The Effect of the COVID-19 Pandemic on Non-COVID-19 Deaths: Population-Wide Retrospective Cohort Study.

BACKGROUND: Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non-COVID-19 deaths. OBJECTIVE: This study aimed to measure the impact of hospital avoidance on excess non-COVID-19 deaths in public hospitals in Hong Kong. METHODS: This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. RESULTS: Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non-COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non-COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non-DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. CONCLUSIONS: We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences.

Synthesis of the Macrolactone Cores of Maltepolides via a Diene-Ene Ring-Closing Metathesis Strategy.

Synthesis of the C19-truncated maltepolide E has been accomplished via a diene-ene ring-closing metathesis (RCM) strategy without damage to the C11-C14 alkenyl epoxy unit. Upon release of the C17-OH group, it attacked at the C14 position with double bond migration and epoxide ring opening to furnish the C19-truncated maltepolides A and B as proposed for the biosynthesis of maltepolides.

An artificial intelligence-enabled smartphone app for real-time pressure injury assessment.

The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%-100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management.

Incidence of Emergency Department Visits for Sexual Abuse Among Youth in Hong Kong Before and During the COVID-19 Pandemic.

This cohort study assesses the incidence of emergency department (ED) visits in Hong Kong, China, for sexual abuse among youth before and during the COVID-19 pandemic.

A Review of Historical Changes of Tropical and Extra-Tropical Cyclones: A Comparative Analysis of the United States, Europe, and Asia.

Tropical cyclones are highly destructive weather systems, especially in coastal areas. Tropical cyclones with maximum sustained winds exceeding 74 mph (≈119 kph) are classified as typhoons in the Northwest Pacific, whilst the term 'hurricanes' applies to other regions. This study aims to investigate the general characteristics of the most devastating and catastrophic tropical cyclones in the USA Europe, and Asia. To achieve the study objectives, the three most devastating typical tropical cyclones in each region were selected. The tropical cyclones were examined based on various features, such as the number of deaths, minimum pressure, highest wind speed, total financial losses, and frequency per year. In contrast to Europe and Asia, the USA has recorded the highest number of catastrophic tropical cyclones. The damage induced by hurricanes Katrina, Harvey, and Maria in the USA totalled approximately USD USD 380 billion. In addition, the present research highlights the demand to improve the public attitude and behaviour toward the impact of climate change along with the enhancement of climate change alleviation strategies. The number of intense tropical cyclones is expected to rise, and the tropical cyclone-related precipitation rate is expected to increase in warmer-climate areas. Stakeholders and industrial practitioners may use the research findings to design resilience and adaptation plans in the face of tropical cyclones, allowing them to assess the effects of climate change on tropical cyclone incidents from an academic humanitarian logistics viewpoint in the forthcoming years.

The method to quantify cell elasticity based on the precise measurement of pressure inducing cell deformation in microfluidic channels.

The cell elasticity has attracted extensive research interests since it not only provides new insights into cell biology but also is an emerging mechanical marker for the diagnosis of some diseases. This paper reports the method for the precise measurement of mechanical properties of single cells deformed to a large extent using a novel microfluidic system integrated with a pressure feedback system and small particle separation unit. The particle separation system was employed to avoid the blockage of the cell deformation channel to enhance the measurement throughput. This system is of remarkable application potential in the precise evaluation of cell mechanical properties. In brief, this paper reports:•The manufacturing of the chip using standard soft lithography;•The methods to deform single cells in a microchannel and measure the relevant pressure drop using a pressure sensor connecting to the microfluidic chip;•Calculation of the mechanical properties including stiffness and fluidity of each cell based on a power-law rheology model describing the viscoelastic behaviors of cells;•Automatic and real-time measurement of the mechanical properties using video processing software.

Built environment and the metropolitan pandemic: Analysis of the COVID-19 spread in Hong Kong.

