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The heterogeneity of chronic post-COVID neuropsychiatric symptoms (PCNPS), especially after infection by the Omicron strain, has not been adequately explored.
Aims
To explore the clustering pattern of chronic PCNPS in a cohort of patients having their first COVID infection during the ‘Omicron wave’ and discover phenotypes of patients based on their symptoms’ patterns using a pre-registered protocol.
Method
We assessed 1205 eligible subjects in Hong Kong using app-based questionnaires and cognitive tasks.
Results
Partial network analysis of chronic PCNPS in this cohort produced two major symptom clusters (cognitive complaint–fatigue and anxiety–depression) and a minor headache–dizziness cluster, like our pre-Omicron cohort. Participants with high numbers of symptoms could be further grouped into two distinct phenotypes: a cognitive complaint–fatigue predominant phenotype and another with symptoms across multiple clusters. Multiple logistic regression showed that both phenotypes were predicted by the level of pre-infection deprivation (adjusted P-values of 0.025 and 0.0054, respectively). The severity of acute COVID (adjusted P = 0.023) and the number of pre-existing medical conditions predicted only the cognitive complaint–fatigue predominant phenotype (adjusted P = 0.003), and past suicidal ideas predicted only the symptoms across multiple clusters phenotype (adjusted P < 0.001). Pre-infection vaccination status did not predict either phenotype.
Conclusions
Our findings suggest that we should pursue a phenotype-driven approach with holistic biopsychosocial perspectives in disentangling the heterogeneity under the umbrella of chronic PCNPS. Management of patients complaining of chronic PCNPS should be stratified according to their phenotypes. Clinicians should recognise that depression and anxiety cannot explain all chronic post-COVID cognitive symptoms.
Loess, a geologic record of dust, is an optimal archive for exploring paleoclimate and the paleo-dust path from source to sink. The dust path for the Songnen Plain, NE China, during the last glacial period has not been established. To address this, 63 surface sediment samples from the Northeast China Sandy Lands, i.e., Onqin Daga Sandy Land (OD), Horqin Sandy Land (HQ), Hulun Buir Sandy Land (HL), and Songnen Sandy Land (SN), and six samples from the last glacial loess in the Harbin area were collected for elemental geochemical analysis of the <10 μm fraction to quantitatively reconstruct the dust pathway using a frequentist model. The results show that these sandy lands have a distinct geochemical composition due to a control from markedly different provenances. The quantitative results indicate that the dust contribution of the southwestern SN to the Harbin loess is as high as 50.4–77.2%, followed by the OD and HQ (3.3–34.8%), the northwestern SN (0–36.8%), and the HL (0–8%). Notably, the dust contribution to the Harbin loess began to change considerably after ~46–41 ka BP, with a significant increase from 1.1% to 41.2% from the northwestern direction. Some ecological safety strategies are proposed to address dust pollution in the Harbin area.
We developed a real-world evidence (RWE) based Markov model to project the 10-year cost of care for patients with depression from the public payer’s perspective to inform early policy and resource planning in Hong Kong.
Methods
The model considered treatment-resistant depression (TRD) and development of comorbidities along the disease course. The outcomes included costs for all-cause and psychiatric care. From our territory-wide electronic medical records, we identified 25,190 patients with newly diagnosed depression during the period from 2014 to 2016, with follow-up until December 2020 for real-world time-to-event patterns. Costs and time varying transition inputs were derived using negative binomial and parametric survival modeling. The model is available as a closed cohort, which studies a fixed cohort of incident patients, or an open cohort that introduces new patients every year. Utilities values and the number of incident cases per year were derived from published sources.
Results
There were 9,217 new patients with depression in 2023. Our closed cohort model projected that the cumulative cost of all-cause and psychiatric care for these patients would reach USD309 million and USD58 million by 2032, respectively. In our open cohort model, 55,849 to 57,896 active prevalent cases would cost more than USD322 million and USD61 million annually in all-cause and psychiatric care, respectively. Although less than 20 percent of patients would develop TRD or its associated comorbidities, they contribute 31 to 54 percent of the costs. The key cost drivers were the number of annual incident cases and the probability of developing TRD and associated comorbidities and of becoming a low-intensity service user. These factors are relevant to early disease stages.
