Assessment of activity energy expenditure during competitive golf: The effects of bag carrying, electric or manual trolleys

Golf is a sport played around the globe, with an estimated 42.6 million people playing within the United Kingdom and United States of America alone. To date, there is limited data on the energy expenditure of golf. The present study assessed the activity energy expenditure (AEE) of 16 high-standard (handicap under 5) golfers who completed three rounds of competitive golf either carrying the golf bag (BC), using a manual push trolley (MT) or an electric trolley (ET) (Stewart Golf, Gloucester, UK). Prior to each round, participants were fitted with an Actiheart® accelerometer (Camntech, Fenstanton, UK) to estimate AEE, whilst ratings of perceived exertion (RPE) and enjoyment were collected following each round. Data were analysed using a one-way repeated measures ANOVA, with Hedges g effect sizes (ES) calculated. Mean (SD) AEE was 688 ± 213 kcal for BC, 756 ± 210 kcal for MT and 663 ± 218 kcal for ET (p = .05) although these differences were deemed small or less. The ET condition resulted in the lowest mean heart rate, moderate or very large from BC or MT, respectively. There were no significant differences in enjoyment although perceived exertion was lowest in the ET condition. In summary, we report meaningful differences in AEE between the three conditions (p = .05), with perceived exertion and maximum HR being lowest when using the electric trolley. Golf may be considered as an effective intervention to increase step count and improve physical activity levels across the general population regardless of transportation methods of clubs.

A Scoping Review of Transgender Policies in the 15 Most Commonly Played UK Professional Sports

INTRODUCTION

There has been much debate recently on the participation of transgender and gender-diverse (TGD) athletes in sport, particularly in relation to fairness, safety and inclusion. The 2021 IOC Framework on Fairness, Inclusion and Non-discrimination acknowledges the central role that eligibility criteria play in ensuring fairness, particularly in the female category, and states that athletes should not be excluded solely on the basis of their TGD identity.

AIMS

To identify policies that address TGD athlete participation in the 15 major United Kingdom (UK) sporting organisations and to summarise the evidence for each of these policies.

METHODS

A scoping review of TGD policies from the 15 major UK sporting organisations.

RESULTS

Eleven of the governing bodies had publicly available TGD policies. Most of the sporting associations drew guidance from the official 2015 IOC Consensus Meeting on Sex Reassignment and Hyperandrogenism, particularly with regard to physiological testosterone levels. Many organisations referenced their policies as a guide for decision making but stated that they ultimately made case-by-case decisions on an athlete's eligibility. Relevant considerations not addressed in most policies included pre- versus post-pubertal athletes, justification for testosterone thresholds, the length of time out of competitive action (if any) for transitioning athletes, the irreversible advantage from male puberty (if any), the responsibility for and frequency of follow up for hormonal testing and the consequences for athletes outside set testosterone limits.

CONCLUSIONS

There is a lack of consensus among the top 15 UK sporting organizations relating to elite sport participation for TGD athletes. It would be useful for sport organizations to work together to develop greater standardization/consensus for TGD athlete policies, taking into consideration fairness, safety and inclusion in each sport.

Mapping quality improvement education initiatives to Standards for QUality Improvement Reporting Excellence (SQUIRE) guidelines

AIMS AND OBJECTIVES

To explore the rigour of nurse-led quality improvement projects involving education, training or continuing professional development, and examine evaluation frameworks contained within.

BACKGROUND

Healthcare organisations invest significantly in quality improvement in the pursuit of cost-effective, safe, evidence-based and person-centred care. Consequently, efforts to examine the success of investment in quality improvement activities are prominent, against a backdrop of rising healthcare expenditure, reforms, consumer expectations and feedback.

DESIGN

A qualitative document analysis of quality improvement projects located in a local health district repository was undertaken.

METHODS

N = 3004 projects were screened against inclusion criteria, with n = 160 projects remaining for analysis. Projects were mapped to an adapted version of the Standards for QUality Improvement Reporting Excellence (SQUIRE), specifically the education extension (SQUIRE-EDU). Additionally, project evaluation frameworks were positioned within Kirkpatrick's four levels of training evaluation model. The SQUIRE checklist was also applied in line with EQUATOR guidelines.

RESULTS

Of n = 60 completed projects assessed against four broad SQUIRE-EDU categories and relevant criteria, n = 36 were assessed not to have met any categories, n = 14 projects met one category, n = 8 projects met two categories, and n = 2 projects met three categories. None of the completed projects met all four SQUIRE-EDU categories. There was insufficient documentation relating to evaluation frameworks in n = 133 projects to position within Kirkpatrick's four levels of training evaluation.

