Use of urban trails and other green space during the early stages of the COVID-19 pandemic reached record highs around the world. Although the use of these resource amenities has been documented to have several physical and mental health benefits, the density of their use during the pandemic required managers to issue guidance and/or use-requirements to mitigate the spread of the virus. Hence, this investigation sought to document adherence to commonly suggested physical distancing guidelines at 14 trails across six states in the United States. Trained research team members unobtrusively observed over 10,000 encounters between trail visitors. Results indicated that over half of visitor groups failed to allow for enough physical distancing between themselves and another party, suggesting a need for trail and green space managers to consider additional messaging and trail design changes to encourage greater adherence to future public health guidelines.

Background/PurposeIn rheumatoid arthritis (RA) autoantibodies including antibodies to citrullinated protein antigens (ACPA) and rheumatoid factor (RF) can be predictive of incident clinical RA. However, there is limited understanding of how antibody changes over time impact prediction of the likelihood and timing the likelihood and timing of future clinical RA.Materials and MethodsWe evaluated relationships between ACPA, the shared epitope (SE), RF isotypes and incident RA in a prospective cohort of 90 ACPA(+) individuals without baseline arthritis identified through health-fair testing (i.e. Healthfair). We also evaluated ACPA and RF isotypes and time-to-diagnosis of RA in a retrospective cohort of 215 individuals with RA from the Department of Defense Serum Repository (DoDSR).ResultsTwenty-six of 90 (29%) of ACPA(+) Healthfair participants developed incident RA. Baseline or incident dual RF-IgA and RF-IgM positivity was associated with increased risk for incident RA (HR 3.09; 95% CI 1.15 to 8.29) although RFs were negative in ~50% of individuals with incident RA. SE was associated with increased risk of RA (HR 2.87, 95% CI 1.22-6.76). In the DoDSR cohort, triple positivity for ACPA, RF-IgA and RF-IgM was present a median of 1-2 years prior to RA diagnosis, with some sex-specific differences.ConclusionThese findings can be used to counsel individuals at-risk for future RA and to design clinical trials for RA prevention. The findings also suggest that RF could be a surrogate outcome as a success of an immunologic intervention in RA prevention. Additional studies are needed to understand the biologic of different patterns of autoantibody elevations in RA evolution.

The emergence of Coronavirus 19 led to societal and behavioral changes, including intensified use of many public parks and trails for mental respite and leisure time physical activity. As visitors sought stress-relief in the great outdoors, they also encountered stressful situations as they navigated risk exposure. Recommendations to physically distance between parties was a key component to reduce risk, but compliance is unknown in the outdoor arena. This observational study of more than 10 000 trail user encounters documented distancing and enabled predictive analysis that revealed wider trails, smaller groups and signage led to greater distancing compliance. Managers and planners can integrate these findings immediately and in consideration of future trail designs to minimize risk exposure. Management implications Select site features increase odds of distancing compliance and can inform management decisions and designs immediately and in addressing future use surges: wider trails, unpaved surfaces, and COVID-19 signage. As distancing compliance waned with time but signage increased compliance, innovative and dynamic signs may sustain compliance and multi-media communications should be considered. Both activity size and group type influence distancing so considering group size recommendations and activity separation are in order.

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