Virtual Leadership and Nurses' Psychological Stress during COVID-19 in the Tertiary Hospitals of Pakistan: The Role of Emotional Intelligence.

Although intelligence has been widely examined in the literature, the correlation of emotional intelligence (EI) has with virtual leadership, work stress, work burnout, and job performance in the nursing profession needs further consideration. Prior studies have confirmed that leadership style and emotional intelligence massively contribute to better outcomes in the nursing profession. Based on these confirmations, this research intended to explore the impact of virtual leadership and EI on work stress, work burnout, and job performance among nurses during the COVID-19 pandemic. A convenient sampling technique was adopted to select the data sample. To analyze our hypotheses, 274 self-reported surveys were distributed in five tertiary hospitals in Pakistan through a cross-sectional quantitative research design. The hypotheses were tested with SmartPLS-3.3.9. Our findings revealed that virtual leadership and EI have considerably influenced nurses' work stress, burnout level, and job performance. The study concludes that EI significantly moderates virtual leadership and psychological stress among nurses.

Efficacy and safety of Lianhua Qingwen capsules combined with standard of care in the treatment of adult patients with mild to moderate COVID-19 (FLOSAN): protocol for a randomized, double-blind, international multicenter clinical trial.

Background: Effective anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) drugs are not only the next defense after vaccines but also the key part of establishing a multi-tiered coronavirus disease 2019 (COVID-19) prevention and control system. Previous studies had indicated that Lianhua Qingwen (LHQW) capsules could be an efficacious Chinese patent drug for treating mild to moderate COVID-19. However, pharmacoeconomic evaluations are lacking, and few trials have been conducted in other countries or regions to evaluate the efficacy and safety of LHQW treatment. So, this study aims to explore the clinical efficacy, safety, and economy of LHQW for treating adult patients with mild to moderate COVID-19. Methods: This is a randomized, double-blind, placebo-controlled, international multicenter clinical trial protocol. A total of 860 eligible subjects are randomized at a 1:1 ratio into the LHQW or placebo group to receive two-week treatment and follow-up visits on days 0, 3, 7, 10, and 14. Clinical symptoms, patient compliance, adverse effects, cost scale, and other indicators are recorded. The primary outcomes will be the measured median time to sustained improvement or resolution of the nine major symptoms during the 14-day observation period. Secondary outcomes regarding clinical efficacy will be evaluated in detail on the basis of clinical symptoms (especially body temperature, gastrointestinal symptoms, smell loss, and taste loss), viral nucleic acid, imaging (CT/chest X-ray), the incidence of severe/critical illness, mortality, and inflammatory factors. Moreover, we will assess health care cost, health utility, and incremental cost-effectiveness ratio (ICER) for economic evaluation. Discussion: This is the first international multicenter randomized controlled trial (RCT) of Chinese patent medicine for the treatment of early COVID-19 in accordance with WHO guidelines on COVID-19 management. This study will help clarify the potential efficacy and cost-effectiveness of LHQW in the treatment of mild to moderate COVID-19, facilitating decision-making by healthcare workers. Registration: This study is registered at the Chinese Clinical Trial Registry, with registration number: ChiCTR2200056727 (date of first registration: 11/02/2022).

Modelling the significance of celebrity endorsement and consumer interest on attitude, purchase intention, and willingness to pay a premium price for green skincare products.

Due to the major shift in online purchasing during the COVID-19 lockdown, celebrity endorsement marketing has gained traction. Concurrently, COVID-19 has also transformed consumers' attitudes toward using eco-friendly products, such as green skincare products, to ensure a healthier lifestyle. This study developed a comprehensive framework based on the stimuli-organism-response theory and the parasocial interaction theory to empirically evaluate the impact of celebrities' credibility attributes and consumers' interests in celebrities on their attitudes towards advertisements for endorsed green skincare products, their intentions to make a purchase, and their willingness to pay a premium price for these products. 778 Malaysian consumers participated in the online survey, and their responses were analyzed using partial least squares structural equation modelling (PLS-SEM). The results showed the positive effects of credibility traits (trustworthiness - ß = 0.100, p-value = 0.026; exquisite personality - ß = 0.075, p-value = 0.028; dignified image - ß = 0.152, p-value = 0.001; expertise - ß = 0.221, p-value <0.001), and customer attention to celebrities (ß = 0.184, p-value <0.001) on their attitudes toward endorsed advertisements. Likewise, credibility features (exquisite personality - ß = 0.116, p-value = 0.002; dignified image - ß = 0.112, p-value = 0.017; expertise - ß = 0.207, p-value <0.001) and customers' companionship with celebrities (ß = 0.142, p-value = 0.001) also have a significant positive impact on attitudes towards brands. Finally, consumers' purchasing intentions and willingness to pay premium prices for green skincare products were strongly influenced by their attitude toward advertising (ß = 0.484, p-value <0.001) and brands (ß = 0.326, p-value <0.001). Evidently, the findings of this study may help players in the cosmetics industry enhance their marketing and promotion tactics for eco-friendly beauty and personal care products.

