DDX21 mediates co-transcriptional RNA m6A modification to promote transcription termination and genome stability.

N6-methyladenosine (m6A) is a crucial RNA modification that regulates diverse biological processes in human cells, but its co-transcriptional deposition and functions remain poorly understood. Here, we identified the RNA helicase DDX21 with a previously unrecognized role in directing m6A modification on nascent RNA for co-transcriptional regulation. DDX21 interacts with METTL3 for co-recruitment to chromatin through its recognition of R-loops, which can be formed co-transcriptionally as nascent transcripts hybridize onto the template DNA strand. Moreover, DDX21's helicase activity is needed for METTL3-mediated m6A deposition onto nascent RNA following recruitment. At transcription termination regions, this nexus of actions promotes XRN2-mediated termination of RNAPII transcription. Disruption of any of these steps, including the loss of DDX21, METTL3, or their enzymatic activities, leads to defective termination that can induce DNA damage. Therefore, we propose that the R-loop-DDX21-METTL3 nexus forges the missing link for co-transcriptional modification of m6A, coordinating transcription termination and genome stability.

Analysis of the prophylactic effect of thymosin drugs on COVID-19 for 435 medical staff: A hospital-based retrospective study.

To explore the role of thymosin drugs in the prevention of novel coronavirus disease (COVID-19), we analyzed the preventive effects of different medication timings on health medical staff, and then provided recommendations for pharmaceutical monitoring of thymus drugs. The hospital-based retrospective study analyzed 435 medical staffers, treated with or without thymosin drugs as preventive medicines in our hospital of Wuhan City, from January 25 to March 25, 2020. For the prophylactics, the medical staff was prevented from pre-exposure prophylaxis (risk prevention of exposure to COVID-19 patients before using thymosin drugs) and postexposure prophylaxis (risk prevention of exposure to COVID-19 patients after using thymosin drugs). The effectiveness and safety of thymosin drugs were studied in the prevention and control of COVID-19 application, in real-world data research for the application of the drug for COVID- 19. In a similar exposure environment, compared to medical staffers who did not take preventive medicine, the use of thymosin drugs, before exposure and after exposure had an insignificant effect, and the adverse drug reaction (ADR) was increased, especially when thymosin drugs were used together with α-interferon.

Perioperative management of patients with suspected or confirmed COVID-19: review and recommendations for perioperative management from a retrospective cohort study.

BACKGROUND: Current guidelines for perioperative management of coronavirus disease 19 (COVID-19) are mainly based on extrapolated evidence or expert opinion. We aimed to systematically investigate how COVID-19 affects perioperative management and clinical outcomes, to develop evidence-based guidelines. METHODS: First, we conducted a rapid literature review in EMBASE, MEDLINE, PubMed, Scopus, and Web of Science (January 1 to July 1, 2020), using a predefined protocol. Second, we performed a retrospective cohort analysis of 166 women undergoing Caesarean section at Tongji Hospital, Wuhan during the COVID-19 pandemic. Demographic, imaging, laboratory, and clinical data were obtained from electronic medical records. RESULTS: The review identified 26 studies, mainly case reports/series. One large cohort reported greater mortality in elective surgery patients diagnosed after, rather than before surgery. Higher 30 day mortality was associated with emergency surgery, major surgery, poorer preoperative condition and surgery for malignancy. Regional anaesthesia was favoured in most studies and personal protective equipment (PPE) was generally used by healthcare workers (HCWs), but its use was poorly described for patients. In the retrospective cohort study, duration of surgery, oxygen therapy and hospital stay were longer in suspected or confirmed patients than negative patients, but there were no differences in neonatal outcomes. None of the 262 participating HCWs was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) when using level 3 PPE perioperatively. CONCLUSIONS: When COVID-19 is suspected, testing should be considered before non-urgent surgery. Until further evidence is available, HCWs should use level 3 PPE perioperatively for suspected or confirmed patients, but research is needed on its timing and specifications. Further research must examine longer-term outcomes. CLINICAL TRIAL REGISTRATION: CRD42020182891 (PROSPERO).

Determinants of Patients' Intention to Use the Online Inquiry Services Provided by Internet Hospitals: Empirical Evidence From China.

