Infections in Patients With Cirrhosis Have a Changing Profile Over Time and Are Linked to a Higher Risk of Death Compared to Patients Without Cirrhosis

Introduction: Intensive care outcomes in patients with cirrhosis are relatively poor. The comparison between outcomes, especially related to infections, remains unclear in those with and without cirrhosis. With the emergence of resistant and fungal organisms, the changes in infection profiles over time are important to analyze. The aim of this study is to determine the impact of cirrhosis and infections on inpatient death over time in a qSOFA-matched cohort of patients with and without cirrhosis. Method(s): Inpatients admitted to ICUs throughout 2015-2021 were analyzed. Patients with cirrhosis were matched 1:1 by age, gender, and admission qSOFA to patients without;COVID-positive patients were excluded. Admission demographics, labs, the reasons for ICU transfer, infections, and inpatient death or hospice referral were obtained for each patient. Comparisons were made between patients with and without cirrhosis and those who died/referred to hospice versus not. Logistic regression for death/hospice was performed. In patients with cirrhosis, the culture results were compared over the years. Result(s): 1669 patients;833 cirrhosis and 836 non-cirrhosis patients were included. Patients with cirrhosis had higher rates of infection, positive culture, abdominal infection, and bacteremia. They also had higher gram-positive and fungal infections with a higher rate of VRE. They showed a greater organ failure load, death, and hospice referral compared to patients without cirrhosis. Logistic regression showed that cirrhosis (OR 4.0, p< 0.0001), admission qSOFA (1.60, p< 0.0001), WBC (1.02, p=0.003), reasons for ICU (altered mental status 1.69, hypotension 1.79, renal support 2.77, respiratory failure 1.79, CVA 1.96, all p< 0.0001) with Infection (1.77, p< 0.0001, >1 microbe isolated 1.86, p=0.05) were risk factors for death/hospice. The infection trend in the cirrhosis group showed a significant decrease in positive cultures and gram-negative infections and an increase in fungal and gram-positive infections over time. Conclusion(s): Despite matching for demographics and qSOFA, patients with cirrhosis had higher risks of death and organ failures. They were more likely to develop gram-positive and fungal infections with multiple organisms and VRE. Time trends in cirrhosis showed lower rates of positive cultures and gram-negative infections and an increase in fungal and gram-positive infections over time, which should encourage re-evaluation of diagnostic and prophylactic strategies in cirrhosis-related infections. (Figure Presented).

The effect of social media communication on intention to vaccinate against COVID-19: A relationship mediated by perceptions of vaccine efficacy and safety

Although previous literature has found significant effects of social media communication (SMC) on intention to vaccinate, the effect of the sources of SMC has not been explored. To fill this gap, this study investigates a) the effects of official sources and user-generated SMC on intention to vaccinate against COVID-19, and b) the mediating effects of perceived vaccine efficacy, safety, and risk perception on the relationship between SMC and intention to vaccinate against COVID-19. Online survey data (n = 428) was analysed using structural equation modelling (SEM). Results revealed that official sources SMC is positively associated with vaccine intention while user-generated SMC had no significant association. Mediation analysis revealed a partial mediation effect of perceived vaccine efficacy and safety in the relationship between official source SMC and intention to vaccinate against COVID-19, while a full mediation effect of perceived vaccine efficacy and safety was found between user-generated SMC and intention to vaccinate against COVID-19. The mediating effect of perceived risk was not found. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Multi-view POI-level Cellular Trajectory Reconstruction for Digital Contact Tracing of Infectious Diseases