CONCLUSIONS

Scientific rigour should underpin all quality improvement efforts. We recommend that SQUIRE international consensus guidelines (full or abridged) should guide both the design and reporting of all local quality improvement efforts.

RELEVANCE TO CLINICAL PRACTICE

To be of value to the expansion of evidence-based practice, quality improvement platforms should be designed to reflect the structural logic, rigour and reporting recommendations being advocated in consensus reporting guidelines. This may require investment in training and development programs, and identification of governance and support systems. No Patient or Public Contribution, as the study was retrospective in nature and involved a health service repository of quality improvement projects accessible to health service staff only.

Simple and accurate transcriptional start site identification using Smar2C2 and examination of conserved promoter features

The precise and accurate identification and quantification of transcriptional start sites (TSSs) is key to understanding the control of transcription. The core promoter consists of the TSS and proximal non-coding sequences, which are critical in transcriptional regulation. Therefore, the accurate identification of TSSs is important for understanding the molecular regulation of transcription. Existing protocols for TSS identification are challenging and expensive, leaving high-quality data available for a small subset of organisms. This sparsity of data impairs study of TSS usage across tissues or in an evolutionary context. To address these shortcomings, we developed Smart-Seq2 Rolling Circle to Concatemeric Consensus (Smar2C2), which identifies and quantifies TSSs and transcription termination sites. Smar2C2 incorporates unique molecular identifiers that allowed for the identification of as many as 70 million sites, with no known upper limit. We have also generated TSS data sets from as little as 40 pg of total RNA, which was the smallest input tested. In this study, we used Smar2C2 to identify TSSs in Glycine max (soybean), Oryza sativa (rice), Sorghum bicolor (sorghum), Triticum aestivum (wheat) and Zea mays (maize) across multiple tissues. This wide panel of plant TSSs facilitated the identification of evolutionarily conserved features, such as novel patterns in the dinucleotides that compose the initiator element (Inr), that correlated with promoter expression levels across all species examined. We also discovered sequence variations in known promoter motifs that are positioned reliably close to the TSS, such as differences in the TATA box and in the Inr that may prove significant to our understanding and control of transcription initiation. Smar2C2 allows for the easy study of these critical sequences, providing a tool to facilitate discovery.

Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED): a protocol for an implementation study in the Veterans Health Administration

BACKGROUND

Empirical evidence supports the use of structured goals of care conversations and documentation of life-sustaining treatment (LST) preferences in durable, accessible, and actionable orders to improve the care for people living with serious illness. As the largest integrated healthcare system in the USA, the Veterans Health Administration (VA) provides an excellent environment to test implementation strategies that promote this evidence-based practice. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) program seeks to improve care outcomes for seriously ill Veterans by supporting efforts to conduct goals of care conversations, systematically document LST preferences, and ensure timely and accurate communication about preferences across VA and non-VA settings.

METHODS

PERSIVED encompasses two separate but related implementation projects that support the same evidence-based practice. Project 1 will enroll 12 VA Home Based Primary Care (HBPC) programs and Project 2 will enroll six VA Community Nursing Home (CNH) programs. Both projects begin with a pre-implementation phase during which data from diverse stakeholders are gathered to identify barriers and facilitators to adoption of the LST evidence-based practice. This baseline assessment is used to tailor quality improvement activities using audit with feedback and implementation facilitation during the implementation phase. Site champions serve as the lynchpin between the PERSIVED project team and site personnel. PERSIVED teams support site champions through monthly coaching sessions. At the end of implementation, baseline site process maps are updated to reflect new steps and procedures to ensure timely conversations and documentation of treatment preferences. During the sustainability phase, intense engagement with champions ends, at which point champions work independently to maintain and improve processes and outcomes. Ongoing process evaluation, guided by the RE-AIM framework, is used to monitor Reach, Adoption, Implementation, and Maintenance outcomes. Effectiveness will be assessed using several endorsed clinical metrics for seriously ill populations.

DISCUSSION

The PERSIVED program aims to prevent potentially burdensome LSTs by consistently eliciting and documenting values, goals, and treatment preferences of seriously ill Veterans. Working with clinical operational partners, we will apply our findings to HBPC and CNH programs throughout the national VA healthcare system during a future scale-out period.

O-147 Genomic analyses in 101,127 UK women show that previously reported monogenic genes are not common causes of premature ovarian insufficiency

Study question

What is the penetrance of variants in previously reported genes for premature ovarian insufficiency (POI) in the general population?

Summary answer

Heterozygous genetic variants in previously reported monogenic genes are not a common, highly penetrant cause of POI.

