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COVID-19 has resulted in the increased use of distance learning around the world. With the advancement of information technology, traditional classroom teaching has gradually integrated the Internet and distance learning methods. Students need to be able to learn on their own in a distance learning environment, so their ability to self-regulate their learning in a distance learning environment cannot be ignored. However, in previous studies on self-regulated learning, most learners learn alone. When they have academic doubts, they cannot obtain help and support from their studies, resulting in reduced learning outcomes. This study uses the peer self-disciplined learning mechanism to establish a distance teaching system that assists students and to improve their own learning status by meeting with peers at a distance. It can also help learners orient themselves by observing their peers' learning status and goal considerations. The participants in this study were 112 college students in the department of information management. The control group used a general self-regulated teaching system for learning, and the experimental group used a distance learning system, incorporating peer self-regulated learning. The results of the study found that learners who used the distance peer learning mechanism were more effective than those who used the general distance self-regulated learning system;learners who used the distance peer-regulated learning mechanism had better motivation, self-efficacy, and reflection after the learning activity than those who used the general distance self-regulated learning system. In addition, with the aid of such mechanisms, learners' cognitive load can be reduced, and learning effectiveness can be improved. © 2023 by the authors.
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The 2019 Novel Coronavirus Pandemic has severely challenged the continuity of post-secondary education around the world. Online learning platforms have been put to the test, in a context where student engagement will not occur as a simple matter of course. To identify the factors supporting online learning under pandemic conditions, a questionnaire based on the Unified Theory of Acceptance and Use of Technology was adapted and administered to a sample of 704 Chinese university students. Structural equation modelling was applied to the resulting data, to identify the most relevant theoretical components. Effort expectancy, social influence, and information quality all significantly predicted both students' performance expectancies and the overall adoption of their university's Moodle-based system. Performance expectancy mediated the effects of effort expectancy, social influence, and information quality on symbolic adoption. Internet speed and reliability had no clear impact on adoption, and neither did gender. The direct impact of information quality on symbolic adoption represents a particularly robust and relatively novel result;one that is not usually examined by comparable research. As outlined, this is one of three key factors that have predicted online learning engagement, and the viability of educational continuity, during the Coronavirus pandemic. The same factors can be leveraged through user-focused development and implementation, to help ensure tertiary education continuity during a range of crises © The Author(s) 2022
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BACKGROUND AND AIMS: The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA. METHODS: LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale. RESULTS: Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively. CONCLUSIONS: The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.
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SESSION TITLE: COVID-19 Infections: Issues During and After Hospitalization SESSION TYPE: Original Investigations PRESENTED ON: 10/17/2022 01:30 pm - 02:30 pm PURPOSE: To characterize the health care utilization (HCU) of patients after discharge from a hospitalization due to Coronavirus Disease 2019 (COVID-19). METHODS: Retrospective analysis from a national cohort using the Optum Clinformatics Data Mart. Included all adults hospitalized with a primary diagnosis of COVID-19 between April 2020 and March 2021, with prior 12 months of continuous enrollment. HCU of patients discharged to a home setting was evaluated in three periods (0-90 