Letter from Maggie Rae Lunam to [John Muir], 1910 May 5.

[4]very well we will hope to see James & Mrs Hay this summerWe will be so pleased to have a few lines from you Mother & I often talk about youMother joins me in kindest loveBelieve meyours affectyMaggie Rae Lunam[1]AnsweredWestfieldDunbarMay 5th 1910Dear CousinWhat a pleasure it gave us to receive the fine large photos last week of your self & friends, they are beautifully taken & it is so good of you in them both, we do prize them04757 [2]Mother is very feeble just now since the middle of March she has not been downstairs, gets up a bit in the evenings but I do hope when warmer weather comes she will get a bit stronger, I am so thankful I have kept well this last winter, by[3]staying indoors I managed to keep free of cold.What a great tour your ex President is having & so royally received I saw he was invited to Dunfermline Carnegie\u27s town but cannot accept to go. The Hays are al

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

Gestational weight gain charts for different body mass index groups for women in Europe, North America and Oceania

Background: Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grade 1, 2 and 3 obese women and compare these charts with those obtained in women with uncomplicated term pregnancies.Methods: We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America and Oceania. Of these women, 9,065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3,597 (1.6%), and 1,095 (0.5%) were underweight, normal weight, overweight, and grade 1, 2 and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2 and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale and shape. Results: We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grade 1, 2 and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications.Conclusions: Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice

Letter from Maggie Rae Lunam to [John Muir], 1910 May 5.

[4]very well we will hope to see James & Mrs Hay this summerWe will be so pleased to have a few lines from you Mother & I often talk about youMother joins me in kindest loveBelieve meyours affectyMaggie Rae Lunam[1]AnsweredWestfieldDunbarMay 5th 1910Dear CousinWhat a pleasure it gave us to receive the fine large photos last week of your self & friends, they are beautifully taken & it is so good of you in them both, we do prize them04757 [2]Mother is very feeble just now since the middle of March she has not been downstairs, gets up a bit in the evenings but I do hope when warmer weather comes she will get a bit stronger, I am so thankful I have kept well this last winter, by[3]staying indoors I managed to keep free of cold.What a great tour your ex President is having & so royally received I saw he was invited to Dunfermline Carnegie\u27s town but cannot accept to go. The Hays are al

Letter from Maggie Rae Lunam to [John Muir], 1912 Dec 16.

[2]mother & I at Cmas time. I am very sorry to say Mother is very feeble does not get out of bed now I have had to get a woman into the house instead of a young girl, I am so glad that I am keeping afoot.Susan Gilroy has[3]come to-day for a few days on her way to Edinbro.I have not seen any of the Hays [illegible] summer James is not able to brave now & Mrs Hay did not come to Scotland.Your are always busy writing but I daresay you willhttps://scholarlycommons.pacific.edu/jmcl/33752/thumbnail.jp

Letter from Maggie Rae Lunam to [John Muir], 1912 Dec 16.

[4]take a little leisure at Xmas time & go to Wanda\u27s & Helen\u27s & see all the little boys. With sincerest thanks & kind wishes for your Xmas timeBelieve me yours affectyMaggie Rae LunamExcuse a messy pen[1]WestfieldDunbarDecr 16th 1912Dear CousinWe have received your kind letter with the enclosed Money Order, it is indeed kind & mindful of you to cheer the poor of your native town & also to remember05320https://scholarlycommons.pacific.edu/jmcl/33751/thumbnail.jp

Letter from Maggie Rae Lunam to [John Muir], 1910 May 5.

[2]Mother is very feeble just now since the middle of March she has not been downstairs, gets up a bit in the evenings but I do hope when warmer weather comes she will get a bit stronger, I am so thankful I have kept well this last winter, by[3]staying indoors I managed to keep free of cold.What a great tour your ex President is having & so royally received I saw he was invited to Dunfermline Carnegie\u27s town but cannot accept to go. The Hays are allhttps://scholarlycommons.pacific.edu/jmcl/31846/thumbnail.jp

Letter from Maggie Rae Lunam to [John Muir], 1912 Dec 16.

[4]take a little leisure at Xmas time & go to Wanda\u27s & Helen\u27s & see all the little boys. With sincerest thanks & kind wishes for your Xmas timeBelieve me yours affectyMaggie Rae LunamExcuse a messy pen[1]WestfieldDunbarDecr 16th 1912Dear CousinWe have received your kind letter with the enclosed Money Order, it is indeed kind & mindful of you to cheer the poor of your native town & also to remember05320https://scholarlycommons.pacific.edu/jmcl/33751/thumbnail.jp

Letter from Maggie Rae Lunam to [John Muir], 1912 Dec 16.

[2]mother & I at Cmas time. I am very sorry to say Mother is very feeble does not get out of bed now I have had to get a woman into the house instead of a young girl, I am so glad that I am keeping afoot.Susan Gilroy has[3]come to-day for a few days on her way to Edinbro.I have not seen any of the Hays [illegible] summer James is not able to brave now & Mrs Hay did not come to Scotland.Your are always busy writing but I daresay you willhttps://scholarlycommons.pacific.edu/jmcl/33752/thumbnail.jp