Geological Net Zero and the need for disaggregated accounting for carbon sinks.

Achieving net zero global emissions of carbon dioxide (CO), with declining emissions of other greenhouse gases, is widely expected to halt global warming. CO emissions will continue to drive warming until fully balanced by active anthropogenic CO removals. For practical reasons, however, many greenhouse gas accounting systems allow some "passive" CO uptake, such as enhanced vegetation growth due to CO fertilisation, to be included as removals in the definition of net anthropogenic emissions.

Siltuximab for chimeric antigen receptor T-cell therapy-related CRS and ICANS: a multicenter retrospective analysis.

Chimeric antigen receptor T-cell (CAR-T) therapies are effective in many hematologic malignancies; however, adverse events including cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) can affect a significant number of patients. Those who develop refractory CRS or ICANS have few treatment options. Siltuximab, a monoclonal antibody binding circulating interleukin-6, has been proposed to have clinical activity in both CRS and ICANS.

Comparing 2-day vs 3-day flu-CY lymphodepleting regimens for CD19 CAR T-cell therapy in patients with non-hodgkin's lymphoma.

Introduction: Lymphodepleting chemotherapy (LDC) is critical to CAR T-cell expansion and efficacy. Despite this, there is not a consensus in the literature regarding the optimal LDC regimen, including dose and frequency.

Methods: We retrospectively reviewed consecutive patients at a single institution that received LDC prior to treatment with the CD19 directed CAR T-cell products axicabtagene ciloleucel and tisagenlecleucel.

Case Report: Use of Obinutuzumab as an Alternative Monoclonal Anti-CD20 Antibody in a Patient With Refractory Immune Thrombocytopenia Complicated by Rituximab-Induced Serum Sickness and Anti-Rituximab Antibodies.

Management of refractory immune thrombocytopenia frequently involves rituximab, a chimeric anti-CD20 monoclonal antibody, to target B cells and induce remission in most patients. However, neutralizing antibodies to rituximab that nullify therapeutic response and may lead to serum sickness have been rarely reported. Here, we present a case of a young adult woman with Evans syndrome treated with rituximab, complicated by the development of serum sickness, acute respiratory distress syndrome, and platelet refractoriness presumed secondary to neutralizing antibodies to rituximab.

Defibrotide Therapy for SARS-CoV-2 ARDS.

Background: SARS-CoV-2-related ARDS is associated with endothelial dysfunction and profound dysregulation of the thrombotic-fibrinolytic pathway. Defibrotide is a polyanionic compound with fibrinolytic, antithrombotic, and antiinflammatory properties.

Research Question: What is the safety and tolerability of defibrotide in patients with severe SARS-CoV-2 infections?

Study Design And Methods: We report a prospective, open-label, single-center safety trial of defibrotide for the management of SARS-CoV-2-related ARDS.

Methane and the Paris Agreement temperature goals.

Meeting the Paris Agreement temperature goal necessitates limiting methane (CH)-induced warming, in addition to achieving net-zero or (net-negative) carbon dioxide (CO) emissions. In our model, for the median 1.5°C scenario between 2020 and 2050, CH mitigation lowers temperatures by 0.

Impact of Pharmacogenetics on Intravenous Tacrolimus Exposure and Conversions to Oral Therapy.

CYP3A5 and CYP3A4 are the predominant enzymes responsible for tacrolimus metabolism; however only a proportion of the population expresses CYP3A5 secondary to genetic variation. CYP3A5 is expressed in both the intestine and the liver and has been shown to impact both the bioavailability and metabolism of orally administered tacrolimus. Increasing the initial tacrolimus dose by 50% to 100% is recommended in patients who are known CYP3A5 expressers; however, whether this dose adjustment is appropriate for i.

Lifetime climate impacts of diet transitions: a novel climate change accounting perspective.

Dietary transitions, such as eliminating meat consumption, have been proposed as one way to reduce the climate impact of the global and regional food systems. However, it should be ensured that replacement diets are indeed nutritious and that climate benefits are accurately accounted for. This study uses New Zealand food consumption as a case study for exploring the cumulative climate impact of adopting the national dietary guidelines and the substitution of meat from hypothetical diets.

Implementation and outcomes of a pharmacist-led collaborative drug therapy management program for oncology symptom management.

Introduction: Nausea, vomiting, constipation, and diarrhea are common cancer and cancer therapy adverse effects. Pharmacists are uniquely positioned to optimize patient symptom control and minimize excess use of hospital resources, such as emergency department visits.

Methods: Michigan Medicine oncology clinical pharmacists have been independently providing patient symptom management through a collaborative drug therapy management (CDTM) program which established guidelines for management of gastrointestinal toxicities (nausea, vomiting, diarrhea, and/or constipation) secondary to a patient's cancer diagnosis or treatment of the cancer.

Adjustments to pharmacologic therapies for hemophagocytic lymphohistiocytosis while on extracorporeal support.

Hemophagocytic lymphohistiocytosis (HLH) is an immune dysregulatory syndrome characterized by severe inflammation and end-organ damage. Due to significant organ dysfunction, patients often require extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT). In this report, we describe consideration for adjusting treatment in the context of extracorporeal organ support.

The use of mycophenolate mofetil area under the curve.

Purpose Of Review: Although mycophenolate mofetil (MMF) has been used successfully to treat a myriad of autoimmune diseases, its complex pharmacokinetics make it difficult to determine the true drug exposure for an individual patient. This review summarizes the body of literature focused on the gold standard measurement of the area under the curve (AUC) of mycophenolic acid (MPA), the active metabolite of MMF.

