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Background The Symptoms of Infection with Coronavirus-19 (SIC) is a 30-item patient-reported outcome measure to evaluate the presence and severity of COVID-19 signs/symptoms in adults. This study expanded the context of use of the adult SIC among adolescents aged 12–17 years and supported a pediatric adaptation (the Pediatric SIC [PedSIC]) for caregiver assessment of signs/symptoms in children aged Methods Draft versions of the PedSIC and reference materials containing sign/symptom definitions for adolescents, based on an assessment of the reading level of SIC items by a professional linguist, were developed to facilitate accurate completion of the SIC by adolescents and observer-report (PedSIC) by caregivers. For adolescents, reference materials were intended to provide definitions for selected signs/symptoms identified to have a higher reading level. Iterative rounds of cognitive debriefing interviews were conducted from November 2020 to January 2021 to evaluate adolescent understanding of the SIC reference materials and inform refinement of the PedSIC for caregivers of children too young to reliably self-report. Participants were identified via databases of individuals who previously expressed interest in participating in qualitative research and were then screened for eligibility. Recruitment quotas were established to improve sample diversity. Thematic analysis and descriptive statistics were used to assess qualitative and demographic data, respectively. Results Nine healthy adolescents (mean [SD, range] age, 14 [1.76, 12–17] years, 56% female, 22% non-White; round 1, n = 6; round 2, n = 3) and 17 caregivers (mean [SD, range] age, 34 [6.28, 26–41] years, 59% female, 35% non-White; round 1, n = 9; round 2, n = 8) were interviewed. Adolescents understood the majority of signs/symptoms (22 of the 30 SIC items) without assistance or use of the reference materials during the cognitive debriefing interview. Definitions were added to the reference materials for 5 additional items, and clarifications provided to existing definitions for 3 items. Seven observer-report (PedSIC) items were modified following feedback from caregivers of healthy young children. Reference materials (similar to those for adolescent use) were developed to support caregiver understanding of the intent of the PedSIC items collecting input from children ages ≥ 5– Conclusions Results support using the SIC, PedSIC, and their associated reference materials to evaluate the presence and severity of COVID-19 signs/symptoms in adolescents and children aged

Intravenous Busulfan-based (IV Bu-) conditioning regimens are widely used in stem cell transplant and have been demonstrated as more effective and safer than cyclophosphamide and total body irradiation. Despite its superiority concerns remain regarding toxicities, specifically, veno-occlusive disease/sinusoidal obstructive syndrome, reproductive toxicity and neurotoxicity. Some of these concerns do not relate to busulfan itself, but to its composite solvent vehicle including N,N‑dimethylacetamide (DMA). Herein, we report a case series of six patients who received high-dose IV Bu-based conditioning regimens, and who developed neurotoxicity with various neurological manifestations and outcomes, ranging from mild to fatal. This case series highlights the need for further studies to investigate the safety of IV Bu, especially in patients with an underlying organic brain disorder, who have been treated with immunoconjugates with a potential for central neurotoxicity, or who have received therapeutic brain irradiation.

Background The Symptoms of Infection with Coronavirus-19 (SIC) is a 30-item patient-reported outcome (PRO) measure developed to assess the presence and severity of COVID-19 signs and symptoms in adults. To further facilitate the evaluation of new vaccines and treatments in development, similar tools are needed for use within pediatric populations. The objectives of this study were to support adolescent self-completion and create an adaptation of the measure for caregiver assessment of signs and symptoms in children aged < 12 years (henceforth, the Pediatric SIC [PedSIC]). Methods After developing draft versions of the PedSIC and reference materials with definitions to facilitate accurate completion of both measures, iterative rounds of cognitive debriefing interviews were conducted from November 2020 through January 2021 to evaluate understanding of the SIC (in adolescents aged 12-17), and inform refinement of the PedSIC for caregivers of children aged < 12. Recruitment quotas were employed to support sample diversity. Results Nine adolescents (mean [SD, range] age, 14 [1.76, 12-17] years, 56% female, 78% white; round 1, n=6; round 2, n=3) and 17 caregivers (mean [SD, range] age, 34 [6.28, 26-41] years, 59% female, 65% white; round 1, n=9; round 2, n=8) completed interviews. All adolescents understood and completed the adult version of the SIC without instrument modification. Ease and accuracy of self-completion was improved through the use of reference materials. Caregiver feedback resulted in modification of the PedSIC to include two sections: observable signs (ages < 12), and symptoms assessed with input from children (ages ≥ 5-< 12). Reference materials provided standardization of item intent. Conclusion Results support using the SIC, PedSIC, and their associated reference materials to assess the presence and severity of COVID-19 signs/symptoms in adolescents and children aged < 12 years, respectively, who participate in vaccine and treatment clinical trials. Supported by Janssen Vaccines & Prevention B.V. Disclosures Carla Romano, MS, Janssen Pharmaceuticals: Grant/Research Support Margaret Mayorga, MS , MPH, Janssen Pharmaceuticals: Grant/Research Support Javier Ruiz-Guiñazu, MD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Géralyn C. Trudel, PhD, Janssen Pharmaceuticals: Stocks/Bonds Sheri Fehnel, PhD, Janssen Pharmaceuticals: Grant/Research Support Kelly McQuarrie, BSN, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Eric K. H. Chan, PhD, Janssen Global Services, LLC: Employee|Janssen Pharmaceuticals: Stocks/Bonds Eva G. Katz, PhD, MPH, RD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds.

