Geographical detector-based assessment of multi-level explanatory powers of determinants on China’s medical-service resumption during the COVID-19 epidemic

Knowing the multi-level influences of determinants on medical-service resumptions is of great benefits to the policymaking for medical-service recovery at different levels of study units during the post-COVID-19 pandemic era. This article evaluated the hospital- and city-level resumptions of medical services in mainland China based on the data of location-based service (LBS) requests of mobile devices during the two time periods (December 2019 and from February 21 to March 18, 2020). We selected medical-service capacity, human movement, epidemic severity, and socioeconomic factors as the potential determinants on medical-service resumptions and then explicitly assessed their multi-level explanatory powers and the interactive effects of paired determinants using the geographical detector method. The results indicate that various determinants had different individual explanatory powers and interactive relationships/effects at different levels of medical-service resumptions. The current study provides a novel multi-level insight for assessing work resumption and individual/interactive influences of determinants, and considerable implications for regionalized recovery strategies of medical services.

Acquisition of a Laser Powder Bed Fusion System to Transform the Additive Manufacturing Value Chain

Metal additive manufacturing (AM) has significant relevance to the missions of all branches of the Department of Defense (DoD) as it has the capability to bring parts to the warfighter more quickly and cost effectively However, DoD's goals of utilizing and deploying AM will not be achieved without substantial research and development to address the technology's current limitations, which exist at every facet of the AM value chain. The DURIP award, along with supplementary funding provided by Virginia Tech, enabled the acquisition of a reactive metal laser powder bed fusion (LPBF) AM system. The advanced AM system acquired through this program features open-access to all process parameters and features integrated in-situ monitoring technologies that enable research focused in increasing materials selection, creating new design for AM tools and methods, enhancing part quality through process-property-structure models, in-situ monitoring and post-processing techniques, and securing the platforms from cyber-physical vulnerabilities. The system is installed as a showcase piece in a newly created multidisciplinary educational and research space dedicated to preparing undergraduate and graduate students for future careers in Industry 4.0 technologies. As such, the new system will enable multi-disciplinary research and education across the entire value chain of AM.

[TAN Bayesian network modeling of online learning decision making of dental undergraduates during the COVID-19 pandemic]

PURPOSE: To perceive the dental undergraduate's policy of coping with online learning and their decision-making laws during the COVID-19 pandemic. METHODS: For dental undergraduate students from the 2016 grade to 2018 grade of Lishui University, two prospective questionnaire surveys were conducted before the online course starting and four weeks later. SPSS Modeler18.0 software was used to screen, review, and analyze the data. TAN (tree augmented naive) Bayesian network models were utilized to analyze and predict variables. Indicators like the overall prediction accuracy, receiver operating characteristic curve (ROC curve), and area under the ROC curve(AUC value) were applied to evaluate the model's predicting performances. RESULTS: The case score of each survey was 422 and 382, and the Cronbach's alpha coefficients of internal consistency were 0.91 and 0.82. Among the decision-making variables in the aspect of "whether to preview online learning materials", the top-two variables were "looking forward to the semester beginning" and "the validity of the network materials". In speaking of "whether the online courses meet the offline course standards", the top-three variables were "the rhythm of lecturing on live or in recorded videos", "how many online tasks', and" the data frame and organization". The overall prediction accuracy of each constructed TAN Bayesian network model was 89.42% and 87.82%, and their AUC values were 0.75 and 0.93, respectively. CONCLUSIONS: To truly make online courses comparable to the off-line curriculum, teachers should fully understand how the students cope with their online learning at first. Then, only by perceiving and recognizing the students' expectations for education, by efficiently preparing and organizing online materials with all-round, clearly-structured, vivid, comprehensible contents and moderate difficult tasks, by well interacting with students through different websites and social media, can we truly achieve " ongoing learning with suspended class".

Effect of COVID-19 on dialysis practices on the ground: Early results from an international DOPPS program survey