What is known already

Premature ovarian insufficiency (POI), defined as menopause before 40, has been associated with variants in over 70 genes. However, the evidence to support the causality of individual genetic variants varies between studies. As genomic data becomes more accessible, it is essential to ascertain the penetrance of variants in the absence of family history information. We identified 75 genes associated with POI from the literature, including family segregation studies, consanguineous pedigrees and cohort analyses of whole-exome/targeted sequencing data. Functional evaluation was also available for many of the genes.

Study design, size, duration

We used data from 101,127 females of European ancestry in the UK Biobank, to study the role of previously reported monogenic causal genes on ovarian function. We tested the association of 301 previously reported variants with POI and ANM, plus more than 2.5 million rare variants which were annotated and had not been implicated in POI previously. Genomic variants were tested individually and also combined into a gene burden test.

Participants/materials, setting, methods

Age at natural menopause (ANM) was derived from self-reported questionnaire data from the age at last menstrual period, excluding those with surgical menopause or taking hormone replacement therapy. POI cases were classified as women with ANM under 40 years (N = 2,213). Linked primary care records were used to identify a clinical cohort of POI cases, including primary amenorrhea (N = 113).

Main results and the role of chance

All of the previously reported individual variants we identified in our POI cases were also detected in the control group. Moreover, the gene burden tests were not associated with POI or ANM as a quantitative trait. Our results indicate that autosomal dominant causes of POI are rare; a single predicted loss-of-function (LOF) or non-synonymous genetic variant in one of the previously reported genes is generally not pathogenic.

Limitations, reasons for caution

The penetrance of monogenic disease-causing variants is likely to be lower in population-based cohorts such as UK Biobank than in clinically-ascertained cohorts.

Wider implications of the findings

Heterozygous LOF or non-synonymous variants in previously reported POI genes should be interpreted with caution and are unlikely to cause POI. The findings have implications for clinicians diagnosing causes of POI.

Trial registration number

Not applicable

Lipidomic Approaches to Study HDL Metabolism in Patients with Central Obesity Diagnosed with Metabolic Syndrome

The metabolic syndrome (MetS) is a cluster of cardiovascular risk factors characterised by central obesity, atherogenic dyslipidaemia, and changes in the circulating lipidome; the underlying mechanisms that lead to this lipid remodelling have only been partially elucidated. This study used an integrated "omics" approach (untargeted whole serum lipidomics, targeted proteomics, and lipoprotein lipidomics) to study lipoprotein remodelling and HDL composition in subjects with central obesity diagnosed with MetS (vs. controls). Compared with healthy subjects, MetS patients showed higher free fatty acids, diglycerides, phosphatidylcholines, and triglycerides, particularly those enriched in products of de novo lipogenesis. On the other hand, the "lysophosphatidylcholines to phosphatidylcholines" and "cholesteryl ester to free cholesterol" ratios were reduced, pointing to a lower activity of lecithin cholesterol acyltransferase (LCAT) in MetS; LCAT activity (directly measured and predicted by lipidomic ratios) was positively correlated with high-density lipoprotein cholesterol (HDL-C) and negatively correlated with body mass index (BMI) and insulin resistance. Moreover, many phosphatidylcholines and sphingomyelins were significantly lower in the HDL of MetS patients and strongly correlated with BMI and clinical metabolic parameters. These results suggest that MetS is associated with an impairment of phospholipid metabolism in HDL, partially led by LCAT, and associated with obesity and underlying insulin resistance. This study proposes a candidate strategy to use integrated "omics" approaches to gain mechanistic insights into lipoprotein remodelling, thus deepening the knowledge regarding the molecular basis of the association between MetS and atherosclerosis.

1005 HEALTH-RELATED QUALITY OF LIFE AND FUTURE RISK OF HEALTH OUTCOMES AMONG OLDER ADULTS LIVING IN AUSTRALIA AND THE UNITED STATES

Introduction

Poor health-related quality of life (HRQoL) is associated with higher morbidity and mortality in patient populations. However, whether HRQoL is associated with health outcomes among community-dwelling older people requires further investigation. This study aimed to examine whether HRQoL predicts cognitive decline, dementia, cardiovascular disease (CVD), and mortality in community-dwelling older people living in Australia and the United States.

Method

A cohort of 19,106 individuals from the ASPirin in Reducing Events in the Elderly (ASPREE) study, aged 65–98 years, initially free of dementia or CVD, and who completed the HRQoL 12-item short form (SF-12, version-2) at baseline (2010–2014), were followed until June 2017. The physical (PCS) and mental component scores (MCS) of SF-12 were generated using standardized norm-based method.

