Impact of vaccination on kinetics of neutralizing antibodies against SARS-CoV-2 by Serum live neutralization test based on a prospective cohort.

How much the vaccine contributes to the induction and development of neutralizing antibodies (NAbs) of breakthrough cases relative to those unvaccinated-infected cases is not fully understood. We conducted a prospective cohort study and collected serum samples from 576 individuals who were diagnosed with SARS-CoV-2 Delta strain infection, including 245 breakthrough cases and 331 unvaccinated-infected cases. NAbs were analyzed by live virus microneutralization test and transformation of NAb titer. NAbs titers against SARS-CoV-2 ancestral and Delta variant in breakthrough cases were 7.8-fold and 4.0-fold higher than in unvaccinated-infected cases, respectively. NAbs titers in breakthrough cases peaked at the second week after onset/infection. However, the NAbs titers in the unvaccinated-infected cases reached their highest levels during the third week. Compared to those with higher levels of NAbs, those with lower levels of NAbs had no difference in viral clearance duration time (P>0.05), did exhibit higher viral load at the beginning of infection/maximum viral load of infection. NAb levels were statistically higher in the moderate cases than in the mild cases (P<0.0001). Notably, in breakthrough cases, NAb levels were highest longer than 4 months after vaccination (Delta strain: 53118.2 U/mL), and lowest in breakthrough cases shorter than 1 month (Delta strain: 7551.2 U/mL). Cross-neutralization against the ancestral strain and the current circulating isolate (Omicron BA.5) was significantly lower than against the Delta variant in both breakthrough cases and unvaccinated-infected cases. Our study demonstrated that vaccination could induce immune responses more rapidly and greater which could be effective in controlling SARS-CoV-2.

Kinetics of SARS-CoV-2 neutralizing antibodies in Omicron breakthrough cases with inactivated vaccination: Role in inferring the history and duration of infection.

Background: The quantitative level and kinetics of neutralizing antibodies (NAbs) in individuals with Omicron breakthrough infections may differ from those of vaccinated individuals without infection. Therefore, we aimed to evaluate the difference in NAb levels to distinguish the breakthrough cases from the post-immunized population to identify early infected person in an outbreak epidemic when nasal and/or pharyngeal swab nucleic acid real-time PCR results were negative. Methods: We collected 1077 serum samples from 877 individuals, including 189 with Omicron BA.2 breakthrough infection and 688 post-immunized participants. NAb titers were detected using the surrogate virus neutralization test, and were log(2)-transformed to normalize prior to analysis using Student's unpaired t-tests. Geometric mean titers (GMT) were calculated with 95% confidence intervals (CI). Linear regression models were used to identify factors associated with NAb levels. We further conducted ROC curve analysis to evaluate the NAbs' ability to identify breakthrough infected individuals in the vaccinated population. Results: The breakthrough infection group had a consistently higher NAb levels than the post-immunized group according to time since the last vaccination. NAb titers in the breakthrough infection group were 6.4-fold higher than those in the post-immunized group (GMT: 40.72 AU/mL and 6.38 AU/mL, respectively; p<0.0001). In the breakthrough infection group, the NAbs in the convalescent phase were 10.9-fold higher than in the acute phase (GMT: 200.48 AU/mL and 18.46 AU/mL, respectively; p<0.0001). In addition, the time since infection, booster vaccination, and the time since last vaccination were associated with log(2)-transformed NAb levels in the breakthrough infection group. ROC curve analysis showed that ROC area was largest (0.728) when the cut-off value of log(2)-transformed NAb was 6, which indicated that NAb levels could identify breakthrough infected individuals in the vaccinated population. Conclusion: Our study demonstrates that the NAb titers of Omicron BA.2 variant breakthrough cases are higher than in the post-immunized group. The difference in NAb levels could be used to identify cases of breakthrough infection from the post-immunized population in an outbreak epidemic.

Short-Term Associations between Size-Fractioned Particles and Cardiopulmonary Function in COPD Patients: A Panel Study in Shanghai, China, during 2014-2021.

