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Abstract
OBJECTIVES This observational study evaluated the impact of return-to-play protocols to prevent transmission of SARS-CoV-2 in a youth ice hockey programme in Virginia Beach, Virginia. METHODS Following an outbreak of SARS-CoV-2 in November 2020, a COVID-19 Response Team evaluated the epidemiological data to identify transmission dynamics and develop enhanced protocols to prevent transmission. During the subsequent 18-week study period, incident cases were investigated to identify the likely transmission source; testing, quarantine and isolation recommendations were provided to families in accordance with Centers for Disease Control and Prevention guidelines. RESULTS Simple but stringent protocols were implemented among 148 youth ice hockey players ages 6-18. Players were required to arrive at the rink in full gear; locker rooms were closed, building entry was limited to one parent per player, and masks were required at all times except for players on the ice. Following implementation of the enhanced protocols, more than 500 practices and games were completed with at least 15 858 athlete-hours of exposure and no within-programme COVID-19 transmission was detected despite high community incidence and sporadic household exposures. CONCLUSION This study suggests indoor youth sports can operate safely with appropriate protocols in place, even within communities of high COVID-19 transmission, even when athletes are not yet vaccinated or wearing masks during play. Transmission appears to be more likely in congested indoor areas involving adults than on the ice during play. Protocols should be developed in collaboration with programme participants. Strong collaboration in the interest of youth sports can motivate adoption of protocols which prevent within-team transmission.
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Affiliation(s)
- Allison Krug
- Artemis Biomedical Communications LLC, Virginia Beach, Virginia, USA
| | - Richard Appleby
- Hampton Roads Youth Hockey Association, Virginia Beach, Virginia, USA
| | - Robert Pizzini
- Hampton Roads Youth Hockey Association, Virginia Beach, Virginia, USA
| | - Tracy Beth Høeg
- Department of Physical Medicine & Rehabilitation, University of California-Davis, Sacramento, California, USA
- Northern California Orthopaedic Associates, Grass Valley, California, USA
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Pugh E, Fonfara S, Appleby R, Comeau D, Minors S, Singh A. Intrapericardial neuroendocrine tumour in a dog. J Vet Cardiol 2021; 39:63-68. [PMID: 34979483 DOI: 10.1016/j.jvc.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 11/19/2022]
Abstract
An 11-year-old neutered male Border Terrier presented for pericardiectomy after a nine-month history of tricavitary effusion, dyspnoea and lethargy. Transthoracic echocardiography revealed a fluid-filled structure at the heart base, starting at the mid-right ventricle and extending to the middle of the right atrium. Almost complete compression of the right atrium and the cranial vena cava was noted. Thoracic computed tomography revealed a heterogeneously enhancing and poorly marginated mass within the cranial aspect of the pericardium. A median sternotomy and subtotal pericardiectomy were performed. A non-distinct fluid-filled structure within the pericardium adhered to the epicardium was visualised. The structure was removed via marsupialisation along with extirpation of enlarged sternal lymph nodes. Histopathological examination of the sternal lymph nodes revealed expansile, well-demarcated, unencapsulated nodules of neoplastic cells consistent with a neuroendocrine tumour suspected to be thyroid in origin. After surgery, intractable pleural effusion resulted in euthanasia. Intrapericardial ectopic thyroid tumours are rarely reported in animals. The location of the mass and unusual presentation may have made it challenging for echocardiography to identify this neoplasia. Thoracic computed tomography at an earlier stage may have identified the neoplasia and potentially allowed for surgical intervention.
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Affiliation(s)
- E Pugh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, Ontario, N1G 2W1, Canada
| | - S Fonfara
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, Ontario, N1G 2W1, Canada
| | - R Appleby
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, Ontario, N1G 2W1, Canada
| | - D Comeau
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, 419 Gordon St., Guelph, Ontario, N1G 2W1, Canada
| | - S Minors
- Mississauga Oakville Veterinary Emergency and Specialty Hospital, 2285 Bristol Circle, Oakville, Ontario, L6H 6P8, Canada
| | - A Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, 50 Stone Road E., Guelph, Ontario, N1G 2W1, Canada.
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Kennedy NA, Jones GR, Lamb CA, Appleby R, Arnott I, Beattie RM, Bloom S, Brooks AJ, Cooney R, Dart RJ, Edwards C, Fraser A, Gaya DR, Ghosh S, Greveson K, Hansen R, Hart A, Hawthorne AB, Hayee B, Limdi JK, Murray CD, Parkes GC, Parkes M, Patel K, Pollok RC, Powell N, Probert CS, Raine T, Sebastian S, Selinger C, Smith PJ, Stansfield C, Younge L, Lindsay JO, Irving PM, Lees CW. British Society of Gastroenterology guidance for management of inflammatory bowel disease during the COVID-19 pandemic. Gut 2020; 69:984-990. [PMID: 32303607 PMCID: PMC7211081 DOI: 10.1136/gutjnl-2020-321244] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 02/07/2023]
Abstract
The COVID-19 pandemic is putting unprecedented pressures on healthcare systems globally. Early insights have been made possible by rapid sharing of data from China and Italy. In the UK, we have rapidly mobilised inflammatory bowel disease (IBD) centres in order that preparations can be made to protect our patients and the clinical services they rely on. This is a novel coronavirus; much is unknown as to how it will affect people with IBD. We also lack information about the impact of different immunosuppressive medications. To address this uncertainty, the British Society of Gastroenterology (BSG) COVID-19 IBD Working Group has used the best available data and expert opinion to generate a risk grid that groups patients into highest, moderate and lowest risk categories. This grid allows patients to be instructed to follow the UK government's advice for shielding, stringent and standard advice regarding social distancing, respectively. Further considerations are given to service provision, medical and surgical therapy, endoscopy, imaging and clinical trials.
