Comparison of depressive symptoms among healthcare workers in high-risk versus low-risk areas during the first month of the COVID-19 pandemic in China.

Introduction: The psychological health of healthcare workers (HCWs) has become a significant concern, particularly during the initial stage of a pandemic. This study compared the depressive symptoms among HCWs in high-risk areas (HRAs) and low-risk areas (LRAs) with matching demographics. Methods: A cross-sectional study was employed to compare the depressive symptoms (Patient Health Questionnaire score ≥ 10), workplace environment characteristics, the Health Belief Model (HBM) and socio-demographics of the HCWs working in HRAs and LRAs in several accessible regions (mainly Hubei Province and Guangdong-Hong Kong-Macao Greater-Bay-Area) in China. Eight hundred eighty-five HCWs were recruited for unmatched analysis between March 6 and April 2, 2020. After matching with occupation and years of service using a 1:2 ratio, 146 HCWs in HRAs and 290 HCWs in LRAs were selected for matched analysis. Subgroup analyzes were performed using two individual logistic regressions to delineate the associated factors in LRAs and HRAs, respectively. Results: HCWs in LRAs (Prevalence = 23.7%) had 1.96 times higher odds of depressive symptoms than those in HRAs (Prevalence = 15.1%) after adjusting for occupation and years of service (p < 0.001). Significant differences in workplace environment characteristics (p < 0.001) and the 5-dimension of the HBM of HCWs (p < 0.001 to p = 0.025) were found between HRAs and LRAs.Logistic regression showed that workers with years of service between 10 and 20 years (OR:6.27), ever had contact with COVID-19 patients (OR:14.33) and had higher scores of "perceived barrier" of HBM (OR:4.48) predicted depressive symptoms in HRAs while working in pneumology departments and infectious disease units (OR:0.06), and high "self-efficacy" in the HBM (OR:0.13) was a protective factor against depressive symptoms.Contrarily, in LRAs, those HCWs who worked in ICUs (OR:2.59), had higher scores of "perceived susceptibility toward the COVID-19 outbreak" (OR:1.41), "perceived severity of the pandemic" (OR:1.25), and "perceived barriers of wearing masks" (OR:1.43) in the HBM predicted depressive symptoms. High "cues to action" (OR:0.79), and better "knowledge" (OR:0.79) in the HBM were protective factors against depressive symptoms. Conclusion: The risk of depressive symptoms of HCWS was double in LRAs than in HRAs in the first month of the COVID-19 pandemic. Furthermore, salient predictors for depressive symptoms among HCWs in HRAs and LRAs were very different.

In Vitro Comparison of Local Nasal Vaccine Delivery and Correlation with Device Spray Performance.

PURPOSE: This study is the first vaccine candidate in vitro investigation with a focus on finding a correlation between the spray characteristics and the delivery efficiency of the local deposition in the nasal airways of infants under 24 months using various intranasal devices. METHODS: In vitro tests were developed to measure the spray characteristics of four intranasal delivery devices and how they regionally deliver a candidate vaccine formulation matrix in five nasal airway replicas (3 to 24 months). The correlation between the spray performance, geometric parameters, and delivery efficiency were assessed. RESULTS: All four devices performed consistently in terms of spray characteristics and were capable of delivering a high percentage of the candidate vaccine to the target areas, with a minimum delivery efficiency of 80%. Moreover, the delivery efficiency was affected by either the spray droplet size distribution or the distance between the nozzle tip and the internal nasal valve. Correlations between the spray performance and the in vitro local dose deposition were established. CONCLUSION: The infant nasal model tests can be complementary to device spray performance evaluation. In the absence of in vivo correlations, they can also facilitate the process of new product development by estimating delivery a priori.

The use of mobile health technology in the management of osteoarthritis: A scoping review with scientometric analyses.

INTRODUCTION: Although mHealth technology is an emerging approach for enabling self-management/education of hip/knee osteoarthritis (OA) that may reduce burdens in primary and secondary care, no scoping review has been conducted to comprehensively review the scope of mHealth technology in managing hip/knee OA. This scoping review and scientometric analyses aimed to summarize the current state of research on the use of mHealth technology (mobile applications/web-based interventions) for self-management/education of adults with hip/knee OA, identify key research activities, and provide future directions on the development/usage of mHealth technology. METHODS: The Arksey and O'Malley methodological framework was employed, augmented with scientometric analyses. Six databases were searched from inception to 31 May 2021. Findings were reported according to the PRISMA extension for scoping review. Co-word, co-author, and co-citation scientometric analyses were conducted to examine the social and intellectual connections of the research field (e.g., research hotspots and researcher collaborations). RESULTS: Twenty mHealth programs for promoting self-management of hip/knee OA were identified. The programs mainly included exercises or directives on performance of exercises. Compared to no interventions, mHealth technology was usable and might be more effective in improving pain, physical function, and quality of life in individuals with OA. The scientometric analyses identified multiple co-occurring keywords that reflected conceptual properties of this research domain. Although some intellectual connections among authors, research articles, and journals were noted, there were insufficient international collaborations in this field. DISCUSSION: While individual small-scale studies highlighted promising short-term effects of mHealth technology in self-managing hip/knee OA, many mHealth technologies were developed without clinicians' and/or patients' contributions. Future mHealth programs should be developed based on a strong theoretical background and professional inputs. The long-term benefits and cost-effectiveness of mHealth technologies, user experience, as well as cross-cultural adaptation of these technologies should be evaluated.

