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Objectives: Malnutrition is a prevalent condition affecting 30-50% of hospitalized patients. Malnutrition is linked to impairments in health outcomes and increased economic burden on healthcare systems. We assessed the prevalence and burden of malnutrition by examining demographic characteristics, Disease Related Group (DRG) payments and associated claims among Medicare inpatients (65+ years) with and without COVID-19. Method(s): Hospital inpatient COVID-19 claims from the Centers for Medicare & Medicaid Services (CMS) Inpatient Prospective Payment System (IPPS) between October 2020 - September 2021 were analyzed. The International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) were used for malnutrition diagnoses. Demographic variables were compared based on the COVID-19 status;economic burden was analyzed by DRG payment of malnutrition cases with and without COVID-19. Result(s): Among 7,394,657 Medicare inpatient claims, only 12% had a documented malnutrition diagnosis. Of these patients, 1.2% had COVID-19. Regardless of COVID-19 status, malnourished patients averaged 75 years of age, and were predominantly female (54%) and White (78%) followed by Black (14%), and Hispanic (2%). Sepsis, kidney failure, and urinary tract infection (UTI) were the most common primary diagnoses in malnourished patients, regardless of COVID-19 status. Malnourished patients with COVID-19 had significantly higher DRG payments ($27,407 vs. $18,327) and increased cost of outlier payment ($3,208 vs. $2,049) compared to those without COVID-19, regardless of other diagnoses. Conclusion(s): Malnutrition diagnosis was confirmed in only 12% of the Medicare inpatients, thus suggesting that malnutrition continues to be underdiagnosed and undertreated - evidenced by high rates of hospitalizations/claims and payments in both COVID-19 and non-COVID-19 cases. It is imperative for hospitals to implement nutrition-focused protocols to identify, diagnose and address malnutrition among all Medicare inpatients regardless of COVID-19 status (and especially among patients with sepsis, kidney failure, and UTI). Nutrition-focused protocols can effectively improve patient health outcomes and reduce healthcare costs.Copyright © 2023
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Introduction: Global health (GH) education is expanding and 23.1% of US medical students acquire international health experience prior to postgraduate training. Digestive diseases carry a high global burden. However, few GH programs and professional societies consider the inclusion of gastroenterology into their standard curriculum. In addition, travel restrictions during the COVID-19 pandemic have brought traditional GH rotations to a halt and spurred new educational approaches. Our goal is to develop a comprehensive online learning module on gastroenterology issues in GH for medical students undertaking GH electives. Method(s): A team of faculty and residents was convened between the Center for Community and Global Health and the Division of Gastroenterology. GH curricula across institutions and core competencies across 2 professional societies were examined via literature review. A survey was conducted among 2nd (MS2) and 3rd year medical students (MS3) interested in GH to assess attitudes toward GI-related issues in GH curriculum. An online learning module was developed consisting of 10, video-based lessons each addressing specific GH competencies (Figure 1). Result(s): In total, 41% (28/69) of MS2 and MS3 interested in GH responded to the survey, with a similar distribution of MS2 (13/28) and MS3 (15/28). Nearly all (92.8%) reported that learning GI conditions in a GH curriculum is moderately or very important (Table 1). A majority (78.5%) also reported feeling at least somewhat anxious or more about managing GI conditions during GH electives. Few medical students reported feeling moderately or extremely prepared to identify risk factors for GI conditions in different settings (21.5%) and to define approaches to therapy in resource-limited settings (14.3%). Interestingly, a majority (71.4%) reported feeling not at all prepared or slightly prepared to deliver cost-effective care to challenging populations. Conclusion(s): Our survey responses demonstrated an unmet need for GI-related training and cost-conscious care in the GH curriculum. Developing an online learning module on GI conditions to supplement GH curriculum may be useful and feasible. A randomized controlled trial is underway to examine the effect of this online learning module on medical student knowledge and preparedness to address GI conditions in GH electives.
