How the use of an online healthcare community affects the doctor-patient relationship: An empirical study in China.

Possible improvements to the doctor-patient relationship are an important subject confronting national healthcare policy and health institutions. In recent years, online healthcare communities have changed the ways in which doctors and patients communicate, especially during the COVID-19 pandemic. However, previous research on how usage of online healthcare communities has affected the doctor-patient relationship is rather limited. This paper proposes a research model to investigate the relationship between online healthcare community usage and the doctor-patient relationship. An analysis of 313 patients' data using structural equation modeling showed the following. First, the use of an online healthcare community has a positive impact on doctor-patient communication, helps improve the performance of healthcare procedures, and reduces healthcare costs. Second, doctor-patient communication and healthcare costs have a positive impact on patients' emotional dependence and patients' perception of healthcare quality, while healthcare procedures do not have this impact. Finally, patients' emotional dependence and perception of healthcare quality have a positive effect on doctor-patient relationship through the mediator of patients' satisfaction.

How to improve consumers' travel intentions under the COVID-19 pandemic: An empirical study in China

One of the most challenging issues confronting tour operators is how to improve consumers' travel intention after the COVID-19 pandemic. Considering the immediacy of the situation, existing studies exploring this problem are necessarily limited. Based on a theory of reasoned action, this paper proposes a research model to investigate factors influencing consumers' travel intentions in the wake of the pandemic. Using structural equation modeling analysis of 826 consumers in China, the results showed that: (1) physical risk had the greatest negative impact on consumers' attitudes toward travel, followed by psychological risk;(2) physical risk had a negative effect on consumers' subjective norms, while the effect of psychological risk on consumers' subjective norms was not significant;(3) risk perception, including physical and psychological risk, affected consumers' travel intentions through subjective norms and attitudes;and (4) consumers' perceptions of the seriousness of the pandemic and travel experience act as a negative moderators between attitude toward travel and travel intentions. The conclusions of this study provide vital information for tour operators to create viable and sustainable operations in this time of crisis. [ABSTRACT FROM AUTHOR] Copyright of International Journal of Sustainable Transportation is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The impact of perceived racism on walking behavior during the COVID-19 lockdown.

The COVID-19 pandemic lockdown has had a significant impact on people's travel behavior. The level of this impact has been unevenly distributed among different population groups. The recent rise in anti-Asian racism implies that Asians have faced increased stress during the pandemic. As a result, the impact on their travel behavior is likely to differ from other ethnic groups. We examined this hypothesis by focusing on the impact of the pandemic on walking behavior. We collected survey data in Melbourne, Australia, during the pandemic lockdown, and analyzed the data using a Structural Equation Model approach. The results suggest that Asians experienced a significantly higher level of discrimination than other racial groups and were less likely to increase walking than White people. We also found that neighborhood cohesion helped alleviate perceived discrimination and promote walking. This study offers new insights into the role of racism in travel behavior.

Fast and Sensitive Detection of SARS-CoV-2 Nucleic Acid Using a Rapid Detection System Free of RNA Extraction.

Objectives: To establish and evaluate the analytical and clinical performance of the Flash20 SARS-CoV-2 nucleic acid rapid detection system free of RNA extraction. Methods: The limit of detection (LoD) was determined using a negative nasopharyngeal swab matrix spiked with different concentrations of SARS-CoV-2 virus; a total of 734,337 reference sequences of viral genomes from GenBank were used for the in-silico analysis to assess the inclusivity of the assay. The specificity of the system was evaluated by testing 27 medically relevant organisms. A total of 115 clinical specimens were collected and tested on the Flash20 SARS-CoV-2 detection system and with an FDA-approved comparator test to assess the clinical performance of the system. Results: The LoD of the Flash20 SARS-CoV-2 detection system is 250 copies/mL with a positive rate ≥90% (n = 20); alignments results showed that over 99% identity of the primer and probe of the Flash20 SARS-CoV-2 nucleic acid rapid detection system to the available SARS-CoV-2 sequences; the omicron samples tested 100% positive. None of the 27 organisms showed cross-reactivity with the Flash20 SARS-CoV-2 nucleic acid rapid detection system. Among all the 215 clinical samples, the Flash20 SARS-CoV-2 nucleic acid rapid detection system exhibits a high sensitivity of 99.24% (131/132) and 100% (83/83) specificity. Conclusion: The nucleic acid rapid detection system provides sensitive and accurate detection of SARS-CoV-2 free of RNA extraction. The high sensitivity and short time to results of approximately 35 minutes may impact earlier infection control and disease management.

