Balancing Flexibility and Compliance in Response to Long-Tailed Business Process Changes (preprint)

The resilience of process-aware information systems (PAIS) is vital for enterprises' competitiveness in the ever-changing world. Enterprises need continuously maintain business processes in PAIS against uncertainty, resulting in the constant research topic of change management in business process management (BPM). However, previous efforts have left some gaps in dealing with uncertainties in change requirements, either due to high costs or technical incapability. Among these gaps, long-tailed change (LTC), characterized as the urgent and customizable maintenance needs in response to the residual uncertainty, has been largely undeveloped. COVID-19 and some emergent events in 2022 call for more effective solutions to such problems, to mitigate the business loss and to seek emerging opportunities. LTC challenges come from the contention between the degree of flexibility and compliance with business regulations in the context of rapid adaptation. In this paper, we develop a systematic approach to deal with these issues. First, we formulate the problem as a cooperation of multiple participants in the business by leveraging the separation of concerns principle to clarify the division of labor contributing to agility and fine-tuning capability of the approach, and to provide a controllable mechanism to balance operational resilience and dependable adaptation for PAIS. According to the framework, we develop a domain-specific language (DSL) and corresponding techniques to support business people in customizing business processes' behavior to meet circumstances. At the same time, business stakeholders can enforce core functions and service-level agreement (SLA) constraints on the whole business process. We validate our framework through two scenarios, one for design-time model adaptation and the other for run-time instance adaptation. These experiments reveal promising potentials of the framework in adapting to LTC and resolving the contention between agility/flexibility in change and compliance with business regulations, which significantly improves PAIS's resilience to wide-spectrum, low-frequent, sporadic, and transitory events.

Single-cell RNA sequencing to decipher the immunogenicity of ChAdOx1 nCoV-19/AZD1222 and mRNA-1273 vaccines in patients with autoimmune rheumatic diseases.

Objectives: To investigate the differences between the vector vaccine ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca) and mRNA-based vaccine mRNA-1273 (Moderna) in patients with autoimmune rheumatic diseases (AIRD), and to explore the cell-cell interactions between high and low anti-SARS-CoV-2 IgG levels in patients with rheumatic arthritis (RA) using single-cell RNA sequencing (scRNA-seq). Methods: From September 16 to December 10, 2021, we consecutively enrolled 445 participants (389 patients with AIRD and 56 healthy controls), of whom 236 were immunized with AZD1222 and 209 with mRNA-1273. The serum IgG antibodies to the SARS-CoV-2 receptor-binding domain was quantified by electrochemiluminescence immunoassay at 4-6 weeks after vaccination. Moreover, peripheral blood mononuclear cells (PBMCs) were isolated from RA patients at 4-6 weeks after vaccination for scRNA-seq and further analyzed by CellChat. ScRNA-seq of PBMCs samples from GSE201534 in the Gene Expression Omnibus (GEO) database were also extracted for analysis. Results: The anti-SARS-CoV-2 IgG seropositivity rate was 85.34% for AIRD patients and 98.20% for healthy controls. The anti-SARS-CoV-2 IgG level was higher in patients receiving mRNA-1273 than those receiving AZD1222 (ß: 35.25, 95% CI: 14.81-55.68, p=0.001). Prednisolone-equivalent dose >5 mg/day and methotrexate use in AIRD patients, and non-anti-tumor necrosis factor-α biologics and Janus kinase inhibitor use in RA patients were associated with inferior immunogenicity. ScRNA-seq revealed CD16-monocytes were predominant in RA patients with high anti-SARS-CoV2-IgG antibodies, and enriched pathways related to antigen presentation via MHC class II were found. HLA-DRA and CD4 interaction was enhanced in high anti-SARS-CoV2-IgG group. Conclusions: mRNA-1273 and AZD1222 vaccines exhibited differential immunogenicity in AIRD patients. Enriched pathways related to antigen presentation via MHC class II in CD16-monocytes might be associated with higher anti-SARS-CoV2-IgG level in RA patients and further study is warranted.