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Background: Viral infections pose some of the most serious human health concerns worldwide. The infections caused by several viruses, including coronavirus, hepatitis virus, and human immunodeficiency virus, are difficult to treat. Method(s): This review details the findings of a literature search performed on the antiviral properties of luteolin. The keywords engaged in the search are "virus" along with "luteolin." Results: Luteolin possesses antiviral properties, which is the basis for the current review. It is an important natural flavonoid with numerous important biological properties, including anti-inflammatory, immune regulatory, and antitumor effects, and is found in vegetables, fruits, and several medicinal plants. Recent studies have revealed that many traditional Chinese medicines that contain luteolin inhibit the replication of coronaviruses. Conclusion(s): Luteolin effectively inhibits the replication of coronavirus, influenza virus, enterovirus, rotavirus, herpes virus, and respiratory syncytial virus, among others. In particular, it prevents viral infection by improving the body's nonspecific immunity and antioxidation capacity and inhibiting many pathways related to virus infection and replication, such as MAPK, PI3K-AKT, TLR4/8, NF-kappaB, Nrf-2/hemeoxygenase-1, and others. It also regulates the expression of some receptors and factors, including hepatocyte nuclear factor 4alpha, p53, NLRP3, TNF-alpha, and interleukins, thereby interfering with the replication of viruses in cells. Luteolin also promotes the repair of damaged cells induced by proinflammatory factors by regulating the expression of inflammatory molecules. The overall effect of these processes is the reduction in viral replication and, consequently, the viral load. This review summarizes the antiviral effect of luteolin and the mechanism underlying this property.Copyright © The Author(s) 2023.
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Doctor's effort of active stress coping is a key factor for keeping stability of healthcare system in the COVID pandemic. The Internet hospital breaks through the boundaries and expands external resources of the physical hospital, but brings doctors stress and challenges. However, it is not clear how Internet hospital innovation affects doctors' active stress coping effort. To address this question, based on conservation of resource theory (COR), we explore the issue and examine the model through a face-to-face situational investigation of 174 doctors from 66 Internet hospitals with complete online service functions in China. The results show that the personal characteristics and energy resources provided by platform-based hospital will promote doctors to actively respond to stress. The increase in object and condition resources will lead to doctors' avoidance of coping with stress in the short term, but help doctors to actively cope with stress in the long term. We extend the COR theory by considering platform-based feature of Internet hospital and suggest that hospital should continue to promote technological innovation for its long-term benefits. This study contributes to the growing literature on platform-based healthcare innovation and its non-economic benefits for healthcare professionals.
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Objective To explore the occurrence and influencing factors of serum uric acid elevation in patients with coronavirus disease 2019 (COVID-19) treated with favipiravir. Methods Medical records of patients with COVID-19 who were hospitalized in Beijing Ditan Hospital between June 1, 2020 and June 30, 2021 and treated with the 5- or 10-day regimen of favipiravir were collected and retrospectively analyzed. After favipiravir withdrawal, if the elevation in serum uric acid was >=30% of baseline level, it was defined as serum uric acid elevation. Then patients were divided into serum uric acid elevation group and non-serum uric acid elevation group. The clinical characteristics such as gender, age, body mass index, comorbidities, smoking and drinking behavior, COVID-19 grade, favipiravir regimen, and serum uric acid level and renal function before treatment in patients between the 2 groups were compared. Influencing factors of favipiravir-associated serum uric acid elevation was analyzed using multivariate logistic regression method. Results A total of 179 patients were included in the analysis, including 104 (58.1%) males and 75 (41.9%) females, aged from 19 to 70 years with a median age of 43 years. The level of serum uric acid in 179 patients after favipiravir treatment was significantly higher than before [(451+/-119) mumol/L vs. (332+/-94) mumol/L, P<0.001]. The change rate of serum uric acid from baseline level ranged from -57.1% to 157.8% with the median of 38.6%. The elevation in serum uric acid of >= 30% of baseline level occurred in 108 (60.3%) patients. The incidences of serum uric acid elevation in patients treated with 5-day and 10-day regi- mens of favipiravir were 46.8% (36/77) and 70.6% (72/102), respectively, and the difference between them was significant (P=0.001). Multivariate logistic regression analysis showed that body mass index 24.0 to <28.0 kg/m2 (OR=3.109, 95%CI: 1.209-7.994, P=0.019) and 10-day regimen of favipiravir (OR=3.017, 95%CI: 1.526-5.964, P=0.001) were independent risk factors for favipiravir-associated serum uric acid elevation. Conclusions More than half of COVID-19 patients treated with favipiravir can develop serum uric acid elevation. Overweight and 10-day regimen of favipiravir are independent risk factors for serum uric acid elevation in patients.Copyright © 2022 Adverse Drug Reactions Journal.
