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Ruuskanen O, Dollner H, Luoto R, Valtonen M, Heinonen OJ, Waris M. Contraction of Respiratory Viral Infection During air Travel: An Under-Recognized Health Risk for Athletes. SPORTS MEDICINE - OPEN 2024; 10:60. [PMID: 38776030 PMCID: PMC11111432 DOI: 10.1186/s40798-024-00725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
Air travel has an important role in the spread of viral acute respiratory infections (ARIs). Aircraft offer an ideal setting for the transmission of ARI because of a closed environment, crowded conditions, and close-contact setting. Numerous studies have shown that influenza and COVID-19 spread readily in an aircraft with one virus-positive symptomatic or asymptomatic index case. The numbers of secondary cases differ markedly in different studies most probably because of the wide variation of the infectiousness of the infector as well as the susceptibility of the infectees. The primary risk factor is sitting within two rows of an infectious passenger. Elite athletes travel frequently and are thus prone to contracting an ARI during travel. It is anecdotally known in the sport and exercise medicine community that athletes often contract ARI during air travel. The degree to which athletes are infected in an aircraft by respiratory viruses is unclear. Two recent studies suggest that 8% of Team Finland members traveling to major winter sports events contracted the common cold most probably during air travel. Further prospective clinical studies with viral diagnostics are needed to understand the transmission dynamics and to develop effective and socially acceptable preventive measures during air travel.
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Affiliation(s)
- Olli Ruuskanen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | - Henrik Dollner
- Department of Clinical and Molecular Medicine, Children's Clinic, St. Olavs University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Raakel Luoto
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | | | - Olli J Heinonen
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Matti Waris
- Institute of Biomedicine, University of Turku and Department of Clinical Virology, Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland.
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Abbasi A, Ahmad K, Ferguson C, Soriano A, Calmelat R, Rossiter HB, Casaburi R, Stringer WW, Porszasz J. Lack of effect of an in-line filter on cardiopulmonary exercise testing variables in healthy subjects. Eur J Appl Physiol 2024; 124:1027-1036. [PMID: 37803179 DOI: 10.1007/s00421-023-05327-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 09/20/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Pathogen transmission during cardio-pulmonary exercise testing (CPET) is caused by carrier aerosols generated during respiration. METHODS Ten healthy volunteers (age range: 34 ± 15; 4 females) were recruited to see if the physiological reactions to ramp-incremental CPET on a cycle ergometer were affected using an in-line filter placed between the mouthpiece and the flow sensor. The tests were in random order with or without an in-line bacterial/viral spirometer filter. The work rate aligned, time interpolated 10 s bin data were compared throughout the exercise period. RESULTS From rest to peak exercise, filter use increased only minute ventilation ([Formula: see text]E) (Δ[Formula: see text]E = 1.56 ± 0.70 L/min, P < 0.001) and tidal volume (VT) (ΔVT = 0.10 ± 0.11 L, P = 0.014). Over the entire test, the slope of the residuals for [Formula: see text]CO2 was positive (0.035 ± 0.041 (ΔL/L), P = 0.027). During a ramp-incremental CPET in healthy subjects, an in-line filter increased [Formula: see text]E and VT but not metabolic rate. CONCLUSION In conclusion, using an in-line filter is feasible, does not affect appreciably the physiological variables, and may mitigate risk of aerosol dispersion during CPET.
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Affiliation(s)
- Asghar Abbasi
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA.
| | - Khadije Ahmad
- Division of Cardiology, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Carrie Ferguson
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - April Soriano
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Robert Calmelat
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Harry B Rossiter
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Richard Casaburi
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - William W Stringer
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
| | - Janos Porszasz
- Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W Carson St, CDCRC Building, Torrance, CA, 90502, USA
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Schumm B, Bremer S, Knödlseder K, Schönfelder M, Hain R, Semmler L, Lorenz E, Wackerhage H, Kähler CJ, Jörres R. Indices of airway resistance and reactance from impulse oscillometry correlate with aerosol particle emission in different age groups. Sci Rep 2024; 14:4644. [PMID: 38409397 PMCID: PMC10897442 DOI: 10.1038/s41598-024-55117-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 02/20/2024] [Indexed: 02/28/2024] Open
Abstract
Airborne transmission of pathogens plays a major role in the spread of infectious diseases. Aerosol particle production from the lung is thought to occur in the peripheral airways. In the present study we investigated eighty lung-healthy subjects of two age groups (20-39, 60-76 years) at rest and during exercise whether lung function parameters indicative of peripheral airway function were correlated with individual differences in aerosol particle emission. Lung function comprised spirometry and impulse oscillometry during quiet breathing and an expiratory vital capacity manoeuvre, using resistance (R5) and reactance at 5 Hz (X5) as indicators potentially related to peripheral airway function. The association between emission at different ventilation rates relative to maximum ventilation and lung function was assessed by regression analysis. In multiple regression analyses including age group, only vital capacity manoeuvre R5 at 15% to 50% of end-expiratory vital capacity as well as quiet breathing X5 were independently linked to particle emission at 20% to 50% of maximum ventilation, in addition to age group. The fact that age as predictive factor was still significant, although to a lower degree, points towards further effects of age, potentially involving surface properties not accounted for by impulse oscillometry parameters.