Background Respiratory syncytial virus (RSV) can cause serious lower respiratory tract disease (LRTD) among older adults. There is no licensed RSV vaccine. In CYPRESS (a randomized, double-blind, placebo-controlled, phase 2b proof-of concept trial; NCT03982199), an Ad26.RSV.preF/RSV preF protein vaccine demonstrated 80.0% efficacy for prevention of RSV LRTD and 69.8% efficacy for prevention of any RSV acute respiratory infection in adults aged ≥65 years through the first RSV season. This study evaluated the durability of immune responses elicited by Ad26.RSV.preF/RSV preF protein after two RSV seasons (up to 1.5 years post-vaccination) in the overall study population and in groups of participants stratified by age and risk level for severe RSV LRTD. Methods Participants (N=5782) were randomized 1:1 to receive vaccine or placebo before the RSV season. The primary endpoint was first occurrence of RSV LRTD. RSV A2 virus neutralizing antibodies (VNAs; through Day 365), RSV preF binding antibodies (through Day 533), and RSV-F–specific IFN-γ enzyme-linked immune absorbent spot (ELISpot; through Day 533), were evaluated in an immunogenicity subset (n=195; ages 65–74 years: n=141; 75–84 years: n=47; ≥85 years: n=6; increased risk [chronic heart or lung disease]: n=48; non-increased risk: n=147). Results In the vaccine group of the immunogenicity subset, RSV A2 VNAs peaked at Day 15 and were maintained at 2.8-fold over baseline at 1 year. Similarly, RSV preF-specific binding antibodies peaked at Day 15 and were maintained at 2.1-fold above baseline at 1.5 years. Median RSV-F–specific IFN-γ T-cell frequency increased from 34 spot-forming cells (SFC)/106 peripheral blood mononuclear cells (PBMCs) at baseline to 143 SFC/106 PBMCs at 1.5 years. Comparable immune responses were observed in age/risk subgroups. No relevant changes were observed in the placebo group at any time point. Pre-existing Ad26 VNAs did not appear to impact RSV-specific immune response durability. Conclusion Ad26.RSV.preF/RSV preF protein vaccine was efficacious and elicited robust, durable (to at least 1.5 years) humoral and cellular immune responses in adults aged ≥65 years, older participants (≥75 years), and in participants with increased risk for severe RSV LRTD. Disclosures Christy A. Comeaux, MD, PhD, Janssen Vaccines & Prevention B.V.: Employee Ann R. Falsey, MD, BioFire Diagnostics: Grant/Research Support|Janssen: Grant/Research Support|Merck Sharp & Dohme: Grant/Research Support|Novavax: Advisor/Consultant|Pfizer: Grant/Research Support Kristi Williams, PhD, Janssen Research and Development: Employee John E. Ervin, MD, The Alliance for Multispecialty Research – KCM: Contractual agreement for conduct of study protocol Arangassery R. Bastian, PhD, Janssen Vaccines & Prevention BV: Employee Joris Menten, PhD, Janssen Infectious Diseases: Employee Els De Paepe, MSc, Janssen Infectious Diseases: employee Sjouke Vandenberghe, PhD, Janssen Infectious Diseases: Employee Eric K. H. Chan, PhD, Janssen Global Services, LLC: Employee Jerald Sadoff, MD, Janssen Vaccines & Prevention BV: Employee Macaya Douoguih, MD, MPH, Janssen Vaccines & Prevention B.V.: Employee Benoit Callendret, PhD, Janssen Vaccines & Prevention B.V.: Employee Esther Heijnen, MD, PhD, Janssen Vaccines & Prevention B.V.: Employee.

