Rationale and design of the Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs (ESPRIT): A multicenter open-label randomized controlled trial.

BACKGROUND: Lowering blood pressure (BP) effectively reduces the risk of cardiovascular (CV) events in high CV risk individuals. The optimal target of BP lowering among high CV risk individuals remains unclear. METHODS: The Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs (ESPRIT) trial is a multi-center, open-label, randomized controlled trial to compare the efficacy and safety of intensive BP lowering strategy (Systolic BP target <120 mm Hg) and standard BP lowering strategy (Systolic BP target <140 mm Hg). Participants aged at least 50 years old with baseline systolic BP within 130 to 180 mm Hg at high CV risk, defined by established CV diseases or 2 major CV risk factors, were enrolled. The primary outcome is a composite CV outcome of myocardial infarction, coronary or non-coronary revascularization, hospitalization or emergency department visit from new-onset heart failure or acute decompensated heart failure, stroke, or death from CV diseases. Secondary outcomes include components of the primary composite outcome, all-cause death, a composite of the primary outcome or all-cause death, kidney outcomes, as well as cognitive outcomes. RESULTS: Despite of the interruption of COVID-19 outbreak, the ESPRIT trial successfully enrolled and randomized 11,255 participants from 116 hospitals or primary health care institutions. The mean age of the participants was 64.6 (standard deviation [SD], 7.1) years, 4,650 (41.3%) were women. Among them 28.9%, 26.9% and 38.7% had coronary heart disease, prior stroke and diabetes mellitus, respectively. COVID-19 outbreak affected the BP lowering titration process of the trial, and delayed the reach of BP target. CONCLUSIONS: The ESPRIT trial will address the important question on the optimal BP lowering target for individuals with high CV risk, and generate high quality evidence for treating millions of patients from East Asian countries.

Can Trust Bring Satisfaction to the Festival Under Pandemic?

In existing festival research, trust is often placed at the post-experience stage by scholars, and there is no research to explore the relationship between festivalscape, trust, and experience. In addition, the main function of trust is to reduce uncertainty and risk perception. Existing festival-related research scenarios do not have typical risks, which will limit the findings of the research. This research focuses on festivals under covid-19 pandemic, which is a typical risky scenario. Exploring the antecedent variables and the consequences of the trust of the festival participants in this context may therefore make up the deficiency of existing research. Several interesting findings have been made: the perception of the festivalscape during the pandemic has been significantly simplified. Epidemic prevention measures and staff may increase trust, but trust cannot have a direct and significant impact on festival satisfaction. While staff positively strengthen trust, they will have a significant negative impact on satisfaction.

Exploration of Leisure Constraints Perception in the Context of a Pandemic: An Empirical Study of the Macau Light Festival.

Individuals' capacity to participate in leisure activities is contingent upon their ability to overcome obstacles. It is worthwhile to investigate how individuals perceive constraints on their leisure activities participation during the COVID-19 pandemic. This study demonstrates that the connotation of leisure constraints during pandemic includes personal health concerns, shock on economic revenue, reduced freedom of travel, and inconvenience associated with epidemic prevention. Reduced travel freedom is the most influential factor on participation intentions, followed by personal health concerns. Significant differences in perceptions of constraints are observed between groups with different characteristics.

Modeling and Evaluation of the Joint Prevention and Control Mechanism for Curbing COVID-19 in Wuhan.

The spread of COVID-19 in Wuhan was successfully curbed under the strategy of "Joint Prevention and Control Mechanism." To understand how this measure stopped the epidemics in Wuhan, we establish a compartmental model with time-varying parameters over different stages. In the early stage of the epidemic, due to resource limitations, the number of daily reported cases may lower than the actual number. We employ a dynamic-based approach to calibrate the accumulated clinically diagnosed data with a sudden jump on February 12 and 13. The model simulation shows reasonably good match with the adjusted data which allows the prediction of the cumulative confirmed cases. Numerical results reveal that the "Joint Prevention and Control Mechanism" played a significant role on the containment of COVID-19. The spread of COVID-19 cannot be inhibited if any of the measures was not effectively implemented. Our analysis also illustrates that the Fangcang Shelter Hospitals are very helpful when the beds in the designated hospitals are insufficient. Comprised with Fangcang Shelter Hospitals, the designated hospitals can contain the transmission of COVID-19 more effectively. Our findings suggest that the combined multiple measures are essential to curb an ongoing epidemic if the prevention and control measures can be fully implemented.

Association between use of Qingfei Paidu Tang and mortality in hospitalized patients with COVID-19: A national retrospective registry study.

BACKGROUND: Qingfei Paidu Tang (QPT), a formula of traditional Chinese medicine, which was suggested to be able to ease symptoms in patients with Coronavirus Disease 2019 (COVID-19), has been recommended by clinical guidelines and widely used to treat COVID-19 in China. However, whether it decreases mortality remains unknown. PURPOSE: We aimed to explore the association between QPT use and in-hospital mortality among patients hospitalized for COVID-19. STUDY DESIGN: A retrospective study based on a real-world database was conducted. METHODS: We identified patients consecutively hospitalized with COVID-19 in 15 hospitals from a national retrospective registry in China, from January through May 2020. Data on patients' characteristics, treatments, and outcomes were extracted from the electronic medical records. The association of QPT use with COVID-19 related mortality was evaluated using Cox proportional hazards models based on propensity score analysis. RESULTS: Of the 8939 patients included, 28.7% received QPT. The COVID-19 related mortality was 1.2% (95% confidence interval [CI] 0.8% to 1.7%) among the patients receiving QPT and 4.8% (95% CI 4.3% to 5.3%) among those not receiving QPT. After adjustment for patient characteristics and concomitant treatments, QPT use was associated with a relative reduction of 50% in-hospital COVID-19 related mortality (hazard ratio, 0.50; 95% CI, 0.37 to 0.66 p < 0.001). This association was consistent across subgroups by sex and age. Meanwhile, the incidences of acute liver injury (8.9% [95% CI, 7.8% to 10.1%] vs. 9.9% [95% CI, 9.2% to 10.7%]; odds ratio, 0.96 [95% CI, 0.81% to 1.14%], p = 0.658) and acute kidney injury (1.6% [95% CI, 1.2% to 2.2%] vs. 3.0% [95% CI, 2.6% to 3.5%]; odds ratio, 0.85 [95% CI, 0.62 to 1.17], p = 0.318) were comparable between patients receiving QPT and those not receiving QPT. The major study limitations included that the study was an observational study based on real-world data rather than a randomized control trial, and the quality of data could be affected by the accuracy and completeness of medical records. CONCLUSIONS: QPT was associated with a substantially lower risk of in-hospital mortality, without extra risk of acute liver injury or acute kidney injury among patients hospitalized with COVID-19.