Digital contact tracing is an effective solution to prevent such a pandemic, but the low adoption rate of a required mobile app hinders its effectiveness. A large collection of cellular trajectories from mobile subscribers can be an out-of-the-box solution that is free from the low adoption issue, but has been overlooked due to its low spatial resolution. In this paper, to increase the resolution of this cellular trajectory, we present a new problem that estimates the user's visited places at the point-of-interest(POI) level, which we call POI-level cellular trajectory reconstruction. We propose a novel algorithm, Pincette, that accomplishes more accurate POI reconstruction by leveraging various external data such as road networks and POI contexts. Specifically, Pincette comprises multi-view feature extraction and GCN-LSTM-based POI estimation. In the multi-view feature extraction, Pincette extracts three complementary features from three views: efficiency, periodicity, and popularity. In the GCN-LSTM-based POI estimation, these three views are seamlessly integrated, where spatio-temporal periodic patterns are captured by graph convolutional networks (GCNs) and an LSTM. With extensive experiments on two real data collections of two cities, we show that Pincette outperforms four POI estimation baselines by up to 21.20%. We believe that our work sheds light on the use of cellular trajectories for digital contact tracing. We release the source code at https://github.com/kaist-dmlab/Pincette. © 2022 IEEE.

E-commerce retail and reverse factoring: A newsvendor approach

This study builds a theoretical model to examine how supply chain finance (SCF) services using fintech can ease e-commerce suppliers' capital constraints. Despite the innovation in the logistics industry during the Fourth Industrial Revolution and the increasing online shopping in the post-COVID era, small e-commerce enterprises may fail to grow owing to their budget constraints. Reverse factoring is believed to ease such suppliers' capital constraints. We analyze the effect of reverse factoring using the capital-constrained newsvendor model, and we consider the impacts of additional funding from SCF services. Our results show that SCF services reduce e-commerce suppliers' initial orders and, thus, alleviate their budget constraints. This finding suggests that the discount factor of reverse factoring should be higher to ease small suppliers' budget constraints and allow the e-commerce industry to grow sustainably. © 2022 John Wiley & Sons Ltd.

On the volatility of WTI crude oil prices: A time-varying approach with stochastic volatility

This study investigates the impacts of crude oil-market-specific fundamental factors and financial indicators on the realized volatility of West Texas Intermediate (WTI) crude oil price. A time-varying parameter vector autoregression model with stochastic volatility (TVP-VAR-SV) is applied to weekly data series spanning January 2008 to October 2021. It is found that the WTI oil price volatility responds positively to a shock in oil production, oil inventories, the US dollar index, and VIX but negatively to a shock in the US economic activity. The response to the EPU index was initially positive and then turned slightly negative before fading away. The VIX index has the most significant effect. Furthermore, the time-varying nature of the response of the WTI realized oil price volatility is evident. Extreme effects materialize during economic recessions and crises, especially during the COVID-19 pandemic. The findings can improve our understanding of the time-varying nature and determinants of WTI oil price volatility. © 2022

Impact of COVID-19 on Korea-China Import and Export Trade and Countermeasures

Purpose – This paper empirically investigates the changes and trends in export and import trade between Korea and China since 2000, especially after the establishment of Korea-China FTA and since the outbreak of COVID-19. This paper uses empirical analysis to determine the future trade types and trends of import/ export trade between Korea and China and estimates the impact on import/export trade between Korea and China in the post-epidemic era. Design/Methodology/Approach – This paper first reviews the theories related to regional economic inte-gration, sorts out the process of Korea-China FTA, and summarizes the changes and trends in import and export trade since COVID-19;second, it analyzes the current situation of bilateral trade between Korea and China using quantitative analysis, and investigates the specific impact of COVID-19 on Korea-China import and export trade using empirical analysis;finally, it summarizes the above studies, a conclusion is drawn, and policy recommendations are made to better utilize the challenges brought by COVID-19 to effectively address the problems that may be encountered in Korea-China trade and to promote the development of bilateral trade between the two countries. Findings – The global spread of the epidemic in Korea and China has led to the shutdown of both domestic and foreign operations, resulting in a foreign trade cliff effect in the short to medium term;the trade creation effect inspired by the international system dividend is no longer available in China in 2020, and the trade in goods is diminishing at the margin;the trade suppression effect is generated by the rise of international trade protectionism. The epidemic has led to a large upstream supply shortage pressure on the electronic information industry and the automobile manufacturing industry, and a large downstream demand shortage pressure on the energy industry and the electronic information industry. Research Implications – The establishment of Korea-China FTA will significantly promote bilateral trade between the two countries, change the trade and industrial structure of the two countries, and help to promote the development of the FTA strategy of the two countries;the outbreak of COVID-19 has changed the trade pattern and type, and the import and export of related epidemic prevention products as a new trade growth point and strengthened the trade market relationship between Korea and China. © 2022 International Academy of Global Business and Trade. All rights reserved.

