Effect of wearing a face mask on hand-to-face contact by children in a simulated school environment: the Back-to-School COVID-19 Simulation Randomized Clinical Trial

Importance Wearing a face mask in school can reduce SARS-CoV-2 transmission but it may also lead to increased hand-to-face contact, which in turn could increase infection risk through self-inoculation. Objective To evaluate the effect of wearing a face mask on hand-to-face contact by children while at school. Design, Setting, and Participants This prospective randomized clinical trial randomized students from junior kindergarten to grade 12 at 2 schools in Toronto, Ontario, Canada, during August 2020 in a 1:1 ratio to either a mask or control class during a 2-day school simulation. Classes were video recorded from 4 angles to accurately capture outcomes. Interventions Participants in the mask arm were instructed to bring their own mask and wear it at all times. Students assigned to control classes were not required to mask at any time (grade 4 and lower) or in the classroom where physical distancing could be maintained (grade 5 and up). Main Outcomes and Measures The primary outcome was the number of hand-to-face contacts per student per hour on day 2 of the simulation. Secondary outcomes included hand-to-mucosa contacts and hand-to-nonmucosa contacts. A mixed Poisson regression model was used to derive rate ratios (RRs), adjusted for age and sex with a random intercept for class with bootstrapped 95% CIs. Results A total of 174 students underwent randomization and 171 students (mask group, 50.6% male; control group, 52.4% male) attended school on day 2. The rate of hand-to-face contacts did not differ significantly between the mask and the control groups (88.2 vs 88.7 events per student per hour; RR, 1.00; 95% CI, 0.78-1.28; P = >.99). When compared with the control group, the rate of hand-to-mucosa contacts was significantly lower in the mask group (RR, 0.12; 95% CI, 0.07-0.21), while the rate of hand-to-nonmucosa contacts was higher (RR, 1.40; 95% CI, 1.08-1.82). Conclusions and Relevance In this clinical trial of simulated school attendance, hand-to-face contacts did not differ among students required to wear face masks vs students not required to wear face masks; however, hand-to-mucosa contracts were lower in the face mask group. This suggests that mask wearing is unlikely to increase infection risk through self-inoculation. Trial Registration ClinicalTrials.gov Identifier: NCT0453125

MACH14: A Multi-Site Collaboration on ART Adherence Among 14 Institutions

The integration of original data from multiple antiretroviral (ARV) adherence studies offers a promising, but little used method to generate evidence to advance the field. This paper provides an overview of the design and implementation of MACH14, a collaborative, multi-site study in which a large data system has been created for integrated analyses by pooling original data from 16 longitudinal ARV adherence studies. Studies selected met specific criteria including similar research design and data domains such as adherence measured with medication event monitoring system, psychosocial factors related to adherence behavior, and virologic and clinical outcomes. The data system created contains individual data (collected between 1997 and 2009) from 2,860 HIV patients. Collaboration helped resolve the challenges inherent in pooling data across multiple studies, yet produced a data system with strong statistical power and potentially greater capacity to address key scientific questions than possible with single-sample studies or even meta-analytic designs

The Validity of Self-Reported Medication Adherence as an Outcome in Clinical Trials of Adherence-Promotion Interventions: Findings from the MACH14 Study

In medication adherence-promotion trials, participants in the intervention arm are often cognizant of the researcher’s aim to improve adherence; this may lead to their inflating reports of their own adherence compared to control arm participants. Using data from 1,247 HIV-positive participants across eight U.S. Studies in the Multisite Adherence Collaboration on HIV (MACH14) collaboration, we evaluated the validity of self-reported adherence by examining whether its association with two more objective outcomes [1], electronically monitored adherence and [2] viral load, varied by study arm. After adjusting for potential confounders, there was no evidence of greater overestimation of self-reported adherence among intervention arm participants, supporting its potential as a trial outcome indicator

L-Arginine Affects Aerobic Capacity and Muscle Metabolism in MELAS (Mitochondrial Encephalomyopathy, Lactic Acidosis and Stroke-Like Episodes) Syndrome.

To study the effects of L-arginine (L-Arg) on total body aerobic capacity and muscle metabolism as assessed by (31)Phosphorus Magnetic Resonance Spectroscopy ((31)P-MRS) in patients with MELAS (Mitochondrial Encephalomyopathy with Lactic Acidosis and Stroke-like episodes) syndrome.We performed a case control study in 3 MELAS siblings (m.3243A>G tRNA(leu(UUR)) in MTTL1 gene) with different % blood mutant mtDNA to evaluate total body maximal aerobic capacity (VO(2peak)) using graded cycle ergometry and muscle metabolism using 31P-MRS. We then ran a clinical trial pilot study in MELAS sibs to assess response of these parameters to single dose and a 6-week steady-state trial of oral L-Arginine.At baseline (no L-Arg), MELAS had lower serum Arg (p = 0.001). On 3(1)P-MRS muscle at rest, MELAS subjects had increased phosphocreatine (PCr) (p = 0.05), decreased ATP (p = 0.018), and decreased intracellular Mg(2+) (p = 0.0002) when compared to matched controls. With L-arginine therapy, the following trends were noted in MELAS siblings on cycle ergometry: (1) increase in mean % maximum work at anaerobic threshold (AT) (2) increase in % maximum heart rate at AT (3) small increase in VO(2peak). On (31)P-MRS the following mean trends were noted: (1) A blunted decrease in pH after exercise (less acidosis) (2) increase in Pi/PCr ratio (ADP) suggesting increased work capacity (3) a faster half time of PCr recovery (marker of mitochondrial activity) following 5 minutes of moderate intensity exercise (4) increase in torque.These results suggest an improvement in aerobic capacity and muscle metabolism in MELAS subjects in response to supplementation with L-Arg. Intramyocellular hypomagnesemia is a novel finding that warrants further study.Class III evidence that L-arginine improves aerobic capacity and muscle metabolism in MELAS subjects.ClinicalTrials.gov NCT01603446