BACKGROUND: Internet hospitals show great potential for adequately fulfilling people's demands for high-quality outpatient services, and with the normalization of the epidemic prevention and control of COVID-19, internet hospitals play an increasingly important role in delivering health services to the public. However, the factors that influence patients' intention to use the online inquiry services provided by internet hospitals remain unclear. Understanding the patients' behavioral intention is necessary to support the development of internet hospitals in China and promote patients' intention to use online inquiry services provided by internet hospitals during the prevention and control of the COVID-19 epidemic. OBJECTIVE: The purpose of this study is to identify the determinants of patients' intention to use the online inquiry services provided by internet hospitals based on the theory of planned behavior (TPB). METHODS: The hypotheses of our research model were developed based on the TPB. A questionnaire was developed through patient interviews, verified using a presurvey, and used for data collection for this study. The cluster sampling technique was used to include respondents with chronic diseases. Structural equation modeling was used to test the research hypotheses. RESULTS: A total of 638 valid responses were received from patients with chronic diseases. The goodness-of-fit indexes corroborated that the research model was a good fit for the collected data. The model explained 45.9% of the variance in attitude toward the behavior and 60.5% of the variance in behavioral intention. Perceived behavioral control and perceived severity of disease had the strongest total effects on behavioral intention (ß=.624, P=.004 and ß=.544, P=.003, respectively). Moreover, perceived convenience, perceived information risk, emotional preference, and health consciousness had indirect effects on behavioral intention, and these effects were mediated by attitude toward the behavior. Among the four constructs, perceived convenience had the highest indirect effect on behavioral intention (ß=.207; P=.001). CONCLUSIONS: Perceived behavioral control and perceived severity of disease are the most important determinants of patients' intention to use the online inquiry services provided by internet hospitals. Therefore, internet hospitals should further optimize the design of online service delivery and ensure a reasonable assembly of high-quality experts, which will benefit the promotion of patients' adoption intention toward online inquiry services for health purposes. Perceived convenience, emotional preference, and perceived risks also have effects on behavioral intention. Therefore, the relevant quality control standards and regulations for internet hospitals should be further developed and improved, and the measures to protect personal information should be strengthened to ensure the patient safety. Our study supports the use of the TPB in explaining patients' intention to use online inquiry services provided by internet hospitals.

Phytoremediation of heavy metal contaminated soil potential by woody plants on Tonglushan ancient copper spoil heap in China.

Fast-growing metal-accumulating woody plants are considered potential candidates for phytoremediation of metals. Tonglushan mining, one of the biggest Cu production bases in China, presents an important source of the pollution of environment. The sample was collected at Tonglushan ancient copper spoil heap. The aims were to measure the content of heavy metal in the soil and woody plants and to elucidate the phytoremediation potential of the plants. The result showed that soil Cu, Cd and Pb were the main contamination, the mean contents of which were 3166.73 mg/kg, 3.66 mg/kg and 137.06 mg/kg respectively, which belonged to severe contamination. Fourteen species from 14 genera of 13 families were collected and investigated; except for Ligutrum lucidum, the other 13 woody plants species were newly recorded in this area. In addition, to assess the ability of metal accumulation of these trees, we proposed accumulation index. Data suggested that Platanus × acerilolia, Broussonetia papyrifera, Ligutrum lucidum, Viburnum awabuki, Firmiana simplex, Robina pseudoacacia, Melia azedarach and Osmanthus fragrans exhibited high accumulated capacity and strong tolerance to heavy metals. Therefore, Platanus × acerilolia and Broussonetia papyrifera can be planted in Pb contaminated areas; Viburnum awabuki, Firmiana simplex, Robina pseudoacacia and Melia azedarach are the suitable trees for Cd contaminated areas; Viburnum awabuki, Melia azedarach, Ligutrum lucidum, Firmiana simplex, Osmanthus fragrans and Robina pseudoacacia are appropriate to Cu, Pb and Cd multi-metal contaminated areas.

Terrestrial water storage regime and its change in the endorheic Tibetan Plateau.

