Convergence Evaluation of Sports and Tourism Industries in Urban Agglomeration of Guangdong–Hong Kong–Macao Greater Bay Area and Its Spatial-Temporal Evolution

The convergence of sports and tourism industries is a vital direction for the coordinated development of industries, and a vital means to build a quality life circle suitable for living, working and traveling in the urban agglomeration of the Guangdong–Hong Kong–Macao Greater Bay Area (GBA). By using the coupling coordination degree model and exploratory spatial data analysis and establishing an evaluating indicator system for the converged development of sports and tourism industries, this paper measures and analyzes the convergence development level, spatial-temporal evolution, and spatial correlation of the two industries in 11 cities of GBA from 2011 to 2020. The results showed that the synthetical development level of the two industries in urban agglomeration of GBA was steadily rising, with significant differences in regional development, showing the east coast of GBA > the north coast of GBA > the west coast of GBA. The growth trend of industrial convergence degree is obvious, but the overall coupling coordination degree is not high, basically in the late maladjustment stage and transition stage. The convergence of the two industries shows a positive aggregation distribution in space, and the degree of agglomeration is rising. Cities around the Pearl River Estuary mostly belong to the “high-high” spatial association type, with obvious spillover effect, and become a significant growth pole for the converged development of the two industries in GBA. Cities in the periphery of GBA and the west coast of GBA mostly belong to the “low-low” and “low-high” spatial association types. Finally, sustainable development strategies are put forward from four aspects: spatial layout coordination, industrial division coordination, exchange platform coordination, and regional policy coordination, so as to promote the highly converged and coordinated development of the sports and tourism industries in the urban agglomeration of GBA.

Exploring Sustainable Fashion Consumption Behavior in the Post-Pandemic Era: Changes in the Antecedents of Second-Hand Clothing-Sharing in China

Second-hand consumption of clothing plays a vital role in promoting the overall global trend of low-carbon transition;however, the COVID-19 outbreak put this consumption model into a development dilemma. Cultivating consumers' sustainable behavior will be an effective way to promote the sustainable development of the apparel industry. Based on the unified theory of acceptance and use of technology (UTAUT), this study starts with fashion-sharing behavior and investigates the antecedents that influence consumers' use of second-hand clothing-sharing platforms in the post-pandemic era. The research background involves the Chinese clothing-sharing market in the growing period. The findings revealed that the pandemic raised people's awareness of health and hygiene protection. In addition, the cleaning problem of platform clothing has become the primary reason for curbing consumers' choice of sharing. High-cost performance, high efficiency, and convenience can stimulate consumers to use shared services. Considering that the pandemic has driven consumer economic fluctuations, perceived economic risks could widen the gap between willingness and behavior. In conclusion, platforms must fully realize the transparency of the clothing cleaning and maintenance process, improve their own construction level such as ease of use, convenience, and safety, and incorporate functional clothing-sharing to refine people's sustainable consumption habits.

Benchmarking emergency department triage prediction models with machine learning and large public electronic health records (preprint)

The demand for emergency department (ED) services is increasing across the globe, particularly during the current COVID-19 pandemic. Clinical triage and risk assessment have become increasingly challenging due to the shortage of medical resources and the strain on hospital infrastructure caused by the pandemic. As a result of the widespread use of electronic health records (EHRs), we now have access to a vast amount of clinical data, which allows us to develop predictive models and decision support systems to address these challenges. To date, however, there are no widely accepted benchmark ED triage prediction models based on large-scale public EHR data. An open-source benchmarking platform would streamline research workflows by eliminating cumbersome data preprocessing, and facilitate comparisons among different studies and methodologies. In this paper, based on the Medical Information Mart for Intensive Care IV Emergency Department (MIMIC-IV-ED) database, we developed a publicly available benchmark suite for ED triage predictive models and created a benchmark dataset that contains over 400,000 ED visits from 2011 to 2019. We introduced three ED-based outcomes (hospitalization, critical outcomes, and 72-hour ED reattendance) and implemented a variety of popular methodologies, ranging from machine learning methods to clinical scoring systems. We evaluated and compared the performance of these methods against benchmark tasks. Our codes are open-source, allowing anyone with MIMIC-IV-ED data access to perform the same steps in data processing, benchmark model building, and experiments. This study provides future researchers with insights, suggestions, and protocols for managing raw data and developing risk triaging tools for emergency care.

