"No more COVID-19 messages via social media, please": the mediating role of COVID-19 message fatigue between information overload, message avoidance, and behavioral intention.

Employing the stressor-strain-outcome framework, this study demonstrates that COVID-19 information overload on social media exerts a significant effect on the level of fatigue toward COVID-19-related messages. This feeling of message fatigue also makes people avoid another exposure to similar types of messages while diminishing their intentions to adopt protective behaviors in response to the pandemic. Information overload regarding COVID-19 on social media also has indirect effects on message avoidance and protective behavioral intention against COVID-19, respectively, through the feeling of fatigue toward COVID-19 messages on social media. This study emphasizes the need to consider message fatigue as a significant barrier in delivering effective risk communication.

Efficacy of distance training program for cardiopulmonary resuscitation utilizing smartphone application and home delivery system.

AIM OF THE STUDY: Community cardiopulmonary resuscitation (CPR) education is important for laypersons. However, during the COVID-19 pandemic, with social distancing, conventional face-to-face CPR training was unavailable. We developed a distance learning CPR training course (HEROS-Remote) using a smartphone application that monitors real-time chest compression quality and a home delivery collection system for mannikins. This study aimed to evaluate the efficacy of the HEROS-Remote course by comparing chest compression quality with that of conventional CPR training. METHODS: We applied layperson CPR education with HEROS-Remote and conventional education in Seoul during the COVID-19 pandemic. Both groups underwent a 2-min post-training chest compression test, and we tested non-inferiority. Chest compression depth, rate, complete recoil, and composite chest compression score was measured. Trainees completed a satisfaction survey on CPR education and delivery. The primary outcome was the mean chest compression depth. RESULTS: A total of 180 trainees were enrolled, with 90 assigned to each training group. Chest compression depth of HEROS-Remote training showed non-inferiority to that of conventional training (67.4 vs. 67.8, p = 0.78), as well as composite chest compression score (92.7 vs. 95.5, p = 0.16). The proportions of adequate chest compression depth, chest compression rate, and chest compressions with complete chest recoil were similar in both training sessions. In the HEROS-Remote training, 90% of the trainees were satisfied with CPR training, and 96% were satisfied with the delivery and found it convenient. CONCLUSION: HEROS-Remote training was non-inferior to conventional CPR training in terms of chest compression quality. Distance learning CPR training using a smartphone application and mannikin delivery had high user satisfaction and was logistically feasible.

Analysis of protein-protein interface with incorporating low-frequency molecular interactions in molecular dynamics simulation.

Protein-protein interactions are vital for various biological processes such as immune reaction, signal transduction, and viral infection. Molecular Dynamics (MD) simulation is a powerful tool for analyzing non-covalent interactions between two protein molecules. In general, MD simulation studies on the protein-protein interface have focused on the analysis of major and frequent molecular interactions. In this study, we demonstrate that minor interactions with low-frequency need to be incorporated to analyze the molecular interactions in the protein-protein interface more efficiently using the complex of SARS-CoV2-RBD and ACE2 receptor as a model system. It was observed that the dominance of interactions in the MD-simulated structures didn't directly correlate with the interactions in the experimentally determined structure. The interactions from the experimentally determined structure could be reproduced better in the ensemble of MD simulated structures by including the less frequent interactions compared to the norm of choosing only highly frequent interactions. Residue Interaction Networks (RINs) analysis also showed that the critical residues in the protein-protein interface could be more efficiently identified by incorporating low-frequency interactions in MD simulation. It is expected that the approach proposed in this study can be a new way of studying protein-protein interaction through MD simulation.

False-positive Xpert® Xpress SARS-CoV-2 assay in an emergency room and trauma center: A retrospective chart review study.

