation to address item nonresponse and linear regressions to conduct mediation analyses. Higher COVID-19 vaccination stage was strongly associated with older age, liberal political ideology, and higher income in adjusted analyses (all p < .001). Vaccination stage was more modestly associated with urbanicity, white race, and Hispanic ethnicity (all p < .05). Some key mediators that explained more than one-third of demographic differences in vaccination stage were perceived vaccine effectiveness, social norms, and recommendations from family and friends across most demographic characteristics (all p < .05). Other mediators included safety concerns, trust, altruism, provider recommendation, and information seeking. Access to vaccination, barriers to vaccination, and self-efficacy explained few demographic differences. One of the most reliable explanations for demographic differences in COVID-19 vaccination stage is social processes, including social norms, recommendations, and altruism. Interventions to promote COVID-19 vaccination should address social processes and other domains in the IVM.

Recommending COVID-19 vaccination for adolescents in primary care.

BACKGROUND: COVID-19 vaccines are available for adolescents in the United States, but many parents are hesitant to have their children vaccinated. The advice of primary care professionals strongly influences vaccine uptake. OBJECTIVE: We examined the willingness of primary care professionals (PCPs) to recommend COVID-19 vaccination for adolescents. METHODS: Participants were a national sample of 1,047 US adolescent primary care professionals. They participated in an online survey in early 2021, after a COVID-19 vaccine had been approved for adults but before approval for adolescents. Respondents included physicians (71%), advanced practice providers (17%), and nurses (12%). We identified correlates of willingness to recommend COVID-19 vaccination for adolescents using logistic regression. RESULTS: The majority (89%) of respondents were willing to recommend COVID-19 vaccination for adolescents, with advanced practice providers and nurses being less likely than paediatricians to recommend vaccination (84% vs. 94%, aOR 0.47, 95% CI 0.23-0.92). Respondents who had received at least one dose of a COVID-19 vaccine were more likely to recommend adolescent vaccination (92% vs. 69%, aOR 4.20, 95% CI 2.56-6.87) as were those with more years in practice (94% vs. 88%, aOR 2.93, 95% CI 1.79-4.99). Most respondents (96%) said they would need some measure of support in order to provide COVID-19 vaccination to adolescents, with vaccine safety and efficacy information being the most commonly cited need (80%). CONCLUSION: Adolescent primary care professionals were generally willing to recommend COVID-19 vaccination. However, most indicated a need for additional resources to be able to administer COVID-19 vaccines at their clinic.

Spatial-temporal differences of COVID-19 vaccinations in the U.S.

Although the disparities in COVID-19 outcomes have been proved, they have not been explicitly associated with COVID-19 full vaccinations. This paper examines the spatial and temporal patterns of the county-level COVID-19 case rates, fatality rates, and full vaccination rates in the United States from December 24, 2020 through September 30, 2021. Statistical and geospatial analyses show clear temporal and spatial patterns of the progression of COVID-19 outcomes and vaccinations. In the relationship between two time series, the fatality rates series was positively related to past lags of the case rates series. At the same time, case rates series and fatality rates series were negatively related to past lags of the full vaccination rates series. The lag level varies across urban and rural areas. The results of partial correlation, ordinary least squares (OLS) and Geographically Weighted Regression (GWR) also confirmed that the existing COVID-19 infections and different sets of socioeconomic, healthcare access, health conditions, and environmental characteristics were independently associated with COVID-19 vaccinations over time and space. These results empirically identify the geographic health disparities with COVID-19 vaccinations and outcomes and provide the evidentiary basis for targeting pandemic recovery and public health mitigation actions. Supplementary Information: The online version contains supplementary material available at 10.1007/s44212-022-00019-9.

Concerns about and stimuli of COVID-19 vaccination hesitancy among diverse occupational groups in metropolitan areas of China: a cross-sectional study.

OBJECTIVES: In this study, we aimed to identify concerns and stimuli regarding COVID-19 vaccination acceptance and to compare the findings by occupation. METHODS: We conducted a cross-sectional study of individuals vaccinated against COVID-19 between 1 April and 30 June 2021 in four metropolitan areas of China. A total of 20 863 participants completed questionnaires, 20 767 of which were eligible for analysis. We used ordered logistic regression to assess the association of vaccination concerns and stimuli with vaccination hesitancy according to occupation. RESULTS: Farmers were mainly concerned about the quality of vaccines (adjusted OR (aOR): 3.18, 95% CI (CI): 1.83 to 5.54). Among civil servants, media publicity reduced hesitancy (aOR: 0.44, 95% CI: 0.21 to 0.92). Among medical staff, concerns about a short duration of protective effects increased hesitancy (aOR: 8.31, 95% CI: 2.03 to 33.99). For most occupations, concerns about side effects, poor protective effects and health status increased hesitancy. In contrast, protecting oneself and protecting others acted as a stimulus to decrease hesitancy. Interestingly, 'people around me have been vaccinated' was associated with higher vaccination hesitancy among farmers (aOR: 2.19, 95% CI: 1.20 to 4.00). CONCLUSION: The association of vaccination concerns and stimuli with vaccination hesitancy varied by occupation. The characteristics and concerns of specific target audiences should be considered when designing informational campaigns to promote vaccination against COVID-19.