Background The Symptoms of Infection with Coronavirus-19 (SIC), a patient reported outcome (PRO) measure, was developed to assess COVID-19 signs and symptoms. Qualitative and cross-sectional studies demonstrated its content validity and preliminary psychometric properties. This study provides additional evidence on the reliability, responsiveness, known-group validity, and meaningful change thresholds of the SIC using methods aligned with regulatory guidance and best practices. Methods Data were from ENSEMBLE-2, a multicenter, randomized, double-blind, placebo-controlled phase 3 trial to assess the efficacy and safety of Ad26.COV2.S for the prevention of SARS-CoV-2 infections in adults (aged 18+). The SIC was used in the trial to evaluate COVID-19 signs and symptoms and the Patient Global Impression of Severity (PGIS) was used as an anchor for validation. Intra-class correlations (ICCs) and Cronbach’s alphas were computed to evaluate the test-retest reliability and internal consistency, and analyses of variance (ANOVAs) were performed to assess the known-group validity of the SIC. Responsiveness was evaluated using PGIS as an anchor variable and a 1- or 2-point improvement in PGIS was used to estimate the meaningful change thresholds of the SIC. Results 183 participants with polymerase chain reaction (PCR) confirmed moderate to severe/critical COVID-19 were included (mean ± SD age: 51.5 ± 14.8 y; female: 44%; White 65%). ICCs showed strong test-retest reliabilities for most SIC domains (.60 and above). The internal consistency reliability of the SIC had a Cronbach’s alpha > .70 for all but one domain (Neurological). Statistically significant differences (p values < 0.05) for the different PGIS severity levels were found for all but one domain (Sensory), supporting known-group validity. All domains showed responsiveness based on changes (improvement and worsening) in PGIS, supporting the ability of the SIC to detect changes in COVID-19 signs and symptoms. Based on mean changes in the PGIS, estimated meaningful change thresholds for SIC domains ranged from -.36 to -2.11. Conclusion These results, based on data from ENSEMBLE-2, build upon prior cross-sectional analyses and provide additional supportive psychometric evidence on the SIC. Support: Janssen Vaccines & Prevention B.V. Disclosures Eric K. H. Chan, PhD, Janssen Global Services, LLC: Employee|Janssen Pharmaceuticals: Stocks/Bonds Jeffrey Stoddard, MD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Jerald Sadoff, MD, Janssen Vaccines & Prevention BV: Employee Yan Liu, PhD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Ilse van Dromme, PhD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Eva G. Katz, PhD, MPH, RD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Yi-hsuan Liu, PhD, MS, RD, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds Kelly McQuarrie, BSN, Janssen Pharmaceuticals: Employee|Janssen Pharmaceuticals: Stocks/Bonds.

Despite the fact that many Asian cities have integrated the autonomous vehicle (AV) into their urban and transportation planning, very few studies have examined the impacts of the AV in the context of Asian cities. This chapter discusses the social and ethical impacts of the AV in Seoul and Singapore. Through glimpses offered by urban vignettes of the AV constructed for each of these cities, this chapter examines how the AV can bring to the surface issues of gender inequity and prejudice in Seoul and challenge convivial urban relations in Singapore. This chapter argues that socio-ethical issues are deeply intertwined with the safety concerns of the AV, and it suggests that attending to these issues can advance both the moral quality of the AV and standards of public safety.

