Impact of COVID-19 on psychological wellbeing.

This cross-sectional study aims to record post-traumatic stress (PTS) and post-traumatic growth (PTG) of the general population of China during the first wave of COVID-19 spread. Method: An online survey was distributed in China during February and March 2020 to record the general population's PTS (using the Post-traumatic Stress Disorder Checklist-Civilian Version, PCL-C) and PTG (using the Post-traumatic Growth Inventory, PTGI) due to COVID-19. Confirmatory Factor Analyses (CFAs) and a Two-Part Model (TPM) of regression analysis were conducted. Results: In total, 29,118 Chinese participants completed the survey (54.20% were in their 20s, 68% were males, and 60.30% had a university education). CFA results illustrated that bifactor models described the Chinese psychometric traits of PTS and PTG over the default models. Results of TPM suggested that female, low-educated, and middle-aged individuals were more vulnerable to PTS. Remarkably, mutual and positive correlations between the PTS and the PTG, though small in statistics, were observed through regression analyses. Conclusions: The current results presented new best-fit structural models, potential predictors, and valuable baseline information on the PTS and the PTG of the Chinese population in the context of COVID-19.

Este estudio transversal se realizó para registrar el estrés postraumático (EPT) y el crecimiento de estrés postraumático (CPT) de la población general de China durante la primera ola de la extensión del COVID-19. Método: Se realizó una encuesta en línea en China durante febrero y marzo del año 2020 para registrar EPT de la población (utilizando el Post-traumatic Stress Disorder Checklist-Civilian Version, PCL-C) y CPT (utilizando el Post-traumatic Growth Inventory, PTGI). Se llevaron a cabo Análisis Factorial Confirmatorio (AFC) y Modelo de Dos Partes (MDP) de análisis de regresión. Resultados: En total, 29.118 chinos completaron la encuesta (54,2% de ellos tenían 20~29 años, 68,0% eran hombres, y 60,3% tenían una Educación Universitaria). Los resultados de AFC ilustraron que los modelos de bifactoriales eran mejores para descubrir los rasgos psicométricos de EPT y CPT de los participantes chinos que los modelos predeterminados. Los resultados de MDP sugirieron que las mujeres, las personas con bajo nivel educativo y de mediana edad eran más vulnerables a EPT. Se observaron correlaciones mutuas y positivas entre EPT y CPT, aunque pequeñas. Conclusiones: Los resultados actuales presentaron nuevos modelos estructurales de mejor ajuste, predictores potenciales e información de referencia valiosa de EPT y CPT de la población China en el contexto de COVID-19.

Burnout of special educators serving students with emotional-behavioral disorders: A longitudinal study

We examined changes in burnout across three timepoints in one school year, in a sample (N = 230) of special educators serving students with emotional-behavioral disorders, in 15 school districts selected through stratified random sampling at the national level. Emotional exhaustion decreased at each timepoint in the school year and personal accomplishment increased from fall to spring. Latent growth curve modeling did not produce latent trajectories of burnout among teachers;however, cross-lagged panel structure equation modeling revealed that emotional exhaustion and personal accomplishment had both direct and indirect effects on depersonalization. Differences in burnout were significant by race/ethnicity but not by gender. Participants reported higher emotional exhaustion, lower depersonalization, and higher personal accomplishment than a national sample. We provide implications for researchers and practitioners. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Academic Anxiety, Self-Regulated Learning Ability, and Self-Esteem in Chinese Candidates for College Entrance Examination During the COVID-19 Outbreak: A Survey Study.

