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Aims: This study examined the impact of the COVID-19 pandemic on mothers or childbearing parents using ongoing, systematic screening of a representative Ontario sample. Method(s): An interrupted time series analysis was conducted on data captured in the Healthy Babies Healthy Children (HBHC) screening tool to determine effects of the pandemic on relationships, support, mental health, and related clinical outcomes at the time of postpartum discharge from hospital. The ability to parent or care for the baby/child and other psychosocial and behavioural outcomes were assessed. Result(s): The co-primary outcomes of inability to parent or care for the baby/child were infrequently observed in both the pre -pandemic (March 9, 2019-March 15, 2020) and initial pandemic periods (March 16, 2020-March 23, 2021) ((parent 209/63,006 (0.33%) to 177/56,117 (0.32%), care 537/62,955 (0.85%) to 324/56,086 (0.58%)). Changes following pandemic onset were not observed for either outcome although a significant (beta = 1.013, 95% CI 1.002-1.025, p = 0.02) increase in slope was observed for inability to parent (with questionable clinical significance). For secondary outcomes, worsening was only seen for complications during labour/delivery. Significant improvements were observed in the likelihood of being unable to identify a support person to assist with care, need of newcomer support, and concerns about money over time. Conclusion(s): Despite more complications during labour/delivery, there were no substantive changes in concerns about ability to parent or care for children. Adverse impacts of the pandemic may have been mitigated by accommodations for remote work and social safety net policies.Copyright © 2023
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PurposeWhile researchers recognize the significance of philanthropic donations in disaster relief and recovery, the benefits that firms derive from such donations remain unclear, particularly when firms are adversely impacted by the disaster. To address this gap, this study seeks to elucidate the impact of various donation strategies on firm resilience in the context of the COVID-19 pandemic.Design/methodology/approachBased on the hand-collected data on donations, the authors employ ordinary least squares regressions to investigate the effectiveness of various donation strategies - including type, timing and location - in enhancing firm resilience in terms of the severity of stock price losses during the pandemic. To address potential endogeneity concerns, the authors use a two-stage least squares regression with instrumental variables.FindingsThis study finds robust evidence that certain donation strategies are more effective at mitigating stock price losses during the pandemic. Specifically, the authors find that in-kind donations (compared to monetary ones), earlier donations (compared to later ones) and donations targeting severely impacted areas (Hubei province vs. other places) are more effective methods to reduce the severity of stock price losses.Originality/valueThis study points out an alternative mechanism through which donations influence firm resilience during a crisis context and provides important managerial implications for firms to better engage in disaster donations.
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The aim of this article is to explore whether COVID-19 aroused an awareness of death, inflamed death anxiety, and affected mental health and to assess the degree that meaning in life played in the relationship between death anxiety and general mental health. A total of 197 participants were recruited using convenience sampling and were divided into an experimental group (n = 100) and a control group (n = 97). All participants completed the Death Anxiety Scale (DA), the Meaning in Life Questionnaire (MLQ), and the General Health Questionnaire (GHQ-12). Death anxiety had a significant positive predictive effect on general mental health and meaning in life. When death anxiety and meaning in life were included in the regression equation, death anxiety still had a significant positive predictive effect on general mental health, and meaning in life had a significant positive predictive effect on general mental health. These results indicated that meaning in life played a partially mediating role in the influence of death anxiety on general mental health. In the COVID-19 context, death information was found to arouse awareness of death and death anxiety, which adversely affected mental health, and it was also confirmed that meaning in life played a partially mediating role between death anxiety and general mental health, which suggested that mental health problems could be alleviated in the future by helping people find meaning and value in their lives and cope more positively with death.
