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Venovenous extracorporeal membrane oxygenation (VV ECMO) has been used to treat severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome; however, patient selection criteria have evolved throughout the pandemic. In this study, we sought to determine the association of patient mortality with time from positive COVID-19 test and infiltrate on chest radiograph (x-ray) to VV ECMO cannulation. We hypothesized that an increasing duration between a positive COVID-19 test or infiltrates on chest x-ray and cannulation would be associated with increased mortality. This is a single-center retrospective chart review of COVID-19 VV ECMO patients from March 1, 2020 to July 28, 2021. Unadjusted and adjusted multivariate analyses were performed to assess for mortality differences. A total of 93 patients were included in our study. Increased time, in days, from infiltrate on chest x-ray to cannulation was associated with increased mortality in both unadjusted (5-9, P = 0.002) and adjusted regression analyses (odds ratio [OR]: 1.49, 95% CI: 1.22-1.81, P0.01). Time from positive test to cannulation was not found to be significant between survivors and nonsurvivors (7.5-11, P = 0.06). Time from infiltrate on chest x-ray to cannulation for VV ECMO should be considered when assessing patient candidacy. Further larger cohort and prospective studies are required.

Prone positioning has been widely utilized in ARDS management before and during the COVID-19 pandemic due to its demonstrated mortality benefits. In pregnancy, proning requires careful attention to often overlooked physiologic changes in pregnancy and additional technical challenges accompanying a gravid abdomen. The purpose of this manuscript is to demonstrate a proning technique that was successfully used at our institution to avoid premature delivery of the fetus while improving maternal outcomes. All technical challenges are addressed in the instructional videos using a pregnant model with twin gestation at 32 weeks.We reviewed all the patients' charts with positive SARS-CoV-2 from March 2020 until July 2020 and identified those who developed ARDS. Subsequently, we identified four patients that were proned during the antepartum period. We described their clinical course, including the change in ventilatory parameters in relationship with proning timing. Stepwise instructions for self-proning and proning in mechanically ventilated patients are illustrated in video format.During the study period, we identified 100 pregnant patients with SARS-CoV-2 infection. Mechanical ventilation was required in 8 of these patients. In four cases, proning was performed during the antepartum period. We were able to improve the P/F ratio while decreasing FiOProning remains a well-proven intervention in ARDS and should be considered in pregnant women when indicated. We recognize that proning might not be effective in all cases. However, proning positioning is an option to improve oxygenation in patients with severe hypoxemia when the next consideration is delivery of a premature infant or maternal cannulation for extracorporeal membrane oxygenation.

BackgroundRecovery after SARS-CoV-2 infection is extremely variable, with some individuals recovering quickly, and others experiencing persistent long-term symptoms or developing new symptoms after the acute phase of infection, including fatigue, poor concentration, impaired attention, or memory deficits. Many existing studies reporting cognitive deficits associated with SARS-CoV-2 infection are limited by the exclusive use of self-reported measures or a lack of adequate comparison groups.MethodsForty-five participants, ages 18-70, (11 Long-COVID, 14 COVID, and 20 No-COVID) underwent behavioral testing with the NIH Toolbox Neuro-Quality of Life survey and selected psychometric tests, including a flanker interference task and the d2 Test of Attention.ResultsWe found greater self-reported anxiety, apathy, fatigue, emotional dyscontrol, sleep disturbance and cognitive dysfunction in COVID compared No-COVID groups. After categorizing COVID patients according to self-reported concentration problems, we observed declining performance patterns in multiple attention measures across No-COVID controls, COVID and Long-COVID groups. COVID participants, compared to No-COVID controls, exhibited worse performance on NIH Toolbox assessments, including the Eriksen Flanker, Nine-Hole Pegboard and Auditory Verbal Learning tests.ConclusionThis study provides convergent evidence that previous SARS-CoV-2 infection is associated with impairments in sustained attention, processing speed, self-reported fatigue and concentration. The finding that some patients have cognitive and visuomotor dysfunction in the absence of self-reported problems suggests that SARS-CoV-2 infection can have unexpected and persistent subclinical consequences.

