Mainland China Research Articles

Antepartum risk factors and outcomes of massive transfusion for elective cesarean section: a nationwide retrospective cohort study

BackgroundPostpartum hemorrhage is one of the leading causes of maternal mortality and morbidity. The etiology of postpartum hemorrhage exhibits variations in relation to the mode of birth; consequently, risk factors for massive transfusion in elective cesarean section might diverge from those encountered in vaginal birth or emergency cesarean section. The main purpose of this study was to investigate antepartum risk factors of massive transfusion for elective cesarean section.MethodsWe conducted a retrospective cohort study based on data from a nationwide system that collected inpatient medical records from tertiary hospitals in mainland China. We included women who had undergone elective cesarean section from January 2013 to August 2018. Primary outcome was massive transfusion defined as transfusion of more than eight units of red blood cells on the day of childbirth. Candidate risk factors were identified by the 10th revision of International Classification of Diseases Codes of admission diagnoses. The relationship between each factor and massive transfusion was assessed using multivariable logistic regression.ResultsA total of 294,695 women were included and 572 of them received massive transfusion (incidence: 194 per 100,000 elective cesarean sections). Maternal age [adjusted odds ratio (aOR) 1.22; 95% confidence interval (CI) 1.10–1.48], anemia (aOR 1.66; 95% CI 1.34–2.05), thrombocytopenia (aOR 3.54; 95% CI 2.39–5.05), coagulopathy (aOR 25.92; 95% CI 8.59–69.50), hypoalbuminemia (aOR 2.97; 95% CI 1.86–4.53), hepatic dysfunction (aOR 1.65; 95% CI 1.04–2.47), uterine scar (aOR 1.39; 95% CI 1.15–1.67), multiple pregnancy (aOR 2.84; 95% CI 1.74–4.38), polyhydramnios (aOR 2.52; 95% CI 1.19–4.68) and placenta previa (aOR 25.03; 95% CI 21.04–29.77) were associated with massive blood transfusion for elective cesarean section. Among the women receiving massive blood transfusion, 7 (1.2%) died during hospitalization, 126 (22.0%) needed hysterectomy, 25 (4.4%) uterine packing and 57 (10.0%) uterine artery ligation.ConclusionsTen risk factors of massive transfusion were identified in women undergoing elective cesarean section. Our findings may facilitate blood products preparation and provide opportunities for applying prophylactic strategies prior to cesarean section for women at high risk of massive transfusion.

New genus, species, and faunistic records of the tribe Ripidiini (Coleoptera: Ripiphoridae) from the mainland of China

Anatoripidius cylindricus gen. & sp. nov., a new genus and species of Ripidiinae Gerstaecker, 1855 from Guangdong, China, is described and illustrated. The new genus is distinguished from other ripidiine genera by the combined characters that include postocular ommatidia missing, mouthparts strongly reduced, 11-segmented antennae, and others dealing with hind wings, and tarsal formula. A key to the extant genera of Ripidiini from the Palaearctic and Oriental regions is presented. Furthermore, Ripidius longicollis (Schilder, 1923) is newly recorded for the mainland of China, as well as redescribed and illustrated.

Two new species and additional records of the genus Lathrobium Gravenhorst (Coleoptera: Staphylinidae: Paederinae) from the Huaping Natural Reserve, Guangxi, southern China

Material of the paederine genus Lathrobium Gravenhorst, 1802 from the Huaping Natural Reserve, southern China, is examined. Three species are identified, one of them described previously and two undescribed. Two species are described and illustrated for the first time, all of them micropterous: L. duanfeiyui Peng &Tang, sp. nov. and L. huapingense Peng &Tang, sp. nov. Including the new taxa, 229 Lathrobium species are currently known from mainland China.