OBJECTIVES: To review reports false-positive Xpert results in an emergency room and trauma center. METHODS: Patients' data with false-positive Xpert results from November 2020 to February 2022 at Pusan National University Hospital, Busan, Republic of Korea, were extracted from the electronic medical records. RESULTS: The positive predictive value of Xpert was 40%. Of the 12 patients with false-positive results, 5 (41.7%) were re-positives (such as, patients recovered from coronavirus disease-19 [COVID-19]), and 4 (33.3%) had head or facial trauma. Two out of 4 head or facial trauma cases had documented sample contamination with blood. CONCLUSION: We found a high incidence of false-positive Xpert results among patients who recovered from COVID-19 and those with head or facial injury. Careful history taking for COVID-19 and physical examination of the sample collection site is essential before Xpert analysis.

The effect of regional distribution of isolation rooms in emergency departments on ambulance travel time during the COVID-19 pandemic.

OBJECTIVE: The number and distribution of isolation rooms in Korea differ by region. The distribution of isolation beds in emergency departments may have affected ambulance travel time and burden on emergency medical service (EMS) during the COVID-19 pandemic. METHODS: This retrospective observational study analyzed EMS records in four regions of the Gyeonggi Province, Korea, from January 01, 2019 to December 31, 2020. The main exposure was the number of emergency department isolation rooms in each region. The primary outcome was call-to-return time for the EMS. The interaction effect of the number of regional isolation rooms on the call-to-return time during the COVID-19 pandemic was analyzed using a generalized linear model (GLM) and logistic regression. RESULTS: A total of 781,246 cases was included in the analyses. During the COVID-19 pandemic, the call-to-scene time (before 8 minutes vs. after 9 minutes, P<0.05) and call-to-return time (before 46 minutes vs. after 52 minutes, P<0.05) for emergency patients increased significantly compared to before the pandemic. As the number of regional isolation rooms increased, the effect of COVID-19 on the call-to-return time decreased significantly in the multivariable GLM with an interaction term (with 10.14 isolation rooms per million population: adjusted exponential ß coefficient [exp(ß)], 1.33; with 12.24 isolation rooms per million population: adjusted exp(ß), 1.18). As the number of regional isolation rooms increased, the effect of COVID-19 on the call-to-scene time decreased significantly in the multivariable GLM with an interaction term (with 10.14 isolation rooms per million population: adjusted exp(ß), 1.20; with 12.24 isolation rooms per million population: adjusted exp(ß), 1.09). CONCLUSION: During the pandemic, the increases in call-to-return time and call-to-scene time were smaller in regions with more isolation rooms per population.

Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019.

The need of palliative care at the end-of-life in the emergency departments (ED) is growing. The study aims to investigate the epidemiology of patients who died during care in ED using nationwide database, and to estimate the need for palliative care in the ED. A retrospective observational study was conducted using the National Emergency Department Information System (NEDIS) database. Patients who died during ED care between 2016 and 2019 were included. Palliative care-eligible disease was defined as cancer (C00-C99 of ICD-10), chronic respiratory disease (CRD, J44-J46), chronic liver disease (CLD, K70-K77), and heart failure (HF, I50). Among the 36,538,486 ED visits during 4 years, 34,086 ED deaths were included. The crude incidence rate of ED deaths per 100,000 person-year was steady between 16.6 in 2016 and 16.3 in 2019 (p-for-trend = 0.067). Only 3370 (9.9%) ED deaths were injury, while 30,716 (90.1%) deaths were related to diseases. The most common ED diagnosis was cardiac arrest (22.1%), followed by pneumonia (8.6%) and myocardial infarction (4.7%). In cases of disease-related ED deaths, about 34.0% stayed longer than 8 h in the ED (median (interquartile range): 4.5 (1.9-11.7) h) and 44.2% received cardiopulmonary resuscitation (CPR) at end-of-life time. A quarter of the disease-related ED deaths were diagnosed with palliative care eligible disease: cancer (16.9%), CLD (3.8%), HF (3.5%), and CRD (1.4%). Cancer patients received less CPR (23.4%) and stayed longer in the ED (median (interquartile range): 7.3 (3.2-15.9) h). Over the past 4 years, more than 30,000 patients, including 5200 cancer patients, died during care in the ED. A quarter of disease-related ED death were patients with palliative care-eligible condition and more than 30% of them stayed longer than 8 h in the ED before death. It is time to discuss about need of palliative care in the ED.

