Influencing factors of patients' trust in nurses during the COVID-19 pandemic: a mixed-methods study.

OBJECTIVE: This study aimed to investigate the nurse-patient trust among in-patients in the context of the COVID-19 epidemic; it further analyzed the related influencing factors, which will provide a theoretical basis for developing corresponding measures. METHODS: This study employed a mixed-method design and analyzed 149 patients at the Hongqi Hospital, affiliated with Mudanjiang Medical University, from December 2020 to February 2021. Quantitative analysis was carried out using the "Nurse Patient Trust Scale," and qualitative analysis was performed using a semi-structured interview with in-patients. RESULTS: The average score on the scale was 46.65 ±2.83, and the scores of the two dimensions were: 23.24 ±1.51 for ability and peace of mind, and 23.32 ±1.53 for attitude and care. According to the interview data, the factors included three aspects: a comfortable hospital environment and humane management measures; the nurse's own competence; effective communication with patients. CONCLUSION: During the COVID-19 epidemic, there are still many factors affecting patients' trust in nurses that can be addressed by taking different measures. All these factors must be considered by the relevant managers and clinical nursing staff to maintain a better nurse-patient trust relationship.

The Dynamic Role of FOXP3+ Tregs and Their Potential Therapeutic Applications During SARS-CoV-2 Infection.

Coronavirus disease 2019 (COVID-19) has been raging all around the world since the beginning of 2020, and leads to acute respiratory distress syndrome (ARDS) with strong cytokine storm which contributes to widespread tissue damage and even death in severe patients. Over-activated immune response becomes one of the characteristics of severe COVID-19 patients. Regulatory T cells (Treg) play an essential role in maintaining the immune homeostasis, which restrain excessive inflammation response. So FOXP3+ Tregs might participate in the suppression of inflammation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Besides suppressive function, tissue resident Tregs are also responsible for tissue repair. In this review, we mainly summarize the latest research focusing on the change of FOXP3+ Tregs in the COVID-19 patients, discuss the relationship between disease severity and number change of Tregs and speculate the potential role of FOXP3+ Tregs during SARS-CoV-2 infection. Furthermore, we introduce some potential Treg-based therapies to improve patients' outcomes, which include small molecular drugs, antibody drugs, CAR-Treg and cytokine treatment. We hope to reduce tissue damage of severe COVID-19 patients and offer better prognosis through Treg-based therapy.

Does the COVID-19 pandemic derail US-China collaboration on carbon neutrality research? A survey

The COVID-19 pandemic has seriously impacted scientific research activities, especially international cooperation in scientific research. Using bibliometric methods and scientific knowledge graph software, and by calculating collaboration indicators such as international collaboration rates, this work conducts a comprehensive review of carbon neutrality publications in the Web of Science database before and during the COVID-19 pandemic, aiming to explore whether the COVID-19 pandemic derail China-U.S. collaboration on carbon neutrality research. The results show that (i) During the COVID-19 pandemic, more extensive research on carbon neutrality was carried out around the world, with China and the United States leading the way in carbon neutrality scientific output. (ii) Following the outbreak of the COVID-19, the global center of global carbon neutrality shifted from the United States to China. (iii) During the COVID-19 pandemic, research ties between China and the United States strengthened. The number of joint publications on carbon neutrality between China and the United States has greatly increased during the COVID-19 pandemic compared to those before. (iv) The proportion of China-U.S. cooperation in China's international cooperation has decreased, while it is the opposite for the United States. At the end of the article, we put forward relevant suggestions for realizing the sustainable development goals of climate change in the post-epidemic era for policymakers' reference. This paper provides offers important insights into the theoretical research of scholars in the field of carbon neutrality.

Does marine environmental research meet the challenges of marine pollution induced by the COVID-19 pandemic? Comparison analysis before and during the pandemic based on bibliometrics.