An efficient improved singular spectrum analysis for processing GNSS position time series with missing data

Summary The improved SSA (ISSA) method is widely recognized for directly extracting signals from gappy time series without requiring prior interpolation. However, it is rather time consuming, particularly for long time series with large window sizes, such as Global Navigation Satellite System (GNSS) position time series. This study proposes an efficient ISSA method that yields equivalent results to the ISSA method while significantly reducing computation time. Both methods aim to minimize the quadratic norm of principal components, while our method has fewer unknown parameters in the principal component computation than those of the ISSA method. We evaluate the performance of the proposed method using real GNSS position time series from 27 permanent stations located in mainland China. Results show that the proposed method can effectively reduce computation time than the ISSA method and the improvement depends on the chosen window size, the time series length, and the percentage of missing data. This efficient approach can be naturally extended to principal component analysis (PCA) and multi-channel SSA (MSSA) for processing multiple incomplete time series, improving computational efficiencies compared to the modified PCA and the improved MSSA while maintaining unchanged results. We also compare the ISSA method with the modified SSA (SSAM) and the iterative SSA methods using both real and synthetic time series data. Results indicate that the ISSA method outperforms the SSAM method, and when conducted iteratively, also surpasses the iterative SSA method.

Identity Construction in Fan Community: An Analysis of Online Discourse among (G)I-DLE Fans in Mainland China on Sina Weibo

Fandom has become a social and cultural phenomenon reflecting practical activities in the fan community. The prevalence of social media and online fan communities has facilitated the transnational industries of Korean popular culture (K-pop) in mainland China. Fans are enthusiastic about creating posts dedicated to their idol(s) or music bands to broaden the influence of the celebrities and establish personal connections with them. The unique interaction patterns in the K-pop fan community reflect the process of fans’ identity identification and construction. This article explores how mainland fans employ discursive strategies to construct their identity and legitimize their behaviors on social media. A total of 80 posts in (G)I-DLE Super Topic made by mainland China netizens have been collected from Sina Weibo. The findings illustrate the construction of both individual and collective identities among fans, which are shaped by various contexts and different communicative purposes. Further analysis explores the potential impact of fans' identities within online communities on the K-pop market in mainland China.

Identity Construction in Fan Community: An Analysis of Online Discourse among (G)I-DLE Fans in Mainland China on Sina Weibo

Fandom has become a social and cultural phenomenon reflecting practical activities in the fan community. The prevalence of social media and online fan communities has facilitated the transnational industries of Korean popular culture (K-pop) in mainland China. Fans are enthusiastic about creating posts dedicated to their idol(s) or music bands to broaden the influence of the celebrities and establish personal connections with them. The unique interaction patterns in the K-pop fan community reflect the process of fans’ identity identification and construction. This article explores how mainland fans employ discursive strategies to construct their identity and legitimize their behaviors on social media. A total of 80 posts in (G)I-DLE Super Topic made by mainland China netizens have been collected from Sina Weibo. The findings illustrate the construction of both individual and collective identities among fans, which are shaped by various contexts and different communicative purposes. Further analysis explores the potential impact of fans' identities within online communities on the K-pop market in mainland China.

Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, in patients from China mainland, Taiwan, and South Korea with moderate to severe plaque psoriasis: a phase 3 randomized clinical trial.

Deucravacitinib, an oral, selective, allosteric tyrosine kinase 2 inhibitor, is approved in the United States, European Union, Japan, South Korea, China, and other countries for treatment of moderate-to-severe plaque psoriasis. To evaluate the efficacy and safety of deucravacitinib in Asian patients with moderate to severe plaque psoriasis. In the 52-week, blinded, phase 3 POETYK PSO-3 trial (NCT04167462), patients were randomized 1 : 2 to placebo (n = 74) or deucravacitinib 6 mg once daily (n = 146) for 16 weeks followed by deucravacitinib alone. Coprimary endpoints were achievement of ≥ 75% reduction from baseline in Psoriasis Area and Severity Index (PASI 75) and static Physician Global Assessment score of 0 (clear) or 1 (almost clear) (sPGA 0/1) at Week 16. Efficacy and safety were evaluated throughout. At Week 16, significantly higher proportions of patients receiving deucravacitinib versus placebo achieved PASI 75 (68.8% vs. 8.1%; P < 0.0001) and sPGA 0/1 (55.6% vs. 6.8%; P < 0.0001). Response rates with deucravacitinib were maintained through Week 52. Common adverse events included upper respiratory tract infection and nasopharyngitis. Serious adverse event and discontinuation rates were low. Deucravacitinib was efficacious and well tolerated in Asian patients with moderate to severe plaque psoriasis.