Background: Hepatitis B surface antigen (HBsAg) loss is associated with improved clinical outcomes for individuals with chronic hepatitis B (CHB); however, the effects of varying HBsAg levels on clinical outcomes in diverse cohorts are understudied. Methods: In this cross-sectional, multicentre, retrospective study, the data on adult subjects enrolled in the Canadian HBV Network with CHB seen from 1 January 2012 to 30 January 2021 with the treatment and virologic data within 1 year of HBsAg testing were analyzed. Patients were tested for HBsAg using qualitative (for HBsAg-negative samples) and/or commercial quantitative assays. Fibrosis or hepatic necroinflammation was determined by the liver stiffness measurement (LSM). The baseline data were summarized using descriptive statistics and compared by using univariable/multivariable analyses. Results: This study included 844 CHB patients, with a median age of 49.6 years (IQR 40.1–60.5), and 37% were female. In total, 751 patients (78.6%) had known ethnicity data, and 76.7% self-reported as Asian, 11.4% as Black, 6.8% as White, and 4.8% as other. Among the 844 patients, 237 (28.0%) were HBsAg (−) (1000 IU/mL. Overall, 80% (682) had known HBeAg status at the last follow-up, and the majority (87.0%) were HBeAg-negative. In addition, 54% (461/844) had prior antiviral therapy, 19.7% of which (16.3, 23.7, n = 91) were HBsAg (−). The treated patients had a lower risk of cirrhosis (16.46, 95% CI 1.89–143.39, p = 0.01) or HCC (8.23, 95% CI 1.01–67.39, p = 0.05) than the untreated patients. A lower proportion of the HBsAg-loss group had cirrhosis (5.7% vs. 10.9%, p = 0.021) and HCC (0.9% vs. 6.2%, p = 0.001). Conclusion: In this retrospective, ethnically diverse cohort study, CHB patients who received antiviral therapy and/or had HBsAg loss were less likely to develop cirrhosis and HCC, confirming the results of the studies in less diverse cohorts. No association was found between the qHBsAg level and fibrosis determined with LSM. Individuals who achieved HBsAg loss had low-level qHBsAg within 1 year of seroclearance.

Background and aims Data are emerging on 10-year mortality comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stenting for multivessel disease (MVD) without left main (LM) involvement. We conducted an updated two-stage meta-analysis using reconstructed individual patient data to compare long-term mortality between CABG and PCI for patients with MVD without significant LM coronary disease. Methods Medline and Embase databases were searched for articles comparing CABG with PCI for MVD. A two-stage meta-analysis was conducted using reconstructed patient level survival data for all-cause mortality with subgroups by SYNTAX score. The shared-frailty and stratified Cox models were fitted to compare survival endpoints. Results We screened 1496 studies and included six randomized controlled trials with 7181 patients. PCI was associated with greater 10-year all-cause mortality risk (HR: 1.282, CI: 1.118–1.469, p Conclusion This updated reconstructed individual patient-data meta-analysis revealed a sustained lower cumulative all-cause mortality of CABG over PCI for multivessel disease without LM involvement. Funding Acknowledgement Type of funding sources: None.

Background Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results. Objectives We performed a systematic review from inception to 23 May 2021 and one-stage reconstructed individual-patient data meta-analysis (IPDMA) that included 10-year mortality outcomes. Methods The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke and unplanned revascularization at 5 years. We did IPDMA using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups. Results Of 583 articles retrieved, 5 RCTs were included. A total of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297) or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925–1.292; p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI: 0.992–1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998–1.013, p=0.133) at 5 years. Unplanned revascularization was more frequent following PCI compared with CABG (HR 1.807, 95% CI: 1.524–2.144, p Conclusion This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD. Funding Acknowledgement Type of funding sources: None.

Bystanders Join in Cyberbullying on Social Networking Sites: The Deindividuation and Moral Disengagement PerspectivesCyberbullying on social networking sites escalates when bystanders join in the bullying. Bystanders’ joining-in behaviors reinforce the abuse, expose victims to a larger audience, and encourage further abuse by signaling their approval of the aggressive behavior. This study developed an integrative model that explains bystanders’ joining-in cyberbullying behaviors on SNSs to offer actionable insights into reducing such harmful behaviors. We tested the model using 1,179 responses using a scenario survey study. Our findings suggest that IT artifacts (including digital profile, search and privacy, relational ties, and network transparency) activated two key mechanisms that lead to cyberbullying joining-in behaviors: (i) the deindividuation experiences that attenuate self-identity and put salience on group/social identity, and (ii) the moral disengagement practices that permit the exercise of cognitive maneuvers to justify group-interested choices that do not align with social standard. The findings explain why people who do not know each other gang up to bully a target on social media. Platform owners who wish to discourage bystanders from joining in undesirable activities may consider regulating how users could share and access digital resources in a social network and should acknowledge the influence of social identity in igniting, driving, and prolonging harmful online group behaviors.Cyberbullying on social networking sites (SNSs) escalates when bystanders join in the bullying. Although researchers have recognized the harmful consequences of joining in cyberbullying behaviors, little is known about the role of information technology (IT) and its underlying mechanisms in fueling such negative group behavior on SNSs. To address this research gap, we develop and test an integrative model that explains bystanders’ joining-in cyberbullying behaviors on SNSs. Based on the theoretical premises of the social identity model of deindividuation effects (the SIDE model), we derive two deindividuation experiences enabled by SNSs, namely experienced anonymity and experienced social identity. We further use the social network research framework to gain insights into how IT features (i.e., digital profile, search and privacy, relational ties, and network transparency) enable these two deindividuation experiences. Considering the socially undesirable nature of joining-in behaviors, we integrate the SIDE model with moral disengagement theory to explain how deindividuation experiences allow bystanders to bypass their psychological discomfort when engaging in such behaviors through the practice of moral disengagement mechanisms. Our research model is tested using a scenario survey, with two samples recruited from Amazon Mechanical Turk and Facebook. Our results support the influences of IT-enabled deindividuation experiences on bystanders joining in cyberbullying and demonstrate the mediating effects of moral disengagement mechanisms in bridging the effects of deindividuation experiences on joining-in behaviors. For researchers, the integrative view offers a conceptual bridge connecting IT features, deindividuation, moral disengagement, and negative online group behaviors on SNSs. For practitioners, our findings provide platform owners and governmental agencies with directions on how to mitigate cyberbullying on SNSs and other forms of deviant and undesirable online group behaviors.