days;91-180 days;181-275 days post-discharge). HCU was defined as emergency department (ED) visits, inpatient (IP) admissions, rehabilitation/skilled nursing facility (SNF) admissions, outpatient (OP) and telemedicine visits and was expressed as the number of visits per 10,000 person-days to adjust for time from discharge. We also examined the distribution of office visits by provider specialty RESULTS: We identified 91,374 unique patients who were discharged alive after a hospitalization due to COVID-19. A greater percentage of patients was discharged to a home setting (n=63,674 or 65.6%: home 41.54%;home with home health services 14.65%: home with outpatient services 4.42%) than to a non-home setting (26.23%: i.e., SNF, hospice, rehabilitation facility, etc.). The patients discharged to a home setting were mostly white (58.8%), females (53.4%), whose mean age was 72.4 (SD± 12). The percentage of office visits to Primary care provider (57.8%;48.3%, 47.7%), Cardiology (7.7%;8.0%;7.4%) Pulmonary medicine (4.7%;3.9%;3.1%) varied in the 3 time periods evaluated. Additionally, the outpatient visits to endocrinology (1.3%, 1.6%, 1.7%), Neurology (1.1%, 1.5%, 1.5%), Physical Medicine & Rehabilitation (0.7%, 1.0%, 1.2%), Psychiatry (0.7%, 0.9%, 1.1%) and other mental health professionals (0.4%, 0.5%, 0.5%) increased over time. CONCLUSIONS: In our nationally representative study, health care utilization remains high among patients discharged to a home setting after a hospitalization due to COVID-19. Additionally, the use of mental health services increased overtime among survivors. CLINICAL IMPLICATIONS: Understanding post-discharge health care utilization of patients after an index hospitalization due to COVID-19 will help health systems prepare and allocate resources for the most likely to be used services. DISCLOSURES: No relevant relationships by Alexander Duarte No relevant relationships by Yong-Fang Kuo No relevant relationships by Shawn Nishi, value=Consulting fee Removed 04/03/2022 by Shawn Nishi No relevant relationships by Efstathia Polychronopoulou No relevant relationships by Daniel Puebla Neira No relevant relationships by Gulshan Sharma No relevant relationships by Mohammed Zaidan
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Background and Aims: The COVID-19 pandemic has impacted the care of patients with liver disease. We examined impact of COVID-19 on liver transplant (LT) activity in the USA. Methods: LT listings in the United Network for Organ Sharing (UNOS) database (April 2018-May 2021) were analyzed to examine the impact of COVID-19 pandemic on the LT activity based on etiology: hepatitis C virus (HCV), alcohol-associated liver disease (ALD), alcoholic hepatitis (AH), and nonalcoholic steatohepatitis (NASH) complications: hepatocellular carcinoma (HCC) and acute-on-chronic liver failure (ACLF) grade 2 or 3) and Model for End-Stage Liver Disease (MELD) score. Joinpoint regression models assessed time trend changes on a log scale. Results: Of 23,871 recipients (8,995 in the COVID era, April 2018-February 2020), mean age 52 years, 62% men, 61% Caucasian, 32% ALD, 15% HCC, 30% ACLF grades 2-3, and mean MELD score 20.5), monthly LT changes were a decrease of 3.4% for overall LTs and 22% for HCC after September 2020, and increase of 4.5% for ALD since 11/2020 and 17% since 03/2021 for ACLF grade 2-3. Monthly MELD scores increased by 0.7 and 0.36 after June 2020 for HCV and HCC respectively. Conclusions: The COVID-19 pandemic has impacted LT activity, with a decrease of LTs especially for HCC, and an increase of LTs for ALD and severe ACLF. Strategies are needed to reorganize cirrhosis patients to overcome the aftereffects of COVID-19 pandemic.
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Since the start of the COVID-19 pandemic, the recognition and management of thrombotic complications has become a clinical challenge, either in severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) patients or in those receiving vector-based COVID-19 vaccination. In addition to blood clot formation, platelets can also respond to a variety of inflammatory cytokines and act in concert with circulating leukocytes to prevent pathogen infection. Herein, we review the basic biological roles of platelets in infection/inflammation, tools for assessment, and mechanisms of platelet activation to elucidate their immune regulatory roles. Copyright (C) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.