Transition from in-person to telehealth standardized patient encounters: A retrospective analysis of 18 cases.

INTRODUCTION: Due to the COVID-19 pandemic, many pedagogical activities shifted from in-person to virtual modalities, including standardized patient (SP) encounters. While many academic institutions may not have previously been conducting SP encounters virtually, this change provided student pharmacists with new opportunities to learn and practice telehealth techniques, which are important with the continuously evolving healthcare landscape. METHODS: This retrospective study analyzed pharmacy student performance on and perceptions of SP cases in fall 2019 (in-person) and fall 2020 (telehealth) semesters. The primary objective was to compare average total scores on SP cases from fall 2019 (in-person) and fall 2020 (telehealth) for first-, second-, and third-year pharmacy students (P1, P2, and P3, respectively). Secondary objectives were to compare average scores from case-specific and relationship and communication (R&C) checklists, as well as to describe student perceptions of the pedagogy. RESULTS: Total scores on SP cases decreased from in-person to telehealth for the average of all P1 SP cases, but not for P2 or P3 cases. Case-specific scores did not change, but R&C scores decreased significantly across all three years. Student survey data revealed difficulty with communicating effectively and building rapport via telehealth. CONCLUSIONS: Overall, student performance on in-person vs. telehealth SP encounters was similar, though P1 students performed more poorly on SP cases conducted via telehealth compared to P2 or P3 students. Thus, faculty could consider focusing on in-person encounters for early learners before introducing virtual encounters. This study also highlights the difficulty in establishing rapport when communicating with patients via telehealth.

Immunogenicity and Durability of Antibody Responses to Homologous and Heterologous Vaccinations with BNT162b2 and ChAdOx1 Vaccines for COVID-19.

During the COVID-19 pandemic, vaccines were developed based on various platform technologies and were approved for emergency use. However, the comparative analysis of immunogenicity and durability of vaccine-induced antibody responses depending on vaccine platforms or vaccination regimens has not been thoroughly examined for mRNA- or viral vector-based vaccines. In this study, we assessed spike-binding IgG levels and neutralizing capacity in 66 vaccinated individuals prime-boost immunized either by homologous (BNT162b2-BNT162b2 or ChAdOx1-ChAdOx1) or heterologous (ChAdOx1-BNT162b2) vaccination for six months after the first vaccination. Despite the discrepancy in intervals for the prime-boost vaccination regimen of different COVID-19 vaccines, we found stronger induction and relatively rapid waning of antibody responses by homologous vaccination of the mRNA vaccine, while weaker boost effect and stable maintenance of humoral immune responses were observed in the viral vector vaccine group over 6 months. Heterologous vaccination with ChAdOx1 and BNT162b2 resulted in an effective boost effect with the highest remaining antibody responses at six months post-primary vaccination.

Understanding motivations and deterrents for COVID-19 vaccination among US working adults: A mixed method approach.

COVID-19 vaccines have been developed and administered in the United States. Despite evidence from clinical trials for the effectiveness of the COVID-19 vaccines, many individuals are still hesitant or even unwilling to receive one. The purposes of this study are (1) to examine characteristics associated with those willing and unwilling to receive a COVID-19 vaccine and (2) to illuminate the reasons behind their willingness and unwillingness to receive the vaccine using both quantitative and qualitative data. Data collected from 505 US working adults showed that several demographic variables (i.e. education, the size of their organization, the number of dependents, political orientation, and religion) and influence sources (i.e. family members, workplace leaders, political leaders, social media influencers, and healthcare workers) significantly correlated with people's willingness/unwillingness to receive a COVID-19 vaccine. Furthermore, protecting oneself was the most common reason cited by participants for willingness to get the vaccine, while being concerned about vaccine side effects was the most frequently given reason for being unwilling to receive a COVID-19 vaccine. This study expands our current understanding of the COVID-19 vaccine motivators and intention factors. Practically, the findings can help develop health campaign messages effectively target working adults who are unwilling to receive the COVID-19 vaccines and ultimately increase the vaccination rate in the United States.

