Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Gender-neutral bathrooms on campus: a multicampus study of cisgender and transgender and gender diverse college students

Objective: This study examined cisgender and transgender and gender diverse (TGD) college students’ perceptions of gender-neutral bathroom availability across eight U.S. campuses, TGD students’ fear of harassment related to (lack of) availability of gender-neutral bathrooms, and the relation between fear of harassment and TGD students’ psychological distress. Methods: Participants were 4,328 college students (4,195 cisgender, 30 binary transgender, 103 gender diverse) from eight U.S. institutions of higher education. Results: The majority (84.2%) of TGD students and 34.6% of cisgender students perceived there were too few gender-neutral bathrooms on their campus. Further, TGD students’ fear of harassment related to a lack of availability of gender-neutral bathrooms on campus was positively associated with psychological distress (i.e., symptoms of depression and anxiety). Conclusion: This study highlights the significance of increasing accessibility of gender-neutral bathrooms on campuses to help mitigate TGD students’ fear of harassment and psychological distress

STATE FARM: TALK TO AN AGENT

Established in 1922, State Farm has become a trustworthy, reliable company that prides itself on the dedication of its agents and their ability to provide personalized insurance policies. Even though State Farm leads the insurance industry, the company is struggling to gain customers in the 18-25 year old demographic. As a part of this demographic, many of us were guilty of quickly purchasing our insurance policies online. We thought that we had the coverage we needed — that was before we talked to an agent. In one hour, local State Farm agent Vincon Krikac changed 25 minds. We learned how little we actually knew and how necessary it is to have an agent. Our peers are no more informed about insurance than we were. Simple questions like, “What’s the difference between liability and collision?” were difficult for them to answer. We knew that if we could give the target audience a glimpse of what we experienced, they would want to talk to a State Farm agent, too. Our research led us to build creative executions that work with media to make our campaign engage the target audience and encourage them to contact a State Farm agent. Our “Talk to an Agent” campaign highlights what the target audience doesn’t know about insurance and illustrates how to fi nd the answers to their questions. This campaign ensures State Farm will remain the market leader in the insurance industry and gain new customers in the 18-25 year old demographic. It works because it illustrates the key benefit of State Farm Insurance—the agent

UAS Literary & Arts Journal

Tidal Echoes presents an annual showcase of writers and artists who share one thing in common: a life surrounded by the rainforests and waterways of Southeast Alaska.Dedication -- Editor's Note -- Acknowledgements -- Dear Toi -- Light like coal -- Dream Seed -- Sleepy Monk -- Hymn -- December Like a Photograph -- A Change of Horizons -- Name Please -- Breathe Deep the Leaves of Autumn -- My Father who Art in Heaven -- Does Blue Milk Really Come From Blue Cows -- In the Winter Kitchen -- Trappers' Tailings -- Eulachon on the Chilkoot -- Tulips -- Miracle -- A Message for Those Who Hate -- The Fifth Meaning: An Interview with Christy NaMee Eriksen -- AMERICAN DREAMS -- HOW A ZOMBIE MAKES A PROMISE -- BENT -- THE MOST BEAUTIFUL WOMEN IN THE WORLD -- Walking Around: Translation -- When it's Sunny in Southeast Alaska -- Autumn Binge -- A New Creation Story -- North to Kluane -- An Offering -- Rustic Encounters: An Interview with Rachael Juzeler -- Below the River's Wings -- Objects In Mirror Are Larger Than They Appear -- m -- Gone Friend Leaving -- All I Could Salvage for You -- echo -- New Neighbors -- The Whiskey Woman -- Getting God's Attention -- Shaking Hands with Beethoven -- When You Say Goodbye, Go -- Auschwitz Greening -- All the Ways that I Have Died -- Backward Progression -- Halleluiah Fire at the Wrangell Institute -- Receiving Your Name at Glacier Bay -- Traditions -- Gold Field Dreaming -- Clay Bodies -- The Chemist -- Passing Spades Playing Hearts -- Rewinding Futures -- Untitled -- Mountain 4 -- Gargirl -- Tartarus -- ballerina 1 -- robot 1 -- A Dance for a Quiet Place -- Lost in Thought -- Swiss Army Rhino -- Davy Jones' Locker -- Queen Anne's Revenge Naval Chronometer -- Mother's Ink -- Fish Mongers -- Double Shift -- Hidden Work series {recycled life drawings} -- Friend Fencepost -- Juneau Past & Present Wrenches -- Wrenches -- Axe no. 1 {red line} -- Ball Peen Hammer no. 1 {Chiton frame} -- Bones -- Shovel Chartreuse Detail -- Chisel no. 2 {Chiton frame} -- Pieces of My House no. 1 -- Fish On -- Rainforest Night -- Aurora Over Douglas Harbor -- Challenger -- Splitboarders -- DeHart's -- cow skull -- Stilled Life -- Life 'n' Death -- Writer and Artist Biographie

Functional EPAS1/HIF2A missense variant is associated with hematocrit in Andean highlanders

Hypoxia-inducible factor pathway genes are linked to adaptation in both human and nonhuman highland species. EPAS1, a notable target of hypoxia adaptation, is associated with relatively lower hemoglobin concentration in Tibetans. We provide evidence for an association between an adaptive EPAS1 variant (rs570553380) and the same phenotype of relatively low hematocrit in Andean highlanders. This Andean-specific missense variant is present at a modest frequency in Andeans and absent in other human populations and vertebrate species except the coelacanth. CRISPR-base-edited human cells with this variant exhibit shifts in hypoxia-regulated gene expression, while metabolomic analyses reveal both genotype and phenotype associations and validation in a lowland population. Although this genocopy of relatively lower hematocrit in Andean highlanders parallels well-replicated findings in Tibetans, it likely involves distinct pathway responses based on a protein-coding versus noncoding variants, respectively. These findings illuminate how unique variants at EPAS1 contribute to the same phenotype in Tibetans and a subset of Andean highlanders despite distinct evolutionary trajectories