Modeling the significance of dynamic capability on the performance of microfinance institutions.

According to strategic management theory, dynamic capability plays a significant role in enhancing organizational performance. Using a cross-sectional research design, the current study quantitatively assesses the mediating effect of dynamic capability on the relationships of total quality management, customer intellectual capital, and human resource management practice with the performance of microfinance institutions. An online survey involving 120 members of Induk Koperasi Kredit, a credit union association in West Kalimantan, Indonesia, is conducted. All the data are subjected to variance-based partial least squares structural equation modeling (PLS-SEM) analysis. The obtained results demonstrate the significant and positive influence of total quality management and human resource management practice on dynamic capability. Furthermore, dynamic capability is found to mediate the relationship between total quality management and human resource management practice on the performance of microfinance institutions. However, this study is unable to conclude that total quality management and human resource management practice have any significant impact on the performance of microfinance institutions. Nonetheless, this study demonstrates the crucial need for microfinance institutions to enhance their management activities via dynamic capability to enhance performance. This is one of the earliest studies conducted during the COVID-19 pandemic to examine the capabilities and performance of microfinance institutions in Indonesia. Notably, the performance of microfinance institutions can be further sustained by improving customers' intellectual and dynamic capabilities.

Primary angiosarcoma of breast: A case report and literature review.

INTRODUCTION AND IMPORTANCE: Primary angiosarcoma of breast (PAB)3 is a rare and aggressive malignancy with limited published literature. This article aims to disclose the diagnosis and treatment of this case, review previous case reports, and provide clinical experience to breast surgeons. CASE PRESENTATION: A 36-year-old Asian female presented with a diffuse mass growing rapidly in her left breast. The ultrasonography (USG)4 suspected granulomatous mastitis. The core needle biopsy (CNB)5 confirmed the diagnosis of breast angiosarcoma (AS).6 She underwent mastectomy without axillary lymph node dissection (ALND)7 followed by adjuvant chemotherapy. About 11 months after mastectomy, the patient had bone metastasis. CLINICAL DISCUSSION: PAB is a rare vascular neoplasia, characterized by aggressive patterns, poor prognosis, and high malignant potential. It is difficult to diagnose or differentiate only by clinical or imaging examination. Biopsy and immunohistochemical staining are the most reliable method. Mastectomy is the most common treatment. CONCLUSION: PAB is a rare and malignant cancer. We should pay attention to the diffuse progressive masses in the breast of young female, and perform MRI and biopsy if necessary. Mastectomy is the only treatment known that has proven to benefit these patients. There are no evidence-based guidelines regarding treatment.

Risk assessment of infectious disease epidemic based on fuzzy Bayesian network.

The prevention and control of infectious disease epidemic (IDE) is an important task for every country and region. Risk assessment is significant for the prevention and control of IDE. Fuzzy Bayesian networks (FBN) can capture complex causality and uncertainty. The study developed a novel FBN model, integrating grounded theory, interpretive structural model, and expert weight determination algorithm for the risk assessment of IDE. The algorithm is proposed by the authors for expert weighting in fuzzy environment. The proposed FBN model comprehensively takes into account the risk factors and the interaction among them, and quantifies the uncertainty of IDE risk assessment, so as to make the assessment results more reliable. Taking the epidemic situation of COVID-19 in Wuhan as a case, the application of the proposed model is illustrated. And sensitivity analysis is performed to identify the important risk factors of IDE. Moreover, the effectiveness of the model is checked by the three-criterion-based quantitative validation method including variation connection, consistent effect, and cumulative limitation. Results show that the probability of the outbreak of COVID-19 in Wuhan is as high as 82.26%, which is well-matched with the actual situation. "Information transfer mechanism," "coordination and cooperation among various personnel," "population flow," and "ability of quarantine" are key risk factors. The constructed model meets the above three criteria. The application potential and effectiveness of the developed FBN model are demonstrated. The study provides decision support for preventing and controlling IDE.

Effectiveness and Safety of Lianhua Qingwen Capsules for COVID-19: A Propensity-Score Matched Cohort Study.

