Back to the city: the re-emergence of the urban grocery store in mid-sized cities

This paper investigates how an urban grocery store can be tailored to fit into an urban context and adapt to the urban consumer. In approaching this research, the researcher observed two successful urban grocery stores in medium sized cities in North Carolina and compared the visual evidence to previous research of grocery scholars. The investigation looks at the urban grocery store as an essential feature of a successful revitalized downtown. The stores selected for this research are located in Charlotte and Raleigh, NC. These urban stores have clearly set themselves apart from their competitive suburban grocery stores by tailoring their store circulation, department location, display fixtures, lighting, and overall ambiance of the store. The décor and music of the two urban stores were also examined in the visual analysis process. The researcher conducted a visual study by collecting field notes and used photo-documentation of the two urban stores, then analyzed the grocery stores' exterior and interior architecture. The findings were then compared to what previous grocery scholars outlined as the traits of an urban grocery store. A pattern emerged during the analysis process, which confirmed existing theories. The gaps in the research were filled by looking at the visual evidence of these two urban stores. The researcher found that most of the characteristics that make an urban grocery store successful were implemented in the two urban stores. The stores were similar in their location, target clientele, architecture, and store layout. The two stores are both located on desirable urban sites that are convenient to other downtown amenities. They also target the same customers who are usually high-income singles, young professionals and empty nesters. Both stores blend their exterior architectural features with surrounding buildings, and the store layouts fit with the needs of the community. This thesis has clarified what characteristics are desired of the urban grocery store in order to be accepted in an urban environment and how the store's existence could contribute to downtown revitalization efforts

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

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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