Outbreak Period Research Articles

Retrospective analysis of hospital electronic health records reveals unseen cases of acute hepatitis with unknown aetiology in adults in Oxfordshire

BackgroundAn outbreak of acute severe hepatitis of unknown aetiology (AS-Hep-UA) in children during 2022 was subsequently linked to infections with adenovirus-associated virus 2 and other ‘helper viruses’, including human adenovirus. It is possible that evidence of such an outbreak could be identified at a population level based on routine data captured by electronic health records (EHR).MethodsWe used anonymised EHR to collate retrospective data for all emergency presentations to Oxford University Hospitals NHS Foundation Trust in the UK, between 2016–2022, for all ages from 18 months and older. We investigated clinical characteristics and temporal distribution of presentations of acute hepatitis and of adenovirus infections based on laboratory data and clinical coding. We relaxed the stringent case definition adopted during the AS-Hep-UA to identify all cases of acute hepatitis with unknown aetiology (termed AHUA). We compared events within the outbreak period (defined as 1st Oct 2021—31 Aug 2022) to the rest of our study period.ResultsOver the study period, there were 903,433 acute presentations overall, of which 391 (0.04%) were classified as AHUA. AHUA episodes had significantly higher critical care admission rates (p < 0.0001, OR = 41.7, 95% CI:26.3–65.0) and longer inpatient admissions (p < 0.0001) compared with the rest of the patient population. During the outbreak period, significantly more adults (≥ 16 years) were diagnosed with AHUA (p < 0.0001, OR = 3.01, 95% CI: 2.20–4.12), and there were significantly more human adenovirus (HadV) infections in children (p < 0.001, OR = 1.78, 95% CI:1.27–2.47). There were also more HAdV tests performed during the outbreak (p < 0.0001, OR = 1.27, 95% CI:1.17–1.37). Among 3,707 individuals who were tested for HAdV, 179 (4.8%) were positive. However, there was no evidence of more acute hepatitis or increased severity of illness in HadV-positive compared to negative cases.ConclusionsOur results highlight an increase in AHUA in adults coinciding with the period of the outbreak in children, but not linked to documented HAdV infection. Tracking changes in routinely collected clinical data through EHR could be used to support outbreak surveillance.

Epidemic dynamics of complex networks under pulse treatment and vaccination

The dynamics of a new Susceptible-Vaccinated-Infected-Recovered (SVIR) epidemic model in complex networks under constant and pulse control are investigated. Firstly, the epidemic model in complex networks under constant control is proposed. Utilizing the basic reproduction number, the sufficient conditions for stabilizing the epidemic under constant control are established. Since constant control is not conducive to resource conservation, it has been replaced by pulse control in epidemic model. The paper demonstrates the global attractiveness of the disease-free periodic solution of the model under pulse treatment and pulse vaccination. In addition, a sufficient condition is put forward to make sure that the system persists under pulse control, indicating periodic outbreaks of the epidemic. Furthermore, the epidemic is uniformly persistent when the pulse period is greater than the pulse period threshold or the vaccination rate is less than the vaccination threshold. Finally, several numerical simulations prove the feasibility of the theoretical results. By comparing the pulse period with a critical value, the strategy that most contributes to controlling the epidemic propagation is chosen from constant control and pulse control to achieve maximum utilization of resources. Moreover, it shows that decreasing the fraction of pulse treatment and pulse vaccination or prolonging the pulse period is beneficial to epidemic propagation. The topology of complex networks has a non-negligible influence on the epidemic propagation under pulse control, which is demonstrated both theoretically and numerically.

The depression and anxiety status and influencing factors survey of international students during COVID-19 outbreak period in Hunan, China: A cross-sectional study