Stress Management Design Guideline with Smart Devices during COVID-19

Background Stress among the general population has been steadily increasing, and the COVID-19 outbreak across the globe amplified stress by changing how we live our daily lives. As the social cost of stress increases and individual lives become devastated, managing stress becomes a critical issue. Government organizations suggest general guidelines to cope with stress during the COVID-19 pandemic. Also, smart devices such as smartwatches and smartphones detect and monitor physiological data as an integral part of our daily life, enabling us to recognize our stress level anytime, anywhere. However, there is a lack of studies regarding stress-relieving methods with smart devices. Methods We proposed a stress management flow correlating the human cognitive process with smart device interventions. Then, we developed a step-by-step guideline on a smartphone paired with a smartwatch to relieve physical stress with lack of movement, psychological stress with fear from uncertainty, psychosocial stress with loneliness and social isolation, and psycho-spiritual stress with limitations for faith community routine during COVID-19. We recruited 24 university students as participants (8 males, 16 females), and we measured perceived stress scale (PSS) score based on the case study to verify the new design guidelines. The participants ranged in age from 20 to 25 years (mean age = 22.08). We used 14 stress measurement questions to calculate the PSS (PSS maximum = 56). In addition, we used a one-way ANOVA to analyze the PSS results. Results In general, the results of one-way ANOVA for total PSS indicated a noticeable difference between before and after the prototype (F = 33.47;p < 0.01). The mean scores were 33.25 before the prototype and 28.13 after the prototype in the statistical analysis. Findings from this study advocated our new design guidelines with smart devices that help relieve stress but there are limitations such as constrained recruiting sample and the duration of the prototype testing, fundamental difference between short-term and long-term stresses, and limited scope of stress categories and smart devices. Conclusions This study's contribution is to expand smart device's usage to stress relief during COVID-19, not only limited to stress measurement. From this study, we hope to open a discussion on the role of smart devices to manage stress and how to design guidelines for user's quality of life. © This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted educational and non-commercial use, provided the original work is properly cited.

Airborne migration behaviour of SARS-CoV-2 coupled with varied air distribution systems in a ventilated space

Air distribution system could critically affect SARS-CoV-2 transmission in indoor space;therefore, this study aims at demonstrating numerical characteristics of SARS-CoV-2 migration with varied air distribution system configurations. Seven cases were investigated regarding three major aspects: how fast suspended particles can be removed from the ventilated space or changed into deposited particles;how much particles are attached to various object surfaces which leads to an infection by touching fomite. All cases were analyzed through computational fluid dynamics (CFD). Both different shapes (round or linear diffusers) and installation locations (ceiling or floor) of inlet and outlet diffusers were investigated. Results showed that different air distribution system would lead to different dispersion profiles of infectious particles and different deposition pattern of particles on interior surfaces. With the same air flow rate, linear-diffuser would perform better for CO2 extraction while requiring less time to remove or collide the same magnitude of suspended droplets compared to round-diffuser. However, how quickly removed or suspended droplets collide is not proportional to how less the number of total particles are remained. Two additional cases with double sized space possessing best ventilation configuration were also examined to explore potential application of the best-ventilated configuration to various spatial expansion cases.