S Trimer Derived from SARS-CoV-2 B.1.351 and B.1.618 Induced Effective Immune Response against Multiple SARS-CoV-2 Variants.

The spread of SARS-CoV-2 and its variants leads to a heavy burden on healthcare and the global economy, highlighting the need for developing vaccines that induce broad immunity against coronavirus. Here, we explored the immunogenicity of monovalent or bivalent spike (S) trimer subunit vaccines derived from SARS-CoV-2 B.1.351 (S1-2P) or/and B.1. 618 (S2-2P) in Balb/c mice. Both S1-2P and S2-2P elicited anti-spike antibody responses, and alum adjuvant induced higher levels of antibodies than Addavax adjuvant. The dose responses of the vaccines on immunogenicity were evaluated in vivo. A low dose of 5 µg monovalent recombinant protein or 2.5 µg bivalent vaccine triggered high-titer antibodies that showed cross-activity to Beta, Delta, and Gamma RBD in mice. The third immunization dose could boost (1.1 to 40.6 times) high levels of cross-binding antibodies and elicit high titers of neutralizing antibodies (64 to 1024) prototype, Beta, Delta, and Omicron variants. Furthermore, the vaccines were able to provoke a Th1-biased cellular immune response. Significantly, at the same antigen dose, S1-2P immune sera induced stronger broadly neutralizing antibodies against prototype, Beta, Delta, and Omicron variants compared to that induced by S2-2P. At the same time, the low dose of bivalent vaccine containing S2-2P and S1-2P (2.5 µg for each antigen) significantly improved the cross-neutralizing antibody responses. In conclusion, our results showed that monovalent S1-2P subunit vaccine or bivalent vaccine (S1-2P and S2-2P) induced potent humoral and cellular responses against multiple SARS-CoV-2 variants and provided valuable information for the development of recombinant protein-based SARS-CoV-2 vaccines that protect against emerging SARS-CoV-2 variants.

Kidney health in the COVID-19 pandemic: An umbrella review of meta-analyses and systematic reviews.

Background: This umbrella review aims to consolidate evidence from systematic reviews and meta-analyses investigating the impact of the coronavirus disease-2019 (COVID-19) on kidney health, and the associations between kidney diseases and clinical outcomes in COVID-19 patients. Methods: Five databases, namely, EMBASE, PubMed, Web of Science, the Cochrane Database of Systematic Reviews and Ovid Medline, were searched for meta-analyses and systematic reviews from January 1, 2020 to June 2, 2022. Two reviewers independently selected reviews, identified reviews for inclusion and extracted data. Disagreements were resolved by group discussions. Two reviewers independently assessed the methodological quality of all included reviews using ROBIS tool. A narrative synthesis was conducted. The characteristics and major findings of the included reviews are presented using tables and forest plots. The included meta-analyses were updated when necessary. The review protocol was prospectively registered in PROSPERO (CRD42021266300). Results: A total of 103 reviews were identified. Using ROBIS, 30 reviews were rated as low risk of bias. Data from these 30 reviews were included in the narrative synthesis. Ten meta-analyses were updated by incorporating 119 newly available cohort studies. Hospitalized COVID-19 patients had a notable acute kidney injury (AKI) incidence of 27.17%. AKI was significantly associated with mortality (pooled OR: 5.24) and severe conditions in COVID-19 patients (OR: 14.94). The pooled prevalence of CKD in COVID-19 patients was 5.7%. Pre-existing CKD was associated with a higher risk of death (pooled OR: 2.21) and disease severity (pooled OR: 1.87). Kidney transplant recipients were susceptible to SARS-CoV-2 infection (incidence: 23 per 10,000 person-weeks) with a pooled mortality of 18%. Conclusion: Kidney disease such as CKD or recipients of kidney transplants were at increased risk of contracting COVID-19. Persons with COVID-19 also had a notable AKI incidence. AKI, the need for RRT, pre-existing CKD and a history of kidney transplantation are associated with adverse outcomes in COVID-19. Systematic review registration: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021266300, identifier: CRD42021266300.

