关键词： COVID-19   Acute respiratory failure   Noninvasive ventilation   High flow oxygen therapy   Outcomes   Mortality   Intubation   Acute respiratory distress syndrome   INVASIVE MECHANICAL VENTILATION   RESPIRATORY-FAILURE   THERAPY   CANNULA  

摘要： Background We assessed the effect of noninvasive ventilation (NIV) on mortality and length of stay after high flow nasal oxygenation (HFNO) failure among patients with severe hypoxemic COVID-19 pneumonia. Methods In this multicenter, retrospective study, we enrolled COVID-19 patients admitted in intensive care unit (ICU) for severe COVID-19 pneumonia with a HFNO failure from December 2020 to January 2022. The primary outcome was to compare the 90-day mortality between patients who required a straight intubation after HFNO failure and patients who received NIV after HFNO failure. Secondary outcomes included ICU and hospital length of stay. A propensity score analysis was performed to control for confounding factors between groups. Exploratory outcomes included a subgroup analysis for 90-day mortality. Results We included 461 patients with HFNO failure in the analysis, 233 patients in the straight intubation group and 228 in the NIV group. The 90-day mortality did not significantly differ between groups, 58/228 (25.4%) int the NIV group compared with 59/233 (25.3%) in the straight intubation group, with an adjusted hazard ratio (HR) after propensity score weighting of 0.82 [95%CI, 0.50-1.35] (p = 0.434). ICU length of stay was significantly shorter in the NIV group compared to the straight intubation group, 10.0 days [IQR, 7.0-19.8] versus 18.0 days [IQR,11.0-31.0] with a propensity score weighted HR of 1.77 [95%CI, 1.29-2.43] (p < 0.001). A subgroup analysis showed a significant increase in mortality rate for intubated patients in the NIV group with 56/122 (45.9%), compared to 59/233 (25.3%) for patients in the straight intubation group (p < 0.001). Conclusions In severely hypoxemic COVID-19 patients, no significant differences were observed on 90-day mortality between patients receiving straight intubation and those receiving NIV after HFNO failure. NIV strategy was associated with a significant reduction in ICU length of stay, despite an increase in mortality in th

关键词： COVID-19 lockdown   Negative emotions   Helplessness   Spatial heterogeneity   Quality environment  

摘要： While quality environments (e.g., greenery) have been widely reported to alleviate residents' psychological stress during COVID-19 quarantines, this study argues that roles of the built environment and other commonly found emotion determinants can vary or reverse under strict lockdowns when human mobility is seriously restricted. We took Shanghai's "citywide static management" as a case study and scraped over 100,000 Weibo posts between February and July 2022 to capture civic emotions before/during/after the lockdown. Natural Language Processing (NLP) was applied to grade the unique "helplessness" sentiment along with other negative emotions. Spatial regressions were utilized to investigate their determinants. We present three controversial findings: 1) Quality environments (e.g., perceived greenness, sky view) alleviated negative emotions before/after the lockdown but exacerbated stress during the lockdown, indicating that residents become more vulnerable when they lose superior access to urban amenities for which they have paid price premiums; 2) Sociodemographics' impact on negative emotions varied significantly throughout three lockdown phases, with the elderly experiencing increased stress when losing access to emergency services; 3) Housing prices and rents inversely correlated with negative emotions (higher housing price indicated richer social resources), implying the complex interplay between residents' socioeconomic status and well-being. Our data -driven approach effectively retraces local voices and discloses civic emotions, informing more human -centric urban management strategies to facilitate social sustainability in the face of future crises.

关键词： Public attitude   Sentiment   Topic   Social media   Mobile cabin hospital  

摘要： The diverse and ambivalent public attitudes toward Mobile Cabin Hospitals (MCHs) markedly influence MCHs' social sustainability. Conventional studies regarding MCHs' public attitudes rely heavily on survey-based approaches (e.g., questionnaires) that suffer from limited respondents, short durations, and narrow geographical coverages, overlooking tempo-spatial variations of MCHs' public attitudes. Hence, this study proposes a social media data (SMD)-based approach to reveal public attitudes toward MCHs. It consists of MCH-related SMD collection, SMD preprocessing and annotation, sentiment and topic analysis model development, model performance verification, and statistical analyses of public sentiments and topics. This newly devised approach has been demonstrated for mining 413,572 pieces of MCH-related SMD covering MCH policy lifecycle in China. The findings reveal that (i) positive sentiment can surpass or fall below negative sentiments toward MCHs, which is correlated with the number of Covid-19 cases (NoCC), and (ii) the rankings of public concerns on 8 positive topics shift between two patterns temporally and spatially with NoCC, while the rankings among 6 negative topics remain stable for China's MCHs. This study not only offers an SMD-based supplementary approach for exploring public attitudes toward MCHs but also updates current understandings to enhance their social sustainability.