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Introduction: COVID-19-infection caused by Severe Acute Respiratory Syndrome Coronavirus-2- has protean manifestations ranging from asymptomatic infection to multi-organ failure and death. Cardiovascular complications from COVID-19 include myocarditis, acute myocardial infarction (AMI), heart failure (HF). These complications-captured clinically and by tests (troponins, 2-D ECHO, MRI)-can occur either by direct injury to the myo-pericardium or by an inflammatory response and cytokine storm. Population-level data is lacking on the relationship between COVID19 and onset of Myocarditis, AMI, and HF. Therefore, we examined the incidence and correlations of Myocarditis, AMI, and HF after COVID-19 infection across the United States using a large nationwide database. Hypothesis: Infection with COVID-19 is associated with an increased risk of myocarditis. Methods: We used a retrospective cohort study using de-identified data from 35 health systems across the United States. Cohort groups were created using patients ≥18, who were admitted to hospitals for respiratory illness with COVID in 2020 and respiratory illness without COVID-19 for the years 2020 and 2019. Patients with prior cardiovascular events were excluded from the study. There were 103,187 patients with COVID;77,242 patients with respiratory illness in 2020, and 114,908 patients with respiratory illness in 2019. The COVID group was matched to each of the respiratory illness groups by propensity score. Three main cardiovascular outcomes were studied: myocarditis, AMI, HF. Results: In the COVID-19 group, 79 patients had new-onset myocarditis compared to 29 patients in the non-COVID-19 control group (Odds ratio [OR] 2.73, CI 95%, 1.78-4.18). In the COVID-19 group, 1512 patients developed HF compared to 2,659 patients in the non-COVID-19 group, (OR 0.49, CI 95%, 0.46-0.52). 1125 patients in COVID-19 group had AMI compared to 1243 patients in nonCOVID-19 group (OR 0.87, CI 95 %, 0.80-0.94). Conclusions: COVID-19 patients had 2 to 3 times the odds of incident myocarditis compared to non-COVID controls. Unexpected findings were the lower rates of HF diagnoses in the COVID-19 group, suggesting possible under testing (e.g., 2-D ECHO) and underdiagnosis in isolated COVID patients.
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Several studies have shown that COVID-19 patients with prior comorbidities have a higher risk for adverse outcomes, resulting in a disproportionate impact on older adults and minorities that fit that profile. However, although there is considerable heterogeneity in the comorbidity profiles of these populations, not much is known about how prior comorbidities co-occur to form COVID-19 patient subgroups, and their implications for targeted care. Here we used bipartite networks to quantitatively and visually analyze heterogeneity in the comorbidity profiles of COVID-19 inpatients, based on electronic health records from 12 hospitals and 60 clinics in the greater Minneapolis region. This approach enabled the analysis and interpretation of heterogeneity at three levels of granularity (cohort, subgroup, and patient), each of which enabled clinicians to rapidly translate the results into the design of clinical interventions. We discuss future extensions of the multigranular heterogeneity framework, and conclude by exploring how the framework could be used to analyze other biomedical phenomena including symptom clusters and molecular phenotypes, with the goal of accelerating translation to targeted clinical care.
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Rationale. Chronic obstructive Pulmonary Disease (COPD) has been associated with severe coronavirus disease 2019 (COVID-19) in Chinese and European cohorts. To date, no studies have evaluated the outcomes of COVID-19 in a selected cohort of patients with COPD in the United States (USA). We hypothesize that patients with COPD infected with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) will have higher likelihood of 14-day hospitalization, mechanical ventilation use, and mortality compared to non-COPD SARS-CoV2 positive patients. Methods. We performed a retrospective analysis of electronic health records (EHR) from facilities across the 4 geographical regions of the USA (Optum Covid-19 Biweekly Data). We defined COVID-19 positive as having International Classification of Disease-10 (ICD-10) code of U07.1, or positive laboratory test results. COPD patients are defined by having at least 2-outpatient visits or 1- inpatient visit with any COPD diagnosis codes within a year prior to COVID-19 positive date. Results. We studied a cohort of 150,775 patients with COVID-19 between March and August 2020 in the United States. COPD was identified in 6,056 (4%) patients. The baseline characteristics of the cohort are presented in table 1. The percentage of patients with COPD and COVID-19 admitted to the hospital in 14-days for any cause was greater than that for non-COPD COVID-19 patients (28.7% vs 10.42%, p< 0.0001). The mean length of stay was longer for COPD with COVID-19 individuals than that for non-COPD COVID-19 patients (12.3 days vs 9.0 days, p<0.001). Amongst all hospitalized, the percentage of patients who required ICU was greater for COPD patients with COVID-19 than that for non-COPD patients (26.4% vs 16.11%, p<0.001). In addition, mechanical ventilation use was higher in COPD vs non-COPD COVID-19 patients (26.4% vs 16.11%, p<0.001) Moreover, the percentage of patients who died in 30 days was greater for COPD than that for non-COPD COVID-19 patients (13.6% vs 7.25%, p<0.0001). Discussion. Patients with COPD and COVID-19 have worse outcomes compared to non-COPD COVID-19 patients.