Purpose: The novel coronavirus disease 2019 (COVID-19) pandemic has become a challenge for adolescents in China. This study aimed to explore the relationship between academic anxiety and self-esteem in Chinese candidates preparing for the college entrance examination during the COVID-19 pandemic and to examine the mechanism of mediating effect of self-regulated learning ability. Methods: A cross-sectional study was conducted among 293 college entrance examination candidates (including 170 females) from two middle schools in China using a voluntary, web-based, and anonymous questionnaire implemented via the Questionnaire Star app during COVID-19 prevalence in 2020. Results: This study found that 1) students in the high and low academic anxiety groups had different levels of self-regulated learning ability and self-esteem, 2) the academic anxiety, self-regulated learning ability, and self-esteem levels of students were significantly correlated and 3) after controlling the two independent variables of gender and subject type, academic anxiety had a significant negative predictive effect on self-esteem, and self-regulated learning ability played a mediating role between academic anxiety and self-esteem, where the mediating effect was 18.6%. Conclusion: Based on the observations of the present study, self-regulated learning capacity was a mediator between academic anxiety and self-esteem. These findings suggest an underlying process by which low academic anxiety may increase self-esteem in candidates preparing for the college entrance examination by increasing self-regulated learning ability.

High-flow nasal cannula: Evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system.

Objective: In order to facilitate education for clinical users, performance aspects of the high-flow nasal cannula (HFNC) devices were evaluated in the present study. A multidimensional HFNC clinical evaluation system was established accordingly. Materials and Methods: Clinical staff from Chinese hospitals were invited to participate in an online questionnaire survey. The questionnaire was mainly about the accuracy of temperature, flow rate, and oxygen concentration of HFNC, as well as its humidification capacity. We also investigated how the clinical staff of different professions made decisions on HFNC evaluation indicators. Based on the results of the questionnaire survey of clinicians with rich experience in using HFNC, the relative weights of temperature accuracy, flow velocity accuracy, oxygen concentration accuracy, and humidification ability of HFNC equipment were calculated by the AHP to establish a clinical evaluation system. Four kinds of common HFNC devices were tested and evaluated, and the clinical performance of the four kinds of HFNC devices was evaluated by the new scoring system. Results: A total of 356 clinicians participated in and completed the questionnaire survey. To ensure the reliability of the HFNC evaluation system, we only adopted the questionnaire results of clinicians with rich experience in using HFNCs. Data from 247 questionnaires (80 doctors, 105 nurses, and 62 respiratory therapists [RTs]) were analyzed. A total of 174 participants used HFNC more than once a week; 88.71% of RTs used HFNC ≥ 1 score daily, 62.86% of nurses used HFNC ≥ 1 score daily, and 66.25% of doctors used HFNC ≥ 1 daily. There was no significant difference in the frequency of use between doctors and nurses. Finally, the relative weights of temperature accuracy (0.088), humidification capacity (0.206), flow velocity accuracy (0.311), and oxygen concentration accuracy (0.395) in the HFNC clinical evaluation system were obtained. The relative weights of clinicians with different occupations and the frequency of HFNC use were obtained. After testing four kinds of HFNC devices through the evaluation system, it was found that the four kinds of HFNC devices have different advantages in different clinical performances, and AiRVO2 has excellent performance with regard to temperature accuracy and humidification ability. HF-75A and NeoHiF-i7 are good at ensuring the stability of oxygen concentration and the accuracy of the flow velocity of the transported gas, while OH-80S is relatively stable in all aspects. Conclusion: The clinical evaluation system of HFNC is based on the weight of the experience of clinical personnel with different medical backgrounds. Although the existing practitioners have different educational backgrounds (academic qualifications, majors), our evaluation system can enhance clinical staff's awareness of HFNC and further optimize the clinical use of HFNC.

Elevated D-dimer and Adverse In-hospital Outcomes in COVID-19 Patients and Synergism with Hyperglycemia.