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Affiliation(s)
- Benedikt Schumm
- Department of Aerospace Engineering, Institute of Fluid Mechanics and Aerodynamics, Universität der Bundeswehr München, 85577, Neubiberg, Germany.
| | - Stephanie Bremer
- Professorship of Exercise Biology, Department of Sport and Health Sciences, Technische Universität München, 80809, Munich, Germany
| | - Katharina Knödlseder
- Professorship of Exercise Biology, Department of Sport and Health Sciences, Technische Universität München, 80809, Munich, Germany
| | - Martin Schönfelder
- Professorship of Exercise Biology, Department of Sport and Health Sciences, Technische Universität München, 80809, Munich, Germany
| | - Rainer Hain
- Department of Aerospace Engineering, Institute of Fluid Mechanics and Aerodynamics, Universität der Bundeswehr München, 85577, Neubiberg, Germany
| | - Luisa Semmler
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, 81675, Munich, Germany
| | - Elke Lorenz
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, 80636, Munich, Germany
| | - Henning Wackerhage
- Professorship of Exercise Biology, Department of Sport and Health Sciences, Technische Universität München, 80809, Munich, Germany
| | - Christian J Kähler
- Department of Aerospace Engineering, Institute of Fluid Mechanics and Aerodynamics, Universität der Bundeswehr München, 85577, Neubiberg, Germany
| | - Rudolf Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, LMU Hospital, Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Ludwig Maximilian University of Munich, Munich, Germany
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Andrup L, Krogfelt KA, Stephansen L, Hansen KS, Graversen BK, Wolkoff P, Madsen AM. Reduction of acute respiratory infections in day-care by non-pharmaceutical interventions: a narrative review. Front Public Health 2024; 12:1332078. [PMID: 38420031 PMCID: PMC10899481 DOI: 10.3389/fpubh.2024.1332078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Children who start in day-care have 2-4 times as many respiratory infections compared to children who are cared for at home, and day-care staff are among the employees with the highest absenteeism. The extensive new knowledge that has been generated in the COVID-19 era should be used in the prevention measures we prioritize. The purpose of this narrative review is to answer the questions: Which respiratory viruses are the most significant in day-care centers and similar indoor environments? What do we know about the transmission route of these viruses? What evidence is there for the effectiveness of different non-pharmaceutical prevention measures? Design Literature searches with different terms related to respiratory infections in humans, mitigation strategies, viral transmission mechanisms, and with special focus on day-care, kindergarten or child nurseries, were conducted in PubMed database and Web of Science. Searches with each of the main viruses in combination with transmission, infectivity, and infectious spread were conducted separately supplemented through the references of articles that were retrieved. Results Five viruses were found to be responsible for ≈95% of respiratory infections: rhinovirus, (RV), influenza virus (IV), respiratory syncytial virus (RSV), coronavirus (CoV), and adenovirus (AdV). Novel research, emerged during the COVID-19 pandemic, suggests that most respiratory viruses are primarily transmitted in an airborne manner carried by aerosols (microdroplets). Conclusion Since airborne transmission is dominant for the most common respiratory viruses, the most important preventive measures consist of better indoor air quality that reduces viral concentrations and viability by appropriate ventilation strategies. Furthermore, control of the relative humidity and temperature, which ensures optimal respiratory functionality and, together with low resident density (or mask use) and increased time outdoors, can reduce the occurrence of respiratory infections.