Results

Over a median of 4.7 years, there were 2,412 cognitive declines, 574 dementia, 922 incident CVD events, and 1,052 deaths. Using Cox proportional-hazard regression adjusted for a range of covariates, every 10-unit increase in PCS was associated with a 6% lower risk of cognitive decline, a 14% lower risk of incident CVD, and 17% lower risk of all-cause mortality, but was not associated with incident dementia. In contrast, higher MCS was only associated with a 12% and 15% lower risk of cognitive decline and dementia, respectively. Findings did not differ by sex.

Conclusion

Our study provides some of the first evidence that HRQoL can be used in combination with clinical data to identify the future risks of health outcomes among older individuals living in the community. Our findings support the decision of the Australian Commission on Safety and Quality in Health Care to incorporate the SF-12 into the annual Patient-Reported Outcome Measures (PROMs assessment.

POS1304 CORRELATION OF SKIN SCORES (LoSCAT) WITH PATIENT REPORTED OUTCOMES IN JUVENILE LOCALISED SCLERODERMA

Background

Juvenile localised scleroderma (JLS) or morphea is a rare condition, causing inflammation and fibrosis in skin and underlying tissues. A validated skin score (Localized Scleroderma Cutaneous Assessment Tool, LoSCAT) has been developed [1]. This tool has both activity (mLoSSi) and damage indices (LoSDI). Several patient-reported outcomes (PRO) have been studied in JLS including visual analogue scales (VAS), functional and health-related quality of life measures.

Objectives

To assess the associations between different PROs and the activity and damage indices of the LoSCAT.

Methods

Participants aged 4 to 17 were recruited from 3 tertiary paediatric rheumatology centres in the UK and attended 4 visits at 3 monthly intervals as part of a program of research on JLS. Patient-reported VAS (6 different scales), the Children’s Dermatology Life Quality Index (CDLQI) and Childhood Health Assessment Questionnaires (CHAQ) were completed at each visit. LoSCAT was completed by the two same clinicians throughout the study (both trained in skin score techniques). Pearson correlation coefficients were calculated between each PRO and each component of the LoSCAT.

Results

24 participants completed all 4 visits and 1 attended 3 visits. 20 participants were female (80%) and 5 were male (20%). Mean age at diagnosis was 7.6 years with mean disease duration of 4.9 years. Subtype of disease was linear head in 5/25 (20%), linear limb 12/25 (48%), generalised morphoea 1/25 (4%), mixed 5/25 (20%) and superficial plaque in 2/25 (8%). Table 1 shows the correlations with figures in bold highlighting positive correlations which were statistically significant (p<0.05) and medium-sized (r>0.3).

Table 1.

Correlation between patient reported outcomes and LoSCAT

PROTotal skin activity (mLoSSi)Total skin damage (LoSDI)r (95% CI)p-valuer (95% CI)p-valueCDLQI0.61 (0.02, 1.20)0.0440.42 (0.01, 0.83)0.044CHAQ0.30 (0.03, 0.57)0.0270.20 (-0.14, 0.54)0.244VAS 1: How much IMPACT has your disease had on your life in the PAST MONTH?0.49 (0.00, 0.98)0.0500.38 (0.06, 0.71)0.021VAS 2: How much has your condition (localized scleroderma) affected you OVERALL in the PAST MONTH?0.59 (0.09, 1.09)0.0220.42 (0.13, 0.72)0.005VAS 3: Have your lesions felt itchy and/or scratchy in PAST MONTH?0.40 (-0.01, 0.81)0.0560.31 (0.03, 0.59)0.028VAS 4: Have you felt numbness, tingling, and/or other “funny” feeling in or around your lesion in PAST MONTH?0.55 (0.04, 1.05)0.0330.33 (-0.04, 0.71)0.084VAS 5: How much WORRY do you have about LONG- -TERM problems from your disease?0.40 (-0.01, 0.81)0.0530.32 (0.00, 0.63)0.047VAS 6: How much WORRY do you have about problems from MEDICATIONS used to treat your condition?0.41 (0.00, 0.82)0.0500.29 (-0.09, 0.66)0.131

The VAS of symptoms of numbness/tingling showed a strong positive correlation with mLoSSi but a weak and/or non-significant correlation with LoSDI. VAS itchy/scratchy did not show a strong correlation with mLoSSi but showed a moderate correlation with LoSDI. Patient global VAS correlated with both mLoSSi and LoSDI, as did CDLQI. CHAQ correlated with activity only.

