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Background The benefits of early continuous neuromuscular blockade in patients with acute respiratory distress syndrome (ARDS) who are receiving mechanical ventilation remain unclear. Meth...

Importance Data on the efficacy of hydroxychloroquine for the treatment of coronavirus disease 2019 (COVID-19) are needed. Objective To determine whether hydroxychloroquine is an efficacious treatment for adults hospitalized with COVID-19. Design, Setting, and Participants This was a multicenter, blinded, placebo-controlled randomized trial conducted at 34 hospitals in the US. Adults hospitalized with respiratory symptoms from severe acute respiratory syndrome coronavirus 2 infection were enrolled between April 2 and June 19, 2020, with the last outcome assessment on July 17, 2020. The planned sample size was 510 patients, with interim analyses planned after every 102 patients were enrolled. The trial was stopped at the fourth interim analysis for futility with a sample size of 479 patients. Interventions Patients were randomly assigned to hydroxychloroquine (400 mg twice daily for 2 doses, then 200 mg twice daily for 8 doses) (n = 242) or placebo (n = 237). Main Outcomes and Measures The primary outcome was clinical status 14 days after randomization as assessed with a 7-category ordinal scale ranging from 1 (death) to 7 (discharged from the hospital and able to perform normal activities). The primary outcome was analyzed with a multivariable proportional odds model, with an adjusted odds ratio (aOR) greater than 1.0 indicating more favorable outcomes with hydroxychloroquine than placebo. The trial included 12 secondary outcomes, including 28-day mortality. Results Among 479 patients who were randomized (median age, 57 years; 44.3% female; 37.2% Hispanic/Latinx; 23.4% Black; 20.1% in the intensive care unit; 46.8% receiving supplemental oxygen without positive pressure; 11.5% receiving noninvasive ventilation or nasal high-flow oxygen; and 6.7% receiving invasive mechanical ventilation or extracorporeal membrane oxygenation), 433 (90.4%) completed the primary outcome assessment at 14 days and the remainder had clinical status imputed. The median duration of symptoms prior to randomization was 5 days (interquartile range [IQR], 3 to 7 days). Clinical status on the ordinal outcome scale at 14 days did not significantly differ between the hydroxychloroquine and placebo groups (median [IQR] score, 6 [4-7] vs 6 [4-7]; aOR, 1.02 [95% CI, 0.73 to 1.42]). None of the 12 secondary outcomes were significantly different between groups. At 28 days after randomization, 25 of 241 patients (10.4%) in the hydroxychloroquine group and 25 of 236 (10.6%) in the placebo group had died (absolute difference, −0.2% [95% CI, −5.7% to 5.3%]; aOR, 1.07 [95% CI, 0.54 to 2.09]). Conclusions and Relevance Among adults hospitalized with respiratory illness from COVID-19, treatment with hydroxychloroquine, compared with placebo, did not significantly improve clinical status at day 14. These findings do not support the use of hydroxychloroquine for treatment of COVID-19 among hospitalized adults. Trial Registration ClinicalTrials.gov:NCT04332991

Background The purpose of this study was to see if 3-dimensional (3D) magnetic resonance imaging (MRI) could improve our understanding of rotator cuff tendon tear shapes. We believed that 3D MRI would be more accurate than two-dimensional (2D) MRI for classifying tear shapes. Methods We performed a retrospective review of MRI studies of patients with arthroscopically proven full-thickness rotator cuff tears. Two orthopedic surgeons reviewed the information for each case, including scope images, and characterized the shape of the cuff tear into crescent, longitudinal, U- or L-shaped longitudinal, and massive type. Two musculoskeletal radiologists reviewed the corresponding MRI studies independently and blind to the arthroscopic findings and characterized the shape on the basis of the tear's retraction and size using 2D MRI. The 3D reconstructions of each cuff tear were reviewed by each radiologist to characterize the shape. Statistical analysis included 95% confidence intervals and intraclass correlation coefficients. Results The study reviewed 34 patients. The accuracy for differentiating between crescent-shaped, longitudinal, and massive tears using measurements on 2D MRI was 70.6% for reader 1 and 67.6% for reader 2. The accuracy for tear shape characterization into crescent and longitudinal U- or L-shaped using 3D MRI was 97.1% for reader 1 and 82.4% for reader 2. When further characterizing the longitudinal tears as massive or not using 3D MRI, both readers had an accuracy of 76.9% (10 of 13). The overall accuracy of 3D MRI was 82.4% (56 of 68), significantly different (P = .021) from 2D MRI accuracy (64.7%). Conclusion Our study has demonstrated that 3D MR reconstructions of the rotator cuff improve the accuracy of characterizing rotator cuff tear shapes compared with current 2D MRI–based techniques.

