Protective effect of plasma neutralization from prior SARS-CoV-2 Omicron infection against BA.5 subvariant symptomatic reinfection (preprint)

From December 2022 to January 2023, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections caused by BA.5 and BF.7 subvariants of B.1.1.529 (Omicron) swept across mainland China. It is crucial to estimate the protective effect of the neutralizing antibodies generated by such mass infections against the next potential SARS-CoV-2 reinfection wave, especially if driven by CH.1.1 or XBB.1.5. Previously, we recruited and continuously followed a cohort of individuals that experienced Omicron BA.1, BA.2, and BA.5 breakthrough infections, as well as a control cohort with no history of SARS-CoV-2 infection. In the previously uninfected cohort, the total symptomatic infection rate surveyed during the outbreak was 91.6%, while the symptomatic reinfection rate was 32.9%, 10.5%, and 2.8% among individuals with prior Omicron BA.1, BA.2 and BA.5 infection, respectively, with median intervals between infections of 335, 225 and 94 days. Pseudovirus neutralization assays were performed in plasma samples collected from previously Omicron BA.1-infected individuals approximately 3 months before the outbreak. Results indicate a robust correlation between the plasma neutralizing antibody titers and the protective effect against symptomatic reinfection. The geometric mean of the 50% neutralizing titers (NT50) against D614G, BA.5, and BF.7 were 2.0, 2.5, and 2.3-fold higher in individuals without symptomatic reinfection than in those with symptomatic reinfection (p < 0.01). Low plasma neutralizing antibody titer (below the geometric mean of NT50) was associated with an enhanced cumulative risk of symptomatic reinfection, with a hazard ratio (HR) of 23.55 (95% CI: 9.23-60.06) against BF.7 subvariant. Importantly, neutralizing antibodies titers post one month after BF.7/BA.5 breakthrough infections against CH.1.1 and XBB.1.5 are similar to that against BF.7 from individuals with prior BA.1 infection while not experiencing a symptomatic BF.7/BA.5 reinfection (plasma collected 3 months before the outbreak), suggesting that the humoral immunity generated by the current BF.7/BA.5 breakthrough infection may provide protection against CH.1.1 and XBB.1.5 symptomatic reinfection wave for 4 months. Of note, the higher hACE2 binding of XBB.1.5 may reduce the protection period since the potential increase of infectivity.

Cross-lagged analysis of the relationship between risk perception, physical activity, and adolescent mental health (preprint)

Background Anxiety symptoms were prevalent in teenagers during the new coronavirus pandemic at 31% and depression symptoms were at 34%, both significantly higher than they were before the pandemic, according to research on global adolescent mood disorders during the epidemic. It is unclear, nevertheless, if physical activity still promotes mental health given the perceived danger of sickness, even though it has been demonstrated to be useful in reducing teenage mental health issues. Therefore, this study looked into the relationship between teenage mental health, risk perception, and physical activity. Methods In December 2022 and January 2023, two surveys were given to the same pupils in five high schools. During the New Crown pandemic, the risk perception scores, physical activity levels, and mental health of adolescents were examined in the study N=344. Results For adolescents' risk perceptions, there were significant gender differences (P＜0.01), with gender difference effects of 0.255 (d = 0.416) and 0.195 (d = 0.402) for the two measurements, respectively. For mental health, there were gender differences, with gender difference effects of 0.159 (d = 0.262) and 0.179 (d = 0.278) for the two measurements. The levels of risk perception, physical activity, and teenage mental health met persistent connections across months with contemporaneous correlations, however gender differences in physical activity levels were not significant (p > 0.05); Contrarily, in the cross-lagged study, males had higher levels of physical activity and mental health than females, and teenagers' risk perception was higher. Physical activity and mental health were both predicted by T1 ( values of 0.28, 0.19, and P＜0.01, respectively). Risk perception T1 physical exercise T2 mental health T2 (mediating value impact of 0.012, the Z value of 0.112), as well as the indirect effect of Bootstrap, were all able to predict mental health T2 (β= 0.33, P ＜0.01). Indicating a substantial mediating role for physical activity between risk perception and mental health is the 95% CI, not the 0 value from this pathway. Conclusion Raising awareness of physical activity among adolescents according to gender is important for improving mental health and there is a longitudinal causal relationship between perceived risk of disease, physical activity, and mental health among adolescents, suggesting that physical activity still has a role in mental health in the presence of risk perception.

