Recommendations for Face Coverings While Exercising During the COVID-19 Pandemic

In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in "enclosed spaces" where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.

84 Effects of incremental conditioning and supplemental dietary tryptophan on pre, mid, and post-exercise heart rate and respiratory rate in sled dogs

Repetitive bouts of resistance and aerobic exercise can have dramatic effects on whole body physiology. Dietary tryptophan supplementation supports protein turnover and serotonin production, which assist in responses to exercise. The objective of this study was to investigate the effects of a 12-week incremental exercise regimen and supplemental dietary tryptophan on pre-, mid-, and post-exercise heart rate and respiratory rate in sled dogs. Sixteen dogs (mean age of 4.8 ± 2.5 years, body weight 24.3 ± 4.3 kg) were blocked for sex, age, and body weight, and randomly allocated to a control diet or the control plus tryptophan diet (tryptophan to large-neutral-amino-acid ratio of 0.075:1). All dogs participated in a 12-week conditioning regimen with controlled exercise challenges at week -1 and subsequently every 3 weeks. Electrocardiogram electrodes and thoracic rib bands were worn to record heart rate and respiratory rate (EMKA Tech., Falls Church, VA, USA) prior to, during, and following each exercise challenge. A trans regression, mixed, and correlation model were used where appropriate to assess the fixed effects of treatment and week, and explore linear relationships between recovery time and week in SAS (v 9.4). No differences were found in heart rate between treatment groups for any training level (P > 0.10). Working, recovery, and time required for heart rate to recover post-exercise decreased from week -1 to week 11 (P < 0.05). Correlation analysis indicated that treatment dogs recovered respiratory rate faster post-exercise compared to control (r = -0.421, P < 0.05). Resting, recovery and time required for respiratory rate to recover post-exercise decreased from baseline to week 11 (P < 0.05). This data suggests improvement in cardiorespiratory fitness was observed over 12 weeks of training and that tryptophan may support respiratory function during exercise recovery.

Recommendations for return to sport during the SARS-CoV-2 pandemic

In this viewpoint we make specific recommendations that can assist and make the return to sport/exercise as safe as possible for all those impacted - from the recreational athlete to the elite athlete. We acknowledge that there are varying rules and regulations around the world, not to mention the varying philosophies and numerous schools of thought as it relates to return to sport/exercise and we have been cognisant of this in our recommendations. Despite the varying rules and circumstances around the world, we believe it is essential to provide some helpful and consistent guidance for return to training and sport for sport and exercise physicians around the world at this most difficult time. The present viewpoint provides practical and medical recommendations on the resumption to sport process.

Rotavirus acceleration of murine type 1 diabetes is associated with a T helper 1-dependent specific serum antibody response and virus effects in regional lymph nodes

AIMS/HYPOTHESIS

Rotavirus infection in at-risk children correlates with production of serum autoantibodies indicative of type 1 diabetes progression. Oral infection with rhesus monkey rotavirus (RRV) accelerates diabetes onset in mice. This relates to their rotavirus-specific serum antibody titre and local pro-inflammatory cytokine induction without pancreatic infection. Our aim was to further investigate the roles of serum antibodies and viral extra-intestinal spread in diabetes acceleration by rotavirus.

METHODS

Rotavirus-specific serum antibody production was detected by ELISA in diabetes-prone mice given either inactivated or low-dose RRV, in relation to their diabetes development. Serum anti-rotavirus antibody titres and infectious virus in lymph nodes were measured in mice given RRV or porcine rotavirus CRW-8. In lymph node cells, rotavirus antigen presence and immune activation were determined by flow cytometry, in conjunction with cytokine mRNA levels.

RESULTS

Acceleration of diabetes by RRV required virus replication, which correlated with antibody presence. CRW-8 induced similar specific total immunoglobulin and IgA titres to those induced by RRV, but did not accelerate diabetes. RRV alone elicited specific serum IgG antibodies with a T helper (Th)1 bias, spread to regional lymph nodes and activated antigen-presenting cells at these sites. RRV increased Th1-specific cytokine expression in pancreatic lymph nodes. Diabetes onset was more rapid in the RRV-infected mice with the greater Th1 bias.

CONCLUSIONS/INTERPRETATION

Acceleration of murine diabetes by rotavirus is virus strain-specific and associated with virus spread to regional lymph nodes, activation of antigen-presenting cells at these sites and induction of a Th1-dominated antibody and cytokine response.

