Switching from offline to online health consultation in the post-pandemic era: the role of perceived pandemic risk.

Introduction: Due to its effectiveness and various benefits, the use of online health consultation (OHC) has dramatically increased in recent years, especially since the outbreak of the COVID-19 pandemic. However, underlying mechanism whereby the pandemic impacted OHC usage is still unclear. Methods: Via an online survey (N=318), the present paper measures the users' perceptions towards both offline and online services, their intention to switch to OHC, and the perceived pandemic risks. The relationships among these factors are conceptualized by the push-pull-mooring framework, and tested via structural equation modelling. Results: Dissatisfaction with offline service (process inefficiency and consultation anxiety), the attractiveness of OHC (perceived benefits and perceived ease of use), and users' behavioral inertia (switching cost and habit) jointly influence the intention to switching to OHC. The significant role of the perceived pandemic risk of going to medical facilities is particularly addressed. On the one hand, the perceived pandemic risk is found with an indirect impact on the switching intention by enlarging the dissatisfaction with offline service and the attractiveness of OHC. On the other hand, a high perceived pandemic risk induces more actual switching behavior and also amplifies the transition from switching intention to behavior. Discussion: The study provides novel insights into the understanding of OHC usage in the post-pandemic era, and also informs medical facilities, OHC platforms, and policymakers on managing and balancing the online and offline healthcare provision.

The impact of the COVID-19 pandemic on global trade-embodied carbon emissions.

We evaluate the response of global supply chains to carbon emissions through compiling multi-regional input-output (MRIO) models for import and export shocks in 14 countries/territories dominated by the COVID-19 crisis. Instead of traditional production-based inventories, we achieve CO2 emissions inventories based on intermediate inputs and final consumption to analyze the connected environmental impacts. In addition, we adopt the available data up to date to construct inventories of carbon emissions involved in imports and exports from different sectors. The results show that global carbon emissions could be decreased by 6.01% during the COVID-19, while export carbon emissions remained basically unchanged. As a result, imported carbon emissions fell by 5.2%, with the energy products sector most affected by the pandemic. Transport sector witnessed 18.42% carbon emission reduction. The impact of developing countries with a large proportion of resource-based industries is comparatively higher than that of developed countries with the technological advantage. International trade plays a crucial role in the choice of supply chain partners to control carbon emissions. Building a sustainable supply chain and reducing the "trade carbon deficit" between countries/regions requires the coordination of all departments of each country/region to promote the trade of energy-saving products, environmental protection services and environmental services.

SARS-CoV-2 infection aggravates chronic comorbidities of cardiovascular diseases and diabetes in mice.

Background: Cardiovascular diseases (CVDs) and diabetes mellitus (DM) are top two chronic comorbidities that increase the severity and mortality of COVID-19. However, how SARS-CoV-2 alters the progression of chronic diseases remain unclear. Methods: We used adenovirus to deliver h-ACE2 to lung to enable SARS-CoV-2 infection in mice. SARS-CoV-2's impacts on pathogenesis of chronic diseases were studied through histopathological, virologic and molecular biology analysis. Results: Pre-existing CVDs resulted in viral invasion, ROS elevation and activation of apoptosis pathways contribute myocardial injury during SARS-CoV-2 infection. Viral infection increased fasting blood glucose and reduced insulin response in DM model. Bone mineral density decreased shortly after infection, which associated with impaired PI3K/AKT/mTOR signaling. Conclusion: We established mouse models mimicked the complex pathological symptoms of COVID-19 patients with chronic diseases. Pre-existing diseases could impair the inflammatory responses to SARS-CoV-2 infection, which further aggravated the pre-existing diseases. This work provided valuable information to better understand the interplay between the primary diseases and SARS-CoV-2 infection.

Thoughts on the effects of moxa smoke in the epidemic prevention.

Through summarizing and analyzing the modern mechanism researches and controversial questions of moxibustion fumigation in the epidemic prevention, the thoughts on tackling the critical points are proposed in the paper, such as the recognition of moxa smoke in traditional Chinese medicine (TCM), the mechanism of moxa smoke in air disinfection and the characteristics of clinical application of moxa smoke so as to provide the references to the prevention and control of COVID-19 in TCM.