Conclusions
A small proportion of patients with depression develop TRD, but they contribute to a high proportion of the care costs. Our projection also demonstrates the application of RWE to model the long-term costs of care, which can aid policymakers in anticipating foreseeable burden and undertaking budget planning to prepare for future care needs.
As an important component of prehistoric subsistence, an understanding of bone-working is essential for interpreting the evolution of early complex societies, yet worked bones are rarely systematically collected in China. Here, the authors apply multiple analytical methods to worked bones from the Longshan site of Pingliangtai, in central China, showing that Neolithic bone-working in this area, with cervid as the main raw material, was mature but localised, household-based and self-sufficient. The introduction of cattle in the Late Neolithic precipitated a shift in bone-working traditions but it was only later, in the Bronze Age, that cattle bones were utilised in a specialised fashion and dedicated bone-working industries emerged in urban centres.
In order to establish a compact all-optical Thomson scattering source, experimental studies were conducted on the 45 TW Ti: sapphire laser facility. By including a steel wafer, mixed gas, and plasma mirror into a double-exit jet, several mechanisms, such as shock-assisted ionization injection, ionization injection, and driving laser reflection, were integrated into one source. So, the source of complexity was remarkably reduced. Electron bunches with central energy fluctuating from 90 to 160 MeV can be produced. Plasma mirrors were used to reflect the driving laser. The scattering of the reflected laser on the electron bunches led to the generation of X-ray photons. Through comparing the X-ray spots under different experimental conditions, it is confirmed that the X-ray photons are generated by Thomson scattering. For further application, the energy spectra and source size of the Thomson scattering source were measured. The unfolded spectrum contains a large amount of low-energy photons besides a peak near 67 keV. Through importing the electron energy spectrum into the Monte Carlo simulation code, the different contributions of the photons with small and large emitting angles can be used to explain the origin of the unfolded spectrum. The maximum photon energy extended to about 500 keV. The total photon production was 107/pulse. The FWHM source size was about 12 μm.
We obtained 24 air samples in 8 general wards temporarily converted into negative-pressure wards admitting coronavirus disease 2019 (COVID-19) patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant BA.2.2 in Hong Kong. SARS-CoV-2 RNA was detected in 19 (79.2%) of 24 samples despite enhanced indoor air dilution. It is difficult to prevent airborne transmission of SARS-CoV-2 in hospitals.
Air dispersal of respiratory viruses other than SARS-CoV-2 has not been systematically reported. The incidence and factors associated with air dispersal of respiratory viruses are largely unknown.
Methods:
We performed air sampling by collecting 72,000 L of air over 6 hours for pediatric and adolescent patients infected with parainfluenza virus 3 (PIF3), respiratory syncytial virus (RSV), rhinovirus, and adenovirus. The patients were singly or 2-patient cohort isolated in airborne infection isolation rooms (AIIRs) from December 3, 2021, to January 26, 2022. The viral load in nasopharyngeal aspirates (NPA) and air samples were measured. Factors associated with air dispersal were investigated and analyzed.
Results:
Of 20 singly isolated patients with median age of 30 months (range, 3 months–15 years), 7 (35%) had air dispersal of the viruses compatible with their NPA results. These included 4 (40%) of 10 PIF3-infected patients, 2 (66%) of 3 RSV-infected patients, and 1 (50%) of 2 adenovirus-infected patients. The mean viral load in their room air sample was 1.58×103 copies/mL. Compared with 13 patients (65%) without air dispersal, these 7 patients had a significantly higher mean viral load in their NPA specimens (6.15×107 copies/mL vs 1.61×105 copies/mL; P < .001). Another 14 patients were placed in cohorts as 7 pairs infected with the same virus (PIF3, 2 pairs; RSV, 3 pairs; rhinovirus, 1 pair; and adenovirus, 1 pair) in double-bed AIIRs, all of which had air dispersal. The mean room air viral load in 2-patient cohorts was significantly higher than in rooms of singly isolated patients (1.02×104 copies/mL vs 1.58×103 copies/mL; P = .020).
Conclusion:
Air dispersal of common respiratory viruses may have infection prevention and public health implications.