Sex Differences in Students’ Performance in VR-based Learning of Gross Anatomical Education (preprint)

Background: Studying anatomy has always challenged medical students. The coronavirus disease 2019 pandemic has transformed medical education worldwide, and virtual reality (VR) has recently emerged as a useful learning tool to promote memorization through understanding and visualization. With a remarkable rise in the use of remote learning methods during the pandemic, more schools are adopting distance learning through VR for anatomy. However, scholars have yet to explore the potential sex differences among students who use VR-based anatomical learning. Thus, we investigated the effects of teaching strategies on learners’ experiences with and performance in an anatomy course using VR-based learning. Method: Fifty first-year medical students enrolled in a human anatomy course were provided with VR devices for anatomical learning. They received a questionnaire comprising four determinants of experience: demographic background, discomfort symptoms, satisfaction levels, and opinions about the VR-based learning experience after their final examination. Student performance was then compared to previous performances over three-semester years when traditional teaching methods were used. A three-way mixed-model ANOVA was used to test the effects of sex, examination, and teaching methods on the examination scores. Results: VR-based learning resulted in better exam scores when compared to the traditional learning method. Female students experienced significantly higher disorientation symptoms compared with male students, and male students showed significant improvement in laboratory examination performance. Results showed that VR-based teaching can facilitate gross anatomical learning among first-year medical students and improve the laboratory performance of male students. Conclusion: Medical schools can use VR to teach anatomy effectively; however, faculty should be prepared to support inexperienced users when learning to use a VR system. Future research should further explore sex differences for reliability.

N-Acetylcysteine Treatment Accelerates Patient-Reported Outcomes Improvement in Patients With COVID-19 A Prospective Study (preprint)

Background: Since its outbreak in late December 2019, the coronavirus disease 2019 (COVID-19) has culminated in a global pandemic, and its causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has continued to mutate, with increasing rates of transmission and pathogenicity, having a serious worldwide impact. This study aims to assess the benefits of the health-related quality of life of using N-acetylcysteine(NAC).Methods: In this prospective observational research, 63 confirmed COVID-19 patients who were treated between the ends of January and March 2020 were divided into patients treated with NAC-treatment (32 cases) and non-NAC-treatment groups (31 cases). Patients were followed up at discharge and at 1, 3, and 6 months after discharge. The clinical treatment effects of the two groups were compared, and the St. George’s Respiratory Questionnaire (SGRQ) evaluated patient-reported outcomes.Results: There were strong correlations between SGRQ component scores (0.728, 0.749, 0.850; P < 0.001 for all items) as well as between each SGRQ component score and the total patient score (0.822, 0.958, 0.957; P < 0.001 for all items). In the univariate analysis, the change differences of one month after discharge compared with discharge between two groups patients were statistically significant in the impacts and total scores (753.000, P < 0.001; 644.000, P = 0.042); the change differences of three months after discharge compared with discharge were also significant in the activity, impacts, and total scores (660.500, P = 0.022; 800.000, P < 0.001; 707.000, P = 0.004). In the multivariate analysis, the factors that have statistically significant influence on the unit value of SGRQ total score difference (UVDSGRQ) is NAC treatment (β = 1.954, P < 0.001), disease severity (β = 3.179, P < 0.001), follow-up duration (β = -0.232, P = 0.001), as well as NAC treatment and follow-up duration interaction item (β = -0.436, P = 0.004).Conclusion: Our study shows as the follow-up time increases, the SGRQ total scores of patients treated with NAC decreases significantly faster than those who were treated without NAC. In the treatment of COVID-19 patients, increasing the use of NAC has clinical significance.