As a traditional Chinese medicine, Lianhua Qingwen capsules have been widely used to treat Coronavirus Disease 2019 (COVID-19). This study was aimed to demonstrate the association between treatment with Lianhua Qingwen capsules and the clinical outcomes of hospitalized patients with COVID-19. This retrospective study was conducted at four hospitals in Central China. Data of hospitalized COVID-19 patients were collected between December 19, 2019 and April 26, 2020. Based on whether Lianhua Qingwen capsules were used, patients were classified into Lianhua Qingwen and non-Lianhua Qingwen (control) groups. To control for confounding factors, we used conditional logistic regression in a propensity-score matched (PSM) cohort (1 : 1 balanced), as well as logistic regression without matching as sensitivity analysis. A total of 4918 patients were included, 2760 of whom received Lianhua Qingwen capsules and 2158 of whom did not. In the PSM model, after adjusting for confounders, the in-hospital mortality was similar between the Lianhua Qingwen group and the control group (6.8% vs. 3.3%, adjusted OR, 0.66 [95% CI, 0.38-1.15], p = 0.138). The negative conversion rate of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection was higher in the Lianhua Qingwen group (88.3% vs. 96.1%, adjusted OR, 4.02 [95% CI, 2.58-6.25], p < 0.001). The incidence of acute liver injury was comparable between the two groups (14.0% vs. 11.5%, adjusted OR: 0.85 [95% CI, 0.71-1.02], p = 0.083), and the incidence of acute kidney injury was lower in the Lianhua Qingwen group (5.3% vs. 3.0%, adjusted OR: 0.71 [95% CI, 0.50-1.00], p = 0.048). Treatment with Lianhua Qingwen capsules was not significantly associated with in-hospital mortality in COVID-19 patients. In the Lianhua Qingwen group, the negative conversion rate of SARS-CoV-2 infection was higher and the incidence of acute kidney injury was lower than in the control group.

Analysis of the Influencing Factors of Seeking Intention on COVID-19 Risk Information: A Cross-Sectional Study.

Background: Information seeking, as an important part of the prevention and control of infectious diseases, can lead to positive outcomes by reducing uncertainty and alleviating panic. However, most previous studies have limited their analysis to individual-level psychosocial factors, and little is known about how social-level factors influence individuals' information-seeking intentions. Methods: The cross-sectional survey was conducted from July 30, 2020 to August 15, 2020 in China. We used a convenience sampling strategy to recruit participants from among the Internet users. The structural equation model was used to identify the incentives associated with coronavirus disease 2019 (COVID-19) risk information-seeking intention. Results: In this study, the responses of 871 Internet users who reflected a response rate of 85% were analyzed. Information-seeking intention was found to be directed by informational subjective norms (ISNs), perceived information need, risk knowledge, the sense of community (SOC), and negative affective responses, and ISNs were found to be the strongest driving factor. Individuals with a stronger SOC, which was associated with greater pressure and expectations, show negative affective responses. COVID-19 risk knowledge can affect the information-seeking intention of Internet users not only directly but also indirectly through their perceived information need. In addition, more risk knowledge was associated with a lower perceived risk likelihood. Conclusion: When formulating risk communication strategies, governments and health institutions should take targeted measures to improve the public's SOC and knowledge. This will provide an opportunity to explore the role of individual cognition and environmental risk information in public health.

Predicting the Willingness and Purchase of Travel Insurance During the COVID-19 Pandemic.

This study explored the willingness and purchase of travel insurance during the COVID-19 pandemic amongst working adults to ensure their safety and welfare through the lens of the theory of planned behavior. Primary data were gathered from 1,118 working adults across Malaysia and analyzed using the partial least squares structural equation modeling. The study outcomes revealed that attitude toward travel insurance was significantly influenced by insurance literacy, perceived health risk, and health consciousness. The willingness of working adults to purchase travel insurance was highly influenced by attitudes, subjective norms, and perceived behavioral controls but unaffected by perceived product risks. The purchase of travel insurance was positively influenced by the willingness to purchase travel insurance. In fact, travel insurance literacy and perceived health risk should be emphasized amongst working adults to encourage them to purchase travel insurance policies for traveling abroad.

Ambroxol for the treatment of COVID-19 among hospitalized patients: A multicenter retrospective cohort study.

