Food Bag Program to Address the Immediate Food Needs of Patients During the COVID-19 Crisis

The COVID-19 pandemic has heightened food insecurity across the country. In this report we describe creation of a novel emergency department (ED) food bag program in New York City. The food bag program was designed to help meet immediate food needs of patients being discharged from the ED. Each bag contained shelf-stable food as well as a handout describing other community food resources. The program leveraged community-hospital partnerships, was met with enthusiasm from patients and staff alike, and would be highly replicable to other settings.https://deepblue.lib.umich.edu/bitstream/2027.42/156010/1/FINAL_Food bag program article_complete_7.2.20.pdfDescription of FINAL_Food bag program article_complete_7.2.20.pdf : Main Articl

Eocene dike orientations across the Washington Cascades in response to a major strike-slip faulting episode and ridge-trench interaction

The northern Cascade Mountains in Washington (USA) preserve an exceptional shallow to mid-crustal record of Eocene transtension marked by dextral strike-slip faulting, intrusion of dike swarms and plutons, rapid non-marine sedimentation, and ductile flow and rapid cooling in parts of the North Cascades crystalline core. Transtension occurred during ridge-trench interaction with the formation of a slab window, and slab rollback and break-off occurred shortly after collision of the Siletzia oceanic plateau at ca. 50 Ma. Dike swarms intruded a \u3e1250 km2 region between ca. 49.3 Ma and 44.9 Ma, and orientations of more than 1500 measured dikes coupled with geochronologic data provide important snapshots of the regional strain field. The mafic Teanaway dikes are the southernmost and most voluminous of the swarms. They strike NE (mean = 036°) and average ~15 m in thickness. To the north, rhyolitic to basaltic dikes overlap spatially with 49.3-46.5 Ma, mainly granodioritic plutons, but they typically predate the nearby plutons by ca. 500 k.y. The average orientations of five of the six dike domains range from 010° to 058°; W-NW- to NW-striking dikes characterize one domain and are found in lesser amounts in a few other domains. Overall, the mean strike for all Eocene dikes is 035°, and the average extension direction (305°-125°) is oblique to the strike (~320°) of the North Cascades orogen. Extension by diking reached ~45% in one \u3e7-km-long transect through the Teanaway swarm and ranged from ~5% to locally ~79% in shorter transects across other swarms, which corresponds to a minimum of ~12 km of extension. The dominant NE-striking dikes are compatible with the dextral motion on the N- to NW-striking (~355-320°) regional strike-slip faults. Some of the W-NW- to NW-striking dikes were arguably influenced by pre-existing faults, shear fractures, and foliations, and potentially in one swarm where both NE-and lesser W-NW-striking dikes are present, by a switch in principal stress axes induced by dike emplacement. Alternatively, the W-NW- to NW-striking dikes may reflect a younger regional strain field, as ca. 49.3-47.5 Ma U-Pb zircon ages of the NE-striking dikes are older than those of the few dated W-NW- to NW-trending dikes. In one scenario, NE-striking dikes intruded during an interval when strain mainly reflected dextral strike-slip faulting, and the younger dikes record a switch to more arc-normal extension. Diking ended as magmatism migrated into a N-S-trending belt west of the North Cascades core that marks the initiation of the ancestral Cascade arc

SARS-CoV-2 Receptor ACE2 Is an Interferon-Stimulated Gene in Human Airway Epithelial Cells and Is Detected in Specific Cell Subsets across Tissues.

There is pressing urgency to understand the pathogenesis of the severe acute respiratory syndrome coronavirus clade 2 (SARS-CoV-2), which causes the disease COVID-19. SARS-CoV-2 spike (S) protein binds angiotensin-converting enzyme 2 (ACE2), and in concert with host proteases, principally transmembrane serine protease 2 (TMPRSS2), promotes cellular entry. The cell subsets targeted by SARS-CoV-2 in host tissues and the factors that regulate ACE2 expression remain unknown. Here, we leverage human, non-human primate, and mouse single-cell RNA-sequencing (scRNA-seq) datasets across health and disease to uncover putative targets of SARS-CoV-2 among tissue-resident cell subsets. We identify ACE2 and TMPRSS2 co-expressing cells within lung type II pneumocytes, ileal absorptive enterocytes, and nasal goblet secretory cells. Strikingly, we discovered that ACE2 is a human interferon-stimulated gene (ISG) in vitro using airway epithelial cells and extend our findings to in vivo viral infections. Our data suggest that SARS-CoV-2 could exploit species-specific interferon-driven upregulation of ACE2, a tissue-protective mediator during lung injury, to enhance infection

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

Photosynthetic acclimation of white spruce (Picea glauca) to canopy microhabitats