Antibacterial and Antiviral Activities of Multi-coating Polyester Textiles

The effect of coated polyester (PET) textiles with metal oxide, chitosan, and copper ion on the antibacterial and antiviral activities was evaluated to investigate the applicability of multi-coated PET textiles as antiviral materials. Compared to coated PETs with a single agent, multi-coated PETs reduced the loading amount of coating materials as well as the contact time with bacteria for a bacterial cell number of < 10 CFU/mL, which was not detectable with the naked eyes. Metal oxides gen-erate reactive oxygen species (ROS) such as free radicals by a catalytic reaction, and copper ions can promote contact killing by the generation of ROS. Chitosan not only enhanced antibacterial activities due to amine groups, but enabled it to be a template to load copper ions. We observed that multi-coated PET textiles have both antibacterial activities for E. coli and S. aureus and antiviral efficiency of more than 99.9% for influenza A (H1N1) and SARS-CoV-2. The multi-coated PET textiles could also be prepared via a roll-to-roll coating process, which showed high antiviral efficacy, demonstrating its potential use in air filtration and antiviral products such as masks and personal protective equipment. © 2022, Korean Society of Industrial Engineering Chemistry. All rights reserved.

E-commerce retail and reverse factoring: A newsvendor approach

This study builds a theoretical model to examine how supply chain finance (SCF) services using fintech can ease e-commerce suppliers' capital constraints. Despite the innovation in the logistics industry during the Fourth Industrial Revolution and the increasing online shopping in the post-COVID era, small e-commerce enterprises may fail to grow owing to their budget constraints. Reverse factoring is believed to ease such suppliers' capital constraints. We analyze the effect of reverse factoring using the capital-constrained newsvendor model, and we consider the impacts of additional funding from SCF services. Our results show that SCF services reduce ecommerce suppliers' initial orders and, thus, alleviate their budget constraints. This finding suggests that the discount factor of reverse factoring should be higher to ease small suppliers' budget constraints and allow the e-commerce industry to grow sustainably.

PATIENTS WITH CIRRHOSIS EXPERIENCE HIGHER ICU MORTALITY COMPARED TO NON-CIRRHOTIC PATIENTS WHICH CONTINUED WITH OR WITHOUT COVID-19 DESPITE CONTROLLING FOR ORGAN FAILURE SEVERITY

Patients with cirrhosis have a relatively poor prognosis in intensive care (ICU) that could be affected by the9 pandemic. However, the impact of cirrhosis care compared to noncirrhotic patients is unclear pre and post-pandemic. Aim: Define impact of cirrhosis on mortality in ICU patients before & after COVID-19. Methods: ICU pts from a large tertiary hospital who were admitted for >24 hours were divided into pre-COVID (2019) and postpandemic (2020) eras. We excluded patients where cirrhosis diagnosis was unclear. Within the 2020 cohort, we further divided pts into COVID-positive or negative based on PCR. Pts with cirrhosis were matched 1:1 to non-cirrhotic pts with respect to age, ICU admission qSOFA & ICU length of stay in both cohorts. Reasons for ICU admission, infections, organ failures and discharge information were collected. We first compared only COVID negative cirrhosis vs other pts in the pre and post cohorts & then further compared these within the COVID positive pts. Logistic regression with death/hospice as the outcome was used with cirrhosis status, qSOFA, reason for ICU admission and organ failures as independent variables in the three matched cohorts (pre-COVID, post-COVID positive & post-COVID negative). Finally, to evaluate the relative impact of cirrhosis vs COVID-19, we combined the 2020 cohort and determined death/hospice determinants. Results: We included 200 age/LOS/qSOFA-matched pts with/without cirrhosis in pre-COVID cohort. Post-COVID similarly, 200 pts were included in the COVID negative group. 64 COVID+ pts (with/ without cirrhosis) were also included. More non-cirrhotic pts were admitted for procedural observation & stroke while altered mental status (AMS) were similar. Remaining organ failures were higher in cirrhosis in pre- and post-COVID settings (Table 1). In COVIDpositive pts, cirrhosis had lower infections, respiratory failure and intubation but trended towards higher death. Cirrhosis comparison pre vs post-COVID: Post-COVID cirrhosis pts had a higher MELDNa score (15.4±7.9 vs 22.3±10.2, p=0.004)and qSOFA (2.4 vs 1.7, p<0.001) compared to pre-COVID. Logistic regression for death/hospice (Table 2): Pre COVID was significant for cirrhosis, qSOFA , altered mental status & Pressors. Post-COVID in COVID-negative pts it was again significant for cirrhosis, Infection, renal failure & qSOFA. For only COVID positive patients, only renal failure was significant. In the entire 2020 cohort, COVID-19 positive status was not significant in death/hospice prediction, but cirrhosis remained significant. Conclusions: Cirrhosis remains a major cause of mortality in patients admitted to intensive care that continues regardless of COVID-19 pandemic-induced changes in the health system. Cirrhosis is predictive of death independent of COVID-19 despite controlling for demographics and organ failure severity. (Table Presented)

