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1.
Int J Mol Sci ; 23(21)2022 Oct 25.
Article in English | MEDLINE | ID: covidwho-2090204

ABSTRACT

Messenger RNA (mRNA) technology has already been successfully tested preclinically and there are ongoing clinical trials for protein replacement purposes; however, more effort has been put into the development of prevention strategies against infectious diseases. Apparently, mRNA vaccine approval against coronavirus disease 2019 (COVID-19) is a landmark for opening new opportunities for managing diverse health disorders based on this approach. Indeed, apart from infectious diseases, it has also been widely tested in numerous directions including cancer prevention and the treatment of inherited disorders. Interestingly, self-amplifying RNA (saRNA)-based technology is believed to display more developed RNA therapy compared with conventional mRNA technique in terms of its lower dosage requirements, relatively fewer side effects, and possessing long-lasting effects. Nevertheless, some challenges still exist that need to be overcome in order to achieve saRNA-based drug approval in clinics. Hence, the current review discusses the feasibility of saRNA utility for protein replacement therapy on various health disorders including rare hereditary diseases and also provides a detailed overview of saRNA advantages, its molecular structure, mechanism of action, and relevant delivery platforms.


Subject(s)
COVID-19 , RNA , Humans , RNA/genetics , Vaccines, Synthetic , RNA, Messenger/genetics
2.
Applied psychology = Psychologie appliquee ; 2022.
Article in English | EuropePMC | ID: covidwho-1980967

ABSTRACT

Although past research has found that professional isolation can affect discernible work‐related outcomes (e.g. job performance and turnover) and important job attitudes, researchers have not examined its impact on those less discernible but still costly work behaviours. Drawing on self‐regulation theories, this study examined the effect of professional isolation on employees' cyberloafing and time theft through self‐control capacity impairment. With longitudinal data collected from 343 U.S. employees across five consecutive weeks at the early stage of the pandemic (i.e. from mid‐March to late April 2020), our results of latent change score modelling analyses found that professional isolation change was positively related with changes in cyberloafing and time theft via change in self‐control capacity impairment. The results increase our understanding of the hidden performance cost of professional isolation. This research also shifts the research focus from a static, between‐person perspective to dynamic, within‐person changes in professional isolation and related outcomes. The findings shed light on the self‐regulation perspective in understanding the harmful consequences of professional isolation. Implications for future research are discussed along with practical implications for organisations.

3.
Pharmaceutics ; 14(5)2022 May 20.
Article in English | MEDLINE | ID: covidwho-1953859

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is undoubtedly the most challenging pandemic in the current century and remains a global health emergency. As the number of COVID-19 cases in the world is on the rise and variants continue to emerge, there is an urgent need for vaccines. Among all immunization approaches, mRNA vaccines have demonstrated more promising results in response to this challenge. Herein, we designed an mRNA-based vaccine encoding the receptor-binding domain (RBD) of SARS-CoV-2 encapsulated in lipid nanoparticles (LNPs). Intramuscular (i.m.) administration of the mRNA-RBD vaccine elicited broad-spectrum neutralizing antibodies and cellular responses against not only the wild-type SARS-CoV-2 virus but also Delta and Omicron variants. These results indicated that two doses of mRNA-RBD immunization conferred a strong immune response in mice against the wild-type SARS-CoV-2, while the booster dose provided a sufficient immunity against SARS-CoV-2 and its variants. Taken together, the three-dose regimen strategy of the mRNA-RBD vaccine proposed in the present study appears to be a promising reference for the development of mRNA vaccines targeting SARS-CoV-2 variants.

4.
Stud Health Technol Inform ; 290: 309-313, 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1933559

ABSTRACT

The rapid growth of clinical trials launched in recent years poses significant challenges for accurate and efficient trial search. Keyword-based clinical trial search engines require users to construct effective queries, which can be a difficult task given complex information needs. In this study, we present an interactive clinical trial search interface that retrieves trials similar to a target clinical trial. It enables user configuration of 13 clinical trial features and 4 metrics (Jaccard similarity, semantic-based similarity, temporal overlap and geographical distance) to measure pairwise trial similarities. Among 1,007 coronavirus disease 2019 (COVID-19) trials conducted in the United States, 91.9% were found to have similar trials with the similarity threshold being 0.85 and 43.8% were highly similar with the threshold 0.95. A simulation study using 3 groups of similar trials curated by COVID-19 clinical trial reviews demonstrates the precision and recall of the search interface.