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Objective: To systematically evaluate the efficacy and safety of arbidol in the treatment of novel coronavirus pneumonia (COVID-19). Method(s): Randomized controlled trials (RCTs), cohort studies, and case-control studies on the efficacy and safety of arbidol for COVID-19, influenza, andother respiratory virus infections were collected by searching related database at home and abroad and network platform for preprint of Health Science Papers (medRxiv) (up to April 25, 2020). Quality of the enrolled studies was evaluated by bias risk assessment tool of Cochrane collaboration network and Newcastle-Ottawa Scale (NOS). Meta-analysis and descriptive analysis of relevant outcome indicators were performed using RevMan 5.3 software. Result(s): A total of 15 studies were enrolled in the study, including 7 cohort studies with high-quality and 8 RCTs, 6 of which were with low bias risk and the other 2 of which were with medium bias risk. Among these studies, 8 were on arbidol treatment for COVID-19, including 5 retrospective cohort studies, 2 prospective cohort studies, and 1 RCT, and involving 809 patients (479 patients in the arbidol group and 330 in the control group);7 were RCTs on arbidol treatment for influenza or other respiratory virus infections, involving 1 471 patients (745 patients in the arbidol group and 726 in the control group).In these studies, patients were treated with arbidol (0.15-1.2 g daily for 5-21 d) in the arbidol group while with the other antiviral agents or without any antiviral drug in the control group. Meta analysis on the efficacy and safety of arbidol in treatment for COVID-19 showed that the novel coronavirus (2019-nCoV) nucleic acid negative conversion rate in the arbidol group was significantly higher than that in the control group [71.7% (109/152) vs. 58.8% (94/160), relative risk (RR)=1.30, 95% confidence interval (CI): 1.01-1.67, P=0.04];the difference of time taken for 2019-nCoV nucleic acid negative conversion between the 2 groups was not statistically significant (standardized mean difference=-0.17, 95%CI: -0.72-0.38, P=0.55);the difference of disease improvement rate shown by chest CT on day 7 after treatment between the 2 groups was not statistically significant [46.2% (30/65) vs. 50.7% (36/71), RR=0.88, 95%CI: 0.39-1.98, P=0.76];and the difference of incidence of adverse reactions between the 2 groups was not statistically significant [16.9% (39/231) vs. 19.2% (47/245), risk difference (RD)=-0.03, 95%CI: -0.10-0.04, P=0.44]. Meta analysis on the safety of arbidol in treatment for influenza and other respiratory virus infections showed that the incidence of adverse reactions in the arbidol group was significantly lower than that in the control group [5.9% (44/745) vs. 11.3% (82/726), RR=0.52, 95%CI: 0.37-0.74, P<0.01]. Conclusion(s): Arbidol could effectively increase the 2019-nCoV nucleic acid negative conversion rate and it might be safe to treat COVID-19 using arbidol.Copyright © 2020 by the Chinese Medical Association.
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During highly uncertain times such as the coronavirus disease 2019 (COVID-19) pandemic, it is vital to understand and predict individuals' responses to governments' crisis and risk communication. This study draws on the Orientation-Stimulus-Orientation-Response (O-S-O-R) model to examine (1) whether uncertainty reduction motivation (a pre-orientation factor) drove Americans to turn to traditional news media and/or social media (stimuli) to obtain COVID-19 information;(2) if these media preferences shaped their COVID-19 knowledge, cognitive information vetting, and trust in government communication (post-orientation factors);and finally (3) whether these factors contributed to their intended and actual behaviors (responses), such as getting vaccinated. Thus, this study explores how multiple communicative and cognitive mechanisms contribute to public compliance with government health recommendations during a pandemic. Mediation analyses showed positive indirect effects between uncertainty reduction motivation and behavioral outcomes via use of social media (in relation to traditional news media) and COVID-19 knowledge and cognitive information vetting. This study discusses theoretical and practical health communication implications of these findings. © 2023 SAGE Publications.