Aim: One of the most common laboratory findings in COVID-19 patients has been observed to be hypercoagulability with elevated D-dimer levels. An activation of thrombosis may be generated by hyperglycemia. We aimed to explore the association between D-dimer and in-hospital outcomes, and evaluate the synergistic effect between elevated D-dimer and hyperglycemia on COVID-19 prognosis. Methods: A retrospective cohort study was undertaken with 2467 COVID-19 inpatients. D-dimer and fasting blood glucose (FBG) on admission and adverse in-hospital outcomes (events of death and aggravated severity) were collected. Cox proportional risk model was performed to assess the association of D-dimer and adverse in-hospital outcomes, and the combined effects of D-dimer and FBG. Results: Among these COVID-19 patients, 1100 (44.6%) patients had high D-dimer (≥0.50 mg/L). Patients with high D-dimer were older, with higher FBG (≥7.00 mmol/L), and had significantly higher adjusted risk of adverse in-hospital outcomes when comparing with those who with D-dimer<0.50 mg/L (hazard ratio, 2.73; 95% confidence interval, 1.46-5.11). Moreover, patients with high FBG and D-dimer levels had an increasing risk (hazard ratio, 5.72; 95% confidence interval: 2.65-12.34) than those with normal FBG and D-dimer. Conclusion: Risk of adverse in-hospital outcomes is higher among patients with high D-dimer levels. Additionally, this study found for the first time that elevated D-dimer and hyperglycemia had a synergistic effect on COVID-19 prognosis, and this risk was independent of diabetes history.

A New Precise High Flow Oxygen Therapy System Based on Sliding Mode Control Strategy

In recent years, precise high flow oxygen therapy as a new type of oxygen therapy machine has gradually attracted people’s attention and has been widely used in hospital emergency and clinical treatment of respiratory diseases;especially in recent years, severe coronavirus disease (COVID-19) has played an important role in the treatment of patients. This paper presents a new type of precise high flow oxygen therapy machine with electromagnetic pneumatic flow valve as the core control element. A sliding mode control strategy based on the system is proposed to realize the accurate control of oxygen concentration and output flow of oxygen therapy mixture. The physical equipment of the precision high flow system is established, and its working performance is verified through the test platform. The optimization design goal of the precision high flow equipment is achieved.

Working Conditions and Burnout of Special Educators of Students With EBD: Longitudinal Outcomes

Special education teacher (SET) burnout is a significant concern, especially for SETs serving students with emotional?behavioral disorders (EBD), as they tend to experience higher burnout than other teachers. Working conditions, especially social support, have the potential to ameliorate burnout, but prior research has not articulated the sources and types of social support that are most important. The authors conducted a longitudinal study, surveying 230 SETs serving students with EBD at three time points across 1 school year. Data revealed administrative support, adequacy of planning time, and autonomy in fall predicted emotional exhaustion and personal accomplishment in winter and spring. Associations between working conditions and burnout components were partially mediated by SETs? perceptions of workload manageability. SET change in well-being due to COVID-19 during the early months of the pandemic was not associated with burnout. The authors discuss implications, limitations, and directions for future inquiry.

Psychological experience of COVID-19 patients: A systematic review and qualitative meta-synthesis.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has not only placed an unprecedented strain on healthcare systems worldwide, but has also caused irreparable physical and psychological damage to those infected. It is essential to understand the disease process and psychological experience of patients with COVID-19, to provide them with efficacious psychological guidance and interventions. This qualitative systematic review sought to explore the experience of COVID-19 patients. METHODS: The meta-analysis methodology developed by the Joanna Briggs Institute guided this systematic review and qualitative meta-analysis. Seven databases were searched, with no language restrictions. This study was registered with PROSPERO under accession number CRD42021279266. RESULTS: A total of 3107 potentially eligible articles were identified through database and reference list searches, among which 23 studies (from 10 countries) were ultimately included in our analysis. Five interrelated themes emerged: the complex psychological course of COVID-19 patients; the impact of the disease on the body; the expectation of support and guidance from multiple sources; coping strategies; and post-traumatic growth. CONCLUSIONS: Psychological distress among patients with COVID-19 was found to be widespread. Healthcare providers should pay attention to the psychological changes in patients, ensure continuity of care and provide professional support from hospital to home, and build patients' confidence so that they can return to their families and society. Long-term follow-up studies may provide deeper insight into the psychological needs of survivors.

Changes in stoichiometric characteristics of ambient air pollutants pre-to post-COVID-19 in China.