Subject(s)
COVID-19 , Benchmarking , Data Collection , Humans , Search Engine , Semantics
5.
JMIR Public Health Surveill ; 8(5): e35311, 2022 05 24.
Article in English | MEDLINE | ID: covidwho-1862504

ABSTRACT

BACKGROUND: COVID-19 messenger RNA (mRNA) vaccines have demonstrated efficacy and effectiveness in preventing symptomatic COVID-19, while being relatively safe in trial studies. However, vaccine breakthrough infections have been reported. OBJECTIVE: This study aims to identify risk factors associated with COVID-19 breakthrough infections among fully mRNA-vaccinated individuals. METHODS: We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of the Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York City (NYC) adult residences with at least 1 polymerase chain reaction (PCR) record were included in this analysis. Poisson regression was performed to assess the association between the breakthrough infection rate in vaccinated individuals and multiple risk factors-including vaccine brand, demographics, and underlying conditions-while adjusting for calendar month, prior number of visits, and observational days in the EHR. RESULTS: The overall estimated breakthrough infection rate was 0.16 (95% CI 0.14-0.18). Individuals who were vaccinated with Pfizer/BNT162b2 (incidence rate ratio [IRR] against Moderna/mRNA-1273=1.66, 95% CI 1.17-2.35) were male (IRR against female=1.47, 95% CI 1.11-1.94) and had compromised immune systems (IRR=1.48, 95% CI 1.09-2.00) were at the highest risk for breakthrough infections. Among all underlying conditions, those with primary immunodeficiency, a history of organ transplant, an active tumor, use of immunosuppressant medications, or Alzheimer disease were at the highest risk. CONCLUSIONS: Although we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Immunocompromised and male individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2 pandemic, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time.


Subject(s)
2019-nCoV Vaccine mRNA-1273 , BNT162 Vaccine , COVID-19 , 2019-nCoV Vaccine mRNA-1273/administration & dosage , Adult , BNT162 Vaccine/administration & dosage , COVID-19/epidemiology , COVID-19/prevention & control , Female , Humans , Male , New York City/epidemiology , Retrospective Studies , Risk Factors
6.
Pharmaceutics ; 14(5):1101, 2022.
Article in English | MDPI | ID: covidwho-1857429

ABSTRACT

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is undoubtedly the most challenging pandemic in the current century and remains a global health emergency. As the number of COVID-19 cases in the world is on the rise and variants continue to emerge, there is an urgent need for vaccines. Among all immunization approaches, mRNA vaccines have demonstrated more promising results in response to this challenge. Herein, we designed an mRNA-based vaccine encoding the receptor-binding domain (RBD) of SARS-CoV-2 encapsulated in lipid nanoparticles (LNPs). Intramuscular (i.m.) administration of the mRNA-RBD vaccine elicited broad-spectrum neutralizing antibodies and cellular responses against not only the wild-type SARS-CoV-2 virus but also Delta and Omicron variants. These results indicated that two doses of mRNA-RBD immunization conferred a strong immune response in mice against the wild-type SARS-CoV-2, while the booster dose provided a sufficient immunity against SARS-CoV-2 and its variants. Taken together, the three-dose regimen strategy of the mRNA-RBD vaccine proposed in the present study appears to be a promising reference for the development of mRNA vaccines targeting SARS-CoV-2 variants.