International students are susceptible to several mental health disorders, including anxiety and depression amid the COVID-19 pandemic due to the implementation of epidemic control measures such as lockdown, quarantine, etc. The study aimed to investigate the depression and anxiety status as well as influencing factors of international students in Hunan, China during the COVID-19 outbreak lockdown. An online cross-sectional survey was conducted between May and June 2020. A snowball sampling technique was used to recruit participants. Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) were used to assess depression and anxiety status, respectively. 450 participants completed the online survey. The overall prevalence of depression and anxiety was 28.7 % and 36.9 %, respectively. Multivariate logistic regression analyses showed that having suspected symptoms of COVID-19 (aOR = 3.54, 95 %CI = 1.30–9.64) and having family members or friends infected with COVID-19 (aOR = 1.51, 95 %CI = 1.31–3.84) were positively associated with depression. Being single was positively associated with anxiety (aOR = 3.10, 95 %CI = 1.46–6.57). Also, obtaining news or updates about the COVID-19 daily (aOR = 1.76, 95 %CI = 1.13–3.75), and using electronic devices for 5–6 h every day (aOR = 2.21, 95 %CI = 1.17–4.17) showed a positive association with anxiety. Furthermore, having a high coping strategy was negatively associated with anxiety (aOR = 0.33, 95 %CI = 0.12–0.92). Although implementing lockdown was an excellent measure, it resulted in a high prevalence of depression and anxiety symptoms. The findings support previous studies that reported an increased in depression and anxiety status due to the COVID-19 pandemic. Therefore, mental health education and psychological support should be provided to this population during the pandemic or future epidemic diseases.

Acute primary angle closure concurrent with coronavirus disease 2019 recurrence in Northern China: A retrospective multi-centre study

Aims and objectivesDuring the new coronavirus disease 2019 (COVID-19) outbreak period, there was increasing presentation in the number of patients with acute primary angle closure (APAC). This study aimed to report the occurrence of APAC during the COVID-19 post-restriction period and investigate the related characteristics of these patients with APAC. MethodsThis retrospective, multi-center study included consecutive patients seeking APAC treatment at two eye centers in China from December 7, 2022 to January 13, 2023 (post-restriction period) and from December 7, 2021 to January 13, 2022 (control period). Electronic medical records were reviewed, and ocular data of the affected eye(s) were analyzed for patients with unilateral or bilateral APAC. Information including COVID-19 related symptoms, medications used for COVID-19 infection, and living habits and emotions related to the COVID-19 outbreak during the post restriction period were collected using a questionnaire. ResultsOverall, 189 (219 APAC eyes) and 51 (54 APAC eyes) patients with APAC were identified during the post-restriction and control periods, respectively. The patients identified during the post-restriction period were younger (P = 0.043) and had a longer duration from symptoms to treatment (P = 0.039), shorter axial length (P = 0.002), larger pupil diameter (P = 0.004), larger vertical cup disc ratio (P = 0.004), poorer mean deviation values (P = 0.003), and more glaucomatous optic neuropathy diagnoses (P = 0.032) compared with the patients with APAC identified during the control period. Among 151 included patients with APAC who completed the questionnaires, 130 patients with APAC were diagnosed with concurrent COVID-19 infection, of which 54 (41.5 %) had coughing and/or vomiting as the main symptoms. Of these, 89.2 % spent 0 h per day on outdoor activity; 44.6 % drank more water than usual, with 14.6 % drinking more than twice the amount of water than usual; 91.5 % used antipyretics; and 20.0 % had mood swings, including anxiety, depression, and tension, during the concurrent COVID-19 infection. ConclusionIn our study, a significant increase in the number of patients presenting with APAC with certain characteristics was observed during the COVID-19 post-restriction period. And whether COVID-19 symptoms, such as coughing and vomiting, and behavioral and psychological changes caused by COVID-19 infection contributing to the concurrence of APAC and COVID-19 recurrence require further investigation.

Temporal decreases in pathogen colonization and infection among hospitalized neonates following routine skin antisepsis with chlorhexidine gluconate: Botswana 2022 – 2023

