A Multicenter Evaluation of the Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19.

The Seraph100 Microbind Affinity Blood Filter (Seraph 100) (ExThera Medical, Martinez, CA) is an extracorporeal therapy that can remove pathogens from blood, including severe acute respiratory syndrome coronavirus 2. The aim of this study was to evaluate safety and efficacy of Seraph 100 treatment for COVID-19. DESIGN: Retrospective cohort study. SETTING: Nine participating ICUs. PATIENTS: COVID-19 patients treated with Seraph 100 (n = 53) and control patients matched by study site (n = 53). INTERVENTION: Treatment with Seraph 100. MEASUREMENTS AND MAIN RESULTS: At baseline, there were no differences between the groups in terms of sex, race/ethnicity, body mass index, and need for mechanical ventilation. However, patients in the Seraph 100 group were younger (median age, 54 yr; interquartile range [IQR], 41-65) compared with controls (median age, 64 yr; IQR, 56-69; p = 0.009). Charlson comorbidity index scores were lower in the Seraph 100 group (2; IQR, 0-3) compared with the control group (3; IQR, 2-4; p = 0.006). Acute Physiology and Chronic Health Evaluation II scores were also lower in Seraph 100 subjects (12; IQR, 9-17) compared with controls (16; IQR, 12-21; p = 0.011). The Seraph 100 group had higher vasopressor-free days with an incidence rate ratio of 1.30 on univariate analysis. This difference was not significant after adjustment. Seraph 100-treated subjects were less likely to die compared with controls (32.1% vs 64.2%; p = 0.001), a difference that remained significant after adjustment. However, no difference in mortality was observed in a post hoc analysis utilizing an external control group. In the full cohort of 86 treated patients, there were 177 total treatments, in which only three serious adverse events were recorded. CONCLUSIONS: Although this study did not demonstrate consistently significant clinical benefit across all endpoints and comparisons, the findings suggest that broad spectrum, pathogen agnostic, blood purification can be safely deployed to meet new pathogen threats while awaiting targeted therapies and vaccines.

Data justice and biodiversity conservation.

Increases in data availability coupled with enhanced computational capacities are revolutionizing conservation. But in the excitement over the opportunities afforded by new data, there has been less discussion of the justice implications of data used in conservation, that is, how people and environments are represented through data, the conservation choices made based on data, and the distribution of benefits and harms arising from these choices. We propose a framework for understanding the justice dimensions of conservation data composed of five elements: data composition, data control, data access, data processing and use, and data consequences. For each element, we suggest a set of guiding questions that conservationists could use to think through their collection and use of data and to identify potential data injustices. The need for such a framework is illustrated by a synthesis of recent critiques of global conservation prioritization analyses. These critiques demonstrate the range of ways data could serve to produce social and ecological harms due to the choice of underlying data sets, assumptions made in the analysis, oversimplification of real-world conservation practice, and crowding out of other forms of knowledge. We conclude by arguing that there are ways to mitigate risks of conservation data injustices, through formal ethical and legal frameworks and by promoting a more inclusive and more reflexive conservation research ethos. These will help ensure that data contribute to conservation strategies that are both socially just and ecologically effective.

