Application of short-term sediment dynamics and particle-bound phosphorus fractionation methods (SEDEX) to estimate the benthic nutrient loading potential in Upper Newport Estuary, California

Estuaries act as sources, sinks, and biogeochemical transformation sites for natural and anthropogenically-derived nutrients. Sediment loading from watersheds provides an important source of particulate nutrients to estuaries often neglected when constructing nutrient budgets. Deposition and resuspension of these sediments are known to impact biogeochemical cycles in estuarine environments. Phosphorus (P) exists in many forms in aquatic environments, and increased P loading to coastal environments increases primary productivity potentially leading to eutrophication. Magnitude and variability of sediment deposition, resuspension, and sediment-bound P concentrations were evaluated in Upper Newport Bay (UNB), California. During 2004, seven push cores were collected from the intertidal and subtidal zones of three sites to evaluate recent sediment dynamics using 7Be and sediment-bound P fractions. Two sequential phosphorus extraction methods were used to determine the distribution of potentially bioavailable forms of P (labile, iron-bound, and organic), and refractory forms of P (calcium-bound and detrital) in sediment. A seasonal trend appears with greatest deposition occurring during the wet season (spring) when watershed runoff increases (0.1 to 0.4 g/cm2 d), and greatest sediment resuspension occurring during the dry season (summer) when minimal input from precipitation or stream runoff occurs. The average annual short-term sediment deposition rate calculated from the 7Be inventories indicated that deposition is 24.7cm/yr in the upper estuary. However, the long-term sediment deposition rate of 0.15 cm/year indicates that less than 1% of the annual sediment deposited in UNB is permanently buried. Sediment P concentrations revealed enrichment of P during the spring, corresponding to increased sediment input. During time periods when net sediment resuspension dominated over net deposition (e.g. summer), total-P concentrations decreased. This decrease was attributed to increased biological uptake of water column P during summer blooms, which lead to the desorption of P from particles. Nonetheless, most of the sequentially extracted P (~66%) was contained in the refractory phase. Based on the long term deposition rate in UNB, the burial rate for the refractory P was approximately 0.97 μmol P/cm2 yr. Sediment deposition and resuspension processes may act as important internal mechanisms for recycling phosphorus, particularly reactive P, and must be considered in estuarine biogeochemical cycles

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

Supplemental Material – Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery

Supplemental Material for Remote consultations in primary care across low-, middle- and high-income countries: Implications for policy and care delivery by Siân Williams, Amanda Barnard, Phil Collis, Jaime Correia de Sousa, Suraj Ghimire, Monsur Habib, Tessa Jelen, Frank Kanniess, Vince Mak, Sonia Martins, Ema Paulino, Hilary Pinnock, Miguel Roman, Hanna Sandelowsky, Ioanna Tsiligianni, Laurine van der Steen and Fabio Weber Donatelli in the Journal of Health Services Research & Policy.</p