The outbreak of the COVID-19 pandemic has brought enormous challenges to the global marine environment. Various responses to the COVID-19 pandemic have led to increased marine pollution. Has the COVID-19 pandemic affected marine pollution research? This work comprehensively reviewed marine pollution publications in the Web of Science database before and during the COVID-19 pandemic. Results show that the COVID-19 outbreak has influenced the marine pollution research by: (i) increasing the number of publications; (ii) reshaping different countries' roles in marine pollution research; (iii) altering the hotspots of marine pollution research. The ranking of countries with high productivity in the marine pollution research field changed, and developed economies are the dominant players both before and after the outbreak of the COVID-19 pandemic in this field. Other high-productivity countries, with the exception of China, have higher international cooperation rates in marine pollution research than those before the pandemic. Microplastic pollution has been the biggest challenge of marine pollution and has been aexplored in greater depth during the COVID-19 pandemic. Furthermore, the mining results of marine pollution publications show the mitigation of plastic pollution in the marine environment remains the main content requires future research. Finally, this paper puts forward corresponding suggestions for the reference of researchers and practitioners to improve the global ability to respond to the challenges posed by the pandemic to the marine environment.

The Dynamic Role of FOXP3+ Tregs and Their Potential Therapeutic Applications During SARS-CoV-2 Infection

Coronavirus disease 2019 (COVID-19) has been raging all around the world since the beginning of 2020, and leads to acute respiratory distress syndrome (ARDS) with strong cytokine storm which contributes to widespread tissue damage and even death in severe patients. Over-activated immune response becomes one of the characteristics of severe COVID-19 patients. Regulatory T cells (Treg) play an essential role in maintaining the immune homeostasis, which restrain excessive inflammation response. So FOXP3+ Tregs might participate in the suppression of inflammation caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Besides suppressive function, tissue resident Tregs are also responsible for tissue repair. In this review, we mainly summarize the latest research focusing on the change of FOXP3+ Tregs in the COVID-19 patients, discuss the relationship between disease severity and number change of Tregs and speculate the potential role of FOXP3+ Tregs during SARS-CoV-2 infection. Furthermore, we introduce some potential Treg-based therapies to improve patients’ outcomes, which include small molecular drugs, antibody drugs, CAR-Treg and cytokine treatment. We hope to reduce tissue damage of severe COVID-19 patients and offer better prognosis through Treg-based therapy.

The negative impact of the COVID-19 on renewable energy growth in developing countries: Underestimated.

According to the United Nations Environment Programme, the COVID-19 pandemic has created challenges for the economy and the energy sector, as well as uncertainty for the renewable energy industry. However, the impact on renewable energy during the pandemic has not been consistently determined. Instead of relying on data from year-to-year comparisons, this study redesigned the analytical framework for assessing the impact of a pandemic on renewable energy. First, this research designed an "initial prediction-parameter training-error correction-assignment combination" forecasting approach to simulate renewable energy consumption in a "no pandemic" scenario. Second, this study calculates the difference between the "pandemic" and "no pandemic" scenarios for renewable energy consumption. This difference represents the change in renewable energy due to the COVID-19 pandemic. Various techniques such as nonlinear grey, artificial neural network and IOWGA operator were incorporated. The MAPEs were controlled to within 5% in 80% of the country samples. The conclusions indicated that renewable energy in China and India declined by 8.57 mtoe and 3.19 mtoe during COVID-19 period. In contrast, the rise in renewable energy in the US is overestimated by 8.01 mtoe. Overall, previous statistics based on year-to-year comparisons have led to optimistic estimates of renewable energy development during the pandemic. This study sheds light on the need for proactive policy measures in the future to counter the global low tide of renewable energy amid COVID-19.

Prediction of in-hospital recurrence and false-negative results in patients with COVID-19 by red blood cell values on admission.