Background: Multidrug-resistant Gram-negative bacteria are a major cause of sepsis among hospitalized neonates globally. Aqueous chlorhexidine gluconate (CHG) skin antisepsis has been shown to be safe for use in infants; however, its sustained effectiveness in preventing Gram-negative pathogen colonization, bloodstream infection (BSI), and mortality is unclear. Methods: We conducted a period prevalence survey, with 26 sampling events over 12 months (18 October 2022 – 31 October 2023) at a 33-bed neonatal unit in a tertiary public hospital in Botswana where ESBL-producing Klebsiella pneumoniae and carbapenem-resistant Acinetobacter baumannii are leading causes of BSI. Perirectal and periumbilical skin swabs were collected every two weeks from all inpatients. Swabs were inoculated onto chromogenic media selective and differential for extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) and Acinetobacter spp. (CHROMagar™ ESBL, Acinetobacter). Colonization status was determined based on culture growth and colony morphology. Contemporaneous data on all-cause mortality and BSI were abstracted from routine surveillance records. Pre- and post-CHG prevalences were compared using a simple Chi-square test. During the surveillance period, an outbreak of K. pneumoniae linked to contaminated multi-use vials was detected, thus BSIs and deaths during the outbreak period (2 February–6 April, 2023) were excluded. In February 2023, the hospital infection prevention and control (IPC) team introduced twice-weekly whole-body cleansing with commercially available 2% aqueous CHG, performed by caregivers and healthcare workers on neonates &gt;24 hours old and weighing ≥1 kg until discharge. Results: There were significant decreases in ESBL-E and Acinetobacter skin and perirectal colonization following the CHG intervention (Table 1; Figure 1). After the CHG intervention, the incidence of Acinetobacter BSIs declined significantly and there was a trend toward a decline in other BSIs and mortality. No adverse events associated with CHG were reported. Conclusions: Twice-weekly CHG application was temporally associated with significant reductions in neonatal ESBL-E and Actinetobacter skin and perirectal colonization and Acinetobacter BSI. This analysis was limited by a short pre-intervention surveillance period and thus may have been influenced by confounders such as seasonality, and intensified IPC efforts following the outbreak. Analysis of the routine CHG use in other settings and over longer surveillance periods are needed to better understand its effectiveness as an IPC strategy in settings where neonatal sepsis incidence is high. Table 1. Colonization prevalence, BSI incidence, and mortality surrounding introduction of CHG skin cleansing in a neonatal unit, 18 October 2022 – 31 October 2023.

Severity of depressive and anxious symptoms and its association with birth outcomes among pregnant women during the COVID-19 pandemic: a prospective case-control study

Aim Comparing the anxiety and depression severity and their impact on subsequent birth outcomes in pregnant women before and during Omicron wave in Shanghai in 2022. Methods The depression-anxiety symptoms networks were compared between the pregnant women during the outbreak period (outbreak group; n = 783) and a matched control group of pregnant women before the outbreak (pre-outbreak group; n = 783). The impact of baseline mental state on follow-up pregnancy and neonatal outcomes was also explored by logistic regression. Findings Levels of depression and anxiety between the two groups were not significant different. Network analysis showed that central symptom "trouble relaxing" and bridge symptom "depressed mood" shared by both groups. Different symptom associations in different periods of the pandemic. Total scores and sub-symptom scores of prenatal depressive and anxious severities increased the odds ratios of maternal and neonatal syndromes. The influence of mental state on gestational and neonatal outcomes differed across different pandemic periods. Conclusion The Omicron wave did not have a significant negative impact on the depressive and anxious mood in pregnant women. Targeting central and bridge symptoms intervention may be effective in reducing their adverse effects on co-occurring of anxious and depressive mood and birth outcomes.

Wastewater-based epidemiology to monitor 68 NPS/conventional drug use in Taipei metropolitan area in Taiwan during and after COVID-19 pandemic

Amidst far-reaching COVID-19 effects and social constraints, this study leveraged wastewater-based epidemiology to track 38 conventional drugs and 30 new psychoactive substances (NPS) in northern Taiwan. Analyzing daily samples from four Taipei wastewater plants between September 2021 and January 2024—encompassing club reopenings, holidays, Lunar New Year, an outbreak, and regular periods—thirty-one drugs were detected, including 5 NPS. Tramadol, zolpidem tartrate, CMA, and MDPV were newly detected in Taiwanese sewage with frequency of 1.4 %− 89.0 %. Conventional drug use typically increased post-pandemic, aside from benzodiazepines and methadone. Methamphetamine showed 100 % frequency, indicating ongoing daily consumption despite COVID-19 measures. Methamphetamine and morphine's consumption dipped then rose around club reopening, hinting at limited access. The consumption trend of methadone appeared to compensate for the use of morphine. Ketamine and NPS demonstrated similar patterns throughout the entire period. NPS as party drugs seemed influenced by an unstable supply chain and complexities in implementation. Benzodiazepines, commonly abused alongside synthetic cathinones in Taiwan exhibited an opposing trend to NPS while aligned with acetaminophen, suggesting elevated stress and anxiety levels during the pandemic. No significant differences were observed in drug consumption between weekdays and weekends, potentially indicating that COVID-19 measures blurred the traditional distinctions between these timeframes. Environmental ImplicationNew psychoactive substances refer to chemically modified variants of controlled drugs designed to mimic the effects of the original drugs while evading modern detection methods, categorizing them as hazardous materials. The study presents a sewage monitoring project conducted from 2021 to 2024, collecting samples from four WWTPs to analyze NPS and conventional drug trends during and after the COVID-19 pandemic. The findings uncovered connections between drug consumption patterns and pandemic-related policies. In light of the persistent drug abuse and their environmental presence, the results bear critical importance for both environmental and public health. We provide a thorough assessment of these relationships and prioritize areas for future research.