Frozen embryo transfer (FET) has been adopted by growing number of reproductive medicine centers due to the improved outcome compared with fresh embryo transfer. However, few studies have focused on the impact of embryo cryopreservation duration on pregnancy-related complications and neonatal birthweight. Thus, a retrospective cohort study including all FET cycles with livebirth deliveries in a university affiliated hospital from May 2010 to September 2017 was conducted. These deliveries were grouped by the cryopreservation duration of the transferred embryo (≤3 months, 4–6 months, 7–12 months, and >12 months). The associations between embryo cryopreservation duration and pregnancy-related complications were evaluated among the groups using multinomial logistic regression. Neonatal birthweight was compared according to the stratification of singletons and multiples using multinomial and multilevel logistic regression, respectively. Among all 12,158 FET cycles, a total of 3864 livebirth deliveries comprising 2995 singletons and 1739 multiples were included. Compared with those within 3 months, women undergoing FET after a cryopreservation time longer than 3 months did not show any increased risk of gestational diabetes mellitus, gestational hypertension, preeclampsia, meconium staining of the amniotic fluid, or preterm birth. Furthermore, the risk of lower birthweight, macrosomia, small-for-gestational-age, or large-for-gestational-age for either singletons or multiples was not affected by long-term cryopreservation. In summary, embryo cryopreservation duration does not have negative effects on pregnancy-related complications or birthweight after FET.
In this paper, the generation of relativistic electron mirrors (REMs) and the reflection of an ultra-short laser off this mirrors are discussed, applying two-dimensional particle-in-cell (2D-PIC) simulations. REMs with ultra-high acceleration and expanding velocity can be produced from a solid nanofoil illuminated normally by an ultra-intense femtosecond laser pulse with a sharp rising edge. Chirped attosecond pulse can be produced through the reflection of a counter-propagating probe laser off the accelerating REM. In the electron moving frame, the plasma frequency of the REM keeps decreasing due to its rapidly expanding. The laser frequency, on the contrary, keeps increasing due to the acceleration of REM and the relativistic Doppler shift from the lab frame to the electron moving frame. Within an ultra-short time interval, the two frequencies will be equal in the electron moving frame, which leads the resonance between laser and REM. The reflected radiation near this interval and the corresponding spectra will be amplified due to the resonance. Through adjusting the arriving time of the probe laser, certain part of the reflected field could be selectively amplified or depressed, leading to the selectively adjusting of the corresponding spectra.
Universal masking for healthcare workers and patients in hospitals was adopted to combat coronavirus disease 2019 (COVID-19), with compliance rates of 100% and 75.9%, respectively. Zero rates of nosocomial influenza A, influenza B, and respiratory syncytial virus infection were achieved from February to April 2020, which was significantly lower than the corresponding months in 2017–2019.
The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)–laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports.
Methods:
Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients’ clinical samples and environmental samples was analyzed.
Results:
All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 × 102 copies/mL (range, 1.1 × 102 to 9.4 × 104 copies/mL). The contamination rate was highest on patients’ mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001).
Conclusion:
SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.
The relationship between the subtypes of psychotic experiences (PEs) and common mental health symptoms remains unclear. The current study aims to establish the 12-month prevalence of PEs in a representative sample of community-dwelling Chinese population in Hong Kong and explore the relationship of types of PEs and common mental health symptoms.
Method
This is a population-based two-phase household survey of Chinese population in Hong Kong aged 16–75 (N = 5719) conducted between 2010 and 2013 and a 2-year follow-up study of PEs positive subjects (N = 152). PEs were measured with Psychosis Screening Questionnaire (PSQ) and subjects who endorsed any item on the PSQ without a clinical diagnosis of psychotic disorder were considered as PE-positive. Types of PEs were characterized using a number of PEs (single v. multiple) and latent class analysis. All PE-positive subjects were assessed with common mental health symptoms and suicidal ideations at baseline and 2-year follow-up. PE status was also assessed at 2-year follow-up.
Results
The 12-month prevalence of PEs in Hong Kong was 2.7% with 21.1% had multiple PEs. Three latent classes of PEs were identified: hallucination, paranoia and mixed. Multiple PEs and hallucination latent class of PEs were associated with higher levels of common mental health symptoms. PE persistent rate at 2-year follow-up was 15.1%. Multiple PEs was associated with poorer mental health at 2-year follow-up.
Conclusions
Results highlighted the transient and heterogeneous nature of PEs, and that multiple PEs and hallucination subtype of PEs may be specific indices of poorer common mental health.