Real-world study of the effectiveness of BBIBP-CorV (Sinopharm) COVID-19 vaccine in the Kingdom of Morocco (preprint)

The Kingdom of Morocco approved BBIBP-CorV (Sinopharm) COVID-19 vaccine for emergency use on 22 January 2021 in a two-dose, three-to-four-week interval schedule. We conducted a case-control study to determine real-world BBIBP-CorV vaccine effectiveness (VE) against serious or critical hospitalization of individuals RT-PCR-positive for SARS-CoV-2 during the first five months of BBIBP-CorV use in Morocco. The study was conducted among adults 18-99 years old who were tested by RT-PCR for SARS-CoV-2 infection between 1 February and 30 June 2021. RT-PCR results were individually linked with outcomes from the COVID-19 severe or critical hospitalization dataset and with vaccination histories from the national vaccination registration system. Individuals with partial vaccination (<2 weeks after dose two) or in receipt of any other COVID-19 vaccine were excluded. Unadjusted and adjusted VE estimates against hospitalization for serious or critical illness were made by comparing two-dose vaccinated and unvaccinated individuals in logistic regression models, calculated as (1-odds ratio) * 100%. There were 348,190 individuals able to be matched across the three databases. Among these, 140,892 were fully vaccinated, 206,149 were unvaccinated, and 1,149 received homologous BBIBP-CorV booster doses. Unadjusted, full-series, unboosted BBIBP-CorV VE against hospitalization for serious or critical illness was 90.2% (95%CI: 87.8% - 92.0%). Full-series, unboosted VE, adjusted for age, sex, and calendar day of RT-PCR test, was 88.5% (95%CI: 85.8% - 90.7%). Calendar day- and sex-adjusted VE ranged from 93.9% to 100% for individuals <60 years, and was 53.3% for individuals 60 years and older. There were no serious or critical illnesses among BBIBP-CorV-boosted individuals. Effectiveness of Sinopharm's BBIBP-CorV was consistent with phase III clinical trial results. Two doses of BBIBP-CorV was highly protective against COVID-19-associated serious or critical hospitalization in working-age adults under real-world conditions and moderately effective in older adults. Booster dose VE should be evaluated, as booster doses of BBIBP-CorV are recommended and are being used.

The trustworthiness and impact of trial preprints for COVID-19 decision-making: A methodological study (preprint)

Purpose: To assess the trustworthiness and impact of preprint trial reports during the COVID-19 pandemic. Data sources: WHO COVID-19 database and the L-OVE COVID-19 platform by the Epistemonikos Foundation (up to August 3rd, 2021) Design: We compare the characteristics of COVID-19 trials with and without preprints, estimate time to publication of COVID-19 preprint reports, describe discrepancies in key methods and results between preprint and published trial reports, report the number of retracted preprints and publications, and assess whether including versus excluding preprint reports affects meta-analytic estimates and the certainty of evidence. For the effects of eight therapies on mortality and mechanical ventilation, we performed meta-analyses including preprints and excluding preprints at 1 month, 3 months, and 6 months after the first trial addressing the therapy became available either as a preprint or publication (120 meta-analyses in total). Results: We included 356 trials, 101 of which are only available as preprints, 181 as journal publications, and 74 as preprints first and subsequently published in journals. Half of all preprints remain unpublished at six months and a third at one year. There were few important differences in key methods and results between trial preprints and their subsequent published reports. We identified four retracted trials, three of which were published in peer-reviewed journals. With two exceptions (2/60; 3.3%), point estimates were consistent between meta-analyses including versus excluding preprints as to whether they indicated benefit, no appreciable effect, or harm. There were nine comparisons (9/60; 15%) for which the rating of the certainty of evidence differed when preprints were included versus excluded, for four of these comparisons the certainty of evidence including preprints was higher and for five of these comparisons the certainty of evidence including preprints was lower. Limitations: The generalizability of our results is limited to COVID-19. Preprints that are subsequently published in journals may be the most rigorous and may not represent all trial preprints. Conclusion: We found no compelling evidence that preprints provide less trustworthy results than published papers. We show that preprints remain the only source of findings of many trials for several months, for a length of time that is unacceptable in a health emergency. We show that including preprints may affect the results of meta-analyses and the certainty of evidence. We encourage evidence users to consider data from preprints in contexts in which decisions are being made rapidly and evidence is being produced faster than can be peer-reviewed.

