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Performance of Susceptible-Infected-Recovered (SIR) model in the early stage of a novel epidemic may be hindered by data availability. Additionally, the traditional SIR model may oversimplify the disease progress, and knowledge about the virus and transmission is limited early in the epidemic, resulting in a greater uncertainty of such modelling. We aimed to investigate the impact of model inputs on the early-stage SIR projection using COVID-19 as an illustration to evaluate the application of early infection models. We constructed a modified SIR model using discrete-time Markov chain to simulate daily epidemic dynamics and estimate the number of beds needed in Wuhan in the early stage of COVID-19 epidemic. We compared eight scenarios of SIR projection to the real-world data (RWD) and used root mean square error (RMSE) to assess model performance. According to the National Health Commission, the number of beds occupied in isolation wards and ICUs due to COVID-19 in Wuhan peaked at 37,746. In our model, as the epidemic developed, we observed an increasing daily new case rate, and decreasing daily removal rate and ICU rate. This change in rates contributed to the growth in the needs of bed in both isolation wards and ICUs. Assuming a 50% diagnosis rate and 70% public health efficacy, the model based on parameters estimated using data from the day reaching 3200 to the day reaching 6400 cases returned a lowest RMSE. This model predicted 22,613 beds needed in isolation ward and ICU as on the day of RWD peak. Very early SIR model predictions based on early cumulative case data initially underestimated the number of beds needed, but the RMSEs tended to decline as more updated data were used. Very-early-stage SIR model, although simple but convenient and relatively accurate, is a useful tool to provide decisive information for the public health system and predict the trend of an epidemic of novel infectious disease in the very early stage, thus, avoiding the issue of delay

Background: Virtual reality (VR) can be used to build many different scenes aimed at reducing study-related stress. However, only few academic experiments on university students for preference testing have been performed. Objective: This study aims to assess the preference of VR games for stress and depression treatment using a discrete choice experiment (DCE). Methods: A total of 5 different attributes were selected based on the depression therapy parameters and attributes related to VR: (1) treatment modality; (2) therapy duration; (3) perceived remission rate; (4) probability of adverse events; and the (5) monthly cost of adding treatment to a discrete choice experiment. By comparing different attributes and levels, we could draw some conclusions about the depression therapy testing preference for university students; 1 university student was responsible for VR scene development and 1 for participant recruitment. Results: The utility value of different attributes for “0% Probability of adverse events” was higher than others (99.22), and the utility value of VR treatment as the most popular treatment method compared with counseling and medicine treatment was 80.95. Three parameter aspects (different treatments for depression) were statistically significant (P<.001), including “0%” and “50%” of “Probability of adverse events” and “¥500” (a currency exchange rate of ¥1 [Chinese yuan]=US $0.15 is applicable) of “The monthly cost of treatment.” Most individuals preferred 12 months as the therapy duration, and the odds ratio of “12 months” was 1.095 (95% CI 0.945-1.270) when compared with the reference level (6 months). Meanwhile, the cheapest price (¥500) of depression therapy was the optimum choice for most students. Conclusions: People placed great preference on VR technology psychological intervention methods, which indicates that VR may have a potential market in the treatment of psychological problems. However, adverse events and treatment costs need to be consid