Patient-derived monoclonal antibodies to SARS-CoV-2 nucleocapsid protein N-terminal and C-terminal domains cross-react with their counterparts of SARS-CoV, but not other human betacoronaviruses.

Introduction: SARS-CoV-2 nucleocapsid (N) protein plays a key role in multiple stages of the viral life cycle such as viral replication and assembly. This protein is more conserved than the Spike protein of the virus and can induce both humoral and cell-mediated immune responses, thereby becoming a target for clinical diagnosis and vaccine development. However, the immunogenic characteristics of this protein during natural infection are still not completely understood. Methods: Patient-derived monoclonal antibodies (mAbs) against SARS-CoV-2 N protein were generated from memory B cells in the PBMCs using the antigen-specific B cell approach. For epitope mapping of the isolated hmAbs, a panel of series-truncated N proteins were used , which covered the N-terminal domain (NTD, aa 46-174 ) and C-terminal domain (CTD, aa 245-364 ), as well as the flanking regions of NTD and CTD. NTD- or CTD-specific Abs in the plasma from COVID-19 patients were also tested by ELISA method. Cross-binding of hmAbs or plasma Abs in COVID-19 patients to other human ß-CoV N proteins was determined using the capture ELISA. Results: We isolated five N-specific monoclonal antibodies (mAbs) from memory B cells in the peripheral blood of two convalescent COVID-19 patients. Epitope mapping revealed that three of the patient-derived mAbs (N3, N5 and N31) targeted the C-terminal domain (CTD), whereas two of the mAbs (N83 and 3B7) targeted the N-terminal domain (NTD) of SARS-CoV-2 N protein. All five patient-derived mAbs were cross-reactive to the N protein of SARS-CoV but showed little to no cross-reactivity to the N proteins of other human beta coronaviruses (ß-CoVs). We also tested 52 plasma samples collected from convalescent COVID-19 patients for Abs against the N proteins of human ß-CoVs and found that 78.8% of plasma samples showed detectable Abs against the N proteins of SARS-CoV-2 and SARS-CoV. No plasma sample had cross-reactive Abs to the N protein of MERS-CoV. Cross-reactive Abs to the N proteins of OC43 and HKU1 were detected in 36.5% (19/52) and 19.2% (10/52) of plasma samples, respectively. Discussion: These results suggest that natural SARS-CoV-2 infection elicits cross-reactive Abs to the N protein of SARS-CoV and that the five patient-derived mAbs to SARS-CoV-2 N protein NTD and CTD cross-react with their counterparts of SARS-CoV, but not other human ß-CoVs. Thus, these five patient-derived mAbs can potentially be used for developing the next generation of COVID-19 At-Home Test kits for rapid and specific screening of SARS-CoV-2 infection.

Identifying Traffic Congestion Patterns of Urban Road Network Based on Traffic Performance Index

Urban congestion has become a global problem with urbanization and motorization. The analysis of time-varying traffic congestion patterns is necessary to formulate effective management strategies. The existing studies have focused on traffic flow patterns developed by the volume, speed and density of road sections in a limited district, while the long-time analysis of congestion patterns of the macro road network at the city level is inadequate. This paper aims to recognize traffic congestion patterns of the urban road network based on the traffic performance index (TPI) of 699 days in 2018, 2019 and 2021 in Beijing. The self-organizing maps (SOM) method improved by an automatic clustering number determination algorithm is proposed to cluster congestion patterns based on time-varying TPI. The traffic congestion of the macro road network is clustered into Mondays, Fridays, ordinary weekdays, congested weekdays, weekdays of winter and summer vacation, Saturdays, Sundays and festivals patterns. Patterns of Mondays and congested weekdays have a prominent morning peak, while patterns of Fridays, ordinary weekdays, and weekdays of winter and summer vacation have a prominent evening peak. Saturdays, Sundays and festivals are less congested than weekday patterns. It is verified that the SOM method proposed in this paper clusters traffic congestion into more detailed and accurate patterns, and it is applicable to TPI clustering in different years. The degree of congestion in 2021 increases by 7.15% in peak hours and decreases by 7.50% in off-peak hours compared with that in 2019 due to COVID-19. This method is helpful for traffic management in terms of making decisions according to different congestion patterns.

