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A century of changes combined with the COVID-19 pandemic has sounded the alarm on energy security around the world. How to deeply understand the relationship between energy transition and energy security, and how to explore the path of China's energy security and the carbon peaking and carbon neutrality (abbreviated as "dual carbon”) strategy have become a major problem. Based on detailed analyses of China's energy consumption predictions and dual carbon strategy requirements, this study proposes: (1) Energy security is the foundation of energy transition. The oil and gas shortage situation in China may persist for a long time. The "dual carbon” goal does not conflict with hydrocarbon security strategy. (2) China's hydrocarbon security needs to be considered at two levels. The deployment needs to be made in the near-, medium-and long-term. First, it is necessary to continue exploring traditional oil and gas resources, including land and sea, conventional and unconventional resources. The second is to actively explore at new areas of oil and gas resources, and focus on organizing the "three revolutions” of in-situ conversion of medium-low mature shale oil, thermal conversion and utilization of oil-rich coal and underground coal gasification to prepare for large-scale increase of oil and gas production. (3) The "dual carbon” strategy is an extensive and profound system revolution. The withdrawal of fossil energy must be based on energy security. The clean use of fossil energy, the increased use of renewable energy, the construction of flexible smart grids, the construction of energy storage infrastructure and the improvement of efficiency in energy utilization, must be paid close attention to simultaneously. On the basis of ensuring energy security, the goal of "carbon neutrality” can be achieved through multiple ways relying on technological progress. © 2023, Science Press. All rights reserved.
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Numerous studies links movement activity (e.g., physical activity, sedentary behavior [SB], and sleep) with mental health or illness indicators during the COVID-19 pandemic;however, research has typically examined time-use behaviors independently, rather than considering daily activity as a 24-hour time-use composition. This cross-sectional study aimed to use compositional isotemporal analysis to estimate the association between reallocation of time-use behaviors and depression symptoms in young adults in China. Participants (n = 1475;68.0% of female;20.7 [1.60] years) reported their time spent in moderate to vigorous physical activity (MVPA), light physical activity (LPA), SB, and sleep. Replacing SB with sleep, LPA, and MVPA at 5, 10, or 15 min was significantly associated with lower estimated depression symptoms scores. For example, adding MVPA from SB at 15 min was associated with lower depression symptoms scores (estimated difference: -0.13 [-0.17, -0.09]). The associations between reallocation of time use behaviors with depression symptoms scores were slightly differentiated. Our results emphasize the importance of increased MVPA and decreased SB as well as their mutual replacements for lowering the risks of depression symptoms in young adults during the COVID-19 pandemic. Our results can inform policy to develop effective plans and strategies for mental health promotion.
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Introduction: IgA nephropathy (IgAN) is an immune complex glomerulonephritis (GN) characterized by glomerular deposition of IgA-dominant immune complexes, often accompanied by mesangial hypercellularity. Antineutrophil cytoplasmic antibodies (ANCAs) cause small-vessel vasculitis and pauci-immune crescentic GN. The coexistence of ANCAs and IgAN is quite rare. ANCAs have been associated with inflammatory bowel disease (IBD) but are more prevalent in ulcerative colitis (~75%) than Crohn's disease (~17%). IBD-associated ANCAs are usually p-ANCA or atypical ANCA rather than c-ANCA. ANCA-associated vasculitis (AAV) can be associated with tumor necrosis factor-alpha inhibitors such as infliximab. We report a rare case of c-ANCA PR3-positive IgAN in a patient with IBD treated with infliximab who presented with proteinuria. Case Description: A 27-year-old female with history of Crohn's disease since 2010 treated with infliximab, allergic rhinoconjunctivitis, mild asthma, erythema nodosum in June 2021 (resolved with prednisone), Charcot-Marie-Tooth disease, psoriasis, and COVID-19 disease in Oct 2021, was found to have positive c-ANCA (1:160) and PR3 (5.0 AI, reference <1.0) in Dec 2021, raising question of vasculitis. Her rhinosinusitis was well controlled with allergy medications without oral steroids. She was referred to Nephrology for proteinuria with urinalysis (UA) in April 2022 showing 2+ protein, 3+ blood, 2-10 WBC, 20-50 RBC. Urine protein/creatinine ratio was 1.9. She had foamy urine but no gross hematuria. She previously had UA with packed RBC in June 2021. Urogram showed non-specific bladder wall thickening. Cystourethroscopy was negative. In April 2022, her BP was 97/66 and she had no edema. A renal biopsy in May 2022 revealed IgAN (M0 E1 S1 T0 C0). She was started on lisinopril and fish oil. Discussion(s): This is a very rare case of c-ANCA PR3-positive IgAN in IBD treated with infliximab. The patient's history of sinusitis along with c-ANCA PR3 antibody positivity suggested possibly an AAV associated with infliximab, which has been reported rarely in IBD. Her proteinuria of 1.9 g/day raised concern for GN due to pauci-immune AAV. However, renal biopsy showed IgAN rather than AAV. This case highlights the importance of renal biopsy in establishing a definitive diagnosis of glomerular disorders in patients with ANCA positivity, as serum ANCAs do not necessarily represent pauciimmune GN.