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The Global Justice Index is a multiyear research project based at Fudan Institute for Advanced Study in Social Sciences that assesses the contributions made by each country to achieving greater global justice. We have published results from 2010 to 2019 in Global Justice Index Report, Global Justice Index Report 2020, Global Justice Index Report 2021, and we are now presenting our fourth-year results for 2020 in Global Justice Index Report 2022, which is an updated version of previous years' reports. This year, we take into account changes to global justice influenced by the COVID-19 pandemic. The report consists of four sections: introduction, findings, main results, and conclusion. In the introduction, we discuss the development of the conceptual framework and evaluative principles to justify our selection of the dimensions and indicators for measurement. Next, in the findings section, we report the data, indicators, and our results for each country for each of the 10 issues we identify, and provide regional comparisons for Asia, Europe, North America, Latin America, Africa, and Oceania. In the following section, we present the main results for the global justice indices, and report the ranking of each country's contribution to achieving greater global justice. In the final section, we discuss the applications and limitations of the index and potential further research trajectories. © 2023, The Author(s).
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The global pandemic of coronavirus disease 2019 (COVID-19) is still ongoing, and the literature concerning COVID-19 is growing exponentially. The existing data from case reports, retrospective cohort studies and bioinformatics have suggested the relationship between SARS-CoV-2 and acute pancreatitis (AP). The mechanism of how SARS-CoV-2 attacks pancreas remains unclear. However, the expression of the receptor of SARS-CoV-2 in pancreatic tissue has been confirmed, and the components of SARS-CoV-2 have been isolated in the pancreas from patients with COVID-19. These evidences indicate that there may be a causality between SARS-CoV-2 and AP. The SARS-CoV-2 associated acute pancreatitis (SAAP) is likely to be misdiagnosed in clinical settings. Its diagnosis, severity classification and prognosis have specificities that deserve special attention. © 2021 Authors. All rights reserved.
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Build and practice innovation and entrepreneurship education reform combining the revision of training programs with experimental platform construction under the background of new engineering. The reform solves the problems of poor cognition, low positioning, and an imperfect practical teaching system. The reform also provides a coping strategy for the highly difficult situation of student employment in the context of COVID-19. Based on improving the experimental platform and following the OBE (Outcome Based Education) education concept, the "integrated” innovation and entrepreneurship education reform and practice plan appears. It builds a progressive, organic, scientific, and reasonable experimental teaching system. It forms a platform to consolidate primary practical teaching, improve professional practical ability, exercise innovation and entrepreneurship ability. Based on "course ideology and politics”, the reform enhances the quality of teachers and creates a good atmosphere for students to establish correct socialist core values. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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For the purpose of capturing the semantic information accurately and clarifying the user's questioning intention, this paper proposes a novel, ensemble deep architecture BERT-MSBiLSTM-Attentions (BMA) which uses the Bidirectional Encoder Representations from Transformers (BERT), Multi-layer Siamese Bi-directional Long Short Term Memory (MSBiLSTM) and dual attention mechanism (Attentions) in order to solve the current question semantic similarity matching problem in medical automatic question answering system. In the preprocessing part, we first obtain token-level and sentence-level embedding vectors that contain rich semantic representations of complete sentences. The fusion of more accurate and adequate semantic features obtained through Siamese recurrent network and dual attention network can effectively eliminate the effect of poor matching results due to the presence of certain non-canonical texts or the diversity of their expression ambiguities. To evaluate our model, we splice the dataset of Ping An Healthkonnect disease QA transfer learning competition and "public AI star” challenge - COVID-19 similar sentence judgment competition. Experimental results with CC19 dataset show that BMA network achieves significant performance improvements compared to existing methods. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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This cross-sectional survey evaluated well-being and family dynamics before and during the COVID-19 pandemic in 1287 (16 + years of age, 68.3% female) Chinese participants. Structural equation modeling was used to test the association of well-being and systemic family dynamics, and related moderating factors. Results indicated some subscales of well-being and systemic family dynamics significantly worsened during the pandemic. A modified model fits well for both data before and during the pandemic in which well-being was significantly associated with systemic family dynamic and by family income. Age also positively related systemic family dynamics. The relationship between family income and well-being and the relationship between systemic family dynamics and well-being were moderated by the pandemic. The results suggest that well-being and systemic family dynamics and their associations are impacted by the COVID-19 pandemic. Systemic family dynamics could be a potential resource for enhancing well-being during the COVID-19 pandemic by some interventions. © The Author(s) 2023.
