Simulating the Environmental Spread of SARS-CoV-2 via Cough and the Effect of Personal Mitigations.

BACKGROUND: A cough is known to transmit an aerosol cloud up to 2 m. During the COVID-19 pandemic of 2020 the United Kingdom's National Health Service (NHS), other UK government agencies and the World Health Organization (WHO) advised people to cough into their elbows. It was thought that this would reduce viral spread and protect the public. However, there is limited peer reviewed evidence to support this. OBJECTIVES: To determine if cough related interventions reduce environmental contamination, protecting members of the public from infection. METHODS: Scientists and engineers at the Health and Safety Executive (HSE) laboratory used a human cough simulator that provided a standardised cough challenge using a solution of simulated saliva and a SARS-CoV-2 surrogate virus; Phi6. Pseudomonas syringae settle plates were used to detect viable Phi6 virus following a simulated cough into a 4 × 4 m test chamber. The unimpeded pattern of contamination was compared to that when a hand or elbow was placed over the mouth during the cough. High speed back-lit video was also taken to visualise the aerosol dispersion. RESULTS AND DISCUSSION: Viable virus spread up to 2 m from the origin of the cough outwards in a cloud. Recommended interventions, such as putting a hand or elbow in front of the mouth changed the pattern of cough aerosol dispersion. A hand deflected the cough to the side, protecting those in front from exposure, however it did not prevent environmental contamination. It also allowed for viral transfer from the hand to surfaces such as door handles. A balled fist in front of the mouth did not deflect the cough. Putting an elbow in front of the mouth deflected the aerosol cloud to above and below the elbow, but would not have protected any individuals standing in front. However, if the person coughed into a sleeved elbow more of the aerosol seemed to be absorbed. Coughing into a bare elbow still allowed for transfer to the environment if people touched the inside of their elbow soon after coughing. CONCLUSIONS: Interventions can change the environmental contamination pattern resulting from a human cough but may not reduce it greatly.

Interactive Versus Passive Distraction and Parent Psychoeducation as Pain Management Techniques During Pediatric Venepuncture: A Randomized Controlled Trial.

OBJECTIVES: The aim of the current research was to compare the relative efficacy of interactive and passive distraction, with or without parental psychoeducation, on child pain and distress during a venepuncture. We also compared the effect of parental psychoeducation on parental distress, knowledge of distraction strategies, and engagement in distraction. MATERIALS AND METHODS: This cross-sectional study included 213 children scheduled for a venepuncture, and one of their parents, who were randomly allocated to 1 of 4 conditions; interactive distraction, passive distraction, interactive distraction with parent psychoeducation, and passive distraction with parent psychoeducation. Analyses of covariances were used to investigate the impact of distraction type and the use of parent psychoeducation on child and parent pain-related outcome variables. RESULTS: Statistical analyses revealed no significant differences between groups for child-reported pain and distress. The parents of children who received interactive distraction reported significantly higher levels of distress than the parents of children who received passive distraction. Parents who received parent psychoeducation had a significantly higher level of knowledge than parents who did not receive psychoeducation, but did not engage in more effective pain management behavior. CONCLUSIONS: The results indicated that distraction type did not have a significantly different influence on child pain-related outcome variables. In addition, while psychoeducation was demonstrated to be effective in increasing parental knowledge, it was not sufficient to change parental behavior.

Protein kinase A site-specific phosphorylation regulates ATP-binding cassette A1 (ABCA1)-mediated phospholipid efflux.

ATP-binding cassette A1 (ABCA1) is a key mediator of cholesterol and phospholipid efflux to apolipoprotein particles. We show that ABCA1 is a constitutively phosphorylated protein in both RAW macrophages and in a human embryonic kidney cell line expressing ABCA1. Furthermore, we demonstrate that phosphorylation of ABCA1 is mediated by protein kinase A (PKA) or a PKA-like kinase in vivo. Through site-directed mutagenesis studies of consensus PKA phosphorylation sites and in vitro PKA kinase assays, we show that Ser-1042 and Ser-2054, located in the nucleotide binding domains of ABCA1, are major phosphorylation sites for PKA. ApoA-I-dependent phospholipid efflux was decreased significantly by mutation of Ser-2054 alone and Ser-1042/Ser-2054 but was not significantly impaired with Ser-1042 alone. The mechanism by which ABCA1 phosphorylation affected ApoA-I-dependent phospholipid efflux did not involve either alterations in ApoA-I binding or changes in ABCA1 protein stability. These studies demonstrate a novel serine (Ser-2054) on the ABCA1 protein crucial for PKA phosphorylation and for regulation of ABCA1 transporter activity.