Scale-up and scale-out of a gender-sensitized weight management and healthy living program delivered to overweight men via professional sports clubs: the wider implementation of Football Fans in Training (FFIT)

Increasing prevalence of obesity poses challenges for public health. Men have been under-served by weight management programs, highlighting a need for gender-sensitized programs which can be embedded into routine practice or adapted for new settings/populations, to accelerate the process of implementing programs which are successful and cost-effective under research conditions. To address gaps in examples of how to bridge the research to practice gap, we describe the scale-up and scale-out of Football Fans in Training (FFIT), a weight management and healthy living program in relation to two implementation frameworks. The paper presents the development, evaluation and scale-up of FFIT, mapped onto the PRACTIS guide; outcomes in scale-up deliveries and the scale-out of FFIT through programs delivered in other contexts (other countries, professional sports, target groups, public health focus). FFIT has been scaled-up through a single-license franchise model in over 40 UK professional football clubs to 2019 (and 30 more from 2020) and scaled-out into football and other sporting contexts in Australia, Canada, New Zealand, England and other European countries. The successful scale-up and scale-out of FFIT demonstrates that, with attention to cultural constructions of masculinity, public health interventions can appeal to men and support them in sustainable lifestyle change

Direct Lysis RT-qPCR of SARS-CoV-2 in Cell Culture Supernatant Allows for Fast and Accurate Quantification

Studying the entire virus replication cycle of SARS-CoV-2 is essential to identify the host factors involved and treatments to combat infection. Quantification of released virions often requires lengthy procedures, whereas quantification of viral RNA in supernatant is faster and applicable to clinical isolates. Viral RNA purification is expensive in terms of time and resources, and is often unsuitable for high-throughput screening. Direct lysis protocols were explored for patient swab samples, but the lack of virus inactivation, cost, sensitivity, and accuracy is hampering their application and usefulness for in vitro studies. Here, we show a highly sensitive, accurate, fast, and cheap direct lysis RT-qPCR method for quantification of SARS-CoV-2 in culture supernatant. This method inactivates the virus and permits detection limits of 0.043 TCID(50) virus and <1.89 copy RNA template per reaction. Comparing direct lysis with RNA extraction, a mean difference of +0.69 ± 0.56 cycles was observed. Application of the method to established qPCR methods for RSV (-ve RNA), IAV (segmented -ve RNA), and BHV (dsDNA) showed wider applicability to other enveloped viruses, whereby IAV showed poorer sensitivity. This shows that accurate quantification of SARS-CoV-2 and other enveloped viruses can be achieved using direct lysis protocols, facilitating a wide range of high- and low-throughput applications

Raised interleukin 31 transcription in a canine model of acute atopic dermatitis does not correlate with T cell infiltration