Understanding the Influencing Factors and Experiences of Clinical Learning Environment in COVID-19

This study aims to understand the factors influencing clinical practices and experiences of nursing students in varied clinical learning environments during the COVID-19 pandemic. It uses an exploratory sequential mixed methods design where quantitatively, the subjects’ sense of powerlessness, self-efficacy, clinical practice satisfaction, and learning flow according to the clinical learning environment were evaluated, and qualitatively, in-depth interview and analysis of the reflections were conducted. Data analysis was performed by paired t-test and multivariate regression analysis using the SPSS 25.0 program, and qualitative thematic analysis was performed. As a result of the study, in online clinical education, it was found that the lower the sense of helplessness (p=.018) and the higher the clinical practice satisfaction (p=.004), the higher the learning commitment was, and the model composed of these variables explained 39.2% of the learning flow. In addition, the higher the satisfaction with clinical practice, the higher the learning immersion (p<.001), and the explanation power was 54.1%. As a result of qualitative thematic analysis, three central themes and six sub-themes were derived, and it was found that students experienced 'a fearful but useful experience, regret about the limited experience, and pride and high satisfaction in the nursing profession’. In the context of the spread of COVID-19, it is necessary to develop effective practical training methods to improve the quality of nursing education. © 2022, Success Culture Press. All rights reserved.

RECOVERY and SURVIVAL in COVID-19 RESPIRATORY FAILURE, WHEN TREATED with AVIPTADIL

Background: COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Vasoactive Intestinal Peptide (VIP) blocks replication of the SARS-CoV-2 virus in alveolar type II cells, inhibits cytokine synthesis, prevents cytopathy, and up regulates surfactant production. Synthetic VIP-aviptadil is a novel strategy to treat patients with COVID-19 and respiratory failure. Methods: This was a prospective, multicenter, randomized, placebo-controlled trial with 196 patients, nasal swab PCR+ for COVID-19 receiving intensive care at 10 U.S. hospitals (6 tertiary care and 4 regional hospitals) to determine if intravenous aviptadil is superior to placebo in achieving recovery from respiratory failure and survival at 60 days post treatment. The analysis was by modified intent to treat (ITT) using a pre-specified logistic regression model. The primary pre-specified endpoint was being alive with no respiratory failure at day 60. Results: There were 213 subjects screened, with 203 eligible and 196 randomized and treated. Baseline characteristics were comparable except for worse NIAID severity for aviptadil (Table 1). All subjects were followed up to 60 days. A favorable trend (OR 1.63;P=.14) was seen for the primary endpoint at 60 days with significance achieved after adjusting for hospital setting. Overall, there was 2.0-fold increased odds of survival (95% CI 1.05-3.88;P<.035) for aviptadil at Day 60 controlling for baseline NIAID score. Odds of survival increased to over 4-fold after adjusting for site of care (Tertiary care vs regional hospital, OR 4.35 (95% CI 1.91, 9.90;P<.035). Logistic regression indicated aviptadil treated patients were also significantly more likely to be discharged earlier than placebo-treated patients (p=0.01). The most common adverse events noted were diarrhea (32.8% vs. 1.5%) and hypotension (26% vs.21.5%) for aviptadil vs. placebo. Additional adverse events occurring more frequently in aviptadil treated patients included acute kidney injury (23.7% vs 20%), hyperkalemia (12.2% vs 6.2%), and atrial fibrillation (11.5% vs 4.6%). Multiple organ dysfunction syndrome (6.9% vs 13.8%) and respiratory failure (12.2% vs 13.8%) occurred more commonly in placebo-treated patients. Conclusion: Treatment with aviptadil demonstrates efficacy in improving the likelihood of recovering from respiratory failure, surviving to 60 days, and reducing hospital stay in critically ill patients with respiratory failure caused by COVID-19.