Maternal supraphysiological estradiol (E2) environment during pregnancy leads to adverse perinatal outcomes. However, the influence of oocyte exposure to high E2 levels on perinatal outcomes remains unknown. Thus, a retrospective cohort study was conducted to explore the effect of high E2 level induced by controlled ovarian stimulation (COH) on further outcomes after frozen embryo transfer (FET). The study included all FET cycles (n = 10,581) between 2014 and 2017. All cycles were categorized into three groups according to the E2 level on the day of the human Chorionic Gonadotropin trigger. Odds ratios (ORs) and their confidence intervals (CIs) were calculated to evaluate the association between E2 level during COH and pregnancy outcomes and subsequent neonatal outcomes. From our findings, higher E2 level was associated with lower percentage of chemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth as well as increased frequency of early miscarriage. Preterm births were more common among singletons in women with higher E2 level during COH (aOR1 = 1.93, 95% CI: 1.22–3.06; aOR2 = 2.05, 95% CI: 1.33–3.06). Incidence of small for gestational age (SGA) was more common in both singletons (aOR1 = 2.01, 95% CI: 1.30–3.11; aOR2 = 2.51, 95% CI: 1.69–3.74) and multiples (aOR1 = 1.58, 95% CI: 1.03–2.45; aOR2 = 1.99, 95% CI: 1.05–3.84) among women with relatively higher E2 level. No association was found between high E2 level during COH and the percentage of macrosomia or large for gestational age. In summary, oocyte exposure to high E2 level during COH should be brought to our attention, since the pregnancy rate decreasing and the risk of preterm birth and SGA increasing following FET.
To analyze the current development of HTA in China and to identify areas for improvement, we mapped the level of HTA development in China and compared it with the level of HTA development in ten other countries using a survey instrument.
Methods
We launched a nationwide survey targeting different stakeholders. For this purpose, we used a validated instrument that enables mapping HTA development in a country using eight domains. The views of the respondents regarding the overall level of HTA development and for each domain were compared with the results of a mapping study that included ten countries.
Results
In total, we received 222 responses, 33 from policy-makers, 158 from researchers, and 31 from industry, as well as health provider representatives including 8 from hospitals, centers for disease control and prevention. We calculated the mean score for the level of HTA development. The overall HTA development for China was scored at 76.4 (out of a maximum of 146). Although the total score for China was comparable to the mean score of 75.6 among the ten countries, China scored significantly lower than the mean score of 117.0 among the three developed countries. In addition, China scored significantly lower in the domain of institutionalization compared to the other ten countries.
Conclusions
China needs to tackle the issue of low HTA institutionalization to strengthen the foundation of HTA development. Future government initiatives that institutionalize HTA, for example, establishing a national HTA system or consortium, will improve the development of HTA in China.
We investigated attitudes toward 10 specific groups of individuals with disabilities among students in college settings. These groups comprised major depression, substance use disorder (SUD), anxiety disorder, autism spectrum disorder (ASD), cerebral palsy, hearing impairment, learning disability, visual impairment, spinal cord injury, and cancer survivor. The multidimensional scaling (MDS) analysis revealed a two-dimension space representing participants’ attitudes toward those disabilities. The MDS biplot further indicated higher levels of perceived dangerousness from the groups with SUD, major depression, anxiety disorder, and ASD. The hierarchical cluster analysis revealed that cluster A (SUD and major depression) was rated as having the highest level of social distance (i.e., negative attitudes). The implications for research and practice in rehabilitation counseling were discussed.
An in-house self-held respiration monitoring device (SHRMD) was developed for providing deep inspiration breath hold (DIBH) radiotherapy. The use of SHRMD is evaluated in terms of reproducibility, stability and heart dose reduction.
Methods and materials:
Sixteen patients receiving radiotherapy of left breast cancer were planned for treatment with both a free breathing (FB) scan and a DIBH scan. Both FB and DIBH plans were generated for comparison of the heart, left anterior descending (LAD) artery and lung dose. All patients received their treatments with DIBH using SHRMD. Megavoltage cine images were acquired during treatments for evaluating the reproducibility and stability of treatment position using SHRMD.