Abstract LB-308: Combination of CTx-0294945 a highly selective inhibitor of focal adhesion kinase with bevacizumab in pre-clinical models of breast cancer

Background: Focal adhesion kinase (FAK) is a non-receptor tyrosine kinase that provides a critical hub for signalling from at least four different classes of cellular sensing mechanisms including growth factor receptors, GPCRs, integrins and mechanical stress forces. By temporal and spatial integration of signals from these sources, FAK plays a central role in cell migration, invasion and proliferation; processes vital for tumorigenesis. The significance of FAK to the function of signal transduction pathways provides a strong rationale for the combination of FAK inhibitors with other targeted agents to achieve improved efficacy against a range of cancers. Others have demonstrated the importance of FAK in angiogenesis and therefore combining a FAKi with anti-VEGF agents is attractive as it employs two complementary mechanisms of suppressing the formation of tumor vasculature. Here we present results from the co-administration of CTx-0294945, a highly selective FAKi, and bevacizumab (bev) in an orthotopic model of human breast cancer. Methods and Results: CTx-0294945 is an orally bioavailable small molecule ATP competitive inhibitor of focal adhesion kinase (FAK KD=0.21 nM). It exhibits high selectivity against a diverse panel of 125 kinases including the closely related Pyk2. CTx-0294945 inhibits autophosphorylation of 397Y-FAK in MDA-MB-231 cells with an IC50 = 7 nM and exhibits low general cellular toxicity (IC50 = 2.7 µM, MDA-MB-231 cells). CTx-0294945 is suitable for oral administration (%F=58 and t1/2=5.1 h at 20 mg/Kg in rat) and does not inhibit (IC50 >20 µM) any of the cytochrome p450 isoforms tested to date. To assess the co-administration of CTx-0294945 with bev, mice were injected orthotopically with MDA-MB-231 cells (106). After 14 days, when tumors were palpable, mice were randomized into 4 groups and dosing commenced. The groups were treated with CTx-0294945 (80 mg/kg QD, PO), bev (12.5 mg/Kg IP, x2/week), CTx-0294945 (80 mg/Kg QD, PO) and bev (12.5 mg/Kg IP, x2/week) or vehicle. Tumor growth was monitored and on day 28 animals in the vehicle and CTx-0294945 arms were culled when the size of the tumors reached ethical end point (1000 mm3). Tumor growth in the bev only and the CTx-0294945 + bev arms was significantly inhibited (75% and 88% TGI respectively). At this time the treatment regimes for both cohorts were stopped and tumor growth allowed to progress. After an additional 14 days the experiment was terminated when the bev treatment group reached ethical end point; however the average size of the tumors in the CTx-0294945 + bev cohort was still was only 562 mm3. Conclusions: Our data suggest the potential utility of combining a selective FAK inhibitor with bevacizumab to prevent tumour progression and enhance the durability of response.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-308. doi:1538-7445.AM2012-LB-308

Hepatitis C virus (HCV) prevalence, and injecting risk behaviour in multiple sites in England in 2004

We sought to corroborate geographical differences in hepatitis C virus (HCV) prevalence and assess whether these can be explained by differences in injecting risk behaviour. A community recruited interview survey of 1058 injecting drug users (IDU) - including a blood spot specimen for antibody testing - was undertaken in seven cities in England. HCV prevalence varied from 27% to 74% across sites (chi(2)(6) = 115.3, P < 0.001). There was a significant variation in crack-injection, prison history, injecting frequency, homelessness, groin injecting, syringe reuse and sharing between the sites. Adjustment for clustering by site and other covariates attenuated the odds ratios (OR) for most variables: e.g. crack injection changed from an unadjusted OR of >2 to an adjusted OR of 1.4 (95% CI 0.9-2.0). Remaining significant covariates included: homelessness (OR 2.2; 1.4-3.6); ever imprisonment (OR 1.7; 1.2-2.5); syringe sharing >18 months ago (OR 2.0; 1.3-3.0); injecting duration and age. Introducing site as a second level variable did not reach significance (P = 0.10). HCV prevalence among IDU reporting 'never sharing' was 48%. Geographical variation in HCV prevalence remains poorly explained, but should be the key focus of our surveillance effort. Measures of sharing and their interpretation require greater scrutiny.

Does pesticide risk assessment in the European Union assess long-term effects?