Objective To quantify neuropsychiatric symptoms reported by individuals with Post-Acute Sequelae of COVID-19 (PASC) using the NIH Toolbox for Assessment of Neurological and Behavioral Function (NIHTB) and Patient-Reported Outcomes Measurement Information System (PROMIS). Methods 30 PASC (20 women, 21–63 years) and 27 control (16 women, 25–68 years) participants completed three NIHTB batteries and selected PROMIS tests. Group differences on fully corrected T-scores were evaluated using analysis of covariance and Cohen’s d effect sizes. A linear regression model predicted the effects from time since diagnosis. Results PASC had poorer emotional health and motor function than controls, including poorer locomotion, endurance and dexterity, but normal cognitive function, ∼7 months post-infection. PASC participants had a steeper age-related decline on the 2-Minute Walk Endurance Test than controls. T-scores on four cognitive and three motor tests improved with longer time since diagnosis. Conclusion NIHTB and PROMIS captured the poorer emotional health and motor function in PASC, including the novel findings of deficits in locomotion and dexterity. The normal cognitive performance suggests subclinical effects that may be compensated by neural and cognitive reserves, and manifested subjectively by the negative psychological effects and fatigue. The persistent emotional and psychiatric symptoms necessitate mental health treatment be prioritized.

BACKGROUND: We aimed to assess the efficacy and safety of two neutralising monoclonal antibody therapies (sotrovimab [Vir Biotechnology and GlaxoSmithKline] and BRII-196 plus BRII-198 [Brii Biosciences]) for adults admitted to hospital for COVID-19 (hereafter referred to as hospitalised) with COVID-19.METHODS: In this multinational, double-blind, randomised, placebo-controlled, clinical trial (Therapeutics for Inpatients with COVID-19 [TICO]), adults (aged ≥18 years) hospitalised with COVID-19 at 43 hospitals in the USA, Denmark, Switzerland, and Poland were recruited. Patients were eligible if they had laboratory-confirmed SARS-CoV-2 infection and COVID-19 symptoms for up to 12 days. Using a web-based application, participants were randomly assigned (2:1:2:1), stratified by trial site pharmacy, to sotrovimab 500 mg, matching placebo for sotrovimab, BRII-196 1000 mg plus BRII-198 1000 mg, or matching placebo for BRII-196 plus BRII-198, in addition to standard of care. Each study product was administered as a single dose given intravenously over 60 min. The concurrent placebo groups were pooled for analyses. The primary outcome was time to sustained clinical recovery, defined as discharge from the hospital to home and remaining at home for 14 consecutive days, up to day 90 after randomisation. Interim futility analyses were based on two seven-category ordinal outcome scales on day 5 that measured pulmonary status and extrapulmonary complications of COVID-19. The safety outcome was a composite of death, serious adverse events, incident organ failure, and serious coinfection up to day 90 after randomisation. Efficacy and safety outcomes were assessed in the modified intention-to-treat population, defined as all patients randomly assigned to treatment who started the study infusion. This study is registered with ClinicalTrials.gov, NCT04501978.FINDINGS: Between Dec 16, 2020, and March 1, 2021, 546 patients were enrolled and randomly assigned to sotrovimab (n=184), BRII-196 plus BRII-198 (n=183), or placebo (n=179), of whom 536 received part or all of their assigned study drug (sotrovimab n=182, BRII-196 plus BRII-198 n=176, or placebo n=178; median age of 60 years [IQR 50-72], 228 [43%] patients were female and 308 [57%] were male). At this point, enrolment was halted on the basis of the interim futility analysis. At day 5, neither the sotrovimab group nor the BRII-196 plus BRII-198 group had significantly higher odds of more favourable outcomes than the placebo group on either the pulmonary scale (adjusted odds ratio sotrovimab 1·07 [95% CI 0·74-1·56]; BRII-196 plus BRII-198 0·98 [95% CI 0·67-1·43]) or the pulmonary-plus complications scale (sotrovimab 1·08 [0·74-1·58]; BRII-196 plus BRII-198 1·00 [0·68-1·46]). By day 90, sustained clinical recovery was seen in 151 (85%) patients in the placebo group compared with 160 (88%) in the sotrovimab group (adjusted rate ratio 1·12 [95% CI 0·91-1·37]) and 155 (88%) in the BRII-196 plus BRII-198 group (1·08 [0·88-1·32]). The composite safety outcome up to day 90 was met by 48 (27%) patients in the placebo group, 42 (23%) in the sotrovimab group, and 45 (26%) in the BRII-196 plus BRII-198 group. 13 (7%) patients in the placebo group, 14 (8%) in the sotrovimab group, and 15 (9%) in the BRII-196 plus BRII-198 group died up to day 90.INTERPRETATION: Neither sotrovimab nor BRII-196 plus BRII-198 showed efficacy for improving clinical outcomes among adults hospitalised with COVID-19.FUNDING: US National Institutes of Health and Operation Warp Speed.