Global Forum of Cancer Surgeons: Cancer Surgery During the COVID-19 Pandemic: Impact and Lessons Learned.

BACKGROUND: The purpose of this article is to summarize the opinions of the surgical oncology leaders from the Global Forum of Cancer Surgeons (GFCS) about the global impact of COVID-19 pandemic on cancer surgery. METHODS: A panel session (virtual) was held at the annual Society of Surgical Oncology 2021 International Conference on Surgical Cancer Care to address the impact of COVID-19 on cancer surgery globally. Following the virtual meeting, a questionnaire was sent to all the leaders to gather additional opinions. The input obtained from all the leaders was collated and analyzed to understand how cancer surgeons from across the world adapted in real-time to the impact of COVID-19 pandemic. RESULTS: The surgical oncology leaders noted that the COVID-19 pandemic led to severe disruptions in surgical cancer care across all domains of clinical care, education, and research. Several new changes/protocols associated with increased costs were implemented to deliver safe care. Leaders also noted that preexisting disparities in care were exacerbated, and the pandemic had a detrimental effect on well-being and financial status. CONCLUSIONS: The COVID-19 pandemic has led to severe disruptions in surgical cancer care globally. Leaders of the GFCS opined that new strategies need to be implemented to prepare for any future catastrophic events based on the lessons learned from the current events. The GFCS will embark on developing such a roadmap to ensure that surgical cancer care is preserved in the future regardless of any catastrophic global events.

Myocarditis After COVID-19 Vaccination: A Systematic Review of Case Studies

Background: The coronavirus disease of 2019 (COVID-19) is a global pandemic with over 200 million cases and four million deaths worldwide. Anti-COVID-19 vaccinations have had exceptional success in subduing the incidence, prevalence, and disease severity of COVID-19, but rare cases of myocarditis have been reported after COVID-19 vaccinations. Methods: We performed a systematic literature search on PUBMED, MEDLINE, EMBASE, and Cochrane Reviews database from inception to July 18, 2021. Studies were analyzed based on predetermined eligibility criteria. Results: A total of 19 studies containing 73 cases of COVID-19 vaccine-associated myocarditis were catalogued. Mean age was 25 years, and male to female ratio was 17:1. For 87.7% of patients, myocarditis occurred after the second dose. Average time to onset and length of hospitalization were 3.5 days and 5.2 days, respectively. Prognosis was benign with 100% recovery. Chest pain (100%);elevation of troponin (100%) and CRP (94.4%);and ST elevation on EKG (81.4%) were common. NSAIDs (73.5%) were the most used medication, followed by colchicine (50%). Conclusions: Patients with COVID-19 vaccine-associated myocarditis are usually younger males presenting with chest pain 3.5 days after receiving their second dose. Work-up typically shows elevation of troponin and CRP with ST changes in EKG. Diagnosis is made after excluding all other etiologies. Given significant population benefit from COVID-19 vaccination, physicians should continue to encourage vaccination while remaining vigilant of the very rare occurrence of myocarditis following COVID-19 vaccination. [Formula presented]