Performance Analysis of Self-Collected Nasal and Oral Swabs for Detection of SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the third highly pathogenic human coronavirus and is rapidly transmitted by infected individuals regardless of their symptoms. During the COVID-19 pandemic, owing to the dearth of skilled healthcare workers (HCWs) to collect samples for early diagnosis, self-collection emerged as a viable alternative. To evaluate the reliability of self-collection, we compared the virus detection rate using 3990 self-collected swabs and HCW-collected swabs, procured from the same individuals and collected immediately after the self-collection. The results of multiplex reverse-transcription quantitative polymerase chain reaction revealed that the viral load in the HCW-collected swabs was marginally (18.4–28.8 times) higher than that in self-collected swabs. Self-collection showed no significant difference in sensitivity and specificity from HCW-collection (κ = 0.87, McNemar’s test;p = 0.19), indicating a comparable performance. These findings suggest that self-collected swabs are acceptable substitutes for HCW-collected swabs, and that their use improved the specimen screening efficiency and reduced the risk of SARS-CoV-2 infection among HCWs during and after the COVID-19 pandemic.

Performance Analysis of Self-Collected Nasal and Oral Swabs for Detection of SARS-CoV-2.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the third highly pathogenic human coronavirus and is rapidly transmitted by infected individuals regardless of their symptoms. During the COVID-19 pandemic, owing to the dearth of skilled healthcare workers (HCWs) to collect samples for early diagnosis, self-collection emerged as a viable alternative. To evaluate the reliability of self-collection, we compared the virus detection rate using 3990 self-collected swabs and HCW-collected swabs, procured from the same individuals and collected immediately after the self-collection. The results of multiplex reverse-transcription quantitative polymerase chain reaction revealed that the viral load in the HCW-collected swabs was marginally (18.4-28.8 times) higher than that in self-collected swabs. Self-collection showed no significant difference in sensitivity and specificity from HCW-collection (κ = 0.87, McNemar's test; p = 0.19), indicating a comparable performance. These findings suggest that self-collected swabs are acceptable substitutes for HCW-collected swabs, and that their use improved the specimen screening efficiency and reduced the risk of SARS-CoV-2 infection among HCWs during and after the COVID-19 pandemic.

The school education, ritual customs, and reciprocity associated with self-regulating hand hygiene practices during COVID-19 in Japan.

BACKGROUND: The role of social ties, other-regarding preferences, and cultural traits in boosting community resilience and minimizing citizens' vulnerability to crises such as COVID-19 is increasingly being recognized. However, little is presently known about the possible routes through which such personal preferences and cultural norms pertinent to social behaviors are formulated. Thus, in this paper, factors that can be potentially associated with individuals to self-regulate strict hand hygiene practices before the pandemic, during the state of emergency, and after the state of emergency was lifted in Japan are investigated. Focus is given to the handwashing education in primary school, a cultural practice originating from the old Shinto tradition, and individuals' reciprocal inclinations. As people in Japan are known to be highly conscious of hygiene in all aspects of their daily life and are less likely to contract an infection, evidence obtained in this specific context could contribute to the better understanding of individuals' health-related behaviors in general, and during crises in particular. METHODS: Using the data derived from a four-wave nationwide longitudinal online survey, we examined the extent to which elementary school education, childhood cultural experiences at shrines, and individual other-regarding preferences are associated with self-regulating hand hygiene practices prior to the pandemic and people's efforts to comply with the government-imposed measures aimed at preventing the spread of COVID-19 infection during the state of emergency. We also investigated the long-term trends in the relationships among these factors (i.e., after the abolishment of the state of emergency) using panel data. RESULTS: Our findings reveal that childhood education and cultural experiences related to handwashing practices, as well as reciprocal inclinations, are significantly associated with Japanese attitudes toward personal hygiene (beyond handwashing practices) prior to, during, and after the state of emergency. In recognition of the possible effects of recall bias and measurement errors, several important attempts to mitigate these issues were made to strengthen the value of our findings. CONCLUSIONS: The importance of school education received during childhood, as well as culture and other-regarding preferences, in the individual attitudes toward hand hygiene in adulthood highlighted in this study contributes to the better understanding of the role that these factors play in the variations in voluntary compliance with strict hand hygiene practices before and during an uncertain and prolonged crisis.