关键词： cellular immunity   combined vaccines   COVID-19 serological testing   COVID-19 vaccines   cytokines   HIV   SARS-CoV-2  

摘要： Objective: We evaluated the immunogenicity of a bivalent BA.1 COVID-19 booster vaccine in people with HIV (PWH). Design: Prospective observational cohort study. Methods: PWH aged >= 45 years received Wuhan-BA.1 mRNA-1273.214 and those <45 years Wuhan-BA.1 BNT162b2. Participants were propensity score-matched 1 : 2 to people without HIV (non-PWH) by age, primary vaccine platform (mRNA-based or vector-based), number of prior COVID-19 boosters and SARS-CoV-2 infections, and spike (S1)-specific antibodies on the day of booster administration. The primary endpoint was the geometric mean ratio (GMR) of ancestral S1-specific antibodies from day 0 to 28 in PWH compared to non-PWH. Secondary endpoints included humoral responses, T-cell responses and cytokine responses up to 180 days post-vaccination. Results: Forty PWH received mRNA-1273.214 (N = 35) or BNT162b2 (N = 5) following mRNA-based (N = 29) or vector-based (N = 11) primary vaccination. PWH were predominantly male (87% vs. 26% of non-PWH) and median 57 years [interquartile range (IQR) 53-59]. Their median CD4(+) T-cell count was 775 (IQR 511-965) and the plasma HIV-RNA load was <50 copies/ml in 39/40. The GMR of S1-specific antibodies by 28 days post-vaccination was comparable between PWH [4.48, 95% confidence interval (CI) 3.24-6.19] and non-PWH (4.07, 95% CI 3.42-4.83). S1-specific antibody responses were comparable between PWH and non-PWH up to 180 days, and T-cell responses up to 90 days post-vaccination. Interferon-gamma, interleukin (IL)-2, and IL-4 cytokine concentrations increased 28 days post-vaccination in PWH. Conclusion: A bivalent BA.1 booster vaccine was immunogenic in well treated PWH, eliciting comparable humoral responses to non-PWH. However, T-cell responses waned faster after 90 days in PWH compared to non-PWH. Copyright (c) 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

关键词： Bacteremia   Bloodstream infection   Covid-19   Mortality   SARS-CoV-2   BLOOD-STREAM INFECTION   HEALTH  

摘要： Objectives: Bacteremia is an acute severe infection with high mortality. Changes in healthcare services and coinfections with SARS-CoV-2 may have affected the mortality for bacteremia during the COVID-19 pandemic, which has been reported for other major diseases. In this study we examine the all-cause bacteremia mortality amidst the COVID-19 pandemic. Methods: A population-based cohort study comprised of laboratory confirmed bacteremia episodes in the Capital Region, Denmark (March 2019-February 2022). Cox proportional hazards models were used to calculate hazard ratios (HR) and 95 % confidence intervals (CI) for all-cause bacteremia mortality associated with the Covid-19 restriction period, a strike period, and coinfection with SARS-CoV-2, adjusted for possible confounders. Results: A total of 14,912 bacteremia episodes were identified in 12,693 patients during the study period. The 30- and 90-day all-cause mortality were 19 % and 27 %, respectively. The fully adjusted HR for 30- and 90-day all-cause mortality associated with the Covid-19 restriction period were 0.91 (95 % CI, 0.84 to 0.99) and 0.90 (95 % CI, 0.84 to 0.96), respectively, compared to the remaining time period. The corresponding HRs associated with SARS-CoV-2 coinfection were 1.29 (95 % CI, 1.11 to 1.50) and 1.36 (95 % CI, 1.20 to 1.55) compared to patients without coinfection. The association between the national nurse strike and all-cause bacteremia mortality was inconclusive. Conclusions: In this large population-based cohort study, a significant reduction in all-cause mortality for bacteremia was observed during the Covid-19 restriction period in Denmark, while coinfection with SARS-CoV-2 seem to be a substantial risk factor for all-cause bacteremia mortality.

关键词： pandemic   COVID-19   surveillance and forecast system   public health   infectious diseases   mathematical model   WASTE-WATER SURVEILLANCE   SARS-COV-2   CARE   TRANSMISSION   STRATEGIES   CHINA  

摘要： The COVID-19 pandemic has highlighted the need to upgrade systems for infectious disease surveillance and forecasting and modeling of the spread of infection, both of which inform evidence-based public health guidance and policies. Here, we discuss requirements for an effective surveillance system to support decision making during a pandemic, drawing on the lessons of COVID-19 in the U.S., while looking to jurisdictions in the U.S. and beyond to learn lessons about the value of specific data types. In this report, we define the range of decisions for which surveillance data are required, the data elements needed to inform these decisions and to calibrate inputs and outputs of transmission-dynamic models, and the types of data needed to inform decisions by state, territorial, local, and tribal health authorities. We define actions needed to ensure that such data will be available and consider the contribution of such efforts to improving health equity.