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In this policy and practice brief, we analyze the U.S. Paycheck Protection Program (PPP). The PPP provided loans to support businesses during the COVID-19 pandemic. Some businesses received timely relief from the PPP loans, while some were not able to acquire assistance. Production agriculture received 617,128 PPP loans totaling $17 billion.' The reach of PPP loans across the country was broad. In 80% of U.S. zip codes, at least one farm received a PPP loan. The average size of the loan in agriculture ($27,744) was substantially smaller than the national average ($74,156). The authors conducted interviews with PPP recipients and present some findings from those. The most recent data reveal challenges and opportunities for agricultural businesses, depending on their scale of operations and regional disparities. Community organizations working with small agriculture-related businesses need to be aware of various impacts while providing future assistance.
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Introduction: Primary membranous nephropathy (MN) is most commonly due to phospholipase A2 receptor antibodies (PLA2R Ab). It is unclear whether the COVID-19 vaccine can trigger flares of glomerular diseases such as primary MN. We present a patient with MN and metastatic breast cancer who developed nephrotic syndrome after receiving her second mRNA-1273 COVID-19 vaccine with positive PLA2R Ab by ELISA suggesting MN flare. Case Description: A 62 year old female with history of Stage IIIB T3N3M1 ER/PR positive HER-2 negative metastatic left breast invasive ductal carcinoma, hypertension, hyperlipidemia, and primary MN presented with bilateral leg edema, dyspnea, and proteinuria 2 weeks after COVID-19 vaccination. She had previous proteinuria of 7029 mg/24hr in August 2018 with PLA2R Ab 128 RU/mL in October 2018. She underwent modified radical mastectomy in September 2018 followed by adjuvant chemotherapy in November 2018, after which PLA2R Ab decreased to <2 RU/mL in February 2019 and urine protein/Cr ratio (UPCR) decreased to 1094 mg/g Cr in April 2019. She was diagnosed with metastatic breast cancer and started anastrazole transiently. She received mRNA-1273 COVID-19 vaccines in late January and February 2021. In March 2021, she presented with bilateral leg edema, dyspnea, and bilateral pleural effusions. Urinalysis had >1000 protein, 24hr urine protein 11.2 g, Cr 1.6 mg/dL, and PLA2R Ab 787 RU/mL. Renal biopsy showed immune complex-mediated glomerulopathy with positive PLA2R, consistent with primary MN stage II-III. Glomerular basement membrane deposits were strongly positive for IgG4. Electron microscopy showed numerous subepithelial and occasional intramembranous electron-dense immune-type deposits. She was treated with lisinopril and furosemide followed by rituximab in May 2021. Prior to rituximab PLA2R Ab was 342 RU/mL and UPCR was 8671 mg/g Cr. Discussion: There is insufficient data on the risk of flare after COVID-19 vaccine in glomerular diseases. There have been a few case reports of primary MN and minimal change disease after COVID-19 vaccine as well as MN after influenza vaccine. Our case of primary MN flare after COVID-19 vaccine adds support to a potential association between SARS-CoV-2 antigens and loss of tolerance to the PLA2R antigen. Close follow-up of patients with primary MN and other glomerular diseases after COVID-19 vaccination is warranted.
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INTRODUCTION AND OBJECTIVE: Immunocompromised kidney transplant (KTX) recipients with the coronavirus of severe acute respiratory syndrome coronavirus 2 (COVID-19) may be at increased risk of morbidity and mortality. We sought to evaluate a series of COVID-19 positive KTX recipients hospitalized at our institution during both the first and second wave of the COVID-19 pandemic. METHODS: We retrospectively examined our KTX recipients hospitalized from March 2020 to June 2020 for the first wave, and November 2020 to February 2021 for the second wave of COVID-19. Data for demographics, clinical course, laboratory tests, outcomes, and management were collected. Descriptive statistics were performed for all data. RESULTS: We identified 25 KTX from the first and 17 from the second COVID-19 wave. All study subjects had their KTX performed at our institution, tested positive, and were hospitalized. Since August 2003, all KTX recipients received a single dose of alemtuzumab induction therapy. During the first wave, the average length of stay (LOS) was 9.4 days. Four patients (16%) required ICU level of care, 3 patients were intubated, and there were no mortalities. 6 (24%) and 7 (28%) patients had their mycophenolate (MMF) and tacrolimus (TAC) immunosuppression held. 19 (76%) received hydroxychloroquine, 3 (12%) received steroids, 1 (4%) received Remdesivir. During the second wave, average LOS was 7.6 days. One patient (6%) required ICU level of care with intubation, and 2 (12%) patients suffered mortality. No patients received hydroxychloroquine, 9 (53%) received steroids, and 3 (18%) received Remdesivir. MMF was not held and TAC was held in 1 (5.9%) patient. Table 1 illustrates the demographic and clinical data of COVID19 positive KTX patients hospitalized during the pandemic. There were no events of acute rejection in KTX patients during either wave. CONCLUSIONS: At our institution, the clinical manifestations and outcomes of COVID-19 in KTX recipients are variable and similar to non-immunocompromised patients. Our approach to diagnosis and management is similar to that for the general population, with adjustments made based on the individual disease severity. Nonetheless, we have a low threshold for evaluating, hospitalizing, and treating COVID KTX recipients. (Table Presented).