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Affiliation(s)
- Lars Andrup
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Karen A Krogfelt
- Department of Science and Environment, Molecular and Medical Biology, PandemiX Center, Roskilde University, Roskilde, Denmark
| | - Lene Stephansen
- Gladsaxe Municipality, Social and Health Department, Gladsaxe, Denmark
| | | | | | - Peder Wolkoff
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Anne Mette Madsen
- The National Research Centre for the Working Environment, Copenhagen, Denmark
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Asai T, Kurosaki E, Kimachi K, Nakayama M, Koido M, Hong S. Peak risk of SARS-CoV-2 infection within 5 s of face-to-face encounters: an observational/retrospective study. Sci Rep 2023; 13:17520. [PMID: 37845540 PMCID: PMC10579401 DOI: 10.1038/s41598-023-44967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023] Open
Abstract
The link between aerosol dynamics and viral exposure risk is not fully understood, particularly during movement and face-to-face interactions. To investigate this, we employed Particle Trace Velocimetry with a laser sheet and a high-speed camera to measure microparticles from a human mannequin's mouth. The average peak time in the non-ventilated condition (expiratory volume, 30 L; passing speed, 5 km/h) was 1.33 s (standard deviation = 0.32 s), while that in the ventilated condition was 1.38 s (standard deviation = 0.35 s). Our results showed that the peak of viral exposure risk was within 5 s during face-to-face encounters under both ventilated and non-ventilated conditions. Moreover, the risk of viral exposure greatly decreased in ventilated conditions compared to non-ventilated conditions. Based on these findings, considering a risk mitigation strategy for the duration of 5 s during face-to-face encounters is expected to significantly reduce the risk of virus exposure in airborne transmission.
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Affiliation(s)
- Takeshi Asai
- Faculty of Health and Sports Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, 305-8574, Japan.
- Faculty of Physical Education, International Pacific University, Okayama, Japan.
| | - Erina Kurosaki
- Faculty of Health and Sports Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, 305-8574, Japan
| | - Kaoru Kimachi
- Faculty of Health and Sports Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, 305-8574, Japan
| | - Masao Nakayama
- Faculty of Health and Sports Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, 305-8574, Japan
| | - Masaaki Koido
- Faculty of Health and Sports Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, 305-8574, Japan
| | - Sungchan Hong
- Faculty of Health and Sports Sciences, University of Tsukuba, Tennodai 1-1-1, Tsukuba, 305-8574, Japan
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Zhou J, Singanayagam A, Goonawardane N, Moshe M, Sweeney FP, Sukhova K, Killingley B, Kalinova M, Mann AJ, Catchpole AP, Barer MR, Ferguson NM, Chiu C, Barclay WS. Viral emissions into the air and environment after SARS-CoV-2 human challenge: a phase 1, open label, first-in-human study. THE LANCET. MICROBE 2023; 4:e579-e590. [PMID: 37307844 PMCID: PMC10256269 DOI: 10.1016/s2666-5247(23)00101-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Effectively implementing strategies to curb SARS-CoV-2 transmission requires understanding who is contagious and when. Although viral load on upper respiratory swabs has commonly been used to infer contagiousness, measuring viral emissions might be more accurate to indicate the chance of onward transmission and identify likely routes. We aimed to correlate viral emissions, viral load in the upper respiratory tract, and symptoms, longitudinally, in participants who were experimentally infected with SARS-CoV-2. METHODS In this phase 1, open label, first-in-human SARS-CoV-2 experimental infection study at quarantine unit at the Royal Free London NHS Foundation Trust, London, UK, healthy adults aged 18-30 years who were unvaccinated for SARS-CoV-2, not previously known to have been infected with SARS-CoV-2, and seronegative at screening were recruited. Participants were inoculated with 10 50% tissue culture infectious dose of pre-alpha wild-type SARS-CoV-2 (Asp614Gly) by intranasal drops and remained in individual negative pressure rooms for a minimum of 14 days. Nose and throat swabs were collected daily. Emissions were collected daily from the air (using a Coriolis μ air sampler and directly into facemasks) and the surrounding environment (via surface and hand swabs). All samples were collected by researchers, and tested by using PCR, plaque assay, or lateral flow antigen test. Symptom scores were collected using self-reported symptom diaries three times daily. The study is registered with ClinicalTrials.gov, NCT04865237. FINDINGS Between March 6 and July 8, 2021, 36 participants (ten female and 26 male) were recruited and 18 (53%) of 34 participants became infected, resulting in protracted high viral loads in the nose and throat following a short incubation period, with mild-to-moderate symptoms. Two participants were excluded from the per-protocol analysis owing to seroconversion between screening and inoculation, identified post hoc. Viral RNA was detected in 63 (25%) of 252 Coriolis air samples from 16 participants, 109 (43%) of 252 mask samples from 17 participants, 67 (27%) of 252 hand swabs from 16 participants, and 371 (29%) of 1260 surface swabs from 18 participants. Viable SARS-CoV-2 was collected from breath captured in 16 masks and from 13 surfaces, including four small frequently touched surfaces and nine larger surfaces where airborne virus could deposit. Viral emissions correlated more strongly with viral load in nasal swabs than throat swabs. Two individuals emitted 86% of airborne virus, and the majority of airborne virus collected was released on 3 days. Individuals who reported the highest total symptom scores were not those who emitted most virus. Very few emissions occurred before the first reported symptom (7%) and hardly any before the first positive lateral flow antigen test (2%). INTERPRETATION After controlled experimental inoculation, the timing, extent, and routes of viral emissions was heterogeneous. We observed that a minority of participants were high airborne virus emitters, giving support to the notion of superspreading individuals or events. Our data implicates the nose as the most important source of emissions. Frequent self-testing coupled with isolation upon awareness of first symptoms could reduce onward transmissions. FUNDING UK Vaccine Taskforce of the Department for Business, Energy and Industrial Strategy of Her Majesty's Government.
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Affiliation(s)
- Jie Zhou
- Section of Virology, Imperial College London, London, UK
| | - Anika Singanayagam
- Section of Adult Infectious Disease, Imperial College London, London, UK
| | | | - Maya Moshe
- Section of Virology, Imperial College London, London, UK
| | | | - Ksenia Sukhova
- Section of Virology, Imperial College London, London, UK
| | - Ben Killingley
- Department of Infectious Diseases, University College London Hospital, London, UK
| | | | | | | | - Michael R Barer
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Neil M Ferguson
- Department of Infectious Disease, and MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Christopher Chiu
- Section of Adult Infectious Disease, Imperial College London, London, UK
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Palmowski J, Kohnhorst S, Bauer P, Puta C, Haunhorst S, Gebhardt K, Reichel T, Keller C, Huber M, Raifer H, Krüger K. T-cell-derived TNF-α and a cluster of immunological parameters from plasma allow a separation between SARS-CoV-2 convalescent versus vaccinated elite athletes. Front Physiol 2023; 14:1203983. [PMID: 37427401 PMCID: PMC10324374 DOI: 10.3389/fphys.2023.1203983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Guidelines for medical clearing after SARS-CoV-2 infection in elite athletes do not include T-cell immunity aspects despite its relevance in the course of COVID-19 disease. Therefore, we aimed to analyze T-cell-related cytokines before and after in-vitro activation of CD4+ T-cells. We sampled professional indoor sports athletes at medical clearing after SARS-CoV-2 infection obtaining clinical, fitness data, and serological data including CD4+ T-cell cytokines. All data were analyzed by principal component analysis and 2 × 2 repeated measures ANOVA. CD4+ T-cells were sampled for cell culture activation with anti-CD3/anti-CD28 tetramers. At medical clearing, CD4+ T-cells from convalescent athletes secreted increased levels of TNF-α 72 h after in-vitro activation compared to vaccinated athletes. IL-18 levels in plasma were elevated and a cluster of parameters differentiated convalescent from vaccinated athletes by 13 parameters at the timepoint of medical clearing. All clinical data indicate infection is resolved, while increased TNF-α may reflect altered proportions of peripheral T-cells as a hangover of infection.