Justicia Informativa y Conservación de la Biodiversidad Resumen El incremento en la disponibilidad de datos acoplado con las capacidades computacionales mejoradas está revolucionando la conservación. Sin embargo, debido a la emoción generada por las oportunidades proporcionadas por los datos nuevos, ha habido menos discusiones sobre las implicaciones de justicia de los datos que se usan en la conservación, es decir, cómo las personas y los ecosistemas están representados por los datos, las opciones de conservación basadas en estos datos y la distribución de los daños y beneficios que surgen de estas opciones. Proponemos un marco de trabajo para entender las dimensiones de justicia de los datos de conservación compuestos por cinco elementos: composición de los datos, control de datos, acceso a los datos, procesamiento y uso de los datos, y consecuencias de los datos. Diseñamos un conjunto de preguntas guía para cada elemento, el cual los conservacionistas podrían usar para analizar detalladamente la recolección y uso de los datos y así identificar posibles injusticias informativas. La necesidad de tener este marco de trabajo está ilustrada por una síntesis de críticas recientes a los análisis de priorización de la conservación global. Estas críticas demuestran la gama de formas en la que podrían usarse los datos para producir daño ecológico y social debido a la elección de los conjuntos de datos subyacentes, las suposiciones hechas en el análisis, la sobresimplificación de las prácticas de conservación reales y la exclusión de otras formas de conocimiento. Existen maneras de mitigar los riesgos de injustica informativa en la conservación por medio de los marcos de trabajo éticos y legales y mediante la promoción de una ética de investigación de la conservación más incluyente y reflexiva. Todo lo anterior ayudará a asegurar que los datos contribuyan a las estrategias de conservación que son socialmente justas y ecológicamente efectivas.

Epidemiology, Clinical Features, and Outcomes of Hospitalized Adults with COVID-19: Early Experience from an Academic Medical Center in Mississippi.

OBJECTIVES: To describe the demographics, clinical characteristics, and outcomes of hospitalized adults with coronavirus disease 2019 (COVID-19) in an academic medical center in the southern United States. METHODS: Retrospective, observational cohort study of all adult patients (18 years and older) consecutively admitted with laboratory-confirmed severe acute respiratory syndrome-coronavirus-2 infection between March 13 and April 25, 2020 at the University of Mississippi Medical Center. All of the patients either survived to hospital discharge or died during hospitalization. Demographics, body mass index, comorbidities, clinical manifestations, and laboratory findings were collected. Patient outcomes (need for invasive mechanical ventilation and in-hospital death) were analyzed. RESULTS: One hundred patients were included, 53% of whom were women. Median age was 59 years (interquartile range 44-70) and 66% were younger than 65. Seventy-five percent identified themselves as Black, despite representing 58% of hospitalized patients at our institution in 2019. Common comorbid conditions included hypertension (68%), obesity (65%), and diabetes mellitus (31%). Frequent clinical manifestations included shortness of breath (76%), cough (75%), and fever (64%). Symptoms were present for a median of 7 days (interquartile range 4-7) on presentation. Twenty-four percent of patients required mechanical ventilation and, overall, 19% died (67% of those requiring mechanical ventilation). Eighty-four percent of those who died were Black. On multivariate analysis, ever smoking (odds ratio [OR] 5.9, 95% confidence interval [CI] 1.2-28.6) and history of diabetes mellitus (OR 5.9, 95% CI 1.5-24.3) were associated with mortality, and those admitted from home were less likely to die (vs outside facility, OR 0.2, 95% CI 0.0-0.7). Neither age, sex, race, body mass index, insurance status, nor rural residence was independently associated with mortality. CONCLUSIONS: Our study adds evidence that Black patients appear to be overrepresented in those hospitalized with and those who die from COVID-19, likely a manifestation of adverse social determinants of health. These findings should help guide preventive interventions targeting groups at higher risk of acquiring and developing severe COVID-19 disease.

Early Sport Specialization in Elite Weightlifters: Weightlifting Injury Occurrence and Relevant Opinions.

