De Gea facing fitness check after coming off injured in Man Utd’s win at Southampton

Dean Henderson was subbed on to make his Premier League debut for the Red Devils at St Mary’s

David de Gea is an injury worry for Manchester United, with manager Ole Gunnar Solskjaer admitting the goalkeeper will be assessed by the club’s medical team after coming off injured against Southampton.

The Spain international did not come out for the second half – being replaced by Dean Henderson – after appearing to damage his knee when beaten for a second time at St Mary’s on Sunday.

De Gea dived to his right in a bid to keep out James Ward-Prowse’s free kick, but failed to make the save and collided with the post.

Henderson was seen going through a rigorous warm-up at half-time, and was subbed on for his Premier League debut for the club.

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Following the game, Solskjaer spoke to Sky Sports about De Gea’s injury and said he is unsure if he will be fit to face Paris Saint-Germain in the UEFA Champions League on Wednesday evening.

“Let’s have a little check on him (David de Gea),” Solskjaer said . “Hopefully he can be okay for Wednesday but I’m not sure.”

While United trailed 2-0 at the break, they produced a thrilling fightback and thanks to a goal from Bruno Fernandes and brace from Edinson Cavani were able to secure a 3-2 win.

United dominated after the interval, meaning Henderson’s Premier League bow for the club was not overly taxing, but Solskjaer felt the 23-year-old was polished in what he did.

“Dean played well though,” the Norwegian said. “He’s a keeper who has been used to being vocal. He wants to organise the team. 

“He had a couple of tidy saves to make. He was safe with his hands. After the first half, we played well again.”

If De Gea is ruled out of the PSG game, it will hand Henderson a major stage to operate on.

Neymar, Kylian Mbappe and co. are likely to provide a stern test of United’s defensive resolve, particularly as PSG trail the Red Devils by three points in Champions League Group G.

A commanding performance from Henderson could make him difficult to dislodge – with a rapid turnaround of games on the horizon.

Following PSG’s visit to Old Trafford, the Red Devils take on West Ham, RB Leipzig, Manchester City, Sheffield United, Leeds United and Everton before Christmas.

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A Biden win could lead to a mask mandate, more testing: Expert

Dr. Ashish Jha, dean of Brown University’s School of Public Health, told Yahoo Finance Monday a Joe Biden presidency could bring mask mandates and greater investment in treatments and testing to the fore.

If Biden were to take office in January, he said, there would be a far more focused strategy at the federal level.

“I think starting in January, you’re going to see a much bigger push towards testing, towards a national mask mandate,” Jha said, adding that’s what the Biden team has indicated it will do.

In addition, he predicts there’d be more investment in vaccines and treatments than has been made to-date.

“What’s been interesting about the Trump response is for a few months at least … it was a lot of evidence-based approaches. In the last couple of months under Dr. Atlas, it’s very much been a kind of ‘let it go and let people get infected and hope we get to immunity,’ ” Jha said.

The earliest months of the coronavirus outbreak were marked by the formation of the White House coronavirus task force, which included the nation’s top health officials. It’s how Centers for Disease Control director Dr. Robert Redfield, FDA Commissioner Stephen Hahn, Sec. Alex Azar, Ambassador Deborah Birx and NIAID director Dr. Anthony Fauci became household names.

When Operation Warp Speed was launched to coordinate the investment in vaccine efforts, including manufacturing and distribution, it marked a robust public-private partnership that could streamline logistics once a vaccine is authorized or approved.

But that focus on science was derailed when Trump perceived he was losing control of the messaging to the task force’s doctors and brought on Dr. Scott Atlas as a task force advisor, said Jha.

Democratic presidential candidate former Vice President Joe Biden holds up his face mask as he speaks to members of the media outside a voter service center, Monday, Oct. 26, 2020, in Chester, Pa. (AP Photo/Andrew Harnik)
Democratic presidential candidate former Vice President Joe Biden holds up his face mask as he speaks to members of the media outside a voter service center, Monday, Oct. 26, 2020, in Chester, Pa. (AP Photo/Andrew Harnik)

Despite the billions invested in a handful of companies through Operation Warp Speed, investment in treatments and testing has lagged. That was revealed recently from data published by the Biomedical Advanced Research and Development Authority (BARDA), a part of Health and Human Services.