To prevent the Corona Virus Disease 2019 (COVID-19) spreading, Chinese government takes a series of corresponding measures to restrict human mobility, including transportation lock-down and industries suspension, which significantly influenced the ambient air quality and provided vary rare time windows to assess the impacts of anthropological activities on air pollution. In this work, we divided the studied timeframe (2019/12/24-2020/2/24) into four periods and selected 88 cities from 31 representative urban agglomerations. The indicators of PM2.5/PM10 and NO2/SO2 were applied, for the first time, to analyze the changes in stoichiometric characteristics of ambient air pollutants pre-to post-COVID-19 in China. The results indicated that the ratios of NO2/SO2 presented a responding decline, especially in YRD (-5.01), YH (-3.87), and MYR (-3.84), with the sharp reduction of traffic in post-COVID-19 periods (P3-P4: 2.34 ± 0.94 m/m) comparing with pre-COVID-19 periods (P1-P2: 4.49 ± 2.03 m/m). Whereas the ratios of PM2.5/PM10 increased in P1-P3, then decreased in P4 with relatively higher levels (>0.5) in almost all urban agglomerations. Furthermore, NO2 presented a stronger association with PM2.5/PM10 variation than CO; and PM2.5 with NO2/SO2 variation than PM10. In summary, the economic structure, lockdown measures and meteorological conditions could explain the noteworthy variations in different urban agglomerations. These results would be in great help for improving air quality in the post-epidemic periods.

Negative Emotions in Chinese Frontline Medical Staff During the Early Stage of the COVID-19 Epidemic: Status, Trend, and Influential Pathways Based on a National Investigation.

Objective: The outbreak of coronavirus disease 2019 (COVID-19), declared as a major public health emergency, has had profound effects on public mental health especially emotional status. Due to professional requirements, medical staff are at a higher risk of infection, which might induce stronger negative emotions. This study aims to reveal the emotional status of Chinese frontline medical staff in the early epidemic period to better maintain their mental health, and provide adequate psychological support for them. Methods: A national online survey was carried out in China at the early stage of the COVID-19 epidemic. In total, 3025 Chinese frontline medical staff took part in this investigation which utilized a general information questionnaire, the Emotion Regulation Questionnaire (ERQ), and the Berkeley Expressivity Questionnaire (BEQ). Results: At the early stage of COVID-19, anxiety was the most common negative emotion of Chinese medical staff, followed by sadness, fear, and anger, mainly at a mild degree, which declined gradually over time. Nurses had the highest level of negative emotions compared with doctors and other healthcare workers. Women experienced more fear than men, younger and unmarried medical staff had more anxiety and fear compared with elders and married ones. Risk perception and emotional expressivity increased negative emotions, cognitive reappraisal reduced negative emotions, while negative emotions led to more avoidant behavior and more physical health disturbances, in which negative emotions mediated the effect of risk perception on avoidant behavior tendency in the model test. Conclusion: Chinese frontline medical staff experienced a mild level of negative emotions at the early stage of COVID-19, which decreased gradually over time. The findings suggest that during the epidemic, nurses' mental health should be extensively attended to, as well as women, younger, and unmarried medical staff. To better ensure their mental health, reducing risk perception and improving cognitive reappraisal might be important, which are potentially valuable to form targeted psychological interventions and emotional guidance under crisis in the future.

Modelling the effect of local and regional emissions on PM2.5 concentrations in Wuhan, China during the COVID-19 lockdown