Screening and Characterization of Shark-Derived VNARs against SARS-CoV-2 Spike RBD Protein.

The receptor-binding domain (RBD) of the SARS-CoV-2 spike protein is the major target for antibody therapeutics. Shark-derived variable domains of new antigen receptors (VNARs) are the smallest antibody fragments with flexible paratopes that can recognize protein motifs inaccessible to classical antibodies. This study reported four VNARs binders (JM-2, JM-5, JM-17, and JM-18) isolated from Chiloscyllium plagiosum immunized with SARS-CoV-2 RBD. Biolayer interferometry showed that the VNARs bound to the RBD with an affinity KD ranging from 38.5 to 2720 nM, and their Fc fusions had over ten times improved affinity. Gel filtration chromatography revealed that JM-2-Fc, JM-5-Fc, and JM-18-Fc could form stable complexes with RBD in solution. In addition, five bi-paratopic VNARs, named JM-2-5, JM-2-17, JM-2-18, JM-5-18, and JM-17-18, were constructed by fusing two VNARs targeting distinct RBD epitopes based on epitope grouping results. All these bi-paratopic VNARs except for JM-5-18 showed higher RBD binding affinities than its component VNARs, and their Fc fusions exhibited further enhanced binding affinities, with JM-2-5-Fc, JM-2-17-Fc, JM-2-18-Fc, and JM-5-18-Fc having KD values lower than 1 pM. Among these Fc fusions of bi-paratopic VNARs, JM-2-5-Fc, JM-2-17-Fc, and JM-2-18-Fc could block the angiotensin-converting enzyme 2 (ACE2) binding to the RBD of SARS-CoV-2 wildtype, Delta, Omicron, and SARS-CoV, with inhibition rates of 48.9~84.3%. Therefore, these high-affinity VNAR binders showed promise as detectors and therapeutics of COVID-19.

Bitcoin as a Safe-Haven Asset and a Medium of Exchange

A monetary model is established to introduce that bitcoin does have the characteristics of a price rise when the economic situation is terrible under high risk aversion. At this time, Bitcoin has the property of a safe-haven asset, and when economic conditions are good and risk aversion is low, Bitcoin has a pro-cyclical nature. At this time, Bitcoin has a stronger property as a medium of exchange. To show the movement law of the bitcoin price, we make a logarithmic linearization of the model and simulation, and the result is consistent with the theoretical analysis. To better understand the role of bitcoin in the real economy, several standard portfolio models are used to measure the similarities and differences between gold and bitcoin in an investment portfolio. After the outbreak of COVID-19, bitcoin has shown stronger safe-haven asset properties.

Human parainfluenza 3 and respiratory syncytial viruses detected in pangolins.

Pangolins have gained increasing global attention owing to their public health significance as potential zoonotic hosts since the identification of SARS-CoV-2-related viruses in them. Moreover, these animals could carry other respiratory viruses. In this study, we investigated the virome composition of 16 pangolins that died in 2018 with symptoms of pneumonia using metagenomic approaches. A total of eight whole virus sequences belonging to the Paramyxoviridae or Pneumoviridae families were identified, including one human parainfluenza virus 3, one human respiratory syncytial virus A, and six human respiratory syncytial virus B. All of these sequences showed more than 99% nucleotide identity with the virus isolated from humans at the whole-genome level and clustered with human viruses in the phylogenetic tree. Our findings provide evidence that pangolins are susceptible to HPIV3 and HRSV infection. Therefore, public awareness of the threat of pangolin-borne pathogens is essential to stop their human consumption and to prevent zoonotic viral transmission.