Thesis (Ph.D.) University of Alaska Fairbanks, 2000Slow growing white spruce (Picea glauca) seedlings and saplings often become established early in succession and mature through several succession seres. During early succession, spruce often germinate in mineral soils and become established in alder (Alnus tenuifolia or A. crispa) thickets, with the potential for both competitive and facilitative relationships. Although competitive and facilitative plant interactions are often identified by changes in the growth or density of the interacting species, the result of the interaction will depend upon the individual plant's physiological acclimation to abiotic changes caused by neighboring plants. This study analyzes components of photosynthesis to provide information about the effects of alder on spruce. To isolate the responses of components of the photosynthetic process to neighbors, gas exchange techniques, needle chemical analysis, and observations of environmental parameters were utilized in growth chamber experiments, with individual plants in the field, and in controlled density plantations of alder and spruce. Growth at high light in all experiments resulted in lower maximum photosynthetic rates in current year shoots. Light response curves showed lower incident quantum yields in spruce seedlings growing at the high light levels typical on the floodplain. Increased soil nitrogen did not increase photosynthetic rates per gram needle in any of the experiments. However, increased seedling growth at high light in growth chamber experiments, and increased plant density in spruce/alder plantations, resulted in dilution of needle nitrogen. High needle nitrogen concentrations did not result in higher maximum net assimilation rates, although needle nitrogen was positively correlated with dark respiration rates. Concentrations of rubsico, a potentially rate limiting enzyme for photosynthesis at high light, was very responsive to changes in irradiance, but constituted only a small part of the needle nitrogen pool and did not appear to be limited by nitrogen availability. This work suggests that on a physiological level, spruce is a stress adapted plant with a low capacity to up-regulate photosynthetic physiological processes in response to increased light or nitrogen conditions

Information search and use in consumer decision making : an in-depth study of Chinese and North American consumers

This dissertation explores individuals' approaches to information search and use in consumer decision making in two dissimilar cultures: China and North America. The research consists of two exploratory studies designed to develop a deep description of information search and use in each of the two cultures studied. Since the two cultures are so different, the research also examined cultural dimensionality and the specific dimensions that appear to impact information search and use in each culture. In addition, the studies probed the implications of these findings for other stages of consumer decision making in Chinese and North American culture.The dissertation utilizes primarily qualitative approaches to investigate the topic in an interpretive fashion. Throughout the research, an emphasis is placed on a multi-method approach in an attempt to develop descriptions and theories of information search and use for the two cultures being investigated. The Chinese study was directed from a base in Beijing, China, and the North American study was directed from two bases in Montreal, Canada, and Boston, Massachusetts. The two studies each utilize three product categories chosen to maximize understanding of information search and use characteristics of each culture. The methods employed include focus groups and interviews, observation, content analysis, and store layout and product availability analyses.The contributions of this research are both theoretical and practical. The dissertation provides a deeply descriptive study of information search and use for two disparate cultures. In addition, the insights gained from the two separate studies should lead to a better understanding of the role culture plays in information search and use more generally. Moreover, the research should help managers to adapt their promotional efforts to the differing cultural needs of two disparate cultures, and to understand how differences in information search and use between cultures can impact other phases of the decision making process, such as the evaluation of alternatives and post-purchase satisfaction

Proteomic profiling of animal models mimicking skeletal muscle disorders

Over the last few decades of biomedical research, animal models of neuromuscular diseases have been widely used for determining pathological mechanisms and for testing new therapeutic strategies. With the emergence of high-throughput proteomics technology, the identification of novel protein factors involved in disease processes has been decisively improved. This review outlines the usefulness of the proteomic profiling of animal disease models for the discovery of new reliable biomarkers, for the optimization of diagnostic procedures and the development of new treatment options for skeletal muscle disorders. Since inbred animal strains show genetically much less interindividual differences as compared to human patients, considerably lower experimental repeats are capable of producing meaningful proteomic data. Thus, animal model proteomics can be conveniently employed for both studying basic mechanisms of molecular pathogenesis and the effects of drugs, genetic modifications or cell-based therapies on disease progression. Based on the results from comparative animal proteomics, a more informed decision on the design of clinical proteomics studies could be reached. Since no one animal model represents a perfect pathobiochemical replica of all of the symptoms seen in complex human disorders, the proteomic screening of novel animal models can also be employed for swift and enhanced protein biochemical phenotyping

Aging skeletal muscle shows a drastic increase in the small heat shock proteins aB-crystallin/HspB5 and cvHsp/HspB7

Most heat shock proteins operate as molecular chaperones and play a central role in the maintenance of normal cellular function. In skeletal muscle, members of the alpha-crystallin domain-containing family of small heat shock proteins are believed to form a cohort of essential stress proteins. Since alphaB-crystallin (alphaBC/HspB5) and the cardiovascular heat shock protein (cvHsp/HspB7) are both implicated in the molecular response to fibre transformation and muscle wasting, it was of interest to investigate the fate of these stress proteins in young adult versus aged muscle. The age-related loss of skeletal muscle mass and strength, now generally referred to as sarcopenia, is one of the most striking features of the senescent organism. In order to better understand the molecular pathogenesis of age-related muscle wasting, we have performed a two-dimensional gel electrophoretic analysis, immunoblotting and confocal microscopy study of aged rat gastrocnemius muscle. Fluorescent labelling of the electrophoretically separated soluble muscle proteome revealed an overall relatively comparable protein expression pattern of young adult versus aged fibres, but clearly an up-regulation of alphaBC and cvHsp. This was confirmed by immunofluorescence microscopy and immunoblot analysis, which showed a dramatic age-induced increase in these small heat shock proteins. Immunodecoration of other major stress proteins showed that they were not affected or less drastically changed in their expression in aged muscle. These findings indicate that the increase in muscle-specific small heat shock proteins constitutes an essential cellular response to fibre aging and might therefore be a novel therapeutic option to treat sarcopenia of old age