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We investigate the predictive relationship between uncertainty and global stock market volatilities from a high-frequency perspective. We show that uncertainty contains information beyond fundamentals (volatility) and strongly affects stock market volatility. Using several crucial uncertainty measures (i.e., uncertainty and implied volatility indices), we prove that the CBOE volatility index (VIX) performs best in point (density) forecasting;the financial stress index (FSI) in directional forecasting. Furthermore, VIX's predictive power improved dramatically after the COVID-19 outbreak, and the VIX-based portfolio strategy enables mean-variance investors to achieve higher returns. There are two empirical properties of VIX: (i) it helps reduce significantly forecast variance rather than bias;and (ii) its forecasts encompass other uncertainty forecasts well. Overall, we highlight the importance of considering uncertainty when exploring the expected stock market volatility. © 2022 Elsevier Inc.
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The COVID-19 pandemic has caused severe health problems worldwide and unprecedented decimation of the global economy. Moreover, after more than 2 years, many populations are still under pressure of infection. Thus, a broader perspective in developing antiviral strategies is still of great importance. Inspired by the observed multiple benefits of heparin in the treatment of thrombosis, the potential of low molecular weight heparin (LMWH) for the treatment of COVID-19 have been explored. Clinical applications found that LMWH decreased the level of inflammatory cytokines in COVID-19 patients, accordingly reducing lethality. Furthermore, several in vitro studies have demonstrated the important roles of heparan sulfate in SARS-CoV-2 infection and the inhibitory effects of heparin and heparin mimetics in viral infection. These clinical observations and designed studies argue for the potential to develop heparin mimetics as anti-SARS-CoV-2 drug candidates. In this review, we summarize the properties of heparin as an anticoagulant and the pharmaceutical possibilities for the treatment of virus infection, focusing on the perspectives of developing heparin mimetics via chemical synthesis, chemoenzymatic synthesis, and bioengineered production by microbial cell factories. The ultimate goal is to pave the eminent need for exploring novel compounds to treat coronavirus infection-caused diseases.
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In recent years, chest X-ray (CXR) imaging has become one of the significant tools to assist in the diagnosis and treatment of novel coronavirus pneumonia. However, CXR images have complex-shaped and changing lesion areas, which makes it difficult to identify novel coronavirus pneumonia from the images. To address this problem, a new deep learning network model (BoT-ViTNet) for automatic classification is designed in this study, which is constructed on the basis of ResNet50. First, we introduce multi-headed self-attention (MSA) to the last Bottleneck block of the first three stages in the ResNet50 to enhance the ability to model global information. Then, to further enhance the feature expression performance and the correlation between features, the TRT-ViT blocks, consisting of Transformer and Bottleneck, are used in the final stage of ResNet50, which improves the recognition of complex lesion regions in CXR images. Finally, the extracted features are delivered to the global average pooling layer for global spatial information integration in a concatenated way and used for classification. Experiments conducted on the COVID-19 Radiography database show that the classification accuracy, precision, sensitivity, specificity, and F1-score of the BoT-ViTNet model is 98.91%, 97.80%, 98.76%, 99.13%, and 98.27%, respectively, which outperforms other classification models. The experimental results show that our model can classify CXR images better. © 2022 by the authors.
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While most immigrant-receiving countries have restricted immigration during the COVID-19 pandemic, Canada has taken a very different approach, increasing its immigration targets over the next three years. With this move, Canada has made it clear that immigrants are expected to play a lead role in the post-pandemic economic recovery. Most of these immigrants will be admitted through Express Entry, a hybrid system introduced in 2015 that combines elements of both supply- and demand-driven selection. In this article, we examine whether Canada's hybrid selection system meets its current and future labor market needs in a post-pandemic world. Using a mixed methods approach, we combine analysis of an administrative dataset with data from qualitative interviews with employers and experts in the immigration sector. We find that while Express Entry is a flexible and responsive tool for selecting immigrants, it narrows the occupational profiles of newcomers. The system also does not fully address the labor shortages and skills gaps described by Canadian employers. We argue that Canada's post-pandemic labor market will require a wider range of skills, and that Express Entry's adaptability should be carefully monitored and adjusted to broaden the skill mix of immigrants and facilitate skills match between immigrants and employers. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.