Mortality in Amputees with Peripheral Artery Disease during the Post-COVID Era: A Three-Year Analysis.

Patients with peripheral artery disease (PAD) have 40-70% higher three-year mortality after lower limb amputation compared to non-amputees. In this study, we examined the consequences of delayed treatment for patients with PAD during the coronavirus disease 2019 (COVID-19) pandemic. This study employed a retrospective single-centre cohort design at a large tertiary care hospital. We compared amputees with PAD during the initial COVID-19 outbreak period in 2020 with a control group of amputees from 2019 after a three-year follow-up. In total, 134 amputees with PAD were included due to unsuccessful revascularization (n = 84 in 2020 vs. n = 50 in 2019). Patients in 2020 were significantly younger than those in 2019 (p = 0.01) and mostly admitted with advanced stages of PAD (p < 0.03). The proportion of major limb amputations increased significantly in 2020 (p = 0.03). Non-COVID-19-related deaths among patients in 2020 were more than twice as many as those in 2019, and long-term mortality in 2020 was 49% compared to 39% in 2019 (p = 0.04). Diabetes and renal insufficiency had a significantly negative impact on the survival of amputees with PAD (p < 0.01). Delayed treatment in patients with PAD leads to high long-term mortality risk after amputation, especially in PAD patients with diabetes and renal insufficiency. Therefore, in future pandemics, continuously monitoring patients with PAD will be crucial to prevent delayed treatment and severe short-term and long-term consequences.

Clinically inapparent mpox virus (MPXV) infections among clients of three anonymous Community Based Voluntary Counselling and Testing centres in Berlin, Germany, 2022–2023

IntroductionSince the mpox outbreak in 2022, it was unclear if and how often infections with mpox virus (MPXV) were clinically inapparent, i.e. not presenting to clinical care with mpox symptoms. Moreover, it was hypothesized that MPXV circulated in the affected communities before the outbreak was officially detected.MethodsWe retrospectively tested rectal and urethral swabs, and pooled samples for presence of MPXV. Samples were obtained from routine STI testing of three anonymous Community Based Voluntary Counselling and Testing (CBVCT) centres in Berlin, in 2022 and 2023. Testing results were linked to anonymously provided behavioural data.ResultsOverall, 9,053 samples from 6,600 client visits were included. Clinically inapparent MPXV infections were detectable in 1.1% of the samples. We did not find MPXV infections in the month before the first cases appeared in Berlin or between October 2022 and January 2023 when case numbers were low in Germany. However, during the outbreak period in 2022, we found clinically inapparent MPXV infections among 2.2% of the clients and during summer/autumn 2023 among 0.3%. The number of condomless anal/vaginal intercourse partners within the previous 6 months and PrEP use were identified as predictors of clinically inapparent MPXV infection.ConclusionClinically inapparent MPXV infections occurred during the mpox outbreak in Berlin in 2022 and post-outbreak in summer/autumn 2023. Unrecognized MPXV circulation in Berlin before the recognition of the outbreak in May 2022 appears unlikely. However, low-level sustained circulation of clinically inapparent MPXV infections need to be acknowledged in mpox prevention strategies.

Youth's climate consciousness: unraveling the Dengue-climate connection in Bangladesh.