An exploratory study to understand how people use Twitter to share experiences or information about spinal stenosis.

BACKGROUND: Spinal stenosis is a narrowing of the spinal canal that may compress neurological tissues resulting in pain and disability. Although previous qualitative studies have solicited data regarding the life experience of patients with spinal stenosis or their opinions on relevant non-surgical treatments, their data was collected from participants in a controlled setting. Therefore, it remains unclear whether patients' or caregivers' concerns/opinions about spinal stenosis would be different in a non-experimental environment. Since Twitter is a popular online platform for people to share information and interact, it may reveal people's thoughts and attitudes about spinal stenosis. This study aimed to identify tweets that are related to spinal stenosis on Twitter, and to categorize them into common themes. METHODS: A social media monitoring and analysis software program (TalkWalker) was used to search relevant tweets using the keywords 'spinal stenosis' and 'stenosis' between 29 May 2019 and 24 June 2020. Two independent reviewers screened and conducted content analysis of the tweets and classified the tweets into different themes. RESULTS: Of 510 identified tweets, 362 tweets met the selection criteria. Five themes were identified: (1) compromised physical, psychological, and social wellbeing (n = 173); (2) diverse treatment options (n = 69); (3) coping strategies (n = 30); (4) dissemination of scientific information (n = 86); and (5) health policy (n = 4). Most of the tweets revealed negative impacts of spinal stenosis on patients' physical and psychosocial wellbeing. People with spinal stenosis shared their experiences and sought helps from others, while some people used Twitter to disseminate relevant information and research findings. CONCLUSIONS: This is the first study exploring Twitter using an online analytical tool to identify themes related to spinal stenosis. The approach not only helps understand people's concerns about spinal stenosis in an uncontrolled environment, but also can be adopted to monitor influences of diseases or public health education on Twitter users.

Point-of-care microvolume cytometer measures platelet counts with high accuracy from capillary blood.

BACKGROUND: Point-of-care (PoC) testing of platelet count (PLT) provides real-time data for rapid decision making. The goal of this study is to evaluate the accuracy and precision of platelet counting using a new microvolume (8 µL), absolute counting, 1.5 kg cytometry-based blood analyzer, the rHEALTH ONE (rHEALTH) in comparison with the International Society of Laboratory Hematology (ISLH) platelet method, which uses a cytometer and an impedance analyzer. METHODS: Inclusion eligibility were healthy adults (M/F) ages 18-80 for donation of fingerprick and venous blood samples. Samples were from a random N = 31 volunteers from a single U.S. site. Samples were serially diluted to test thrombocytopenic ranges. Interfering substances and conditions were tested, including RBC fragments, platelet fragments, cholesterol, triglycerides, lipids, anti-platelet antibodies, and temperature. RESULTS: The concordance between the rHEALTH and ISLH methods had a slope = 1.030 and R2 = 0.9684. The rHEALTH method showed a correlation between capillary and venous blood samples (slope = 0.9514 and R2 = 0.9684). Certain interferents changed platelet recovery: RBC fragments and anti-platelet antibodies with the ISLH method; platelet fragments and anti-platelet antibodies on the rHEALTH; and RBC fragments, platelets fragments, triglycerides and LDL on the clinical impedance analyzer. The rHEALTH's precision ranged from 3.1-8.0%, and the ISLH from 1.0-10.5%. CONCLUSIONS: The rHEALTH method provides similar results with the reference method and good correlation between adult capillary and venous blood samples. This demonstrates the ability of the rHEALTH to provide point-of-care assessment of normal and thrombocytopenic platelet counts from fingerprick blood with high precision and limited interferences.

Evaluation of Intranasal Vaccine Delivery Using Anatomical Replicas of Infant Nasal Airways.