It remains unknown which size fractions dominate the adverse cardiopulmonary effects of particulate matter (PM). Therefore, this study aimed to explore the differential associations between size-fractioned particle number concentrations (PNCs) and cardiopulmonary function measures, including the forced expiratory volume in one second (FEV1), the forced vital capacity (FVC), and the left ventricular ejection fraction (LVEF). We conducted a panel study among 211 patients with chronic obstructive pulmonary disease (COPD) in Shanghai, China, between January 2014 and December 2021. We applied linear mixed-effect models to determine the associations between cardiopulmonary function measures and PNCs ranging from 0.01 to 10 µm in diameter. Generally, only particles <1 µm showed significant associations, i.e., ultrafine particles (UFPs, <0.1 µm) for FVC and particles ranging from 0.1 to 1 µm for FEV1 and LVEF. An interquartile range (IQR) increment in UFP was associated with decreases of 78.4 mL in FVC. PNC0.1-0.3 and PNC0.3-1 corresponded to the strongest effects on FEV1 (119.5 mL) and LVEF (1.5%) per IQR increment. Particles <1 µm might dominate the cardiopulmonary toxicity of PM, but UFPs might not always have the strongest effect. Tailored regulations towards particles <1 µm should be intensified to reduce PM pollution and protect vulnerable populations.

Predicting nursing students' psychological well-being: network analysis based on a model of thriving through relationships.

BACKGROUND: Psychological well-being plays a vital role in nursing students' mental health and affects their decisions to stay in the nursing profession, particularly during the COVID-19 outbreak. Close relationships are undeniably linked to psychological well-being, but it is unknown how the specific pathways through which close relationships are related to each other and which are most strongly linked to nursing students' psychological well-being. AIMS: To explore the network structure, central and bridge factors among well-being characteristics, and predictors based on a model of thriving through relationships. METHODS: A cross-sectional research design was used with a sample of undergraduate nursing students (531 participants from the Southwest part of China). We used a network model to analyze the network structure of perceived social support, mindfulness, self-integrity, self-compassion, professional self-concept, savoring, intentional self-regulation, non-relational self-expansion, relational self-expansion, attachment insecurity, and psychological well-being. RESULTS:  A highly interconnected network of psychological well-being featured predictors and traits were formed. Node 8 (self-kindness), node 9 (self-judgment), and node 23 (non-relational self-expansion) were the predictors with the highest centrality in the network. Perceived social support and professional self-concept were most central in linking predictors to psychological well-being traits. Attachment insecurity was a non-supportive factor for predicting psychological well-being among female nursing students. CONCLUSIONS: Interventions based on these supportive/non-supportive predictors, which operate on different psychological levels, hold promise to achieve positive effects on psychological well-being among nursing students.

Impact of COVID-19 Pandemic on Elevated Anxiety Symptoms of Maintenance Hemodialysis Patients in China: A One-Year Follow-Up Study.

Recent studies have shown that coronavirus disease 2019 (COVID-19) aggravates anxiety in patients with maintenance hemodialysis (MHD), but it is still unclear how long this adverse effect will last. This study aims to investigate the impact of COVID-19 on the elevated anxiety symptoms of MHD patients 1 year after the outbreak. Assessment of elevated anxiety symptoms was performed on patients with MHD during early COVID-19 (February 17-February 29, 2020) and 1-year follow-up (March 1-March 13, 2021), and a total of 100 patients had completed face-to-face questionnaires at the first and 1-year follow-up. At the beginning of the outbreak, 40% of the patients with MHD had anxiety symptoms [self-rating anxiety scale (SAS) score ≥ 50], and 11% (SAS score: 60-69) and 2% (SAS score ≥ 70) of the patients had moderate and severe anxiety symptoms, respectively. Multivariate analysis shows that possibility of unaccompanied transfer, possibility of family members or themselves being infected in a hospital, added body temperature monitoring during dialysis, and increased medical procedures are the risk factors in elevated anxiety symptoms during early COVID-19. At the 1-year follow-up, the incidence of anxiety symptoms in the same group of patients declined to 28%, and all the patients had mild anxiety symptoms (SAS score: 50-59), which is significantly lower than that of the early COVID-19 pandemic with statistically significant difference (p = 0.003). Increased protective measures taken by the medical staves were the only risk factor in elevated anxiety symptoms during the 1-year follow-up. This study shows that COVID-19 has a direct impact on the deterioration of anxiety symptoms in patients with MHD. With the changes of the requirements for COVID-19 prevention and control, as well as the enhancement of propaganda and education of the pandemic and psychological care, the severity and risk factors of anxiety symptoms in the patients with MHD are changing. Thus, targeted interventions are suggested to improve the psychological endurance of the patients with MHD.