Background: The OlympiA trial demonstrated the benefits of adjuvant usage of olaparib for high-risk patients with human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC) and germline BRCA (gBRCA) mutation. This provoked thoughts on the clinical criteria of gBRCA testing. This study aims to estimate the costs and benefits of gBRCA testing and adjuvant olaparib therapy for patients with triple-negative breast cancer (TNBC) and hormone-receptor (HR)-positive and HER2-negative BC in China and the United States of America (USA). Methods: We used a Markov chain decision tree analytic model to compare three gBRCA screening policies in China and the USA: (1) no gBRCA testing; (2) selected gBRCA testing and (3) universal gBRCA testing for nonmetastatic TNBC and HR-positive HER2-negative BC patients. We modelled the benefit of systemic therapy and risk-reducing surgeries among patients identified with pathogenic or likely pathogenic variants (PVs) in BRCA1 and BRCA2. Results: Changing from the selected gBRCA testing to the universal gBRCA testing in TNBC patients is cost-effective, with the incremental cost-effectiveness ratios (ICERs) being 10991.1 and 56518.2 USD/QALY in China and the USA, respectively. Expanding universal gBRCA testing to HR-positive HER2-negative BC and TNBC patients has ICERs of 2023.3 and 16611.1 USD/QALY in China and the USA, respectively. Discussion: By performing gBRCA testing on all HER2-negative BC patients, adjuvant olaparib can be offered to high-risk patients with a PV in BRCA1 or BRCA2. These patients are also candidates for risk-reducing surgeries, an important aspect of their survivorship care, and these interventions can improve survival outcomes. With the willingness-to-pay thresholds being 31,500.0 and 100,000.0 USD per QALY gained in China and the USA, respectively, universal gBRCA testing is likely cost-effective for all HER2-negative BC patients. This simplified criterion of gBRCA testing for BC is recommended for ad

The original version of this article contained a mistake. The first affiliation should be changed to Department of Breast Surgery, Key Laboratory of Breast Cancer in Shanghai, Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China. The original article has been corrected. © 2023, The Author(s), under exclusive licence to Springer Nature Limited.

Background: Despite an increasing adoption rate of the tracking technologies (e.g., radio-frequency identification (RFID) and barcode) for hospitals in the United States (U.S.), scarce empirical studies examined hospital size, location, and types of hospital affiliations that are associated with the uptake, leaving the understanding towards the trend unclear. Objective: This study aimed to identify the hospital characteristics, geographic location, and hospital affiliation type attributive to adopting tracking technologies with a longitudinal dataset, and to compare critical factors associated with tracking technologies adoption for clinical and supply chain uses. We assume that hospital characteristics and hospital location have more impact on tracking technologies for clinical use, and types of hospital affiliation would have more impact on tracking technologies for supply chain use. Methods: This study was conducted based on national census data obtained from the American Hospital Association (AHA) Annual Survey and an AHA Information Technology Supplement survey. In the analysis, 3623 hospitals across 50 states in the U.S. from 2012 to 2015 were included. The effects of the hospital characteristics, location, and types of hospital affiliations were captured and assessed using population logistic regression models with the adjustment of the innate development of tracking technology over time. Results: We find that the proportion of hospitals where tracking technologies were implemented for clinical use increased from 36.3% to 54.6%, whilst that for supply chain increased from 28.6% to 41.3%. We also find that time effect and hospital size positively impact the hospital implementation of tracking technologies for both clinical and supply chain use. The implementation rate of tracking technologies for clinical use increased for the hospitals affiliated to the health systems compared to those that are not but decreased in the hospitals located in the rural area in c

Background: Despite an increasing adoption rate of the tracking technologies (e.g., radio-frequency identification (RFID) and barcode) for hospitals in the United States (U.S.), scarce empirical studies examined hospital size, location, and types of hospital affiliations that are associated with the uptake, leaving the understanding towards the trend unclear. Objective: This study aimed to identify the hospital characteristics, geographic location, and hospital affiliation type attributive to adopting tracking technologies with a longitudinal dataset, and to compare critical factors associated with tracking technologies adoption for clinical and supply chain uses. We assume that hospital characteristics and hospital location have more impact on tracking technologies for clinical use, and types of hospital affiliation would have more impact on tracking technologies for supply chain use. Methods: This study was conducted based on national census data obtained from the American Hospital Association (AHA) Annual Survey and an AHA Information Technology Supplement survey. In the analysis, 3623 hospitals across 50 states in the U.S. from 2012 to 2015 were included. The effects of the hospital characteristics, location, and types of hospital affiliations were captured and assessed using population logistic regression models with the adjustment of the innate development of tracking technology over time. Results: We find that the proportion of hospitals where tracking technologies were implemented for clinical use increased from 36.3% to 54.6%, whilst that for supply chain increased from 28.6% to 41.3%. We also find that time effect and hospital size positively impact the hospital implementation of tracking technologies for both clinical and supply chain use. The implementation rate of tracking technologies for clinical use increased for the hospitals affiliated to the health systems compared to those that are not but decreased in the hospitals located in the rural area in c