Conclusion

Symptoms within lesions are often interpreted as indicating disease activity. A previous study in adults and children showed itch positively correlated with mLoSSi suggesting it may be a marker of active disease [2]. However, in our study numbness/tingling correlated with disease activity whereas itch did not. Further work is required to understand whether itch correlates to both activity and damage and whether numbness/tingling is a better indicator of activity than itch. Limitations of our study include a heterogenous group of participants with longstanding high-burden disease.

References

[1]Arkachaisri et al. Rheumatology 2010. 49(2): 373-81.

[2]Klimas et al. Br J Derm 2015; 175:1329-1337

Acknowledgements

This study was funded by Scleroderma & Raynaud’s UK.

Disclosure of Interests

None declared

Vascular risk factors affect different brain regions in people with Alzheimer’s disease

Introduction

Vascular risk factors including hypertension, diabetes and dyslipidaemia promote diverse pathological mechanisms in the brain leading to cerebral hypoperfusion and ultimately cognitive decline in people. Medial temporal, medial frontal and anterior cingulate atrophy has been closely associated with diabetes and medial temporal lobe atrophy is associated with hypertension in people with Alzheimer’s disease (AD).

Objectives

To assess if hypertension, diabetes and dyslipidaemia have differential effects on different brain locations using brain imaging in people with AD.

Methods

The current study is based on [¹⁸F] fluorodeoxyglucose- positron emission tomography (FDG-PET) data of 970 participants from two large Phase III multi-centre clinical trials of a novel tau aggregation inhibitor drug Leuco-Methylthioninium (LMTX)meeting research criteria for mild to moderate AD. Vascular risk factor data including hypertension, diabetes and dyslipidaemia were collected and quantification of FDG PET hypo-metabolism was done by calculating Standardized Uptake Value Ratio(SUVR).

Results

Hypertension, diabetes and dyslipidaemia were found to have differential effects on brain locations in people with AD. When people with hypertension, diabetes and dyslipidaemia were compared to those without, mean SUVR was increased significantly in both left and right parietal and occipital lobes and decreased in left and right anterior cingulate gyri in hypertensives. SUVR was significantly higher in both left and right temporal lobes in diabetics andlower in both left and right anterior cingulate gyri in people with dyslipidaemia.

Conclusions

Vascular risk factors including hypertension, diabetes and dyslipidaemia have differential effects on different brain regions, measured using SUVR analysis of FDG-PET.

Disclosure

The FDG-PET data was taken from participants of two large phase III clinical trials sponsored by TauRx Therapeutics (Singapore). TauRx Therapeutics has contributed towards my studentship during my PhD but the data related to drug used in the clinical tria

POS0168 NON-INVASIVE IMAGING IN JUVENILE LOCALISED SCLERODERMA: HIGH-FREQUENCY ULTRASOUND, THERMOGRAPHY, LASER DOPPLER & MULTISPECTRAL IMAGING

Background

Outcome measures which can differentiate activity (inflammation) from damage (fibrosis/atrophy) would facilitate development of new treatment strategies in juvenile localized scleroderma (JLS) to target the inflammatory phase of the disease.

Objectives

To evaluate whether in JLS, non-invasive imaging modalities (high frequency ultrasounds (HFUS), multispectral imaging (MSI), laser doppler imaging (LDI) & infra-red thermography (IRT)) can detect differences between affected & non-affected skin, as a next step in developing these as outcome measures. Our hypothesis was that blood flow (and therefore temperature & oxygenation) would be increased in lesional skin.

Methods

Participants aged 4-17 were recruited from 3 paediatric rheumatology centres in the UK. For each participant, a single lesion was selected. HFUS (30MHz), MSI (bespoke camera and tuneable liquid crystal filter, coupled to custom analysis software, 500nm/710nm wavelengths), LDI and IRT imaging were performed at four sites relating to each lesion: two of affected skin (centre & inner edge of lesion) and two of non-affected skin (one cm from edge of lesion (‘outer’) & contralateral unaffected side). Imaging was performed at 4 visits at 3 monthly intervals. Mean values were compared between the four sites using data from all visits by mixed-effects linear regression to account for individual-level clustering.

Results

24 participants completed all 4 visits and 1 attended 3. 20 participants were female (80%) & 5 male (20%). Mean age at diagnosis was 7.6 years & disease duration 4.9 years. Subtype of disease was linear head in 5/25 (20%), linear limb 12/25 (48%), generalised morphea 1/25 (4%), mixed 5/25 (20%) and superficial plaque in 2/25 (8%).