The COVID-19 reported initially in December 2019 led to thousands and millions of people infections, deaths at a rapid scale, and a global scale. Metropolitans suffered serious pandemic problems as the built environments of metropolitans contain a large number of people in a relatively small area and allow frequent contacts to let virus spread through people's contacting with each other. The spread inside a metropolitan is heterogeneous, and we propose that the spatial variation of built environments has a measurable association with the spread of COVID-19. This paper is the pioneering work to investigate the missing link between the built environment and the spread of the COVID-19. In particular, we intend to examine two research questions: (1) What are the association of the built environment with the risk of being infected by the COVID-19? (2) What are the association of the built environment with the duration of suffering from COVID-19? Using the Hong Kong census data, confirmed cases of COVID-19 between January to August 2020 and large size of built environment sample data from the Hong Kong government, our analysis are carried out. The data is divided into two phases before (Phase 1) and during the social distancing measure was relaxed (Phase 2). Through survival analysis, ordinary least squares analysis, and count data analysis, we find that (1) In Phase 1, clinics and restaurants are more likely to influence the prevalence of COVID-19. In Phase 2, public transportation (i.e. MTR), public market, and the clinics influence the prevalence of COVID-19. (2) In Phase 1, the areas of tertiary planning units (i.e., TPU) with more restaurants are found to be positively associated with the period of the prevalence of COVID-19. In Phase 2, restaurants and public markets induce long time occurrence of the COVID-19. (3) In Phase 1, restaurant and public markets are the two built environments that influence the number of COVID-19 confirmed cases. In Phase 2, the number of restaurants is positively related to the number of COVID-19 reported cases. It is suggested that governments should not be too optimistic to relax the necessary measures. In other words, the social distancing measure should remain in force until the signals of the COVID-19 dies out.

Restraint Stress Alters Expression of Glucocorticoid Bioavailability Mediators, Suppresses Nrf2, and Promotes Oxidative Stress in Liver Tissue.

Hepatic glutathione synthesis and antioxidant protection are critically important for efficient detoxification processes in response to metabolic challenges. However, this biosynthetic pathway, regulated by nuclear factor (erythroid-derived 2)-like 2 (Nrf2), previously demonstrated paradoxical repression following exposure to glucocorticoid stress hormones in cultured hepatic cells. Therefore, the present study used an in vivo model of sub-acute psychological stress to investigate the relationship between hepatic corticosteroid regulation and antioxidant systems. Male Wistar rats were kept under control conditions or subjected to six hours of restraint stress applied for 1 or 3 days (n = 8 per group) after which the liver was isolated for assays of oxidative/nitrosative status and expression of corticosteroid regulatory and Nrf2-antioxidant response element pathway members. A single stress exposure produced a significant increase in the expression of corticosterone reactivator, 11-beta-hydroxysteroid dehydrogenase 1 (11ß-Hsd1), while the 11ß-Hsd2 isozyme and corticosteroid-binding globulin were down-regulated following stress, indicative of an elevated availability of active corticosterone. Exposure to restraint significantly decreased hepatic concentrations of total cysteine thiols and the antioxidant reduced glutathione on Day 1 and increased 3-nitrotyrosinated and carbonylated proteins on Day 3, suggestive of oxidative/nitrosative stress in the liver following stress exposure. Conversely, there was a sustained down-regulation of Nrf2 mRNA and protein in addition to significant reductions in downstream glutamate-cysteine ligase catalytic subunit (Gclc), the rate-limiting enzyme in glutathione synthesis, on Day 1 and 3 of stress treatment. Interestingly, other antioxidant genes including superoxide dismutase 1 and 2, and glutathione peroxidase 4 were significantly up-regulated following an episode of restraint stress. In conclusion, the results of the present study indicate that increased expression of 11ß-Hsd1, indicative of elevated tissue glucocorticoid concentrations, may impair the Nrf2-dependent antioxidant response.

Differences in study workload stress and its associated factors between transfer students and freshmen entrants in an Asian higher education context.