Effectiveness of a Brief Mindfulness-Based Intervention of “STOP" (Stop, Take a Breath, Observe, Proceed) Touching Your Face” During the COVID-19 Pandemic: Randomised Controlled Trial (preprint)

Background: Avoid touching our eyes, nose, and mouth (T-zone) is one of recommended strategies to reduce the spread of the coronavirus disease 2019 (COVID-19) and other infectious diseases. However, face-touching is a frequent behaviour, and it is often done automatically without self-awareness. Raising self-awareness of habituated face-touching behaviour may help individuals to avoid face-touching by contaminated hands. Our aim was to evaluate whether mindfulness-based brief behaviour-change intervention (MBI) named “STOP (Stop, Take a Breath, Observe, Proceed) touching your face” can reduce face-touching behavior. Methods: In this online-based, two group, wait-list, randomized controlled trial, participants aged 18 years or more from general population in China were recruited via Chinese social media platforms. Eligible participants were randomly assigned in a 1:1 ratio to receive “STOP touching your face” intervention or control intervention. Those researchers who assessing outcomes were masked to group allocation. A 60-minute self-monitoring of face-touching behaviour was required to report in the pre- and post-intervention. Reduction of percentage of T-Zone touching was set as primary outcome, with reduction of face-touching frequency being a key secondary outcome. These outcomes were analysed in the intention-to-treat (ITT) basis with a complete case analysis (CCA). Safety was monitored in all randomly assigned participants. This trial is registered at ClinicalTrials.gov (Trial registration number: NCT04330352), and is completed. Findings: Between April 2, 2020 to July 2, 2020, 10194 participants were invited to the trial. Of these, we recruited and randomly assigned 1090 (10.7%) participants to the “STOP touching your face” intervention group (n=545) or to the wait-list control intervention (comparator) group (n=545) after reporting the first 60-minute self-monitoring of face-touching behaviour (pre-intervention). Among them, 71.6% (n=390) participants from the intervention group and 63.9% (n=348) from the control group reported the second 60-minute self-monitoring of face-touching behaviour (post-intervention). ITT analysis revealed that percentage of T-Zone touching was significantly reduced by 8.1% in the intervention group (from 81.1% to 73.0%, RR=0.901, OR=0.631, RD=-0.081, p=0.002), and insignificantly reduced by 0.6% in the control intervention (from 80.0% to 79.4%, p=0.821). Group comparison showed that fewer participants had T-Zone touching in the intervention group than that in the control group (73.0% vs 79.4%, RR=0.919, OR=0.700, RD=-0.064, p=0.015) after intervention, and that there was more reduction of T-Zone touching frequency in the intervention group than that in the control group (mean ± SD: 1.7 ± 5.13 vs 0.7 ± 3.98, Mean difference (95% CI): 1.03 (0.48 to 1.58), p<0.001, Cohen's d=-0.218). The above results were further confirmed by CCA. Compared with older individuals (≥30 years old), young adults (18–29 years old) have twice risk of having T-Zone touching behaviour (OR=2.029, 95% CI=1.145 to 3.597, p=0.015), and younger participants reduced face-touching frequency more than their older counterparts (mean ± SD: 9.9 ± 14.24 vs 3.6 ± 11.25, Mean difference (95% CI)=6.270 (3.615 to 8.924), p<0.001, Cohen's d=-0.47). Interpretation This trial is the first to evaluate the efficacy of “STOP touching your face” intervention to reduce face-touching behaviour during the outbreak of COVID-19. The findings of significantly reduced T-Zone touching behaviour in the intervention group supports the widely dissemination of this brief and simple mindfulness-based behaviour-change intervention to low the risk for the COVID-19 and other hand-to face-touching infectious diseases.Trial registration number: NCT04330352Trial Registration. Funding: Zhejiang University, number (2020XGZX046). Declaration of Interest: We declare no competing interests.Ethical Approval: The trial was approved by The Ethics Committee of Sir Run Run Shaw hospital, an affiliate of Zhejiang University, Medical College (NO. 20200401-32).