The clinical characteristics and risk factors of patients with coronavirus disease 2019 (COVID-19) with re-positive or false-negative test results have so far remained to be determined. The present study provides a cross-sectional observational study on 134 hospitalized patients selected from Huoshenshan Hospital (Wuhan, China) using cluster sampling. A total of 68 patients had reduced red blood cell (RBC) counts, 55 a decrease in the hemoglobin concentration (HBC) and 73 a decline in hematocrit (HCT). The false-negative rate of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RNA detection in pharyngeal swab specimens was 18.7%. The absolute lymphocyte count (ALC), RBC, HBC and HCT levels in false-negative patients were significantly higher than those in patients who tested positive for viral nucleic acids. Multivariate logistic regression analysis indicated that RBC [odds ratio (OR)=0.43, 95% CI: 0.18-0.99], HBC (OR=0.97, 95% CI: 0.94-0.99) and ALC (OR=0.43, 95% CI: 0.20-0.91) were the factors influencing the negative testing results for viral nucleic acid. The rate of re-positive patients was 16.4%. The white blood cell, RBC, HBC and HCT values in re-positive patients were lower than those in non-re-positive patients. The median (interquartile range) values for RBC, HBC and HCT of male re-positive patients were 3.95 (3.37, 4.2) x1012/l, 123 (103, 133) g/l and 36.6 (31.1, 39.2)%, respectively, while the RBC, HBC and HCT of female re-positive patients were 3.54 (3.13, 3.74) x1012/l, 115 (102, 118) g/l and 34.2 (28.5, 34.9)%, respectively. It was determined that RBC, HBC and HCT values had moderate accuracy in predicting SARS-CoV-2 recurrence in patients with COVID-19 using receiver operating curve analysis. The present study suggested that RBC may have an important role in the pathogenesis of COVID-19.

Preventing a rebound in carbon intensity post-COVID-19 - lessons learned from the change in carbon intensity before and after the 2008 financial crisis.

The carbon emission rebound of the post-2008 financial crisis teaches us a lesson that avoiding a rebound in carbon intensity is key to prevent the carbon emission increase afterward. Although how carbon emission will change the world after the COVID-19 pandemic is unknown, it is urgent to learn from the past and avert or slow down the potential rebound effect. Therefore, this study aims to identify key drivers of carbon intensity changes of 55 sectors, applying the decomposition techniques and the world input-output data. Our results demonstrate that global carbon intensity fluctuates drastically when shocked by the global financial crisis, presenting an inversed-V shape for the period 2008-2011. Industrial carbon emission and gross output vary among different industries, the growth rate of industrial carbon intensity varies from -55.55% to 23.77%. The energy intensity effect and economic structure effect have opposite impacts on carbon intensity decrease, accelerating and hindering the decreasing carbon intensity, respectively. However, the energy mix effect has a minor impact on carbon intensity decrease. The industrial carbon intensity decomposition results show the impact of technological and structural factors are significantly different among industries. Moreover, the impact of energy intensity is slightly stronger than the energy mix. More measures targeting avoiding the rebound in carbon intensity should be developed.

Discovering potent inhibitors against the Mpro of the SARS-CoV-2. A Medicinal Chemistry approach. (preprint)

The global pandemic caused by a single-stranded RNA (ssRNA) virus known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still at its peak, with new cases being reported daily. Though the vaccinations are done on a massive scale, the frequent mutations in the viral gene and resilience of the future strains could be more problematic. Therefore, there is always a need for new compounds to be available for therapeutic studies. We carried out the present research to discover potential drug compounds against the SARS-CoV-2 main protease. A total of 16,000 drug-like small molecules from the ChemBridge database were virtually screened to obtain the top hits. As a result, 1032 hits were selected based on their docking scores. Next, these structures were prepared for molecular docking, and each small molecule was docked into the active site of the Mpro. Only those compounds with strong interactions with the active site residues and had the highest docking score were subjected to molecular dynamics (MD) simulation. The post-simulation analyses were carried out using the in-built GROMACS commands to gauge the stability, flexibility, and compactness. Principal component analysis (PCA) and hydrogen bonding were also calculated to observe trends and affinity of the drugs towards the target. Among the five top compounds, C1, C3, and C4 revealed strong interaction with the target’s active site and remained highly stable throughout the simulation. We believe the predicted compounds in this study could be potential inhibitors in the natural system and must be considered for further practice.

COVID-19 and metabolic comorbidities: An update on emerging evidences for optimal therapies.