Ambroxol is a commonly used mucolytic agent principally used to treat respiratory diseases, which may have a role as adjunctive therapy for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, but there is lack of evidence about its effectiveness on coronavirus disease-2019 (COVID-19) patients. To study the association between ambroxol use and clinical outcomes among hospitalized patients of COVID-19 infection. We conducted a multicenter retrospective cohort study involving 3,111 patients with confirmed SARS-CoV-2 infection from three hospitals in Wuhan from 19 December 2019 to 15 April 2020, and the primary outcome was in-hospital mortality. COVID-19 patients were classified into ambroxol and non-ambroxol groups based on the administration of ambroxol during hospitalization. Two analyses including propensity score matching (PSM) to obtain a 1:1 balanced cohort and logistic regression were used to control for confounding factors. The average age of 3,111 patients was 57.55 ± 14.93 years old, 127 of them died during hospitalization, and 924 of them used ambroxol. Treatment with ambroxol did not have a significant effect on in-hospital mortality of COVID-19 patients when compared with non-ambroxol in PSM model after adjusting for confounders (8.0% vs. 3.5%, adjusted OR, 1.03 [95% CI, 0.54-1.97], p = 0.936). Adverse events such as nausea/vomiting, headache, and rash were comparable between the two groups. Our results suggest that the use of ambroxol is not significantly associated with in-hospital mortality in COVID-19 patients, which provides evidence for evaluating the effects of ambroxol on COVID-19 patient outcomes and may be helpful for physicians considering medication alternatives for COVID-19 patients.

Chicken intestinal microbiota modulation of resistance to nephropathogenic infectious bronchitis virus infection through IFN-I.

BACKGROUND: Mammalian intestinal microbiomes are necessary for antagonizing systemic viral infections. However, very few studies have identified whether poultry commensal bacteria play a crucial role in protecting against systemic viral infections. Nephropathogenic infectious bronchitis virus (IBV) is a pathogenic coronavirus that causes high morbidity and multiorgan infection tropism in chickens. RESULTS: In this study, we used broad-spectrum oral antibiotics (ABX) to treat specific pathogen free (SPF) chickens to deplete the microbiota before infection with nephropathogenic IBV to analyze the impact of microbiota on IBV infections in vivo. Depletion of the SPF chicken microbiota increases pathogenicity and viral burden following IBV infection. The gnotobiotic chicken infection model further demonstrated that intestinal microbes are resistant to nephropathogenic IBV infection. In addition, ABX-treated chickens showed a severe reduction in macrophage activation, impaired type I IFN production, and IFN-stimulated gene expression in peripheral blood mononuclear cells and the spleen. Lactobacillus isolated from SPF chickens could restore microbiota-depleted chicken macrophage activation and the IFNAR-dependent type I IFN response to limit IBV infection. Furthermore, exopolysaccharide metabolites of Lactobacillus spp. could induce IFN-ß. CONCLUSIONS: This study revealed the resistance mechanism of SPF chicken intestinal microbiota to nephropathogenic IBV infection, providing new ideas for preventing and controlling nephropathogenic IBV. Video abstract.

Predicting the Willingness and Purchase of Travel Insurance During the COVID-19 Pandemic

This study explored the willingness and purchase of travel insurance during the COVID-19 pandemic amongst working adults to ensure their safety and welfare through the lens of the theory of planned behavior. Primary data were gathered from 1,118 working adults across Malaysia and analyzed using the partial least squares structural equation modeling. The study outcomes revealed that attitude toward travel insurance was significantly influenced by insurance literacy, perceived health risk, and health consciousness. The willingness of working adults to purchase travel insurance was highly influenced by attitudes, subjective norms, and perceived behavioral controls but unaffected by perceived product risks. The purchase of travel insurance was positively influenced by the willingness to purchase travel insurance. In fact, travel insurance literacy and perceived health risk should be emphasized amongst working adults to encourage them to purchase travel insurance policies for traveling abroad.

Modelling the mass adoption potential of wearable medical devices.

Digital technologies empower users to manage their health and reduce the burden on the public health system. The mass adoption of wearable medical devices (WMDs) promotes the ageing population's confidence besides facilitating users. Thus, the current study aims to empirically evaluate the formation of perceived product value (PPV) with the WMDs' computability, usefulness, cost, and accuracy, the intention to use WMDs influenced by health consciousness (HCS), health anxiety (HAY), product value, and perceived critical mass (PCM), and later the adoption of WMDs among Chinese adults. The study examined the mediating effect of PPV on the relationship between the intention to use WMDs and perceived compatibility (PCT), perceived cost (PCO), perceived usefulness (PUS), and perceived technology accuracy (PTA). This study adopted a cross-sectional approach and used an online survey to collect quantitative data from 1,160 Chinese adults. Data analysis was performed using the partial least squares structural equation modelling (PLS-SEM). Results showed that PCT, PUS, and PTA significant positive effect on PPV. Meanwhile, HCS, PCM, and PPV has a significant positive effect on intention to use WMDs, and the intention to use WMDs and PCM influenced the adoption of WMDs. Consequently, the analysis confirmed that PPV mediated the relationships between the intention to use WMD and PCT, PUS, and PTA. The WMD cost must be reduced to enhance the value of WMDs. Finally, the study's implications, limitations, and suggestions for future studies are discussed.