Results:
Compared with FB plans, the maximum dose to the heart by DIBH technique with SHRMD was reduced by 29·9 ± 15·6%; and the maximum dose of the LAD artery was reduced by 41·6 ± 18·3%. The inter-fractional overall mean error was 0·01 cm and the intra-fractional overall mean error was 0·04 cm.
Conclusion:
This study demonstrated the potential benefits of using the SHRMD for DIBH to reduce the heart and LAD dose. The patients were able to perform stable and reproducible DIBHs.
To simulate the effects of hot working parameters on microstructure and flow resistance during dynamic recrystallization (DRX) of a Ni–Cr–Mo-based C276 superalloy, a 2D mesoscopic model has been established using cellular automaton (CA) method. The isothermal hot compression tests were performed on a Gleeble 1500 thermal-mechanical simulator at the temperature range of 1273–1473 K and strain rate range of 0.001–5 s−1. The flow stress behaviors were then obtained and the microstructures of quenching specimen were observed after compression. Then the dislocation density evolution, nucleation and grain growth during hot compression were determined from experiments and integrated to the CA model. The topology of microstructure evolution and deformation resistance were calculated using the developed CA model and compared with the experimental ones. The CA simulation results show reasonable agreements with the experiments, implying the developed CA can capture the effects of processing parameters on the DRX behavior of C276 superalloy.
Blue-ice areas (BIAs) and their geographical distribution in Antarctica were mapped using Landsat-7 ETM+ images with 15 m spatial resolution obtained during the 1999–2003 austral summers and covering the area north of 82.5° S, and a snow grain-size image of the MODIS-based Mosaic of Antarctica (MOA) dataset with 125 m grid spacing acquired during the 2003/04 austral summer from 82.5°S to the South Pole. A map of BIAs was created with algorithms of thresholds based on band ratio and reflectance for ETM+ data and thresholds based on snow grain size for the MOA dataset. The underlying principle is that blue ice can be separated from snow or rock by their spectral discrepancies and by different grain sizes of snow and ice. We estimate the total area of BIAs in Antarctica during the data acquisition period is 234 549 km2, or 1.67% of the area of the continent. Blue ice is scattered widely over the continent but is generally located in coastal or mountainous regions. The BIA dataset presented in this study is the first map covering the entire Antarctic continent sourced solely from ETM+ and MODIS data. This dataset can potentially benefit other studies in glaciology, meteorology, climatology and paleoclimate, meteorite collection and airstrip site selection.
During the 30th Chinese Antarctic Expedition in 2013/14, the Chinese icebreaker RV Xuelong answered a rescue call from the Russian RV Akademik Shokalskiy. While assisting the repatriation of personnel from the Russian vessel to the Australian RV Aurora Australis, RV Xuelong itself became entrapped within the compacted ice in the Adélie Depression region. Analysis of MODIS and SAR imagery provides a detailed description of the regional sea-ice conditions which led to the 6 day long besetment of RV Xuelong. The remotely sensed imagery revealed four stages of sea-ice characteristics during the entrapment: the gathering, compaction, dispersion and calving stages. Four factors characterizing the local sea-ice conditions during late December 2013 and early January 2014 were identified: surface component of the coastal current; near-surface wind; ocean tides; and surface air temperature. This study demonstrates that shipping activity in ice-invested waters should be underpinned by general knowledge of the ice situation. In addition, during such activity high spatiotemporal resolution remotely sensed data should be acquired regularly to monitor local and regional sea-ice changes with a view to avoiding the besetment of vessels.
Manganese (Mn) and rare-earth elements (REEs) in a stalagmite (SJ3) collected from Central China were analyzed, using an ICP-MS method for the precise determination of > 40 trace elements in geological samples by enriched-isotope internal standardization. Unlike speleothem Mn and REEs investigated by cathodoluminescence, which may be incorporated into crystal lattice, the Mn and REEs analyzed in SJ3 should come largely from colloidal and particle phases in groundwater and may be associated with non-carbonate inclusions. The Mn and REEs in SJ3 vary significantly during the period between 20 and 10 ka. These elements show remarkable increases since ∼ 14.5 ka, suggesting enhanced weathering of the overlying soil layer and the host rock since the onset of the last deglaciation and the strengthening of the Asian summer monsoon. In addition, the Mn and REEs in SJ3 display significant centennial fluctuations which may reflect groundwater dynamics.