Impact of the COVID-19 pandemic on congenital diaphragmatic hernia patients: a single-center retrospective study (preprint)

Purpose To investigate the impact of COVID-19 on the treatment of children with congenital diaphragmatic hernia (CDH).Methods We retrospectively collected and compared the data of patients with CDH admitted between January 1, 2020 and December 31, 2021 with the CDH patients admitted before the pandemic between January 1, 2018 and December 31, 2019 (control group).Results During the pandemic, 41 patients with CDH diagnosed prenatally were transferred to our hospital, and 40 underwent surgical repair. The number of patients treated in our hospital increased by 24.2% compared with that before the pandemic. During the pandemic, the overall survival rate, postoperative survival rate and recurrence rate were 85.4%, 87.5% and 7.3%, respectively, and there were no significant differences compared with the control group. The average length of hospital stay in patients admitted during the pandemic was longer than that in the control group, and the incidence of nosocomial infection was higher than that in the control group.Conclusions CDH patients confirmed to be SARS-CoV-2 infection-free can receive routine treatment. Our data indicate that the implementation of protective measures during the COVID-19 pandemic, along with appropriate screening and case evaluation, do not have a negative impact on the prognosis of children.

Nutritional therapy for critical coronavirus disease 2019 patients: a case report (preprint)

Background: An ongoing outbreak of coronavirus disease 2019 (COVID-19) is spreading, there are few reports on exploring individualized nutritional therapy for critical coronavirus disease 2019 (COVID-19) patients. Case presentation: To explore individualized nutritional therapy for critical coronavirus disease 2019 (COVID-19) patients.A nutritional treatment plan was created through nutritional risk screening and nutritional assessment, and an individualized nutritional treatment was implemented through multidisciplinary collaboration. The patient’s gastrointestinal symptoms were corrected, and her nutrition-related indicators such as albumin and body weight were improved. She was cured and discharged. Conclusion: Nutritional therapy is beneficial to improve the nutritional status and clinical outcome of critical COVID- 19 patients.

The Influence of COVID-19 on Irrational Consumption Behavior in a Chinese Sample: Based on a Serial Mediating Model.

Based on the scarcity theory, this study focuses on exploring the relationship between the severity of public health emergencies (i.e., COVID-19) and individual irrational consumer behaviors through the serial mediating variables of perceived scarcity (PS) and negative mentality (NM). An online questionnaire was used to collect data from participants in China and we obtained 466 effective (115 male and 351 female) questionnaires in total. The findings showed that the relationship between each pair of factors - perceived pandemic severity, PS, NM, and irrational consumption behaviors - was significantly positive. Although the perception of the severity of this public health emergency did not directly predict irrational consumer behavior, the effect was mediated by PS and NM independently and serially. These findings reveal that people who strongly perceive scarcity and are prone to negative attitudes are more likely to demonstrate irrational consumer behaviors (such as rushing to buy and hoard living supplies) once the public perceives a public health emergency as severe. This effect occurs because the PS that results from the epidemic affects people's cognition, emotion, and behavior.

