Pennsylvania Folklife Vol. 22, No. 2

• The Easton Bible Artist Identified • Christmas Customs in the Lehigh Valley • The Inn Crowd: The American Inn, 1730-1830 • Pennsylvania German Astronomy and Astrology IV: Tombstones • Emigrants of the 18th Century from the Northern Palatinate • Butchering on the Pennsylvania Farm: Folk-Cultural Questionnaire No. 27https://digitalcommons.ursinus.edu/pafolklifemag/1051/thumbnail.jp

Pennsylvania Folklife Vol. 18, No. 4

• Discord in the Garden • The Folk Festival Seminars: Crafts and Customs of the Year • What to Read on the Amish • Soup\u27s On! • Festival Highlights • Folk Festival Program • Folk Festival Geisinger • Four Interviews with Powwowers • The First Historian of the Pennsylvania Germans • The Public Sale Sixty Years Ago • The Long Shingle • Quilts and Quilting: Folk-Cultural Questionnaire No. 12https://digitalcommons.ursinus.edu/pafolklifemag/1036/thumbnail.jp

Pennsylvania Folklife Vol. 17, No. 3

• Easter Customs in the Lehigh Valley • From Paoli to Frederick in 1854: An Anonymous Travel Account • Jumping Into Spring • A Welsh Antecedent for St. David\u27s Church, Radnor: Gwydir Uchaf Chapel, Caernarvonshire, Wales • Pumps, Rams, Windmills and Waterwheels in Rural Pennsylvania • A Western Pennsylvania Graveyard, 1787-1967 • Baptism and Confirmation: Folk-Culture Questionnaire No. 7https://digitalcommons.ursinus.edu/pafolklifemag/1031/thumbnail.jp

Pennsylvania Folklife Vol. 26, Folk Festival Supplement

• Bonnets, Bonnets, Bonnets • Theorem Painting on Velvet • Spinning, Weaving and Lace Making • Mennonites: A Peaceful People • Special Police Force Directs Traffic • Candle Dipping and Molding • Festival Focus • Folk Festival Programs • The Old One-Room School • The Art of Making Brooms • Koom Rei, Huck Dich un Essa (Come In, Sit Down and Eat) • Old Fashioned Apple Butter Making • Fraktur: An Enduring Art Form • Covered Bridges: Folk Festival Questionnairehttps://digitalcommons.ursinus.edu/pafolklifemag/1074/thumbnail.jp

Pennsylvania Folklife Vol. 22, Folk Festival Supplement

• Sounds of the Folk Festival: A Visitor\u27s Walking Tour • Herbs at Kutztown • Amish Weddings • Food Varieties at the Festival • Festival Highlights • Folk Festival Program • Taverns and Tavern Lore of Dutchland • The Lure of Tinsmithing • Folk Whittling in Pennsylvania • The Dance in Pennsylvania - Current Status: Folk-Cultural Questionnaire No. 30https://digitalcommons.ursinus.edu/pafolklifemag/1054/thumbnail.jp

Pennsylvania Folklife Vol. 19, No. 4

• Whittling: Dumb Dutch Pastime • Amish Plain Costume: A Matter of Choice • It\u27s Sticky - But We Love It • The Folk Festival Seminars: Folk Art and Antique Collecting • Festival Highlights • Folk Festival Program • 19th-Century Ballooning Tradition Continues at Kutztown Festival • Jump-Rope Rhymes • Ghost Stories and Old Superstitions of Lancaster County • Mary Goes Over the Mountain • Children\u27s Games: Folk-Cultural Questionnaire No. 16https://digitalcommons.ursinus.edu/pafolklifemag/1040/thumbnail.jp

Pennsylvania Folklife Vol. 23, Folk Festival Supplement

• Twenty-Five Years of the Folk Festival • Our Farmer\u27s Market • Simple Basics of Egg Decorating • The Folk Festival\u27s Bookstore • Setting Up the Festival • Festival Highlights • Folk Festival Program • Behind the Scenes of We Remain Unchanged • Granges at the Kutztown Folk Festival • How to Design Pressed Flower Pictures • There is This Place - And These People • Metalcrafting at the Festival • Hex Signs and Magical Protection of House and Barn: Folk-Cultural Questionnaire No. 35https://digitalcommons.ursinus.edu/pafolklifemag/1059/thumbnail.jp

Pennsylvania Folklife Vol. 20, No. 4

• Flight of the Distelfink • The Newswangers, Interpreters of Amish Life • The Sorrow Song of Susanna Cox • Country Butcher: An Interview with Newton Bachman • Swing Your Partner : Folk Dancing at the Festival • Festival Highlights • Folk Festival Program • Leaving the Festival with Thoughts of Food • Spindrift: The Old Dog Churn • Candy Making in the Dutch Country • Gee, Haw and Geehaw • The Evil Eye in Philadelphia • The Country School: Folk-Cultural Questionnaire No. 20https://digitalcommons.ursinus.edu/pafolklifemag/1044/thumbnail.jp

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Patterns of Sedation Weaning in Critically Ill Children Recovering From Acute Respiratory Failure.

ObjectiveTo characterize sedation weaning patterns in typical practice settings among children recovering from critical illness.DesignA descriptive secondary analysis of data that were prospectively collected during the prerandomization phase (January to July 2009) of a clinical trial of sedation management.SettingTwenty-two PICUs across the United States.PatientsThe sample included 145 patients, aged 2 weeks to 17 years, mechanically ventilated for acute respiratory failure who received at least five consecutive days of opioid exposure.InterventionsNone.Measurements and main resultsGroup comparisons were made between patients with an intermittent weaning pattern, defined as a 20% or greater increase in daily opioid dose after the start of weaning, and the remaining patients defined as having a steady weaning pattern. Demographic and clinical characteristics, tolerance to sedatives, and iatrogenic withdrawal symptoms were evaluated. Sixty-six patients (46%) were intermittently weaned; 79 patients were steadily weaned. Prior to weaning, intermittently weaned patients received higher peak and cumulative doses and longer exposures to opioids and benzodiazepines, demonstrated more sedative tolerance (58% vs 41%), and received more chloral hydrate and barbiturates compared with steadily weaned patients. During weaning, intermittently weaned patients assessed for withdrawal had a higher incidence of Withdrawal Assessment Tool-version 1 scores of greater than or equal to 3 (85% vs 46%) and received more sedative classes compared with steadily weaned patients.ConclusionsThis study characterizes sedative administration practices for pediatric patients prior to and during weaning from sedation after critical illness. It provides a novel methodology for describing weaning in an at-risk pediatric population that may be helpful in future research on weaning strategies to prevent iatrogenic withdrawal syndrome