General and Intensive Care Outcomes for Hospitalized Patients With Solid Organ Transplants With COVID-19

© The Author(s) 2020. Purpose: COVID-19 has been associated with a dysregulated inflammatory response. Patients who have received solid-organ transplants are more susceptible to infections in general due to the use of immunosuppressants. We investigated factors associated with mechanical ventilation and outcomes in solid-organ transplant recipients with COVID-19. Materials and Methods: We conducted a retrospective cohort study of all solid-organ transplant recipients admitted with a diagnosis of COVID-19 in our 23-hospital health system over a 1-month period. Descriptive statistics were used to describe hospital course and laboratory results and bivariate comparisons were performed on variables to determine differences. Results: Twenty-two patients with solid-organ transplants and COVID-19 were identified. Eight patients were admitted to the ICU, of which 7 were intubated. Admission values of CRP (p = 0.045) and N/L ratio (p = 0.047) were associated with the need for mechanical ventilation. Seven patients (32%) died during admission, including 86% (n = 6) of patients who received mechanical ventilation. Conclusions: In solid-organ transplant recipients with COVID-19, initial CRP and N/L ratio were associated with need for mechanical ventilation

Brightest Cluster Galaxies and Core Gas Density in REXCESS Clusters

We investigate the relationship between brightest cluster galaxies (BCGs) and their host clusters using a sample of nearby galaxy clusters from the Representative XMM Cluster Structure Survey (REXCESS). The sample was imaged with the Southern Observatory for Astrophysical Research (SOAR) in R band to investigate the mass of the old stellar population. Using a metric radius of 12h^-1 kpc, we found that the BCG luminosity depends weakly on overall cluster mass as L_BCG \propto M_cl^0.18+-0.07, consistent with previous work. We found that 90% of the BCGs are located within 0.035 r_500 of the peak of the X-ray emission, including all of the cool core (CC) clusters. We also found an unexpected correlation between the BCG metric luminosity and the core gas density for non-cool core (non-CC) clusters, following a power law of n_e \propto L_BCG^2.7+-0.4 (where n_e is measured at 0.008 r_500). The correlation is not easily explained by star formation (which is weak in non-CC clusters) or overall cluster mass (which is not correlated with core gas density). The trend persists even when the BCG is not located near the peak of the X-ray emission, so proximity is not necessary. We suggest that, for non-CC clusters, this correlation implies that the same process that sets the central entropy of the cluster gas also determines the central stellar density of the BCG, and that this underlying physical process is likely to be mergers.Comment: 16 pages, 8 figures, accepted Astrophysical Journa

Evaluating preschool visual attentional selective-set: Preliminary erp modeling and simulation of target enhancement homology

We reanalyzed, modeled and simulated Event-Related Potential (ERP) data from 13 healthy children (Mean age = 5.12, Standard Deviation = 0.75) during a computerized visual sustained target detection task. Extending an ERP-based ACT–R (Adaptive Control of Thought–Rational) neurocognitive modeling approach, we tested whether visual sustained selective-set attention in preschool children involves the enhancement of neural response to targets, and it shows key adult-like features (neurofunctional homology). Blinded automatic peaks analysis was conducted on vincentized binned grand ERP averages. Time-course and distribution of scalp activity were detailed through topographic mapping and paths analysis. Reaction times and accuracy were also measured. Adult Magnetic Resonance Imaging-based mapping using ACT–R dipole source modeling and electric-field spiking simulation provided very good fit with the actual ERP data (R2 > 0.70). In most electrodes, between 50 and 400 ms, ERPs concurrent with target presentation were enhanced relative to distractor, without manual response confounds. Triangulation of peak analysis, ACT–R modeling and simulation for the entire ERP epochs up to the moment of manual response (~700 ms, on average) suggested converging evidence of distinct but interacting processes of enhancement and planning for response release/inhibition, respectively. The latter involved functions and structures consistent with adult ERP activity which might correspond to a large-scale network, implicating Dorsal and Ventral Attentional Networks, corticostriatal loops, and subcortical hubs connected to prefrontal cortex top-down working memory executive control. Although preliminary, the present approach suggests novel directions for further tests and falsifiable hypotheses on the origins and development of visual selective attention and their ERP correlates

Physiologic Response to Angiotensin II Treatment for Coronavirus Disease 2019-Induced Vasodilatory Shock: A Retrospective Matched Cohort Study.