Predicting the Mass Adoption of eDoctor Apps During COVID-19 in China Using Hybrid SEM-Neural Network Analysis.

Technology plays an increasingly important role in our daily lives. The use of technology-based healthcare apps facilitates and empowers users to use such apps and saves the burden on the public healthcare system during COVID-19. Through technology-based healthcare apps, patients can be virtually connected to doctors for medical services. This study explored users' intention and adoption of eDoctor apps in relation to their health behaviors and healthcare technology attributes among Chinese adults. Cross-sectional data were collected through social media, resulting in a total of 961 valid responses for analysis. The hybrid analysis technique of partial least squares structural equation modeling (PLS-SEM) and artificial neural network (ANN) analysis was applied. The obtained results revealed the significant influence of eDoctor apps in terms of usefulness, compatibility, accuracy, and privacy on users' intention to use eDoctor apps. Intention and product value were also found to suggestively promote the adoption of eDoctor apps. This study offered practical recommendations for the suppliers and developers of eHealth apps to make every attempt of informing and building awareness to nurture users' intention and usage of healthcare technology. Users' weak health consciousness and motivation are notable barriers that restrict their intention and adoption of the apps. Mass adoption of eDoctor apps can also be achieved through the integration of the right technology features that build the product value and adoption of eDoctor apps. The limitations of the current study and recommendations for future research are presented at the end of this paper.

Epidemiological Study and Clinical Characterization of COVID-19 Cases in Xuzhou, China

In this paper, an epidemiological study was performed by focusing on all confirmed patients with COVID-19 in Xuzhou, a prefecture-level city, and a transportation hub with 10.44 million population in the east region of China. The median age of the patients is 42-year-old and 45.57% are male;25 cases (31.65%) are imported. 23 cases (29.11%) were confirmed between January 26 to 31, 2020 while 56 cases (70.89%) were from February 1 to 16, 2020. Among the ten administrative divisions of Xuzhou city, Suining county (n=31) and Pizhou City (n=15) have the most cases while Tongshan district has none. A representative familial cluster with 6 cases was analyzed in detail in order to get a better understanding of the transmission routes of the virus. Furthermore, we performed a retrospective, single-centre study of 41 COVID-19 patients at Xuzhou Infectious Diseases Hospital in terms of clinical findings, which provided an insightful understanding of the disease.

Warfarin or non-Vitamin K antagonist oral anticoagulants: Navigating the choice of oral anticoagulant drugs in the COVID-19 pandemic era.

Emerging evidence indicates that thromboembolic complications are a key determinant of inhospital mortality of patients with COVID-19. Prophylactic anticoagulation therapy is an important component of inhospital management of patients with COVID-19. Considering that millions of patients worldwide are prescribed oral anticoagulation therapy, herein, we summarize the pros and cons of non-Vitamin K antagonist oral anticoagulants (NOACs) and warfarin, in terms of pharmacodynamics, and therapeutic efficacy and adverse effect monitoring in the context of the global pandemic of COVID-19. Despite a lack of evidence from high-quality randomized trials, an NOAC, rather than warfarin, would be a scientifically reasonable treatment option for patients with COVID-19 in the outpatient setting.

A Pilot Study to Investigate the Role of Virtual Reality in the Preservice Training of Nursing Staff in Isolation Wards.

Healthcare providers without working experience in isolation wards experience enormous challenges. Traditional ward orientation is constrained by space, time, and even infection risk in particular periods (eg, the coronavirus disease 2019 pandemic). Virtual reality has been used widely, but rarely in wards. This study aimed to explore the experience of utilizing virtual reality for isolation ward training among nurses. In this study, nurses completed virtual reality training via an online platform and were then trained in isolation wards, after which their perceptions were explored by questionnaire and interviews. A total of 1868 participants completed the training. Most participants thought the preservice training was important and believed the virtual reality experience was consistent with the in-person training. Virtual reality was found not only to be convenient and valuable for training but also to have the benefits of occupational protection. However, whereas 50.48% of participants wanted to learn the ward via virtual reality, 87.21% of participants wanted to learn via in-person training before working in the wards. As a substitute for in-person training, virtual reality is a feasible and practical instrument to provide preservice training in particular periods. However, there is room for improvement due to general discomfort and technological problems.