7.
Viruses ; 14(5)2022 05 15.
Article in English | MEDLINE | ID: covidwho-1855823

ABSTRACT

Despite the existence of various types of vaccines and the involvement of the world's leading pharmaceutical companies, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains the most challenging health threat in this century. Along with the increased transmissibility, new strains continue to emerge leading to the need for more vaccines that would elicit protectiveness and safety against the new strains of the virus. Nucleic acid vaccines seem to be the most effective approach in case of a sudden outbreak of infection or the emergence of a new strain as it requires less time than any conventional vaccine development. Hence, in the current study, a DNA vaccine encoding the trimeric prefusion-stabilized ectodomain (S1+S2) of SARS-CoV-2 S-protein was designed by introducing six additional prolines mutation, termed HexaPro. The three-dose regimen of designed DNA vaccine immunization in mice demonstrated the generation of protective antibodies.


Subject(s)
COVID-19 , Vaccines, DNA , Viral Vaccines , Animals , COVID-19/prevention & control , Mice , SARS-CoV-2/genetics , Vaccination , Vaccines, DNA/genetics
8.
Ultrasonics ; 124: 106749, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1778477

ABSTRACT

The coronavirus Covid-19 mutates quickly in the pandemic, leaves people struggling to verify and improve the effectiveness of the vaccine based on biochemistry. Is there any physical invariant in the variants of such kind of pathogen that could be taken advantage to ease the tensions? To this point, extensive numerical experiments based on continuity mechanics have been accomplished to discover the consistent vibration modes and the range of natural frequency of coronavirus Covid-19. Such invariant could help us in developing some flexible technique to deactivate the coronavirus, like as resonantly breaking the viral spike by ultrasound wave. The fundamental mechanisms governing such process are demonstrated via solving the coupled acoustic wave and elastic dynamic equations, after which the practical strategies are proposed to efficiently realize the technique concept.


Subject(s)
COVID-19 , Humans , Pandemics/prevention & control , Sound , Vibration
9.
Protein Cell ; 13(8): 602-614, 2022 08.
Article in English | MEDLINE | ID: covidwho-1777862

ABSTRACT

The nucleocapsid (N) protein of SARS-CoV-2 has been reported to have a high ability of liquid-liquid phase separation, which enables its incorporation into stress granules (SGs) of host cells. However, whether SG invasion by N protein occurs in the scenario of SARS-CoV-2 infection is unknow, neither do we know its consequence. Here, we used SARS-CoV-2 to infect mammalian cells and observed the incorporation of N protein into SGs, which resulted in markedly impaired self-disassembly but stimulated cell cellular clearance of SGs. NMR experiments further showed that N protein binds to the SG-related amyloid proteins via non-specific transient interactions, which not only expedites the phase transition of these proteins to aberrant amyloid aggregation in vitro, but also promotes the aggregation of FUS with ALS-associated P525L mutation in cells. In addition, we found that ACE2 is not necessary for the infection of SARS-CoV-2 to mammalian cells. Our work indicates that SARS-CoV-2 infection can impair the disassembly of host SGs and promote the aggregation of SG-related amyloid proteins, which may lead to an increased risk of neurodegeneration.


Subject(s)
Amyotrophic Lateral Sclerosis , COVID-19 , Amyloidogenic Proteins/metabolism , Amyotrophic Lateral Sclerosis/genetics , Animals , Cytoplasmic Granules/metabolism , Mammals , SARS-CoV-2 , Stress Granules
10.
Environ Int ; 159: 107022, 2022 01 15.
Article in English | MEDLINE | ID: covidwho-1616484