Smoking and SARS-CoV-2 Impair Dendritic Cells and Regulate DC-SIGN Expression in Tissues (preprint)

The current spreading novel coronavirus SARS-CoV-2 is highly infectious and pathogenic. In this study, we screened the gene expression of three SARS-CoV-2 host receptors (ACE2, DC-SIGN and L-SIGN) and DC status in bulk and single cell transcriptomic datasets of upper airway, lung or blood of smokers, non-smokers and COVID-19 patients. We found smoking increased DC-SIGN gene expression and inhibited DC maturation and its ability of T cell stimulation. In COVID-19, DC-SIGN gene expression was interestingly decreased in lung DCs but increased in blood DCs. Strikingly, DCs shifted from cDCs to pDCs in COVID-19, but the shift was trapped in an immature stage (CD22+ or ANXA1+ DC) with MHCII downregulation in severe cases. This observation indicates that DCs in severe cases stimulate innate immune responses but fail to specifically recognize SARS-CoV-2. Our study provides insights into smoking effect on COVID-19 risk and the profound modulation of DC function in severe COVID-19.

The Impact of COVID-19 on Primary Care General Practice Consultations in a Teaching Hospital in Shanghai, China (preprint)

Objective: To evaluate the detrimental impact of COVID-19 pandemic public health measures and media reporting on the pattern of primary care consultations within a Shanghai health district.Design: Retrospective observational cohort study.Setting: Data was analysed concerning the pattern of the patient visits to general practitioners within Tongren Hospital, a teaching hospital located in the western part of Shanghai, that is the sole provider of general practice primary care to the local population of approximately 700,000 people.Participants: Data from all primary care consultations for adults (age ≥ 12 years) were collected for the first 6 months of 2020, that included a 60 day lockdown period (24January- 24 March 2020) and compared to data obtained during the first 6 months of 2019.Main outcome measure: Changes to the numbers and patterns of primary care consultations, including sub-group analysis based on age, sex, primary diagnosis.Results: A substantial reduction in patient visits, associated with increased median age, was observed during the first wave of the pandemic in the first 6 months 2020, compared to the same interval during 2019. Consistent with these data, we observed reduced reappointments and waiting times, but increased cost per visit. When analysed by primary disease diagnosis, patient visits were reduced for all the major systems. The most striking reductions of outpatient visits were in CVD, respiratory, endocrine and GI, but psychological disorders (particularly anxiety and insomnia) were increased followed lockdown. However, there was a dramatic fall in consultations for depression. A correlation was observed between monthly patient numbers and both rate of reappointment and average waiting time during the first 6 months of both 2019 and 2020, but an inverse correlation was observed between cost per visit and monthly patient numbers. During the lockdown period there was ~50% reduced patient visits. There was no correlation between the daily number of confirmed COVID-19 cases and daily patient visits during the lockdown period.Conclusions: Our data suggest that there has been a serious impact of the lockdown on patients’ physical and psychological health. Our analysis provides objective health-related data that may inform the current controversy concerning the balance between the detrimental effects of the use of lockdown versus the development of some form of herd immunity against transmission of SARS-CoV-2. These data may also contribute to the further development of WHO Disease Commodity Packages, and improve decision-making in medical practice, policy and education.Funding Statement: This work was supported by grants from: Commission of Health, Changning District, Shanghai (YXMZK009, YZJH005, YJZH003), China Hospital Development Institute, Shanghai Jiao Tong University (CHDI-2020-A-26), Industry Support Plan Project for Colleges and Universities in Gansu Province (2020C-36), Research Project Grant, Shanghai Jiao Tong University (DYXYDGD20); SJTU research project Grant, The University of Sydney.Declaration of Interests: The authors declare that they have no competing interests.Ethics Approval Statement: A retrospective investigation study was conducted within the Department of GP in Tongren Hospital in Shanghai and was approved by the Medical Ethics Committee of the hospital (NO. 2020-079-01), strictly follow the World Medical Association's Declaration of Helsinki. The information of the patients was obtained from the Centre of Electronic Health Records (EHR) in Tongren Hospital. All data obtained from patients were deidentified prior to analysis, and strictly followed the guidelines of Helsinki. Written consents were obtained that the deidentified data can be used for public health purpose, from all of the patients when they were registered with the clinics.