Perceived Social Support Promotes Nursing Students' Psychological Wellbeing: Explained With Self-Compassion and Professional Self-Concept.

Background: The psychological distress of nursing students is ongoing and getting worse during the coronavirus disease 2019 (COVID-19) outbreak. Numerous calls for future research on exploring the effects of perceived social support would be an effective way to improve nursing students' mental health. However, the pathway(s) between perceived social support and psychological wellbeing (PWB) remain unknown. Objective: The aim of this study was to explore how self-compassion and professional self-concept mediate the relationship between perceived social support and PWB to explain the theoretical mechanisms of the relationship. Design: This study is the analytical cross-sectional research based on online self-reports and completed validated measures of perceived social support, PWB, self-compassion, and professional self-concept. Methods: The Structural Equation Model (SEM) was used to estimate the mediation effects on the relationship between perceived social support and PWB. To examine the directionality of effects, this study also tested the reverse serial mediation model. Multigroup SEM was used to test gender differences in the mediation model. Results: The results of an empirical study involving 487 undergraduate nursing students verified an integrative model of social support. In addition, no gender difference was found in these associations. These findings suggest that self-compassion and professional self-concept accounted for the association between perceived social support and PWB, and self-compassion was a significant predictor of professional self-concept. Conclusion: There is a pathway of self-compassion and professional self-concept through which perceived social support may improve PWB. Also, improving nursing students' perceived social support, self-compassion and professional self-concept are beneficial for promoting their mental health. It is meaningful for nursing educators to take measures to develop nursing students' PWB and enhance their professional self-concept.

Impact of Epidemics on Enterprise Innovation: An Analysis of COVID-19 and SARS

This study analyzes the impact of SARS and COVID-19, the two most severe epidemics to occur in China since the 21st century, on corporate innovation, in order to find a path for sustained innovation growth under the epidemic. For COVID-19, the analysis used data from China's A-share-listed companies from 2019 to 2020;a longer period (1999–2006) and a wider sample of Chinese industrial enterprises were used for the SARS epidemic. The empirical model was constructed using the difference-in-differences method. Both COVID-19 and SARS were found to have significantly reduced enterprise innovation. However, the effect of SARS disappeared after two years. For COVID-19, information asymmetry, financing constraints, and economic policy uncertainty moderated the epidemic's effect on innovation. The results show that financing constraints and economic policy uncertainty reduce the epidemic's negative impact. However, while most previous studies have found that an epidemic reduces the information asymmetry between investors and enterprises in the short term, thus raising enterprise innovation, we found that information asymmetry aggravated the epidemic's negative impact. These findings can be applied to alleviate the current epidemic's negative impact as well as improve enterprise innovation thereafter.

Impact of Catastrophic Health Expenditures on Chinese Household Consumption.