Current methods would allow reasonable predictions of long-term effects of pesticide application if three changes were instituted. First, more population-based laboratory studies should be applied in predictive pesticide risk assessment. Second, ERA should include as much effort on collating and integrating ecological knowledge into the assessment in Tier 1 as is currently expended on gathering chemical and toxicological information on exposure and effects. Production of a formal conceptual ecological risk assessment model for each product or active substance for which authorization is sought would provide an appropriate framework for integrating and applying such knowledge. Third, in acknowledgment of the uncertainties in the predictive risk assessment process, more postauthorization monitoring should be done. The application of Occam's razor to pesticide risk assessment makes good sense, as it does in any other field of science. However, we must take care that simplicity in risk assessment process does not lead to oversimplification: Essentially all science is the study of either very small bits of reality or simplified surrogates for complex whole systems. How we simplify can be critical. Careless simplification leads to misleading simplistic conclusions. (Slobodkin 1994).

Lethal and sublethal effects of a neem-based insecticide on balsam fir sawfly (Hymenoptera: Diprionidae)

Lethal and sublethal effects of Neemix 4.5 EC, a commercial neem preparation, on balsam fir sawfly, Neodiprion abietis (Harris), were determined in the laboratory. Larval mortality of N. abietis increased in a concentration-dependent manner, and lethal time decreased with increasing Neemix 4.5 EC concentration. Fifty percent of the larvae died after 4.6 d at a concentration of 90 ppm azadirachtin (AZA) and 12.3 d at a concentration of 0.08 ppm. Neemix 4.5 EC showed some deterrent effects to feeding site selection on N. abietis larvae at high concentrations, but not at low concentrations. Strong reduction of food intake by N. abietis larvae after exposure to Neemix 4.5 EC was demonstrated by significant reduction of frass production. Larvae fed on Neemix 4.5 EC-treated foliage at 90 ppm AZA produced only 16% as much frass as that produced by larvae fed on control foliage (0 ppm). Neemix 4.5 EC at a concentration of 0.08 ppm AZA retarded larval and pupal development. Sublethal doses significantly reduced pupal weight and adult emergence, although the sex ratio of N. abietis adults was not affected. Results indicate that sublethal effects of Neemix 4.5 EC on N. abietis may contribute greatly to the overall field efficacy.

Interaction with simian Hck tyrosine kinase reveals convergent evolution of the Nef protein from simian and human immunodeficiency viruses despite differential molecular surface usage

Simian and human immunodeficiency virus type 1 (SIV and HIV-1) Nef proteins are thought to use different molecular surfaces to mediate the protein-protein interactions required for their otherwise similar functions. This genetically separable function suggests convergent evolution of primate lentiviruses and/or structural differences between human and nonhuman primate cellular target proteins. However, such comparative molecular analyses have not been undertaken so far using the respective natural host-derived cellular targets. We cloned simian Src family kinase Hck and analyzed structurally and biochemically its interaction with SIV Nef.

The relationship between mimetic imperfection and phenotypic variation in insect colour patterns

Many hoverflies (Syrphidae) mimic wasps or bees through colour or behavioural adaptations. The relationship between phenotypic variation in colour pattern and mimetic perfection (as determined by pigeons) was investigated in three species of Müllerian mimics (Vespula spp.) and 10 Batesian hoverfly mimics, plus two non-mimetic species of flies. Four predictions were tested: (i) Batesian mimics might be imperfect because they are in the process of evolving towards perfection, hence there should be a positive relationship between variation and imperfection; (ii) some Batesian mimics are imperfect because they do not have the appropriate genetic variation to improve and have evolved to be as good as possible, hence there should be no differences between species, all displaying a low level of variation; (iii) very common hoverflies should show the highest levels of variation because they outnumber their models, resulting in high predation and a breakdown in the mimetic relationship; and (iv) social wasps (Vespula) have such a powerful defence that anything resembling a wasp, both Müllerian and perfect Batesian mimics, would be avoided, resulting in relaxed selection and high variance. Poor mimics may still evolve to resemble wasps as well as possible and display lower levels of variation. The data only provided support for the fourth prediction. The Müllerian mimics, one of the most perfect Batesian mimics, and the non-mimetic flies displayed much higher levels of variation than the other species of Batesian mimics.