Potential Life-Cycle Environmental Impacts of the COVID-19 Nucleic Acid Test.

Massive diagnostic testing has been performed for appropriate screening and identification of COVID-19 cases in the ongoing global pandemic. However, the environmental impacts of COVID-19 diagnostics have been least considered. In this paper, the environmental impacts of the COVID-19 nucleic acid diagnostics were assessed by following a full cradle-to-grave life-cycle approach. The corresponding life-cycle anthology was established to provide quantitative analysis. Moreover, three alternative scenarios, i.e., material substitution, improved waste treatment, and electric vehicle (EV)-based transportation, were further proposed to discuss the potential environmental mitigation and conservation strategies. It was estimated that the life cycle of a single COVID-19 nucleic acid diagnostic test in China would lead to the emission of 612.9 g CO2 equiv global warming potential. Waste treatment, as a step of life cycle, worsen the environmental impacts such as global warming potential, eutrophication, and ecotoxicity. Meanwhile, diesel-driven transportation was considered as the major contributor to particulate air. Even though COVID-19 diagnostics are of the greatest importance to end the pandemic, their environmental impacts should not be ignored. It is suggested that improved approaches for waste treatment, low-carbon transportation, and a reliable pool sampling strategy are critical for the achievement of sustainable and green diagnostics.

Unequal impact of the COVID-19 pandemic on mental health: Role of the neighborhood environment.

The COVID-19 pandemic has taken a significant toll on people's mental wellbeing. Few studies have investigated how the neighborhood environment might help to moderate the mental health impact in a natural disaster context. We aim to investigate the unequal impact of the pandemic on mental health between different population groups, and the role of the neighborhood environment in alleviating this impact. We collected survey data (n=2,741) on mental health, neighborhood environment, and pandemic-related behaviors in Beijing metropolitan region between July 10 and 28, 2020, and then applied the partial proportional odds model. Overall, we found that the pandemic has disproportionately affected the lower-income people. The lower-income residents experienced a greater psychological impact than the higher-income residents. We further found that distance to an urban park was a key built environment variable that moderates mental health impact. Residents who lived near urban parks were 4.2 to 4.6% less likely to report an increase in negative emotions, and therefore are more resilient to the mental health impact. In addition to the built environment, a cohesive neighborhood environment may have also helped to mitigate the negative mental health impacts. These findings can inform planning policies that aim to promote healthy and resilient communities.

Stem-cell-derived trophoblast organoids model human placental development and susceptibility to emerging pathogens.

Trophoblast organoids derived from placental villi provide a 3D model system of human placental development, but access to first-trimester tissues is limited. Here, we report that trophoblast stem cells isolated from naive human pluripotent stem cells (hPSCs) can efficiently self-organize into 3D stem-cell-derived trophoblast organoids (SC-TOs) with a villous architecture similar to primary trophoblast organoids. Single-cell transcriptome analysis reveals the presence of distinct cytotrophoblast and syncytiotrophoblast clusters and a small cluster of extravillous trophoblasts, which closely correspond to trophoblast identities in the post-implantation embryo. These organoid cultures display clonal X chromosome inactivation patterns previously described in the human placenta. We further demonstrate that SC-TOs exhibit selective vulnerability to emerging pathogens (SARS-CoV-2 and Zika virus), which correlates with expression levels of their respective entry factors. The generation of trophoblast organoids from naive hPSCs provides an accessible 3D model system of the developing placenta and its susceptibility to emerging pathogens.

Government dissemination of epidemic information as a policy instrument during COVID-19 pandemic: Evidence from Chinese cities.

COVID-19 has given rise to a surge in the number of policy instruments used to deal with the pandemic at different levels of governments globally. While much attention has been placed on travel bans, lockdown, social distancing, and economic stimulus packages, government dissemination of epidemic information as a policy instrument has received less attention. Based on 14,637 news items collected from the portals of 79 municipal governments in China, this study aims to 1) conduct a content analysis of news items and construct three key attributes of governments' practices of epidemic information dissemination, namely, comprehensiveness, responsiveness, and the protection of privacy, and 2) study the patterns and determinants of the dissemination of epidemic information. Our results show that these cities vary substantially in how they disseminate statistical data and information on individual cases of COVID-19 infections within their localities, which are shaped by government performance in open data, severity of the pandemic, cities' administrative level, population, and health sector capacities. The findings generate theoretical and policy implications for government dissemination of epidemic information.