China has built a social medical insurance system that covers the entire population so as to reduce the impact of diseases on individuals and families. Although the decline in the incidence of catastrophic health expenditures (CHEs) in China is encouraging, this issue remains important. On the basis of considering selectivity bias and heterogeneity, we applied propensity score matching (PSM) to analyze the 2018 data from the China Family Panel Studies. We assigned CHE households and non-CHE households to the treatment group and the control group, respectively, and used non-random data to simulate a randomized trial to investigate the impact of CHE on household consumption in China. The results of this study indicate that, when the threshold is set at 40%, the consumption of households experiencing CHEs (CHE household) is significantly lower than that of households not experiencing CHEs (non-CHE households) and that CHEs have a significant negative impact on other household consumption and a significant impact on the household property and debt. This effect still exists when the threshold is set lower, with household essential consumption most affected. The occurrence of CHEs leads to a reduction in household consumption and a significantly worsening financial situation for the CHE households, impacting the basic quality of life of the families. Therefore, it is necessary to further reform the medical and health system to reduce the high medical expenses.

Association among sleep, depression, and health-related quality of life in patients with non-dialysis chronic kidney disease during the coronavirus disease 2019 pandemic.

BACKGROUND: Sleep disturbance is well documented as a crucial element that impairs health. Depression and health-related quality of life (HRQOL), which on behalf of a patient's overall perception of emotional, physical and social well-being, are increasingly emphasized self-reported health outcomes especially during the coronavirus disease 2019 (COVID-19) pandemic. Among dialysis patients, sleep disturbance is associated with depression and poorer HRQOL. The study was designed to depict the prevalence of sleep disturbance, and to explore the association among sleep, depression, and HRQOL in patients with non-dialysis chronic kidney disease (CKD) during the COVID-19 pandemic. METHODS: A total of 172 non-dialysis CKD patients enrolled in this cross-sectional study, with sociodemographic and clinical data recorded. Sleep, HRQOL, and depression were evaluated via the Pittsburgh Sleep Quality Index (PSQI), the Kidney Disease Quality of Life 36-Item Short-Form Survey (KDQOL-36), and the 9-item Patient Health Questionnaire (PHQ-9), respectively. RESULTS: A total of 100 (58%) met the criteria for poor sleep. Good sleepers had strikingly disparate HRQOL and depression scores compared to poor sleepers. Sleep disorders were significantly associated with decreased HRQOL and increased depression in regression models adjusted or unadjusted for sociodemographic and clinical characteristics. Mediation analysis indicated depression was a significant mediator explaining 51% of the relationship between sleep status with physical component summary (PCS) and played a fully mediating role in the association between sleep and mental component summary (MCS). CONCLUSIONS: Our study suggested the high incidence of sleep disorders in patients with non-dialysis CKD during the COVID-19 pandemic, as well as the tight associations among sleep, depression, and HRQOL. Considering the negative influences of sleep and depression on HRQOL, appropriate screening and treatment for these treatable health-related domains are necessary for patients with non-dialysis CKD.

Long-Term Kinetics of SARS-CoV-2 Antibodies and Impact of Inactivated Vaccine on SARS-CoV-2 Antibodies Based on a COVID-19 Patients Cohort.

Background: Understanding the long-term kinetic characteristics of SARS-CoV-2 antibodies and the impact of inactivated vaccines on SARS-CoV-2 antibodies in convalescent patients can provide information for developing and improving vaccination strategies in such populations. Methods: In this cohort, 402 convalescent patients who tested positive for SARS-CoV-2 by RT-PCR from 1 January to 22 June 2020 in Jiangsu, China, were enrolled. The epidemiological data included demographics, symptom onset, and vaccination history. Blood samples were collected and tested for antibody levels of specific IgG, IgM, RBD-IgG, S-IgG, and neutralizing antibodies using a the commercial magnetic chemiluminescence enzyme immunoassay. Results: The median follow-up time after symptom onset was 15.6 months (IQR, 14.6 to 15.8). Of the 402 convalescent patients, 44 (13.84%) received an inactivated vaccine against COVID-19. A total of 255 (80.19%) patients were IgG-positive and 65 (20.44%) were IgM-positive. The neutralizing antibody was 83.02%. Compared with non-vaccinated individuals, the IgG antibody levels in vaccinated people were higher (P=0.007). Similarly, antibody levels for RBD-IgG, S-IgG, and neutralizing antibodies were all highly increased in vaccinated individuals (P<0.05). IgG levels were significantly higher after vaccination than before vaccination in the same population. IgG levels in those who received 'single dose and ≥14d' were similar to those with two doses (P>0.05). Similar conclusions were drawn for RBD-IgG and the neutralizing antibody. Conclusion: 15.6 months after symptom onset, the majority of participants remained positive for serum-specific IgG, RBD-IgG, S-IgG, and neutralizing antibodies. For convalescent patients, a single dose of inactivated vaccine against COVID-19 can further boost antibody titres.

