Walking Our Talk in the Neighborhoods: Building Professional/Natural Helper Partnerships

This article describes our efforts in Tacoma, Washington, to establish professional and natural helper partnerships to work with families involved in the child protective service system. It uses our experiences to describe the ways that natural helpers and professionals can help one another in getting better results for families

Systemic Teriparatide Administration Promotes Osseous Regeneration of an Intrabony Defect: A Case Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142231/1/cap0066.pd

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

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

“Letters, pen, and tilling the field” : Quaker schools among the Seneca Indians on the Allegany River, 1798-1852

Thesis (Ph. D.)--University of Rochester. Dept. of History, 2009.In 1798, the Society of Friends’ Philadelphia Yearly Meeting Indian Committee sent three young men to reside among the Seneca Indians on the Allegany reservation in the state of New York and the private land grant of chief warrior Cornplanter in adjacent Pennsylvania. Their goal was to provide the Senecas with agricultural, mechanical, and literary instruction in order to equip the Senecas for self-sufficiency in a rapidly changing world. Through their instruction, Friends altered Seneca religion and culture. While some Senecas embraced Quaker instruction, others simply elected not to participate in the “civilization” program or the school. Over time, the Quaker presence and the school itself became a divisive force in the Allegany community. Scholars have examined Quaker instruction in domestic crafts, agriculture, and trades, but the school and curriculum have been neglected in previous scholarship. This study demonstrates not only that the Friends’ school brought English language instruction, literacy, and new ideas; it divided the Allegany community, and ultimately opened the door for more heavily proselytizing sects

Lipid extraction effects on stable isotope values (δ13C and δ15N) of elasmobranch muscle tissue

Given the known effect of lipid content on δ13C values and the potential effect of urea on δ15N values, examining the effects of lipid extraction, which can potentially extract both, is of particular importance for elasmobranch isotope ecology. Through analysing paired δ13C, total %C, δ15N, total %N and C:N values of non-lipid extracted (BULK) and lipid extracted (LE) muscle samples from twenty-one elasmobranch species, we assessed whether lipid extraction was required: (i) to remove lipids given reported low lipid content and, (ii) to determine if δ15N values were affected and whether this relates to the retention of isotopically light urea by elasmobranchs. The mean (± SD) δ13C values of eight out of twenty-one species significantly increased following lipid extraction with two species, the Greenland (Somniosus microcephalus) and whale (Rhincodon typus) shark, showing a marked increase (5.0 ± 0.4‰ and 3.3‰, respectively). The mean (± SD) and maximum increase in δ13C values were 0.6 ± 1.2‰ and 5.9‰, respectively. For δ15N data, thirteen species showed a significant increase following lipid extraction and a concomitant reduction in total percent nitrogen (%N). The C:N ratio for these species also increased from unexpectedly low values of < 3.0 to ~ 3.0, the value expected for pure protein. The mean and maximum observed increase in δ15N values were 0.6 ± 0.6‰ and 2.3‰, respectively. There was no effect of increasing animal size on δ13C and δ15N difference (LE–BULK) for the two species examined. Field sampled animals (sampled immediately upon capture in the marine environment) showed a greater δ15N difference than animals sampled in the laboratory (sampled several hours after capture in the marine environment) (1.0 ± 0.5‰ and 0.4 ± 0.4‰ respectively), while estuarine sampled animals (sampled immediately) showed the smallest difference (0.1 ± 0.6‰). The δ13C data demonstrate that lipid extraction is required to remove lipids from elasmobranch muscle tissue given both intra- and inter- species variability. In addition, the increase in δ15N values, decrease in %N and increase in C:N ratio indicate that lipid extraction is removing soluble urea. Given lower δ15N diet-tissue discrimination factors for large marine predators, removal of urea is required to elucidate accurate trophic position estimates and relative food web position of elasmobranchs and for diet reconstruction. It is recommended that investigators undertake lipid extraction trials on elasmobranch muscle tissue to determine effects on δ13C and δ15N values on a species-by-species basis