Climate change affects the transmission of vector-borne diseases like dengue, posing a substantial public health threat. Bangladesh, with its favorable conditions for Dengue transmission, has experienced periodic outbreaks. This study explores the relationship between climate change knowledge, perceptions of the Dengue-climate link, and the associated factors among Bangladeshi youth. In the Dhaka district of Bangladesh, a cross-sectional study was conducted between September and October 2023, involving face-to-face interviews with 1,358 participants. Convenient (non-probability) sampling was utilized for participant selection. Data collection involved the administration of a semi-structured questionnaire encompassing informed consent, socio-demographic information, and inquiries pertaining to climate change-related knowledge (13 items) and perception (11 items). Data analysis utilized STATA (Version 15.0) and SPSS (Version 26.0). The mean scores for knowledge and perceptions were determined to be 7.10 ± 3.20 (out of 13) and 26.60 ± 4.12 (out of 33) respectively. Participants had a mean age of 22.02 ± 1.58 years. The study revealed that unmarried status, living in a nuclear family, being a non-smoker, good self-perception of physical health, regular sleep patterns, moderate social media usage, older age, unemployment, and daily media consumption are factors associated with higher knowledge and perception regarding the Dengue-climate change link. Moreover, a positive association was observed between knowledge of climate change and favorable attitudes toward the Dengue-climate connection. This study underscores the importance of tailored climate change education for youth in Bangladesh and highlights key variables influencing their knowledge and perceptions. Notably, there exists a positive association between climate change knowledge and favorable attitudes toward the Dengue-climate connection. These insights underscore the importance of targeted educational campaigns and policy interventions aimed at enhancing climate consciousness among the youth population, thereby fostering proactive measures to mitigate the impact of Dengue fever in the context of climate change.

Change in the incidence of stillbirth in Japanese Black cattle during the animal movement restrictions and suspended insemination.

We aimed to characterize the change in the incidence of stillbirth (IS) in Japanese Black cattle during and after animal movement restrictions and suspended insemination because of a foot-and-mouth disease (FMD) outbreak in Miyazaki Prefecture in 2010. Calving data from 2006 to 2018 were collected from approximately 900 farms. Post-FMD period was divided into three based on the median IS per month (1.80%): period 1 (May 2011 to February 2013), period 2 (March 2013 to August 2015), and period 3 (September 2015 to December 2018). The ISs were similar during the Pre-FMD period and Post-FMD period 1, then substantially decreased during Post-FMD period 2 (p < .05), before returning to the value before the FMD outbreak period during Post-FMD period 3. Compared with the Pre-FMD period, Post-FMD period 1 was associated with a higher proportion of calvings by primiparous cows and Post-FMD period 2 was associated with a smaller number of calvings per month (p < .05). There were high ISs in primiparous cows during the Pre-FMD period, Post-FMD period 1, and Post-FMD period 3 (p < .05), but not during Post-FMD period 2. In summary, after the animal movement restrictions and suspended insemination introduced because of the FMD outbreak, the IS temporarily decreased and consequently returned to the pre-FMD level.

West Nile Virus Seroprevalence in Wild Birds and Equines in Madrid Province, Spain.

West Nile virus (WNV) is a re-emerging flavivirus, primarily circulating among avian hosts and mosquito vectors, causing periodic outbreaks in humans and horses, often leading to neuroinvasive disease and mortality. Spain has reported several outbreaks, most notably in 2020 with seventy-seven human cases and eight fatalities. WNV has been serologically detected in horses in the Community of Madrid, but to our knowledge, it has never been reported from wild birds in this region. To estimate the seroprevalence of WNV in wild birds and horses in the Community of Madrid, 159 wild birds at a wildlife rescue center and 25 privately owned equines were sampled. Serum from thirteen birds (8.2%) and one equine (4.0%) tested positive with a WNV competitive enzyme-linked immunosorbent assay (cELISA) designed for WNV antibody detection but sensitive to cross-reacting antibodies to other flaviviruses. Virus-neutralization test (VNT) confirmed WNV antibodies in four bird samples (2.5%), and antibodies to undetermined flavivirus in four additional samples. One equine sample (4.0%) tested positive for WNV by VNT, although this horse previously resided in a WN-endemic area. ELISA-positive birds included both migratory and resident species, juveniles and adults. Two seropositive juvenile birds suggest local flavivirus transmission within the Community of Madrid, while WNV seropositive adult birds may have been infected outside Madrid. The potential circulation of flaviviruses, including WNV, in birds in the Madrid Community raises concerns, although further surveillance of mosquitoes, wild birds, and horses in Madrid is necessary to establish the extent of transmission and the principal species involved.