EnglishWith a strong adherence to liberalism, the labor market in Hong Kong is character-ized by a low level of external regulation and an emphasis on self-adaptation as coping. The government mainly attend to the quality of manpower supplied meet-ing the market need, as well as peaceful industrial relations. Segmentation of labor is a natural result of this lowly regulated liberal market. Benefited from a relatively stable economy, unemployment in the past two decades mainly contained, but dualisation observed with widening income gap, as well as an emerging sector of insecure labor. The recent COVID-19 pandemic is leading to a sudden and unex-pected economic crisis. Though with more ad hoc measures, cautious in regulating the labor market maintained. While we are waiting for further government initia-tives, the ending of the employment subsidy from December will certainly worsen the situation. Further dualisation will be the result. italianoCon una forte adesione al liberismo, il mercato del lavoro di Hong Kong e caratterizzato da un basso livello di regolamentazione e da un’enfasi sulla capacita di adattamento. Il governo si occupa principalmente della qualita della manodopera fornita per soddisfare le esigenze del mercato, nonche di garantire relazioni industriali pacifiche. La segmentazione del lavoro e un risultato naturale di un mercato poco regolamentato. Beneficiato da un’economia relativamente stabile, la disoccupazione negli ultimi due decenni e stata per lo piu contenuta, ma e stata altresi osservata una crescente dualizzazione caratterizzata con un divario dei redditi, nonche dall’aumento del lavoro precario. La recente pandemia di COVID-19 sta causando una crisi economica improvvisa e inaspettata. Anche se con misure ad hoc, e stata comunque perpetuata la tradizionale ridotta regolamentazione del mercato del lavoro. In attesa di ulteriori iniziative del governo, la fine degli incentivi all’occupazione a partire da dicembre peggiorera sicuramente la situazione. Il risultato sara un’ulteriore dualizzazione.

Acute appendicitis is one of the most common causes of intra-abdominal emergency surgery worldwide. This study was conducted to contribute to global databases by presenting data from our institution, which consist of multi-racial population. We aimed to evaluate the presentation, diagnosis, and management of acute appendicitis and post-operative outcome in our institution and evaluate the risks factors associated with severe complications and prolonged length of stay (LOS).We performed a retrospective analysis using multivariate regression analysis of all patients who underwent appendectomy (2009-2014) in our institution. The primary outcomes included demographics, presentation, and perioperative management, and the secondary outcomes included risk factors associated with prolonged LOS.Of the 1185 patients, the mean age was 36.4 years, and 940 (79.3%) were male. Majority (98.1%) of patients were ASA (American Society of Anaesthesiologists) 1 or 2. Most of them (83.9%) were from the four racial subgroups (Chinese, Malay, Bangladeshi, and Indian). There was no racial variation in the diagnosis and presentation of disease. The mean duration of symptoms was 1.8 days. The history was commonly a localised or migratory abdominal pain associated with anorexia, nausea, vomiting, and fever. The commonest physical findings were right-sided abdominal tenderness associated with rebound and guarding. About 42.9% of the patients underwent pre-operative CT scan to establish the diagnosis of appendicitis prior to surgery, whilst 57.1% underwent surgery on clinical diagnosis and blood investigation (NWR and CRP). An open appendectomy was performed in 13.2% of the patients. The conversion rate of laparoscopic appendectomy was 4.9% (n = 50). The mean length of hospital stay was 3.6 days. On multivariate Cox regression, patients of Burmese and Thai descent were independently associated with a prolonged LOS. The postoperative morbidity was 5.5%. The 30-day readmission rate was 2.4%. There was no mortality in our study.Our study showed that pre-operative diagnosis of acute appendicitis can be made accurately by classical clinical presentation or by imaging. Independent risk factors associated with increased LOS included increased age, male gender, prolonged duration of symptoms pre-admission, fever, generalised tenderness, and prolonged operative time. The effect of race on LOS has been observed in the literature for other surgical procedures. The prolonged LOS found in Burmese and Thai patients contribute to the possibility of intrinsic racial differences in the post-surgery recovery. However, the numbers are small and therefore prone to type I error. Compared to the open approach, the use of laparoscopic appendectomy was associated with shorter LOS. This has similar outcomes to those reported in the literature.The identification of risks factors could help surgical team to predict the clinical outcomes and develop risk reduction strategy in post-operative care of these patients.