Unlike the studies of freshmen entrants, the learning experiences of community college transfer (CCT) students in the receiving university is a topic that has only started to gain attention in recent decades. Little is known about the differences between CCT and freshmen entrants with regard to their study workload stress and its relationship with their perceptions of the teaching and learning environment, approaches to learning, self-efficacy and generic skills. The purpose of our study was to address this gap. This was a cross-sectional survey study conducted from April 2018 to November 2018 in a university in Hong Kong. The HowULearn questionnaire was adapted to local usage and validated for data collection. In total, 841 CCT students and 978 freshmen entrants completed the survey. The respondents were aged between 19 and 52 years (mean = 21.6, SD = 1.92), and 66.0% were women. The HowULearn questionnaire was determined by factor analyses to have eight factors. The reliabilities of the eight factors were found to be acceptable (Cronbach alphas = 0.709-0.918). The CCT students scored significantly higher than the freshmen entrants for perceived study workload stress and surface approaches to learning, but lower on teaching for understanding & encouraging learning, peer support, and self-efficacy beliefs. The surface approach to learning, deep & organized studying, alignment & constructive feedback, and generic skills were found to be predictors of study workload stress in both groups of students, and in the overall student data. This study has shown that CCT students and freshmen entrants differed with regard to their study workload stress and learning experiences. Our findings provide a message, both for educators in higher education and policy makers in the government-there is not a one-size-fits-all approach to different student populations when it comes to enhancing their learning experiences.

Effects of COVID-19 on maritime industry: a review.

COVID-19 is a global disease that has quickly shaken the world economy since the beginning of 2020 and consequently has significantly affected the shipping industries development (including shipping operators, port operators, government authorities, shippers, seafarers, passengers, supply chain operators, etc.). Currently, the clinical management of COVID-19 remains unclear. In order to understand the newest challenges and figure out potential solutions for the maritime industries post COVID-19, this paper selected four shipping industries (including dry bulk, tanker, container, and cruiser sector) and reviewed these industries' newest development. The research findings can strengthen the awareness of COVID-19 and reduce operational risk and further improve business performance for the maritime related industries and authorities.

Why hope can reduce negative emotion? Could psychosocial resource be the mediator?

The interrelationship between hope, psychological resources and depression needs clarification. The current study aimed to examine the interrelationship using empirical data. A total of 139 Chinese adults living in the community were invited to fill in questionnaires measuring dispositional hope, psychological resources (i.e. optimism, self-efficacy, social support and positive affect) and negative emotion (i.e. negative affect and depression). Structural equation modelling showed that negative emotion is partially mediated between hope and psychological resources. A bootstrap-estimated analysis corrected for bias showed that negative emotion plays a mediation role between hope and psychological resources. Hope is directly and indirectly related to psychological resources via negative emotion. The potential of hope as an intervention to assist patients with depression to achieve their treatment goals is discussed.

Sub-acute restraint stress progressively increases oxidative/nitrosative stress and inflammatory markers while transiently upregulating antioxidant gene expression in the rat hippocampus.