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Lu and Jin provide insights into public health crisis communication (PHCC) by reconceptualizing how we think about the concept of dosage. The chapter extends the notion of dosage from the amount of exposure to publics' engagement over time in a competitive and conflicting media environment. Lu and Jin delineate a new direction in PHCC by formulating the effect of crisis communication strategy and dosage according to a chemical analogy of solution concentration (i.e. strategy) and volume of solution (i.e. dosage). First, this chapter visualizes PHCC as a neutralization process, in which the base solution (i.e. PHCC strategy and dosage) to neutralize the harm caused by the acid solution (i.e. a public health crisis). Second, this chapter further analogizes the PHCC as the base solution consisting of a solute dissolved into a solvent, where the solute is the message strategy (e.g. emotional appeal) and the solvent is the carrier of the message similar to messengers and channels. Lu and Jin define the concept of PHCC dosage as the volume of "base solution,” which will influence the effectiveness of the neutralization (i.e. PHCC). This new conceptual framework, illustrated with recent public health crisis cases, helps explain PHCC (in)effectiveness. Lu and Jin also provide a theoretical foundation for empirical studies that examine and predict how both the strategy and dosage of a crisis response message might exert intended and/or unintended effects among publics confronted with information clutters and desensitized by previous and/or ongoing crisis situations. The chapter explores new possibilities for research and application of PHCC. © 2023 John Wiley & Sons Ltd.
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Crude oil and agricultural product prices are important factors affecting a country's economic and social stability. The pure contagion between these two markets may lead to excessive price linkage, increasing the fragility of the financial system. This paper uses the CEEMDAN method, fine-to-coarse reconstruction method, and TVP-VAR model to study the pure contagion between crude oil and agricultural futures markets. The empirical results show that there always is significant pure contagion between agricultural futures markets. However, pure contagion between crude oil and agricultural futures markets only exists in some specific periods. The crude oil futures market has obvious pure contagion to the agricultural futures markets in most periods. Only a few periods the agricultural futures have pure contagion to the crude oil futures. It is worth noting that the COVID-19 epidemic aggravates the pure contagion between crude oil and the agricultural futures markets. Based on the research conclusions, this paper puts forward corresponding policy recommendations, hoping to provide a reference and theoretical basis for the government to formulate corresponding policies. © 2023 Elsevier Ltd
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Coronavirus disease 2019 (COVID-19) has become a major global public health event as a new acute respiratory infectious disease. During the COVID-19 pandemic, compared with the healthy population, cancer patients had a higher risk of developing comorbidities of other systems, due to their bad poor immunity and older age. Research showed that breast cancer, as a malignant disease, had the highest disease incidence in female patients. Breast cancer patients with COVID-19 infection often have worse prognosis, and they have to postpone anti-tumor treatment due to COVID-19 infection. At present, the effect of delayed treatment on the survival rate of breast cancer patients is unclear, and whether the treatment plan of these patients should be adjusted is still being studied. Through the systematic review of existing clinical research studies, the guidelines of various societies and the expert consensus, this paper reviews the selection and rationalization of breast cancer treatment options under the COVID-19 epidemic, and discusses the opportunity and approaches of anti-tumor treatment for breast cancer patients infected with COVID-19.Copyright © 2022 Editorial Department of Journal of Shanghai Second Medical University. All rights reserved.
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PurposeThe purpose of the study is to provide insights on the COVID-19 pandemic communication from the lessons learned by health communication executives-how they perceived the COVID-19 pandemic and recommend preparing for communication management of future public health crises.Design/methodology/approachA number of top health communication executives in the United States, who worked in the healthcare industry for at least 25 years and held titles like director, president and chief strategist, were interviewed for their unique perspectives on the COVID-19 pandemic. This study used the contingency theory of strategic conflict management for qualitative deductive analysis of the following segmentations of key factors that drove organizational communication management decision making during the pandemic: organization characteristics, relationship characteristics, general external climate, external publics and the issue under question.FindingsHealth communication executives heavily relied on their past health communication experiences, which led to nuanced understandings of the COVID-19 pandemic. Practically, the health communication executives urged future practitioners to constantly assess risks, hire and use diverse and representative decision-makers;set a communication protocol;and keep the communication in perspective. Theoretically, the contingency theory is furthered-there appears to be a theoretical linkage between the construct of general external climate and the construct of the external public.Originality/valueThe unique perspectives of top health communication executives, based in the United States, provided in-depth insights on the COVID-19 pandemic-its nuances, challenges and main influences (e.g. political, racial, etc.). These takeaways and recommendations can be adapted by other organizations and future health communicators in other parts of the world.