Multiple changes in gene expression in chronic human Achilles tendinopathy

Atlas cDNA cell interaction arrays (CLONTECH) were used to examine degenerate tissue from four patients with Achilles tendon disorders, in order to identify changes in expression of genes important in cell-cell and cell-matrix interactions. The greatest difference between normal (post-mortem) and degenerate tissue samples was in the level of MMP-3 (stromelysin) mRNA, which was down-regulated in all the degenerate samples. Quantitative RT-PCR assay of RNA extracted from paired 'normal' and degenerate Achilles tendon tissue samples taken from tendons during surgery mirrored the results of the arrays. Levels of MMP-3 mRNA were lower, whereas levels of type-I and type-III collagen mRNAs were significantly higher, in the degenerate compared to the 'normal' samples. Immunoblotting of proteins extracted from the same tendon samples showed that three of four normal tissue samples taken from individuals without apparent tendon disorder had much higher levels of MMP-3 protein than 'normal' or degenerate samples from patients with tendinosis. We suggest that MMP-3 may play an important role in the regulation of tendon extracellular matrix degradation and tissue remodelling.

The creation of a database for cancer screening: is the consent of clients required?

Professional caregivers have an obligation to maintain the privacy and confidentiality of all personal information given to them by their patients or clients. Such information is to be released to a party who is not participating in the care of the patient only with the express consent of the patient. The question is whether or not the express consent of a client of an organized cancer screening program is ethically required before the client's personal information is entered into a centralized database. The arguments in favour of express consent are grounded largely in a desire to respect clients' privacy and autonomy fully. The arguments for the reliance on nonexpress, implied or tacit consent are based chiefly on the desire to provide clients with the full benefits of screening. It is suggested here that neither extreme position is satisfactory. A novel, balanced approach that would be sensitive to both electronic data storage and a preventive care situation is needed. Progress on this issue requires focused empirical research, a debate in both professional and public forums, and further critical analysis.

Area-wide diabetes care: the Manchester experience with primary health care teams 1991-1997

Diabetes 2000 has evolved over 6 years from a practice-based audit to a cross-sector, multidisciplinary, multi-agency project. Its prime aim is to improve the care of people with diabetes in Manchester. There are 93 out of 111 practices and all four Trusts now involved. The prevalence of diabetes known to the project is 1.46% (among 418,000 people). Eighteen practices have never participated at any level. There are 6088 people on the now outdated DOS database, another 2000-5000 people are thought to be missing. The audit has shown limited improvements in care over the years. Despite only modest quantitative success there is now in place a mechanism for implementing Department of Health recommendations for a good diabetes service, namely, a city-wide register, management and referral guidelines across primary and secondary care, the start of an integrated care programme and, above all, goodwill on behalf of all participating providers.

Anomalies in Nef expression within the central nervous system of HIV-1 positive individuals/AIDS patients with or without AIDS dementia complex

In determining levels of expression of HIV-1 Nef protein within the central nervous system (CNS) we assessed antibody responses to the protein both peripherally and in CNS. Antibodies to Nef were not detected within the CNS despite detection of antibodies to both gp41 and Nef in peripheral blood and representative virus isolates derived from CNS and peripheral blood (PB) samples containing full length nef sequence and virus-infected cells expressing Nef protein. We conclude from this that expression of Nef within the CNS is such that little or no antibody production occurs and that these differences indicate that Nef protein may not be directly contributing to the AIDS dementia complex. Expression of Nef protein in PHA-activated peripheral blood mononuclear cells from CNS derived isolates was different to that of coincidental PB derived isolates in that partial surface expression was observed for the latter. The results suggest that antigenic presentation of Nef within the CNS is anomalous and that Nef protein expression, at least for the limited number of in vitro derived isolates tested, has a different localization pattern.

Suppression of relaxin gene expression by retinoids in squamous differentiated rabbit tracheal epithelial cells

Northern blot analysis of total RNA from a variety of rabbit tissues indicated that placenta is the primary site of expression of the protein hormone relaxin (previously called SQ10) in rabbits. Relaxin was not detected by this method in other rabbit tissues, including normal trachea and several squamous tissues. However, relaxin is highly induced during squamous cell differentiation in cultured rabbit tracheal epithelial (RbTE) cells. Retinoic acid and retinoids that selectively bind to the nuclear retinoid receptors, the retinoic acid receptors (RARs) and the retinoid X receptors (RXRs), and induce RARE- or RXRE-dependent transactivation as well as repression of AP-1-dependent transactivation, were all effective in suppressing relaxin expression. In addition, the retinoid SR11302, which exhibits only anti-AP-1 activity but does not induce RARE- or RXRE-dependent transactivation, was also able to inhibit relaxin expression. These results suggest that the suppression of relaxin expression is related to the anti-AP-1 activity of retinoids. To determine whether the relaxin gene is regulated by retinoids at the level of transcription, a 4.3 kb fragment of the 5' flanking region of the rabbit relaxin gene was cloned and analyzed. This regulatory region included a classic TATA-box as well as consensus sequences for several transcription factors, including CREB, NF-kappaB and AP-1. The ability of the 4.3 kb regulatory region to control the transcription of a luciferase reporter gene was analyzed in transiently transfected, squamous-differentiated RbTE cells. The results demonstrated that this regulatory region caused strong transactivation of the reporter gene. This transactivation was inhibited by retinoic acid, suggesting retinoid control at the transcriptional level. Deletion analysis indicated that multiple regulatory elements are involved in the regulation of relaxin gene expression during squamous differentiation as well as in the suppression by retinoids.

