Survey of High Expressed Emotions Experienced By Community Mental Health Service Users in Hong Kong During the COVID-19 Pandemic

Background High expressed emotion (EE) experienced by people with mental illness is a known risk factor of relapse. With drastically increased time spent at home and limited health and social service provision during the COVID-19 pandemic, patients’ experience of high EE warranted attention. Aims and Methods The study aimed to investigate the experience of high EE among people with mental illness during the COVID-19 pandemic. We surveyed the service users of 2 community mental health centers, including participants with psychotic and nonpsychotic disorders. Results Valid responses from 303 participants indicated an overall high EE prevalence of 71.62%, much higher than previous findings, which range between 30% and 40%. People with other psychotic and nonpsychotic disorders showed a higher probability of experiencing high EE than people with schizophrenia. Participants reported a higher probability of experiencing high EE as a result of caregiving by other family relatives and friends than by parents. Conclusion Findings suggest a significantly elevated high EE prevalence among people suffering from mental illness in the community during the COVID-19 pandemic. It is worth further evaluating the long-term effects of high EE beyond the pandemic.

Development of a UVC-based disinfection robot

Purpose>The disinfection robot developed by the authors and team focuses on achieving fast and precise disinfection under a given or specific disinfection zone. This looks to solve problems with traditional robots that pay less attention to the level, efficiency and zones of disinfection. To effectively support and guarantee normal running for the whole system, a digital twin system is applied to the disinfection robot. This study aims to achieve fast, precise and thorough disinfection via the developed mobile robot.Design/methodology/approach>The designed robot is composed primarily of the following three parts: a mobile platform, a six-axis robotic arm and a ultraviolet-C (UVC) LED array. The UVC LED array is installed on the end-effector to achieve large-scale, precise manipulation. The adoption of all types of advanced sensors and the development of an intuitive and user-friendly client interface are helpful in achieving remote control, path planning, data monitoring and custom disinfection functions.Findings>Disinfection of three different locations in the laboratory was performed;the dosage distribution of the surface as radiated by the UVC robot was detected;and feasibility of development was validated.Originality/value>The developed disinfection robot achieved fast, precise and thorough disinfection for a given or specific disinfection zone.

Evaluating Tourist Experience of Rural Homestays in Coastal Areas by Importance–Performance Analysis: A Case Study of Homestay in Dapeng New District, Shenzhen, China

In recent years, the rural homestay has developed rapidly against the background of rural-revitalization policies. However, in early 2020, COVID-19 broke out in China, and the homestay industry was faced with a great challenge. It was difficult for self-employed homestays to resist the risks of the pandemic. As a result, defective operation and business failure occurred in some regions. However, rural homestays with a background in the brand, chain and cluster development mode persisted in the market with a diversity of operation principles. This paper tries to set up an evaluation system for understanding the occupancy needs of tourists, in order to improve the ability of rural homestays to resist risks. The article offers a methodology for assessing the tourist experience of rural homestays in coastal areas, with homestays in Dapeng New District of Shenzhen taken as the research objectives. Then, the evaluation system of rural homestays is set up from the perspective of tourist experience. Based on the results of a questionnaire survey and interviews of operators, this paper proposes the tourist experience–importance analysis in Jiaochangwei and Xichong by the importance–performance analysis (IPA) method. Finally, it suggests policy recommendations that can resist high risk based on tourist experience, for the sustainable development of rural homestays in China.