Multisystemic Therapy for a Child in Difficult Circumstances With Disruptive Behavior in China: A Single-Case Design

Purpose: This study aims to address concerns about the ability of Chinese social workers to collaborate with multiple systems and effectively implement multisystemic therapy (MST), given their low professional status. Based on the first MST practice in Mainland China, the study evaluates the effectiveness of MST in addressing disruptive behaviors in a child in difficult circumstances (CDCs), assesses its fitness within the Chinese context, and explores strategies for social workers to collaborate within the contexts of the specialized protection system for CDCs and the establishment of social work service stations. Method: A single-case AB research design with repeated measures across multiple contexts was adopted. Results: The study suggests MST's potential effectiveness and cultural and political compatibility in China, and identifies three strategies for social workers to intervene across multiple systems. Conclusion: MST could be a valuable tool in social work practice with proper integration into local systems in China.

CiteSpace-based Survey of International Advances in Chinese Traditional Culture Research in 1999-2019

With the globalization strategy and the initiative “One Belt and One Road” in China, Chinese traditional culture has a great impact on the world. This study, based on CiteSpace, explores the total numbers, hotspots, characteristics and tendency of international research on Chinese traditional culture, by retrieving 866 articles from SSCI and A&amp;HCI in the Web of Science (Core Collection). The results of the study revealed that: there is a strong increases in total output from 1999 to 2019 and the research on the theme of Chinese traditional culture has become interdisciplinary; the most productive authors aren’t the ones in the most cited documents and the journals on which the most cited documents publish aren’t the prolific journals; most of the researchers are from Hong Kong, Taiwan, mainland of China, Canada and USA. In view of the results, it is obvious that it is a good way to spread Chinese traditional culture over the world. It is strongly recommended that we should do more analysis on the international literatures with different paradigms, methods and metrics in order to get a more comprehensive and correct domain visualization map of Chinese traditional culture research.

An exploratory qualitative analysis of public awareness, communication dynamics, and behavioral patterns regarding food safety in Mainland China

BackgroundFood safety stands as a critical public health concern in China. People’s perceptions and communication regarding food safety crises significantly impact their emotions and food preferences. The rise of social media has also complicated information sharing and decision-making. Exploring public’s cognitive, emotional and behaviral responses toward food safety risks is crucial for improving food safety practices and public health.MethodsFrom fall 2018 to fall 2023, 23 in-depth interviews were held using a semi-structured protocol aligned with the Risk Analysis Framework (RAF) components: risk assessment, communication, and management.ResultsOur findings showed that the public blamed unethical agriculture practices and food processing for food safety issues. People, dissatisfied with mainstream media, turned to social media to collect food safety information. Many adopted self-protective behaviors, assuming personal responsibility for food safety.ConclusionFindings from this study highlighted individuals’ concerns about environmental pollution and the use of chemical substances in food safety issues. The results underscored the need for accurate and prompt media coverage, stronger government regulation, industry self-regulation, and targeted consumer education to effectively tackle these challenges.

Identification and Evaluation of Synergy Between Carbon Emissions and Air Pollutants in Inter-Industrial Trade Among Provinces in China

With the vigorous promotion in China of efforts to reduce pollution and carbon emissions, examining their synergies becomes increasingly crucial. This study used the multi-regional input–output (MRIO) table to build the consumption-based industrial emissions inventories of CO2 and three major air pollutants (PM2.5, NOx, and SO2) and constructed synergistic emission indices of the intensity and magnitude to identify and evaluate the synergy between carbon emissions and air pollutants in inter-industrial trade among 30 provinces in mainland China. The results show that more than 85% and 40% of inter-provincial and inter-industrial trades have synergistic emissions between CO2 and air pollutants, respectively. We identified 77 inter-provincial trades and 84 inter-industrial trades among provinces with strong synergistic emissions. They are mainly reflected in the demand of the construction industry in Zhejiang and Guangdong for the nonmetal mineral products manufacturing industry in Henan, and the metal smelting and processing industry in Hebei, along with the demand of the service industry in Beijing for the electric power, steam, and hot water production and supply industry in Inner Mongolia. Our study provides new insights into the synergistic reduction of CO2 and air pollutants within the supply chain, thereby enriching the discourse on regional and industrial synergies in achieving sustainable development goals.