Interleukin 31 (IL-31) has been identified as an important cytokine in the pathophysiology of atopic dermatitis (AD) in both humans and dogs, and is a key mediator in the pruritus and TH2-weighted inflammation which characterizes this allergic condition.1 IL-31 is produced predominantly by activated T cells and memory T cells, preferentially TH2, and also by mast cells, eosinophils, basophils, macrophages and dendritic cells.1,2 However the origin of IL-31 in the skin is unclear: one study identified IL-31 transcription in infiltrating cells, presumed to be T cells, but another study associated IL-31 protein immunostaining with CD11b+ or CD11c+ cells in the skin, but not CD3+ T cells.3,4 IL-31 is thought to have diverse functions in the skin including regulation of keratinocyte differentiation and filaggrin expression, promoting interaction between keratinocytes and eosinophils, eosinophil chemotaxis, promoting nerve growth and stimulating secretion of proinflammatory cytokines, chemokines, and matrix metalloproteinase by keratinocytes and dendritic cells.5-11 In addition, IL-31 has been shown to directly activate sensory neurons in the skin, providing a critical link between cells of the immune and nervous systems in communicating the sensation of pruritus associated with allergic skin disease.12 Over the last 20 years, numerous studies have established the striking similarities between human (AD) and canine atopic dermatitis (cAD), leading to the proposition that cAD can be used as a relevant model for humans.13-15 Naturally occurring cAD is very common in dogs, and its epidemiology, clinical presentation, diagnosis and pathophysiology appear to closely parallel that of AD in human patients, with the exception that dogs very rarely develop allergic asthma and rhinitis.13-15 As in humans, the hallmarks of cAD are epidermal barrier defects and aberrant T helper type 2 (TH2)-weighted immune responses to environmental allergens.13-15 Likewise, 80% of affected dogs have classical cAD, with allergen-specific IgE, while 20% have cAD-like disease which is clinically indistinguishable but presents without detectable allergen-specific IgE.13 Concomitant food allergies, dysbiosis of the skin microbiome and secondary Staphylococcal infection are also common in dogs.13,16 The management and treatment of cAD is also similar human AD, with the addition of allergen-specific immunotherapy, Janus Kinase (JAK) inhibitors and anti-IL-31 therapeutic monoclonal antibody being in general use for cAD.13-15 The development and adoption of novel treatments for cAD, such as JAK inhibitors and anti-IL-31 monoclonals, is often accelerated by the reduced expense of clinical trials and lower regulatory requirements in veterinary medicine.13,15 Levels of IL-31 in the serum of atopic dogs has been found to correlate with the severity of clinical signs, and transcription of IL-31 mRNA has been shown to be increased in peripheral blood mononuclear cells from atopic dogs.17-19 Early studies failed to demonstrate IL-31 transcription in canine skin, however Olivry et al demonstrated increased IL-31 mRNA in lesional skin from an experimental canine model of acute house dust mite-induced AD. 20,21 A recent study of IL-31 transcription in canine skin demonstrated very low levels of IL-31 transcription in both healthy and atopic dogs using in-situ hybridization, but this study did not examine which cells in the skin were responsible or changes during inflammation.22The objectives of our studies were to identify transcription of IL-31 in normal and atopic canine skin, to examine how transcription is affected during allergic inflammation, and to examine whether transcription of IL-31 correlates with changes in eosinophils and CD3+ T cells in the skin of atopic dogs over the course of an acute inflammatory response. <br/

Medication storage in Emergency Medical Services : temperature ranges from a South African sample

CITATION: Wylie, C. A., et al. 2021. Medication storage in Emergency Medical Services : temperature ranges from a South African sample. South African Journal of Pre-hospital Emergency Care, 2(1):2-6, doi:10.24213/2-1-4480.The original publication is available at https://www.journals.ac.za/index.php/sajpec/Background: Pre-hospital emergency care providers working in emergency medical services (EMS) are licenced to administer medication to the acutely ill and injured. In South Africa, there are significant seasonal variations in temperature, sometimes far exceeding the recommended medication storage temperature. The aim of this study was to determine the summer temperature ranges inside select emergency vehicles and storage facilities in four provinces in South Africa. Methods: A prospective, observational study was conducted in four (Cape Town, Western Cape; Johannesburg, Gauteng; Durban, KwaZulu-Natal; Potchefstroom, North West) provinces during the summer (February – March) months of 2019. A continuous temperature monitoring device was placed in the medication storage room, the response vehicle drug bags, and an ambulance at a single private EMS base in each of the provinces. Temperature data were recorded in fifteen-minute intervals. The data were extracted after six weeks and subjected to descriptive analysis. Data were also analysed in six-hourly strata to account for daily temperature variations. Results: A total of 36 002 temperature readings were recorded during the study period. The mean (range) temperature across the four bases was 25.4°C (13.1–56.8) for ambulances, 25.7°C (13.3–49.1) for primary response vehicles, and 24.4°C (17.3–33.9) for medication storage facilities. The highest mean (range) temperatures, of 33.7°C (20.4–47.9), were recorded in a Johannesburg-based primary response vehicle between 12h00 and 18h00. Conclusion: Current medication storing and transporting practices not maintain temperatures according to the recommended storage conditions. Further investigation should address the implication of temperature fluctuations on medication degradation, and a sustainable, cost-effective solution should be developed to store medication in the pre-hospital setting.https://www.journals.ac.za/index.php/sajpec/article/view/4480Publisher's versio