Table 1 shows a subset of data. All 4 imaging techniques could detect differences between healthy (outer/contralateral) & affected skin (centre/inner edge). For HFUS, there was strong evidence of a difference between affected & unaffected skin (p<0.001) indicating affected skin is thinner than unaffected. Higher mean values of oxygenation, perfusion & temperature were observed in affected compared to non-affected skin in MSI, LDI and IRT respectively. There was no statistical difference seen between inner edge and centre of the lesion in any of the methods.

Table 1.

Mean differences between different locations for each imaging technique

Imaging techniqueLocationOverall mean difference (95% CI)p-valueHFUS (mm)Centre - Contralateral-0.34 (-0.46, -0.22)<0.001Inner edge - Contralateral-0.30 (-0.40, -0.20)<0.001Centre - Outer-0.35 (-0.46, -0.24)<0.001Inner edge - Outer-0.31 (-0.40, -0.21)<0.001Centre - Inner edge-0.04 (-0.10, 0.02)0.168MSI (rel units)Centre - Contralateral0.06 (0.03, 0.10)<0.001Inner edge - Contralateral0.06 (0.03, 0.09)<0.001Centre - Outer0.04 (0.01, 0.07)0.012Inner edge - Outer0.03 (0.00, 0.06)0.028Centre - Inner edge0.01 (0.00, 0.02)0.251LDI Relative perfusion unitsCentre - Contralateral44.8 (24.4, 65.2)<0.001Inner edge - Contralateral47.9 (21.0, 74.8)<0.001Centre - Outer19.1 (1.0, 37.1)0.039Inner edge - Outer24.8 (6.7, 42.9)0.007Centre - Inner edge-3.5 (-20.3, 13.2)0.679IRT oCCentre - Contralateral0.58 (0.24, 0.91)0.001Inner edge - Contralateral0.44 (0.13, 0.75)0.005Centre - Outer0.44 (0.22, 0.66)<0.001Inner edge - Outer0.30 (0.09, 0.52)0.006Centre - Inner edge0.14 (-0.05, 0.32)0.153

The overall mean difference is the measurement of the first location minus the measurement from the second location (e.g. centre minus contralateral), averaged across the four visits.

Conclusion

Our results suggest non-invasive imaging can detect differences between healthy & unaffected skin in JLS. Whether each technique is only measuring activity & not damage requires further evaluation. The leading edge of lesions has historically been considered as most active compared to the centre. However, no difference was seen between centre & inner edge measurements suggesting that in future studies, imaging protocols can be simplified.

Acknowledgements

This study was funded by Scleroderma & Raynaud’s UK.

Disclosure of Interests

None declared

Risk assessment and implementation of risk reduction measures is not associated with increased transmission of SARS-CoV-2 compared with standard isolation at professional golf events

Objectives

The purpose of this prospective study was to report incidence and transmission of SARS-CoV-2, among professional golfers and essential support staff undergoing risk assessment and enhanced risk reduction measures when considered a close contact as opposed to standard isolation while competing on the DP World Tour during the 2021 season.

Methods

This prospective cohort study included all players and essential support staff participating in 26 DP World Tour events from 18 April 2021 to 21 November 2021. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with reverse transcriptase-polymerase chain reaction (RT-PCR) tesing on day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts typically received rapid antigen testing every 48 hours and RT-PCR testing on day 5.

Results

The total study cohort compromised 13 394 person-weeks of exposure. There were a total of 30 positive cases over the study period. Eleven contacts were stratified as ‘high risk’. Two of these subsequently tested positive for SARS-CoV-2. There were 79 moderate-risk contact and 73 low-risk contacts. One moderate-risk contact subsequently tested positive for SARS-CoV-2 but did not transmit the virus. All other contacts, remained negative and asymptomatic to the end of the tournament week.

Conclusions

A risk assessment and risk reduction-based approach to contact tracing was safe in this professional golf event setting when Alpha and Delta were the predominant variants. It enabled professional golfers and essential support staff to work.

Returning persons with SARS-CoV-2 to the field of play in professional golf: a risk assessment and risk reduction approach

Objectives

This pilot study aimed to see whether a risk assessment and risk reduction approach was a practical and feasible approach, as compared with standard isolation for fully vaccinated, asymptomatic persons positive for SARS-CoV-2.

Methods

This prospective cohort study included all players and caddies participating in two large professional golf events from 7 to 20 February 2022 in South Africa. Fully vaccinated persons testing positive who were asymptomatic were subject to risk assessment and risk reduction measures to protect the integrity of the event. Asymptomatic individuals who could socially distance in outdoor areas were allowed to participate. Close contacts were subject to daily rapid antigen tests and asked to prioritise outdoor space.