Analysis of neutralizing antibody to COVID-19 vaccine in hospitalized patients with liver dysfunction (preprint)

Background: To evaluate the level of neutralizing antibodies(NAbs) after COVID-19 vaccination in patients suffered from liver dysfunction.Methods: In this cross-sectional study with longitudinal follow-up , a total of 137 patients and 134 healthy volunteers with full-course COVID-19 vaccination for more than 1 month were enrolled. Data of clinical characteristics , dates after vaccination and the types of vaccine were collected. Blood samples were collected for NAbs test when the patient was hospitalized, and some collected second time after treatment. Results: Both seropositivity and mean titer of NAbs in patients was significantly lower than that in healthy control(65.7% vs 80.60%; 3.954 vs 4.944 log2AU/ml ). The decrease of antibody titer in patients was significantly faster than that in healthy controls（-2.642 vs -0.9654 AU/ml per day). In multiple logistic regression analysis, more severe liver damage (odds ratio (OR): 0.30; 95% confidence interval (95%CI): 0.12–0.71; p=0.0067) and male (OR: 0.17; 95%CI: 0.06–0.46; p=0.0005)were significantly associated with reduction of the probability of NAbs seropositivity. Chronic liver status(β =−1.45; 95% CI: −2.13 to −0.76; p<0.0001) and male sex (β =−1.18; 95% CI: −1.73 to −0.64; p<0.0001) were significantly associated with higher NAbs titers. In 26 patients with liver failure, both the antibody seropositivity and titer did not decrease, but increased(before 53.8% vs after 84.6%; 3.553 vs 4.321 log2AU/ml)after artificial liver plasmapheresis.Conclusions: Compared with healthy people, the seropositivity and titer of NAbs after COVID-19 vaccination in patients with liver dysfunction were lower and the titer decreased faster. Male, severe liver injury and chronic liver status have increased risk of poor antibody responses, and artificial liver treatment does not reduce NAbs titers in patients with liver failure. 

Relationship between risk perception of COVID-19 and job withdrawal among Chinese nurses: The effect of work-family conflict and job autonomy.

AIM: The aim of this study was to examine the mediating role of work-family conflict and the moderating role of job autonomy on the association between risk perception of COVID-19 and job withdrawal among Chinese nurses during the initial disease outbreak. BACKGROUND: Nurses' job withdrawal can not only reduce the quality and efficiency of care but also give rise to turnover during the COVID-19 pandemic. Thus, it is essential to clarify how and when the risk perception of COVID-19 influences the job withdrawal behaviours of nurses and to provide guidelines for reducing nurses' job withdrawal. METHODS: A two-wave study was conducted among 287 Chinese nurses from 11 COVID-19-designated hospitals during the initial outbreak of the disease from March through April 2020. Data on the risk perception of COVID-19, job autonomy and work-family conflict were collected at time 1, and 1 month later, job withdrawal data were collected at time 2. Model 4 and Model 14 from SPSS macro PROCESS were used to test the mediating effect of work-family conflict and the moderating effect of job autonomy, respectively. RESULTS: Work-family conflict mediated 60.54% of the relationship between risk perception of COVID-19 and job withdrawal. Job autonomy positively moderated the relation between work-family conflict and job withdrawal (ß = 0.12, P < 0.01). CONCLUSION: Risk perception of COVID-19 influenced nurses' job withdrawal through work-family conflict. Job autonomy exaggerated the association between work-family conflict and job withdrawal. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should provide more supportive resources to help nurses cope with the risk of COVID-19 to decrease work-family conflict and job withdrawal, and they should strengthen supervision over the work processes of nurses.

Development of an Adeno-Associated Virus-Vectored SARS-CoV-2 Vaccine and Its Immunogenicity in Mice.