Background: The COVID-19 pandemic caused unprecedented disruption to dialysis patients care globally. Facility surveys were distributed to assess the impact of COVID-19 pandemic on hemodialysis (HD) and peritoneal dialysis (PD) practices. Methods: Medical Director (MD) and Nurse Manager (NM) Surveys (MDS, NMS) are being distributed in May/June 2020 to 723 clinics enrolled in the Dialysis (in-center HD, DOPPS) or Peritoneal (PDOPPS) Dialysis Outcomes and Practice Patterns Study in Canada, China, Japan, the United States, 7 European countries, 5 Gulf Cooperative Council countries, and China metropolitan areas (Beijing, Guangzhou, Shanghai). Surveys content includes the number of COVID-19 cases, testing, and clinical management, screening, infection control, staffing, patient transportation, and psychological support. Results: As of 27 May 2020, we have 80 MDS (China, Europe, US = 33, 38, 5) and 101 NMS (45, 46, 9) responses from DOPPS sites. The following percentages are presented sequentially for China, Europe, and US. Among MDs, 0%, 67%, 67% reported at least one confirmed COVID-19 case among dialysis patients, and 85%, 70%, 66% reported being on the late phase of the COVID-19 curve. 40%, 23%, 100% of MDs were more likely to recommend home dialysis;19%, 5%, 29% reported an increase in missed dialysis treatments;30%, 24%, 50% were more likely to prescribe potassium binders;and 75%, 68%, 43% had greater challenges obtaining vascular access interventions. Among NMs, 30%, 9%, 40% reported current limitations in access to COVID-19 testing;and 61%, 51%, 29% reported having, or risk of, shortage in staffing. Conclusions: Early results indicate many clinics in Europe and US have had COVID-19 cases, but sites in the three DOPPS-China cities have avoided COVID-19 to date. In all regions, shortages of human and medical resources were common, as were changes to dialysis delivery/practice including more skipped sessions, greater use of potassium binders, and preferentially recommending home dialysis. Over the next month, we expect hundreds more responses, and will compare approaches in PD and HD clinics. These data will inform guidance for dialysis care as the COVID-19 pandemic ensues.

[Infection prevention and control of bedside blood purification treatment in patients with COVID-19].

OBJECTIVE: To explore the infection prevention and control strategy of bedside blood purification treatment in corona virus disease 2019 (COVID-19) isolation ward, and to evaluate the effect of infection prevention and control management measures. METHODS: We summarized and analyzed the clinical features, infection status, outcome and infection prevention and control measures of bedside blood purification treatment patients in COVID-19 isolation ward from February 8, 2020 to March 31, 2020, analyzed the COVID-19 cross-infection between the patients and medical staffs, and the blood-borne pathogens cross-infection situation between the patients, and analyzed the effect of bundle prevention and control measures in controlling the occurrence and spread of cross-infection. RESULTS: A total of 101 COVID-19 patients were hospitalized in this COVID-19 isolation ward, of whom 10 patients (9.90%) received bedside blood purification treatment and the blood purification treatment method was continuous hemodialysis filtration (CVVHDF), and the 10 patients received 79 times of blood purification treatment in total. The prevention and control management measures adopted included divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room air purification, object surfaces, medical devices and medical fabrics dis-infection management. There were no occurrence and spread of COVID-19 in the medical healthcare workers and blood-borne pathogens cross-infection in the patients. And all the twice throat swabs (two sampling interval > 1 day) of the medical staffs in COVID-19 virus nucleic acid test were negative. The 2 suspected COVID-19 patients' throat swab virus nucleic acid test and the COVID-19 IgG, IgM were always both negative, the chest CT showed no viral pneumonia. CONCLUSION: Bedside blood purification treatment in the COVID-19 isolation ward, the occurrence and spread of healthcare associated infection can be effectively controlled through effective infection prevention and control management, including divisional isolation, patient behavior isolation and patient placement, operator personal protection and hand hygiene, dialysis waste fluid disposal, isolation room's air purification, object surfaces, medical devices and medical fabrics disinfection, which can provide experience for diagnosis, treatment and prevention and control of patients in the respiratory infectious disease ward.

[Epidemiological investigation on a cluster epidemic of COVID-19 in a collective workplace in Tianjin].

Objective: To investigate and analysis the epidemiological characteristics of a cluster epidemic of COIVD-19 in a collective workplace in Tianjin, evduate the prevention and control measures based on limited evidence and experience in early period of COVID-19 epidemic. Methods: Descriptive research method was used to describe the distribution and other epidemiological characteristics of the cluster cases of COVID-19. Results: Since the onset of the first index case on January 15, ten confirmed COVID-19 cases had occurred in the workplace, and the epidemic had spread from the workplace to 4 families, infecting 7 family members. The median age of 17 cases was 55 (19-79) years. All the 10 employee cases were males, and in the family cases, 3 were males and 4 were females. Of the employee cases, 8 worked in CW workshop and 2 worked in administrative office building. The median exposure-onset interval of all the cases was 4 days, and the median exposure-onset interval was 4.5 days in the employee cases and 4 days in the family cases. The median onset-medical care seeking interval was 4 days in the non-isolated cases, 2.5 days in the cases with home isolation after onset, and 0.5 day in the cases with home isolation before onset. Conclusions: The clustering of COVID-19 cases was observed in this workplace in Tianjin, which affected 4 families. In the early stage of the epidemic, accurate and rapid blocking and control measures can completely prevent the large-scale spread of COVID-19.