Susto and the career path of the victim of an industrial accident: a sociological case study

This is a case study of the processes involved in attaining the status of 'victim' after an industrial accident. In this case a migrant working in the manufacturing industry becomes increasingly 'disabled' and seeks legitimation as a 'victim' who is 'worthy' of financial compensation. The institutional processes involved are the industrial, medical and legal systems. Chronic pain is a condition that often defies an unambiguous diagnosis. Most chronic pain victims are therefore constantly seeking legitimation for their condition as physicians attempt to uncover the aetiology of the pain. Most chronic pain victims also fail to fulfil the expectation of getting well as soon as possible. Physicians can, at best, only give a prognosis that is little better than an 'educated guess'. The conditional nature of the legitimacy gives the chronic pain victims only limited legitimacy for their sick role and this often results in physicians seeking psychological or moral explanations for what began as a relatively simple physical problem. Psychological or psychiatric diagnoses are considerably weaker metaphorically than physiological diagnoses and tend to infer the strong possibility of the victim contributing to her/his condition as a result of hypochondriacal or psychosomatic 'tendencies' or, even worse, 'malingering'. The migrant client can exacerbate this situation through an earnest desire to (over)conform to norms by going along with whatever is recommended by people who hold superior status by virtue of their knowledge and power ('posicíon'). Among some Latin American countries 'over-compliance' has been recognised a socio-medical condition and is termed 'susto'. In the workers' compensation context the shift to overconformity ('susto') results from the uncertainty about receiving (legitimate) acknowledgement and compensation. The desire is to ensure, as far as possible, that a certainty of outcome is achieved (i.e. a return to work or adequate compensation). In other words, concurrent practises within the system (medical-social-legal) produces what it tries to eliminate--the seemingly unjustifiable/illegitimate internalising of the role of victim intent on receiving compensation. 'Susto' is therefore an adaptive response to normative ambiguity and uncertainty about future outcomes. Under conditions of worsening health (physical and mental), and the pressure to continue treatment, the best "solution" for the victim appears to be to "pull the victim out of the medical system", to de-socialise her/him from semi-institutionalisation, and to use social and informal support structures to build up on the victim's independence, self-esteem, personal integrity and sense of control of her/his own life.

Changes in the binding characteristics of oestrogen and progesterone in uterine and intrauterine tissue with the progression of human pregnancy

The binding characteristics of oestrogen and progesterone in intrauterine tissue were studied in the non-pregnant state and throughout pregnancy using sucrose density gradient centrifugation and titration analyses. High affinity receptors for these steroids which were present in high concentrations in tissue from non-pregnant patients and patients in early pregnancy, decreased with the advance of pregnancy to undetectable levels at term. Non-saturable binding to progesterone detected in term tissue was identified as albumin and cortisol binding globulin.

IUD insertion forces: effects of recent childbirth and lactation

This investigation compared the force required to insert an IUD in women who were breastfeeding and who had recently delivered a child with that required in control women who were not breastfeeding and who had not recently delivered. Twenty-eight women who had recently delivered and who were breastfeeding were compared with twenty-eight controls. The women were matched for age and parity and for the type of IUD used. The mean IUD insertion force in the breastfeeding, recently-delivered women was 1.75 newtons (N) as compared to 2.80 N in the controls. The difference was statistically highly significant (paired t-test, p less than 0.01). Recent childbirth and lactation are associated with a reduction in IUD-related insertion pain, probably due to a reduction in the force required for insertion. This reduction in IUD insertion force is not necessarily related to lower uterine perforation rates in IUD insertion in this group. A number of physiological mechanisms may be responsible for this finding.