PM2.5 concentrations in Wuhan, China decreased by 36.0% between the period prior to the COVID-19 pandemic (1‒23 January, 2020) and the COVID-lockdown period (24 January to 29 February, 2020). However, decreases in PM2.5 concentration due to regional PM2.5 transport driven by meteorological changes, and the relationship between the PM2.5 source and receptor, are poorly understood. Therefore, this study assessed how changes in meteorology, local emissions, and regional transport from external source emissions contributed to the decrease in Wuhan’s PM2.5 concentration, using FLEXPART-WRF and WRF-Chem modelling experiments. The results showed that meteorological changes in central China explain up to 22.2% of the total decrease in PM2.5 concentrations in Wuhan, while the remaining 77.8% was due to air pollutant emissions reduction. Reduction in air pollutant emissions depended on both local and external sources, which contributed alomst equally to the reduction in PM2.5 concentrations (38.7% and 39.1% of the total reduction, respectively). The key emissions source areas affecting PM2.5 in Wuhan during the COVID-lockdown were identified by the FLEXPART-WRF modeling, revealing that regional-joint control measures in key areas accounted for 89.3% of the decrease in PM2.5 concentrations in Wuhan. The results show that regional-joint control can be enhanced by identifying key areas of emissions reduction from the source‒receptor relationship of regional PM2.5 transport driven by meteorology under the background of East Asian monsoon climate change.

Scoring System to Evaluate the Performance of ICU Ventilators in the Pandemic of COVID-19: A Lung Model Study.

Ventilators in the intensive care units (ICU) are life-support devices that help physicians to gain additional time to cure the patients. The aim of the study was to establish a scoring system to evaluate the ventilator performance in the context of COVID-19. The scoring system was established by weighting the ventilator performance on five different aspects: the stability of pressurization, response to leaks alteration, performance of reaction, volume delivery, and accuracy in oxygen delivery. The weighting factors were determined with analytic hierarchy process (AHP). Survey was sent out to 66 clinical and mechanical experts. The scoring system was built based on 54 valid replies. A total of 12 commercially available ICU ventilators providing non-invasive ventilation were evaluated using the novel scoring system. A total of eight ICU ventilators with non-invasive ventilation mode and four dedicated non-invasive ventilators were tested according to the scoring system. Four COVID-19 phenotypes were simulated using the ASL5000 lung simulator, namely (1) increased airway resistance (IR) (10 cm H2O/L/s), (2) low compliance (LC) (compliance of 20 ml/cmH2O), (3) low compliance plus increased respiratory effort (LCIE) (respiratory rate of 40 and inspiratory effort of 10 cmH2O), (4) high compliance (HC) (compliance of 50 ml/cmH2O). All of the ventilators were set to three combinations of pressure support and positive end-expiratory pressure levels. The data were collected at baseline and at three customized leak levels. Significant inaccuracies and variations in performance between different non-invasive ventilators were observed, especially in the aspect of leaks alteration, oxygen and volume delivery. Some ventilators have stable performance in different simulated phenotypes whereas the others have over 10% scoring differences. It is feasible to use the proposed scoring system to evaluate the ventilator performance. In the COVID-19 pandemic, clinicians should be aware of possible strengths and weaknesses of ventilators.

Fear in the Chinese Population: Influential Patterns in the Early Stage of the COVID-19 Pandemic.

Major global public health emergencies challenge public mental health. Negative emotions, and especially fear, may endanger social stability. To better cope with epidemics and pandemics, early emotional guidance should be provided based on an understanding of the status of public emotions in the given circumstances. From January 27 to February 11, 2020 (during which the cases of COVID-19 were increasing), a national online survey of the Chinese public was conducted. A total of 132,482 respondents completed a bespoke questionnaire, the Emotion Regulation Questionnaire, and the Berkeley Expressivity Questionnaire (BEQ). Results showed that at the early stage of the COVID-19 epidemic, 53.0% of the Chinese population reported varying degrees of fear, mostly mild. As seen from regression analysis, for individuals who were unmarried and with a relatively higher educational level, living in city or area with fewer confirmed cases, cognitive reappraisal, positive expressivity and negative inhibition were the protective factors of fear. For participants being of older age, female, a patient or medical staff member, risk perception, negative expressivity, positive impulse strength and negative impulse strength were the risk factors for fear. The levels of fear and avoidant behavior tendencies were risk factors for disturbed physical function. Structural equation modeling suggested that fear emotion had a mediation between risk perception and escape behavior and physical function disturbance. The findings help to reveal the public emotional status at the early stage of the pandemic based on a large Chinese sample, allowing targeting of the groups that most need emotional guidance under crisis. Findings also provide evidence of the need for psychological assistance in future major public health emergencies.