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This study collected epidemic data of COVID-19 in Zhengzhou from January 1 to January 20 in 2022. The epidemiological characteristics of the local epidemic in Zhengzhou High-tech Zone caused by the SARS-CoV-2 Delta variant were analyzed through epidemiological survey and big data analysis, which could provide a scientific basis for the prevention and control of the Delta variant. In detail, a total of 276 close contacts and 599 secondary close contacts were found in this study. The attack rate of close contacts and secondary close contacts was 5.43% (15/276) and 0.17% (1/599), respectively. There were 10 confirmed cases associated with the chain of transmission. Among them, the attack rates in close contacts of the first, second, third, fourth and fifth generation cases were 20.00% (5/25), 17.86% (5/28), 0.72% (1/139) and 14.81% (4/27), 0 (0/57), respectively. The attack rates in close contacts after sharing rooms/beds, having meals, having neighbor contacts, sharing vehicles with the patients, having same space contacts, and having work contacts were 26.67%, 9.10%, 8.33%, 4.55%, 1.43%, and 0 respectively. Collectively, the local epidemic situation in Zhengzhou High-tech Zone has an obvious family cluster. Prevention and control work should focus on decreasing family clusters of cases and community transmission.
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COVID-19 , Epidemics , Humans , SARS-CoV-2 , IncidenceABSTRACT
Currently, experience with COVID-19 in multiple myeloma (MM) is still very limited. Terefore, we conducted this analysis of MM patients infected by COVID-19 from two prominent hematology centers in Wuhan and Wurzburg (Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China and University Hospital of Wurzburg, Wurzburg, Germany) as of 9 June 2020. In total, we identifed fve Caucasian patients from Wurzburg and three Asian patients from Wuhan. The majority of the patients were male (n=5, 63%), and the median age at COVID-19 diagnosis was 57 (range 39-83 years). Tree patients had newly diagnosed (ND) MM, and two of them were therapy naive at diagnosis of COVID-19. One patient from Wuhan was receiving the second cycle of VTD (bortezomib, thalidomide, and dexamethasone) as the first line therapy. In Wuhan, a patient with extramedullary progression (No. 6) received leukapheresis to prepare for a salvage chimeric antigen receptor T-cell (CAR-T) therapy. Due to COVID-19 infection, systemic anti-MM treatment was discontinued in all eight patients. Notably, two patients in Wurzburg showed no COVID-19 symptoms, and the other three patients exhibited only mild symptoms such as fever, cough, and nausea, which did not require an intensive care unit (ICU) admission. Tree patients did not receive any COVID-19 treatment, and all fve patients in Wurzburg recovered. In contrast, two patients from Wuhan developed severe respiratory syndrome so that mechanical ventilation and circulatory support were needed. The patient who was receiving the frontline therapy with VTD also had an elevated procalcitonin value (30.05 ng/ml), suggesting an additional bacterial infection, and this patient died due to acute respiratory failure. In addition, two out of fve patients in our cohort did not show positive IgM or IgG for COVID-19 afer recovery. In summary, our observations showed that COVID-19 infection could be severe especially in NDMM, and also suggested inadequate humoral immune response in MM patients, probably due to secondary immune defciency caused by the treatments or the disease itself. Surprisingly, the MM patients in Wurzburg did not present any signs of severe COVID-19 infection. Other than Wuhan where COVID-19 was reported for the first time, in Europe, the pandemic had already been announced, and in Germany the lock-down came relatively early in comparison to other countries.
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Artificial intelligence (AI), a new branch of research in computer science, has been applied to a variety of fields in recent years and has received increasing attention from research scholars. Since the outbreak of the new epidemic, AI has played an extremely important role in the diagnosis of the epidemic, the development of drugs, and the mental health of patients. This paper summarises some of the current applications of AI technology during the epidemic, to contribute to the control of the epidemic and the development of AI technology. © 2022 ACM.