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Introduction: This study is the first to focus on the different respiratory support modes and outcomes of critically ill patients with COVID- 19 in Wuhan. The cohort study design is persuasive. The number of studies retrieved is limited in patients with MDRO coinfected with COVID-19. This study only selected critically ill patients with COVID-19 in Leishenshan Hospital. Objectives: We aimed to describe the clinical characteristics and outcomes of five different modes of respiratory support among critically ill patients with coronavirus disease 2019 (COVID-19). Methods: This was a hospital-based, retrospective cohort study which setting on Leishenshan hospital in Wuhan, central China. Patients with COVID-19 admitted to the ICU of Leishenshan Hospital from February 8, 2020 to April 18, 2020 were recruited. The outcome was living status and survival time. Results: Thirty-five patients died among 114 hospitalization patients (mortality rate, 30.7%), and 56 patients (49.12%) used mechanical ventilation. The mean survival time (days) of patients without respiratory support, noninvasive positive-pressure ventilation (NIPPV), endotracheal intubation, tracheotomy, or endotracheal intubation before and after tracheotomy (EI + T) was 15, 34, 32, 12.5, and 6, respectively (p < 0.000). Eighteen (15.79%) patients were co-infected with MDROs, primarily in the EI + T group (83.33%). The mortality risk of patients treated with NIPPV and EI + T was 0.20 and 0.21 times higher than that of patients without any respiratory support (95% confidence interval [CI] = 0.002-0.203;95% CI = 0.002-0.218). The mode of respiratory support was an independent factor affecting the survival of ICU patients with COVID-19. Conclusion: Mortality risk in patients with NIPPV and EI + T was lower than in those without any respiratory support. Timely and correct respiratory support mode is the key to reducing the death of critically ill patients with COVID-19.
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Background: During the COVID-19 pandemic, many non-urgent elective cardiac MRI (CMR) appointments were cancelled to minimise the risk of infection to patients coming to hospital. At the time of the first lockdown, our scanning schedule allowed on average 228 scans/month. Non-urgent elective studies were cancelled from April-June 2020, resulting in 684 scans added to the waiting list. Upon reactivation of our clinical CMR service, we developed a service quality improvement initiative consisting of using a 'Rapid CMR' protocol to reduce scanning time without compromising the test's diagnostic accuracy, increase our scanning capacity and improve efficiency in reducing the backlog of requests. Purpose: To demonstrate the increased scanning capacity generated by the adoption of the “Rapid CMR” protocol. Methods: The Rapid CMR protocol was implemented in November 2020 to all scans requiring cines, late gadolinium enhancement ± adenosine stress (non-stress and stress studies). The protocol was modelled on prior published experiences[1,2]. Patients who underwent these scans with additional imaging (e.g. T2-STIR imaging) were excluded. Data was collected from Nov 2020 to Jan 2021 and compared with the same time period the previous year when the standard protocol was used (cf. Image 1). Data collected included scan duration (time from first to last image), whether the Rapid CMR studies maintained diagnostic quality (yes/no), and the did-not-attend (DNA) rate. Results: With the Rapid CMR protocol 254 patients were scanned (114 non-stress, 140 stress), compared with 286 patients scanned with standard protocol in November 2019 to January 2020 (155 non-stress, 131 stress). Median scanning time in minutes for non-stress was 29 (IQR 25-34;Rapid) vs 37 (IQR 33-41;standard);(p < 0.001). For stress studies the median scanning time in minutes was 32 (IQR 28-36;Rapid) vs 41 (IQR 29-45;standard;(p < 0.001). The rate of suboptimal imaging due to patient factors (such as breathing or arrhythmia) was similar for each protocol (14.4% Rapid, 20.2% standard;p = 0.04). All Rapid studies were of diagnostic quality (Table 1). Saving c.8 minutes per scan led to an improved scanning time and schedule capacity of 21%. Fewer patients were scanned with the Rapid protocol due to pandemic related issues: patient reluctance to accept appointments (unfilled slots), cleaning measures between patients (on average -5 mins per slot reducing overall capacity), and a higher DNA rate: 15.3% (Rapid) vs 6.5% (standard);p < 0.001. Conclusion: The Rapid CMR protocol resulted in a statistically significant reduction in scanning time (-8 min for both stress and non-stress CMRs) increasing our schedule capacity and improving efficiency by 21%, whilst maintaining diagnostic quality. The implementation of the Rapid CMR protocol is a feasible and effective strategy to tackle the backlog of CMR clinical request accumulated during the pandemic.