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Affiliation(s)
- Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Gareth-Rhys Jones
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Christopher A Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Richard Appleby
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - R Mark Beattie
- Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Stuart Bloom
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Alenka J Brooks
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Cooney
- Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Robin J Dart
- King's College London, London, UK
- The Royal Free Hospital, London, UK
| | | | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Subrata Ghosh
- Queen Elizabeth Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | | | - Richard Hansen
- University of Glasgow, Glasgow, UK
- Royal Hospital for Children, Glasgow, UK
| | - Ailsa Hart
- St Mark's Hospital, London, UK
- Imperial College London, London, UK
| | | | - Bu'Hussain Hayee
- King's College London, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | | | - Gareth C Parkes
- Barts and the London School of Medicine and Dentistry, London, UK
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Miles Parkes
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Kamal Patel
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Richard C Pollok
- St George's University Hospitals NHS Foundation Trust, London, UK
- St George's, University of London, London, UK
| | - Nick Powell
- Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Chris S Probert
- Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - Tim Raine
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | - Philip J Smith
- Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | | | - Lisa Younge
- Crohn's and Colitis UK, St Albans, Hertfordshire, UK
| | - James O Lindsay
- Barts and the London School of Medicine and Dentistry, London, UK
- The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Peter M Irving
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charlie W Lees
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
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4
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Abstract
We present the case of a 34-year-old woman with haemorrhagic ascites and an extrinsic rectal mass on endoscopy. Endometrioma was subsequently confirmed by laparoscopy and biopsy. Intestinal endometriosis is common, and often mimics other gastrointestinal pathology. Haemorrhagic ascites or intestinal masses are rare presentations of endometriosis, and this is the only reported case of both occurring together. Endometriosis and ascites are more common in women of African descent, and although histological diagnosis requires laparoscopy, MRI has a high negative predictive value; 95% for intestinal endometriosis. Re-accumulation of ascites were prevented by starting a gonadotrophin antagonist.
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Affiliation(s)
- Richard Appleby
- Department of Gastroenterology, Imperial College, London, UK
| | - Haseeb Saroya
- Department of Gastroenterology, Hillingdon Hospital, London, UK
| | - Aymer Postgate
- Department of Gastroenterology, Hillingdon Hospital, London, UK
| | - Ziad Meer
- Department of Radiology, Hillingdon Hospital, London, UK
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Abstract
It is well known that millimetre-wave systems can penetrate poor weather, dust and smoke far better than infrared or visible systems. Imaging in this band offers the opportunity to be able to navigate and perform surveillance in these conditions of poor visibility. Furthermore, the ability to penetrate dielectrics such as plastic and cloth has opened up the opportunity of detecting weapons and contraband hidden under people's clothing. The optical properties of materials have a direct impact on the applicability of imaging systems. In the terahertz band solids have absorptions which can be assigned to vibrational modes. Lattice modes occur at the lowest frequencies and polythene, for example, has a lattice mode at 2.4 THz. Solids have no such absorptions in the millimetre bands (30-300 GHz) and image contrast is produced by differences in transmission, reflection and absorption. A novel, real-time, mechanically scanned, passive millimetre-wave imager has been designed. The antenna elements are based on a combination of a Schmidt camera and a conical scanner, both of which have their origins in optical systems. Polarization techniques, which were developed for operation in the centimetric band, are used to fold the optics. Both 35 GHz and 94 GHz versions have been constructed.
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Affiliation(s)
- R Appleby
- QinetiQ, St Andrews Rd, Great Malvern WR14 3PS, UK.
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Fitches AC, Appleby R, Lane DA, De Stefano V, Leone G, Olds RJ. Impaired cotranslational processing as a mechanism for type I antithrombin deficiency. Blood 1998; 92:4671-6. [PMID: 9845533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Most secretory proteins, including antithrombin (AT), are synthesized with a signal peptide, which is cleaved before the mature protein is exported from the cell. The signal peptide is important in the process whereby nascent protein is recognized as requiring subsequent modification within the endoplasmic reticulum (ER). We have identified a novel mutation, 2436T-->C L(-10)P, which affects the central hydrophobic domain of the AT signal peptide, in a proband presenting with venous thrombotic disease and type I AT deficiency. We investigated the basis of the phenotype by examining expression in mammalian cells of a range of variant AT cDNAs with mutations affecting the -10 residue. Glycosylated AT was secreted from COS-7 cells transfected with wild-type AT, -10L deletion, -10V or -10M variants, but not variants with P, T, R, or G at -10. Cell-free expression of wild-type and variant AT cDNAs was then performed in the presence of canine pancreatic microsomes, as a substitute for ER. Variant AT proteins with P, T, R, or G at residue -10 did not undergo posttranslational glycosylation, and their susceptibility to trypsin digestion suggested they had not been translocated into microsomes. Our results suggest that the ability of AT signal peptide to direct the protein to ER for cotranslational processing events appears to be critically dependent on maintaining the hydrophobic nature of the region including residue -10. The investigations have defined impaired cotranslational processing as a hitherto unrecognized cause of hereditary AT deficiency.
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Affiliation(s)
- A C Fitches
- Department of Pathology, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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