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Rationale. The association between smoking status and severe Coronavirus Disease-2019 (COVID-19) remains controversial. To assess the risk of 14-day hospitalization, as a marker of severe COVID-19, in patients who are ever-smokers and tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) compared to those who are never smokers and tested positive for the virus in a single academic health system in the United States. Methods. We conducted a retrospective cohort study of patients who tested positive for SARS-CoV-2 in the University of Texas Medical Branch Health System between March 1st and October 30th 2020 to identify the risk of 14-day hospitalization in ever-smokers compared to non-smokers. Results. In our study period, we identified 5,738 patients who met the inclusion criteria and had documentation of smoking habits. Out of this group, 636 (11%) were consider to be ever-smokers. One hundred and ninety one patients were current smokers and 445 were former smokers. Of the 5,738 patients, 35.1% were male, average age was 43.8 (SD± 17.6), 37.4% were Caucasian, 51.5% were obese (BMI≥30), 3.19 % had vaping history, and 76.5% had at least one comorbidity. We identified 624 (10.8%) patients who were admitted in 14 days and 49(0.8%) who died in 14 days during hospitalization. The percentage of ever smokers admitted in 14 days was greater than that of never smokers (17.9% vs 10%, p<0.0001). In addition, the percentage of smokers who died in 14 days was greater than that of never smokers (2.8% vs 0.6%, p<0.0001). However, after adjusting for other covariates the odds for 14-day hospitalization among ever smokers with COVID-19 was not significant (OR 0.96, 95% CI 0.7-1.2). Conclusions. In our single center study, smoking status was not associated with severe COVID-19 infection.
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RATIONALE: The attempt at direct liberation from mechanical ventilation (MV) using open-circuit oxygen in the tracheostomized patients with prolonged MV might carry a substantial failure rate. Frequent switching between closed-circuit MV support and open-circuit oxygen, such as a T-piece during the liberation attempt, might also carry a risk of dispersing aerosol particles to the care environment, especially during the pandemic era. We aimed to analyze the feasibility and predictability of adding a screening test with automated tube compensation (ATC) or airway resistance compensation (ARC) mode before the attempt of an open-circuit oxygen trial. METHODS: We conducted a retrospective analysis of tracheostomized patients admitted to a medical center's dedicated weaning unit in Taiwan. Because of coronavirus's global pandemic, the unit implemented a universal process to apply ATC/ARC screening tests to patients since April 2020. Before starting the MV liberation trial with continuous spontaneous breathing via open-circuit oxygen (T-piece), the patients received a screening test consisting of 12 hours of ATC/ARC the first day followed by 72 hours of continuous ATC/ARC. Those who passed the test then proceeded to the open-circuit liberation trial. Those who failed the test would receive repeated ATC/ARC or open circuit trials. RESULTS: A total of 79 (51% of the admitted) patients, including 54 male, aged 69 [18-95] years, and averaged 32 days of MV before admission to the weaning unit, received the screening test (59 for ATC;20 for ARC) after MV settings reduction. Of the 79 patients, 48 (61%) succeeded in the test. Upon discharge from the unit, 49 (62%) were liberated from MV, and 43 (54%) were MV-free status 30 days after the ATC/ARC test. Of the 31 who failed ATC/ARC, 22 (71%) remained MV-dependent at 30 days after the ATC/ARC test. Therefore, the sensitivity, specificity, positive predictive value, and negative predictive values of the ATC/ARC test for outcomes of MV-liberation upon discharge from the unit were 90%, 87%, 92%, and 84%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of the ATC/ARC test for outcomes of MV-free status 30 days after the test were 93%, 78%, 83%, and 90%, respectively. CONCLUSION: Before proceeding with open-circuit oxygen, a screening test with ATC/ARC provides an optimal prediction for the 30-day outcomes of MV liberation.