Real-world safety data for MVA-BN: Increased frequency of syncope following intradermal administration for immunization against mpox disease

BackgroundMVA-BN vaccine (Jynneos, Imvamune, Imvanex) was used widely in the 2022 mpox outbreak. This experience provides real-world evidence about the vaccine’s safety, particularly regarding intradermal use. MethodsBavarian Nordic’s global safety database was searched for all adverse events following immunization (AEFIs) with MVA-BN. AEFI numbers were compared among administration routes. Selected events and administered doses were graphed over the mpox outbreak period. ResultsA total of 9585 AEFIs have been reported. The rate of myocarditis or pericarditis was <1 per 100,000 doses administered. Eighty-nine cases of syncope, fainting, or loss of consciousness were reported. This number rose after the August 2022 US emergency use authorization for intradermal administration, as did the proportion of all syncope AEFIs reported following intradermal administration (78,7 %). ConclusionReal-world data from large-scale administration of MVA-BN has confirmed the vaccine’s established safety profile when administered subcutaneously. Intradermal administration is likely associated with increased syncopal event frequency.

Cost-Effectiveness Analysis of Routine Outreach and Catch-Up Campaign Strategies for Measles, Mumps, and Rubella Vaccination in Chuuk, Federated States of Micronesia.

The Federated States of Micronesia (FSM) experience periodic outbreaks of vaccine-preventable diseases. Our objective was to assess the cost-effectiveness of routine outreach and catch-up campaign strategies for increasing vaccination coverage for the measles, mumps, and rubella (MMR) vaccine among children aged 12 months through 6 years in Chuuk, FSM. We used a cost-effectiveness model to assess 4 MMR vaccination strategies from a public health perspective: routine outreach conducted 4 times per year (quarterly routine outreach), routine outreach conducted 2 times per year (biannual routine outreach), catch-up campaigns conducted once per year (annual catch-up campaign), and catch-up campaigns conducted every 2 years with quarterly routine outreach in non-catch-up campaign years (status quo). We calculated costs and outcomes during a 5-year model horizon and summarized results as incremental cost-effectiveness ratios. We analyzed the following public health outcomes: additional protected person-month (PPM), doses administered and protected people (ie, a child who completed a 2-dose MMR series). We conducted 1-way sensitivity analyses to evaluate the stability of incremental cost-effectiveness ratios and to identify influential model inputs. Among the 4 MMR vaccination strategies, quarterly routine outreach was the most effective and most expensive strategy, and biannual routine outreach was the least expensive and least effective strategy. Quarterly routine outreach (vs status quo) yielded approximately an additional 7001 PPMs and 132 vaccine doses administered, with incremental costs of about $4 per PPM, $193 per dose administered, and $123 per protected person. Routine outreach and catch-up campaign vaccination strategies can be important interventions to improve health in Chuuk, FSM. More frequent routine outreach events could improve MMR coverage and reduce the likelihood of outbreaks of vaccine-preventable diseases such as measles and mumps.

Quality of life and psychological well-being in non-institutionalized older people during the period of social outbreak of 2019 in Chile

Objetivos: Determinar la calidad de vida y bienestar psicológico en personas mayores no institucionalizadas de Santiago de Chile durante un período de estallido social. Metodología: Estudio de diseño no experimental, descriptivo y transversal. La muestra estuvo constituida por 59 personas mayores de 65 años que viven en la comunidad (13 hombres), edad promedio 75,61±7,39 años; se utilizó un muestreo no probabilístico por conveniencia. Las mediciones se llevaron a cabo en octubre de 2019 a febrero de 2020, durante el período de “estallido social” ocurrido en Chile. La calidad de vida fue medida a través del WHOqol Bref y el bienestar psicológico con la Escala de Bienestar Psicológico de Ryff. Resultados: La calidad de vida, tanto en general como en sus subdimensiones, fue similar entre hombres y mujeres. Para el Bienestar Psicológico, el puntaje promedio general fue mayor en mujeres, marcando diferencias en las dimensiones Relaciones Positivas, Autonomía, Dominio del Entorno y Propósito en la Vida (p &lt; 0,05); siendo menor que en los hombres en las de autoaceptación y Crecimiento (p &lt; 0,05). Conclusiones: Los niveles de Calidad de Vida y Bienestar Psicológico fueron menores a los obtenidos en estudios previos, lo cual podría sugerir que la convulsión generada durante el estallido social podría haberlos afectado negativamente.