PurposeOnline disinhibition is one of the key factors leading to the occurrence of cyberaggression, cyberbullying and various forms of deviant behaviors in the online environment. To understand the composition of online disinhibition, this study aims to conceptualize online disinhibition and develop a measurement instrument for online disinhibition.Design/methodology/approachWe followed a rigorous procedure to develop and validate the multidimensional instrument of online disinhibition in three phases: item generation, measurement development and instrument testing.FindingsWe developed a 23-item online disinhibition scale and identified six key dimensions: dissociative anonymity, invisibility, asynchronicity, solipsistic introjections, dissociative imagination and minimization of authority.Practical implicationsThe online disinhibition instrument is an accessible and easily administered measure that can be used as a checklist for systems designers and administrators to evaluate the level of online disinhibition among users. It offers systems design information on how to prevent and combat online deviant behaviors on platforms.Originality/valueThis work provides a rich conceptualization of an online disinhibition instrument that can serve as a springboard for future work to understand online deviant behaviors. The newly developed measurement instrument of online disinhibition also adds to the repository of rigorous research scales in this area.

Evaluate the effect of intravenous golimumab on health-related quality of life (HRQoL) in patients with ankylosing spondylitis (AS) through week 28 of the phase III, multicenter, randomized, double-blind, placebo-controlled GO-ALIVE study.Adult patients (n = 208) were randomized to IV golimumab 2 mg/kg (n = 105) at weeks 0, 4, and 12 and every 8 weeks or placebo (n = 103) at weeks 0, 4, and 12, with crossover to golimumab 2mg/kg at weeks 16, 20, and every 8 weeks. General HRQoL was evaluated using the Short Form Health Survey (SF-36) Physical Component Summary/Mental Component Summary (PCS/MCS), and the EQ VAS, and AS disease-specific HRQoL was assessed using the Ankylosing Spondylitis Quality of Life (ASQoL) instrument.Mean improvements from baseline in SF-36 PCS were greater in the golimumab group versus the placebo group at weeks 8 and 16 (6.8 vs 2.1 and 8.5 vs 2.9, respectively; P.001); similar results were observed for SF-36 MCS (5.6 vs 1.7 and 6.5 vs 0.8, respectively; P.001). Mean improvement in each of 8 subscale scores of the SF-36 were also greater for golimumab-treated patients versus placebo at weeks 8 and 16. Mean improvements in EQ VAS and ASQoL were greater in the golimumab group versus placebo at week 8 and week 16. Greater proportions of golimumab-treated patients had clinically meaningful improvement in SF-36 PCS, SF-36 MCS, EQ VAS, and ASQoL at weeks 8 and 16; improvements in SF-36 PCS/MCS, EQ VAS, and ASQoL were maintained through week 28.Golimumab-treated patients had greater mean improvements in HRQoL measures compared with placebo through week 16. Clinically meaningful improvements were observed as early as week 8 and continued through week 28.