Implementing telephone triage in general practice: a process evaluation of a cluster randomised controlled trial

Background: Telephone triage represents one strategy to manage demand for face-to-face GP appointments in primary care. However, limited evidence exists of the challenges GP practices face in implementing telephone triage. We conducted a qualitative process evaluation alongside a UK-based cluster randomised trial (ESTEEM) which compared the impact of GP-led and nurse-led telephone triage with usual care on primary care workload, cost, patient experience, and safety for patients requesting a same-day GP consultation. The aim of the process study was to provide insights into the observed effects of the ESTEEM trial from the perspectives of staff and patients, and to specify the circumstances under which triage is likely to be successfully implemented. Here we report perspectives of staff. Methods: The intervention comprised implementation of either GP-led or nurse-led telephone triage for a period of 2-3 months. A qualitative evaluation was conducted using staff interviews recruited from eight general practices (4 GP triage, 4 Nurse triage) in the UK, implementing triage as part of the ESTEEM trial. Qualitative interviews were undertaken with 44 staff members in GP triage and nurse triage practices (16 GPs, 8 nurses, 7 practice managers, 13 administrative staff). Results: Staff reported diverse experiences and perceptions regarding the implementation of telephone triage, its effects on workload, and on the benefits of triage. Such diversity were explained by the different ways triage was organised, the staffing models used to support triage, how the introduction of triage was communicated across practice staff, and by how staff roles were reconfigured as a result of implementing triage. Conclusion: The findings from the process evaluation offer insight into the range of ways GP practices participating in ESTEEM implemented telephone triage, and the circumstances under which telephone triage can be successfully implemented beyond the context of a clinical trial. Staff experiences and perceptions of telephone triage are shaped by the way practices communicate with staff, prepare for and sustain the changes required to implement triage effectively, as well as by existing practice culture, and staff and patient behaviour arising in response to the changes made. Trial registration: Current Controlled Trials ISRCTN20687662. Registered 28 May 2009

PGC-1 alpha and PGC-1 beta increase protein synthesis via ERR alpha in C2C12 myotubes

The transcriptional coactivators peroxisome proliferator-activated receptor-&gamma; coactivator-1&alpha; (PGC-1&alpha;) and PGC-1&beta; are positive regulators of skeletal muscle mass and energy metabolism; however, whether they influence muscle growth and metabolic adaptations via increased protein synthesis is not clear. This study revealed PGC-1&alpha; or PGC-1&beta; overexpression in C2C12 myotubes increased protein synthesis and myotube diameter under basal conditions and attenuated the loss in protein synthesis following the treatment with the catabolic agent, dexamethasone. To investigate whether PGC-1&alpha; or PGC-1&beta; signal through the Akt/mTOR pathway to increase protein synthesis, treatment with the PI3K and mTOR inhibitors, LY294002 and rapamycin, respectively, was undertaken but found unable to block PGC-1&alpha; or PGC-1&beta;&rsquo;s promotion of protein synthesis. Furthermore, PGC-1&alpha; and PGC-1&beta; decreased phosphorylation of Akt and the Akt/mTOR substrate, p70S6K. In contrast to Akt/mTOR inhibition, the suppression of ERR&alpha;, a major effector of PGC-1&alpha; and PGC-1&beta; activity, attenuated the increase in protein synthesis and myotube diameter in the presence of PGC-1&alpha; or PGC-1&beta; overexpression. To characterize further the biological processes occurring, gene set enrichment analysis of genes commonly regulated by both PGC-1&alpha; and PGC-1&beta; was performed following a microarray screen. Genes were found enriched in metabolic and mitochondrial oxidative processes, in addition to protein translation and muscle development categories. This suggests concurrent responses involving both increased metabolism and myotube protein synthesis. Finally, based on their known function or unbiased identification through statistical selection, two sets of genes were investigated in a human exercise model of stimulated protein synthesis to characterize further the genes influenced by PGC-1&alpha; and PGC-1&beta; during physiological adaptive changes in skeletal muscle