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The COVID-19 pandemic has resulted in more than 440 million confirmed cases globally and almost 6 million reported deaths as of March 2022. Consequently, the world experienced grave repercussions to citizens' lives, health, wellness, and the economy. In responding to such a disastrous global event, countermeasures are often implemented to slow down and limit the virus's rapid spread. Meanwhile, disaster recovery, mitigation, and preparation measures have been taken to manage the impacts and losses of the ongoing and future pandemics. Data-driven techniques have been successfully applied to many domains and critical applications in recent years. Due to the highly interdisciplinary nature of pandemic management, researchers have proposed and developed data-driven techniques across various domains. However, a systematic and comprehensive survey of data-driven techniques for pandemic management is still missing. In this article, we review existing data analysis and visualization techniques and their applications for COVID-19 and future pandemic management with respect to four phases (namely, Response, Recovery, Mitigation, and Preparation) in disaster management. Data sources utilized in these studies and specific data acquisition and integration techniques for COVID-19 are also summarized. Furthermore, open issues and future directions for data-driven pandemic management are discussed.
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Using data from user comments to the official social networking account of the Hubei Red Cross Foundation on a participatory web platform, this study attends to the offensive and hateful comments produced by ordinary Internet users to blame the elite authorities for their malfeasance in managing the donation during the COVID-19 in China. Drawing on Discursive Psychology, we focus on the rhetorical strategies that users employ to legitimise their actions as well-founded evidential blame against a norm-breaking act rather than radical extremist speech. The associated hatred among discussants are moral, social judgements. That said, hate speech also helps construct the moral standards of a normalised society.
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Purpose : Health systems' responses to the coronavirus disease 2019 (COVID-19) pandemic created a surgical backlog of unknown size, limiting the ability to develop strategies to effectively address the backlog. We assessed the volume of deferred ophthalmic surgeries associated with the COVID-19 pandemic from March-December 2020 and suggested strategies and duration to clear the backlog in Ontario, Canada. Methods : Ontario Health Insurance Plan physician billing data from 2017-2020 were analyzed. The ophthalmic surgical backlog associated with the pandemic was estimated using time series forecasting models on training set (115 weeks), validation set (52 weeks) and forecasting set (42 weeks). Clearance time was calculated based on the queuing theory using various scenarios. Results : In 2020, there were 5.13 million ophthalmologist services, a reduction of 22% compared to the 6.60 million services in 2019. This included a 27% decrease in ophthalmic surgeries that require the use of operating rooms (OR) and a 6% decrease in anti-VEGF (vascular endothelial growth factor) injections (a common procedure for macular degeneration) that can be done in clinics. From March 16 to December 31, 2020 (a pandemic period), the estimated backlog in ophthalmic surgeries requiring an OR was 92,150 surgeries (95% prediction interval [PI] 71,288-112,841), increasing on average by 2,194 surgeries per week. Roughly 90% of the delayed surgeries were cataract surgeries and 4% were retinal detachment surgeries. Nearly half of the provincial backlog (48%, 44,542/92,150) involved patients from the West health region. Estimated provincial clearance time was 248 weeks (95% confidence interval [CI] 235-260) and 128 weeks (95% CI 121-134) if 10% and 20% of OR surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. Furthermore, an estimated 23,755 (95% PI 14,656-32,497) anti-VEGF injections were missed. Conclusions : The magnitude of ophthalmic surgical backlog in Ontario in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues the accrued backlog size is likely increasing. Planning and actions are needed urgently to manage the collateral impact of the pandemic on the ophthalmic surgical backlog in Ontario.