Large mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta: a case report.

BACKGROUND: The mural thrombus in the ascending aorta is rare, most of which are associated with aneurysm or atherosclerotic lesions, with high risks of causing catastrophic thrombotic events. A mural thrombus in the non-aneurysmal and non-atherosclerotic ascending aorta is exceptionally uncommon. CASE PRESENTATION: We reported a large mural thrombus in normal ascending aorta of an asymptomatic patient. Preoperative imaging confirmed the presence of the sessile thrombus located at the left anterior wall of ascending aorta. Given that it had the potential to cause fatal thrombotic complications, surgical removal and segment of ascending aorta replacement were executed. The patient had an uneventful recovery and discharged 14 days after surgery. CONCLUSIONS: Anticoagulant is the therapeutic cornerstone of ascending aortic thrombus, but surgery should be performed aggressively when the thrombus is large or floating to avoid severe embolic complications or recurrence.

Self-resetting molecular probes for nucleic acids detection enabled by fuel dissipative systems.

A once-in-a-century global public health crisis, the COVID-19 pandemic has damaged human health and world economy greatly. To help combat the virus, we report a self-resetting molecular probe capable of repeatedly detecting SARS-CoV-2 RNA, developed by orchestrating a fuel dissipative system via DNA nanotechnology. A set of simulation toolkits was utilized to design the probe, permitting highly consistent signal amplitudes across cyclic detections. Uniquely, full width at half maximum regulated by dissipative kinetics exhibits a fingerprint signal suitable for high confidential identifications of single-nucleotide variants. Further examination on multiple human-infectious RNA viruses, including ZIKV, MERS-CoV, and SARS-CoV, demonstrates the generic detection capability and superior orthogonality of the probe. It also correctly classified all the clinical samples from 55 COVID-19 patients and 55 controls. Greatly enhancing the screening capability for COVID-19 and other infectious diseases, this probe could help with disease control and build a broader global public health agenda.

Depression and Anxiety Among Quarantined People, Community Workers, Medical Staff, and General Population in the Early Stage of COVID-19 Epidemic.

Background: We described the prevalence of anxiety and depression related to COVID-19 pandemic among different types of population and examined their potential risk factors. Methods: A cross-sectional survey was conducted to collect demographic characteristics, exposure histories, and many other concerns about COVID-19. The Zung's self-rating anxiety scale (SAS) and self-rating depression scale (SDS), followed by a four-step multiple logistic regression analysis was performed to identify factors associated with mental health outcomes. Results: Out of 3,303 participants, the quarantined people (40.9%), community workstation staffs-policemen-volunteers (CPV) (36.4%) and general public (30.7%) reported higher percentages of depression than the general medical staff (18.4%). Moreover, the quarantined people (19.1%) also showed higher prevalence of anxiety than the general public (9.1%) and the general medical staff (7.8%). The quarantined people had the highest risk of anxiety and depression, whereas the self-rated health was negatively associated with the risks of anxiety and depression. Younger age group (18 to 30 years) showed higher risks of anxiety (OR = 6.22, 95% CI = 2.89-13.38, p < 0.001) and depression (OR = 3.69, 95% CI = 2.40-5.69, p < 0.001). People who had exposure history or contact from Hubei province after December 1, 2019 (OR = 1.57, 95% CI = 1.07-2.30, p < 0.001), had family or friends engaged in front-line health care work (OR = 1.47, 95% CI = 1.02-2.14, p < 0.001), had confirmed case nearby (OR = 2.44, 95% CI = 1.43-4.18, p < 0.001) were all more likely to suffer from anxiety. Moreover, the negligence (OR = 1.85, 95% CI = 1.37-2.51, p < 0.001) or overindulgence (OR = 1.45, 95% CI = 1.03-2.04, p < 0.001) toward the epidemic information was associated with a higher risk of depression and anxiety. Conclusions: Our findings show that the CPV and quarantined people were most at-risk population. We have identified that the young people, people with exposure histories and negligence or overindulgence toward epidemic information are in grave need of attention.