ABSTRACT: Bush, CM, Wilhelm, AJ, Lavallee, ME, and Deitch, JR. Early sport specialization in elite weightlifters: weightlifting injury occurrence and relevant opinions. J Strength Cond Res 35(11): 3260-3264, 2021-Sports specialization has been associated with increased injury and burnout. This study sought to determine the age, rate of injury, influence to specialize, and opinions surrounding the impact of sports specialization in attainment of elite-level weightlifting status. A link to an anonymous survey was distributed to the top 20 weightlifters in each weight class (8 male and 7 female weight classes). The survey questioned athletes about both age and motivation to specialize, previous injuries and/or surgeries, and level of competition. Injuries and surgeries were compared between those who specialized at the Youth level (≤age 16), Junior level (ages 17-20), and nonspecialized weightlifters. One hundred forty-one athletes (47.0%) completed the survey. Sixteen subjects (11.3%) specialized at the Youth level, 18 (12.8%) specialized at the Junior level, and the remaining 107 (75.9%) did not specialize before age 21. There was a statistically significant difference in the occurrence of injury before age 21 between weightlifters specializing at the Youth level and those who did not specialize (Χ2(1) = 22.4, p < 0.0001). There were no statistically significant differences in serious injury after age 21 between groups. Weightlifters cited primarily themselves (45.4%) or coach (43.1%) as a driving influence to specialize. The majority of athletes (68.8%) felt that specializing during the Youth age group was not necessary to achieve elite status. Despite a relatively small sample size, injuries occurred more frequently in weightlifters specializing at younger ages, suggesting that risks associated with early sport specialization also apply to weightlifters. These risks should be considered before implementing an early specialization training regimen.

Setup and Characterization of a 137CS Dosimetry Calibration Source in a Space-constrained Environment.

Proper characterization of Cs sources used for dosimeter calibration and performance testing is crucial for accurate and precise knowledge of air kerma rate and delivered dose. A 269 GBq Cs source was relocated to a new facility, which had a footprint of approximately 2.8 m × 3.6 m and a 3.4 m high ceiling. A small room size, such as in the new facility, may significantly increase backscatter from the walls or room return. Due to the limited source strength, a relatively close irradiation position of 1.00 m from the source was selected to decrease required exposure times. Proximity to the small but cylindrical source has the potential to alter the 1/r relationship (inverse square law) of air kerma rate with distance associated with point sources. Practical tutorials concerning dosimetry irradiation facilities are largely absent from the archival literature. For those reasons, standard characterization experiments were repeated multiple times, great care was taken with positioning, several experiments were added to the standard ones, an ion chamber and dosimeters were used rather than film for greater accuracy and precision, and practical details of the process were recorded. The impacts of room size and finite source dimensions were quantified and mitigated by the efforts reported here. Recommendations for simple but thorough facility characterization, beam calibration, and quality control resulted.

Comparing fracture patterns of younger versus older riders involved in nonfatal motorcycle accidents.

OBJECTIVE: The motorcyclist demographic is shifting to a larger proportion of riders over the age of 40. We sought to identify differences in orthopedic injury distribution and severity between 3 age cohorts and identify independent factors that contribute to fractures following a motorcycle collision (MCC). METHODS: A trauma registry at a level 1 trauma center was queried for motorcycle-related orthopedic injuries between January 1, 2008, and December 31, 2014. Subjects were stratified into 3 age groups: Young (<40 years), middle-aged (40-59 years), and elderly (≥60 years). Age groups were compared with respect to gender, weight, mechanism of collision, helmet use, Glascow Coma Scale (GCS), fracture type and location, Injury Severity Score (ISS), and hospital length of stay (LOS). A logistic regression model was constructed to identify independent factors that contribute to fractures following MCCs. RESULTS: Five hundred sixty-seven patients received care for motorcycle-related injuries (219 young, 264 middle-aged, and 84 elderly). Patients were predominantly male (88.7%), were wearing a helmet at the time of collision (58.0%), and sustained a mean of 1.48 fractures per patient. The primary mechanism of collision was noncollision transport accidents (41.4%). Elderly riders weighed significantly more than middle-aged and young riders (P < .0001). There was a significant difference in mean GCS between age groups (P = .02), with elderly patients demonstrating the highest mean GCS (14.0 ± 3.3). Young patients sustained no fractures most frequently when compared with middle-aged and elderly riders (P = .002). There was a significant difference in the percentage of patients sustaining right-sided, lower body fractures between age groups (P = .02) for elderly, middle-aged, and young patients, respectively. There was also a significant difference between age groups in the percentage of riders sustaining fractures other than those of the extremities, pelvis, or spine (P = .0005). Only age was identified as an independent predictor of sustaining a fracture (P = .008). CONCLUSIONS: Elderly patients sustained fractures more frequently. There was no difference between age groups with respect to injury severity. Mechanism of collision may have more influence than age with respect to fracture type and location. Further research is warranted to develop a more widely generalizable characterization of motorcycle collision injury patterns, risk factors, and patient characteristics.