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Purpose : To describe the use and trends of virtual care and exam associated factors in Ontario, Canada during the 2020 COVID-19 pandemic. Methods : Ontario physician billing data from 2017-2020 was analyzed. Virtual care provided by ophthalmologists were identified from fee code and specialty codes. Percentage and adjusted odds ratio (aOR) from logistic regression models were used to assess patients' and ophthalmologists' factors associated with virtual vs in-person visits. Results : Virtual assessments/consults comprised 0.07%-0.10% of ophthalmology assessments/consults in 2017-2019 and 8.31% in 2020. The weekly uptake of virtual visits increased immediately in the week of the Ontario government's directive to ramp down clinic activities and institution of a new virtual fee code (17.6%, week March 16, 2020), peaked 2 weeks later (55.8%, week March 30, 2020) and reduced immediately after the directive was lifted (24.2%, week May 25, 2020). During the 2020 pandemic period, use of virtual care was higher in female (11.6%) vs male (10.3%) patients and in patients <20 (16.4%) and 20-39 years (12.3%) vs those aged 40-64 (10.8%) and 65+ (10.6%) years. Patients residing in the poorest/poorer neighbourhood area (10.9%) used virtual care similarly to their counterparts (11.1%). Patients with an acute infectious disease (14.2%) or non-urgent diagnosis (16.2%) had the highest use. Those with a retinal disease diagnosis had the lowest use (4.2%). Female ophthalmologists provided virtual care more often than male ophthalmologists (15.4% vs 9.9%). Ophthalmologists aged 60-69 (13.1%) provided more virtual care than any other age groups (from 7.7% for 70+ years to 11.3% for <40 years). Regression analyses indicated a significantly higher chance of virtual care use in female (aOR=1.65) vs male ophthalmologists, in female (aOR=1.13) vs male patients, in patients <20 years (aOR=1.57) and 20-39 years (aOR=1.17) vs 65+, in patients residing in Central (aOR=1.37), East (aOR=1.52) and North (OR=1.13) regions vs those in the Toronto region. Compared with ophthalmologists aged 60-69 years, those in other age groups were less likely to use virtual care (aOR ranged 0.57-0.76). Conclusions : Virtual care in ophthalmology significantly increased during the initial phase of the pandemic and decreased thereafter. There were significant variations in virtual care use by patient and ophthalmologist characteristics.
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Objective To explore SARS-CoV-2 nsp8 genetic variation, Nsp8 protein structure, biological function and targeted drugs, and to lay foundation for establishing more effective prevention and control strategies. Methods Analyses of nsp8 genetic variability, physical and chemical characteristics, spatial structure, antigenic epitopes, biological function, and drug combined targets of Nsp8 were carried out using bioinformatics technology and large biological databases. Results Based on nsp8 sequences of 28 isolates of coronavirus of three species, evolutionary tree was successfully constructed. SARS-CoV-2 isolates showed 99%-100% conservation of nsp8 genes, less genetic distance to SARS than MERS isolates. Nsp8 had no signal peptide and transmembrane area. In reticulocytes in vitro, Nsp8 had a half-life of 4 h and was hydrophilic. A secondary model and a tertiary structure model were established. Linear B cell and CTL antigenic epitopes, phosphorylation and SUMB modification sites were found in Nsp8. Using the DrugBank database, four drugs targeted Nsp8 were obtained. Conclusions Nsp8 possesses the characteristics of typical antigens, participates in viral replication, and various isolates of the same species share high conservation of nsp8 gene, suggesting potential applications in researches on pathogenic mechanism, genotyping and prevention of this virus. Notably, this is the first report on Nsp8-targeted chemotherapeutic drugs, and the findings can be of considerable scientific significance and application value, under the conditions that measures with special effect for COVID-19 prevention and control are urgently needed. © 2021, Publication Centre of Anhui Medical University. All rights reserved.