Comparing SARS and COVID-19: Challenges of Governance Capacity and Legitimacy

Governance capacity and legitimacy as two important dimensions in crisis management are crucial for preparing for, making sense of, handling, and learning from crises like epidemics/pandemics. We compare governance capacity and legitimacy of the government in China in response to the SARS and COVID-19 pandemics. Our comparison of the handling processes of two pandemics suggests both positive changes and persistent inertia. Both governance capacity and legitimacy has been improved over time, and there is a tendency that they reinforce each other. Such comparisons help to facilitate learning from the past to be better prepared for the future. [ABSTRACT FROM AUTHOR] Copyright of Public Organization Review is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A SARS-CoV-2 Reference Standard Quantified by Multiple Digital PCR Platforms for Quality Assessment of Molecular Tests.

The outbreak of novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. To meet the urgent and massive demand for the screening and diagnosis of infected individuals, many in vitro diagnostic assays using nucleic acid tests (NATs) have been urgently authorized by regulators worldwide. A reference standard with a well-characterized concentration or titer is of the utmost importance for the study of limit of detection (LoD), which is a crucial feature for a diagnostic assay. Although several reference standards of plasmids or synthetic RNA have already been announced, a reference standard for inactivated virus particles with an accurate concentration is still needed to evaluate the complete procedure. Here, we performed a collaborative study to estimate the NAT-detectable units as a viral genomic equivalent quantity (GEQ) of an inactivated whole-virus SARS-CoV-2 reference standard candidate using digital PCR (dPCR) on multiple commercialized platforms. The median of the quantification results (4.6 × 105 ± 6.5 × 104 GEQ/mL) was treated as the consensus true value of GEQ of virus particles in the reference standard. This reference standard was then used to challenge the LoDs of six officially approved diagnostic assays. Our study demonstrates that an inactivated whole virus quantified by dPCR can serve as a reference standard and provides a unified solution for assay development, quality control, and regulatory surveillance.

Clinical Characteristics and Short-Term Outcomes of Severe Patients With COVID-19 in Wuhan, China.

Background: A novel pneumonia (COVID-19) spread rapidly throughout worldwide, in December, 2019. Most of the deaths have occurred in severe and critical cases, but information on prognostic risk factors for severely ill patients is incomplete. Further research is urgently needed to guide clinicians, and we therefore prospectively evaluate the clinical outcomes of 114 severely ill patients with COVID-19 for short-term at the Union Hospital in Wuhan, China. Methods: In this single-centered, prospective, and observational study, we enrolled 114 severely ill patients with confirmed COVID-19 from Jan 23, 2020, to February 22, 2020. Epidemiological, demographic, laboratory, treatment, and outcome data were recorded, and the risk factors for poor outcome were analyzed. Results: Among the 114 enrolled patients with a mean age of 63.96 ± 13.41 years, 94 (82.5%) patients were classified as a good outcome group. Common clinical manifestations included fever, cough, and fatigue. Compared with the good outcome group, 20 (17.5%) patients in the poor outcome group more frequently exhibited lymphopenia, and lower levels of albumin, partial arterial oxygen pressure, higher levels of lactate dehydrogenase, creatine kinase, hypersensitive troponin I, C-reactive protein, ferritin, blood urea nitrogen, and D-dimer, as well as markedly higher levels of IL-6 and IL-10. Absolute numbers of T lymphocytes, CD8 + T cells, decreased in almost all the patients and were markedly lower in the poor outcome group than the good outcome group. We also found that traditional Chinese medicine can significantly improve the patient's condition, which is conducive to the transformation from a severe to mild condition. In addition, univariate and multivariate Cox analyses of potential factors for poor outcome patients indicated that cytokine storms and uncontrolled inflammation responses as well as liver, kidney, and cardiac dysfunction are related to the development of a poor outcome. Conclusion: In summary, we reported this single-centered, prospective, and observational study for short-term outcome in severe patients with COVID-19. We found that cytokine storms and uncontrolled inflammation responses as well as liver, kidney, and cardiac dysfunction may play important roles in the final outcome of severely ill patients with COVID-19. Our study will allow clinicians to benefit and rapidly estimate the likelihood of a short-term poor outcome for severely ill patients.