Results

The protocols put in place for the events were practical, feasible, and well accepted by event participants and staff during the study period. There was a total of 378 player-week episodes and 378 caddie-week episodes during the study period. Three persons tested positive while registered at events during the study period (0.4% of person episodes). The positive tests were returned from two players and one caddie, all of which were asymptomatic at the time of testing. There was one high-risk contact who consistently returned negative antigen tests. There was no evidence of transmission.

Conclusions

The approach was practical and feasible. A risk assessment and risk reduction approach allowed fully vaccinated asymptomatic persons with SARS-CoV-2 to participate in golf, an outdoor sport where social distancing is possible, compared with standard isolation.

Chronic Phenibut Use: Symptoms, Severe Withdrawal, and Recovery

INTRODUCTION

Phenibut is a psychoactive drug with GABA_B agonism. It remains unregulated and easily attainable in the United States, where it has become a novel drug of abuse.

CASE PRESENTATION

We present the case of a 34-year-old man who used phenibut consistently for 3 years. After 6 months of use, he developed signs of dependence and failed outpatient detoxification. While taking high doses, he experienced parasomnia-like symptoms and periods of dysexecutive function. After abrupt cessation, he developed severe withdrawal symptoms, was hospitalized, and required intubation. His condition improved after 1 week of treatment. After recovery and discharge, he remains stable utilizing an extended taper of acamprosate and baclofen.

DISCUSSION

Phenibut is not detected on urine drug screen and withdrawal symptoms are nonspecific. Optimal treatment of withdrawal remains unknown. Baclofen and phenobarbital have been successful for treatment of dependence.

CONCLUSION

Clinicians should be aware of phenibut abuse and the potential for dependence and withdrawal.

Melanoma secretion of transforming growth factor-β2 leads to loss of epidermal AMBRA1 threatening epidermal integrity and facilitating tumour ulceration

BACKGROUND

For patients with early American Joint Committee on Cancer (AJCC)-stage melanoma the combined loss of the autophagy regulatory protein AMBRA1 and the terminal differentiation marker loricrin in the peritumoral epidermis is associated with a significantly increased risk of metastasis.

OBJECTIVES

The aim of the present study was to evaluate the potential contribution of melanoma paracrine transforming growth factor (TGF)-β signalling to the loss of AMBRA1 in the epidermis overlying the primary tumour and disruption of epidermal integrity.

METHODS

Immunohistochemistry was used to analyse AMBRA1 and TGF-β2 in a cohort of 109 AJCC all-stage melanomas, and TGF-β2 and claudin-1 in a cohort of 30 or 42 AJCC stage I melanomas, respectively, with known AMBRA1 and loricrin (AMLo) expression. Evidence of pre-ulceration was analysed in a cohort of 42 melanomas, with TGF-β2 signalling evaluated in primary keratinocytes.

RESULTS

Increased tumoral TGF-β2 was significantly associated with loss of peritumoral AMBRA1 (P < 0·05), ulceration (P < 0·001), AMLo high-risk status (P < 0·05) and metastasis (P < 0·01). TGF-β2 treatment of keratinocytes resulted in downregulation of AMBRA1, loricrin and claudin-1, while knockdown of AMBRA1 was associated with decreased expression of claudin-1 and increased proliferation of keratinocytes (P < 0·05). Importantly, we show loss of AMBRA1 in the peritumoral epidermis was associated with decreased claudin-1 expression (P < 0·05), parakeratosis (P < 0·01) and cleft formation in the dermoepidermal junction (P < 0·05).

CONCLUSIONS

Collectively, these data suggest a paracrine mechanism whereby TGF-β2 causes loss of AMBRA1 overlying high-risk AJCC early-stage melanomas and reduced epidermal integrity, thereby facilitating erosion of the epidermis and tumour ulceration.

The relationship between cricket participation, health and wellbeing: A scoping review

Summarising and synthesising the evidence on cricket health and wellbeing can help inform cricket stakeholders and navigate future research directions. The purpose of this study was to investigate the relationship between cricket participation, health and wellbeing at all ages and playing standards, and identify research gaps in the existing literature. A scoping review was performed from inception to March, 2020. Studies were included if they assessed a construct related to health and/or wellbeing in cricketers, available in English. 219 articles were eligible. Injury incidence per 1,000 player exposures ranged from 1.8-5.7 injuries. 48% of former cricketers experienced persistent joint pain. However, former cricketers reported greater physical activity levels and mental-components of quality of life compared to the general population. Heat injury/illness and skin cancer are concerns and require further research. Cricket participation is associated with an inherent injury risk, which may have negative implications for musculoskeletal health in later life. However, cricket participation is associated with high quality of life which can persist after retirement. Gaps in the literature include prospective studies on health and wellbeing of cricketers, female cricketers, injury prevention strategies, and the impact of cricket participation on metabolic health and lifetime physical activity.