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The topical book Wuhan Diary, authored by the Chinese writer Fang Fang during the COVID-19 lockdown of Wuhan, is not so much a diary as a “becoming-diary,” given its performative practices. Wuhan Diary’s emphasis on the individual or private nature of its writing activity is attributable to its characteristic realistic conception of authenticity, which resulted historically from the humanist trend within Chinese literature in the 1980s as a significant element of post-socialist realism. Insofar as Wuhan Diary claims an overarching authorship that does not cohere with—or is, indeed, utterly subverted by— its textual complexities, it can be interpreted as a dual allegory of neoliberalism. In 2020, when the established pattern of globalization was in crisis and the post-Cold War state of affairs seemed unprecedentedly unstable, the post-socialist realism implicit in Wuhan Diary proved ineffective in representing the epidemic, as well as in justifying, by its (mis)representation, the conditions that have contributed to the general crisis. © Purdue University.
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Background: Among immunocompromised patients with immune mediated infammatory diseases (IMIDs), those undergoing therapy with B cell depleting agents are among the most vulnerable to both severe COVID-19 disease and sub-optimal response to COVID-19 vaccines(1). Numerous studies have documented suppressed humoral, but relatively maintained cell mediated, responses to COVID-19 vaccines in these patients. However, the clinical signifcance of such immunity in terms of protection from infection and its sequelae are poorly understood. We have analyzed a large cohort of vaccinated IMIDs patients undergoing B cell depleting therapy for the presence of breakthrough infection and assessed their outcomes. Objectives: To defne the frequency and outcomes of COVID-19 breakthrough infection in fully or partially vaccinated IMIDs patients receiving B cell depleting therapies. To assess the characteristics and risk factors for severe outcomes and death. Methods: All pharmacy records from within a large health care system were electronically searched for patients undergoing B cell depleting therapies with approved monoclonal antibodies in 2020. Records with ICD codes for IMIDs but not malignancies were included;patients must also have had at least one documented COVID-19 vaccine. From this cohort all patients with breakthrough COVID-19 disease from time of 1st vaccination through December 15, 2021 were identifed;each record was hand-reviewed to extract clinical data including vaccine history, demographics, comorbidities, use of monoclonal antibodies, dose and timing of B cell depleting therapy, and outcomes as assessed by an 8 point NIH ordinal scale. Univariate and multivariable logistic/proportional-odds regression models were used to examine the risk factors for severe outcomes. Results: A total of 1677 IMIDs patients were identifed who received any B cell depleting monoclonal antibody and at least one COVID-19 vaccine in 2021. From this cohort 74 patients (4.4%) experienced a breakthrough COVID-19 infection. Among the breakthrough patients 34 (46%) had a rheumatic disease (RA 11, AAV 15, SLE 2), 34 (46%) had CNS infammatory disease (MS 32, 2 other), and 6 (8%) had immune hematologic/miscellaneous diseases. Four patients had a previous history of COVID-19 infection. Overall 24 (35%) were hospitalized with 11 patients requiring critical level care (15%) and 6 deaths (8 %). All fatal cases had rheumatic diseases. Monoclonal antibodies were given as outpatient therapy to 21 patients and among these only 1 patient was hospitalized without requiring O2 and none died. In univariate analysis only number of comorbidi-ties had a signifcant positive effect (p=.001) on severe outcomes (i.e. groups 1-4 vs. groups 5-8: Table 1) while monoclonal antibody therapy was associated with more favorable outcomes (p=.005 group 1-2 vs.3-8, Table 1). There were no associations between the dose, duration or timing of the B cell therapy, concomitant therapies including glucocorticoids, vaccine status (incomplete, complete, boosted) or date of vaccination with severe outcomes. Conclusion: In IMIDs patients treated with B cell depleting therapies breakthrough infections are common with many experiencing severe outcomes. Concomitant comorbidities were associated with risk of severe disease. Monoclonal antibody therapy was used in only 28% but was associated with enhanced clinical outcomes with only 1 in 21 requiring hospitalization and zero mortality. This population of immunocompromised patients remains vulnerable to COVID-19 disease despite vaccination. More aggressive use of outpatient management with monoclonal antibody therapy and other preventive and therapeutic measures are urgently needed.