Owing to the outbreak of the novel coronavirus (SARS-CoV-2) worldwide at the end of 2019, the development of a SARS-CoV-2 vaccine became an urgent need. In this study, we developed a type 9 adeno-associated virus vectored vaccine candidate expressing a dimeric receptor binding domain (RBD) of the SARS-CoV-2 spike protein (S protein) and evaluated its immunogenicity in a murine model. The vaccine candidate, named AAV9-RBD virus, was constructed by inserting a signal peptide to the N-terminus of two copies of RBD, spaced by a linker, into the genome of a type 9 adeno-associated virus. In vitro assays showed that HeLa cells infected by the recombinant AAV virus expressed high levels of the recombinant RBD protein, mostly found in the cell culture supernatant. The recombinant AAV9-RBD virus was cultured and purified. The genome titer of the purified recombinant AAV9-RBD virus was determined to be 2.4 × 1013 genome copies/mL (GC/mL) by Q-PCR. Balb/c mice were immunized with the virus by intramuscular injection or nasal drip administration. Eight weeks after immunization, neutralizing antibodies against the new coronavirus pseudovirus were detected in the sera of all mice; the mean neutralizing antibody EC50 values were 517.7 ± 292.1 (n=10) and 682.8 ± 454.0 (n=10) in the intramuscular injection group and nasal drip group, respectively. The results of this study showed that the recombinant AAV9-RBD virus may be used for the development of a SARS-CoV-2 vaccine.

Higher Star, Better Performance in US Nursing Homes during the Covid-19 Pandemic ?

The Covid-19 pandemic has brought terrible difficulties to nursing homes, as they were locations with the highest number of confirmed Covid-19 cases and deaths in the US. The Centers for Medicare & Medicaid Services (CMS) applies the Five-Star Quality Ratings to indicate the quality of care in nursing homes based on health inspection survey, staffing, and resident outcome. Studies to date have contradictory findings regarding the relationship between nursing home reported Quality Ratings and Covid-19 cases and deaths based on US regional data. The purpose of this study is to examine whether nursing homes’ Quality Ratings were related to the total number of resident Covid-19 cases and deaths at the US National level. The study examined US nursing homes (N=13,494) linked with CMS Nursing Home Compare data and Covid-19 Nursing Home data. Using multiple linear regression analyses, results showed nursing home Quality Ratings were significantly associated with Covid-19 residents’ cases and deaths controlling for ownership type, size, occupation rate, and years of operation (p<.001;p<.001). Five-star nursing homes were less likely to have Covid-19 cases and deaths. Further, comparing lower Star Ratings nursing homes, 1-Star nursing homes showed no significant difference to 2-Star and 3-Star nursing homes when examining Covid-19 cases and deaths. Overall, the Five-Star Quality Ratings is a useful measure when investigating nursing homes’ performance during the Covid-19 pandemic. Future policymakers and administrators should also focus on nursing homes with lower star ratings when improving the quality of nursing homes, particularly with regard to resident health.

Emerging Severe Acute Respiratory Syndrome Coronavirus 2 Mutation Hotspots Associated With Clinical Outcomes and Transmission.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Understanding the influence of mutations in the SARS-CoV-2 gene on clinical outcomes is critical for treatment and prevention. Here, we analyzed all high-coverage complete SARS-CoV-2 sequences from GISAID database from January 1, 2020, to January 1, 2021, to mine the mutation hotspots associated with clinical outcome and developed a model to predict the clinical outcome in different epidemic strains. Exploring the cause of mutation based on RNA-dependent RNA polymerase (RdRp) and RNA-editing enzyme, mutation was more likely to occur in severe and mild cases than in asymptomatic cases, especially A > G, C > T, and G > A mutations. The mutations associated with asymptomatic outcome were mainly in open reading frame 1ab (ORF1ab) and N genes; especially R6997P and V30L mutations occurred together and were correlated with asymptomatic outcome with high prevalence. D614G, Q57H, and S194L mutations were correlated with mild and severe outcome with high prevalence. Interestingly, the single-nucleotide variant (SNV) frequency was higher with high percentage of nt14408 mutation in RdRp in severe cases. The expression of ADAR and APOBEC was associated with clinical outcome. The model has shown that the asymptomatic percentage has increased over time, while there is high symptomatic percentage in Alpha, Beta, and Gamma. These findings suggest that mutation in the SARS-CoV-2 genome may have a direct association with clinical outcomes and pandemic. Our result and model are helpful to predict the prevalence of epidemic strains and to further study the mechanism of mutation causing severe disease.