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Population distribution data with high spatiotemporal resolution are of significant value and fundamental to many application areas, such as public health, urban planning, environmental change, and disaster management. However, such data are still not widely available due to the limited knowledge of complex human activity patterns. The emergence of location-based service big data provides additional opportunities to solve this problem. In this study, we integrated ambient population data, nighttime light data, and building volume data;innovatively proposed a spatial downscaling framework for Baidu heat map data during work time and sleep time;and mapped the population distribution with high spatiotemporal resolution (i.e., hourly, 100 m) in Beijing. Finally, we validated the generated population distribution maps with high spatiotemporal resolution using the highest-quality validation data (i.e., mobile signaling data). The relevant results indicate that our proposed spatial downscaling framework for both work time and sleep time has high accuracy, that the distribution of the population in Beijing on a regular weekday shows "centripetal centralization at daytime, centrifugal dispersion at night" spatiotemporal variation characteristics, that the interaction between the purpose of residents' activities and the spatial functional differences leads to the spatiotemporal evolution of the population distribution, and that China's "surgical control and dynamic zero COVID-19" epidemic policy was strongly implemented. In addition, our proposed spatial downscaling framework can be transferred to other regions, which is of value for governmental emergency measures and for studies about human risks to environmental issues.
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Purpose: This study aims to explore the underlying mechanisms that support the resilience of the Chinese hospitality industry during and after the COVID-19 epidemic. Design/methodology/approach: Content analysis was applied to 133 manually collected text articles about COVID-19 responses and strategies. Findings: A two-step learning model (emergency reaction, precautions and prevention stages) was identified in the study. In the emergency reaction step, the primary strategies were related to customers, employees, suppliers and facility/food. In the precautions and prevention step, the strategies were related to customers, employees, suppliers and society/public relations. Multiple stakeholders are discussed in the two circles over a continual process in the learning, reacting and adapting stages. Originality/value: A gap in the literature is filled by this study, providing a learning model and synthesizing various strategies applied in the hotel sector for multiple stakeholders. © 2022, Emerald Publishing Limited.
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Background: This study aimed to evaluate the efficacy and safety of preoperative PD-1 inhibitor tislelizumab combined with CRT in unresectable esophageal squamous cell carcinoma (ESCC). Method(s): This is a single-arm, phase II trial, planned to enroll 30 patients. Eligibility criteria include histologically confirmed unresectable thoracic ESCC stage at cT4bNxM0 (AJCC 8th). Radiotherapy was delivered to a total dose of 50Gy/25f, concurrently with cisplatin (25 mg/m2) and nab-paclitaxel (100 mg) (QW, at least 3 cycles). Then followed by two cycles of tislelizumab (200 mg, Q3W), cisplatin (75 mg/m2, Q3W) and nab-paclitaxel (150 mg/m2, Q3W). If curative resection was considered, esophagectomy was performed within 4 weeks. Patients with pathologically residual disease would receive tislelizumab (200 mg, Q3W) for 1 year. The primary endpoint is 1-year progression free survival rate. Result(s): From December 2021 to July 2022, 21 patients were enrolled. 16 patients completed chemoradiotherapy and received immunochemotherapy. Reasons for 5 patients who did not receive immunochemotherapy included patient refusal (n=1), progressive disease (n=1), esophageal fistula (n=2), waiting for immunochemotherapy (n=1). Finally, 13 patients proceeded to surgery, with R0 resection rate of 100%. Reasons for not undergoing surgery after immunochemotherapy were esophageal mediastinal fistula (n=1), surgery delay due to COVID-19 epidemic (n=2). The pCR and MPR rate was 61.5% (8/13) and 76.9% (10/13). G1, G2, G3 immune related pneumonia occurred in 3 patients, respectively. >=G3 AEs occurred in 9 (42.9%) patients. Postoperative complications included anastomotic fistula (2/13), pleural effusion (2/13), pneumonia (1/13), myocardial damage (1/13), delayed wound healing (1/13). Conclusion(s): Chemoradiotherapy followed by immunochemotherapy might be a useful conversional treatment option for unresectable ESCC. Esophagectomy after this could be safe with acceptable complications for unresectable locally advanced ESCC. Clinical trial identification: ChiCTR2100054327. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest. Copyright © 2022 European Society for Medical Oncology