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      The need for exercise sciences and an integrated response to COVID-19: A position statement from the international HL-PIVOT network

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          Abstract

          COVID-19 is one of the biggest health crises that the world has seen. Whilst measures to abate transmission and infection are ongoing, there continues to be growing numbers of patients requiring chronic support, which is already putting a strain on health care systems around the world and which may do so for years to come. A legacy of COVID-19 will be a long-term requirement to support patients with dedicated rehabilitation and support services. With many clinical settings characterized by a lack of funding and resources, the need to provide these additional services could overwhelm clinical capacity. This position statement from the Healthy Living for Pandemic Event Protection (HL-PIVOT) Network provides a collaborative blueprint focused on leading research and developing clinical guidelines, bringing together professionals with expertise in clinical services and the exercise sciences to develop the evidence base needed to improve outcomes for patients infected by COVID-19.

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          Most cited references84

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          COVID-19: consider cytokine storm syndromes and immunosuppression

          As of March 12, 2020, coronavirus disease 2019 (COVID-19) has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 3·7%, 1 compared with a mortality rate of less than 1% from influenza. There is an urgent need for effective treatment. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. We recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality. Current management of COVID-19 is supportive, and respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of mortality. 2 Secondary haemophagocytic lymphohistiocytosis (sHLH) is an under-recognised, hyperinflammatory syndrome characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, sHLH is most commonly triggered by viral infections 3 and occurs in 3·7–4·3% of sepsis cases. 4 Cardinal features of sHLH include unremitting fever, cytopenias, and hyperferritinaemia; pulmonary involvement (including ARDS) occurs in approximately 50% of patients. 5 A cytokine profile resembling sHLH is associated with COVID-19 disease severity, characterised by increased interleukin (IL)-2, IL-7, granulocyte-colony stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-α, and tumour necrosis factor-α. 6 Predictors of fatality from a recent retrospective, multicentre study of 150 confirmed COVID-19 cases in Wuhan, China, included elevated ferritin (mean 1297·6 ng/ml in non-survivors vs 614·0 ng/ml in survivors; p 39·4°C 49 Organomegaly None 0 Hepatomegaly or splenomegaly 23 Hepatomegaly and splenomegaly 38 Number of cytopenias * One lineage 0 Two lineages 24 Three lineages 34 Triglycerides (mmol/L) 4·0 mmol/L 64 Fibrinogen (g/L) >2·5 g/L 0 ≤2·5 g/L 30 Ferritin ng/ml 6000 ng/ml 50 Serum aspartate aminotransferase <30 IU/L 0 ≥30 IU/L 19 Haemophagocytosis on bone marrow aspirate No 0 Yes 35 Known immunosuppression † No 0 Yes 18 The Hscore 11 generates a probability for the presence of secondary HLH. HScores greater than 169 are 93% sensitive and 86% specific for HLH. Note that bone marrow haemophagocytosis is not mandatory for a diagnosis of HLH. HScores can be calculated using an online HScore calculator. 11 HLH=haemophagocytic lymphohistiocytosis. * Defined as either haemoglobin concentration of 9·2 g/dL or less (≤5·71 mmol/L), a white blood cell count of 5000 white blood cells per mm3 or less, or platelet count of 110 000 platelets per mm3 or less, or all of these criteria combined. † HIV positive or receiving longterm immunosuppressive therapy (ie, glucocorticoids, cyclosporine, azathioprine).
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            Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

            Summary The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.
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              COVID-19: immunopathology and its implications for therapy

              Xuetao Cao (2020)
              Severe coronavirus disease 2019 (COVID-19) is characterized by pneumonia, lymphopenia, exhausted lymphocytes and a cytokine storm. Significant antibody production is observed; however, whether this is protective or pathogenic remains to be determined. Defining the immunopathological changes in patients with COVID-19 provides potential targets for drug discovery and is important for clinical management.
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                Author and article information

                Journal
                Prog Cardiovasc Dis
                Prog Cardiovasc Dis
                Progress in Cardiovascular Diseases
                Elsevier Inc.
                0033-0620
                1873-1740
                4 February 2021
                4 February 2021
                Affiliations
                [a ]Human Science Research Centre, College of Science and Engineering, University of Derby, UK
                [b ]Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
                [c ]Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, USA
                [d ]Department of Exercise and Sport Science, University of North Carolina, USA
                [e ]Case Western Reserve University School of Medicine, Cleveland, OH, USA
                [f ]University Hospitals, Cleveland Medical Centre, Hospitals Cleveland, OH, USA
                [g ]School of Health Sciences, University of Tasmania, Australia
                [h ]Department of Medical Rehabilitation Sciences, King Khalid University, Saudi Arabia
                [i ]Clinic for Cardiology, University Clinical Centre Serbia, University of Belgrade, Serbia
                [j ]Unaffiliated Independent Exercise Scientist, York, UK
                [k ]VA Palo Alto Health Care System, Stanford University School of Medicine, California, USA
                [l ]Department of Health, Kinesiology, and Applied Physiology (HKAP), Concordia University, Montreal, Canada
                [m ]Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, Canada
                [n ]University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Salzburg, Austria
                [o ]Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
                [p ]Department of Human Movement Sciences, Federal University of São Paulo, Santos, SP, Brazil
                [q ]Department of Global Health and Population, Lown Scholars in Cardiovascular Health Program at Harvard T.H. Chan School of Public Health, USA
                [r ]Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
                [s ]Advanced Wellbeing Research Centre, Sheffield Hallam University, Sheffield, UK
                [t ]Centre for Life and Sport Sciences (CLaSS) Research Centre, School of Health Sciences, Birmingham City University, Birmingham, UK
                [u ]Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, USA
                [v ]Centre of Research in Health and Society, University of Cumbria, Carlisle, UK
                [w ]Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
                Author notes
                [* ]Corresponding author at: Human Science Research Centre, University of Derby, Kedleston Road, Derby DE22 1GB, UK.
                Article
                S0033-0620(21)00013-X
                10.1016/j.pcad.2021.01.004
                7859729
                33549590
                1cc1caa6-619a-443e-9ef9-3fa8e337da94
                © 2021 Elsevier Inc. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                covid-19,rehabilitation,integrated roles,sports medicine,exercise sciences

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