Analogous to flow regime, this study proposed a new statistical framework to assess inter-annual and intra-annual terrestrial water storage (TWS) regime and its changes from the aspects of magnitude, variability, duration and components. The framework was applied to two endorheic basins, Inner Basin (IB) and Qaidam Basin (QB), in the Tibetan Plateau and their eight sub-regions. Our major findings are as follows: (1) TWS in the IB (2.09-2.35 mm/a, P < 0.05) and QB (0.05-0.52 mm/a, P > 0.1) increased in all seasons from 1989 to 2019 with regional climate warming and wetting. TWS showed high increase rates (>4.50 mm/a, P < 0.05) in northeastern IB but decrease rates (<-0.90 mm/a) in southern IB. Seasonal total storage in groundwater, lake, permafrost and glacier (GLPIA) also increased in both the IB (2.55-2.68 mm/a, P < 0.05) and QB (0.05-0.43 mm/a). Seasonal soil water storage (SWA) decreased in the IB (-0.39 to -0.26 mm/a) and slightly increased in the QB (0.002-0.08 mm/a); (2) Intra-annual TWS followed approximately a cosine curve. After mutation, monthly TWS showed a higher positive magnitude change (>50 mm), accompanied by a longer duration and higher variability in the IB and its northeastern sub-regions. There was a large reduction in low storage (-18.25 mm) combined with higher variability in southeastern IB; (3) SWA change dominated the storage surplus in summer (82%) and storage deficit in autumn (-78%) and winter (-51%) in the IB, while GLPIA change dominated the storage surplus in spring (57%). In the QB, TWS change was mainly contributed by SWA change in spring (94%) and by GLPIA change in summer (73%), autumn (-62%) and winter (-58%). Component contribution rates showed a significant change in spring and winter but not much change in summer and autumn, indicating that the TWS components were more sensitive to climate change in the cold season.

Lake volume variation in the endorheic basin of the Tibetan Plateau from 1989 to 2019.

Lake storage change serves as a unique indicator of natural climate change on the Tibetan Plateau (TP). However, comprehensive lake storage data, especially for lakes smaller than 10 km2, are still lacking in the region. In this dataset, we completed a census of annual relative lake volume (RLV) for 976 lakes, which are larger than 1 km2, on the endorheic basin of the Tibetan Plateau (EBTP) during 1989-2019 using Landsat imagery and digital terrain models. Our method first identifies individual lakes, determines their analysis extents and calculates annual lake area from Landsat imagery. It then derives lake area-elevation relationship, estimates lake surface elevation, and calculates RLV. Validation and comparison with several existing datasets indicate our data are more reliable and comprehensive. Our study complements existing lake datasets by providing a complete and long-term lake water volume change data for the region.

An Observational Study of Physicians' Workflow Interruptions in Outpatient Departments in China.

Background: Workflow interruptions are frequent in hospital outpatient clinics. Eventually, not only reducing the work efficiency and quality, but also further threatening patient safety. Over the last 10-15 years, research on workflow interruptions in inpatient care has increased, but there is a lack of research on the interruptions in outpatient clinics. The present study aimed to study the differences in physicians' workflow interruptions among outpatient departments in the tertiary hospital in China. Methods: In a tertiary hospital, a standardized observational study of 32 doctors' workflow in outpatient department of four typical clinical specialties was conducted. The record of workflow interruptions was based on a self-made observation instrument after verifying its reliability and validity. Linear regression methods were used to assess outpatient characteristics as predictors of the number of interruptions. The Kruskal-Wallis test was used to analyze the difference about the duration of interruptions among specialties, and the Chi-Square Test was used to examine the sources of interruptions among different specialties, to determine whether interruption source is associated with specialty. Results: The number of patients was the significant independent predictor of the number of interruptions (p < 0.001). In terms of work tasks being interrupted, the highest interruption rate occurred when physicians were asking health history: 19.95 interruptions per hour. The distribution of interruption sources among the four clinical specialties were statistically different (X2 = 16.988, p = 0.049). Conclusion: The findings indicate that physicians' workflow interruptions are connected with many contents in the work system. Further emphasis should be placed on the effective application of hospital management measures in an interrupted environment to promote a safe and efficiency outpatient care.

The Patient Safety Culture Scale for Chinese Primary Health Care Institutions: Development, Validity and Reliability.