"Horrible cruise": a frame analysis of tourism crisis on social media

The tourism crisis communication on social media is an important task in the crisis management of tourism destinations. It affects crisis development and determines whether the crisis will evolve into a public opinion crisis or a tourism market crisis. However, there is limited systematical frame analysis in this field. Based on the Frame Theory, this paper identified the analysis structure of the tourism crisis communication on social media, as well as the dynamic response relationship between the public crisis and media crisis frames. Taking the COVID-19 outbreak on the Diamond Princess as a case, this paper collected 54 229 Weibo comments using data collectors. Besides, analysis techniques such as crisis keywords extraction, identification of hot topics of public concern, and vector autoregression(VAR)model construction were adopted. The results showed that the tourism crisis communication on social media had a life cycle. It can be divided into such four stages as hot discussion, containment, mitigation, and dissipation in light of the crisis life cycle theory, key events, and the timing characteristics of the volume of topics of public concern. In addition, this paper also identified two crisis subject frames and nine crisis information frames. Specifically, the former included the media crisis frame and the public crisis frame, and the latter contained frames of conflict, human touch, morality, economy/consequence, responsibility attribution, response, fact, analogy/understanding, and knowledge. These crisis frames are mutually restricted and interacted, and respond to each other, which provides a panorama of the communication framework and basic facts of the crisis. Moreover, topics of public concern were diversified in the public crisis, and the public and media crisis communication showed obvious differences in public opinion intensity and evolution. To be specific, the crisis frame constructed by the public during the hot discussion stage was dominated by the human touch. This was to arouse the public's emotional resonance and prompt them to make moral evaluations, analogies, and associations, as well as become empathetic. Then, the constructed frame was dominated by fact while mixed with individual emotions and moral evaluations. During the dissipation stage, it focused on the economy/consequence. The crisis frames constructed by the media focused on two core topics of fact and response and had a strong demand for responsibility attribution during the containment stage. Furthermore, the volume of public opinions had a one-way dynamic impact on the media crisis coverage, highlighting the role of social media in public crisis communication. This paper conducted a frame analysis of tourism crisis communication on social media, providing a new direction and theoretical perspective for tourism crisis communication research. Also, this paper examined the effect of public opinion on media crisis coverage from the perspective of the public opinion volume and provided empirical support for analyzing the dynamic impact of the public crisis frame on the media crisis frame in the social media context. In terms of crisis management, this paper provided strategic guidance for tourism destinations to monitor public opinion, set crisis communication agenda, and promote tourism recovery.

How do information overload and message fatigue reduce information processing in the era of COVID-19? An ability–motivation approach

The global outbreak of COVID-19 in 2020 has led to the dominance of COVID-19 prevention information on all media channels. Drawing on the ability–motivation model of information processing, this study examined how such an information overabundance hampered individuals’ ability and motivation to process in the era of COVID-19. With a survey conducted from 493 participants, we found that less message elaboration of COVID-19 prevention information was predicted by greater message fatigue, a state of low motivation due to information overabundance. In addition, greater message fatigue was accompanied by greater information overload, a state of low ability due to information overabundance. Moreover, certain motivation-related (i.e. health status, trait reactance and frequency of information seeking) and ability–related factors (i.e. health literacy, health status, trait anxiety and information quality) were found to be associated with message fatigue and information overload, respectively. The theoretical and practical implications are discussed.

SARS-CoV-2 and Plasmodium falciparum Co-Infection in a Returning Traveler

Since December 2019, the Coronavirus Disease 2019 (COVID-19) pandemic has become a non-neglectable context for the whole healthcare system. Under the background of COVID-19, the detection and diagnosis of malaria cases are under challenge. Here, we reported a COVID-19 and malaria co-infection traveler who has a long living history in Cameroon. The case was administered with dihydroartemisinin and piperaquine tablets for malaria, Lopinavir and Ritonavir tablets, Arbidol, recombinant human interferon α-2b and Compound Maxing Yifei mixture for COVID-19, and Zolpidem Tartrate tablets, Diazepam, Paroxetine Hydrochloride tablets, Thymosin α1, and Lianhua Qinwen Jiaonang during the second hospitalization of the patient since the patient has a certain level of anxiety and insomnia with no evidence of inflammatory reactions. After being tested negative two times for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 48 h, the patient met China's COVID-19 discharge standards and was discharged with stable vital signs and mental state. Since most countries in the sub-Saharan region have a fragile health system, co-infection for both Plasmodium and SARS-CoV-2 may not be uncommon, and raise a challenge in diagnosis, treatment, and prevention for both diseases. We add to the literature on co-infection of P. falciparum malaria and COVID-19 and offer operational advice on diagnosis, prevention, and treatment for the co-infection.