Supporting data for Polymeric medical sutures: An exploration of polymers and green chemistry

Full description in Readme file.These files contain data along with associated output from instrumentation supporting all results reported in Knutson, C. M.; Schneiderman, D. K.; Yu, M.; Javner, C. H.; Distefano, M. D.; Wissinger, J. E. Polymeric medical sutures: An exploration of polymers and green chemistry. J. Chem. Educ. 2017, 94, 1761–1765. In Knutson, et. al. it was found that with new K–12 national science standards emerging, there is an increased need for experiments that integrate engineering into the context of society. Here we describe a chemistry experiment that combines science and engineering principles while introducing basic polymer and green chemistry concepts. Using medical sutures as a platform for investigating polymers, students explore the physical and mechanical properties of threads drawn from poly(ε-caprolactone) samples of different molecular masses and actual purchased absorbable and nonabsorbable medical sutures. An inquiry-based part of the experiment tasks students with designing their own experiment to probe the potential of melt blending poly(ε-caprolactone) with commercially available polylactide products in order to modify the properties of the “sutures” drawn. Through these lessons students gain an appreciation for the importance of plastics in our society and how scientists are working to develop more sustainable alternatives. Overall, this laboratory experiment provides a feasible, versatile, sophisticated laboratory experience that engages students in a relatable topic and meets many of the Next Generation Science Standards.Minnesota Pollution Control Agency (Swift 52526)NSF CHE-1413862NSF RET DMR-155983

Physical activity for children with chronic disease; a narrative review and practical applications

Abstract Background Physical activity (PA) is associated with a diverse range of health benefits. International guidelines suggest that children should be participating in a minimum of 60 min of moderate to vigorous intensity PA per day to achieve these benefits. However, current guidelines are intended for healthy children, and thus may not be applicable to children with a chronic disease. Specifically, the dose of PA and disease specific exercise considerations are not included in these guidelines, leaving such children with few, if any, evidence-based informed suggestions pertaining to PA. Thus, the purpose of this narrative review was to consider current literature in the area of exercise as medicine and provide practical applications for exercise in five prevalent pediatric chronic diseases: respiratory, congenital heart, metabolic, systemic inflammatory/autoimmune, and cancer. Methods For each disease, we present the pathophysiology of exercise intolerance, summarize the pediatric exercise intervention research, and provide PA suggestions. Results Overall, exercise intolerance is prevalent in pediatric chronic disease. PA is important and safe for most children with a chronic disease, however exercise prescription should involve the entire health care team to create an individualized program. Conclusions Future research, including a systematic review to create evidence-based guidelines, is needed to better understand the safety and efficacy of exercise among children with chronic disease

Clinical and neuroimaging features in MELAS cohort and healthy study controls.

<p><b>Key</b>: FVC = forced expiratory vital capacity is the volume change of the lung between a full inspiration to total lung capacity and a maximal expiration to residual volume; FEV1 = forced expiratory volume is the volume exhaled during the first second of a forced expiratory maneuver started from the level of total lung capacity; MOCA = Montreal Cognitive Assessment which is a cognitive screening test—a score of ≥ 26 is considered normal; N/A = not done due to difficulty with cooperation; SLEs = stroke-like episodes.</p><p>Clinical and neuroimaging features in MELAS cohort and healthy study controls.</p

Typical spectra acquired using ³¹P-MRS before (A) and following exercise (B) from a healthy control subject.

<p>Note the changes in the Pi and PCr peaks. Reprinted from Pediatr Res 69 (1); pp 42, Fig 3 (2011) under a CC BY license, with permission from the Nature Publishing Group. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127066#pone.0127066.ref018" target="_blank">18</a>]</p

Baseline muscle metabolism (no L-arginine) during rest and different exercise regimens in MELAS subjects versus healthy control subjects as measured by ³¹P-MRS (mean ± SD).

<p>Key:</p><p>AnPwr = anaerobic power; ATP = adenosine triphosphate</p><p>ATPAn = ATP anaerobic; ATPOx = ATP oxidative; ATPtot = ATP total</p><p>HEP = high energy phosphates; [Mg2+] = intracellular magnesium</p><p>pMg = free or paracellular magnesium and is calculated by the formula—log₁₀[Mg2+]</p><p>Pi = inorganic phosphate; Pi/PCr ratio = ADP ratio</p><p>PCr = phosphocreatine; PCrRec 1/2 = halftime of phosphocreatine recovery in seconds</p><p>RPM = rotations per minute; SD = standard deviation</p><p>P is two-tailed P-value of unpaired t-test</p><p>* statistically significant result</p><p>Kruskal-Wallis one-way analysis of variance is a non-parametric method for testing whether samples originate from the same distribution and is used for comparing two or more samples that are independent and that may have different sample sizes (Pr > Chi-square)</p><p>Baseline muscle metabolism (no L-arginine) during rest and different exercise regimens in MELAS subjects versus healthy control subjects as measured by ³¹P-MRS (mean ± SD).</p