The spatio‐temporal relationship between unusual sightings of dead birds and human West Nile virus infections has been observed in many studies and has been proposed as an indicator of an intense amplification cycle between birds and mosquitoes. However, to date, no single study has provided quantitative evidence that the amplification cycle occurs at the local level and that it operates within certain temporal parameters. Here, we use a novel geostatistical and spatial analytic methodology and present the first evidence that the localized unusual space–time correspondence of dead birds models the amplification cycle and that this cycle peaks 15–16 days prior to human onset of West Nile virus infections. During the process of establishing this relationship, we extend the traditional Knox space–time interaction measure to overcome pair‐dependency limitations and use a novel implementation of the kappa non‐chance agreement measure to identify the temporal characteristics of the association of bird deaths to...

During the summer and fall of 2002, an epidemic (223 cases) and epizootic of West Nile virus infections occurred in Chicago. Retrospective spatial analysis demonstrated that age-adjusted human case rates were three times higher inside geographic areas with high early-season crow deaths than outside these areas.

We sought to estimate West Nile virus (WNV) activity in mosquito populations weekly at the census tract level in Chicago, IL, and to provide this information graphically. Each week we calculated a vector index (VI) for each mosquito trap then generated tract estimates using geographic information systems. During June 29–September 13, 2008, a median of 527 (60%) of 874 possible tracts per week had a VI value. Overall, 94% of the weekly VI tract estimates were 0; among those with a VI estimate greater than 0, the median was 0.33 (range 0.003–3.5). Officials deemed risk levels and weather conditions appropriate for adulticide treatments on 3 occasions, resulting in the treatment of approximately 252 linear kilometers of residential streets and alleys. Our analysis successfully converted complex, raw surveillance data into a format that highlighted areas of elevated WNV activity and facilitated the determination of appropriate response procedures.

Objective: 1) Compare the outcomes of 2 surgical modalities used to treat hypopharyngeal diverticulum and esophageal stenosis at the Medical University of South Carolina (MUSC) and analyze the economic efficiency of each. 2) Compare the MUSC experience with statewide treatment in South Carolina (SC) Medicare patients.Method: Retrospective analysis was conducted of 50 patients treated at MUSC. The 2 approaches utilized were endoscopic laser diverticulotomy and transcervical open diverticulectomy with cricopharyngeal myotomy. SC Medicare data was collected for patients undergoing these procedures. Primary outcomes investigated were intraoperative complications, operative charge, hospital stay, and postoperative complications.Results: Statistically significant differences between the 2 operative groups at MUSC were observed in length of stay (1.08 days endoscopic group and 4.75 days transcervical open group; P > .0001) and operative charge (US $ 2842 endoscopic and US$ 3425 transcervical; P > .0001). The per...

The city of Chicago used ground ultra-low volume treatments of sumithrin (ANVIL 10+10) in areas with high West Nile virus infection rates among Culex mosquitoes. Two sequential treatments in Morbidity and Mortality Weekly Reports wk 31 and 32 decreased mean mosquito density by 54% from 2.5 to 1.1 mosquitoes per trap-day, whereas mosquito density increased by 153% from 1.3 to 3.3 mosquitoes per trap-day at the nonsprayed sites. The difference between these changes in mosquito density was statistically significant (confidence intervals for the difference in change: -4.7 to -1.9). Sequential adulticide treatments in September (wk 34 and 35) had no effect on mosquito density, probably because it was late in the season and the mosquitoes were presumably entering diapause and less active. Overall, there was significant decrease in mosquito density at the trap sites treated in all 4 wk (wk 31, 32, 34, and 35), suggesting that sustained sequential treatments suppressed mosquito density. Maximum likelihood estimates (MLE) of infection rate estimates varied independently of adulticide treatments, suggesting that the adulticide treatments had no direct effect on MLE. Mosquito trap counts were low, which was probably due to large numbers of alternative oviposition sites, especially catch basins competing with the gravid traps.