BACKGROUND: Existing patient safety culture assessment tools are mostly developed in western countries and may not be suitable for Chinese primary health care institutions. Primary care plays an important role in China's medical system, and a targeted tool for its patient safety culture is urgently needed. OBJECTIVE: The aim of the study was to develop a dependable instrument to assess the patient safety culture in Chinese primary health care institutions. METHODS: Three phases were undertaken to develop the scale. The first phase developed a pilot scale by literature review, focus groups, and 2-round Delphi expert consultation. The second phase conducted a pilot survey. The third phase carried out a formal survey to test reliability and validity, involving 369 participants from 9 primary health care institutions. RESULTS: The final scale included 32 items under 7 dimensions. For reliability, the Cronbach α coefficients among dimensions varied from 0.754 to 0.926, and the Cronbach α for the scale was 0.940. For content validity, the corrected item-level content validity varied between 0.64 and 1, the scale-level content validity index/universal agreement was 0.625, and the scale-level content validity index/average was 0.93. For construct validity, the Spearman correlations of dimension-total score varied between 0.129 and 0.851, all Spearman correlations of the dimension-total score were greater than that of interdimensions and the Spearman correlations of item-total score ranged from 0.042 to 0.775. The results of the confirmatory factor analysis indicated that the model fitted well. CONCLUSIONS: The Patient Safety Culture Scale for Chinese primary health care institutions demonstrated good reliability and acceptable validity; thus, it can be used as an assessment instrument for patient safety culture in Chinese primary health care institutions.

An analytical reductionist framework to separate the effects of climate change and human activities on variation in water use efficiency.

Ecosystem water use efficiency (WUE) is a key indicator that depicts the carbon-water coupling relationship in terrestrial ecosystems. Separating the effects of climate change and human activities to the variation in WUE are essential for water resources and ecosystem management, especially for fragile ecosystems such as the Tibetan Plateau (TP). In this study, we introduced an analytical framework that combined the attribution approach with the elastic coefficient separation method to assess the impact of climate change and human activities on WUE variation in the TP from 1982 to 2015. The results are the following: (1) the multiyear mean annual WUE over the TP was 0.65 g C·kg-1 H2O and had a slightly increasing trend with a slope of 0.004 g C·kg-1 H2O yr-1 with about 87% of the vegetated area showed increasing trend. (2) WUE was positively correlated with temperature, precipitation and air pressure. The northwest TP tends to be a water-limited condition, while the thermal stress is spatially universal in the TP, climate warming and wetting promoted the gross primary productivity (GPP) and WUE enhancement in the TP. (3) WUE was more sensitive to GPP, and variation in WUE was mainly contributed by GPP. Climate change and human activities tend to cause more variations in GPP rather than evapotranspiration (ET), but great differences exist for different regions and vegetation types. (4) There was a good consistency between the WUE variation calculated by the framework and the actual WUE variation (R2 = 0.95). Climate change dominated the increase of WUE in the TP with a contribution rate of 79.8%, while human activities tend to reduce WUE (-20.2%). Ecological projects played a positive role in the ecological restoration of the TP, but there may be other human activities, which caused ecological degradation, that may need more attention in future ecological protections.

Coagulopathy in elderly patients with coronavirus disease 2019.

BACKGROUND: Since the outbreak of coronavirus disease 2019 (COVID-19), clinical features have been analyzed in detail. However, coagulopathy in elderly COVID-19 patients has been scarcely reported. METHODS: Coagulation parameters of 189 patients with COVID-19 in Tongji hospital were retrospectively analyzed among age groups. RESULTS: Patients were divided into 2 groups: older group (≥65 years, n = 87) and younger group (<65 years, n = 102). The proportion of patients with elevated fibrinogen (79.0% vs 59.6%, p = .005) and D-dimer (78.0% vs 55.2%, p = .001) shows the significant difference between the groups. The elderly patients revealed significantly longer prothrombin time (14.0 [13.4-14.4]s vs 13.6 [13.2-14.1]s, p = .026), higher D-dimer (1.00 [0.5-1.9] µg/mL vs 0.6 [0.3-1.6] µg/mL, p = .013) and fibrinogen (5.2 [4.1-6.2] g/L vs 4.4 [3.4-5.7] g/L, p = .004) levels, compared to the younger group. A positive correlation was observed between the coagulation parameters and inflammatory markers including high-sensitivity C-reactive protein and interleukin-6 (p < .05). CONCLUSIONS: The hypercoagulable state is more common in elderly COVID-19 patients, and coagulopathy is associated with excessive systemic inflammation.

Clinical characteristics of 312 hospitalized older patients with COVID-19 in Wuhan, China.