BACKGROUND: China and the United States play critical leading roles in the global effort to contain the COVID-19 virus. Therefore, their population's preferences for initial diagnosis were compared to provide policy and clinical insights. OBJECTIVE: We aim to quantify and compare the public's preferences for medical management of fever and the attributes of initial diagnosis in the case of presenting symptoms during the COVID-19 pandemic in China and the United States. METHODS: We conducted a cross-sectional study from January to March 2021 in China and the United States using an online discrete choice experiment (DCE) questionnaire distributed through Amazon Mechanical Turk (MTurk; in the United States) and recruited volunteers (in China). Propensity score matching (PSM) was used to match the 2 groups of respondents from China and the United States to minimize confounding effects. In addition, the respondents' preferences for different diagnosis options were evaluated using a mixed logit model (MXL) and latent class models (LCMs). Moreover, demographic data were collected and compared using the chi-square test, Fisher test, and Mann-Whitney U test. RESULTS: A total of 9112 respondents (5411, 59.4%, from China and 3701, 40.6%, from the United States) who completed our survey were included in our analysis. After PSM, 1240 (22.9%) respondents from China and 1240 (33.5%) from the United States were matched for sex, age, educational level, occupation, and annual salary levels. The segmented sizes of 3 classes of respondents from China were 870 (70.2%), 270 (21.8%), and 100 (8.0%), respectively. Meanwhile, the US respondents' segmented sizes were 269 (21.7%), 139 (11.2%), and 832 (67.1%), respectively. Respondents from China attached the greatest importance to the type of medical institution (weighted importance=40.0%), while those from the United States valued the waiting time (weighted importance=31.5%) the most. Respondents from China preferred the emergency departmen

Objective: India and Europe have large populations, a large number of Coronavirus disease 2019 (COVID-19) cases, and different healthcare systems. This study aims to investigate the differences between the hesitancy toward and preference for COVID-19 vaccines in India and four European countries, namely, the United Kingdom (UK), Germany, Italy, and Spain. Methodology: We conducted a cross-national survey for distribution in India, the UK, Germany, Italy, and Spain. More specifically, a discrete choice experiment (DCE) was conducted to evaluate vaccine preferences, and Likert scales were used to probe the underlying factors that contribute to vaccination acceptance. Propensity score matching (PSM) was performed to directly compare India and European countries. Results: A total of 2565 respondents (835 from India and 1730 from the specified countries in Europe) participated in the survey. After PSM, more than 82.5% of respondents from India positively accepted the COVID-19 vaccination, whereas 79.9% of respondents from Europe had a positive attitude; however, the proportion in Europe changed to 81.6% in cases in which the vaccine was recommended by friends, family, or employers. The DCE found that the COVID-19 vaccine efficacy was the most important factor for respondents in India and the four European nations (41.8% in India and 47.77% in Europe), followed by the vaccine cost (28.06% in India and 25.88% in Europe). Conclusion: Although most respondents in both regions showed high acceptance of COVID-19 vaccines, either due to general acceptance or acceptance as a result of social cues, the vaccination coverage rate shows apparent distinctions. Due to the differences in COVID-19 situations, public health systems, cultural backgrounds, and vaccine availability, the strategies for COVID-19 vaccine promotion should be nation-dependent. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