Objectives:To assess the early physiologic response to angiotensin-II treatment in patients with coronavirus disease 2019-induced respiratory failure and distributive shock. Design:Retrospective consecutive-sample cohort study. Setting:Three medical ICUs in New York during the coronavirus disease 2019 outbreak. Patients:All patients were admitted to the ICU with respiratory failure and were receiving norepinephrine for distributive shock. Interventions:The treatment groups were patients who received greater than or equal to 1 hour of angiotensin-II treatment. Time-zero was the time of angiotensin-II initiation. Controls were identified using a 2:1 hierarchical process that matched for 1) date and unit of admission; 2) specific organ support modalities; 3) age; 4) chronic lung, cardiovascular, and kidney disease; and 5) sex. Time-zero in the control group was 21 hours post vasopressor initiation, the mean duration of vasopressor therapy prior to angiotensin-II initiation in the treated group. Measurements and Main Results:Main outcomes were trajectories of vasopressor requirements (in norepinephrine-equivalent dose) and mean arterial pressure. Additionally assessed trajectories were respiratory (Pao2/Fio2, Paco2), metabolic (pH, creatinine), and coagulation (d-dimer) dysfunction indices after time-zero. We also recorded adverse events and clinical outcomes. Trajectories were analyzed using mixed-effects models for immediate (first 6 hr), early (48 hr), and sustained (7 d) responses. Twenty-nine patients (n = 10 treated, n = 19 control) were identified. Despite matching, angiotensin-II-treated patients had markedly greater vasopressor requirements (mean: 0.489 vs 0.097 µg/kg/min), oxygenation impairment, and acidosis at time-zero. Nonetheless, angiotensin-II treatment was associated with an immediate and sustained reduction in norepinephrine-equivalent dose (6 hr model: β = -0.036 µg/kg/min/hr; 95% CI: -0.054 to -0.018 µg/kg/min/hr, p interaction=0.0002) (7 d model: β = -0.04 µg/kg/min/d, 95% CI: -0.05 to -0.03 µg/kg/min/d; p interaction = 0.0002). Compared with controls, angiotensin-II-treated patients had significantly faster improvement in mean arterial pressure, hypercapnia, acidosis, baseline-corrected creatinine, and d-dimer. Three thrombotic events occurred, all in control patients. Conclusions:Angiotensin-II treatment for coronavirus disease 2019-induced distributive shock was associated with rapid improvement in multiple physiologic indices. Angiotensin-II in coronavirus disease 2019-induced shock warrants further study

The ALFALFA "Almost Darks" Campaign: Pilot VLA HI Observations of Five High Mass-to-Light Ratio Systems

We present VLA HI spectral line imaging of 5 sources discovered by ALFALFA. These targets are drawn from a larger sample of systems that were not uniquely identified with optical counterparts during ALFALFA processing, and as such have unusually high HI mass to light ratios. These candidate "Almost Dark" objects fall into 4 categories: 1) objects with nearby HI neighbors that are likely of tidal origin; 2) objects that appear to be part of a system of multiple HI sources, but which may not be tidal in origin; 3) objects isolated from nearby ALFALFA HI detections, but located near a gas-poor early-type galaxy; 4) apparently isolated sources, with no object of coincident redshift within ~400 kpc. Roughly 75% of the 200 objects without identified counterparts in the $\alpha$.40 database (Haynes et al. 2011) fall into category 1. This pilot sample contains the first five sources observed as part of a larger effort to characterize HI sources with no readily identifiable optical counterpart at single dish resolution. These objects span a range of HI mass [7.41 < log(M$_{\rm HI}$) < 9.51] and HI mass to B-band luminosity ratios (3 < M$_{\rm HI}$/L$_{\rm B}$ < 9). We compare the HI total intensity and velocity fields to SDSS optical imaging and to archival GALEX UV imaging. Four of the sources with uncertain or no optical counterpart in the ALFALFA data are identified with low surface brightness optical counterparts in SDSS imaging when compared with VLA HI intensity maps, and appear to be galaxies with clear signs of ordered rotation. One source (AGC 208602) is likely tidal in nature. We find no "dark galaxies" in this limited sample. The present observations reveal complex sources with suppressed star formation, highlighting both the observational difficulties and the necessity of synthesis follow-up observations to understand these extreme objects. (abridged)Comment: Astronomical Journal, in pres