PURPOSE: Nasal delivery is a favorable route for vaccination against most respiratory infections, as antigen deposited in the nasal turbinate and Waldeyer's ring areas induce mucosal and systemic immune responses. However, little is known about the nasal distribution of the vaccines, specifically for infants. METHODS: Anatomical nasal replicas of five subjects, 3-24 months, were developed to assess local intranasal vaccine delivery using MAD Nasal™ device, and understand impact of breathing conditions and administration parameters. High performance liquid chromatography was used to quantify the deposition pattern and determine the delivery efficiency. RESULTS: The delivery efficiency on average for all models was found to be 86.57±14.23%. There were no significant differences in the total delivery efficiency between the models in all cases. However, the regional deposition pattern was altered based on the model and subsequent administration. Furthermore, removing the foam tip from the MAD Nasal™ device, to study the impact of insertion length, did not significantly increase the efficiency within the two models tested, 5- and 16-month. CONCLUSION: Incorporating nasal replicas in testing provided a benchmark to determine the efficiency of a common intranasal vaccine delivery combination product. This proposed platform would allow comparing other potential nasal vaccine delivery devices.

A Sparse Probabilistic Code Underlies the Limits of Behavioral Discrimination.

The cortical code that underlies perception must enable subjects to perceive the world at time scales relevant for behavior. We find that mice can integrate visual stimuli very quickly (<100 ms) to reach plateau performance in an orientation discrimination task. To define features of cortical activity that underlie performance at these time scales, we measured single-unit responses in the mouse visual cortex at time scales relevant to this task. In contrast to high-contrast stimuli of longer duration, which elicit reliable activity in individual neurons, stimuli at the threshold of perception elicit extremely sparse and unreliable responses in the primary visual cortex such that the activity of individual neurons does not reliably report orientation. Integrating information across neurons, however, quickly improves performance. Using a linear decoding model, we estimate that integrating information over 50-100 neurons is sufficient to account for behavioral performance. Thus, at the limits of visual perception, the visual system integrates information encoded in the probabilistic firing of unreliable single units to generate reliable behavior.

Stabilization of HSV-2 viral vaccine candidate by spray drying.

This work demonstrates that an HSV-2 candidate vaccine can be thermostabilized by spray drying to reduce cold chain demands. This work is also to optimize the process responses by varying spray dry parameters for pre-screened suitable excipients; and to determine the validity of current prescreening techniques. Vaccine activity losses were measured by in vitro plaque forming assay with Vero cell line. An accelerated storage condition of 45 °C for 10 days was used to determine spray dried sample stability. Prescreening studies demonstrated that trehalose and sucrose were superior to other tested excipients spray dry thermal stabilization of HSV-2. Subsequent optimization by design of experiments (DOE) of activity responses to spray dry parameter changes demonstrated significant differences between trehalose and sucrose for stability of the viral vaccine. Model parameters included the drying conditions inlet temperature, spray gas flow rate, and solids concentration for the model responses of vaccine stabilization. Trehalose was an effective and robust stabilizing excipient for spray drying HSV-2 vaccine. In contrast, stabilization by sucrose was greatly dependent on the spray dry process parameters. These DOE differences indicated inadequate excipient selection by prescreening methods and the variability demonstrated current prescreening techniques may not be adequate for determining optimal excipients.

Characterization of Inherent Particles and Mechanism of Thermal Stress Induced Particle Formation in HSV-2 Viral Vaccine Candidate.

BACKGROUND: Vaccine formulations may contain visible and/or subvisible particles, which can vary in both size and morphology. Extrinsic particles, which are particles not part of the product such as foreign contaminants, are generally considered undesirable and should be eliminated or controlled in injectable products. However, biological products, in particular vaccines, may also contain particles that are inherent to the product. Here we focus on the characterization of visible and subvisible particles in a live, replication-deficient viral vaccine candidate against HSV genital herpes in an early developmental stage. METHOD: HSV-2 viral vaccine was characterized using a panel of analytical methods, including Fourier transform infrared spectroscopy (FTIR), sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), Western blot, liquid chromatography-mass spectrometry (LC-MS), light microscopy, transmission electron microscopy (TEM), micro-flow imaging (MFI), dynamic light scattering (DLS), right angle light scattering (RALS), and intrinsic fluorescence. RESULTS: Particles in HSV-2 vaccine typically ranged from hundreds of nanometers to hundreds of micrometers in size and were determined to be inherent to the product. The infectious titer did not correlate with any trend in subvisible particle concentration and size distribution as shown by DLS, MFI, and TEM under stressed conditions. This suggested that particle changes in the submicron range were related to HSV-2 virion structure and had direct impact on biological activity. It was also observed that subvisible and visible particles could induce aggregation in the viral product. The temperature induced aggregation was observed by RALS, intrinsic fluorescence, and DLS. The increase of subvisible particle size with temperature could be fitted to a two-step thermokinetic model. CONCLUSION: Visible and subvisible particles were found to be inherent to the HSV-2 viral vaccine product. The mechanism of protein aggregation was discussed and a two-step thermokinetic aggregation profile was proposed. The approaches reported in this study may be applied to a variety of vaccines and other biological products, as a way to assess the consistency of the manufacturing process and identify key product quality attributes.