Development and Evaluation of an Out-of-Control Scale Measuring Global Contextual Stressors Across 20 Countries and Regions

Abstract: Stressful contexts like the COVID-19 pandemic precipitated remarkable socio-economic changes, exacerbating universal uncertainty and a pervasive loss of control. Improving mental health outcomes on the operational definition and measurement of related concepts. This study analyzed cross-sectional data from 20 countries and regions, collected between January 25 and November 10, 2021. Psychometric evaluation occurred in two stages: initially, item review and factor analysis with a 2,749 adult sample from Mainland of China and Hong Kong SAR; subsequently, confirmation of factor structure, measurement invariance testing, and advanced analyses with a 4,000 adult sample from 20 countries and regions. A six-item, single-factor structure was verified, confirming satisfactory factor loading, fit indices and consistency. Measurement invariance across geographies and groupings was also confirmed. Three Out-of-Control profiles representing low, medium, and high stress levels, were identified, with age, depression/anxiety symptoms, education, socio-economic status, and exposure to COVID-19-affected acquaintances significantly influencing affiliation. The item “I think I cannot control things that I previously could” was the most critical node. This newly validated scale represents a substantial advancement in measuring stress within the context of global health crises, thus enhancing comprehension of psychological responses. Continual evaluation of the scale’s effectiveness and accuracy is crucial.

Genomic and phenotypic characterization of a Clostridioides difficile strain of the epidemic ST37 type from China.

Clostridioides difficile strains of sequence type (ST) 37, primarily including PCR ribotype (RT) 017, are prevalent in mainland China. Our study aimed to compare the major virulence factors of an epidemic C. difficile isolate of ST37 type (Xy06) from China with the well-characterized C. difficile reference strains R20291 (RT027) and CD630E (ST54), as well as a Chinese ST54 strain (Xy07) isolated from the same hospital. The Xy06 genome was predicted to harbor two complete prophages and several transposon-like elements. Comparative analysis of PaLoc revealed a truncated tcdA gene, a functional tcdB gene, a functional tcdC gene, and well-conserved tcdR and tcdE genes. Phenotypic comparisons showed that Xy06 was a robust producer of TcdB, readily sporulated and germinated, and strongly bound to human gut epithelial cells. In a mouse model of C. difficile infection, Xy06 was more virulent than strains CD630E and Xy07 and was comparable to strain R20291 in virulence. Our data suggest the potential threat of the epidemic ST37 strains in China.

An Ensemble Machine Learning Model to Enhance Extrapolation Ability of Predicting Coarse Particulate Matter with High Resolutions in China.

Accurate exposure assessment is important for conducting PM10-2.5-related epidemiological studies, which have been limited thus far. In this study, we aimed to develop an ensemble machine learning method to estimate PM10-2.5 concentrations in mainland China during 2013-2020. The study was conducted in two stages. In the first stage, we developed two methods: the indirect method refers to developing models for PM2.5 and PM10 separately and subsequently calculating PM10-2.5 as the difference between them; and the direct method refers to establishing a model between PM10-2.5 measurements and relevant predictors directly. In the second stage, we employed an ensemble method by integrating predictions from both indirect and direct methods. Internal and external cross-validation (CV) were performed to validate the extrapolation capacity of models. The ensemble method demonstrated enhanced extrapolation accuracy in both internal and external CV compared to indirect and direct methods. The predictions produced by the ensemble method captured the spatiotemporal pattern of PM10-2.5, even in the sand and dust storm seasons. Our study introduces an ensemble strategy leveraging the strengths of both indirect and direct methods to estimate PM10-2.5 concentrations, which holds significant potential to support future epidemiological studies to address knowledge gaps in understanding the health effects of PM10-2.5.

Information Science Advancing while Library Retreating:An Exploratory Study with LIS Education in mainland China

The aim of this study is to highlight the evolving trend of 'delibrarization' in LIS school education in mainland China and to explore the underlying reasons for its emergence. To achieve this, the study employs discourse analysis to examine the nomenclatures and objectives of undergraduate degree programs at the top five LIS schools in mainland China. Furthermore, a critical analysis of the social background and academic evaluation system was conducted to further identify some contributing factors. The study concludes that the trend of 'delibrarization' in LIS education is driven by a combination of factors: the self-imposed perception of library science as 'restricted to library' and interdisciplinary, as constructed by some scholars in the field; the unfavorable nature of the current academic evaluation system; and the diminishing influence of library science within LIS schools.

