Cost analysis of launching telemedicine services by Peking union Medicalcollege hospital during the pandemic of Coronavirus disease 2019.

Objective To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic. Methods The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis. Results During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services. Conclusions Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

The Roles of Language Aptitude and Online Self-regulated Learning in Foreign Language Achievements

Despite extensive use of online language learning during the pandemic of COVID, there is insufficient research on what factors influence students' foreign language achievements in online learning conditions. This article investigated the roles of language aptitude and online self-regulated learning in foreign language achievement in mainland China. 76 freshmen from two classes at a university in Jiangxi participated in this study. They were required to complete an aptitude test of MLAT and a questionnaire on online self-regulated learning. The results showed that: (1) The students' language aptitude is at a relatively low level, and their online self-regulated learning is at an intermediate level;(2) A positive correlation is detected between language aptitude, online self-regulated learning, and their English achievements (r=0.621 & 0.583 respectively);(3) Language aptitude alone (grammatical sensitivity and associative memory ability) accounts for 38.9% variance in English achievement. Language aptitude and online self-regulated learning contributed 52.4% of the variance to their English achievements. Overall, the findings of the study confirm the high predictive power of the MLAT and predictions of the Linguistic Coding Deficit Hypothesis (LCDH) advocated by Sparks and colleagues. Pedagogical implications are also discussed. © 2022 European Knowledge Development (EUROKD). All right reserved.

Claims-Based Study of Transfusion- Associated Circulatory Overload (TACO) Among Inpatient US Medicare Beneficiaries Ages 65 and Older, 2011-2021

Background/Case Studies: TACO is a leading cause of reported fatalities, presenting as respiratory distress with cardiogenic pulmonary edema. The objective was to assess TACO occurrence and potential risk factors among the U.S. population ages 65 and older transfused in the inpatient setting before and during COVID-19 pandemic. Study Design/Methods: This is a hypothesis-generating study utilizing large Medicare databases for January 1, 2011-December 31, 2021. Transfusions were identified by recorded procedure and revenue center codes, and TACO by diagnosis codes. We evaluated unadjusted TACO rates (per 100,000 inpatient transfusion stays): overall, 2 years pre- and during pandemic, by immunocompromised (IC) and COVID-19 status, calendar year, demographics, blood components and number of units. We also assessed inpatient mortality, Charlson Comorbidity Index (CCI) score, ICU/CCU admission, and length of stay (LOS). Fisher's exact tests were performed to compare rates, and Cochran-Armitage tests to ascertain trends by year, age, and units. Results/Findings: Of 13,352,710 inpatient transfusion stays, 12,483 had a TACO diagnosis, an overall rate of 93.5 per 100,000 stays, with 2-year pre- and pandemic rates of 122.7 and 117.4. The annual TACO rates ranged from 61.9 in 2011 to 122.3 in 2021 (p < 0.001). Rates by units increased from 47.2 for 1 unit to 200.8 for >9 units (p < 0.001). Rates by blood components were for convalescent plasma only: 26.5;platelets only: 52.3;plasma only: 64.5;RBCs only: 97.9;RBCs and plasma: 203.0;RBCs and platelets: 237.8;and RBCs, plasma, and platelets: 223.1. Rates by age group ranged from 69.8 for 65-69 to 118.2 for 85+ (p < 0.001). Rates among females and males were 102.2 and 82.8 (p < 0.001);whites and nonwhites: 98.0 and 71.7 (p < 0.001). For IC vs. non-IC, rates were 138.9 vs. 81.7 [rate ratio 1.7 (95% CI 1.6-1.8)]. During pandemic, TACO rates were 39.3 for transfusion stays with vs. 127.8 without COVID-19 (p < 0.001). TACO cases with vs. without COVID-19 were ages 85+ (18.1% vs. 25.0%), females (50.0% vs. 58.4%);had CCI>=3 (50.0% vs. 66.2%), ICU/CCU admission (69.4% vs. 59.3%), mechanical ventilation (40.3% vs. 11.1%), LOS>=11 - days (51.4% vs. 28.1%), and inpatient mortality (45.8% vs. 8.5%). Conclusion(s): Our 11-year population-based study shows significantly increasing TACO trends over time, with greater number of units and advancing age. The study identified similar TACO risk during and pre-pandemic. By components, the highest TACO risk was for RBCs, either alone or in combination, while one of the lowest risks was for convalescent plasma only. Findings show higher rates for IC vs. non-IC, females vs. males, and whites vs. non-whites. For stays with COVID-19, TACO rates were substantially lower, but with marked case severity, which requires further investigation.