Single-cell RNA sequencing to decipher the immunogenicity of ChAdOx1 nCoV-19/AZD1222 and mRNA-1273 vaccines in patients with autoimmune rheumatic diseases

Objectives To investigate the differences between the vector vaccine ChAdOx1 nCoV-19/AZD1222 (Oxford-AstraZeneca) and mRNA-based vaccine mRNA-1273 (Moderna) in patients with autoimmune rheumatic diseases (AIRD), and to explore the cell-cell interactions between high and low anti-SARS-CoV-2 IgG levels in patients with rheumatic arthritis (RA) using single-cell RNA sequencing (scRNA-seq). Methods From September 16 to December 10, 2021, we consecutively enrolled 445 participants (389 patients with AIRD and 56 healthy controls), of whom 236 were immunized with AZD1222 and 209 with mRNA-1273. The serum IgG antibodies to the SARS-CoV-2 receptor-binding domain was quantified by electrochemiluminescence immunoassay at 4-6 weeks after vaccination. Moreover, peripheral blood mononuclear cells (PBMCs) were isolated from RA patients at 4-6 weeks after vaccination for scRNA-seq and further analyzed by CellChat. ScRNA-seq of PBMCs samples from GSE201534 in the Gene Expression Omnibus (GEO) database were also extracted for analysis. Results The anti-SARS-CoV-2 IgG seropositivity rate was 85.34% for AIRD patients and 98.20% for healthy controls. The anti-SARS-CoV-2 IgG level was higher in patients receiving mRNA-1273 than those receiving AZD1222 (β: 35.25, 95% CI: 14.81-55.68, p=0.001). Prednisolone-equivalent dose >5 mg/day and methotrexate use in AIRD patients, and non-anti-tumor necrosis factor-α biologics and Janus kinase inhibitor use in RA patients were associated with inferior immunogenicity. ScRNA-seq revealed CD16-monocytes were predominant in RA patients with high anti-SARS-CoV2-IgG antibodies, and enriched pathways related to antigen presentation via MHC class II were found. HLA-DRA and CD4 interaction was enhanced in high anti-SARS-CoV2-IgG group. Conclusions mRNA-1273 and AZD1222 vaccines exhibited differential immunogenicity in AIRD patients. Enriched pathways related to antigen presentation via MHC class II in CD16-monocytes might be associated with higher anti-SARS-CoV2-IgG level in RA patients and further study is warranted.

Burnout Among Medical Staff 1 Year After the Beginning of the Major Public Health Emergency in Wuhan, China

Objectives Wuhan is the city where coronavirus disease (COVID-19) was first reported and developed into a pandemic. However, the impact of the prolonged COVID-19 pandemic on medical staff burnout remains limited. We aimed to identify the prevalence and major determinants of burnout among medical staff 1 year after the beginning of the COVID-19 pandemic in Wuhan, China. Materials and Methods A total of 1,602 medical staff from three hospitals in Wuhan, China, were included from November 1–28, 2021. Chi-square tests were conducted to compare the prevalence of burnout across groups based on sociodemographic and professional characteristics. A multivariate analysis was performed using a forward stepwise logistic regression model. Results Approximately 37.39% of the medical staff experienced burnout 1 year after COVID-19 pandemic. Emotional exhaustion (EE) was the most common symptom of burnout, with 1,422 (88.76%) participants reporting a severe EE. Burnout was associated with insufficient social support and “neutral” or “dissatisfied” patient-physician relationships. Respondents who participated in the care of COVID-19 patients had a higher risk of burnout symptoms than those who did not participate. In particular, mental resilience was negatively associated with burnout among the medical staff. Conclusion Nearly two-fifths of the participants had symptoms of burnout, with reduced personal accomplishment being the predominant symptom 1 year after COVID-19. Healthcare organizations should regularly measure and monitor burnout among the medical staff. In addition, creating positive work environments and improving the mental resilience of medical staff may be effective ways to reduce burnout.

The burden and trend of gastric cancer and possible risk factors in five Asian countries from 1990 to 2019.

The burdens and trends of gastric cancer are poorly understood, especially in high-prevalence countries. Based on the Global Burden of Disease Study 2019, we analyzed the incidence, death, and possible risk factors of gastric cancer in five Asian countries, in relation to year, age, sex, and sociodemographic index. The annual percentage change was calculated to estimate the trends in age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR). The highest ASIR per 100,000 person-years in 2019 was in Mongolia [44 (95% uncertainty interval (UI), 34 to 55)], while the lowest was in the Democratic People's Republic of Korea (DPRK) [23 (95% UI, 19 to 29)]. The highest ASDR per 100,000 person-years was in Mongolia [46 (95% UI, 37 to 57)], while the lowest was in Japan [14 (95% UI, 12 to 15)]. Despite the increase in the absolute number of cases and deaths from 1990 to 2019, the ASIRs and ASDRs in all five countries decreased with time and improved sociodemographic index but increased with age. Smoking and a high-sodium diet were two possible risk factors for gastric cancer. In 2019, the proportion of age-standardized disability-adjusted life-years attributable to smoking was highest in Japan [23% (95% UI, 19 to 28%)], and the proportions attributable to a high-sodium diet were highest in China [8.8% (95% UI, 0.21 to 33%)], DPRK, and the Republic of Korea. There are substantial variations in the incidence and death of gastric cancer in the five studied Asian countries. This study may be crucial in helping policymakers to make better decisions and allocate appropriate resources.