Korsakoff's syndrome (KS) is characterized by dense anterograde amnesia resulting from damage to the diencephalon region, typically resulting from chronic alcohol abuse and thiamine deficiency. This review assesses the integrity of the implicit memory system in KS, focusing on studies of procedural learning and priming. KS patients are impaired on several measures of procedural memory, most likely due to impairment in cognitive functions associated with alcohol-related neural damage outside of the diencephalon. The pattern of performance on tasks of implicit priming suggests reliance on a residual, non-flexible memory operating more or less in an automatic fashion. Our review concludes that whether measures of implicit memory reveal intact or impaired performance in individuals with KS depends heavily on specific task parameters and demands, including timing between stimuli, the specific nature of the stimuli used in a task, and the integrity of supportive cognitive functions necessary for performance.

This essay argues that in evoking and imagining vivid representations of Jewish bodily difference, Michael Chabon's The Amazing Adventures of Kavalier and Clay and Philip Roth's The Plot Against America produce subjects whose distanced, critical relation to U.S. national culture is legible on their bodies. Rendering mid-twentieth-century Jewish visibility in hyperbolic terms, these texts suggest that ethnicity, queerness, and disability should be read in intimate conjunction with one another and as in some way accountable to one another. By contrast, the Jewish Americans in Tony Kushner's Caroline, or Change , while outsiders in Louisiana in the 1960s, inhabit a space of white privilege and align themselves with dominant racial and national narratives. Kushner's text, then, illuminates the stakes of Chabon's and Roth's imaginative (indeed, counter-factual) efforts to denaturalize the link between Jewish bodies and American national identity.