AimThe present study aimed to investigate the construct structure behind the psychosocial response, behavioral response, prenatal depression, and post-traumatic stress disorder (PTSD) in pregnant women during the COVID-19 pandemic in China. MethodThe validated Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), PTSD CheckList (PCL)-6, and two newly established scales for COVID-19-related psychological and behavioral responses were used. Structural equation modeling (SEM) analysis was applied to evaluate the structural relationships of psychological and behavioral responses during the COVID-19 pandemic. ResultsOf the 1,908 mothers who completed the questionnaires, 1,099 met the criteria for perinatal depression, and 287 were positively screened for PTSD, where 264 women exceed the cut-off points for both. Pregnant women with full-time or part-time jobs tended to have the lowest scores of EPDS (10.07 +/- 5.11, P < 0.001) and stress levels (23.85 +/- 7.96, P = 0.004), yet they were more likely to change their behavior in accordance with the COVID-19 outbreak (13.35 +/- 3.42, P = 0.025). The structural model fit the data (chi(2) = 43.260, p < 0.001) and resulted in satisfactory fit indices (CFI = 0.984, TLI = 0.959, RMSEA = 0.072, and chi(2)/df = 10.815), all path loadings were significant (p < 0.05). The SEM indicates that the level of QoL was attributable to the occurrence of PND, leading to PTSD, and COVID-19 related behavioral and psychological responses. ConclusionThe inter-relationships between the COVID-19-related psychosocial and behavioral responses have been assessed, indicating that the pandemic increased the burden of perinatal depression. Psychoeducation, as well as other psychological interventions, may be needed to alleviate the COVID-19-based anxiety and increase their engagement in protective behaviors.

Background/Objectives: Observational studies link elevated homocysteine concentrations (Hcy) with female fertility, pregnancy loss, and low offspring birthweight. Maternal rs1801133, a functional variant in MTHFR strongly associated with lifelong elevated Hcy, is associated with recurrent pregnancy loss and offspring birthweight in Asian women. We investigated if genetically elevated Hcy is associated with fertility, pregnancy loss, and offspring birthweight in European women. Subjects/Methods: We performed a two-sample Mendelian randomization (MR) study using publicly available data. We obtained 18 genetic variants (five involved in Hcy metabolism) explaining up to 5.9% of the variance in Hcy from a genome-wide association meta-analysis of 44,147 European individuals (82% women). We investigated fertility (including age at menopause), pregnancy loss, and offspring birthweight in the UK Biobank (N = 194,174), EGG (N = 190,406), and ReproGen (N = 69,360–252,514) consortia using summary statistics. We calculated inverse-variance weighted, and several sensitivity MR regression statistics. Results: rs1801133 was associated with a 7.45 months (95% CI: 4.09, 10.80) increase in age at menopause and 29.69 (12.87, 46.51) g decrease in offspring birthweight per SD increase in Hcy in the UK biobank, and confirmed in EGG and ReproGen. MR for Hcy metabolism alone (five variants in MTHFR, MTR, CBS) showed similar results for offspring birthweight across consortia. However, using all 18 variants resulted in no association for any of the outcomes across consortia. Conclusion: Hcy and suggestively vitamin B variants are most likely the drug targets for folate supplementation in pregnant women on the offspring birthweight, while Hcy variants related to renal function or diabetes are not involved.

Background: Robotic technologies involved in skin laser are emerging. Objective: To compare the accuracy, efficacy and safety of novel robotic prototype with human operator in laser operation performance for skin photo-rejuvenation. Methods: Seventeen subjects were enrolled in a prospective, comparative split-face trial. Q-switch 1064nm laser conducted by the robotic prototype was provided on the right side of the face and that by the professional practitioner on the left. Each subject underwent a single time, one-pass, non-overlapped treatment on an equal size area of the forehead and cheek. Objective assessments included: treatment duration, laser irradiation shots, laser coverage percentage, VISIA parameters, skin temperature and the VAS pain scale. Results: Average time taken by robotic manipulator was longer than human operator; the average number of irradiation shots of both sides had no significant differences. Laser coverage rate of robotic manipulator (60.2 +-15.1%) was greater than that of human operator (43.6 +-12.9%). The VISIA parameters showed no significant differences between robotic manipulator and human operator. No short or long-term side effects were observed with maximum VAS score of 1 point. Limitations: Only one section of laser treatment was performed. Conclusion: Laser operation by novel robotic prototype is more reliable, stable and accurate than human operation.