Many Hands Make Light Work: Evidence from China's Anti-Epidemic Bonds (preprint)

Based on China's anti-epidemic bond data, this paper investigates stock market reactions to the anti-epidemic bond issuance announcements during the COVID-19 pandemic. We find that anti-epidemic bond issuance significantly increases the cumulative abnormal return (CAR) compared with conventional bond issuance. Issuing anti-epidemic bonds can enhance firms' risk-resistance capacity and corporate social responsibility (CSR) performance during the pandemic period; thus, anti-epidemic bonds are favored by shareholders. Further analysis reveals that positive announcement stock returns for anti-epidemic bonds emerge only when the epidemic situation worsens, suggesting that market investors expect anti-epidemic bond issuers to perform better during the outbreak.

Conserved T-cell epitopes predicted by bioinformatics in SARS-COV-2 variants (preprint)

BackgroundFinding conservative T cell epitopes in the proteome of numerous variants of SARS-COV-2 is required to develop T cell activating SARS-COV-2 capable of inducing T cell responses against SARS-COV-2 variants. MethodsA computational workflow was performed to find HLA restricted CD8+ and CD4+ T cell epitopes among conserved amino acid sequences across the proteome of 474727 SARS-CoV-2 strains. ResultsA batch of covserved regions in the amino acid sequences were found in the proteome of the SARS-COV-2 strains. 2852 and 847 peptides were predicted to have high binding affinity to distint HLA class I and class II molecules. Among them, 1456 and 484 peptides are antigenic. 392 and 111 of the antigenic peptides were found in the conseved amino acid sequences. Among the antigenic-conserved peptides, 6 CD8+ T cell epitopes and 7 CD4+ T cell epitopes were identifed. The T cell epitopes could be presented to T cells by high-affinity HLA molecules which are encoded by the HLA alleles with high population coverage. ConclusionsThe T cell epitopes are conservative, antigenic and HLA presentable, and could be constructed into SARS-COV-2 vaccines for inducing protective T cell immunity against SARS-COV-2 and their variants.

Impact of human airway epithelial cellular composition on SARS-CoV-2 infection biology (preprint)

Infection biology and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the coronavirus disease 2019 (COVID-19), are incompletely understood. Here, we assessed the impact of airway epithelial cellular composition on infection in air-liquid interface (ALI) cultures of differentiated primary human tracheal (PTEC) and bronchial epithelial cells (PBEC). We first compared SARS-CoV-2 infection kinetics, related antiviral and inflammatory responses, and viral entry factors in PTEC and PBEC. Next, the contribution of differentiation time was investigated by differentiating ALI-PTEC/PBEC for 3-5 weeks and comparing dynamics of viral replication/spread, cellular composition and epithelial responses. We observed a gradual increase in viral load with prolonged culture duration. Ciliated and goblet cells were predominantly infected in both PTEC and PBEC. Immunofluorescence analysis and RT-qPCR showed that compared to other cell types mainly ciliated and goblet cell numbers were affected by increased culture duration. An increased proportion of these two target cell types was associated with increased viral load. Furthermore, modulation of cellular composition using IL-13 and the Notch signaling inhibitor DAPT, underlined the importance of both ciliated and goblet cells for infection. DAPT treatment resulted in a lower viral load and a relative increase in ciliated cells at the expense of goblet cells, compared to IL-13 treated cultures in which both cell types were present and viral load was higher. In conclusion, our results identify cellular composition as a contributing factor to airway epithelial susceptibility to SARS-CoV-2. IMPORTANCEIn this study, we determined an effect of culture duration and airway cellular composition of ALI-PBEC and ALI-PTEC cultures on SARS-CoV-2 infection. We found that SARS-CoV-2 infection was increased with prolonged cell culture time and the total percentage and proportion of ciliated and goblet cells played an important role in infection level, suggesting that airway epithelial differentiation/maturation levels may in part determine susceptibility of SARS-CoV-2 infection. The development of effective therapies either targeting virus replication or pathogenesis against SARS-CoV-2 requires robust cell culture-based infection models to test small molecules and biologicals. Therefore, it is important to identify factors that are essential for reliably modeling SARS-CoV-2-airway epithelial cell interactions. This study sheds light on virus-airway epithelial cell interactions and adds to the complexity of SARS-CoV-2 cell tropism in the airways. In addition, the effect of IL-13 on viral infection hints at a causal connection between SARS-CoV-2 infection and (allergic) asthma.