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Affiliation(s)
- Jana Palmowski
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus Liebig University Giessen, Giessen, Germany
| | - Sarah Kohnhorst
- Center for Tumor and Immunology, Institute for Systems Immunology, Marburg, Germany
| | - Pascal Bauer
- Department of Cardiology and Angiology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Christian Puta
- Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
- Center for Interdisciplinary Prevention of Diseases Related to Professional Activities, Jena, Germany
| | - Simon Haunhorst
- Department of Sports Medicine and Health Promotion, Friedrich Schiller University Jena, Jena, Germany
| | - Kristina Gebhardt
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus Liebig University Giessen, Giessen, Germany
| | - Thomas Reichel
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus Liebig University Giessen, Giessen, Germany
| | - Christian Keller
- Institute of Virology, Philipps University Marburg, Marburg, Germany
| | - Magdalena Huber
- Center for Tumor and Immunology, Institute for Systems Immunology, Marburg, Germany
| | - Hartmann Raifer
- Center for Tumor and Immunology, Institute for Systems Immunology, Marburg, Germany
| | - Karsten Krüger
- Department of Exercise Physiology and Sports Therapy, Institute of Sports Science, Justus Liebig University Giessen, Giessen, Germany
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8
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Lim Y, Lee MH, Jeong S, Han HW. Association of Physical Activity With SARS-CoV-2 Infection and Severe Clinical Outcomes Among Patients in South Korea. JAMA Netw Open 2023; 6:e239840. [PMID: 37097636 PMCID: PMC10130952 DOI: 10.1001/jamanetworkopen.2023.9840] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
Importance The association of moderate to vigorous physical activity (MVPA) with COVID-19 outcomes is unclear and needs to be investigated. Objective To identify the association of longitudinal changes in MVPA with SARS-CoV-2 infection and severe COVID-19 outcomes. Design, Setting, and Participants This nested case-control study used data from 6 396 500 adult patients in South Korean who participated in National Health Insurance Service (NHIS) biennial health screenings from period 1 (2017-2018) to period 2 (2019-2020). Patients were followed from October 8, 2020, until the diagnosis of COVID-19 or December 31, 2021. Exposure Moderate to vigorous physical activity was measured by self-report on questionnaires during both NHIS health screenings and calculated by adding the frequency (times per week) of each moderate (≥30 minutes per day) and vigorous (≥20 minutes per day) physical activity. Main Outcomes and Measures The main outcomes were a positive diagnosis of SARS-CoV-2 infection and severe COVID-19 clinical events. Adjusted odds ratio (aORs) and 99% CIs were calculated using multivariable logistic regression analysis. Results A total of 183 350 patients with COVID-19 (mean [SD] age, 51.9 [13.8] years; female, 89 369 [48.7%]; male, 93 981 [51.3%]) among 2 110 268 participants were identified. For participants with vs without COVID-19, the proportion of MVPA frequency at period 2 was 35.8% vs 35.9% for physically inactive, 18.9% vs 18.9% for 1 to 2 times per week, 17.7% vs 17.7% for 3 to 4 times per week, and 27.5% vs 27.4% for 5 or more times per week. Among unvaccinated, physically inactive patients at period 1, the odds for infection increased when engaged in MVPA 1 to 2 times per week (aOR, 1.08; 99% CI, 1.01-1.15), 3 to 4 times per week (aOR, 1.09; 99% CI, 1.03-1.16), or 5 or more times per week (aOR, 1.10; 99% CI, 1.04-1.17) at period 2. Conversely, among unvaccinated patients with MVPA of 5 or more times per week at period 1, the odds for infection decreased when engaged 1 to 2 times per week (aOR, 0.90; 99% CI, 0.81-0.98) or physically inactive (aOR, 0.80; 99% CI, 0.73-0.87) at period 2. The trend of MVPA and incident infection was mitigated when participants were fully vaccinated. Furthermore, the odds for severe COVID-19 showed significant but limited associations with MVPA. Conclusions and Relevance The findings of this nested case-control study show a direct association of MVPA with risk of SARS-CoV-2 infection, which was mitigated after completion of the COVID-19 vaccination primary series. In addition, higher levels of MVPA were associated with a lower risk of severe COVID-19 outcomes to limited proportions.
