Promoting STEAM Education in Primary School through Cooperative Teaching: A Design-Based Research Study

The COVID-19 pandemic has highlighted the importance of students' information literacy, computer skills, and research competencies for self-regulated learning and problem solving. STEAM education, with interdisciplinary knowledge building and higher-order thinking development as its main purpose, is considered essential for students' sustainable development in the post-pandemic era. However, STEAM education in China's K-12 schools is facing several problems, such as insufficient qualified teachers, unsustainable development, and difficulty in achieving meaningful discipline integration. To address these problems, this study proposes an innovative STEAM education model supported by cooperative teaching and theories of project-based learning and collaborative learning. After two iterations of design, evaluation, and revision, the proposed STEAM education model and a set of instructional design principles were validated. The resulting model features a multi-teacher cooperative strategy, detailed and diverse scaffolding, familiar themes for students, the integration of STEAM education into formal curricula, and extended instruction hours. The study results suggest that cooperative teaching can facilitate meaningful discipline integration and can alleviate the STEAM faculty shortage. This study produced five proven instructional design principles for conducting STEAM education supported by cooperative teaching in primary schools.

Metabotropic glutamate receptor subtype 2 is a receptor of SARS-CoV-2 (preprint)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of novel coronavirus disease 2019 (COVID-19)1. SARS-CoV-2 uses angiotensin converting enzyme 2 (ACE2) as a cellular receptor and enters cells via clathrin-mediated endocytosis (CME)2-4. However, the key molecules involved in internalizing and facilitating CME for virus entry remain unknown. Here, we found metabotropic glutamate receptor subtype 2 (mGluR2) is a key entry receptor for SARS-CoV-2 infection. mGluR2 directly interacts with the SARS-CoV-2 spike protein. Knockdown of mGluR2 decreases endocytosis of SARS-CoV-2 but not cell binding. mGluR2 cooperates with ACE2 to facilitate SARS-CoV-2 entry through CME. Knockout of the mGluR2 gene in mice abolished SARS-CoV-2 infection in the nasal turbinates and significantly reduced viral infection in the lungs. Importantly, mGluR2 also is important for severe acute respiratory syndrome coronavirus spike protein and Middle East respiratory syndrome coronavirus spike protein mediated endocytosis. Our study provides important insights into SARS-CoV-2 infection and reveals an important target for the development of novel approaches to limit coronavirus infection.

An experimental trial of recombinant human interferon alpha nasal drops to prevent coronavirus disease 2019 in medical staff in an epidemic area (preprint)

Objective To investigate the efficacy and safety of recombinant human interferon alpha (rhIFN-) nasal drops in healthy medical staff to prevent coronavirus disease 2019 (COVID-19). Methods A prospective, open-label study was conducted in January 21, 2020at Taihe Hospital in Shiyan City, Hubei Province. Totally, 2944 medical staff members were recruited and allocated into low-risk group or high-risk group according to whether they were directly exposed to COVID-19 patients. Participants in the low-risk group received rhIFN- nasal drops (2-3 drops/nostril/time, 4 times/day) for 28 days with first-level protection; those in the high-risk group received identical rhIFN- nasal drops combined with thymosin-1 (1.6 mg, hypodermic injection, once a week) along with secondary-level or third-level protection. The primary outcome was new-onset COVID-19 over 28 days. The secondary outcome was new-onset fever or respiratory symptoms but with negative pulmonary images. The results were compared with new-onset COVID-19 in medical staff in Hubei Province (including Wuhan) during the same period. Adverse reactions to interferon nasal drops were also observed. Results Among the 2944 subjects in our study, 2415 were included in the low-risk group, including 997 doctors and 1418 nurses with average ages of 37.38 and 33.56 years, respectively; 529 were included in the high-risk group, including 122 doctors and 407 nurses with average ages of 35.24 and 32.16 years, respectively. The 28-day incidence of COVID-19 was zero in both the high and low-risk groups. The 28-day incidence of new-onset clinical symptoms with negative images for pneumonia was also zero in both the high and low-risk groups. As control, a total of 2035 medical personnel with confirmed COVID-19 from the same area (Hubei Province) was observed between January 21 to February 23, 2020. No serious adverse events were observed in our trial during the intervention period. Conclusion In this investigator-initiated open-label study, we observed that rhIFN- nasal drops may effectively prevent COVID-19 in medical staff, as an enhancement protection on the basis of standard physical isolation. Our results also indicate that rhIFN- nasal drops have potential promise for protecting susceptible healthy people during the coronavirus pandemic.