Self-Quarantine System and Personal Information Privacy in South Korea.

The purpose of this study is to present a legal system in which information is actively collected and utilized to monitor the location and health of self-quarantined persons through IT, to identify loopholes in the law and regulatory system in view of data protection and utilization, and to propose a legislative solution for those loopholes. In Korea, the Infectious Disease Control and Prevention Act ("the Prevention Act") regulates all matters related to the prevention and management of infectious diseases, including the use of information on self-quarantine apps. Article 42(2) of the Prevention Act states that local governments are authorized to collect the location and health information of a quarantined citizen; however, the law does not elaborate on how this information can be used and what other information can be used in combination with the collected information. Thus, the Personal Information Protection Act ("the Protection Act"), as a general privacy law, is applied supplementarily. However, since the Protection Act is very general and does not have accumulated cases, there is uncertainty about how governments can utilize the collected information. Therefore, it is necessary to consider a legislative solution that includes a direct and clear basis for the use of personal information collected under the Prevention Act in consideration of Korean privacy regulations.

Evaluation of Alternative Transport Media for RT-qPCR-Based SARS-CoV-2 Testing.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is still rapidly spreading as of March 2022. An accurate and rapid molecular diagnosis is essential to determine the exact number of confirmed cases. Currently, the viral transport medium (VTM) required for testing is in short supply due to a sharp increase in the laboratory tests performed, and alternative VTMs are needed to alleviate the shortage. Guanidine thiocyanate-based media reportedly inactivate SARS-CoV-2 and are compatible with quantitative reverse transcription polymerase chain reaction (RT-qPCR) assays, but the compatibility and the viral detection capacity have not been fully validated. To evaluate the guanidine thiocyanate-based Gene Transport Medium (GeneTM) as an alternative VTM, we prepared 39 SARS-CoV-2-positive and 7 SARS-CoV-2-negative samples in GeneTM, eNAT™, and phosphate-buffered saline (PBS). The cycle threshold (Ct) values of three SARS-CoV-2 targets (the S, RdRP, and N genes) were analyzed using RT-qPCR testing. The comparison of Ct values from the positive samples showed a high correlation (R 2= 0.95-0.96) between GeneTM and eNAT™, indicating a comparable viral detection capacity. The delta Ct values of the SARS-CoV-2 genes in each transport medium were maintained for 14 days at cold (4°C) or room (25°C) temperatures, suggesting viral samples were stably preserved in the transport media for 14 days. Together, GeneTM is a potential alternative VTM with comparable RT-qPCR performance and stability to those of standard media.

Misinformation of COVID-19 vaccines and vaccine hesitancy.

The current study examined various types of misinformation related to the COVID-19 vaccines and their relationships to vaccine hesitancy and refusal. Study 1 asked a sample of full-time working professionals in the US (n = 505) about possible misinformation they were exposed to related to the COVID-19 vaccines. Study 2 utilized an online survey to examine U.S. college students' (n = 441) knowledge about COVID-19 vaccines, and its associations with vaccine hesitancy and behavioral intention to get a COVID-19 vaccine. Analysis of open-ended responses in Study 1 revealed that 57.6% reported being exposed to conspiratorial misinformation such as COVID-19 vaccines are harmful and dangerous. The results of a structural equation modeling analysis for Study 2 supported our hypotheses predicting a negative association between the knowledge level and vaccine hesitancy and between vaccine hesitancy and behavioral intention. Vaccine hesitancy mediated the relationship between the vaccine knowledge and behavioral intention. Findings across these studies suggest exposure to misinformation and believing it as true could increase vaccine hesitancy and reduce behavioral intention to get vaccinated.