OBJECTIVES: Much of the previous research on COVID-19 was based on all population. But substantial numbers of severe episodes occur in older patients. There is a lack of data about COVID-19 in older adults. The aims of this study were to analyze the clinical characteristics of older adult patients with COVID-19. METHODS: Retrospective study of older patients hospitalized with COVID-19 from February 1 st to March 31 st, 2020 was conducted in the Sino-French New City Branch of Tongjing Hospital in Wuhan, China. According to the degree of severity of COVID-19 during hospitalization, 312 older patients were divided into non-severe and severe cases. RESULTS: the mean age of the patients was 69.2 ± 7.3 years, and 47.4 % of patients had exposure history. 77.2 % of patients had a co-morbidity, with hypertension being the most common (57.1 %), followed by diabetes (38.8 %) and cardiovascular disease (29.8 %). Multivariable regression showed increasing odds of severe COVID-19 associated with age(OR 1.59, 95 %CI 1.13-2.08), SOFA score(OR 5.89, 95 %CI 3.48-7.96), APACHEⅡ score(OR 3.13, 95 %CI 1.85-5.62), platelet count＜125 × 109/L(OR 2.36, 95 %CI 1.03-4.14), d-dimer (OR 4.37, 95 %CI 2.58-7.16), creatinine＞133 µmol/L(OR 1.85, 95 %CI 1.12-3.04), interleukin-6(OR 4.32, 95 %CI 2.07-7.13), and lung consolidation(OR 1.94, 95 %CI 1.45-4.27) on admission. The most common complication was acute respiratory distress syndrome (35.6 %), followed by acute cardiac injury (33.0 %) and coagulation disorders (30.8 %). 91.7 % of patients were prescribed antiviral therapy, followed by immune globulin (52.9 %) and systemic glucocorticoids (43.6 %). 21.8 % of patients received invasive ventilation, 1.92 % for extracorporeal membrane oxygenation. The overall mortality was 6.73 %, and mortality of severe patients was 17.1 %, which was higher than non-severe patients (0.962 %). CONCLUSIONS: Older patients with COVID-19 had much more co-morbidity, complications and mortality. More attention should be paid to older patients with COVID-19.

Physician Mental Workload Scale in China: Development and Psychometric Evaluation.

OBJECTIVE: The purpose of our study is to develop a mental workload scale for physicians in China and assess the scale's reliability and validity. DESIGN: The instrument was developed over three phases involving 396 physicians from different tiers of comprehensive public hospitals in China. In the first phase, an initial item pool was developed through a systematic literature review. The second phase consisted of two rounds of Delphi expert consultations and a pilot survey. The third phase tested the reliability and validity of the instrument. SETTING: Public hospitals in China. PARTICIPANTS: A total of 396 physicians from different tiers of comprehensive public hospitals in China participated in this study in 2018. PRIMARY AND SECONDARY OUTCOME MEASURES: Cronbach's α, content validity index, item-total score correlation coefficient, dimension-total score correlation coefficient and indices of confirmatory factor analysis. RESULTS: Six dimensions (mental demands, physical demands, temporal demands, perceived risk, frustration level and performance) and 12 items were identified in the instrument. For reliability, Cronbach's α for the whole scale was 0.81. For validity, the corrected item-content validity index of each item ranged from 0.85 to 1, item-total score correlation coefficients ranged from 0.31 to 0.75, and the correlation coefficients between the dimensions and total score ranged from 0.37 to 0.72. The results of the confirmatory factor analysis showed that the goodness-of-fit indices of the scale were satisfactory. CONCLUSION: The instrument showed good reliability and validity, and it is useful for diagnosing the mental workload of physicians.

What Are the Risk Factors of Negative Patient Experience? A Cross-Sectional Study in Chinese Public Hospitals.

Hospitals are struggling to involve patients and learn from their experience. The risk factor of patient experience is increasingly recognized as a critical component in improving patient experience. Our study explored risk factors of negative patient experience in order to improve the health-service quality of public hospitals. We conducted a cross-sectional study in Hubei province, China. A total of 583 respondents were surveyed by the Outpatient Experience Questionnaire with good validity and reliability in July 2015. T-tests were conducted to compare the experience scores among different outpatient groups. Multiple linear regression was performed to determine the significant factors that influenced the outpatient experience. Outpatients between 18 and 44 years old had the lowest experience scores (65.89 ± 0.79), whereas outpatients completely paying out-of-pocket had the lowest experience scores (64.68 ± 0.81) among all participants. Outpatients with poor self-rated health status had the lowest experience scores (66.14 ± 1.61) among different self-rated health status groups. While age, type of payment, and self-rated health status were significantly risk factors that influenced outpatient experience in the multiple linear regression. Thus, health-care providers should pay more attention to outpatients who are young (age <45), completely out-of-pocket and poor health status, and provide precision health care to improve outpatient experience.