Comorbidity and its impact on 1,590 patients with COVID-19 in China: A Nationwide Analysis (preprint)

Objective: To evaluate the spectrum of comorbidities and its impact on the clinical outcome in patients with coronavirus disease 2019 (COVID-19). Design: Retrospective case studies Setting: 575 hospitals in 31 province/autonomous regions/provincial municipalities across China Participants: 1,590 laboratory-confirmed hospitalized patients. Data were collected from November 21st, 2019 to January 31st, 2020. Main outcomes and measures: Epidemiological and clinical variables (in particular, comorbidities) were extracted from medical charts. The disease severity was categorized based on the American Thoracic Society guidelines for community-acquired pneumonia. The primary endpoint was the composite endpoints, which consisted of the admission to intensive care unit (ICU), or invasive ventilation, or death. The risk of reaching to the composite endpoints was compared among patients with COVID-19 according to the presence and number of comorbidities. Results: Of the 1,590 cases, the mean age was 48.9 years. 686 patients (42.7%) were females. 647 (40.7%) patients were managed inside Hubei province, and 1,334 (83.9%) patients had a contact history of Wuhan city. Severe cases accounted for 16.0% of the study population. 131 (8.2%) patients reached to the composite endpoints. 399 (25.1%) reported having at least one comorbidity. 269 (16.9%), 59 (3.7%), 30 (1.9%), 130 (8.2%), 28 (1.8%), 24 (1.5%), 21 (1.3%), 18 (1.1%) and 3 (0.2%) patients reported having hypertension, cardiovascular diseases, cerebrovascular diseases, diabetes, hepatitis B infections, chronic obstructive pulmonary disease, chronic kidney diseases, malignancy and immunodeficiency, respectively. 130 (8.2%) patients reported having two or more comorbidities. Patients with two or more comorbidities had significantly escalated risks of reaching to the composite endpoint compared with those who had a single comorbidity, and even more so as compared with those without (all P<0.05). After adjusting for age and smoking status, patients with COPD (HR 2.681, 95%CI 1.424-5.048), diabetes (HR 1.59, 95%CI 1.03-2.45), hypertension (HR 1.58, 95%CI 1.07-2.32) and malignancy (HR 3.50, 95%CI 1.60-7.64) were more likely to reach to the composite endpoints than those without. As compared with patients without comorbidity, the HR (95%CI) was 1.79 (95%CI 1.16-2.77) among patients with at least one comorbidity and 2.59 (95%CI 1.61-4.17) among patients with two or more comorbidities. Conclusion: Comorbidities are present in around one fourth of patients with COVID-19 in China, and predispose to poorer clinical outcomes.

Clinical characteristics of 2019 novel coronavirus infection in China (preprint)

Background: Since December 2019, acute respiratory disease (ARD) due to 2019 novel coronavirus (2019-nCoV) emerged in Wuhan city and rapidly spread throughout China. We sought to delineate the clinical characteristics of these cases. Methods: We extracted the data on 1,099 patients with laboratory-confirmed 2019-nCoV ARD from 552 hospitals in 31 provinces/provincial municipalities through January 29th, 2020. Results: The median age was 47.0 years, and 41.90% were females. Only 1.18% of patients had a direct contact with wildlife, whereas 31.30% had been to Wuhan and 71.80% had contacted with people from Wuhan. Fever (87.9%) and cough (67.7%) were the most common symptoms. Diarrhea is uncommon. The median incubation period was 3.0 days (range, 0 to 24.0 days). On admission, ground-glass opacity was the typical radiological finding on chest computed tomography (50.00%). Significantly more severe cases were diagnosed by symptoms plus reverse-transcriptase polymerase-chain-reaction without abnormal radiological findings than non-severe cases (23.87% vs. 5.20%, P<0.001). Lymphopenia was observed in 82.1% of patients. 55 patients (5.00%) were admitted to intensive care unit and 15 (1.36%) succumbed. Severe pneumonia was independently associated with either the admission to intensive care unit, mechanical ventilation, or death in multivariate competing-risk model (sub-distribution hazards ratio, 9.80; 95% confidence interval, 4.06 to 23.67). Conclusions: The 2019-nCoV epidemic spreads rapidly by human-to-human transmission. Normal radiologic findings are present among some patients with 2019-nCoV infection. The disease severity (including oxygen saturation, respiratory rate, blood leukocyte/lymphocyte count and chest X-ray/CT manifestations) predict poor clinical outcomes.