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Forests ; 14(3), 2023.
Article in English | Scopus | ID: covidwho-2306026


In recent years, on-site visitation has been strictly restricted in many scenic areas due to the global spread of the COVID-19 pandemic. "Cloud tourism”, also called online travel, uses high-resolution photographs taken by unmanned aerial vehicles (UAVs) as the dominant data source and has attracted much attention. Due to the differences between ground and aerial observation perspectives, the landscape elements that affect the beauty of colored-leaved forests are quite different. In this paper, Qixia National Forest Park in Nanjing, China, was chosen as the case study area, and the best viewpoints were selected by combining tourists' preferred viewing routes with a field survey, followed by a scenic beauty evaluation (SBE) of the forests with autumn-colored leaves in 2021 from the aerial and ground perspectives. The results show that (1) the best viewpoints can be obtained through the spatial overlay of five landscape factors: elevation, surface runoff, slope, aspect, and distance from the road;(2) the dominant factors influencing the beauty of colored-leaved forests from the aerial perspective are terrain changes, forest coverage, landscape composition, landscape contrast, the condition of the human landscape, and recreation frequency;and (3) the beauty of the ground perspective of the colored-leaved forests is strongly influenced by the average diameter at breast height (DBH), the dominant color of the leaves, the ratio of the colored-leaved tree species, the canopy width, and the fallen leaf coverage. The research results can provide scientific reference for the creation of management measures for forests with autumn-colored leaves. © 2023 by the authors.

Gastroenterology ; 160(6):S-186, 2021.
Article in English | EMBASE | ID: covidwho-1596826


Background: Coronavirus disease 2019 (COVID-19) has infected over 62 million people worldwide as of November 28, 2020. Emerging studies have revealed a high prevalence of gastrointestinal (GI) symptoms among patients with COVID-19, and coronavirus particles have been found in their stool. However, there are minimal data regarding the impact of COVID-19 severity on the GI system. In this study, we evaluated GI and hepatobiliary manifestations in a large number of hospitalized patients across the United States (US) with COVID-19 based on admission to the intensive care unit (ICU), a surrogate for COVID-19 severity. Methods: Seven US academic centers ed data from patients who had a positive COVID-19 test and were hospitalized. Demographics, presenting symptoms, clinical, and laboratory data were ed, as were hospitalization outcomes. Patients were stratified According to admission to the ICU (yes/no) during their hospital course. GI and hepatobiliary manifestations and outcomes were compared using the Chi-square test, and parametric laboratory values were compared using Student’s t test. Results: Of a total of 1,896 COVID-19 positive patients, 730 patients (38.5%) were admitted to the ICU (Table 1). ICU admissions were more likely to be male (64.2% vs. 52.1%;p<0.01). The most common presenting symptom was dyspnea in ICU patients (57.8%) versus cough in non-ICU patients (47.9%).The prevalence of patients reporting GI symptoms was similar between ICU and non-ICU patients (20.4% vs 21.1%;p=0.14). Compared with non-ICU patients, ICU patients had a higher prevalence of abnormal serum aspartate aminotransferase (AST) values (16.0% vs. 6.7%;p<0.01) and total bilirubin > 3 mg/dL (3.1% vs. 0.8%;p<0.01) (Table 2). There was not a significant difference in prevalence of abnormal alanine aminotransferase (ALT) values between the two groups (9.6% vs. 7.1%;p=0.13). The peak values of AST, ALT, and total bilirubin among all patients in the cohort were 3384 U/L, 1274 U/L, and 54 mg/dL, respectively. Conclusions: In a large US-based cohort of hospitalized patients with COVID-19, GI symptoms did not differ between ICU and non-ICU patients despite their high prevalence. ICU patients were more likely to have serum liver test abnormalities. In this context, further investigation is needed to clarify whether hepatobiliary dysfunction stems from direct injury from COVID-19 or an indirect effect of ICU-related multi-organ dysfunc-tion. Such insight would help guide future management to reduce the risk of and mitigate hepatic injury in these patients (Table Presented) (Table Presented)

Gastroenterology ; 160(6):S-187, 2021.
Article in English | EMBASE | ID: covidwho-1596825


Background: Coronavirus disease 2019 (COVID-19) has infected over 14 million people in the United States (US) as of December 1, 2020. Recent data have shown that COVID-19 strains appear to demonstrate geographic variation, such as Asian strains predominating in the Western US and European strains predominating in the Eastern US. However, the clinical significance of this variation remains unclear. In this large, multi-center cohort study, we evaluated gastrointestinal (GI) manifestations of COVID-19 regionally and throughout the US. Methods: Patients hospitalized with a positive COVID-19 test were identified at seven US academic centers. As a surrogate for differing COVID-19 strains, patients were stratified into regions (West, Midwest, or Northeast) depending on hospital location. Demographics, presenting symptoms, laboratory data, and hospitalization outcomes were ed. Statistical comparisons were performed with Chi-square and ANOVA tests, as appropriate. Results: A total of 1896 patients were identified (Table 1). Most patients were male (56.8%), and the most prevalent race was Caucasian (40.5%). The mean age was 58.1 years (±19.1), and the mean body mass index (BMI) was 29.9 (±8.4). A third (29.2%) of patients had a known COVID-19 exposure. The mean presenting temperature was 37.3 °C, and dyspnea was the most common presenting symptom (48.2%). GI symptoms were present in 20.3% of the overall cohort (Table 2);diarrhea was most common (12.4%), followed by nausea and/or vomiting (10.3%) and abdominal pain (6.0%). Geographically, GI symptoms were significantly less common in the Western cohort (17.8%) than the Northeastern (25.6%) and Midwestern (26.7%) cohorts. GI complications (GI hemorrhage and pancreatitis) were also significantly less common in the Western cohort (1.5%, 0.2%) than the Northeastern (6.9%, 1.5%) and Midwestern (3.3%, 1.7%) cohorts. The Midwestern cohort had a higher prevalence of moderately elevated serum aspartate aminotransferase (AST;23.5% vs 8.5% in Western and 10.5% in Northeastern cohorts;p<0.01). Compared to the Northeastern and Midwestern cohorts, the Western cohort had a higher prevalence of mildly elevated serum alanine aminotransferase (ALT;20.9% and 20.9% vs 28.5%;p=0.01) and total bilirubin (6.7% and 7.0% vs 11.4%;p=0.03). The presence of GI symptoms was not associated with increased mortality (p=0.15). Conclusions: Although GI manifestations were common among patients hospitalized with COVID-19, there is significant variability in prevalence across the US. GI symptoms and complications were less common in the West than the Northeast or Midwest. Our study highlights notable geographic variations in GI manifestations of COVID-19, prompting the need for further investigation into the mechanisms of these differences. Such insight could identify strategies that mitigate GI complications of COVID-19 infection.(Table presented) Demographic and Clinical Data of Patients with COVID-19 by Geographic Region. (Table presented) Gastrointestinal Manifestations of COVID-19 in Patients by Geographic Region.