A Rare Cause of Pyogenic Flexor Tenosynovitis: Nocardia nova.

Infection complicates approximately 5% of open trigger digit releases. Both superficial and deep infections may occur. We present a unique case of a cactus farmer who underwent an uneventful thumb trigger finger release and subsequently developed pyogenic flexor tenosynovitis and acute carpal tunnel syndrome resulting from Nocardia nova infection.

Early Sport Specialization: Effectiveness and Risk of Injury in Professional Baseball Players.

BACKGROUND: The rate of early sport specialization in professional baseball players is unknown. PURPOSE: To report the incidence and age of sport specialization in current professional baseball players and the impact of early specialization on the frequency of serious injuries sustained during the players' careers. We also queried participants about when serious injuries occurred, the players' current position on the field, and their opinions regarding the need for young athletes to specialize early to play at the professional level. STUDY DESIGN: Descriptive epidemiological study. METHODS: A total of 102 current professional baseball players anonymously completed a 7-question written survey. Early sport specialization was defined as "single-sport participation prior to high school." Injury was defined as "a serious injury or surgery that required the player to refrain from sports (baseball) for an entire year." Chi-square tests were used to investigate the risk of injury in those who specialized early in baseball versus those who did not. Independent-sample t tests were used to compare injury rates based on current player position. RESULTS: Fifty (48%) baseball players specialized early. The mean age at initiation of sport specialization was 8.91 years (SD, 3.7 years). Those who specialized early reported more serious injuries (mean, 0.54; SD, 0.838) during their professional baseball career than those who did not (mean, 0.23; SD, 0.425) (P = .044). Finally, 63.4% of the queried players believed that early sport specialization was not required to play professional baseball. CONCLUSION: Our study demonstrated a statistically significant higher rate of serious injury during a baseball player's professional career in those players who specialized early. Most current professional baseball players surveyed believed that sport specialization was not required prior to high school to master the skills needed to play at the professional level. Our findings demonstrate an increased incidence of serious injuries in professional baseball players who specialized in baseball prior to high school. Youth baseball athletes should be encouraged not to participate in a single sport given the potential for an increased incidence of serious injuries later in their careers. No data are available to suggest that early specialization is needed to reach the professional level.

Lipid emulsion use precluding renal replacement therapy.

BACKGROUND: Intralipid emulsion (ILE) is a nutritional fatty acid supplementation that is emerging as a potential therapy for local anesthetic systemic toxicity and is also being considered as a therapy for other lipophilic medication intoxications. Isolated reports of pulmonary edema or severe lipemia exist as a complication of therapy. CASE REPORT: A 26-year-old hypertensive, male, kidney transplant recipient presented to an outside emergency department (ED) after an intentional overdose of his medications (ie, amlodipine, metoprolol, lisinopril). At presentation, he had hypotension and bradycardia that was unresponsive to treatment with intravenous saline, calcium, glucagon, and vasopressors. After failure of conventional therapy, an initial bolus of ILE (20%) was given with some improvement in his heart rate, and the dose was repeated. A continuous intravenous infusion of ILE therapy was started. The patient deteriorated, with development of both acute respiratory and renal failure. Continuous venovenous hemofiltration (CVVHF) was attempted to remove volume and correct metabolic abnormalities. Lipemic blood was immediately observed in the CVVHF filter. After 15 min, the transmembrane pressures of the filter began to rise in the absence of observed clotting of the blood and the filter then became completely obstructed. An attempt was made to remove the lipid by plasmapheresis to restart CVVHF, but the patient continued to deteriorate despite maximal vasopressor support. The patient's family decided to withdraw care and the patient expired. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians treat patients with toxic ingestions on a regular basis. Being aware of possible complications of experimental antidote therapy, like ILE, can improve the treatment approach and outcomes for these patients.