The effect of intravenous (IV) golimumab on health-related quality of life (HRQoL) and productivity in patients with ankylosing spondylitis (AS) was evaluated. Patients were randomized to IV golimumab 2 mg/kg (n = 105) at weeks 0, 4, then every 8 weeks (q8w) through week 52 or placebo (n = 103) at weeks 0, 4, 12, with crossover to golimumab 2 mg/kg at weeks 16, 20, then q8w through week 52. Changes from baseline in EuroQol-5 dimension-5 level (EQ-5D-5L) index and visual analog scale (EQ-VAS), daily productivity VAS, Work Limitations Questionnaire (WLQ), and Ankylosing Spondylitis Quality of Life (ASQoL) were assessed. Correlations between these outcomes and disease activity and patient functioning outcomes were evaluated post hoc. At week 16, changes from baseline (mean ± standard deviation) in EQ-5D-5L index (0.17 ± 0.16 vs 0.05 ± 0.14), EQ-VAS (20.3 ± 24.6 vs 4.8 ± 23.5), daily productivity VAS (− 2.9 ± − 2.9 vs − 1.1 ± − 2.5), WLQ productivity loss score (− 3.5 ± − 5.3 vs − 1.9 ± − 4.0), and ASQoL (− 5.4 ± − 5.0 vs − 1.8 ± − 4.5) were greater in the IV golimumab versus placebo group, respectively. At week 28, changes from baseline were similar between the IV golimumab and placebo-crossover groups (EQ-5D-5L index: 0.18 ± 0.17 and 0.16 ± 0.16, EQ-VAS: 20.5 ± 27.9 and 22.5 ± 23.1, daily productivity VAS: − 3.1 ± − 3.0 and − 3.1 ± − 2.8, WLQ productivity loss: − 3.9 ± − 5.5 and − 4.5 ± − 4.5, and ASQoL: − 5.3 ± − 5.2 and − 5.3 ± − 4.8, respectively); improvements were maintained through week 52. HRQoL and productivity outcomes were generally moderately correlated with disease activity and functioning outcomes. In patients with AS, IV golimumab produced sustained improvements in HRQoL and productivity through 1 year, which correlated with improvements in disease activity and functioning. ClinicalTrials.gov registry number is NCT02186873.

Background People with chronic infectious diseases such as hepatitis B can face stigma, which can influence everyday life as well as willingness to engage with medical professionals or disclose disease status. A systematic literature review was performed to characterize the level and type of stigma experienced by people infected with hepatitis B virus (HBV) as well as to identify instruments used to measure it. Methods A literature review was performed using the PubMed, Embase and Cochrane Library databases to identify studies describing HBV-related stigma. For inclusion, articles were required to be published in full-text form, in English and report quantitative or qualitative data on HBV-related stigma that could be extracted. Results A total of 23 (17 quantitative and 6 qualitative) articles examined HBV-related stigma. The scope of the review was global but nearly all identified studies were conducted in countries in the WHO Southeast Asia or Western Pacific regions or within immigrant communities in North America. Several quantitative studies utilized tools specifically designed to assess aspects of stigma. Qualitative studies were primarily conducted via patient interviews. Internalized and social stigma were common among people living with chronic HBV . Some people also perceived structural/institutional stigma, with up to 20% believing that they may be denied healthcare and up to 30% stating they may experience workplace discrimination due to HBV. Conclusion HBV-related stigma is common, particularly in some countries in Southeast Asia and the Western Pacific region and among Asian immigrant communities, but is poorly characterized in non-Asian populations. Initiatives are needed to document and combat stigma (particularly in settings/jurisdictions where it is poorly described) as well as its clinical and socioeconomic consequences.

In China, the correlation between environmental space and drug use by gay male sex workers remains an under-researched public health concern. Drugs are commonly used to enhance sexual performance a...

Background Given the urgent need for vaccines and treatments for coronavirus disease 2019 (COVID-19), the Symptoms of Infection with Coronavirus-19 (SIC), a comprehensive, patient-reported outcome (PRO) measure of signs and symptoms associated with COVID-19, was developed in full alignment with current US regulatory guidance to support evaluations of vaccines and treatments in development. Methods An initial version of the SIC was developed to address concepts identified through a targeted literature review and consultation with experts in infectious diseases and clinicians routinely managing COVID-19 in a hospital setting. A qualitative study was conducted in sites in the United States among 31 participants aged ≥ 18 years who were English-speaking and willing and able to provide informed consent and a self-reported history by telephone or online method. The measure was refined based on additional feedback from the clinicians and three iterative rounds of combined concept elicitation and cognitive debriefing interviews conducted with patients, caregivers, and healthy volunteers. Results Among 39 scientific articles identified in the literature review, 35 COVID-19 signs and symptoms were reported and confirmed during interviews with clinicians, patients, and caregivers. Patients and healthy participants suggested changes for refining the draft SIC to ensure consistent interpretation and endorsed both the 24-h recall period and use of an 11-point numeric rating scale (NRS) for capturing change in symptom severity. The final version of the SIC captures the daily presence or absence of 30 symptoms and a rating of severity for 25 of the 30 symptoms using an NRS for those symptoms reported as present. Conclusions The SIC comprehensively addresses observations described in the literature, by clinicians, and by patients, and captures patients’ experiences with COVID-19 in a manner that minimizes complexity and facilitates completion for both patients and healthy volunteers. This measure is thus appropriate for use in clinical trials of both therapeutics and vaccines for COVID-19.