With the lag in treatments, hospitals are amid the latest surge with no new treatments available and are still struggling with protective gear and testing availability. But even if the country has to wait until January for the change — and watch the death toll rise in the interim — Jha believes it won’t be too late to increase investments if Biden wins.

“What would have been reasonable would have been that back in April and May as these new therapeutics … were being tested, the federal government should have stepped in,” and supported production of tens of millions of doses, Jha said. Instead, the U.S. only has tens of thousands of doses to utilize.

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As Dodgers and Lakers win, coronavirus spreads at celebrations, alarming health officials

LOS ANGELES, CA - OCTOBER 11: Los Angeles Lakers fans gather near the Staples Center to celebrate the Lakers 106 - 93 game 6 over the Miami Heat on Sunday, Oct. 11, 2020 in Los Angeles, CA. (Jason Armond / Los Angeles Times)
Los Angeles Lakers fans gather near Staples Center in downtown L.A. to celebrate the Lakers NBA Finals win over the Miami Heat. (Jason Armond / Los Angeles Times)

Southern California counties are reopening their economies at a slower pace than other parts of the state, and officials blame celebrations. Lakers and Dodgers viewing parties and public events are keeping coronavirus infections high enough to hold the region back, officials warn.

California has avoided the substantial spike in coronavirus cases seen across the country this fall, but some of the state’s most populated counties — Los Angeles, Riverside and San Bernardino — remain in the most restrictive reopening tier.

That means indoor dining rooms are shut, as are indoor operations of gyms and houses of worship. San Diego County, now in the red tier, is teetering on backsliding into the most restrictive category.

Public health officials have identified gatherings as a significant source of virus transmission in Southern California, where young adults are driving the spread of the highly contagious disease.

There are also troubling signs of a potential increase in coronavirus cases. Even after accounting for a backlog, Los Angeles County has gone from about 940 daily new cases at the beginning of October to nearly 1,200 new cases each day as of last week, based on the date of a positive test or the first onset of symptoms, said Barbara Ferrer, the county’s director of public health.

Officials are worried that the post-season success of the Lakers and the Dodgers may be playing a role in the increased coronavirus cases.

“Gatherings in large crowds to watch games indoors, people aren’t wearing their face coverings, people are yelling a lot — that’s just not sensible,” Ferrer said.

Even congregating at outdoor restaurants, while shouting and cheering and hugging strangers without wearing masks, makes it “so easy to spread this virus,” she said.

About 55% of people who knew of a possible exposure to the virus also attended a gathering where two or more people were sick, the county said, based on interviews with the newly infected or people who were in contact with them over the last three weeks.

Coronavirus cases, dated by the date of a positive test or symptom onset, have been rising in recent weeks in L.A. County.
New coronavirus cases, dated by the date of a positive coronavirus test or onset of symptoms, have been rising in recent weeks in Los Angeles County. (Los Angeles County Department of Public Health)

Other parts of Southern California are seeing similar trends.

“We’re seeing more spread at family and friend gatherings,” said Corwin Porter, public health director for San Bernardino County. “It seems to be more prominent in our younger populations — our under-40 crowd, for the most part.”

Among newly infected people who said they attended some kind of large gathering in the previous month in San Bernardino County, 61% attended gatherings of friends or family in the previous month, according to data from the second full week of October.

In Riverside County, public health officer Dr. Cameron Kaiser expressed dismay about a crowd of more than 1,000

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Millie Boyle backs Kezie Apps and Isabelle Kelly to win fitness race for NSW Blues places

Apps then captained the Dragons to their first NRLW grand final, where they were shut down by an Ali Brigginshaw-led Broncos pack at the end of 2019.