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Affiliation(s)
- YoHwan Lim
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Myeong Hoon Lee
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hyun Wook Han
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
- Institute of Biomedical Informatics, CHA University School of Medicine, Seongnam, Republic of Korea
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9
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Raymenants J, Geenen C, Budts L, Thibaut J, Thijssen M, De Mulder H, Gorissen S, Craessaerts B, Laenen L, Beuselinck K, Ombelet S, Keyaerts E, André E. Indoor air surveillance and factors associated with respiratory pathogen detection in community settings in Belgium. Nat Commun 2023; 14:1332. [PMID: 36898982 PMCID: PMC10005919 DOI: 10.1038/s41467-023-36986-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
Currently, the real-life impact of indoor climate, human behaviour, ventilation and air filtration on respiratory pathogen detection and concentration are poorly understood. This hinders the interpretability of bioaerosol quantification in indoor air to surveil respiratory pathogens and transmission risk. We tested 341 indoor air samples from 21 community settings in Belgium for 29 respiratory pathogens using qPCR. On average, 3.9 pathogens were positive per sample and 85.3% of samples tested positive for at least one. Pathogen detection and concentration varied significantly by pathogen, month, and age group in generalised linear (mixed) models and generalised estimating equations. High CO2 and low natural ventilation were independent risk factors for detection. The odds ratio for detection was 1.09 (95% CI 1.03-1.15) per 100 parts per million (ppm) increase in CO2, and 0.88 (95% CI 0.80-0.97) per stepwise increase in natural ventilation (on a Likert scale). CO2 concentration and portable air filtration were independently associated with pathogen concentration. Each 100ppm increase in CO2 was associated with a qPCR Ct value decrease of 0.08 (95% CI -0.12 to -0.04), and portable air filtration with a 0.58 (95% CI 0.25-0.91) increase. The effects of occupancy, sampling duration, mask wearing, vocalisation, temperature, humidity and mechanical ventilation were not significant. Our results support the importance of ventilation and air filtration to reduce transmission.
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Affiliation(s)
- Joren Raymenants
- Laboratory of Clinical Microbiology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Caspar Geenen
- Laboratory of Clinical Microbiology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lore Budts
- Department of Laboratory Medicine, National Reference Center of Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Jonathan Thibaut
- Laboratory of Clinical Microbiology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Marijn Thijssen
- Laboratory of Clinical and Epidemiological Virology (Rega Institute), KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hannelore De Mulder
- Laboratory of Clinical Microbiology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sarah Gorissen
- Laboratory of Clinical Microbiology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Bastiaan Craessaerts
- Department of Laboratory Medicine, National Reference Center of Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lies Laenen
- Laboratory of Clinical Microbiology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Laboratory Medicine, National Reference Center of Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Kurt Beuselinck
- Department of Laboratory Medicine, National Reference Center of Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Sien Ombelet
- Department of Laboratory Medicine, National Reference Center of Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Els Keyaerts
- Department of Laboratory Medicine, National Reference Center of Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Emmanuel André
- Laboratory of Clinical Microbiology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Laboratory Medicine, National Reference Center of Respiratory Pathogens, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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10
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Respiratory aerosol particle emission and simulated infection risk is greater during indoor endurance than resistance exercise. Proc Natl Acad Sci U S A 2023; 120:e2220882120. [PMID: 36802418 PMCID: PMC9992860 DOI: 10.1073/pnas.2220882120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Pathogens such as severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), influenza, and rhinoviruses are transmitted by airborne aerosol respiratory particles that are exhaled by infectious subjects. We have previously reported that the emission of aerosol particles increases on average 132-fold from rest to maximal endurance exercise. The aims of this study are to first measure aerosol particle emission during an isokinetic resistance exercise at 80% of the maximal voluntary contraction until exhaustion, second to compare aerosol particle emission during a typical spinning class session versus a three-set resistance training session. Finally, we then used this data to calculate the risk of infection during endurance and resistance exercise sessions with different mitigation strategies. During a set of isokinetic resistance exercise, aerosol particle emission increased 10-fold from 5,400 ± 1,200 particles/min at rest to 59,000 ± 69,900 particles/min during a set of resistance exercise. We found that aerosol particle emission per minute is on average 4.9-times lower during a resistance training session than during a spinning class. Using this data, we determined that the simulated infection risk increase during an endurance exercise session was sixfold higher than during a resistance exercise session when assuming one infected participant in the class. Collectively, this data helps to select mitigation measures for indoor resistance and endurance exercise classes at times where the risk of aerosol-transmitted infectious disease with severe outcomes is high.