Background The hospitalized acute respiratory tract infection (HARTI) study used the Respiratory Intensity and Impact Questionnaire (RiiQ™) Symptom Scale, derived from FluiiQ™, to assess and compare the burden of respiratory infection symptoms for patients with influenza, respiratory syncytial virus (RSV), and human metapneumovirus (hMPV) infection, with or without core risk factors (CRF) (age ≥65; chronic heart, renal, obstructive pulmonary disease; asthma). Methods This was a prospective cohort study in adult patients hospitalized with acute respiratory tract infection (40 centers, 12 countries) during two consecutive influenza/RSV/hMPV seasons (2017–2019). The RiiQ™ Symptom Scale and EuroQol 5‐Dimensions 5‐Levels (EQ‐5D‐5L) were assessed by interview at two timepoints during hospitalization and at 1, 2, and 3 months post‐discharge. Results Mean lower respiratory tract (LRT) symptom scores were higher for RSV and hMPV participants compared to influenza at 48 h after enrollment/early discharge (p = 0.001) and 3 months post‐discharge (p = 0.007). This was driven by LRT symptoms, including shortness of breath (SOB) (p

Hong Kong's welfare state system is a very peculiar one, with a unique historical and political background that has enabled it to grow steadily over the past years. Social insurance is absent, and only one major provident fund system exists to provide old-age income maintenance and asset building. Most welfare state spending is government-financed, with particularly high social investment in education, health and—what is unique in Asia—a full-fledged system of social assistance and social services, which are mainly financed by the state, but provided by NGOs. There is also significant provision of public housing, although, in general, both the type and quality of publicly constructed housing are inadequate, and government investment in housing has been restricted in the recent decade. All in all, the welfare state system in Hong Kong fails to eliminate poverty, owing to the presence of asset- and means-tested social benefits and services. As a result, a large underclass exists in Hong Kong, while the middle class benefits more from social investment in education, but faces increasing uncertainty. The future of welfare state spending in Hong Kong is path-dependent for political reasons, and the system chosen is unsuitable, as it does not touch on the social structure which manufactures income inequality. Hence, the government, knowingly or not, is managing the continuation, and cementation, of poverty, while having limited effect on tackling overall income distribution before and after taxation and social transfers.

Single cell SNV analysis is an emerging and promising strategy to connect cell-level genetic variation to cell phenotypes. At the present, SNV detection from 10x Genomics scRNA-seq data is typically performed on the pooled sequencing reads across all cells in a sample. Here, we assess the gain of information of SNV assessments from individual cell scRNA-seq data, where the alignments are split by barcode prior to the variant call. For our analyses we use publicly available sequencing data on the human breast cancer cell line MCF7 cell line generated at consequent time-points during anti-cancer treatment. We analyzed SNV calls by three popular variant callers – GATK, Strelka2 and Mu-tect2, in combination with a method for cell-level tabulation of the sequencing read counts bearing SNV alleles – SCReadCounts. Our analysis shows that variant calls on individual cell alignments identify at least two-fold higher number of SNVs as compared to the pooled scRNA-seq. We demonstrate that scSNVs exclusively called in the single cell alignments (scSNVs) are substantially enriched in novel genetic variants and in coding functional annotations, in particular, stop-codon and missense substitutions. Furthermore, we find that the expression of some scSNVs correlates with the expression of their harbouring gene (cis-scReQTLs).Overall, our study indicates an immense potential of SNV calls from individual cell scRNA-seq data and emphasizes on the need of cell-level variant detection approaches and tools. Given the growing accumulation of scRNA-seq datasets, cell-level variant assessments are likely to significantly contribute to the understanding of the cellular heterogeneity and the relationship between genetics variants and functional phenotypes. In addition, cell-level variant assessments from scRNA-seq can be highly informative in cancer where they can help elucidate somatic mutations evolution and functionality.