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Background: Bamlanivimab and casirivimab/imdevimab are recombinant neutralizing monoclonal antibodies that decrease viral load in patients with coronavirus disease 2019 (COVID-19) and can decrease hospitalizations. Few data exist comparing these two therapies. Objective: Our aim was to compare the efficacy and safety of bamlanivimab and casirivimab/imdevimab in emergency department (ED) patients with COVID-19 who met criteria for monoclonal antibody therapy. Methods: We performed a single-center, open-label, prospective study in adult ED patients with confirmed COVID-19 and high-risk features for hospitalization. Enrolled patients received bamlanivimab or casirivimab/imdevimab, depending on the day of the week that they arrived. We observed patients for post–infusion-related reactions and contacted them on days 5, 10, and 30. The primary outcome was the number of hospitalizations through day 30. In addition, we compared groups with regard to return visits to the ED, symptom improvement, antibody-induced adverse events, and deaths. Results: Between December 17, 2020 and January 17, 2021, 321 patients completed the study. We found no statistically significant difference in the rate of subsequent hospitalization between groups (bamlanivimab: n = 18 of 201 [8.9%] and casirivimab/imdevimab: n = 13 of 120 [10.8%]; p = 0.57). In addition, we found no statistically significant differences between groups regarding return visits to the ED or symptom improvement. One patient had a possible adverse reaction to the treatment, and 1 patient died. Both of these events occurred in the bamlanivimab group. Conclusions: We found no statistically significant differences in rates of subsequent hospitalization or other outcomes for ED patients with COVID-19 when they received bamlanivimab as opposed to casirivimab/imdevimab. Adverse events were rare in both groups.

Objective Advanced Trauma Life Support guidelines recommend only 1 L of intravenous (IV) crystalloid before transitioning to blood products. We sought to determine if receiving >1 L of IV crystalloid during the initial resuscitation is associated with worse outcomes. We also sought to determine if receiving no crystalloids is associated with better outcomes. Methods We performed a single center retrospective study using trauma registry data, which was supplemented by manual chart review. We only included patients who had an initial heart rate ≥ 100 beats/min or a systolic blood pressure ≤ 90 mmHg. For each patient, we determined the total amount of IV crystalloid administered in the first 3 h after arrival to the hospital plus prehospital crystalloid. We performed multivariate regression analyses to determine if there is an association between the administration of >1 L of crystalloids or no crystalloids with in-hospital mortality, hospital length of stay (LOS), or packed red blood cells (PRBCs) transfused. Results Between January 1, 2018 and September 30, 2019, there were 878 who met criteria for enrollment. Among those, 55.0% received ≤1 L of IV crystalloids, and 45.0% received >1 L. Multivariate analyses showed no significant association between receiving >1 L and mortality (p = 0.61) or PRBCs transfused (p = 0.29), but patients who received >1 L had longer hospital LOS (p = 0.04). We found no association between receiving no crystalloids and mortality, PRBCs transfused, or LOS. Conclusion On a multivariate analysis of trauma patients, we did not find an association between the administration of >1 L of IV crystalloid and in-hospital mortality or the volume of PRBCs transfused. However, receiving >1 L of crystalloids was associated with a longer hospital LOS. We found no benefit to completely withholding crystalloids.

This review identifies two cognitive benefits of social hierarchy that may contribute to hierarchy maintenance. First, research indicates that people pay attention to hierarchies automatically, early, and accurately. As a result, hierarchies feel easy to process, which increases liking and support of hierarchy. Second, through their clear, predictable structures and the opportunities they provide for personal agency, hierarchies help people satisfy their need for control, which may lead people to seek out and maintain hierarchy, especially if they currently hold a high rank or believe in social mobility. These cognitive benefits of ease and control may have effects on the performance of hierarchies and on people's willingness to change unfair structures.

Fraud in the food supply system will be exacerbated by shortages caused by climate change and COVID-19's impact. The dried herbs market exemplifies complex supply chains attractive to criminals seeking financial gain. Real-time remote testing is achievable through development of globally accessible chemometric models for portable near infrared devices, deployed throughout supply chains. This study describes building of models for detection of oregano adulteration, on portable near infrared devices, and comparison to a laboratory-based Fourier-Transform Infrared spectroscopy method. 33/34 portable devices were able to correctly classify 5 out of 6 samples successfully with all adulterated samples being correctly classified following the use of appropriate transferability pre-processing routines. The devices native setup shows limited ability to perform a true screening of oregano using the setup offered. However modifications to the setup could in the future offer a solution that facilitates fit-for-purpose real time detection of adulterated samples within the supply chain. [Abstract copyright: Copyright © 2020 Elsevier Ltd. All rights reserved.]

