Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Mover and Shaker

One of the most influential and controversial team owners in professional sports history, Walter O’Malley (1903–79) is best remembered—and still reviled by many—for moving the Dodgers from Brooklyn to Los Angeles. Yet much of the O’Malley story leading up to the Dodgers’ move is unknown or created from myth, and there is substantially more to the man. When he entered the public eye, the self-constructed family background and early life he presented was gilded. Later his personal story was distorted by some New York sportswriters, who hated him for moving the Dodgers. In Mover and Shaker Andy McCue presents for the first time an objective, complete, and nuanced account of O’Malley’s life. He also departs from the overly sentimentalized accounts of O’Malley as either villain or angel and reveals him first and foremost as a rational, hardheaded businessman, who was a major force in baseball for three decades and whose management and marketing practices radically changed the shape of the game

Program, Hugo, 2008

The Studio@620 presents the world premiere of a new play by student playwright Jonathan Van Gils, Directed by Bob Devin Jones. This play centers around three characters: Hugo, The Producer, and Rachel. Hugo is young, homeless man; also a filmmaker. The Producer, a drug dealing, pot smoking, Joni Mitchell super-fan, Pellegrino swindling social revolutionary, leader of the band Snack Attack, and movie producer. Rachel, a lustrous, University student, writer with cinematic aspirations; also young. All three of these characters come together to work, live, and party in Hugo\u27s loft. The goal is to manifest Hugo\u27s long lost screenplay, but The Producer has other ideas in mind (involving a post-modern revolution). The play includes original music by Alex Van Gils as well as songs from Wilco, Joni Mitchell, Jennifer Trynin, etc. Hugo is a story about the creative process in general, dancing, filmmaking, conversations, revolutions, spanglish, social constructs, Buddhism, smoking, music fights, romance, friends and Mr. P

Program, Hugo, 2008

The Studio@620 presents the world premiere of a new play by student playwright Jonathan Van Gils, Directed by Bob Devin Jones. This play centers around three characters: Hugo, The Producer, and Rachel. Hugo is young, homeless man; also a filmmaker. The Producer, a drug dealing, pot smoking, Joni Mitchell super-fan, Pellegrino swindling social revolutionary, leader of the band Snack Attack, and movie producer. Rachel, a lustrous, University student, writer with cinematic aspirations; also young. All three of these characters come together to work, live, and party in Hugo\u27s loft. The goal is to manifest Hugo\u27s long lost screenplay, but The Producer has other ideas in mind (involving a post-modern revolution). The play includes original music by Alex Van Gils as well as songs from Wilco, Joni Mitchell, Jennifer Trynin, etc. Hugo is a story about the creative process in general, dancing, filmmaking, conversations, revolutions, spanglish, social constructs, Buddhism, smoking, music fights, romance, friends and Mr. P.https://digitalcommons.usf.edu/bdj_studioat620_programs/1040/thumbnail.jp

Biological and Environmental Research Exascale Requirements Review

The article of record as published may be found at http://dx.doi.org/10.2172/1375720An Office of Science review sponsored jointly by Advanced Scientific Computing Research and Biological and Environmental Research, March 28-31, 2016, Rockville, MarylandUnderstanding the fundamentals of genomic systems or the processes governing impactful weather patterns are examples of the types of simulation and modeling performed on the most advanced computing resources in America. High-performance computing and computational science together provide a necessary platform for the mission science conducted by the Biological and Environmental Research (BER) office at the U.S. Department of Energy (DOE). This report reviews BER’s computing needs and their importance for solving some of the toughest problems in BER’s portfolio. BER’s impact on science has been transformative. Mapping the human genome, including the U.S.-supported international Human Genome Project that DOE began in 1987, initiated the era of modern biotechnology and genomics-based systems biology. And since the 1950s, BER has been a core contributor to atmospheric, environmental, and climate science research, beginning with atmospheric circulation studies that were the forerunners of modern Earth system models (ESMs) and by pioneering the implementation of climate codes onto high-performance computers. See http://exascaleage.org/ber/ for more information.USDOE Office of Science (SC), Advanced Scientific Computing Research (SC-21)USDOE Office of Science (SC), Biological and Environmental Research (BER) (SC-23