Characteristics and influencing factors of risk spillover effects across clean energy stock prices: A comparative analysis during four periods of the COVID-19 pandemic

This paper explores the characteristics and influencing factors of risk spillover effects across clean energy stock prices during four periods of the COVID-19 pandemic, using the TVP-VAR-DY model and the TVP-SVAR-SV model. The empirical results suggest that the risk spillover level across clean energy stock prices declined with the outbreak of the COVID-19 pandemic, and the volatility was initially violent. However, as the pandemic began to mitigate and recovery ensued, the risk spillover level rebounded and became stable. After the COVID-19 pandemic, smart grids and three renewable energy sources (photovoltaics, wind energy, and hydropower) were the main transmitters of net risk spillover effects across clean energy stock prices, while the clean and efficient use of traditional energy was always a net risk spillover effects absorber. Regarding influencing factors, the impact of structural factors (net power generation of various types of clean energy) on the risk spillover effect across clean energy stock prices is generally greater than that of external factors (economic factors and political factors), and these effects last longer. Finally, among structural factors, the net power generation of two renewable energy sources—wind energy and photovoltaics—has a greater impact, especially during the outbreak and mitigation period of the COVID-19 pandemic. Beyond renewable energy, the net power generation from smart grids and nuclear power had a significant impact during the post-COVID-19 recovery period. These new findings suggest useful implications for investors and policymakers in the clean energy markets.

Syrian Hamsters Model Does Not Reflect Human-like Disease after Aerosol Exposure to Encephalitic Alphaviruses.

Venezuelan (VEE), eastern (EEE), and western (WEE) equine encephalitis viruses are encephalitic New World alphaviruses that cause periodic epizootic and epidemic outbreaks in horses and humans that may cause severe morbidity and mortality. Currently there are no FDA-licensed vaccines or effective antiviral therapies. Each year, there are a limited number of human cases of encephalitic alphaviruses; thus, licensure of a vaccine or therapeutic would require approval under the FDA animal rule. Approval under the FDA animal rule requires the disease observed in the animal model to recapitulate what is observed in humans. Currently, initial testing of vaccines and therapeutics is performed in the mouse model. Unfortunately, alphavirus disease manifestations in a mouse do not faithfully recapitulate human disease; the VEEV mouse model is lethal whereas in humans VEEV is rarely lethal. In an effort to identify a more appropriate small animal model, we evaluated hamsters in an aerosol exposure model of encephalitic alphavirus infection. The pathology, lethality, and viremia observed in the infected hamsters was inconsistent with what is observed in NHP models and humans. These data suggest that hamsters are not an appropriate model for encephalitic alphaviruses to test vaccines or potential antiviral therapies.

Root exudate-mediated plant–microbiome interactions determine plant health during disease infection

Understanding the interactions between plants and microbes during pathogen infection is crucial for plant health improvement. However, the integrated role of soil nutrients, root exudates, and plant microbiomes in plant health during disease outbreaks remains unclear. In this study, we hypothesized that root exudate-mediated healthy microbiomes (HealthyBiome) would facilitate the escape of soil-borne pathogen infection, whereas a root exudate-mediated disease-conductive microbiome (PathoBiome) would induce disease occurrence. Using watermelon wilt disease caused by Fusarium oxysporum as a model, we investigated these interactions and their implications in plant disease. We examined the pathogen load across plant compartments during the pathogen accumulation (AH) and disease outbreak periods. We analyzed the plant microbiomes and root exudates during the outbreak, which was associated with the emergence in both healthy (BH) and diseased (BD) plants. Compared with AH and BD plants, BH plants had the lowest F. oxysporum density in the root–soil system (0.74–0.84 times that of AH and BD plants). BD plants showed an elevated amino acid metabolism (2.84–3.38 times that of healthy plants), whereas BH plants showed a higher metabolism of phenolic compounds (1.73 times that of diseased plants). BH plants secreted more palmitic acid (1.53 times that of diseased plants) and recruited more nitrogen (N)-fixing bacteria (e.g., Paenarthrobacter, Sphingomonas), which potentially alleviated N scarcity in the soil, promoted plant growth, and improved the plant defense. Structural equation modeling highlighted the interactions among soil nutrients, root metabolites, and plant nutrients in recruiting pro-growth bacteria to the rhizosphere and roots for healthy plant growth. Our findings provide novel evidence of how root exudates influence plant–microbiome interactions during pathogen infections, highlighting the importance of a balanced root exudate profile and its associated “HealthyBiome” in promoting plant health and growth.