A 10 km daily-level ultraviolet-radiation-predicting dataset based on machine learning models in China from 2005 to 2020

Abstract. Ultraviolet (UV) radiation is closely related to health; however, limited measurements have hindered further investigation of its health effects in China. Machine learning algorithms have been widely used to predict environmental factors with high accuracy, but a limited number of studies have implemented it for UV radiation. The main aim of this study is to develop a UV radiation prediction model using the random forest approach and predict the UV radiation with a daily and 10 km resolution in mainland China from 2005 to 2020. The model was developed with multiple predictors, such as UV radiation data from satellites as independent variables and ground UV radiation measurements from monitoring stations as the dependent variable. Missing satellite-based UV radiation data were obtained using the 3 d moving average method. The model performance was evaluated using multiple cross-validation (CV) methods. The overall R2 and root mean square error between measured and predicted UV radiation from model development and model 10-fold CV were 0.97 and 15.64 W m−2 and 0.83 and 37.44 W m−2 at the daily level, respectively. The model that incorporated erythemal daily dose (EDD) retrieved from the Ozone Monitoring Instrument (OMI) had a higher prediction accuracy than that without it. Based on predictions of UV radiation at the daily level, 10 km spatial resolution, and nearly 100 % spatiotemporal coverage, we found that UV radiation increased by 4.20 %, PM2.5 levels decreased by 48.51 %, and O3 levels increased by 22.70 % from 2013–2020, suggesting a potential correlation among these environmental factors. The uneven spatial distribution of UV radiation was associated with factors such as latitude, elevation, meteorological factors, and season. The eastern areas of China pose a higher risk due to both high population density and high UV radiation intensity. Using a machine learning algorithm, this study generated a gridded UV radiation dataset with extensive spatiotemporal coverage, which can be utilized for future health-related research. This dataset is freely available at https://doi.org/10.5281/zenodo.10884591 (Jiang et al., 2024).

The Impact of Generative Artificial Intelligence Technologies on Chinese Librarians' information Behavior and Ethical Discussion: An Empirical Study Based on a Small Sample

This study used a combination of questionnaires and interviews to survey 68 librarians in mainland China. The questionnaire was divided into three parts: (1) providing descriptive statistics of the interviewed librarians; (2) exploring the impact of generative technologies on librarians' information behaviour from work scenarios; (3) investigating librarians' concerns about ethics and strategies for coping with ethical challenges. The results show that generative AI technologies had a greater impact on information seeking, information encountering, and information using behaviours, and an insignificant impact on information sharing behaviours. In addition, the results of the study reflect that 67.65% of librarians showed a very high level of concern about privacy and security; 66.18% of them believed that the content generated by the tools needed further validation. The study also provided six recommendations from the perspective of libraries and librarians to address ethical challenges such as the spread of disinformation and bias.

Transformative social work education through a joint MSW programme: from participatory action research to policy and practice innovation in China

ABSTRACT In China, social work was reestablished in 1988. Despite the number of social work programmes increased very fast throughout the 1990s, there was a huge need for social work-trained educators. The Hong Kong Polytechnic University and Peking University launched the MSW (China) Programme in 2000 to create a critical mass of social work educators who would assume future leadership in social work development in mainland China. Participatory action research was employed as a methodology to explore how social work education could transform students into catalysts for social work education and social development. Purposive sampling was adopted, and seven cohorts totaling 238 graduates who graduated from the programme were the participants in this research. Data collection and analysis were carried out throughout the action research process. We found the triple capacity building model to be a good pedagogy to foster transformation among participants, and to steer the knowledge co-creation, practice innovation, policy reform, and social change through social work education. In this paper, we will provide an overview of the background, vision, and mission, as well as the teaching pedagogy of the programme and a case study to demonstrate how social work education has an impact on policy and practice innovation in China.