An Improved Method for the Fitting and Prediction of the Number of COVID-19 Confirmed Cases Based on LSTM

New coronavirus disease (COVID-19) has constituted a global pandemic and has spread to most countries and regions in the world. Through understanding the development trend of confirmed cases in a region, the government can control the pandemic by using the corresponding policies. However, the common traditional mathematical differential equations and population prediction models have limitations for time series population prediction, and even have large estimation errors. To address this issue, we propose an improved method for predicting confirmed cases based on LSTM (Long -Short Term Memory) neural network. This work compares the deviation between the experimental results of the improved LSTM prediction model and the digital prediction models (such as Logistic and Hill equations) with the real data as reference. Furthermore, this work uses the goodness of fitting to evaluate the fitting effect of the improvement. Experiments show that the proposed approach has a smaller prediction deviation and a better fitting effect. Compared with the previous forecasting methods, the contributions of our proposed improvement methods are mainly in the following aspects: 1) we have fully considered the spatiotemporal characteristics of the data, rather than single standardized data. 2) the improved parameter settings and evaluation indicators are more accurate for fitting and forecasting. 3) we consider the impact of the epidemic stage and conduct reasonable data processing for different stage.

Neutrophil-to-Lymphocyte Ratio on Admission Predicts In-hospital Mortality in Patients with COVID-19 (preprint)

Background: A novel coronavirus caused an outbreak of acute infectious pneumonia are spreading over the globe. However, studies predicting prognosis are limited. We predicted outcomes of patients with coronavirus disease 2019 (COVID-19) using the neutrophil-to-lymphocyte ratio (NLR) on admission.Methods: We retrospectively analyzed the characteristics of COVID-19 patients diagnosed from February 6 to March 1. The outcomes, including the occurrence of in-hospital mortality, acute kidney injury (AKI), and endotracheal intubation (ETI), were recorded. The relationships of neutrophils, lymphocytes, C-reactive protein, lactate dehydrogenase, and NLR with outcomes were assessed using multivariate regression model. P-values for trends across quartiles of NLR was examined.Results: A total of 182 patients were included. 37 (20.3%) patients died during the hospitalization, 41 (22.5%) developed AKI, and 36 (19.8%) received ETI. The NLR had a superior predictive performance than others. Using an NLR cutoff of 11.4, the area under the curves (AUC) were 0.766 for in-hospital mortality, 0.755 for AKI, and 0.733 for ETI. In multivariate analysis, NLR >11.4 was further identified as an independent prognostic factor. Following stratification with quartiles of NLR, a positive trend between the increasing quartiles of NLR and the three outcomes were observed (p-values for trends across quartiles were 0.043, <0.001, and 0.041, respectively). The multivariate adjusted odds ratio (OR) in the highest quartile vs. the lowest quartile were 5.738 for mortality, 25.307 for AKI, and 5.136 for ETI.Conclusions: Increasing NLR obtained on admission is a powerful predictor for inpatient mortality, AKI, and ETI in COVID-19 patients.

One-Step Rapid Quantification of SARS-CoV-2 Virus Particles via Low-Cost Nanoplasmonic Sensors in Generic Microplate Reader and Point-of-Care Device (preprint)

The spread of SARS-CoV-2 virus in the ongoing global pandemics has led to infections of millions of people and losses of many lives. The rapid, accurate and convenient SARS-CoV-2 virus detection is crucial for controlling and stopping the pandemics. Diagnosis of patients in the early stage infection are so far limited to viral nucleic acid or antigen detection in human nasopharyngeal swab or saliva samples. Here we developed a method for rapid and direct optical measurement of SARS-CoV-2 virus particles in one step nearly without any sample preparation using a spike protein specific nanoplasmonic resonance sensor. We demonstrate that we can detect as few as 30 virus particles in one step within 15 minutes and can quantify the virus concentration linearly in the range of 103 vp/ml to 106 vp/ml. Measurements shown on both generic microplate reader and a handheld smartphone connected device suggest that our low-cost and rapid detection method may be adopted quickly under both regular clinical environment and resource-limited settings.