When journalists and cultural critics discussed the arrest of Harvard scholar Henry Louis Gates Jr. for "disorderly conduct" in July 2009, a particular phrase appeared with regularity Gates was arrested, we heard time and again, "in his own home." Most readers will remember that Gates was arrested after an argument with Cambridge, Massachusetts, police, who came to investigate a report that two men were attempting to force open the front door of a home in an upper-middle-class neighborhood near the Harvard campus. We now know that Gates, just offa transcontinental flight, was actually trying to wrest open his own jammed front door, with the help of his driver. Critics, of course, typically invoked Gates s occupancy of his "own home" in order to underline the outrageousness of his arrest. Mark Anthony Neal (2009), for instance, points out, "Few would begrudge Professor Gates s rage ... in response to the questioning of his right to be in his own home." President Obama himself declared that the police had "acted stupidly in arresting somebody when there was already proof that they were in their own home" (Seelye 2009). And Stanley Fish (2009), writing in the New York Times, alludes to the rights and privileges that home ownership is supposed to confer, suggesting that the perceived implausibility of an African American man occupying a particular kind of home - large, well-appointed, and in a prestigious neighborhood - played a large part in the unfolding of the encounter. He recalls the disbelief that attended Gates s tenure at Duke, where, Fish tells us, Gates purchased and began to renovate the "grandest home in town." In Durham, Gates was frequently taken for a service worker at his own home; "the message was unmistakable: What was a black man doing in a place like this?" Critics, then, legitimately foreground the skepticism that greets an African American man in such a neighborhood. At the same time, they take for granted his right to all of the security, privacy, and respect that possession of such a home is supposed to guarantee. The density of detail in which the story of Gates s encounter with Sergeant Crowley was embedded - the emphasis in the press coverage on the texture and tenor of the Cambridge neighborhood and the PBS documentary on which Gates had been working in China - kept Gates s class privilege visible to the public from the start. A number of critics pointed out that Gates s arrest, while shocking and anomalous when it happens to a distinguished Harvard professor - one who counts New York Times columnists and even the president of the United States as friends - are of course routine events for African Americans, especially men, throughout the United States. As Mark Anthony Neal (2009) writes, "Our concerns should reflect the regularity of such abuse, not just the selective outrage that befits those of more privilege." Michael Eric Dyson similarly suggests that Gates was guilty of "HWB, Housing While Black," and contends that "if a famous and affluent black man in his own home can be accosted, arrested, and humiliated, then all black folk can reasonably expect the same treatment" (2009; emphasis added). What went uninterrogated and undisputed in the rush of critical commentary that followed the arrest was the presumption of the latitude and deference - the "safety" from outside intervention and general hassle - that should attend a homeowner when he is within the parameters of "his own home." Certainly, as Neal and Dyson attest, this is a profoundly classed notion, attaching to the middleclass or wealthy homeowner in a way that it does not to the working-class or poor inhabitant of a rented or government-subsidized domestic space. I would argue as well that the remarkably, even hyperbolically, male tableau that followed the fallout from the arrest - when President Barack Obama invited both Gates and Sergeant Crowley to have a beer at the White House with him and vice president Joe Biden - did nothing to dispel the sense that notions of sanctity and security within the home continue to have a male face. …

Recent research suggests that cocaine may directly affect the pathobiology of HIV by causing immune alterations in different lymphocytes such as helper T cells (CD4), suppressor/cytotoxic T cells (CD8), and natural killer (NK) cells.1 Studies show that cocaine interferes with the body’s ability to defend against infection by inhibiting the effector functions of neutrophils and macrophages, and by suppressing cytokine production, decreasing operation of important immune responses.2 Cocaine also enhances the replication of HIV in vitro.3 Cells from chronic cocaine users more readily support HIV replication and development of AIDS-defining opportunistic infections than cells from nonusers, suggesting a direct role for cocaine in the acquisition and progression of AIDS.2 Recently, cocaine has been shown to cause membrane permeability facilitating endothelial transmigration of infected dendritic cells across the blood brain barrier to the central nervous system.4 There is also evidence of cocaine-mediated alteration of immune responses and host resistance due to disturbances in the balance of Th1 pro-inflammatory versus Th2 anti-inflammatory cytokines and lipid bioeffectors.3 Epidemiologic research confirms that crack users are at high risk for HIV infection and progression.5-6 In a prospective study of HIV-seropositive drug users, crack use was significantly associated with progression to AIDS.7 A study of HIV-positive current and former drug users found that active cocaine use was the strongest predictor of failure to maintain viral suppression; 13% of active users maintained suppression vs. 46% of non-users.8 In a prospective cohort study, compared with nonusers and former users, active cocaine and heroin users experienced smaller median reductions in HIV-1 RNA and smaller median increases in CD4 from baseline, controlling for antiretroviral exposure, adherence, and socio-demographic factors.9 Compared to nonusers, the risk of AIDS-related opportunistic conditions was greater for persistent users and intermittent users during periods of active use, with no difference during periods of abstinence.10 Mixed results characterize studies of drug users in exclusively female U.S. cohorts. In a multi-center cohort of HIV-positive women, injection drug use was not associated with progression to AIDS.11 Another large multi-site cohort study found that hard drug use (i.e., cocaine, heroin, methadone, or injecting drugs) was significantly associated with AIDS-defining illnesses, but not with change in CD4, HIV-RNA, or mortality.12 In a third multi-site cohort of HIV+ women, non-injection drug use was associated with time to AIDS-defining event but not with AIDS-related mortality.13 While suggestive, these studies and others focusing on injection drug use do not uniformly demonstrate a link between illicit drug use and HIV-1 disease progression.14-17 Possible reasons include: diverse definitions of illness progression; failure to differentiate between active and nonactive users; and lack of distinction between mortality due to AIDS versus non-AIDS causes.17 Other reasons include lack of controls for highly active antiretroviral therapy (HAART) use and adherence, and inadequate follow-up periods. We addressed all of these issues by examining patterns of crack use and their association with four distinct measures of HIV/AIDS disease progression in a multi-center cohort over an eight-and-one-half-year period during the HAART era.