Type 2 diabetes mellitus, obesity, hypertension, and other associated metabolic complications have been demonstrated as a crucial contributor to the enhanced morbidity and mortality of patients with coronavirus disease 2019 (COVID-19). Data on the interplay between metabolic comorbidities and the outcomes in patients with COVID-19 have been emerging and rapidly increasing. This implies a mechanistic link between metabolic diseases and COVID-19 resulting in the exacerbation of the condition. Nonetheless, new evidences are emerging to support insulin-mediated aggressive glucose-lowering treatment as a possible trigger of high mortality rate in diabetic COVID-19 patients, putting the clinician in a confounding and difficult dilemma for the treatment of COVID-19 patients with metabolic comorbidities. Thus, this review discusses the pathophysiological link among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), angiotensin-converting enzyme 2 (ACE2), metabolic complications, and severe inflammation in COVID-19 development, especially in those with multi-organ injuries. We discuss the influence of several routinely used drugs in COVID-19 patients, including anti-inflammatory and anti-coagulant drugs, antidiabetic drugs, renin-angiotensin-aldosterone system inhibitors. Especially, we provide a balanced overview on the clinical application of glucose-lowering drugs (insulin and metformin), angiotensin-converting-enzyme inhibitors, and angiotensin receptor blockers. Although there is insufficient evidence from clinical or basic research to comprehensively reveal the mechanistic link between adverse outcomes in COVID-19 and metabolic comorbidities, it is hoped that the update in the current review may help to better outline the optimal strategies for clinical management of COVID-19 patients with metabolic comorbidities.

Association between resilience and burnout of front-line nurses at the peak of the COVID-19 pandemic: Positive and negative affect as mediators in Wuhan.

The outbreak of coronavirus disease 2019 (COVID-19) is having a dramatic effect on the mental health of healthcare workers (HCWs). Upon the emergence of the COVID-19 pandemic, the Chinese government dispatched about 42 000 HCWs to Wuhan City and Hubei Province to fight this pandemic. This study briefly examines front-line nurses who experienced burnout, with the main objective of investigating the mediating roles of positive and negative affect in the relationship between resilience and burnout in Wuhan hospitals at the peak of the COVID-19 pandemic. A total of 180 front-line nurses voluntarily participated via a social media group. They completed the online questionnaires, including the Maslach Burnout Inventory-General Survey (MBI-GS), the Positive and Negative Affect Schedule (PANAS), the Connor-Davidson Resilience Scale (CD-RISC), demographics, and work-related characteristics. Structural equation modelling (SEM) analysis was used to examine the mediating effect of positive and negative affect on the relationship between resilience and burnout. The total prevalence of burnout was 51.7%, of which 15.0% were severe burnout. These preliminary results revealed that positive and negative affect fully mediated the effects of resilience on burnout, emotional exhaustion, depersonalization, and reduced personal accomplishment of front-line nurses. It is necessary to know the impact of resilience on HCWs with burnout through the positive and negative affect of individual backgrounds and situations, and how policymakers can deploy resilience interventions to support front-line HCWs.

Dynamic profiles of SARS-Cov-2 infection from five Chinese family clusters in the early stage of the COVID-19 pandemic.

Although several cases of family clusters with SARS-Cov-2 infection have been reported, there are still limited data preventing conclusions from being drawn regarding the characteristics and laboratory findings in the COVID-19 population within family clusters. In the present study, we retrospectively collected five family clusters with COVID-19 and summarized the dynamic profiles of the clinical characteristics, laboratory findings, immune markers, treatment and prognosis of this population. Furthermore, we also compared clinical and laboratory data between the SARS-Cov-2 infection with family cluster (n = 21) and those without family cluster (n = 16). We demonstrated that the duration of SARS-Cov-2 replication might be varied based on the different family clusters due to their different genetic backgrounds. The onset improved lung radiology might start at the end of the SARS-Cov-2 positive period. Furthermore, the obtained results demonstrated that similar basic characteristics and clinical findings seem to exist between the cases with SARS-Cov-2 and without family clusters. The serum level of ferritin might have a different biological function and be a new biomarker for the family cluster. Further studies with larger numbers of patients are required.

Increasing host cellular receptor-angiotensin-converting enzyme 2 expression by coronavirus may facilitate 2019-nCoV (or SARS-CoV-2) infection.