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RATIONALE: The association between smoking status and severe Coronavirus Disease 2019 (COVID-19) remains controversial. OBJECTIVE: To assess the risk of hospitalization (as a marker of severe COVID-19) in patients by smoking status: former, current and never smokers, who tested positive for the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) at an academic medical center in the United States. METHODS: We conducted a retrospective cohort study in patients with SARS-COV2 between March-1-2020 and January-31-2021 to identify the risk of hospitalization due to COVID-19 by smoking status. RESULTS: We identified 10216 SARS-COV2-positive patients with complete documentation of smoking habits. Within 14 days of a SARS-COV2 positive test, 1150 (11.2%) patients were admitted and 188 (1.8%) died. Significantly more former smokers were hospitalized from COVID-19 than current or never smokers (21.2% former smokers;7.3% current smokers;10.4% never smokers, p<0.0001). In univariable analysis, former smokers had higher odds of hospitalization from COVID-19 than never smokers (OR 2.31;95% CI 1.94-2.74). This association remained significant when analysis was adjusted for age, race and gender (OR 1.28;95% CI 1.06-1.55), but became non-significant when analysis included Body Mass Index, previous hospitalization and number of comorbidities (OR 1.05;95% CI 0.86-1.29). In contrast, current smokers were less likely than never smokers to be hospitalized due to COVID-19. CONCLUSIONS: Significantly more former smokers were hospitalized and died from COVID-19 than current or never smokers. This effect is mediated via age and comorbidities in former smokers.
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BACKGROUND: The aims of the present study were to examine the prediction of the threat and coping appraisal utilizing an extended protection motivation theory (PMT) for the motivation to have COVID-19 vaccination and the influence of various information sources on coping appraisal among university students in China. METHODS: The sample comprised 3145 students from 43 universities in China who completed an online survey including PMT constructs as well as constructs added to PMT. The PMT constructs comprised motivation to have COVID-19 vaccination, threat appraisal, and coping appraisal. The extended PMT constructs comprised knowledge about mechanisms and information sources of COVID-19 vaccination. RESULTS: Perceived severity of COVID-19 was positively associated with motivation to have COVID-19 vaccination. Receiving information concerning COVID-19 vaccination from medical personnel was associated with greater self-efficacy, response efficacy, and knowledge, whereas receiving information concerning COVID-19 vaccination from coworkers/colleagues was associated with less response efficacy and knowledge. Receiving online information concerning COVID-19 vaccination was associated with greater response cost of vaccination efficacy and less knowledge. CONCLUSIONS: This study supported the prediction of perceived severity in the PMT for motivation to have COVID-19 vaccination among university students in China. Vaccination information sources have different effects on students' coping appraisal of COVID-19 vaccination.
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Purpose: Physical gatherings at social events have been found as one of the main causes of COVID-19 transmission all over the world. Smartphone has been used for contact tracing by exchanging messages through Bluetooth signals. However, recent confirmed cases found in venues indicated that indirect transmission of the causative virus occurred, resulting from virus contamination of common objects, virus aerosolization in a confined space or spread from inadequate ventilation environment with no indication of human direct or close contact observed. Design/methodology/approach: This paper presents a novel cyber-physical architecture for spatial temporal analytics (iGather for short). Locations with time windows are modeled as digital chromosomes in cyberspace to represent human activity instances in the physical world. Findings: Results show that the high spatial temporal correlated but indirect tracing can be realized through the deployment of physical hardware and spatial temporal analytics including mobility and traceability analytics. iGather is tested and verified in different spatial temporal correlated cases. From a management perspective of mobilizing social capacity, the venue plays not only a promotion role in boosting the utilization rates but also a supervision-assisted role for keeping the venue in a safe and healthy situation. Social implications: This research is of particular significance when physical distancing measures are being relaxed with situations gradually become contained. iGather is able to help the general public to ease open questions: Is a venue safe enough? Is there anyone at a gathering at risk? What should one do when someone gets infected without raising privacy issues? Originality/value: This study contributes to the existing literature by cyber-physical spatial temporal analytics to trace COVID-19 indirect contacts through digital chromosome, a representation of digital twin technology. Also, the authors have proposed a venue-oriented management perspective to resolve privacy-preserving and unitization rate concerns. © 2021, Emerald Publishing Limited.