Norman Mailer's 1957 essay "The White Negro" has long been regarded as a paradigmatic example of the white male investment in African American masculinity. Few contemporary discussions of the meanings that white men make of 'blackness' fail to invoke Mailer's essay; (1) indeed, his work often serves to name a whole US tradition of interracial desire and fantasy, from nineteenth-century blackface minstrelsy and the white romance with Harlem Renaissance 'primitivism,' to Elvis Presley and the countless interracial male 'buddy' films that Hollywood continues to produce. (2) "The White Negro" is certainly a part of this genealogy, as Eric Lott reminds us when he calls Mailer's essay "the twentieth century reinvention of [the] ... homosocial and homosexual fascinations" that animated minstrel performance (Love and Theft 54). But critical attention to the continuity of this tradition has been perhaps too insistent, working to obscure a central historical referent of Mailer's famous piece. The white preoccupation with black masculinity takes on new resonances, I will suggest, when a Jewish writer begins his 1957 essay with an allusion to the "psychic havoc of the concentration camps and the atom bomb" (338). When critics do locate Mailer's essay within its historical moment, (3) they tend to align it with other 1950s expressions of "generational rebellion" that appealed to the presumed authenticity of blackness to deliver white hipsters from the bleak conformity of the nuclear age. (4) Mailer's celebration of the downtown hip subculture does recall, for instance, Jack Kerouac's paean to the "life, joy, kicks, darkness ... night" he believed were the province of the "Negro" (181), while Allen Ginsberg's "Howl" suggests as well that the beats looked to black culture to "fix their needs" (Lhamon 72). But it is the specificity of Mailer's racial fixation that I want to examine here, precisely because it has so often been called upon to describe a collective or a generational desire. When Mailer recoils from the "stench of fear [that] has come out of every pore of American life" and when he declares that the "heart of Hip is its emphasis upon courage at the moment of crisis" (355), he seeks to vanquish something more particular than the generic postwar anomie he invokes. Mailer's effort to appropriate a powerful phallic 'blackness' for the white hipster functions in part to mask the presence of another racial body: the Jewish victim of the Nazi Holocaust. Mailer's project here is of course by no means an unprecedented one. As Paul Breines and others have amply documented, there is a long history of efforts by Jewish male writers in the US--such as Mike Gold, Gerald Green, and Irwin Shaw, among many others--to "remasculinize" (5) the Jewish body, both before and after World War II, according to dominant notions of physical courage and heterosexual virility. (6) And as 1 suggest below, critics have paid ample attention to those Jewish male writers, ranging from Norman Podhoretz on the right to Ginsberg and Lenny Bruce on the left, who have worked prolifically both to worry about and to celebrate their own presumed linkages to African American masculinity. Mailer's essay occupies a peculiar place in this history, however. Ritually invoked in academic discussions of Jewish masculinity, "The White Negro" is at once read as a Jewish literary production by a Jewish male writer and, as Jeffrey Melnick suggests, simultaneously repositioned as a symptomatic expression of white male desire and anxiety. While Melnick aptly reminds us that "the history of white Negroism in the American twentieth century is a cultural field defined primarily by middle-class Jews engaged in significant acts of individual and group identity formation" (120), I argue here that the essay's own systematic occlusions have functioned successfully to re-write white Negroism as exactly that--white Negroism. My focus on Mailer here, then, does not reflect an effort to position him as the singular creator of a refurbished Jewish masculinity in the postwar era. …