Impact of COVID-19 pandemic on mobility in ten countries and associated perceived risk for all transport modes

The restrictive measures implemented in response to the COVID-19 pandemic have triggered sudden massive changes to travel behaviors of people all around the world. This study examines the individual mobility patterns for all transport modes (walk, bicycle, motorcycle, car driven alone, car driven in company, bus, subway, tram, train, airplane) before and during the restrictions adopted in ten countries on six continents: Australia, Brazil, China, Ghana, India, Iran, Italy, Norway, South Africa and the United States. This cross-country study also aims at understanding the predictors of protective behaviors related to the transport sector and COVID-19. Findings hinge upon an online survey conducted in May 2020 (N = 9,394). The empirical results quantify tremendous disruptions for both commuting and non-commuting travels, highlighting substantial reductions in the frequency of all types of trips and use of all modes. In terms of potential virus spread, airplanes and buses are perceived to be the riskiest transport modes, while avoidance of public transport is consistently found across the countries. According to the Protection Motivation Theory, the study sheds new light on the fact that two indicators, namely income inequality, expressed as Gini index, and the reported number of deaths due to COVID-19 per 100,000 inhabitants, aggravate respondents' perceptions. This research indicates that socio-economic inequality and morbidity are not only related to actual health risks, as well documented in the relevant literature, but also to the perceived risks. These findings document the global impact of the COVID-19 crisis as well as provide guidance for transportation practitioners in developing future strategies.

Correction to: Clinical features and short-term outcomes of 18 patients with corona virus disease 2019 in intensive care unit.

The original version of this article unfortunately contained a mistake. There was an error in Xiaorong Hu's name. The original article has been corrected. The authors apologize for the mistake.

Air pollution perception in ten countries during the COVID-19 pandemic.

As largely documented in the literature, the stark restrictions enforced worldwide in 2020 to curb the COVID-19 pandemic also curtailed the production of air pollutants to some extent. This study investigates the perception of the air pollution as assessed by individuals located in ten countries: Australia, Brazil, China, Ghana, India, Iran, Italy, Norway, South Africa and the USA. The perceptions towards air quality were evaluated by employing an online survey administered in May 2020. Participants (N = 9394) in the ten countries expressed their opinions according to a Likert-scale response. A reduction in pollutant concentration was clearly perceived, albeit to a different extent, by all populations. The survey participants located in India and Italy perceived the largest drop in the air pollution concentration; conversely, the smallest variation was perceived among Chinese and Norwegian respondents. Among all the demographic indicators considered, only gender proved to be statistically significant.

Diagnostic efficacy of anti-SARS-CoV-2 IgG/IgM test for COVID-19: A meta-analysis.

The serological testing of anti-SARS-CoV-2 immunoglobulin G (IgG) and/or IgM is widely used in the diagnosis of COVID-19. However, its diagnostic efficacy remains unclear. In this study, we searched for diagnostic studies from the Web of Science, PubMed, Embase, CNKI, and Wanfang databases to calculate the pooled diagnostic accuracy measures using bivariate random-effects model meta-analysis. As a result, 22 from a total of 1613 articles, including 2282 patients with SARS-CoV-2 and 1485 healthy persons or patients without SARS-CoV-2, were selected for a meta-analysis. Pooled sensitivity, specificity, and area under curve of the summary receiver operator curve (SROC) were: (a) 0.85 (95% confidence interval [CI]: 0.79-0.90), 0.99 (95% CI: 0.98-1.00), and 0.99 (95% CI: 0.97-0.99) for anti-SARS-CoV-2 IgG and (b) 0.74 (95% CI: 0.65-0.81), 0.99 (95% CI: 0.97-1.00), and 0.95 (95% CI: 0.93-0.97) for IgM. A subgroup analysis among detection methods indicated the sensitivity of IgG and IgM using enzyme-linked immunosorbent assay were slightly lower than those using gold immunochromatography assay (GICA) and chemiluminescence immunoassay (P > .05). These results showed that the detection of anti-SARS-CoV-2 IgG and IgM had high diagnostic efficiency to assist the diagnosis of SARS-CoV-2 infection. And, GICA might be used as the preferred method for its accuracy and simplicity.