Metric Variation on the Arikara Pelvis

Metric variation in the innominates, sacra and articulated pelves of the South Dakota Plains Indian group, the Arikara, are analyzed in an attempt to delineate biological relationships. The specimens examined represent 10 archaeological sites ranging in date from A.D. 1600 to 1832. The following sample sizes for innominate, sacrum and articulated pelvis data sets are employed: 292, 305, and 151, respectively. The data are analyzed utilizing univariate as well as multivariate statistical procedures. The results indicate that consistent within-group patterning exists. Common elements of pelvic structure can therefore be identified. Group analysis results indicate that temporal patterning can be identified on the innominate and articulated pelvis. In general, these results are consistent with those of several Arikara craniometric studies. Several explanations, namely obstetrical significance, demographic age structure differences, and gene flow, for the observed patterning are explored. Neither alone, however, appears to completely explain the patterning noted. An analysis of the patterns of sexual dimorphism expressed in the Arikara groups examined indicates that nutritional factors alone are not responsible for the noted patterning. The results tend to more strongly support a greater genetic component to ranging patterns of Arikara sexual dimorphism and are also consistent with the resent results obtained for the Arikara postcranial skeleton. Future studies employing data from other Plains Indians groups are designed to delineate the environmental and genetic components of variation of the boney pelvis as necessary in order to disprove or substantiate the present results. Data collection for this work was supported by NSF Grant BNS 8102650

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