Acquired cystic fibrosis transmembrane conductance regulator dysfunction in the lower airways in COPD.

BACKGROUND: Cigarette smoke and smoking-induced inflammation decrease cystic fibrosis transmembrane conductance regulator (CFTR) activity and mucociliary transport in the nasal airway and cultured bronchial epithelial cells. This raises the possibility that lower airway CFTR dysfunction may contribute to the pathophysiology of COPD. We compared lower airway CFTR activity in current and former smokers with COPD, current smokers without COPD, and lifelong nonsmokers to examine the relationships between clinical characteristics and CFTR expression and function. METHODS: Demographic, spirometry, and symptom questionnaire data were collected. CFTR activity was determined by nasal potential difference (NPD) and lower airway potential difference (LAPD) assays. The primary measure of CFTR function was the total change in chloride transport (Δchloride-free isoproterenol). CFTR protein expression in endobronchial biopsy specimens was measured by Western blot. RESULTS: Compared with healthy nonsmokers (n = 11), current smokers (n = 17) showed a significant reduction in LAPD CFTR activity (Δchloride-free isoproterenol, -8.70 mV vs -15.9 mV; P = .003). Similar reductions were observed in smokers with and without COPD. Former smokers with COPD (n = 7) showed a nonsignificant reduction in chloride conductance (-12.7 mV). A similar pattern was observed for CFTR protein expression. Univariate analysis demonstrated correlations between LAPD CFTR activity and current smoking, the presence of chronic bronchitis, and dyspnea scores. CONCLUSIONS: Smokers with and without COPD have reduced lower airway CFTR activity compared with healthy nonsmokers, and this finding correlates with disease phenotype. Acquired CFTR dysfunction may contribute to COPD pathogenesis.

A pharmacologic approach to acquired cystic fibrosis transmembrane conductance regulator dysfunction in smoking related lung disease.

BACKGROUND: Mucus stasis in chronic obstructive pulmonary disease (COPD) is a significant contributor to morbidity and mortality. Potentiators of cystic fibrosis transmembrane conductance regulator (CFTR) activity pharmacologically enhance CFTR function; ivacaftor is one such agent approved to treat CF patients with the G551D-CFTR gating mutation. CFTR potentiators may also be useful for other diseases of mucus stasis, including COPD. METHODS AND FINDINGS: In primary human bronchial epithelial cells, exposure to cigarette smoke extract diminished CFTR-mediated anion transport (65.8±0.2% of control, P<0.005) and mucociliary transport (0.17±0.05 µm/sec vs. 2.4±0.47 µm/sec control, P<0.05) by reducing airway surface liquid depth (7.3±0.6 µm vs. 13.0±0.6 µm control, P<0.005) and augmenting mucus expression (by 64%, P<0.05) without altering transepithelial resistance. Smokers with or without COPD had reduced CFTR activity measured by nasal potential difference compared to age-matched non-smokers (-6.3±1.4 and -8.0±2.0 mV, respectively vs. -15.2±2.7 mV control, each P<0.005, n = 12-14/group); this CFTR decrement was associated with symptoms of chronic bronchitis as measured by the Breathlessness Cough and Sputum Score (r = 0.30, P<0.05) despite controlling for smoking (r = 0.31, P<0.05). Ivacaftor activated CFTR-dependent chloride transport in non-CF epithelia and ameliorated the functional CFTR defect induced by smoke to 185±36% of non-CF control (P<0.05), thereby increasing airway surface liquid (from 7.3±0.6 µm to 10.1±0.4 µm, P<0.005) and mucociliary transport (from 0.27±0.11 µm/s to 2.7±0.28 µm/s, P<0.005). CONCLUSIONS: Cigarette smoking reduces CFTR activity and is causally related to reduced mucus transport in smokers due to inhibition of CFTR dependent fluid transport. These effects are reversible by the CFTR potentiator ivacaftor, representing a potential therapeutic strategy to augment mucociliary clearance in patients with smoking related lung disease.