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

Microplastics in the Salish Sea: A wholistic approach

Plastic production has increased globally at an exponential rate and with it so has marine plastic pollution. The Salish Sea is home to many ecologically and economically important species as well as substantial urban populations, making it one of the most interesting and important locations to study regional microplastic sources and contamination. The field of marine microplastics is rapidly growing, doubling roughly every year; the Salish Sea has been involved in research since 2008, developed NOAA’s marine debris methods. This panel aims to highlight the wholistic approach of marine microplastic research and removal efforts in the Salish Sea through examining how types of samples (sediment, water, organism etc.), spatial-temporal scales, and methodologies, can be utilized and applied to community-driven questions. Here, we discuss the field from multiple perspectives, including academic, NGO, government, policy, BIPOC youth, and businesses from the US and Canada. We will delve into the intricacies of how regional microplastic research goes beyond tradition published and peer reviewed scientific papers, often including work done with community members, volunteer groups, students, and activists. We are committed to reducing marine plastic pollution and believe that working together through a combination of science, policy, and public awareness are necessary

Developing Social Marketing Strategies to Reduce Puget Sound Shoreline Armoring

The net reduction of shoreline armor along the marine nearshore of Puget Sound is a key goal for ecosystem recovery. WDFW and DNR are the leads of the Puget Sound Marine and Nearshore Grant Program, funded by the U.S. Environmental Protection Agency through the National Estuary Program, and have funded a project to develop a social marketing framework and strategies for voluntary removal and/or replacement of hard armor for residential parcels. In the future, the Grant Program will provide this social marketing and behavior change strategy, as well as information about incentive options, to local governments and other entities interested in implementing armoring reduction programs. Social marketing and behavior change strategies that achieve voluntary stewardship among shoreline landowners can be used to complement regulatory, education, restoration, and other efforts that seek to protect Puget Sound beaches. The project includes a) GIS assessment of all residential marine parcels to in Puget Sound, including shoreform and geomorphology, as well as basic demographic information and segmented parcel types; b) through primary and secondary research, identifying barriers and motivators impacting property owner decisions to remove or forgo hard armor; c) identifying sub-segments of shoreline property owners most likely to be receptive to messages about voluntary armor removal, choosing softer alternatives to armor install, and other “natural” shoreline protection behaviors; d) testing messaging, outreach strategies and motivators for selected population segments to choose alternatives to hard armor along their shorelines (where not needed to protect property); and e) developing an outreach strategy toolkit for program implementers to use when conducting local campaigns. Qualitative interviews with a variety of shoreline property owners and a cross-section of “influencer” audiences were conducted to gain insight about how shoreline armor decisions are made, and what barriers and motivators may be most common. The team also conducted a literature review of existing research, outreach and pilot programs already complete (or in progress) related to shoreline armor. The interviews, database development and literature review were used to develop a quantitative survey distributed to a cross section of shoreline property owners in January 2014, which drilled down into barriers and motivations tied to target behaviors and provided insights into messaging and terminology that the team will then use to inform development of the social marketing strategy/toolkit. The project is scheduled to be complete by May 31, 2014

Integrating evidence-based PTSD treatment into intensive eating disorders treatment: a preliminary investigation

PurposeGiven data suggesting common co-occurrence and worse outcomes for individuals with eating disorders (EDs) and post-traumatic stress disorder (PTSD), it is critical to identify integrated treatment approaches for this group of patients. Past work has explored the feasibility and initial efficacy of intervention approaches that draw on evidence-based treatments for both EDs and PTSD; however, this work remains limited in scope. In the current study, we explored the feasibility and naturalistic outcomes of PTSD treatment delivered within the context of intensive ED treatment.MethodParticipants were 57 adult men and women with DSM-5 EDs and comorbid PTSD who completed a course of either Prolonged Exposure (PE; n = 22) or Cognitive Processing Therapy (CPT; n = 35) (Msessions = 10.40; SD = 5.13) and weekly validated measurements of clinical symptoms while enrolled in ED programming.ResultsMulti-level models for PTSD symptoms indicated a significant linear effect of time, such that participants demonstrated significant decreases over time in PTSD symptoms, regardless of treatment modality.ConclusionOur preliminary investigation provides support for the feasibility and efficacy of an integrated approach to treating EDs and PTSD. It is critical for future work to undertake randomized tests of this integrated approach using large, heterogeneous samples.Level of evidenceLevel IV, multiple time series with intervention

Psilocybin therapy for females with anorexia nervosa: a phase 1, open-label feasibility study.

Anorexia nervosa (AN) is a deadly illness with no proven treatments to reverse core symptoms and no medications approved by the US Food and Drug Administration. Novel treatments are urgently needed to improve clinical outcomes. In this open-label feasibility study, 10 adult female participants (mean body mass index 19.7 kg m-2; s.d. 3.7) who met Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for AN or pAN (partial remission) were recruited to a study conducted at an academic clinical research institute. Participants received a single 25-mg dose of synthetic psilocybin in conjunction with psychological support. The primary aim was to assess safety, tolerability and feasibility at post-treatment by incidences and occurrences of adverse events (AEs) and clinically significant changes in electrocardiogram (ECG), laboratory tests, vital signs and suicidality. No clinically significant changes were observed in ECG, vital signs or suicidality. Two participants developed asymptomatic hypoglycemia at post-treatment, which resolved within 24 h. No other clinically significant changes were observed in laboratory values. All AEs were mild and transient in nature. Participants qualitative perceptions suggest that the treatment was acceptable for most participants. Results suggest that psilocybin therapy is safe, tolerable and acceptable for female AN, which is a promising finding given physiological dangers and problems with treatment engagement. ClinicalTrials.gov identifier NCT04661514

Differences in emotion regulation difficulties among adults and adolescents across eating disorder diagnoses.

OBJECTIVE:Although much empirical attention has been devoted to emotion regulation (ER) in individuals with eating disorders, little is known about ER across a wide age range and among different ED subtypes. The current study sought to examine ER in a sample of eating disorder patients. METHOD:A total of 364 adults and adolescents with anorexia nervosa restricting subtype (AN-R), anorexia nervosa binge/purge subtype (AN-BP), or bulimia nervosa (BN) were assessed with the Difficulties in Emotion Regulation Scale (DERS). RESULTS:Older ages were associated with higher DERS total, nonacceptance, goals, and impulsivity scores. When controlling for age, patients with BN and AN-BP had higher overall DERS scores than those with AN, and there were some differences among diagnostic subtypes on specific facets of ER. CONCLUSIONS:These results indicate that treatments for emotion dysregulation may be applied across eating disorder diagnoses and ages, and inform how these strategies apply to different diagnostic groups

Differences in emotion regulation difficulties among adults and adolescents across eating disorder diagnoses.

OBJECTIVE:Although much empirical attention has been devoted to emotion regulation (ER) in individuals with eating disorders, little is known about ER across a wide age range and among different ED subtypes. The current study sought to examine ER in a sample of eating disorder patients. METHOD:A total of 364 adults and adolescents with anorexia nervosa restricting subtype (AN-R), anorexia nervosa binge/purge subtype (AN-BP), or bulimia nervosa (BN) were assessed with the Difficulties in Emotion Regulation Scale (DERS). RESULTS:Older ages were associated with higher DERS total, nonacceptance, goals, and impulsivity scores. When controlling for age, patients with BN and AN-BP had higher overall DERS scores than those with AN, and there were some differences among diagnostic subtypes on specific facets of ER. CONCLUSIONS:These results indicate that treatments for emotion dysregulation may be applied across eating disorder diagnoses and ages, and inform how these strategies apply to different diagnostic groups