Primary care professionals' support for Covid-19 vaccination mandates: Findings from a US national survey.

Healthcare organizations have been early adopters of Covid-19 vaccine mandates as a strategy to end the pandemic. We sought to evaluate support for such mandates among pediatric primary care professionals (PCPs) in the United States. In February-March 2021, we conducted a national online survey of 1,047 PCPs (71% physicians). We used multivariable logistic regression to assess correlates of PCPs' support for Covid-19 vaccine mandates for health care workers. Most PCPs supported Covid-19 vaccine mandates for health care workers (83%). PCPs were more likely to support mandates if they perceived health care workers to be at highest risk of getting Covid-19 compared to other worker types (8 percentage points, p < 0.01). PCPs were also more likely to support mandates if their clinic recommended or required vaccination (11 percentage points and 20 percentage points respectively, both p < 0.01). However, PCPs were less likely to support mandates if their clinic offered incentives to vaccinate (10 percentage points, p < 0.05). Clinic recommendations and requirements for Covid-19 vaccination may increase support for mandates. Incentives may decrease support, perhaps by creating the perception that viable alternatives to mandates exist.

Explaining higher Covid-19 vaccination among some US primary care professionals.

BACKGROUND AND OBJECTIVE: Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference. METHODS: In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11-17. The national sample included physicians (71%) as well as nurses and advanced practice providers. The survey assessed the three domains of the Increasing Vaccination Model: thinking and feeling, social processes, and direct behavior change. RESULTS: Covid-19 vaccine uptake was higher among physicians than among nurses and advanced practice providers (91% vs. 76%, p < .05). Overall, in the thinking and feeling domain, higher confidence in Covid-19 vaccination, higher perceived susceptibility to the disease, and stronger anticipated regret were associated with higher vaccine uptake (all p < .05). In the social processes domain, perceiving more positive social norms for Covid-19 vaccination, receiving recommendations to get the vaccine, and wanting to help others were associated with higher vaccine uptake (all p < .05). In the direct behavior change domain, receiving an invitation to get the vaccine and better access to vaccination were associated with higher uptake (both p < .05). Of these variables, most of the thinking and feeling and social processes variables mediated the association of training with vaccine uptake. CONCLUSIONS: Physicians had higher Covid-19 vaccine uptake than nurses and advanced practice providers, corresponding with their more supportive vaccine beliefs and social experiences. Efforts to reach the remaining unvaccinated cohort can build on these findings.

Generation of environmental persistent free radicals (EPFRs) enhances ecotoxicological effects of the disposable face mask waste with the COVID-19 pandemic.

A large amount of disposable plastic face masks (DPFs) is produced and used during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which results in an inevitable consequence of the dramatic increase of DPFs waste. However, the impact of DPFs exposure to the environment on their toxicity is rarely considered. In this study, a range of 76-276 items/L microplastics (MPs) was detected in the DPFs leachates, and fibrous (> 80.3%) and polypropylene (PP, > 89.2%) MPs were dominant. Co, Cu, Ni, Sr, Ti and Zn, were commonly detected in all leachates of the tested DPFs. Organics, such as acetophenone, 2,4-Di-tert-butylphenol, benzothiazole, bisphenol-A and phthalide, were found in the DPFs leachate, which were including organic solvents and plasticizer. Besides, we first found an emerging environmental risk substance, namely environmentally persistent free radicals (EPFRs), was generated in the DPFs leachates. The characteristic g-factors of the EPFRs was in a range of 2.003-2.004, identified as mixture of carbon- and oxygen-centered radicals. By means of in vitro toxicity assay, the DPFs leachate were confirmed to cause cytotoxicity and oxidative stress. Significantly, it is found that the formed EPFRs could contribute more toxic effects. Furthermore, when compared to N95 respirators, the tested surgical masks tend to release more MPs, leach more metals and organics, and generate more EPFRs. Surgical masks were thus showed higher risk than N95 respirators after exposure to water. This work highlights the importance of understanding the chemical complexity and possible toxicity of DPFs for their risk assessment.

The relationship between anti-epidemic mentality and post-traumatic stress disorder in medical college students during the COVID-19 pandemic

Objective: To explore the relationship between an anti-epidemic mentality and post-traumatic stress disorder (PTSD) among college students during the corona virus disease 2019(COVID-19) pandemic, and to provide a scientific basis for the prevention of PTSD when college students experience sudden crisis events in the future.