ABSTRACT

BACKGROUND: Under-5 mortality rate is an important indicator in Millennium Development Goals and Sustainable Development Goals. To date, no nationally representative studies have examined the effects of fine particulate matter (PM2.5) air pollution on under-5 mortality. OBJECTIVE: To investigate the association of short-term exposure to PM2.5 with under-5 mortality from total and specific causes in China. METHODS: We used the national Maternal and Child Health Surveillance System to identify under-5 mortality cases during the study period of 2009 to 2019. We adopted a time-stratified case-crossover study design at the individual level to capture the effect of short-term exposure to daily PM2.5 on under-5 mortality, using conditional logistic regression models. RESULTS: A total of 61,464 under-5 mortality cases were included. A 10 µg/m3 increase in concentrations of PM2.5 on lag 0-1 d was significantly associated with a 1.15% (95%confidence interval: 0.65%, 1.65%) increase in under-5 mortality. Mortality from diarrhea, pneumonia, digestive diseases, and preterm birth were significantly associated with exposure to PM2.5. The effect estimates were larger for neonatal mortality (<28 days), female children, and in warm seasons. We observed steeper slopes in lower ranges (<50 µg/m3) of the concentration-response curve between PM2.5 and under-5 mortality, and positive associations remained below the 24-h PM2.5 concentration limit recommended by WHO Air Quality Guidelines and China Air Quality Standards. CONCLUSIONS: This nationwide case-crossover study in China demonstrated that acute exposure to PM2.5 may significantly increase the risk of under-5 mortality, with larger effects for neonates, female children, and during warm seasons. Relevant control strategies are needed to remove this roadblock to achieving under-5 mortality targets in developing countries.


Subject(s)
Air Pollutants , Air Pollution , Premature Birth , Air Pollutants/adverse effects , Air Pollutants/analysis , Air Pollution/adverse effects , Air Pollution/analysis , Child, Preschool , China/epidemiology , Cross-Over Studies , Environmental Exposure/adverse effects , Environmental Exposure/analysis , Female , Humans , Infant , Infant, Newborn , Mortality , Particulate Matter/adverse effects , Particulate Matter/analysis
11.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-295322

ABSTRACT

The coronavirus Covid-19 mutates quickly in the pandemic, leaves people struggling to verify and improve the effectiveness of the vaccine based on biochemistry. Is there any physical invariant in the variants of such kind of pathogen that could be taken advantage to ease the tensions? To this point, extensive numerical experiments based on continuity mechanics were carried out to discover the vibration modes and the range of natural frequency of coronavirus Covid-19. Such invariant could help us in developing some flexible technique to deactivate the coronavirus, like as resonantly breaking the viral spike by ultrasound wave. The fundamental mechanisms governing such process are demonstrated via solving the coupled equations of acoustics and dynamics and thereafter the technique strategies proposed to efficiently realize the concept.

12.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-295321

ABSTRACT

Importance Little is known about COVID vaccine breakthrough infections and their risk factors. Objective To identify risk factors associated with COVID-19 breakthrough infections among vaccinated individuals and to reassess the effectiveness of COVID-19 vaccination against severe outcomes using real-world data. Design, Setting, and Participants We conducted a series of observational retrospective analyses using the electronic health records (EHRs) of Columbia University Irving Medical Center/New York Presbyterian (CUIMC/NYP) up to September 21, 2021. New York adult residence with PCR test records were included in this analysis. Main Outcomes and Measures Poisson regression was used to assess the association between breakthrough infection rate in vaccinated individuals and multiple risk factors – including vaccine brand, demographics, and underlying conditions – while adjusting for calendar month, prior number of visits and observational days. Logistic regression was used to assess the association between vaccine administration and infection rate by comparing a vaccinated cohort to a historically matched cohort in the pre-vaccinated period. Infection incident rate was also compared between vaccinated individuals and longitudinally matched unvaccinated individuals. Cox regression was used to estimate the association of the vaccine and COVID-19 associated severe outcomes by comparing breakthrough cohort and two matched unvaccinated infection cohorts. Results Individuals vaccinated with Pfizer/BNT162b2 (IRR against Moderna/mRNA-1273 [95% CI]: 1.66 [1.17 – 2.35]);were male (1.47 [1.11 – 1.94%]);and had compromised immune systems (1.48 [1.09 – 2.00]) were at the highest risk for breakthrough infections. Vaccinated individuals had a significant lower infection rate among all subgroups. An increased incidence rate was found in both vaccines over the time. Among individuals infected with COVID-19, vaccination significantly reduced the risk of death (adj. HR: 0.20 [0.08 - 0.49]). Conclusion and Relevance While we found both mRNA vaccines were effective, Moderna/mRNA-1273 had a lower incidence rate of breakthrough infections. Both vaccines had increased incidence rates over the time. Immunocompromised individuals were among the highest risk groups experiencing breakthrough infections. Given the rapidly changing nature of the SARS-CoV-2, continued monitoring and a generalizable analysis pipeline are warranted to inform quick updates on vaccine effectiveness in real time. Key Points Question What risk factors contribute to COVID-19 breakthrough infections among mRNA vaccinated individuals? How do clinical outcomes differ between vaccinated but still SARS-CoV-2 infected individuals and non-vaccinated, infected individuals? Findings This retrospective study uses CUIMC/NYP EHR data up to September 21, 2021. Individuals who were vaccinated with Pfizer/BNT162b2, male, and had compromised immune systems had significantly higher incidence rate ratios of breakthrough infections. Comparing demographically matched pre-vaccinated and unvaccinated individuals, vaccinated individuals had a lower incidence rate of SARS-CoV-2 infection among all subgroups. Meaning Leveraging real-world EHR data provides insight on who may optimally benefit from a booster COVID-19 vaccination.