Mechanical ventilation strategy for pulmonary rehabilitation based on patient-ventilator interaction.

Mechanical ventilation is an effective medical means in the treatment of patients with critically ill, COVID-19 and other pulmonary diseases. During the mechanical ventilation and the weaning process, the conduct of pulmonary rehabilitation is essential for the patients to improve the spontaneous breathing ability and to avoid the weakness of respiratory muscles and other pulmonary functional trauma. However, inappropriate mechanical ventilation strategies for pulmonary rehabilitation often result in weaning difficulties and other ventilator complications. In this article, the mechanical ventilation strategies for pulmonary rehabilitation are studied based on the analysis of patient-ventilator interaction. A pneumatic model of the mechanical ventilation system is established to determine the mathematical relationship among the pressure, the volumetric flow, and the tidal volume. Each ventilation cycle is divided into four phases according to the different respiratory characteristics of patients, namely, the triggering phase, the inhalation phase, the switching phase, and the exhalation phase. The control parameters of the ventilator are adjusted by analyzing the interaction between the patient and the ventilator at different phases. A novel fuzzy control method of the ventilator support pressure is proposed in the pressure support ventilation mode. According to the fuzzy rules in this research, the plateau pressure can be obtained by the trigger sensitivity and the patient's inspiratory effort. An experiment prototype of the ventilator is established to verify the accuracy of the pneumatic model and the validity of the mechanical ventilation strategies proposed in this article. In addition, through the discussion of the patient-ventilator asynchrony, the strategies for mechanical ventilation can be adjusted accordingly. The results of this research are meaningful for the clinical operation of mechanical ventilation. Besides, these results provide a theoretical basis for the future research on the intelligent control of ventilator and the automation of weaning process.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)-Associated Urogenital Disease: A Current Update.

Severe Acute Respiratory Syndrome Coronavirus 2, which is quickly spreading around the world and causes coronavirus disease 2019, may attack the urogenital system. We thought that a summary of the current literature about urogenital disease associated with the virus would be useful for physicians treating patients with coronavirus disease 2019. PubMed was comprehensively screened for studies published from 2019 to 2020. Studies of coronavirus disease 2019 patients with kidney disease, reproductive system diseases, or urological cancer were included. Through reviewing current literature, we summarized that acute kidney injury is a risk factor for patients with coronavirus disease 2019 and is related to their survival. A diagnosis of chronic kidney disease increases the risk of infection. The therapy for kidney transplant patients should be cautious and implemented on a case-by-case basis. When the public health burden is too heavy to bear, a rational selection of treatment for patients with urological cancer is vital. The male reproductive system is at high risk of being attacked by the virus, which may cause damage to reproductive function, and the long-term effects require further study. So, the complications associated with the urogenital system should not be ignored during the course of infection treatment and more robust evidence of long-term effects on the urogenital system will be proposed as more studies are published.

A Novel Method to Evaluate Patient-Ventilator Synchrony during Mechanical Ventilation

The synchrony of patient-ventilator interaction affects the process of mechanical ventilation which is clinically applied for respiratory support. The occurrence of patient-ventilator asynchrony (PVA) not only increases the risk of ventilator complications but also affects the comfort of patients. To solve the problem of uncertain patient-ventilator interaction in the mechanical ventilation system, a novel method to evaluate patient-ventilator synchrony is proposed in this article. Firstly, a pneumatic model is established to simulate the mechanical ventilation system, which is verified to be accurate by the experiments. Then, the PVA phenomena are classified and detected based on the analysis of the ventilator waveforms. On this basis, a novel synchrony index SIhao is established to evaluate the patient-ventilator synchrony. It not only solves the defects of previous evaluation indexes but also can be used as the response parameter in the future research of ventilator control algorithms. The accurate evaluation of patient-ventilator synchrony can be applied to the adjustment of clinical strategies and the pathological analyses of patients. This research can also reduce the burden on clinicians and help to realize the adaptive control of the mechanical ventilation and weaning process in the future.