Management strategy of Corona Virus Disease-2019 in quarantine zones outside hospitals: Analysis of 1232 cases from a district in Wuhan (preprint)

The Corona Virus Disease 2019 (COVID-19) has evolved into a global pandemic in the early 2020. Management strategy outside hospitals of the suspected cases, close contacts and discharged patients might be as important as treatment in hospital. We analyzed information from 1232 cases at 14 hotels (requisitioned as quarantine zones) in Qiaokou district, Wuhan during Feb 8th to Mar 4th 2020. Abide by the unquarantine and hospitalization standard, 603 (48.94%) cases were released from quarantine zones; 540 (43.83%) cases were sent to hospital for further medical care. 89 (7.22%) cases remained on quarantine up to the end of the analysis. The reasons for cases sent to the hospital for treatment were either positive for COVID-19 nucleic acid test, progression in pulmonary CT scan, or aggravation of symptoms. 11/59 patients switched from negative to positive for nucleic acid test during stayed in quarantine zones after being discharged from the hospitals. In total, hospitalization and positive rate for COVID-19 nucleic acid test both decreased over time. The quarantine measures were important and played a pivotal role in identification of cardinal number, cutting off the transmission, reducing the scope of prevention and rehabilitation therapy. This protocol adopted in Wuhan provided countries worldwide with valuable experience.

Clinical and transmission dynamics characteristics of 406 children with coronavirus disease 2019 in China: A review.

OBJECTIVE: Chinese pediatricians are working on the front line to fight COVID-19. They have published a great amount of first-hand clinical data. Collecting their data and forming a large sample for analysis is more conducive to the recognition, prevention and treatment of coronavirus disease 2019 in children. The epidemic prevention and control experience of Chinese pediatricians should be shared with the world. METHODS: By searching Chinese and English literature, the data of 406 children with COVID-19 in China were analyzed. RESULTS: It was found that the clustered incidence of children's families is a dynamic transmission feature; the incidence is low; asymptomatic infections and mild cases account for 44.8%, with only 7 cases of critical illness; laboratory examination of lymphocyte counts is not reduced, as it is for adults; chest CT findings are less severe than those for adults. These presentations are the clinical features of COVID-19 in children. Only 55 of the 406 cases were tested by anal swab for virus nucleic acid, 45 of which were positive, accounting for 81.8% of stool samples. CONCLUSION: There are more children than adults with asymptomatic infections, milder conditions, faster recovery, and a better prognosis. Some concealed morbidity characteristics also bring difficulties to the early identification, prevention and control of COVID-19. COVID-19 screening is needed in the pediatric fever clinic, and respiratory and digestive tract nucleic acid tests should be performed. Efforts should be made to prevent children from becoming a hidden source of transmission in kindergartens, schools or families. Furthermore, China's experience in treating COVID-19 in children has led to faster recovery of sick children.

A Hint on the COVID-19 Risk: Population Disparities in Gene Expression of Three Receptors of SARS-CoV (preprint)

The current spreading novel coronavirus SARS-CoV-2 is highly infectious and pathogenic and has attracted global attention. Recent studies have found that SARS-CoV-2 and SARS-CoV share around 80% of homology and use the same cell entry receptor, ACE2. These inspired us to study other receptors of SARS-CoV, which may be used for SARS-CoV-2 binding as well. In this study, we screened the gene expression of three receptors (ACE2, DC-SIGN and L-SIGN) in four datasets of normal lung tissue from lung adenocarcinoma patients and two single-cell RNA sequencing datasets from normal lung and bronchial epithelial cells separately. No significant difference in gene expression of these three receptors were found between gender groups (male vs female). We found higher gene expression of DC-SIGN in elder with age>60 and higher gene expression of L-SIGN in Caucasian than Asian. Similar to ACE2, we observed significantly higher DC-SIGN gene expression in the lungs of smokers, especially former smokers. However, smokers upregulate ACE2 and DC-SIGN gene expression in different cell types. In the whole lung, ACE2 is actively expressed in remodeled Alveolar Type II cells of former smokers, while DC-SIGN is largely expressed in monocytes of former smokers and dendritic cells of current smokers. In bronchial epithelium, no obvious gene expression of DC-SIGN and L-SIGN was observed while ACE2 was found to be actively expressed in goblet cells of current smokers and club cells of non-smokers. In conclusion, our findings may indicate that smokers, especially former smokers, and people over 60 have higher risk and are more susceptible to SARS-CoV-2 infection. Also, this study provides hints on possible SARS-CoV-2 pathogenicity mechanisms in lung infection.