13.
Int J Public Health ; 66: 1604092, 2021.
Article in English | MEDLINE | ID: covidwho-1507064

ABSTRACT

Objectives: China was believed to be the country with the world's highest acceptance rate of the COVID-19 vaccine following several investigations. This study aims to explore the Chinese acceptance of a COVID-19 vaccine before it is made available, including its determinants. Methods: A cross-national online survey was conducted covering all 31 provinces of mainland China. The survey consists of the demographic variables, acceptance of a self-paid COVID-19 vaccine as the dependent variable, and the 3Cs factors (i.e., confidence, convenience, and complacency) as the independent variables. Results: Among the 1,532 participants, 57.9% accepted to get a self-paid COVID-19 vaccine. COVID-19 vaccine acceptors were more likely to be concerned about the effectiveness of the vaccines, believe that they were at risk of COVID-19 infection, have a high perceived susceptibility of COVID-19, and trust in the health care system. Conclusion: Findings indicate that the critical task in the early stage of the COVID-19 vaccine development in China is to increase the tolerance to some intuitive concerns about the vaccines, put more emphasis on the communication of the saliency of the disease threats, and effectively translate people's trust in the government into vaccine acceptance.


Subject(s)
COVID-19 Vaccines , COVID-19 , Pandemics , Patient Acceptance of Health Care , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/supply & distribution , China/epidemiology , Humans , Pandemics/prevention & control , Patient Acceptance of Health Care/statistics & numerical data
14.
J Med Internet Res ; 23(9): e31122, 2021 09 30.
Article in English | MEDLINE | ID: covidwho-1459209

ABSTRACT

BACKGROUND: COVID-19 has threatened the health of tens of millions of people all over the world. Massive research efforts have been made in response to the COVID-19 pandemic. Utilization of clinical data can accelerate these research efforts to combat the pandemic since important characteristics of the patients are often found by examining the clinical data. Publicly accessible clinical data on COVID-19, however, remain limited despite the immediate need. OBJECTIVE: To provide shareable clinical data to catalyze COVID-19 research, we present Columbia Open Health Data for COVID-19 Research (COHD-COVID), a publicly accessible database providing clinical concept prevalence, clinical concept co-occurrence, and clinical symptom prevalence for hospitalized patients with COVID-19. COHD-COVID also provides data on hospitalized patients with influenza and general hospitalized patients as comparator cohorts. METHODS: The data used in COHD-COVID were obtained from NewYork-Presbyterian/Columbia University Irving Medical Center's electronic health records database. Condition, drug, and procedure concepts were obtained from the visits of identified patients from the cohorts. Rare concepts were excluded, and the true concept counts were perturbed using Poisson randomization to protect patient privacy. Concept prevalence, concept prevalence ratio, concept co-occurrence, and symptom prevalence were calculated using the obtained concepts. RESULTS: Concept prevalence and concept prevalence ratio analyses showed the clinical characteristics of the COVID-19 cohorts, confirming the well-known characteristics of COVID-19 (eg, acute lower respiratory tract infection and cough). The concepts related to the well-known characteristics of COVID-19 recorded high prevalence and high prevalence ratio in the COVID-19 cohort compared to the hospitalized influenza cohort and general hospitalized cohort. Concept co-occurrence analyses showed potential associations between specific concepts. In case of acute lower respiratory tract infection in the COVID-19 cohort, a high co-occurrence ratio was obtained with COVID-19-related concepts and commonly used drugs (eg, disease due to coronavirus and acetaminophen). Symptom prevalence analysis indicated symptom-level characteristics of the cohorts and confirmed that well-known symptoms of COVID-19 (eg, fever, cough, and dyspnea) showed higher prevalence than the hospitalized influenza cohort and the general hospitalized cohort. CONCLUSIONS: We present COHD-COVID, a publicly accessible database providing useful clinical data for hospitalized patients with COVID-19, hospitalized patients with influenza, and general hospitalized patients. We expect COHD-COVID to provide researchers and clinicians quantitative measures of COVID-19-related clinical features to better understand and combat the pandemic.