Background Serum lactate increases in states of severe sepsis and shock, but its interpretation may be subject to confounders. Lactated Ringer's solution (LR) is used in the resuscitation of septic patients and contains 28 mmol/L of sodium lactate. Objectives We sought to determine if a bolus of 30 mL/kg of LR increases serum lactate levels. Methods In this double-blind, randomized controlled trial, 30 volunteers were assigned to receive either 30 mL/kg of intravenous LR or normal saline (NS). Serum lactate was measured before and after the fluid bolus. The primary outcome was the difference in the change in lactate between the LR and NS groups. Secondarily, we assessed the change in pH, bicarbonate, sodium, and chloride in each group. Results After 30 mL/kg of intravenous LR, the mean serum lactate level increased by 0.93 mmol/L (95% confidence interval 0.42–1.44 mmol/L). However, there was also a small increase in the mean serum lactate level in the NS group of 0.37 mmol/L (95% confidence interval −0.26 mmol/L to 1.00 mmol/L), such that there was not a statistically significant difference in the change in lactate when comparing the LR group to the NS group (p = 0.2). The NS group saw larger declines in pH and bicarbonate and greater increases in chloride compared with the LR group. Conclusion In healthy individuals, a modest but significant rise in mean serum lactate was seen after a 30 cc/kg LR bolus. There was no difference in mean serum lactate when comparing a 30 mL/kg bolus of NS to LR.

Background Urgent care centers (UCCs) can offer a cheap alternative to emergency departments (EDs) for some patients with acute complaints. However, if patients who initially present to a UCC are unnecessarily transferred to an ED, those patients may suffer undue financial harm. The group of patients transferred from UCCs to EDs have never previously been studied. Objectives The primary objective of this study was to determine the fraction of transfers from a UCC to an ED that were unnecessary. We also assessed the frequency with which these patients were discharged from the ED, and tried to determine which groups of patients were most likely to be unnecessarily transferred. Methods This was a retrospective chart review performed on patients transferred from UCCs to our ED. If the transferred patient had no advanced imaging tests, advanced procedures, or specialty consultations in the ED, and was not admitted, we considered the transfer to be unnecessary. Patients were stratified by age (adult vs. pediatric) and type of insurance. Results We identified 3232 patients who were transferred from UCCs to our ED over a 1-year period. Among those, 1159 (35.9%; 95% confidence interval [CI] 34.2–37.5%) met our criteria as unnecessary, and 2075 (64.2%; 95% CI 62.5–65.8%) were discharged from the ED. Notably, pediatric patients were more likely than adult patients to be unnecessarily transferred. Patients without medical insurance were not more likely to be transferred than those with private insurance. Conclusion Most patients transferred to our ED from a UCC were discharged, and many transfers were unnecessary, especially those involving pediatric patients. These transfers may represent an economic burden to our society.

Use of ivermectin in agro-ecosystems negatively affects non-target dung beetles, which provide keystone ecosystem services for pasture functioning. While the direct effects of ivermectin on dung beetles are at the center of scientific attention, its long-lasting effects on routinely treated pastures have not yet been studied on real communities and under field conditions. We focused on basic characteristics (species richness, abundance, biomass) and functionality (dung removal ability represented by guild composition) of dung beetle communities in response to ivermectin treatment. We selected 15 sites with routine ivermectin treatment and 11 without any treatment, both for at least five consecutive years prior to our sampling. We covered wide range of climatic conditions in the Czech Republic, seasonal variability, and sampled the dung of four main herbivore dung types. Additionally, we separated the samples from ivermectin treated sites into two categories, i) recently treated representing immediate effects (treated 8 weeks, expected sublethal or inconsequential levels of residues). Ivermectin treated sites had ca. 35% lower species richness and 44% lower abundance per pat. Per pat biomass did not change. However, from a functional perspective, ivermectin use significantly decreased the biomass of beetles with high contribution to dung removal (relocating and dwelling beetles), while the biomass of beetles with low contribution (dung visiting adults with saprophagous larvae) was not affected. This was accomplished with decrease in per pat functionality at treated sites, i.e., the dung removal ability of the community. Our results highlight that the effects of ivermectin use can last far beyond its physical presence in the grazing system. Via its effects on dung beetles, routine antiparasitic treatment by ivermectin has negative consequences for both pasture biodiversity and ecosystem functioning. Therefore, all alternatives should be carefully considered to ensure that the positives of any antiparasitic treatment outweigh the damages. In areas where biodiversity is of concern, as well as in organic farming systems, all precautions should be taken to avoid excretion of toxic residues on-site.