We have previously demonstrated that acute stress decreases neuronal nitric oxide synthase (NOS) expression in the hippocampus despite increased concentrations of nitric oxide which may indicate feedback inhibition of neuronal NOS expression via inducible NOS-derived nitric oxide. Moreover, the hippocampus undergoes an initial oxidative/nitrosative insult that is rapidly followed by upregulation of protective antioxidants, including the zinc-binding metallothioneins, in order to counter this and restore redox balance following acute stress exposure. In the present study, we have utilized indicators of oxidative/nitrosative stress, members of the nuclear factor (erythroid-derived 2)-like 2 (Nrf2) pathway, antioxidant metallothioneins, and neuroinflammatory markers to observe the changes occurring in the hippocampus following short term repeated stress exposure. Male Wistar rats were subjected to control conditions or 6 h of restraint stress applied for 1, 2, or 3 days (n = 8 per group) after which the hippocampus was isolated for redox assays and relative gene expression. The hippocampus showed increased oxidative stress, transient dys-homeostasis of total zinc, and increased expression of the Nrf2 pathway members. Moreover, repeated stress increased nitrosative status, nitric oxide metabolites, and 3-nitrotyrosine, indicative of nitrosative stress in the hippocampus. However, levels of neuronal NOS decreased over all stress treatment groups, while increases were observed in inducible NOS and xanthine dehydrogenase. In addition to inducible NOS, mRNA expression of other inflammatory markers including interleukin-6 and interleukin-1ß also increased even in the presence of increased anti-inflammatory glucocorticoids. Together, these results demonstrate that despite increases in antioxidant expression, sub-acute stress causes an inflammatory phenotype in the hippocampus by inducing oxidative/nitrosative stress, zinc dys-homeostasis, and the accumulation of nitrotyrosinated proteins which is likely driven by increased inducible NOS signaling.

Vessel traffic safety in busy waterways: A case study of accidents in western shenzhen port.

Throughout the world, busy waterways near large ports witness heavy vessel traffic in recent decades. The waterways are characterized by high risk in terms of loss of life, property, and pollution to environment. To facilitate maritime safety management with satisfactory efficiency and efficacy, the authors propose a framework of safety indexes to evaluate the risk level in busy waterways according to the accident severity, fatality rate and special indicators of maritime transportation. The safety indexes consist of Safety Evaluation Index (SEI) and Safety Warning Index (SWI), and are derived from the proposed risk criteria of Chinese vessel traffic. As a case study, data on vessel traffic accidents reported in the Western Shenzhen Port, South China from 1995 to 2015 are analyzed. The actual risk level of this area during the period is calculated under the framework. The implementation of the safety indexes indicate that the risk criteria and safety indexes are practicable and effective for the vessel traffic management. The methodology based on long-term accident data can significantly support the risk analysis in the macroscopic perspective for busy ports and waterways, such that SWI can act as threshold to trigger actions, while SEI can act as an indicator to measure safety status.

Advancements in Host-Based Interventions for Influenza Treatment.

Influenza is a major acute respiratory infection that causes mortality and morbidity worldwide. Two classes of conventional antivirals, M2 ion channel blockers and neuraminidase inhibitors, are mainstays in managing influenza disease to lessen symptoms while minimizing hospitalization and death in patients with severe influenza. However, the development of viral resistance to both drug classes has become a major public health concern. Vaccines are prophylaxis mainstays but are limited in efficacy due to the difficulty in matching predicted dominant viral strains to circulating strains. As such, other potential interventions are being explored. Since viruses rely on host cellular functions to replicate, recent therapeutic developments focus on targeting host factors involved in virus replication. Besides controlling virus replication, potential targets for drug development include controlling virus-induced host immune responses such as the recently suggested involvement of innate lymphoid cells and NADPH oxidases in influenza virus pathogenesis and immune cell metabolism. In this review, we will discuss the advancements in novel host-based interventions for treating influenza disease.

Recognition of Double-Stranded RNA and Regulation of Interferon Pathway by Toll-Like Receptor 10.

Toll-like receptor (TLR)-10 remains an orphan receptor without well-characterized ligands or functions. Here, we reveal that TLR10 is predominantly localized to endosomes and binds dsRNA in vitro at endosomal pH, suggesting that dsRNA is a ligand of TLR10. Recognition of dsRNA by TLR10 activates recruitment of myeloid differentiation primary response gene 88 for signal transduction and suppression of interferon regulatory factor-7 dependent type I IFN production. We also demonstrate crosstalk between TLR10 and TLR3, as they compete with each other for dsRNA binding. Our results suggest for the first time that dsRNA is a ligand for TLR10 and propose novel dual functions of TLR10 in regulating IFN signaling: first, recognition of dsRNA as a nucleotide-sensing receptor and second, sequestration of dsRNA from TLR3 to inhibit TLR3 signaling in response to dsRNA stimulation.