Subject(s)
COVID-19 , Influenza, Human , Databases, Factual , Humans , Influenza, Human/epidemiology , Pandemics , SARS-CoV-2
15.
Front Public Health ; 9: 723648, 2021.
Article in English | MEDLINE | ID: covidwho-1414115

ABSTRACT

Introduction: Every outbreak of an epidemic or pandemic disease is accompanied by the tsunami of information, which is also known as the infodemic. Infodemic makes it hard for people to find trustworthy sources and reliable guidance when they need it, and causes social panic about health, widens the gaps between races and regions, and even brings the social chaos all over the world. While most researchers and related parties made efforts to control the inaccurate information spreading online during the COVID-19 pandemic, the infodemic influence caused by the overload of accurate information were almost or completely ignored, and this will hinder the control of infodemic in future public health crises. This study aims to explore the infodemic vs. pandemic influence on people's psychological anxiety across different media sources in the early stage of the COVID-19 outbreak in China. Methods: A cross-sectional study using online survey method was conducted by a data-collection service provider in April 2020. A total of 1,117 valid samples were finally collected from 5,203 randomly invited members via webpages and WeChat. The sample distribution covered the 30 provincial administrative divisions of mainland China. Results: Hierarchical regression analysis for the potential pandemic sources and infodemic sources of psychological anxiety showed that the infodemic factors of attention to the coronavirus information (ß = 0.154, p < 0.001) and commercial media exposure (ß = 0.147, p < 0.001) is positively related to the level of anxiety. Statistics indicated that influence of the infodemic factors is over and above that of the pandemic factors (ΔR 2 = 0.054, F = 14.199, and p < 0.001). Mediation analysis showed that information overload (B = 0.155, Boot SE = 0.022, and 95% Boot CI [0.112, 0.198]) mediates the link between attention to coronavirus information and anxiety; both information overload (B = 0.035, Boot SE = 0.014, and 95% Boot CI [0.009, 0.062]) and media vicarious traumatization (B = 0.106, Boot SE = 0.017, and 95% Boot CI [0.072, 0.140]) mediate the link between commercial media exposure and anxiety. Conclusion: This study suggested that the influence of infodemic with mixed accurate and inaccurate information on public anxiety does exist, which could possibly go beyond that of the pandemic. Information overload and vicarious traumatization explain how infodemic may be associated to public anxiety. Finally, commercial media could be a major source of infodemic in the Chinese media context. Implications for the related parties were discussed.


Subject(s)
COVID-19 , Social Media , Anxiety/epidemiology , China/epidemiology , Cross-Sectional Studies , Disease Outbreaks , Humans , Pandemics , SARS-CoV-2
16.
Chinese Journal of Nosocomiology ; 31(8):1267-1271, 2021.
Article in Chinese | CAB Abstracts | ID: covidwho-1235635