Factors Affecting Nurses' Health Promotion Behavior during the COVID-19 Pandemic Based on the Information-Motivation-Behavioral Skills Model.

Background and Objectives: The COVID-19 pandemic has emerged as a major threat to nurses' health. This study aimed to investigate the factors affecting nurses' health promotion behaviors during the coronavirus disease 2019 (COVID-19) pandemic. Material and Methods: The participants were clinical nurses who had direct contact with patients at a university hospital in G province, Korea. Data were collected from March 16 to April 16, 2021, and the final analysis included data from 162 nurses. The general and lifestyle characteristics of the participants were analyzed using descriptive statistics, and the effect on health promotion behavior was analyzed using multiple regression with SPSS/WIN 21.0. Results: The results showed that the factors influencing nurses' health promotion behavior during the COVID-19 pandemic were social support (ß = 0.40, p < 0.001), self-efficacy (ß = 0.27, p = 0.014), being married (ß = 0.18, p = 0.018), having good health (ß = 0.31, p < 0.001), and not skipping meals (ß = 0.20, p = 0.001). The explanatory power of the variables was 51.4%. Therefore, health promotion programs to promote social support and self-efficacy are needed to improve nurses' health promotion behaviors during the COVID-19 pandemic. Conclusions: These results indicate that the development of additional management strategies for health promotion among nurses during the COVID-19 pandemic is necessary. It is necessary to prepare organizational policies and manage self-care to improve nurses' irregular eating habits during the ongoing pandemic.

Application of Convolutional Neural Network (CNN) to Recognize Ship Structures

The purpose of this paper is to study the recognition of ships and their structures to improve the safety of drone operations engaged in shore-to-ship drone delivery service. This study has developed a system that can distinguish between ships and their structures by using a convolutional neural network (CNN). First, the dataset of the Marine Traffic Management Net is described and CNN’s object sensing based on the Detectron2 platform is discussed. There will also be a description of the experiment and performance. In addition, this study has been conducted based on actual drone delivery operations—the first air delivery service by drones in Korea.

A Novel Approach on Deep Learning-Based Decision Support System Applying Multiple Output LSTM-Autoencoder: Focusing on Identifying Variations by PHSMs' Effect over COVID-19 Pandemic.

Following the outbreak of the COVID-19 pandemic, the continued emergence of major variant viruses has caused enormous damage worldwide by generating social and economic ripple effects, and the importance of PHSMs (Public Health and Social Measures) is being highlighted to cope with this severe situation. Accordingly, there has also been an increase in research related to a decision support system based on simulation approaches used as a basis for PHSMs. However, previous studies showed limitations impeding utilization as a decision support system for policy establishment and implementation, such as the failure to reflect changes in the effectiveness of PHSMs and the restriction to short-term forecasts. Therefore, this study proposes an LSTM-Autoencoder-based decision support system for establishing and implementing PHSMs. To overcome the limitations of existing studies, the proposed decision support system used a methodology for predicting the number of daily confirmed cases over multiple periods based on multiple output strategies and a methodology for rapidly identifying varies in policy effects based on anomaly detection. It was confirmed that the proposed decision support system demonstrated excellent performance compared to models used for time series analysis such as statistical models and deep learning models. In addition, we endeavored to increase the usability of the proposed decision support system by suggesting a transfer learning-based methodology that can efficiently reflect variations in policy effects. Finally, the decision support system proposed in this study provides a methodology that provides multi-period forecasts, identifying variations in policy effects, and efficiently reflects the effects of variation policies. It was intended to provide reasonable and realistic information for the establishment and implementation of PHSMs and, through this, to yield information expected to be highly useful, which had not been provided in the decision support systems presented in previous studies.