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Objective The ongoing coronavirus pandemic has propelled the need for new approaches to disinfection, especially for airborne viruses. The 254 nm emission of low-pressure vacuum lamps is known for its antimicrobial effect;however, its radiation is harmful to human health, causing skin cancer and cataracts. Some studies have shown that short-wavelength ultraviolet (UV) light in the spectral region of 200-230 nm (far-UVC) can inactivate pathogens without harming human cells. Thus, it has great prospects for many applications. Sufficient studies have proved the antibacterial performance of far-UVC band range in an excimer lamp emitting a peak wavelength of 222 nm light. Furthermore, laser light sources can realize long-distance transmission and complement the deficiency of excimer lamps in remote sterilization and disinfection. This study investigates the antibacterial effect of a self-developed far-UVC laser with a peak wavelength of 228 nm and hopes to provide a new technical approach for the inactivation of the novel coronavirus and other microbial pathogens. Methods Bacterial sample preparation: Escherichia coli (E. coli) widely exists naturally and is a pathogen of major focus in human public health defense. It is also one of the most drug-resistant species in the enterobacterium group. Therefore, it is often used in ultraviolet disinfection and environmental health research. Bacillus cereus (B. cereus), which is closely related to humans, causes food poisoning and cannot be eliminated by pasteurization or normal hygiene procedures due to the heat and acid resistance of its spores. Therefore, the strains used in this experiment are E. coli and B. cereus. E. coli and B. cereus are provided by the Ministry of Education Key Laboratory for Ecology of Tropical Islands, Hainan Normal University, and subsp. Kustaki HD-1, provided by the Environmental Microbial Ecology Laboratory of Hainan Normal University. Both strains are cultured in a nutrient agar medium and placed in an incubator at 35 degrees C for 1 day. Nutrient agar medium is provided by Guangdong Huankai Microbial Technology Co., LTD, China. UV irradiation source: the irradiation source is a self-developed all-solid-state 228 nm far-UVC laser, which provides UV irradiance of up to 35 mW/cm(2), and its spectral linewidth is less than 0.1 nm. The laser is realized by LD-pumped Nd3+ laser crystal, Q-switched technology, and nonlinear optical frequency conversion technology. All-solid-state lasers have the advantages of small size, high efficiency, good beam quality, high reliability, long life, and portability. 228 nm far-UVC laser sterilization: we input a certain concentration of 1 mL bacterial suspension sample into a high permeability UVC cuvette. The 228 nm laser irradiance of 0.1 mW/cm(2) is obtained by adjusting the laser output power and the placement of the colorimeter. E. coli suspension samples are irradiated for 5, 10, 15, and 20 s [Fig. 1 (b), and B. cereus suspension samples are irradiated for 15, 30, 45, and 60 s [Fig. 1(c)] at 228 nm far-UV light of 0.1 mW/cm(2). The experiment is repeated three times for each sample at the same irradiation dose. Results and Discussions Figs. 1 (b) and (c) show the distribution of bacteria before and after 228 nm laser irradiation. The concentration of bacterial suspension samples in the control and irradiated groups is determined using the nutrient agar plate counting method. The detection results are shown in Table 1. When the E. coli suspension is irradiated by 228 nm laser for 10, 15, and 20 s (1, 1.5, and 2 mJ/cm(2)), the inactivation rates are 90. 7 %, 96.9 %, and 100 yo, respectively. When the B. cereus suspension is irradiated by 228 nm laser for 30, 45, and 60 s (3, 4. 5, and 6 mJ/cm(2)), the inactivation rates are 88. 4%, 98.6 %, and 100 %, respectively. Conclusions This experimental study shows that the use of several mJ/cm(2) doses of far-UVC 228 nm pulsed laser irradiation can effectively inactivate E. coli and B. cereus, whereas the use of excimer lamps requires dozens of mJ/cm(2) doses. Compared with the excimer light source, the far-UVC pulsed laser light source shows a stronger sterilization effect. The next step is to conduct experimental research on the inactivation of the influenza virus using a far-UVC 228 nm pulsed laser.