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Background: Rheumatoid arthritis (RA) is independently associated with an increased risk of cardiovascular disease (CVD). One of the early stages of atherosclerosis is endothelial dysfunction, which is increased in RA. Using drugs to target endothelial dysfunction is a promising novel strategy for CVD prevention in RA. Sildenafil has been shown to improve endothelial function in diabetics, who have similar increased CVD risk. Our hypothesis was that sildenafil use may be a novel primary CVD prevention strategy in RA. Objectives: To determine if sildenafil use in RA patients improves endothelial dysfunction (as measured by brachial artery flow-mediated dilation [FMD] and peripheral arterial tone [PAT]), as well as serum inflammatory and atherosclerosis biomarkers. Methods: This NIH-funded study was a phase II, randomized double-blind placebo-controlled crossover efficacy trial of 25 RA patients, with no known history of CVD, but at least one traditional CVD risk factor. Patients were randomized 1:1 to receive either sildenafil or placebo for 3 months, then after a 2-week washout, crossed over to each respective group for an additional 3 months. Vascular studies (FMD and PAT) and serum atherosclerosis biomarkers (e-Selectin, ICAM-1, VCAM-1) were performed at baseline, 3 months pre-and post-washout, and 6 months. Adverse events were collected. Given the cross-over design, analyses included a random effects model for within-subject comparisons of sildenafil versus placebo periods, adjusting for the baseline (FMD or EndoPAT) within that period and a term for treatment order. All tests were 2-sided with α=0.05. Results: A total of 233 subjects were assessed for eligibility, with 25 subjects being randomized after written informed consent. A total of 13 subjects were randomized to placebo first, and 12 to sildenafil first. Baseline characteristics were similar between those randomized to Placebo vs. Sildenafil first. Mean age was 62.0+/-10.9 years;84% were female;and 92% were white. A total of 6 adverse events experienced in 3 subjects occurred. The primary endpoint (increase in %FMD in Sildenafil period vs. Placebo period) was not significant (p=0.19). However, note the study was powered at 80% to detect an effect size of 0.37 for change in %FMD or biomarker with a sample size of 60, not 25. However, sildenafil use was associated with a significant increase (improvement) by 0.200 units of PAT ratio (p=0.003) compared with placebo, adjusted by treatment order and baseline PAT ratio (within the given treatment period). Exploratory linear mixed models comparing e-Selectin, ICAM-1, and VCAM-1 between Sildenafil vs. Placebo periods, adjusted for treatment order and the baseline biomarker level, did not show any significant differences except for ICAM-1 (55.3 units higher in Sildenafil vs. Placebo periods, p=0.011). Conclusion: In this pilot trial of 25 RA subjects, sildenafil use was associated with a significant increase (improvement) in endothelial function as measured by PAT. However, there was no significant difference in FMD. The study is limited due to the small sample size, which was impacted by slow recruitment as well as the COVID-19 pandemic. Future larger studies are required to assess whether other PDE5 inhibitors may improve endothelial dysfunction in RA and other autoimmune disease patients at high risk of CVD.
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The Center for Environmental Farming Systems (CEFS) has spent the past two decades developing local food systems to support communities and increase resilience. The COVID-19 pandemic has shown how existing structural inequities, primarily along racial lines, are exacerbated. It has also shown the value of community-based food systems work that helps communities network, sharing valuable resources and funding to respond to the ongoing crisis. In this article, we document how CEFS' community-based food systems initiatives are responding to the pandemic. Some of CEFS programs are community-based, working with food policy councils, offering racial equity trainings, networking schools and early care and education sites, and supporting youth convenings and internships. Others are focused on production and supply chains for meat, seafood, and produce in order to develop stronger local food systems. Throughout the work of all of CEFS' community-based food systems initiatives in response to the pandemic, we have learned that our past efforts have increased local food systems resilience. We also note the importance of flexible funders who allowed grant dollars to be reallocated to community partners to address urgent needs. We have found that online programming has increased participation and access to resources. Finally, we have been inspired by the creativity, flexibility, and adaptability of our community partners, and we are energized to continue to support them while also offering the resources we have developed to a broader audience.