Luminescence from non-bioluminescent tissues in oceanic cephalopods

Several tissues (e.g. kidney, blood, digestive gland) in oceanic cephalopods which do not exhibit in vivo bioluminescence, luminesce when homogenized in the presence of air or when simply exposed to air in a vial (blood). The source of the luminescence appears to be a luciferin: treatment of kidney homogenates and blood with a photophore extract presumably containing luciferase resulted in a 20-fold increase in light production. Luminescence was also found in the renal fluid, which may be the source of luminescent clouds produced by squids. The variability in luminescence found in some tissues of cephalopods appeared to be related to feeding. Luminescence was also detected in the digestive glands of midwater octopods

Gas-rich, field ultra-diffuse galaxies host few globular clusters

We present Hubble Space Telescope imaging of 14 gas-rich, low surface brightness and ultra-diffuse galaxies (UDGs) in the field at distances of 25-36 Mpc. An inspection of point-like sources brighter than the turnover magnitude of the globular cluster luminosity function and within twice the half-light radii of each galaxy reveals that, unlike those in denser environments, gas-rich, field UDGs host very few old globular clusters (GCs). Most of the targets (nine) have zero candidate GCs, with the remainder having one or two candidates each. These findings are broadly consistent with expectations for normal dwarf galaxies of similar stellar mass. This rules out gas-rich, field UDGs as potential progenitors of the GC-rich UDGs that are typically found in galaxy clusters. However, some in galaxy groups may be directly accreted from the field. In line with other recent results, this strongly suggests that there must be at least two distinct formation pathways for UDGs, and that this sub-population is simply an extreme low surface brightness extension of the underlying dwarf galaxy population. The root cause of their diffuse stellar distributions remains unclear, but the formation mechanism appears to only impact the distribution of stars (and potentially dark matter), without strongly impacting the distribution of neutral gas, the overall stellar mass, or the number of GCs.Comment: Submitted to AAS journal

An Innovative Approach for Integrating Mandatory, Longitudinal Spirituality Training into the Medical School Curriculum

Problem: Most Americans indicate they are religious and/or spiritual and wish to have their beliefs taken into account when engaging with health care providers, yet gaps in medical education and health care practice remain. To underscore the importance of spirituality as a significant social determinant of health, a team at the Icahn School of Medicine at Mount Sinai in New York developed mandatory spirituality and health training for students integrated into all 4 years of the undergraduate medical education curriculum. Approach: From 2014 to 2020, a small group of faculty took an innovative approach, launching the initiative and expanding the team by engaging interprofessional faculty and staff from across the institution. The team used an iterative process to integrate 4 distinct modules into 4 existing courses, spanning the four years of medical school. Outcomes: The majority of students found that the spirituality and health curriculum was valuable to training and professional development. They appreciated the importance of patients’ spiritual needs; valued learning about the role chaplains play in patient care and how initiate a consult; and indicated they intended to integrate spiritual history-taking in their patient care. With respect to process, 3 key factors—establishing an interprofessional team, working through an iterative process, and integrating the curriculum into existing courses—were critical to designing and implementing the modules. Next steps: The team aims to expand and improve the curriculum by linking learning to specific standardized competencies as well as developing more specific performance assessments to demonstrate achievement of competencies. Professional development efforts will be enhanced so faculty can better model and reinforce the integration of spirituality into health care practices, and expand the curriculum on spirituality and health into graduate medical education