The ongoing outbreak of a new coronavirus (2019-nCoV, or severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) has caused an epidemic of the acute respiratory syndrome known as coronavirus disease (COVID-19) in humans. SARS-CoV-2 rapidly spread to multiple regions of China and multiple other countries, posing a serious threat to public health. The spike (S) proteins of SARS-CoV-1 and SARS-CoV-2 may use the same host cellular receptor, angiotensin-converting enzyme 2 (ACE2), for entering host cells. The affinity between ACE2 and the SARS-CoV-2 S protein is much higher than that of ACE2 binding to the SARS-CoV S protein, explaining why SARS-CoV-2 seems to be more readily transmitted from human to human. Here, we report that ACE2 can be significantly upregulated after infection of various viruses, including SARS-CoV-1 and SARS-CoV-2, or by the stimulation with inflammatory cytokines such as interferons. We propose that SARS-CoV-2 may positively induce its cellular entry receptor, ACE2, to accelerate its replication and spread; high inflammatory cytokine levels increase ACE2 expression and act as high-risk factors for developing COVID-19, and the infection of other viruses may increase the risk of SARS-CoV-2 infection. Therefore, drugs targeting ACE2 may be developed for the future emerging infectious diseases caused by this cluster of coronaviruses.

Clinical characteristics of patients with COVID-19 presenting with gastrointestinal symptoms as initial symptoms: Retrospective case series.

BACKGROUND: A large number of pneumonia cases due to coronavirus disease 2019 (COVID-19) have been first reported in China. Meanwhile, the virus is sweeping all around the world and has infected millions of people. Fever and pulmonary symptoms have been noticed as major and early signs of infection, whereas gastrointestinal symptoms were also observed in a significant portion of patients. The clinical investigation of disease onset was underestimated, especially due to the neglection of cases presenting with gastrointestinal symptoms. AIM: To characterize the clinical features of coronavirus-infected patients with gastrointestinal symptoms as initial symptoms. METHODS: This is a retrospective, single-center case series of the general consecutive hospitalized patients with confirmed COVID-19 at Wuhan Union Hospital from February 2, 2020 to February 13, 2020. According to their initial symptoms, these patients were classified into two groups. Patients in group one presented with pulmonary symptoms (PS) as initial symptoms, and group two presented with gastrointestinal symptoms (GS). Epidemiological, demographic, clinical, laboratory, and treatment data were collected for analysis. RESULTS: Among the 50 patients recruited, no patient has been admitted to intensive care units, and no patient died during the study. The duration of hospitalization was longer in the GS group than in the PS group (12.13 ± 2.44 vs 10.00 ± 2.13, P < 0.01). All of the 50 patients exhibited decreased lymphocytes. However, lymphocytes in the GS group were significantly lower compared to those in the PS group (0.94 ± 0.06 vs 1.04 ± 0.15, P < 0.01). Procalcitonin and hs-CRP were both significantly higher in the GS group than in the PS group. Accordingly, the duration of viral shedding was significantly longer in the GS group compared to the PS group (10.22 ± 1.93 vs 8.15 ± 1.87, P < 0.01). CONCLUSION: COVID-19 patients presenting with gastrointestinal symptoms as initial symptoms need more days of viral shedding and hospitalization than the patients presenting with pulmonary symptoms.

Long-term coexistence of SARS-CoV-2 with antibody response in COVID-19 patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection causing coronavirus disease 2019 (COVID-19) has spread worldwide. Whether antibodies are important for the adaptive immune responses against SARS-CoV-2 infection needs to be determined. Here, 26 cases of COVID-19 in Jinan, China, were examined and shown to be mild or with common clinical symptoms, and no case of severe symptoms was found among these patients. Strikingly, a subset of these patients had SARS-CoV-2 and virus-specific IgG coexist for an unexpectedly long time, with two cases for up to 50 days. One COVID-19 patient who did not produce any SARS-CoV-2-bound IgG successfully cleared SARS-CoV-2 after 46 days of illness, revealing that without antibody-mediated adaptive immunity, innate immunity alone may still be powerful enough to eliminate SARS-CoV-2. This report may provide a basis for further analysis of both innate and adaptive immunity in SARS-CoV-2 clearance, especially in nonsevere cases.