Constructing a virtual destination: Li Ziqi's Chinese rural idyll on YouTube

This paper investigates the key elements of a rural idyll constructed collaboratively by YouTube influencer Li Ziqi and her global audience in order to provide insights on how the imaginaries of a virtual destination help viewers to experience a rural idyll through watching YouTube videos and its implications for rural tourism. We employed grounded theory analysis in analyzing viewer comments to identify several groups of themes that are linked to the theories of Shi Wai Tao Yuan and rural idyll. The paper discusses a rural idyll constructed online and its potential for developing the current system of rural tourism management.

Cost analysis of launching telemedicine services by Peking union Medicalcollege hospital during the pandemic of Coronavirus disease 2019

Objective  To assess the cost of launching telemedicine services by Peking Union Medical College Hospital (PUMCH) during coronavirus disease 2019 pandemic.  Methods  The patients using telemedicine services were enrolled during the period of pilot run from February 10th to April 15th, 2020. The study was done from the social perspective. A decision-tree model was constructed to compare the costs between telemedicine services and conventional clinical services for outpatients. The main outcome was measured as incre- mental cost-effective ness ratios (ICER). Sensitivity analysis was conducted by using one-way sensitivity analysis.  Results  During a period of forty-seven days, the online fever clinic was applied 3055 person-times(2070 patients) and the online outpatient clinic were applied 36 549 person-times(20 467 patients). On average, 44 febrile cases/d and 435 nonfebrile cases/d were reduced in the outpatient clinic. It helped to reduce roughly 1/4 (febrile) and 1/5(nonfebrile) of total numbers of the patients in the outpatient clinic during the peak period of the epidemic. If calculated according to the actual free-of-charge condition, the ICER was -64.7 yuans/person-time. If the actual cost of each consultant of telemedicine service was estimated according to the level of outpatient-service fee, the ICER was -5.5 yuans/person-time. The results of sensitivity analysis showed that the main factors affecting the ICERs were transportation cost, lost wages, and the efficiency of telemedicine services.  Conclusions  Launching telemedicine services helped to relieve the pressure at the outpatient clinics, and has the potential to provide significant cost saving compared to conventional clinic services for outpatients. It is worth considering applying this practice widely in the medical and health services. © 2021, Peking Union Medical College Hospital. All rights reserved.

China's Conservation Strategy Must Reconcile Its Contemporary Wildlife Use and Trade Practices

China's supply-side conservation efforts in the past decades have led to two bewildering juxtapositions: a rapidly expanding farming industry vs. overexploitation, which remains one of the main threats to Chinese vertebrates. COVID-19 was also the second large-scale zoonotic disease outbreak since the 2002 SARS. Here, we reflect on China's supply-side conservation strategy by examining its policies, laws, and practices concerning wildlife protection and utilization, and identify the unintended consequences that likely have undermined this strategy and made it ineffective in protecting threatened wildlife and preventing zoonotic diseases. We call for China to overhaul its conservation strategy to limit and phase out risky and unsustainable utilization, while improving legislation and enforcement to establish full chain-of-custody regulation over existing utilization.

Trajectories of clinical and laboratory characteristics before COVID-19 diagnosis in hemodialysis patients

Background: The frequency of evaluations in hemodialysis (HD) care affords opportunities to assess profiles that may characterize onset of the 2019 coronavirus disease (COVID-19). We aimed to characterize the trajectories of clinical/laboratory assessments before COVID-19 diagnosis in HD patients. Methods: We assessed data from HD patients with known COVID-19 dialyzed at Fresenius Kidney Care in the United States between 02 Mar and 09 Apr 2020. We computed mean daily values for 40 variables 90 days before a positive rRT-PCR test (COVID-19+). Nonparametric smoothing splines were used to fit data of individual trajectories and estimate the mean change over time. Results: There were 1294 HD patients with COVID-19 (mean age 64±14 years, 60% male, 47% white race, 69% had diabetes, and 24% had coronary artery disease). Mean pre- HD body temperature (primarily oral) increased by about 1° Fahrenheit (F) over 10 days before COVID-19+ test and approached 99° F at diagnosis (Fig 1A). Mean interdialytic weight gain decreased by about 0.75 kg (Fig 1B) over 14 days before COVID-19+ test;concurrent decreases of about 20 minutes were seen in HD treatment time. Mean neutrophil-to-lymphocyte ratio had mild increases (Fig 1C), while mean platelet counts decreased by about 40×109/L over 14 days before COVID-19+ test (Fig 1D). Trajectories of many variables (vitals, heparin, hematology, nutrition, bone, anemia) were observed to change before COVID-19+ test, yet alternations were generally minor. Conclusions: The trajectories of several clinical/laboratory parameters appeared to change before COVID-19 diagnosis in HD patients. Many changes were small and may not be independently useful in identifying onset of COVID-19. Mean pre-HD body temperature before SARS-CoV-2 infection was 97.4° F and should be considered in screening. Findings may have utility in prediction model development. Further comparisons to patients without COVID-19 are needed.