Human Mesenchymal Stem Cells Treatment for Severe COVID-19: 1-Year Follow-Up Results of a Randomized, Double-Blind, Placebo-Controlled Trial (preprint)

Background The long-term consequences of human umbilical cord-derived mesenchymal stem cell (UC-MSC) treatment for COVID-19 patients are yet to be reported. This study assessed the 1-year outcomes in patients with severe COVID-19, who were recruited in our previous UC-MSC clinical trial.Methods: In this prospective, longitudinal, cohort study, 100 patients enrolled in our phase 2 trial were prospectively followed up at 3-month intervals for 1 year to evaluate the long-term safety and effectiveness of UC-MSC treatment. The primary endpoint was an altered proportion of whole-lung lesion volumes measured by high-resolution CT. Other imaging outcomes, 6-minute walking distance (6-MWD), lung function, plasma biomarkers, and adverse events were also recorded and analyzed. This trial was registered with ClinicalTrials.gov (NCT04288102).Findings: Within 3 months, MSC administration exerted numerical improvement in whole-lung lesion volume compared with the placebo, leading to a significant difference of −10.82% (95% CI: −20.69%, −1.46%, P=0.030) on day 10. MSC also reduced the proportion of solid component lesion volume compared with the placebo at each follow-up point, with a significant difference of − 9.02% (95%CI: − 17.44%, − 0.10%, P=0.045) at month 9. More interestingly, 17.86% (10/56) of patients in the MSC group had normal CT images at month 12 ( P= 0.013), but none in the placebo group. The incidence of symptoms was lower in the MSC group than in the placebo group at each follow-up time, particularly sleep difficulties at month 3 (OR 0.19, 95% CI 0.07,0.50; P=0.001), and usual activity at month 12 (OR 0.15, 95% CI 0.03,0.79; P=0.018). Neutralizing antibodies were all positive, with a similar median inhibition rate (61.6% vs. 67.55%) in both groups at month 12. No difference in adverse events at the 1-year follow-up and tumor markers at month 12 were observed between the two groups.Interpretation: UC-MSC administration achieves a long-term benefit in the recovery of lung lesions and symptoms in COVID-19 patients.Trial Registration: This trial was registered with ClinicalTrials.gov (NCT04288102).Funding The National Key R&D Program of China, the Innovation Groups of the National Natural Science Foundation of China, and the National Science and Technology Major Project.Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Ethics Committee of the Fifth Medical Center, Chinese PLA General Hospital (2020-013-D).

Treatment with human umbilical cord-derived mesenchymal stem cells for COVID-19 patients with lung damage: a randomised, double-blind, placebo controlled phase 2 trial (preprint)

Objective To assess the safety and efficacy of human umbilical cord-derived MSCs (UC-MSCs) for severe COVID-19 patients with lung damage. Design, Multicentre , randomised, double-blind, placebo-controlled trial. Setting Two hospitals in Wuhan, China, 5 March 2020 to 28 March 2020. Participants 101 severe COVID-19 patients with lung damage aged between 18-74 years. Intervention Patients were randomly assigned at a 2:1 ratio to receive either UC-MSCs (40 million cells per infusion) or placebo on days 0, 3, and 6. Main outcome measures The primary endpoints were safety and an altered proportion of whole lung lesion size from baseline to day 28, measured by chest computed tomography. Secondary outcomes were reduction of consolidation lesion sizeand lung function improvement (6-minute walk test, maximum vital capacity, diffusing capacity). Primary analysis was done in the modified intention-to-treat (mITT) population and safety analysis was done in all patients who started their assigned treatment. Results 100 patients were finally recruited to receive either UC-MSCs (n = 65) or placebo (n = 35). The patients receiving UC-MSCs exhibited a trend of numerical improvement in whole lung lesion size from baseline to day 28 compared with the placebo cases (the median difference was -13.31%, 95%CI -29.14%, 2.13%, P=0.080). UC-MSCs administration significantly reduced the proportions of consolidation lesion size from baseline to day 28 compared with the placebo (median difference: -15.45%, 95% CI -30.82%, -0.39%, P=0.043). The 6-minute walk test showed an increased distance in patients treated with UC-MSCs (difference: 27.00 m, 95% CI 0.00, 57.00, P=0.057). The incidence of adverse events was similar, and no serious adverse events were observed in the two groups. Conclusions UC-MSCs treatment is a safe and potentially effective therapeutic approach for COVID-19 patients with lung damage. A phase 3 trial is required to evaluate effects on reducing mortality and preventing long-term pulmonary disability.