“She’s obviously been around the game for a long time and she’s had such a positive impact on the team and she’s such a natural leader … we will definitely need her,” Boyle said. “I’m hopeful that both of them will be back.”

Last year, Kezie Apps was named NSW skipper and led the side to back-to-back shields at North Sydney Oval. 

Last year, Kezie Apps was named NSW skipper and led the side to back-to-back shields at North Sydney Oval. Credit:Getty

Earlier this month, the Broncos denied the Dragons’ dream of a premiership with a controversial round two performance that saw Kelly and Apps hobbling off the field before the 60 minutes were up.

Patmore would have had his head in his hands after watching his two biggest stars go down during the Broncos’ 18-4 win, which secured their spot in the grand final. Kelly was injured when a hair pull from Amber Hall turned into an awkward tackle from behind that left the star centre clutching her ankle. Apps suffered a medial problem with her right knee in the first half and watched the rest of the game from the bench.

The Broncos went on to beat the Roosters in the decider on Sunday, claiming their third premiership in a row.

Isabelle Kelly on crutches at Bankwest Stadium.

Isabelle Kelly on crutches at Bankwest Stadium.Credit:Getty

“We’ve got a lot of depth in the [NSW] squad and there are a lot of girls stepping up this year throughout the season and they’ve been playing good club footy,” Boyle said. “There is a definitely the depth there to cover for their spots if they’re not able to play.”

The Blues squad will head to Queensland on Friday, where the group will spend two weeks in isolation.

“It’s two-and-a-half weeks by the time we’re finished and that’s a lot of time away for one game,” Boyle said. “It’s a massive ask for a lot of people.”

The players will be restricted to using facilities at the hotel and have received an exemption from the Queensland government to use Sunshine Coast Stadium for training during their isolation.

Like the men’s version, the women’s State of Origin was delayed until after the season due to COVID-19. The women’s State of Origin will take place on November 13.

“It’s great to now have Origin after the NRLW because you can really see how everyone’s performed, it will just be picked up a level this year,” Boyle said. “Both squads are getting stronger so it’s just more competition.”

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Add-On Psychotherapy a Win in Bipolar Disorder

Adding psychotherapy to pharmacotherapy benefits patients with bipolar disorder (BD), particularly when delivered in family or group settings, results of a new meta-analysis confirms.

Outpatients with BD receiving drug therapy “should also be offered psychosocial treatments that emphasize illness management strategies and enhance coping skills; delivering these components in family or group format may be especially advantageous,” the investigators, led by David Miklowitz, PhD, University of California, Los Angeles, Semel Institute for Neuroscience and Human Behavior, write.

The study was published online October 14 in JAMA Psychiatry.

Drugs Alone Not Enough

It’s increasingly recognized that drug therapy alone can’t prevent recurrences of BD or fully alleviate post-episode symptoms or functional impairment, the researchers note in their article. Several psychotherapy protocols have been shown to benefit patients with BD when used in conjunction with drug therapy, but little is known about their comparative effectiveness, the authors point out.

To investigate, the researchers conducted a systematic review and component network meta-analysis of 39 randomized clinical trials (36 involving adults and three involving adolescents).

The trials involved 3863 patients with BD and compared pharmacotherapy used in conjunction with manualized psychotherapy (cognitive-behavioral therapy [CBT], family or conjoint therapy, interpersonal therapy, and/or psychoeducational therapy) with pharmacotherapy delivered in conjunction with a control intervention (supportive therapy or treatment as usual).

Across 20 two-group trials that provided usable information, manualized psychotherapies were associated with a lower probability of illness recurrence (the primary outcome) compared with control interventions (odds ratio [OR], 0.56; 95% CI, 0.43 – 0.74).

Psychoeducation with guided practice of illness management skills in a family or group format was superior to these strategies delivered in an individual format (OR, 0.12; 95% CI, 0.02 – 0.94).

Family or conjoint therapy and brief psychoeducation were associated with lower attrition rates than standard psychoeducation.