Changes in hippocampal inflammatory-related and redox enzyme genes in response to sub-acute restraint stress: Additional dataset.

This data article presents complementary results pertaining to the research article entitled "Sub-acute restraint stress progressively increases oxidative/nitrosative stress and inflammatory markers while transiently upregulating antioxidant gene expression in the rat hippocampus" (Chen et al., 2018). The present article provides additional gene expression data of selected neuroinflammatory markers and regulatory enzymes involved in oxidation-reduction reactions. Male Wistar rats aged 7-8 weeks were exposed to control, 1, 2, or 3 episodes of 6-h restraint stress in the light cycle after which the whole brain was quickly removed and the hippocampus excised for relative gene expression analysis. Specifically, mRNA levels of inflammatory regulators including allograft inflammatory factor 1, class II major histocompatibility complex, integrin alpha M, interferon gamma, and prostaglandin-endoperoxide synthase 2 were analyzed by real-time PCR. The gene expression of redox regulatory enzymes including glutathione peroxidase 1, glutathione peroxidase 4, superoxide dismutase 1, superoxide dismutase 2, myeloperoxidase, and NADPH oxidase subunit P47phox were also determined. These data provide useful insights in the molecular basis of inflammatory and redox regulation in the hippocampus following a short term to repeated psychological challenge in rats.

Determinants of injuries in passenger vessel accidents.

This paper investigates determinants of crew and passenger injuries in passenger vessel accidents. Crew and passenger injury equations are estimated for ferry, ocean cruise, and river cruise vessel accidents, utilizing detailed data of individual vessel accidents that were investigated by the U.S. Coast Guard during the time period 2001-2008. The estimation results provide empirical evidence (for the first time in the literature) that crew injuries are determinants of passenger injuries in passenger vessel accidents.

Toll-like receptor 10 is involved in induction of innate immune responses to influenza virus infection.

Toll-like receptors (TLRs) play key roles in innate immune recognition of pathogen-associated molecular patterns of invading microbes. Among the 10 TLR family members identified in humans, TLR10 remains an orphan receptor without known agonist or function. TLR10 is a pseudogene in mice and mouse models are noninformative in this regard. Using influenza virus infection in primary human peripheral blood monocyte-derived macrophages and a human monocytic cell line, we now provide previously unidentified evidence that TLR10 plays a role in innate immune responses following viral infection. Influenza virus infection increased TLR10 expression and TLR10 contributed to innate immune sensing of viral infection leading to cytokine induction, including proinflammatory cytokines and interferons. TLR10 induction is more pronounced following infection with highly pathogenic avian influenza H5N1 virus compared with a low pathogenic H1N1 virus. Induction of TLR10 by virus infection requires active virus replication and de novo protein synthesis. Culture supernatants of virus-infected cells modestly up-regulate TLR10 expression in nonvirus-infected cells. Signaling via TLR10 was activated by the functional RNA-protein complex of influenza virus leading to robust induction of cytokine expression. Taken together, our findings identify TLR10 as an important innate immune sensor of viral infection and its role in innate immune defense and immunopathology following viral and bacterial pathogens deserves attention.

The effectiveness of double hulls in reducing vessel-accident oil spillage.

While much work has been done in investigating determinants of oil spillage attributed to vessel accidents, little research has been conducted on the effectiveness of ship hull design in reducing marine pollution. This paper addresses whether the double-hull requirement reduces vessel-accident oil spillage. The volume of oil spillage due to oil-cargo vessel accidents was investigated using tobit regressions and an empirical data set of individual vessel accident pollution incidents investigated by the US Coast Guard from 2001 to 2008. The results indicate that the double hull design on average reduces the size of oil spills by 20% and 62% in tank barge and tanker ship accidents, respectively.