Clinical Characteristics of 2019 Novel Coronavirus Pneumonia in China: A Systematic Review and Meta-analysis (preprint)

Background Although novel pneumonia associated with the Corona Virus Disease 2019 (COVID-19) suddenly broke out in China, China has controlled this epidemic effectively. Therefore, evidence-based descriptions of medical and clinical characteristics in China are necessary.Methods Literatures have been systematically performed a search on PubMed, Embase, Web of Science, GreyNet International, and The Cochrane Library from inception up to March 15, 2020. Quality of evidence was evaluated according to the STROBE checklist, and publication bias was analyzed by Egger’s test. In the single-arm meta-analysis, A random-effects model was used to obtain a pooled incidence rate. We conducted subgroup analysis according to geographic region and research scale.Results A total of 30 Chinese studies and 1969 patients were included in this meta-analysis. The valid pooled incidence rates of symptoms were as follows: rhinorrhea 5.1% (95% CI: 3.7–6.8, I2 = 31.90), diarrhea 11.0% (95% CI: 9.3–12.9, I2 = 16.58), pharyngalgia 9.4% (95% CI: 7.5–11.7, I2 = 36.40), headache 9.5% (95% CI: 8.5–11.1, I2 = 5.7), and lymphocytopenia 36.7% (95% CI: 33.8–39.8 I2 = 28.73). Meanwhile, 4.3% (95% CI: 3.5–5.4, I2 = 0.00) of patients were found without any symptoms, although they were diagnosed by RT-PCR. In terms of lung CT imaging, most of the patients showed bilateral mottling or ground-glass opacity, and 7.7% (95% CI: 4.4–12.9, I2 = 35.64) of patients had a crazy-paving pattern. In subgroup analysis, the pooled incidence rate of normal CT presentations in the Wuhan area and outside Wuhan area was 2.3% (95% CI: 1.4–3.6, I2 = 24.78) and 5.8% (95% CI: 4.4–7.7, I2 = 32.76) respectively (P = 0.001).Conclusions The findings suggest that although most of the COVID-19 patients have symptoms or abnormal CT imaging presentations, a few of them accompany with no symptoms or abnormal CT imaging results should also be noticed. The digestive symptoms and lymphocytopenia may be the potential clinical characteristics, especially for patients with a history of contact with COVID-19. Additionally, the incidence rate of ARDS in the Wuhan area and outside Wuhan area was different; however, the reasons for this phenomenon are unclear.

Clinical Characteristics of 2019 Novel Infected Coronavirus Pneumonia：A Systemic Review and Meta-analysis (preprint)

Background:A Novel pneumonia associated with the 2019 coronavirus infected pneumonia (NCIP) suddenly broke out in Wuhan, China in December 2019. 37287 confirmed cases and 813 death case in China (Until 8th/Feb/2019) have been reported in just fortnight. Although this risky pneumonia with high infection rates and high mortality rates need to be resolved immediately, major gaps in our knowledge of clinical characters of it were still not be established. The aim of this study is to summaries and analysis the clinical characteristics of 2019-nCoV pneumonia. Methods: Literature have been systematically performed a search on PubMed, Embase, Web of Science, GreyNet International, and The Cochrane Library from inception up to February 8, 2020. The Newcastle-Ottawa Scale was used to assess quality, and publication bias was analyzed by Egger test. In the single-arm meta-analysis, A fix-effects model was used to obtain a pooled incidence rate. We conducted subgroup analysis according to geographic region and research scale. Results: A total of nine studies including 356 patients were included in this study, the mean age was 52.4 years and 221 (62.1%) were male. The pooled incidences rate of symptoms as follows: pharyngalgia (12.2%, 95% CI: 0.087-0.167), diarrhea (9.2%, 95% CI: 0.062-0.133) and headache (8.9%, 95% CI: 0.063-0.125). Meanwhile, 5.7% (95% CI: 0.027-0.114) of patients were found without any symptoms although they were diagnosed by RT-PCR. In the terms of CT imaging examination, the most of patients showed bilateral mottling or ground-glass opacity, 8.6% (95% CI: 0.048-0.148) of patients with crazy-paving pattern, and 11.5% (95% CI: 0.064-0.197) of patients without obvious CT imaging presentations. The pooled incidence of mortality was 8.9% (95% CI: 0.062-0.126). Conclusions: To our knowledge, this is the first evidence-based medicine research to further elaborate the clinical characteristics of NCIP, which is beneficial to the next step of prevention and treatment.