Analysis of the Spatiotemporal Distribution of Algal Blooms and Its Driving Factors in Chaohu Lake Based on Multi-source Datasets

Eutrophication and harmful algae blooms are one of the common ecological and environmental problems faced by freshwater lakes all over the world. As a typical inland freshwater lake, Chaohu Lake exhibits a high level of eutrophication and algae blooms year-round and shows a spatiotemporal difference in different regions of the lake. In order to understand the basic regularity of the development and outbreak of algal blooms in Chaohu Lake, the data from the comprehensive water observation platform and remote sensing were integrated to obtain the spatiotemporal distribution of algal blooms from 2015 to 2020. Then, an evaluation model based on Boosted Regression Trees (BRT) was constructed to quantitatively assess the importance and interactions of various environmental factors on algal blooms at different stages. The results indicated that:① The occurrence of algal blooms in Chaohu Lake exhibited significant seasonal variations, with the cyanobacteria beginning to recover in spring and bring about a light degree of algal blooms in the western and coastal areas of Chaohu Lake. The density of cyanobacteria reached its maximum in summer and autumn, accompanied by moderate and severe degrees of algal bloom outbreaks. ② During the non-outbreak period, the variation in the cyanobacteria density was greatly affected by physical and chemical factors, which explained 80.3% of the variance in the change in cyanobacteria density. The high concentrations of dissolved oxygen content in the water column and the weak alkalinity (7.2-7.6) and appropriate water temperature (about 3℃) provided a favorable environmental condition for the breeding and growth of cyanobacteria. In addition, the onset of algal blooms was closely related to the air temperature steadily passing through the threshold. According to the statistics, the date of first outbreak of algal blooms in Chaohu Lake was 11 days or so after the air temperature steadily remained above 7℃. ③ During the outbreak period, the occurrence of algal blooms was influenced by the combination of cyanobacterial biomass and meteorological conditions such as temperature, wind speed, and sunshine duration. The cumulative contribution ratio of the four factors was as high as 95%, and each factor had an optimal interval conductive to the outbreak of algal blooms. Furthermore, the results of multi-factor interaction analysis indicated a larger probability of the outbreak of algal blooms in Chaohu Lake under the combined effect of high cyanobacteria density, suitable temperature, and the breeze. This study analyzed and revealed the spatiotemporal characteristics and the dominant influencing factors of algal blooms in Chaohu Lake at different stages, which could provide the scientific basis for the prediction, early warning, and disposal of algal blooms under the context of climate change.

Respiratory pathogen and clinical features of hospitalized patients in acute exacerbation of chronic obstructive pulmonary disease after COVID 19 pandemic

Respiratory infections are common causes of acute exacerbation of chronic obstructive lung disease (AECOPD). We explored whether the pathogens causing AECOPD and clinical features changed from before to after the coronavirus disease 2019 (COVID-19) outbreak. We reviewed the medical records of patients hospitalized with AECOPD at four university hospitals between January 2017 and December 2018 and between January 2021 and December. We evaluated 1180 patients with AECOPD for whom medication histories were available. After the outbreak, the number of patients hospitalized with AECOPD was almost 44% lower compared with before the outbreak. Patients hospitalized with AECOPD after the outbreak were younger (75 vs. 77 years, p = 0.003) and more often stayed at home (96.6% vs. 88.6%, p < 0.001) than patients of AECOPD before the outbreak. Hospital stay was longer after the outbreak than before the outbreak (10 vs. 8 days. p < 0.001). After the COVID-19 outbreak, the identification rates of S. pneumoniae (15.3 vs. 6.2%, p < 0.001) and Hemophilus influenzae (6.4 vs. 2.4%, p = 0.002) decreased, whereas the identification rates of P. aeruginosa (9.4 vs. 13.7%, p = 0.023), Klebsiella pneumoniae (5.3 vs. 9.8%, p = 0.004), and methicillin-resistant Staphylococcus aureus (1.0 vs. 2.8%, p = 0.023) increased. After the outbreak, the identification rate of influenza A decreased (10.4 vs. 1.0%, p = 0.023). After the outbreak, the number of patients hospitalized with AECOPD was lower and the identification rates of community-transmitted pathogens tended to decrease, whereas the rates of pathogens capable of chronic colonization tended to increase. During the period of large-scale viral outbreaks that require quarantine, patients with AECOPD might be given more consideration for treatment against strains that can colonize chronic respiratory disease rather than community acquired pathogens.