RadImageNet: A Large-scale Radiologic Dataset for Enhancing Deep Learning Transfer Learning Research (preprint)

Most current medical imaging Artificial Intelligence (AI) relies upon transfer learning using convolutional neural networks (CNNs) created using ImageNet, a large database of natural world images, including cats, dogs, and vehicles. Size, diversity, and similarity of the source data determine the success of the transfer learning on the target data. ImageNet is large and diverse, but there is a significant dissimilarity between its natural world images and medical images, leading Cheplygina to pose the question, “Why do we still use images of cats to help Artificial Intelligence interpret CAT scans?”. We present an equally large and diversified database, RadImageNet, consisting of 5 million annotated medical images consisting of CT, MRI, and ultrasound of musculoskeletal, neurologic, oncologic, gastrointestinal, endocrine, and pulmonary pathologies over 450,000 patients. The database is unprecedented in scale and breadth in the medical imaging field, constituting a more appropriate basis for medical imaging transfer learning applications. We found that RadImageNet transfer learning outperformed ImageNet in multiple independent applications, including improvements for bone age prediction from hand and wrist x-rays by 1.75 months (p<0.0001), pneumonia detection in ICU chest x-rays by 0.85% (p<0.0001), ACL tear detection on MRI by 10.72% (p<0.0001), SARS-CoV-2 detection on chest CT by 0.25% (p<0.0001) and hemorrhage detection on head CT by 0.13% (p<0.0001). The results indicate that our pre-trained models that are open-sourced on public domains will be a better starting point for transfer learning in radiologic imaging AI applications, including applications involving medical imaging modalities or anatomies not included in the RadImageNet database.

A meta-analysis on the risk factors adjusted association between cardiovascular disease and COVID-19 severity (preprint)

Background Cardiovascular disease (CVD), one of the most common comorbidities of coronavirus disease 2019 (COVID-19), has been suspected to be associated with adverse outcomes in COVID-19 patients, but their correlation remains controversial.Method This is a quantitative meta-analysis on the basis of adjusted effect estimates. PubMed, Web of Science, MedRxiv, Scopus, Elsevier ScienceDirect, Cochrane Library and EMBASE were searched comprehensively to obtain a complete data source up to January 7, 2021. Pooled effects (hazard ratio (HR), odds ratio (OR)) and the 95% confidence intervals (CIs) were estimated to evaluate the risk of the adverse outcomes in COVID-19 patients with CVD. Heterogeneity was assessed by Cochran’s Q-statistic, I²test, and meta-regression. In addition, we also provided the prediction interval, which was helpful for assessing whether the variation across studies was clinically significant. The robustness of the results was evaluated by sensitivity analysis. Publication bias was assessed by Begg’s test, Egger’s test, and trim-and-fill method.Result Our results revealed that COVID-19 patients with pre-existing CVD tended more to adverse outcomes on the basis of 203 eligible studies with 24,033,838 cases (pooled ORs = 1.41, 95% CIs: 1.32–1.51, prediction interval: 0.84–2.39; pooled HRs = 1.34, 95% CIs: 1.23–1.46, prediction interval: 0.82–2.21). Further subgroup analyses stratified by age, the proportion of male, study design, disease types, sample size, region and disease outcomes also showed that pre-existing CVD was significantly associated with adverse outcomes among COVID-19 patients.Conclusion Our findings demonstrated that pre-existing CVD was an independent risk factor associated with adverse outcomes among COVID-19 patients.