Treatment with Human Umbilical Cord-Derived Mesenchymal Stem Cells for Severe COVID-19 Patients with Lung Damage: A Randomised, Double-Blind, Placebo‑Controlled Phase 2 Trial (preprint)

Background: Treatment of severe Corona Virus Disease 2019 (COVID-19) is challenging. We performed a phase 2 trial to assess the efficacy and safety of human umbilical cord-mesenchymal stem cells (UC‑MSCs) to treat patients with severe COVID-19 with lung damage, based on our phase 1 data.Methods: In this randomised, double-blind, and placebo-controlled trial, we recruited 101 eligible patients with severe COVID-19 with lung damage aged between 18–74 years from two hospitals. Enrolled patients were randomly assigned at a 2:1 ratio to receive either UC-MSCs (4 × 107 cells per infusion) or placebo on day 0, 3, and 6. We excluded patients with malignant tumours, shock, or other organ failure. The primary endpoint was an altered proportion of whole lung lesion areas from baseline to day 28, measured by chest computed tomography. Other imaging outcomes, 6-minute walk test, maximum vital capacity, diffusing capacity, plasma biomarkers, and adverse events were recorded and analysed. Primary analysis was done in the modified intention-to-treat (mITT) population and safety analysis was done in all patients who started their assigned treatment. Findings: From March 5, 2020, to March 28, 2020, 100 patients were finally enrolled and received either UC-MSCs (n = 65) or placebo (n = 35). During follow-up, the patients receiving UC-MSCs exhibited a trend of numerical improvement in whole lung lesions from baseline to day 28 compared with the placebo cases. UC-MSCs administration significantly reduced the proportions of consolidation lesions from baseline to day 28 in the treated patients compared with the placebo subjects. The 6-minute walk test showed an increased distance in patients treated with UC-MSCs. Notably, UC-MSCs delivery was well tolerated, with no serious adverse events.Interpretation: UC-MSCs treatment is a safe and potentially effective therapeutic approach for patients with severe COVID‑19. The trial suggests that UC-MSCs administration might benefit patients with COVID-19 with lung damage at the convalescent stage as well as the progression stage.Trial Registration: This trial is registered with ClinicalTrials.gov, number NCT04288102.Funding Statement: This trial was supported by The National Key R&D Program of China (2020YFC0841900, 2020YFC0844000, 2020YFC08860900); The Innovation Groups of the National Natural Science Foundation of China (81721002); The National Science and Technology Major Project (2017YFA0105703).Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: Ethical approval was obtained from the institutional review boards of each participating hospital. Written informed consent was obtained from all the enrolled patients or their legal representatives if they were unable to provide consent.

The seesaw impacts between reduced emissions and enhanced AOC on O$_3$ during the COVID-19 (preprint)

Due to the lockdown measures during the 2019 novel coronavirus (COVID-19) pandemic, the economic activities and the associated emissions have significantly declined. This reduction in emissions has created a natural experiment to assess the impact of the emitted precursor control policy on ozone (O$_3$) pollution, which has become a public concern in China during the last decade. In this study, we utilized comprehensive satellite, ground-level observations, and source-oriented chemical transport modeling to investigate the O$_3$ variations during the COVID-19 in China. Here we found that the O$_3$ formation regime shifted from a VOC-limited regime to a NOx-limited regime due to the lower NOx during the COVID-19 lockdown. However, instead of these changes of the O$_3$ formation region, the significant elevated O$_3$ in the North China Plain (40%) and Yangtze River Delta (35%) were mainly attributed to the enhanced atmospheric oxidant capacity (AOC) in these regions, which was different from previous studies. We suggest that future O$_3$ control policies should comprehensively consider the synergistic effects of O$_3$ formation regime and AOC on the O$_3$ elevation.