关键词： COVID-19   agent-based model   outbreak   acute care   hospital-acquired infections   cost-effectiveness  

摘要： Background COVID-19 outbreaks in acute care settings can have severe consequences for patients due to their underlying vulnerabilities, and can be costly due to additional patient bed days and the need to replace isolating staff. This study assessed the cost-effectiveness of clinical staff N95 masks and admission screening testing of patients to reduce COVID-19 hospital-acquired infections. Methods An agent-based model was calibrated to data on 178 outbreaks in acute care settings in Victoria, Australia between October 2021 and July 2023. Outbreaks were simulated under different combinations of staff masking (surgical, N95) and patient admission screening testing (none, RAT, PCR). For each scenario, average diagnoses, COVID-19 deaths, quality-adjusted life years (QALYs) from discharged patients, and costs (masks, testing, patient COVID-19 bed days, staff replacement costs while isolating) from acute COVID-19 were estimated over a 12-month period. Findings Compared to no admission screening testing and staff surgical masks, all scenarios were cost saving with health gains. Staff N95s + RAT admission screening of patients was the cheapest, saving A$78.4M [95%UI 44.4M-135.3M] and preventing 1,543 [1,070-2,146] deaths state-wide per annum. Both interventions were individually beneficial: staff N95s in isolation saved A$54.7M and 854 deaths state-wide per annum, while RAT admission screening of patients in isolation saved A$57.6M and 1,176 deaths state-wide per annum. Interpretation In acute care settings, staff N95 mask use and admission screening testing of patients can reduce hospital-acquired COVID-19 infections, COVID-19 deaths, and are cost-saving because of reduced patient bed days and staff replacement needs.

关键词： Ad26.COV2.S   COVID-19 vaccine   COVID-19 variant   Neutralizing antibody   EFFICACY  

摘要： COVID-19 vaccine boosters may optimize durability of protection against variants of concern (VOCs). In this randomized, double-blind, phase 2 trial, participants received 3 different dose levels of an ***2.S booster (5 x 1010 vp [viral particles], 2.5 x 1010 vp, or 1 x 1010 vp) >= 6 months post-primary vaccination with either single-dose ***2.S (homologous boost; n = 774) or 2-dose BNT162b2 (heterologous boost; n = 758). Primary endpoints were noninferiority of neutralizing antibody responses at Day 15 post-boost versus Day 29 post-primary vaccination. Secondary endpoints included reactogenicity/safety and neutralizing antibody responses to VOCs. All primary endpoints passed prespecified hierarchical noninferiority criteria by Day 15 postboost. Geometric mean increases in neutralizing antibody titers against the D614G reference strain ranged from 5.5 to 6.8 at Day 15 for homologous boosting and 12.6 to 22.0 for heterologous boosting. For VOCs, heterologous boosting elicited higher neutralizing antibody responses than homologous boosting. Neutralizing antibody responses were dose-dependent and durable for >= 6 months post-boost. More solicited systemic adverse events occurred following heterologous versus homologous boosting. Trial Registration: *** Identifier: NCT04999111.

关键词： PSYCHOLOGICAL IMPACT   SUPPORT   ASSOCIATIONS   ENVIRONMENT   LOCKDOWN  

摘要： Background: In order to curb the rapid spread of COVID-19, many countries have implemented lockdown or quarantine requirements, but little is known about how this impacts suicide ideation. The purpose of this study is to examine changing trends of suicidal ideation, social trust, and social communication from the quarantine to non-quarantine period during the COVID-19 epidemic in China and the effects of quarantine on suicidal ideation. Methods: A prospective longitudinal observation design was utilized. There were six waves of interviews from the quarantine to the non-quarantine period. Two hundred and twenty-one participants completed all observation points and were included in the study. For the continuing variables, the Mann-Kendall test was used to assess changing trends across the six observation points. For categorical variables, the Cochran-Armitage test was used to examine their changing trends. A generalized estimating equation was used to examine the association between several independent variables and suicide ideation. Results: The prevalence of suicide ideation was 16.7, 14.5 %, and 14.5 %, respectively, in the quarantine period, and 13.8, 10.9 %, and 10.0 %, respectively in the non-quarantine period, which there was a significant downward trend (T: -4.06, p < 0.01) across the total observation period. Negative behavioral belief, negative social trust, and low levels of social communications were positively associated with suicide ideation, with a beta of 0.0310 (P < 0.01), 0.0541 (P < 0.01), and 0.0245 (P < 0.05) respectively. The positive attitude toward lockdown was negatively associated with suicide ideation, with a beta of -0.0137 (P < 0.01) among guaranteed classmates and it was -0.0121 (P < 0.01) among unguaranteed classmates. Conclusions: This study yielded new information and may have important policy implications to design effective intervention strategies to reduce future new infectious diseases while maintaining positive mental health and r