ABSTRACT

OBJECTIVE: To explore the scientific value of the three-level pre-viewing triage management practice by using "Alipay" health code and self-developed electronic version of screening table QR code to assist COVID-19 screening in a general hospital. METHODS: During Beijing Xinfadi wholesale market COVID-19 epidemic, the definition of epidemiological history and clinical symptom case of pre-viewing and triage were determined by referring to the COVID-19 Diagnosis and Treatment Protocol(Trial Seventh Edition). Through strengthening hospital import and export management, setting up the pre-viewing triage points scientifically, improving the three-level pre-viewing triage process by using information technology to improve efficiency, the three-level pre-viewing triage system was strictly implement. Data included information released by the country and the region, daily reports on the workload of the hospital. RESULTS: During the epidemic period in Beijing(June 11-July 5), the number of online appointments and the number of general outpatient clinics showed a downward trend compared with before and after period, and the difference was significant(P<0.05). The number of fever outpatient during the epidemic period in Xinfadi wholesale market accounted for 2.1%(6 647/322 041) of the total number of visits during the epidemic period, which was positively correlated with the number of confirmed cases in Xinfadi wholesale market(r_s=0.755). During the same period, the hospital confirmed 2 cases of coronal virus disease and 3 cases of asymptomatic infection;25 cases with positive epidemiological history and 920 cases with fever were detected, and all of them were guided to the fever clinic in an orderly manner. All medical staff and patients had zero infection. CONCLUSION: The three-level pre-viewing triage system is conductive to reduce the risk of nosocomial infection. The application of "QR code" is of great significance to improve the efficiency of pre-viewing triage and to achieve precise prevention and control of epidemics.

17.
J Am Med Inform Assoc ; 28(1): 14-22, 2021 01 15.
Article in English | MEDLINE | ID: covidwho-1066364

ABSTRACT

OBJECTIVE: This research aims to evaluate the impact of eligibility criteria on recruitment and observable clinical outcomes of COVID-19 clinical trials using electronic health record (EHR) data. MATERIALS AND METHODS: On June 18, 2020, we identified frequently used eligibility criteria from all the interventional COVID-19 trials in ClinicalTrials.gov (n = 288), including age, pregnancy, oxygen saturation, alanine/aspartate aminotransferase, platelets, and estimated glomerular filtration rate. We applied the frequently used criteria to the EHR data of COVID-19 patients in Columbia University Irving Medical Center (CUIMC) (March 2020-June 2020) and evaluated their impact on patient accrual and the occurrence of a composite endpoint of mechanical ventilation, tracheostomy, and in-hospital death. RESULTS: There were 3251 patients diagnosed with COVID-19 from the CUIMC EHR included in the analysis. The median follow-up period was 10 days (interquartile range 4-28 days). The composite events occurred in 18.1% (n = 587) of the COVID-19 cohort during the follow-up. In a hypothetical trial with common eligibility criteria, 33.6% (690/2051) were eligible among patients with evaluable data and 22.2% (153/690) had the composite event. DISCUSSION: By adjusting the thresholds of common eligibility criteria based on the characteristics of COVID-19 patients, we could observe more composite events from fewer patients. CONCLUSIONS: This research demonstrated the potential of using the EHR data of COVID-19 patients to inform the selection of eligibility criteria and their thresholds, supporting data-driven optimization of participant selection towards improved statistical power of COVID-19 trials.


Subject(s)
COVID-19/therapy , Clinical Trials as Topic , Electronic Health Records , Eligibility Determination , Adolescent , Adult , Aged, 80 and over , COVID-19/mortality , Female , Hospital Mortality , Humans , Male , Middle Aged , Oxygen/blood , Patient Selection , Pregnancy , Research Design , Respiration, Artificial , SARS-CoV-2 , Tracheostomy , Treatment Outcome , Young Adult
18.
Front Cardiovasc Med ; 7: 585220, 2020.
Article in English | MEDLINE | ID: covidwho-1052488