Sex differences in clinical characteristics and risk factors for mortality among severe patients with COVID-19: a retrospective study.

The coronavirus disease 2019 (COVID-19) became a global pandemic. Males, compared to females, seem to be more susceptible to COVID-19, but related evidence is scarce, especially in severe patients. We explored sex differences in clinical characteristics and potential risk factors for mortality in severe COVID-19 patients. In this retrospective cohort study, we included all severe COVID-19 patients admitted to Eastern Renmin Hospital of Wuhan University, Wuhan, China, with a definitive clinical outcome as of Apr 10, 2020. Of the included 651 patients, 332 were male, and 319 were female. Males and females did not differ in age and underlying comorbidities. Males were more likely than females to report fever and develop serious complications, including acute respiratory distress syndrome, secondary infection, acute cardiac injury, coagulopathy, acute kidney injury and arrhythmia. Further, males had much higher mortality relative to females. Multivariable regression showed neutrophilia (odds ratio 6.845, 95% CI 1.227-38.192, p=0.028), thrombocytopenia (19.488, 3.030-25.335, p=0.002), hypersensitive troponin I greater than 0.04 pg/mL (6.058, 1.545-23.755, p=0.010), and procalcitonin greater than 0.1 ng/mL (6.350, 1.396-28.882, p=0.017) on admission were associated with in-hospital death. With either of these risk factors, the cumulative survival rate was relatively lower in males than in females. In conclusion, males are more likely than females to develop serious complications and progress to death. The potential risk factors of neutrophilia, thrombocytopenia, hypersensitive troponin I greater than 0.04 pg/mL and procalcitonin more than 0.1 ng/mL may help clinicians to identify patients with poor outcomes at an early stage, especially in males.

Specific ACE2 Expression in Cholangiocytes May Cause Liver Damage After 2019-nCoV Infection (preprint)

A newly identified coronavirus, 2019-nCoV, has been posing significant threats to public health since December 2019. ACE2, the host cell receptor for severe acute respiratory syndrome coronavirus (SARS), has recently been demonstrated in mediating 2019-nCoV infection. Interestingly, besides the respiratory system, substantial proportion of SARS and 2019-nCoV patients showed signs of various degrees of liver damage, the mechanism and implication of which have not yet been determined. Here, we performed an unbiased evaluation of cell type specific expression of ACE2 in healthy liver tissues using single cell RNA-seq data of two independent cohorts, and identified specific expression in cholangiocytes. The results indicated that virus might directly bind to ACE2 positive cholangiocytes but not necessarily hepatocytes. This finding suggested the liver abnormalities of SARS and 2019-nCoV patients may not be due to hepatocyte damage, but cholangiocyte dysfunction and other causes such as drug induced and systemic inflammatory response induced liver injury. Our findings indicate that special care of liver dysfunction should be installed in treating 2019-nCoV patients during the hospitalization and shortly after cure.

Ensuring the Sustainability of University Learning: Case Study of a Leading Chinese University

The spread of the novel coronavirus at the start of 2020 shocked higher education across China then around the rest of the world. To ensure sustainability of learning, this required an unprecedented shift from campus-based to emergency online education. This created an urgent need to learn more about the quality of online education, the provision of global education, and the transformation potential of universities. This paper analyses these matters, presenting insights from large-scale research conducted on a leading Chinese university, the first ever major research university to make this substantial transition. This research applied a mixed methods design, which combines quantitative and qualitative approaches. The results provide important insight into the nature, quality, and outcomes of online learning in major Asian research universities. They signal critical areas that require reform to ensure the sustainability of future higher education.