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11
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Edwards DA, Chung KF. Mouth breathing, dry air, and low water permeation promote inflammation, and activate neural pathways, by osmotic stresses acting on airway lining mucus. QRB DISCOVERY 2023; 4:e3. [PMID: 37529032 PMCID: PMC10392678 DOI: 10.1017/qrd.2023.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/01/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
Respiratory disease and breathing abnormalities worsen with dehydration of the upper airways. We find that humidification of inhaled air occurs by evaporation of water over mucus lining the upper airways in such a way as to deliver an osmotic force on mucus, displacing it towards the epithelium. This displacement thins the periciliary layer of water beneath mucus while thickening topical water that is partially condensed from humid air on exhalation. With the rapid mouth breathing of dry air, this condensation layer, not previously reported while common to transpiring hydrogels in nature, can deliver an osmotic compressive force of up to around 100 cm H2O on underlying cilia, promoting adenosine triphosphate secretion and activating neural pathways. We derive expressions for the evolution of the thickness of the condensation layer, and its impact on cough frequency, inflammatory marker secretion, cilia beat frequency and respiratory droplet generation. We compare our predictions with human clinical data from multiple published sources and highlight the damaging impact of mouth breathing, dry, dirty air and high minute volume on upper airway function. We predict the hypertonic (or hypotonic) saline mass required to reduce (or amplify) dysfunction by restoration (or deterioration) of the structure of ciliated and condensation water layers in the upper airways and compare these predictions with published human clinical data. Preserving water balance in the upper airways appears critical in light of contemporary respiratory health challenges posed by the breathing of dirty and dry air.
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Affiliation(s)
- David A. Edwards
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA
| | - Kian Fan Chung
- Experimental Studies Unit, National Heart and Lung Institute, Imperial College London, London, UK
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12
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Alsaad H, Schälte G, Schneeweiß M, Becher L, Pollack M, Gena AW, Schweiker M, Hartmann M, Voelker C, Rossaint R, Irrgang M. The Spread of Exhaled Air and Aerosols during Physical Exercise. J Clin Med 2023; 12:jcm12041300. [PMID: 36835835 PMCID: PMC9961458 DOI: 10.3390/jcm12041300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/10/2023] Open
Abstract
Physical exercise demonstrates a special case of aerosol emission due to its associated elevated breathing rate. This can lead to a faster spread of airborne viruses and respiratory diseases. Therefore, this study investigates cross-infection risk during training. Twelve human subjects exercised on a cycle ergometer under three mask scenarios: no mask, surgical mask, and FFP2 mask. The emitted aerosols were measured in a grey room with a measurement setup equipped with an optical particle sensor. The spread of expired air was qualitatively and quantitatively assessed using schlieren imaging. Moreover, user satisfaction surveys were conducted to evaluate the comfort of wearing face masks during training. The results indicated that both surgical and FFP2 masks significantly reduced particles emission with a reduction efficiency of 87.1% and 91.3% of all particle sizes, respectively. However, compared to surgical masks, FFP2 masks provided a nearly tenfold greater reduction of the particle size range with long residence time in the air (0.3-0.5 μm). Furthermore, the investigated masks reduced exhalation spreading distances to less than 0.15 m and 0.1 m in the case of the surgical mask and FFP2 mask, respectively. User satisfaction solely differed with respect to perceived dyspnea between no mask and FFP2 mask conditions.
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Affiliation(s)
- Hayder Alsaad
- Department of Building Physics, Faculty of Civil Engineering, Bauhaus-University Weimar, 99423 Weimar, Germany
- Correspondence: (H.A.); (M.I.)
| | - Gereon Schälte
- Department of Anesthesiology, Medical Faculty, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Mario Schneeweiß
- Department of Building Physics, Faculty of Civil Engineering, Bauhaus-University Weimar, 99423 Weimar, Germany
| | - Lia Becher
- Department of Building Physics, Faculty of Civil Engineering, Bauhaus-University Weimar, 99423 Weimar, Germany
| | - Moritz Pollack
- Department of Building Physics, Faculty of Civil Engineering, Bauhaus-University Weimar, 99423 Weimar, Germany
| | - Amayu Wakoya Gena
- Department of Building Physics, Faculty of Civil Engineering, Bauhaus-University Weimar, 99423 Weimar, Germany
| | - Marcel Schweiker
- Healthy Living Spaces Lab, Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany
| | - Maria Hartmann
- Department of Building Physics, Faculty of Civil Engineering, Bauhaus-University Weimar, 99423 Weimar, Germany
| | - Conrad Voelker
- Department of Building Physics, Faculty of Civil Engineering, Bauhaus-University Weimar, 99423 Weimar, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, Medical Faculty, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Matthias Irrgang
- Department of Anesthesiology, Medical Faculty, University Hospital RWTH Aachen, 52074 Aachen, Germany
- Correspondence: (H.A.); (M.I.)
