Virtual Reference Best Practices and the College Student Experience

This capstone addressed the research question: what are today’s best practices in online reference, and how can librarians at academic institutions improve the student experience in online reference transactions? It documents one librarian’s creation of best practices for a virtual reference service based on the guidelines and practices outlined by governing bodies, commercial entities, and other libraries. During the study the practices were implemented at a higher education institution and results about the effectiveness, clarity, and overall improvement of virtual reference transactions were gathered using a mixed-methods approach. The author used related research literature as a foundation for building best practices documentation and evaluation of the results. The author described the successes and difficulties in implementing the best practices and concluded: lack of student awareness of the best practices implemented impacted satisfaction results, staff benefitted from having basic competencies defined, and outlining basic skills and defining what those skills entailed provided a needed structure for online chat

Climate forcing of regional fire years in the upper Great Lakes Region, USA

Background. Drivers of fire regimes vary among spatial scales, and fire history reconstructions are often limited to stand scales, making it difficult to partition effects of regional climate forcing versus individual site histories. Aims. To evaluate regional-scale historical fire regimes over 350 years, we analysed an extensive fire-scar network, spanning 240 km across the upper Great Lakes Region in North America. Methods. We estimated fire frequency, identified regionally widespread fire years (based on the fraction of fire-scarred tree samples, fire extent index (FEI), and synchronicity of fire years), and evaluated fire seasonality and climate-fire relationships. Key results. Historically, fire frequency and seasonality were variable within and among Great Lakes' ecoregions. Climate forcing at regional scales resulted in synchronised fires, primarily during the late growing season, which were ubiquitous across the upper Great Lakes Region. Regionally significant fire years included 1689, 1752, 1754, 1791, and 1891. Conclusions. We found significant climate forcing of region-wide fire regimes in the upper Great Lakes Region. Implications. Historically, reoccurring fires in the upper Great Lakes Region were instrumental for shaping and maintaining forest resilience. The climate conditions that helped promote widespread fire years historically may be consistent with anticipated climate-fire interactions due to climate change

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

International audienc