Recent Findings: Fixed dosing of MMF leads to highly variable drug exposure.

Agriculture's Contribution to Climate Change and Role in Mitigation Is Distinct From Predominantly Fossil CO-Emitting Sectors.

Agriculture is a significant contributor to anthropogenic global warming, and reducing agricultural emissions-largely methane and nitrous oxide-could play a significant role in climate change mitigation. However, there are important differences between carbon dioxide (CO), which is a stock pollutant, and methane (CH), which is predominantly a flow pollutant. These dynamics mean that conventional reporting of aggregated CO-equivalent emission rates is highly ambiguous and does not straightforwardly reflect historical or anticipated contributions to global temperature change.

Chemotherapy Remote Care Monitoring Program: Integration of SMS Text Patient-Reported Outcomes in the Electronic Health Record and Pharmacist Intervention for Chemotherapy-Induced Nausea and Vomiting.

Purpose: Chemotherapy-induced nausea and vomiting (CINV) is a common cause of unplanned healthcare utilization. The University of Michigan Rogel Cancer Center initiated the chemotherapy remote care monitoring program (CRCMP) to proactively identify patients experiencing CINV and intervene before the need for urgent evaluation.

Methods: High-risk patients for CINV are identified by neurokinin-1 (NK-1) antagonist administration, enrolled in the CRCMP, and received a daily text message survey for 7 days after chemotherapy administration to report symptoms.

A digital protein microarray for COVID-19 cytokine storm monitoring.

Despite widespread concern regarding cytokine storms leading to severe morbidity in COVID-19, rapid cytokine assays are not routinely available for monitoring critically ill patients. We report the clinical application of a digital protein microarray platform for rapid multiplex quantification of cytokines from critically ill COVID-19 patients admitted to the intensive care unit (ICU) at the University of Michigan Hospital. The platform comprises two low-cost modules: (i) a semi-automated fluidic dispensing/mixing module that can be operated inside a biosafety cabinet to minimize the exposure of the technician to the virus infection and (ii) a 12-12-15 inch compact fluorescence optical scanner for the potential near-bedside readout.

Tocilizumab for Treatment of Mechanically Ventilated Patients With COVID-19.

Background: Severe coronavirus disease 2019 (COVID-19) can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers, consistent with cytokine release syndrome for which IL-6 blockade is an approved treatment.

Methods: We assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation. The primary endpoint was survival probability postintubation; secondary analyses included an ordinal illness severity scale integrating superinfections.

A Digital Protein Microarray for COVID-19 Cytokine Storm Monitoring.

Despite widespread concern for cytokine storms leading to severe morbidity in COVID-19, rapid cytokine assays are not routinely available for monitoring critically ill patients. We report the clinical application of a machine learning-based digital protein microarray platform for rapid multiplex quantification of cytokines from critically ill COVID-19 patients admitted to the intensive care unit (ICU) at the University of Michigan Hospital. The platform comprises two low-cost modules: (i) a semi-automated fluidic dispensing/mixing module that can be operated inside a biosafety cabinet to minimize the exposure of technician to the virus infection and (ii) a 12-12-15 inch compact fluorescence optical scanner for the potential near-bedside readout.

Tocilizumab for treatment of mechanically ventilated patients with COVID-19.

Background: Severe COVID-19 can manifest in rapid decompensation and respiratory failure with elevated inflammatory markers. This presentation is consistent with cytokine release syndrome in chimeric antigen receptor T cell therapy, for which IL-6 blockade is approved treatment.

Methods: We assessed effectiveness and safety of IL-6 blockade with tocilizumab in a single-center cohort of patients with COVID-19 requiring mechanical ventilation.

Improved calculation of warming-equivalent emissions for short-lived climate pollutants.

Anthropogenic global warming at a given time is largely determined by the cumulative total emissions (or stock) of long-lived climate pollutants (LLCPs), predominantly carbon dioxide (CO), and the emission rates (or flow) of short-lived climate pollutants (SLCPs) immediately prior to that time. Under the United Nations Framework Convention on Climate Change (UNFCCC), reporting of greenhouse gas emissions has been standardised in terms of CO-equivalent (CO-e) emissions using Global Warming Potentials (GWP) over 100-years, but the conventional usage of GWP does not adequately capture the different behaviours of LLCPs and SLCPs, or their impact on global mean surface temperature. An alternative usage of GWP, denoted GWP*, overcomes this problem by equating an increase in the emission rate of an SLCP with a one-off "pulse" emission of CO.

Emissions from the road transport sector of New Zealand: key drivers and challenges.

The transport sector is the fastest growing greenhouse gas-emitting sector in the world and it is also a major source of emissions in New Zealand. Greenhouse gas (GHG) emissions from road transport increased by 84.3% between 1990 and 2016.

HAEMOPROTEUS ( PARAHAEMOPROTEUS) SPP. IN CAPTIVE-BRED BOBWHITE QUAIL ( COLINUS VIRGINIANUS) IN SOUTHERN UTAH, USA.

A captive-bred Bobwhite Quail ( Colinus virginianus) ranch in southern Utah, US experienced high mortality rates in the late summer and fall of 2012. Nine juvenile birds were necropsied at the Utah Veterinary Diagnostic Laboratory. Gross lesions included pale skeletal muscle with multifocal hemorrhages and petechiae in the air sacs and serosal surfaces of most organs.