ABSTRACT

Background: Myocardial injury is a life-threatening complication of coronavirus disease 2019 (COVID-19). Pre-existing health conditions and early morphological alterations may precipitate cardiac injury and dysfunction after contracting the virus. The current study aimed at assessing potential risk factors for COVID-19 cardiac complications in patients with pre-existing conditions and imaging predictors. Methods and Results: The multi-center, retrospective cohort study consecutively enrolled 400 patients with lab-confirmed COVID-19 in six Chinese hospitals remote to the Wuhan epicenter. Patients were diagnosed with or without the complication of myocardial injury by history and cardiac biomarker Troponin I/T (TnI/T) elevation above the 99th percentile upper reference limit. The majority of COVID-19 patients with myocardial injury exhibited pre-existing health conditions, such as hypertension, diabetes, hypercholesterolemia, and coronary disease. They had increased levels of the inflammatory cytokine interleukin-6 and more in-hospital adverse events (admission to an intensive care unit, invasive mechanical ventilation, or death). Chest CT scan on admission demonstrated that COVID-19 patients with myocardial injury had higher epicardial adipose tissue volume ([EATV] 139.1 (83.8-195.9) vs. 92.6 (76.2-134.4) cm2; P = 0.036). The optimal EATV cut-off value (137.1 cm2) served as a useful factor for assessing myocardial injury, which yielded sensitivity and specificity of 55.0% (95%CI, 32.0-76.2%) and 77.4% (95%CI, 71.6-82.3%) in adverse cardiac events, respectively. Multivariate logistic regression analysis showed that EATV over 137.1 cm2 was a strong independent predictor for myocardial injury in patients with COVID-19 [OR 3.058, (95%CI, 1.032-9.063); P = 0.044]. Conclusions: Augmented EATV on admission chest CT scan, together with the pre-existing health conditions (hypertension, diabetes, and hyperlipidemia) and inflammatory cytokine production, is associated with increased myocardial injury and mortality in COVID-19 patients. Assessment of pre-existing conditions and chest CT scan EATV on admission may provide a threshold point potentially useful for predicting cardiovascular complications of COVID-19.

19.
Epidemiol Infect ; 149: e4, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1047897

ABSTRACT

Hypertension represents one of the most common pre-existing conditions and comorbidities in Coronavirus disease 2019 (COVID-19) patients. To explore whether hypertension serves as a risk factor for disease severity, a multi-centre, retrospective study was conducted in COVID-19 patients. A total of 498 consecutively hospitalised patients with lab-confirmed COVID-19 in China were enrolled in this cohort. Using logistic regression, we assessed the association between hypertension and the likelihood of severe illness with adjustment for confounders. We observed that more than 16% of the enrolled patients exhibited pre-existing hypertension on admission. More severe COVID-19 cases occurred in individuals with hypertension than those without hypertension (21% vs. 10%, P = 0.007). Hypertension associated with the increased risk of severe illness, which was not modified by other demographic factors, such as age, sex, hospital geological location and blood pressure levels on admission. More attention and treatment should be offered to patients with underlying hypertension, who usually are older, have more comorbidities and more susceptible to cardiac complications.


Subject(s)
COVID-19/complications , Hypertension/complications , Adult , Aged , COVID-19/diagnosis , China , Comorbidity , Female , Hospitalization , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Factors
20.
J Am Med Inform Assoc ; 28(3): 616-621, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-936404

ABSTRACT

Clinical trials are the gold standard for generating reliable medical evidence. The biggest bottleneck in clinical trials is recruitment. To facilitate recruitment, tools for patient search of relevant clinical trials have been developed, but users often suffer from information overload. With nearly 700 coronavirus disease 2019 (COVID-19) trials conducted in the United States as of August 2020, it is imperative to enable rapid recruitment to these studies. The COVID-19 Trial Finder was designed to facilitate patient-centered search of COVID-19 trials, first by location and radius distance from trial sites, and then by brief, dynamically generated medical questions to allow users to prescreen their eligibility for nearby COVID-19 trials with minimum human computer interaction. A simulation study using 20 publicly available patient case reports demonstrates its precision and effectiveness.


Subject(s)
COVID-19 , Clinical Trials as Topic , Abstracting and Indexing , Adult , Aged , Aged, 80 and over , Child, Preschool , Eligibility Determination , Female , Humans , Information Storage and Retrieval , Male , Middle Aged , Patient Selection
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