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13
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He Y, Chen J, Shi W, Shi J, Ma T, Wang X. Can nonvolatile tastants be smelled during food oral processing? Chem Senses 2023; 48:bjad028. [PMID: 37590987 PMCID: PMC10516591 DOI: 10.1093/chemse/bjad028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Indexed: 08/19/2023] Open
Abstract
While accumulating evidence implied the involvement of retro-nasal sensation in the consumption of nonvolatile taste compounds, it is still unclear whether it was caused by the taste compounds themselves, and if so, how can they migrate from the oral to nasal cavity. At first, we proposed aerosol particles as an alternative oral-nasal mass transfer mechanism. The high-speed camera approved that aerosol particles could be generated by the typical oral and pharynx actions during food oral processing; while the narrow-band imaging of nasal cleft and mass spectrometry of nostril-exhaled air approved the migration of aerosol within the oral-nasal route. Then, the "smelling" of taste compounds within the aerosol particles was testified. The four-alternative forced choices (4AFC) approved that the potential volatile residues or contaminants within the headspace air of pure taste solution cannot arouse significant smell, while the taste compounds embedded in the in vitro prepared aerosol particles can be "smelled" via the ortho route. The "smell" of sucrose is very different from its taste and the "smell" of quinine, implying its actual olfaction. The sweetness intensity of sucrose solution was also reduced when the volunteers' noses were clipped, indicating the involvement of retro-nasal sensation during its drinking. At last, the efficiency of aerosol as a mechanism of oral-nasal mass transfer was demonstrated to be comparable with the volatile molecules under the experimental condition, giving it the potential to be a substantial and unique source of retro-nasal sensation during food oral processing.
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Affiliation(s)
- Yue He
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Jianshe Chen
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Weiyao Shi
- EPC Natural Products Co., Ltd., Beijing, China
| | - Jingang Shi
- EPC Natural Products Co., Ltd., Beijing, China
| | - Tian Ma
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Xinmiao Wang
- Laboratory of Food Oral Processing, School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
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14
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Elliott J, Munford L, Ahmed S, Littlewood A, Todd C. The impact of COVID-19 lockdowns on physical activity amongst older adults: evidence from longitudinal data in the UK. BMC Public Health 2022; 22:1802. [PMID: 36138374 PMCID: PMC9502942 DOI: 10.1186/s12889-022-14156-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background A sedentary lifestyle increases the risk of adverse health outcomes and frailty,particularly for older adults. To reduce transmission during the COVID-19 pandemic, people were instructed to stay at home, group sports were suspended, and gyms were closed, thereby limiting opportunities for physical activity. Whilst evidence suggests that physical activity levels reduced during the pandemic, it is unclear whether the proportion of older adults realising the recommended minimum level of physical activity changed throughout the various stages of lockdown. Methods We used a large sample of 3,660 older adults (aged ≥ 65) who took part in the UK Household Longitudinal Study’s annual and COVID-19 studies. We examined changes in the proportion of older adults who were realising the UK Chief Medical Officers’ physical activity recommendations for health maintenance at several time points before and after COVID-19 lockdowns were imposed. We stratified these trends by the presence of health conditions, age, neighbourhood deprivation, and pre-pandemic activity levels. Results There was a marked decline in older adults’ physical activity levels during the third national lockdown in January 2021. The proportion realising the Chief Medical Officers’ physical activity recommendations decreased from 43% in September 2020 to 33% in January 2021. This decrease in physical activity occurred regardless of health condition, age, neighbourhood deprivation, or pre-pandemic activity levels. Those doing the least activity pre-lockdown increased their activity during lockdowns and those doing the most decreased their activity levels. Conclusions Reductions in older adults’ physical activity levels during COVID-19 lockdowns have put them at risk of becoming deconditioned and developing adverse health outcomes. Resources should be allocated to promote the uptake of physical activity in older adults to reverse the effects of deconditioning. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14156-y.
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Affiliation(s)
- Jack Elliott
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK. .,Manchester Academic Health Science Centre, Manchester, UK. .,Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - Luke Munford
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Health Organisation, Policy and Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Saima Ahmed
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alison Littlewood
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Chris Todd
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK.,Manchester Academic Health Science Centre, Manchester, UK.,Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester University NHS Foundational Trust, Manchester, UK.,Manchester Institute for Collaborative Research On Ageing, Manchester, UK
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