The detection of germline and somatic BRCA1/2 genetic variants through parallel testing of patients with high-grade serous ovarian cancer: a national retrospective audit

Objective

To determine the frequency of germline and somatic pathogenic BRCA1 and BRCA2 variants in patients with high‐grade serous ovarian cancer tested by next‐generation sequencing (NGS), with the aim of defining the best strategy to be implemented in future routine testing.

Design

National retrospective audit.

Setting

The All Wales Medical Genomics Service (AWMGS).

Population

Patients with high‐grade serous ovarian/fallopian tube/peritoneal cancer referred by oncologists to the AWMGS between February 2015 and February 2021 for germline and/or tumour testing of the BRCA1 and BRCA2 genes by NGS.

Methods

Analysis of NGS data from germline and/or tumour testing.

Main outcome measures

Frequency of BRCA1 and BRCA2 pathogenic variants.

Results

The overall observed germline/somatic pathogenic variant detection rate was 11.6% in the 844 patients included in this study, with a 9.2% (73/791) germline pathogenic variant detection rate. Parallel tumour and germline testing was carried out for 169 patients and the overall pathogenic variant detection rate for this cohort was 14.8%, with 6.5% (11/169) shown to have a somatic pathogenic variant. Two BRCA1 dosage variants were found during germline screens, representing 2.0% (2/98) of patients with a pathogenic variant that would have been missed through tumour testing alone.

Conclusions

Parallel germline and tumour BRCA1 and BRCA2 testing maximises the detection of pathogenic variants in patients with high‐grade serous ovarian cancer.

Tweetable abstract

Parallel germline and tumour testing maximises BRCA pathogenic variant detection in ovarian cancer.

Parallel germline and tumour testing maximises BRCA pathogenic variant detection in ovarian cancer.

Linked article This article is commented on by C Gourley, p. 443 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16978.

Methods for Estimating Locations of Housing Units Served by Private Domestic Wells in the United States Applied to 2010

In 1990, the last time the decennial census included a question on domestic drinking water source, it was estimated that private domestic water wells (PDWs) supplied household water to about 15.1 million housing units (15% of the population) in the United States (U.S.). PDWs are not regulated by the Safe Drinking Water Act, and with few exceptions, are not subject to the water quality testing required of public water suppliers. We expanded two methods in estimating housing units reliant on PDWs from an Oklahoma pilot study (Weaver et al. 2017), nationally. Both use 1990 census data on drinking water sources as a baseline. The first method uses housing unit change and private well drilling logs for 20 states. This allows for the rate of well use to change between 1990 and 2010 in these states. The second, based solely on housing unit change, assumes a constant rate of well use. Ordinary least squares regression demonstrated (R ² = 0.78) that the methods yield similar estimates for nationwide well use. Using the housing unit change method, it is estimated that in 2010, 23 million housing units were reliant on PDWs (17% of the population). We provide these estimates at the census block group and census block resolution. This dataset will assist in a better understanding of the reliance on PDWs in the U.S., and position local, tribal, state, and national groups to better protect this water resource from contaminant sources.

RESEARCH IMPACT STATEMENT

The work provides improved estimates of the spatial distribution of housing units reliant on private domestic wells in the United States and a foundation to protect this water supply at all levels of government.

Pilot evaluation of risk assessment and enhanced protocols regarding contacts at an international professional golf event

Objectives

The aim of this study was to assess whether a risk assessment and managed risk approach to contact tracing was practical and feasible at the Gran Canaria Lopesan Open 2021 and could inform further pilot work regarding disease transmission during elite sporting events.

Methods

This prospective cohort study included all international attendees. All participants required a minimum of one negative reverse transcriptase PCR (RT-PCR) test prior to travelling to each tournament. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with RT-PCR day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts received rapid antigen testing every 48 hours and PCR testing on day 5.

Results

A total of 550 persons were accredited and were required to undergo RT-PCR testing before the event. Two of these tests were positive (0.36%). Of these, case 1 had 1 high, 23 moderate and 48 low-risk contacts. Case 2 did not have any significant travel history within 2 days of positive test and had one high-risk contact. There were no further positive tests on site in the wider cohort of attendees, from a total of 872 RT-PCR and 198 rapid antigen tests.

Conclusions

This pilot study showed it is practical, feasible and well accepted to provide enhanced (daily) virus testing and risk-mitigating measures at a professional golf event. Further study is required to assess the efficacy of these interventions; however, no transmission was found in this pilot study.