For the secondary outcome of stabilization of depressive or manic symptoms over 12 months, CBT and, with less certainty, family or conjoint therapy and interpersonal therapy were more effective than treatment as usual.

The investigators note that the findings are in line with a network meta-analysis published earlier this year that found that combining psychotherapy with pharmacotherapy is the best option for stabilizing episodes and preventing recurrences of major depression.

“[T]here is enough evidence from this analysis and others to conclude that health care systems should offer combinations of evidence-based pharmacotherapy and psychotherapy” to outpatients with BD, the researchers note.

“When the goals center on prevention of recurrences, patients should be engaged in family or group psychoeducation with guided skills training and active tasks to enhance coping skills (eg, monitoring and managing prodromal symptoms) rather than being passive recipients of didactic education,” they write.

“When the immediate goal is recovery from moderately severe depressive or manic symptoms, cognitive restructuring, regulating daily rhythms, and communication training may be associated with stabilization,” they add.

A Call to Action

The coauthors of an editorial in JAMA Psychiatry note that the findings “further reinforce extant treatment guidelines recommending medication management and adjunctive evidence-based psychosocial treatments for individuals with

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Win for MitraClip as Bridge to Transplant

MitraClip transcatheter mitral valve repair was safe as a bridge to heart transplant and even helped some patients become eligible for transplant, a pilot study showed.

In a largely European registry of 119 chronic advanced or end-stage heart failure patients with 3+ or 4+ mitral regurgitation (MR) who were potential candidates for heart transplantation and got the MitraClip as a bridge strategy:

  • 23.5% recovered sufficiently to go off the heart transplant list
  • 15.5% became eligible for transplant

Freedom from the primary composite endpoint of all-cause mortality, urgent heart transplant, or left ventricular assist device implantation occurred in 64%, Cosmo Godino, MD, of San Raffaele Hospital in Milan, Italy, reported at the virtual TCT Connect conference.

There were no deaths within 30 days of implantation and 86% procedural success.

The population studied may account for somewhere between 1% and 10% of the total heart failure population and are difficult to manage, with a 1-year mortality risk of 15% on the transplant wait list in Europe, Godino noted.

The study used retrospective clinical records from 119 patients from 17 centers in Europe and Canada:

  • 31 were on the transplant list with low likelihood of receiving a donor organ soon due to factors like blood type or body weight
  • 54 were awaiting a clinical decision on transplant, dubbed bridge-to-decision
  • 34 were not yet listed for transplant due to potentially reversible contraindications, such as severe pulmonary hypertension or elevated pulmonary-vascular resistance, and got the device as a bridge to candidacy

David J. Cohen, MD, of Kansas City, Missouri, noted that the findings did match up with his group’s COAPT trial in that MitraClip was associated with half as many patients going to transplant or left ventricular assist device (LVAD) in that trial.

“Since COAPT came out, we’ve been getting a lot more consults from the transplant service for patients just like this as a bridge to get them safer, keep them out of the hospital, keep them off of inotropes until they’re ready for a destination,” noted Chad Rammohan, MD, of El Camino Hospital in Mountain View, California.

“What’s interesting is that these patients would probably fit into the MITRA-FR data by the size of their LVs [left ventricles], which is interesting because that trial was negative,” he said as part of a discussion panel at a TCT press briefing.

Indeed, about 80% of the population wouldn’t have fit into the COAPT trial criteria, and some were even beyond the MITRA FR criteria, Godino noted. LV end diastolic volume index averaged 122.5 mL/m2.

“So it’s strange that we found some positive results,” he said. The explanation may be the young age of patients, averaging 58 — 20 years younger than that in the MITRA-FR trial, he noted.

“There’s a lot we don’t understand about which LVs are going to benefit — the LV mechanics — and there’s a lot of variability,” agreed panelist Susheel Kodali, MD, of NewYork-Presbyterian/Columbia University Medical Center in New York City. “This is a very sick population, and

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