ACEIC: a comprehensive anthropogenic chlorine emission inventory for China

Abstract. Chlorine species play a crucial role as precursors to Cl radicals, which can significantly impact the atmospheric oxidation capacity and influence the levels of trace gases related to climate and air quality. Several studies have established a chlorine emission inventory in China in recent years, but the emission remains uncertain and requires further investigation. The Anthropogenic Chlorine Emission Inventory for China (ACEIC) was the first chlorine emission inventory for China based on local data developed in our previous study, which only includes the emissions from coal combustion and waste incineration. In this study, we updated this inventory to include data for a more recent year (2019) and expanded the range of species considered (HCl, fine particulate Cl−, Cl2, and hypochlorous acid (HOCl)) and the number of anthropogenic sources (41 specific sources). Compared with previous studies, this updated inventory considered more anthropogenic sources, used more localized emission factors, and adopted more refined estimation methods. The total emissions of HCl, fine particulate Cl−, Cl2, and HOCl in mainland China for the year 2019 were estimated to be 361 (−18 % to 27 %), 174 (−27 % to 59 %), 18 (−10 % to 15 %), and 79 (−12 % to 18 %) Gg, respectively. To facilitate analysis, we aggregated the chlorine emissions from various sources into five economic sectors: power, industry, residential, agriculture, and biomass burning. HCl emissions were primarily derived from the industry (43 %), biomass burning (38 %), and residential (13 %) sectors. The biomass burning and industry sectors accounted for 74 % and 19 % of the fine particulate Cl− emissions, respectively. Residential and industry sectors contributed 61 % and 29 % of the total Cl2 emissions. HOCl emissions were predominantly from the residential sector, constituting 90 % of the total emissions. Notably, the usage of chlorine-containing disinfectants was identified as the most significant source of Cl2 and HOCl emissions in the residential sector. Geographically, regions with high HCl and fine particulate Cl− emissions were found in the North China Plain, northeastern China, central China, and the Yangtze River Delta, whereas the Pearl River Delta, Yangtze River Delta, and Beijing–Tianjin–Hebei regions exhibited elevated levels of Cl2 and HOCl emissions. Regarding monthly variation, emissions of HCl and fine particulate Cl− were higher during early spring (February to April) and winter (December to January) due to intensified agricultural activities, while Cl2 and HOCl emissions were higher in the summer months due to increased demand for water disinfection. We incorporated this emission inventory into the chemical transport model and found the simulated concentrations of chlorine species agreed reasonably well with the observations, which suggested the relatively faithful estimations of their emissions. This updated inventory contributes to a better understanding of anthropogenic sources of chlorine species and can aid in the formulation of emission control strategies to mitigate secondary pollution in China.

Post‑recovery symptoms of infected cases after Omicron pandemic: a quick online cross-sectional study based on C19-YRSm in China

BackgroundThe post COVID-19 health condition of Chinese residents infected with Omicron is not clear after the change of epidemic prevention policies. This study aimed to clarify the epidemiology and associated factors about health status of rehabilitation patients.MethodsA quick questionnaire study based on C19-YRSm was conducted in mainland China through internet from May 1, 2023, to May 7, 2023. Chinese native speakers infected with Omicron variant agreed to participate were included. Persisting symptom and living habits were simultaneously inquired. Logistic regression analysis was used to identify the associated factors.ResultsIn this study 753 individuals were included. Of whom 57.90% were males, 89.38% did not seek medical service, 99.47% recovered within less than 120 days. Breathlessness (47.68%), cognitive impairment (44.89%), Anxiety/mood changes (33.20%), pain/discomfort (32.94%), fatigue or tiredness not improved by rest (32.27%) and post-exertional malaise (30.01%) were the top reported key symptoms. Less than 10% respondents reported functional limitations. The prevalence of fever was reported greater than that of other symptoms, with dry eyes at 14.87%, appetite change at 14.34%, and hair loss at 12.22%. Middle age (OR: 2.353, 95%CI: 1.171 ~ 4.729), underlying diseases (OR: 2.293, 95%CI: 1.216 ~ 4.324), severe key symptom (OR: 6.168, 95%CI: 1.376 ~ 27.642) and at least one other symptom (OR: 1.847, 95%CI: 1.225 ~ 2.718)during the recovery were the risk factors of poor overall health after infection (current overall health score <8; 74.10%), while daily exercise in recovery period (OR: 0.457, 95%CI: 0.229 ~ 0.913), a low-fat diet (OR: 0.600, 95%CI: 0.401 ~ 0.898) and the recovery time from 2 to 4 months (OR: 0.639, 95%CI: 0.445 ~ 0.918) were the protective factors.ConclusionThis is the first time to use the C19-YRSm scale to evaluate the health status in China. The study revealed prevalence of persistent symptoms within 120 days after Omicron onset.