Disinfection effect of hexadecyl pyridinium chloride on SARS-CoV-2 in vitro (preprint)

The novel coronavirus (COVID-19 or 2019-nCoV) is a respiratory virus that can exist in the mouth and saliva of patients and spreads through aerosol dispersion. Therefore, stomatological hospitals and departments have become high-infection-risk environments. Accordingly, the search for oral disinfectants that can effectively inactivate the virus has become a highly active area of research. Hexadecyl pyridinium chloride, povidone-iodine, and other common oral disinfectants are the natural primary choices for stomatological hospitals. Therefore, this study investigated the inhibitory effect of hexadecyl pyridinium chloride on SARS-CoV-2 in vitro. Vero cells infected with SARS-CoV-2 were used to determine disinfection effect; the CCK-8 method was used to determine cytotoxicity; and viral load was determined by real-time PCR. The results showed that hexadecyl pyridinium chloride has no obvious cytotoxic effect on Vero cells in the concentration range 0.0125–0.05 mg/mL. The in vitro experiments showed that hexadecyl pyridinium chloride significantly inhibits the virus at concentrations of 0.1 mg/mL or above at 2 min of action. Thus, the results provide experimental support for the use of hexadecyl pyridinium chloride in stomatological hospitals.

Development and Validation of the Competency Evaluation Model for Hospital Infection Prevention and Control Practitioners in the Post-Pandemic Era: A Mixed Methods Study (preprint)

Background This study was undertaken to determine the practitioners' competence in relation to the hospital infection prevention and control measures that is significant for their professional development as well as to ascertain their role in the prevention and control activities against nosocomial infection. During the current COVID-19 pandemic situation, the hospital infection management has become crucial, which has necessitated the urgency of developing a competency model for healthcare practitioners to combat public health emergencies.Method: On the basis of literature review, the key informant interviews, the Delphi method and the questionnaire survey, a theoretical framework and an assessment tool consisting of 26 items were developed. These items were evaluated based on response rate, maximum score, minimum score, and mean score. Factor analyses, both exploratory and confirmatory, were used to determine the structure of the competence model. Measurement invariance of the instruments was determined to ensure that the variables used for the analyses were of similar constructs across the study groups.Results The effective response rate on the questionnaires was 88.29%, and the Cronbach's α-coefficient of the scale was 0.964. Factor analysis revealed a KMO of 0.945. The Bartlett's test gave an χ² of 10523.439 (df = 435; p < 0.001). After exploratory factor analysis, the 5-factor model was retained, 4 items were deleted, and a 5-dimensional, 26-item scale was obtained. The new structure's confirmatory factor analysis revealed a high goodness of fit (CFI = 0.933; TLI = 0.925; SRMSR = 0.053; and RMSEA = 0.040). The difference between the indexes of the 2 regions was significant at < 0.1, which confirmed measurement invariance across the regions.Conclusion The scale was found to be highly reliable, valid, and credible. Therefore, it can serve as an effective tool for assessing the competencies of hospital infection prevention and control practitioners.

Identification of four linear B-cell epitopes on the SARS-CoV-2 spike protein able to elicit neutralizing antibodiesIdentification of four linear B-cell epitopes on the SARS-CoV-2 spike protein able to elicit neutralizing antibodies (preprint)

SARS-CoV-2 unprecedentedly threatens the public health at worldwide level. There is an urgent need to develop an effective vaccine within a highly accelerated time. Here, we present the most comprehensive S-protein-based linear B-cell epitope candidate list by combining epitopes predicted by eight widely-used immune-informatics methods with the epitopes curated from literature published between Feb 6, 2020 and July 10, 2020. We find four top prioritized linear B-cell epitopes in the hotspot regions of S protein can specifically bind with pooled serum antibodies from horses, mice, and monkeys inoculated with different SARS-CoV-2 vaccine candidates or five patients recovering from COVID-19. The four linear B-cell epitopes can induce neutralizing antibodies against both pseudo and live SARS-CoV-2 virus in immunized wild-type BALB/c mice. This study suggests that the four linear B-cell epitopes are potentially important candidates for serological assay or vaccine development.