We performed a retrospective study of Covid-19 in people with HIV (PWH). PWH with Covid-19 demonstrated severe lymphopenia and decreased CD4+ T cell counts. Levels of inflammatory markers, including C-reactive protein, fibrinogen, D-dimer, interleukin-6, interleukin-8, and TNF-alpha were commonly elevated. In all, 19/72 hospitalized individuals (26.4%) died and 53 (73.6%) recovered. PWH who died had higher levels of inflammatory markers and more severe lymphopenia than those who recovered. These findings suggest that PWH remain at risk for severe manifestations of Covid-19 despite ART and that those with increased markers of inflammation and immune dysregulation are at risk for worse outcomes.

The evidence surrounding US-guided CVC insertion supports its use in adult patients. Pediatric-specific literature is sparse and includes mixed results. As more pediatric emergency physicians adopt the use of point-of-care US, we expect an increase in data supporting its use for CVC placement in pediatric emergency department patients.

Emergency medicine residency program directors (PDs) in areas hit hardest by the initial U.S. COVID-19 pandemic surge faced novel and rapidly evolving organizational, educational, and resident wellness challenges. Despite variations in residency size, hospital setting, and patient population, PDs from eight residencies in "the epicenter" found uniformity in many of the lessons learned. Here we present those lessons and suggestions for high-yield preparation for running a residency during a surge. Of particular importance were frequent, transparent communication and stepwise staffing plans. Illness of residents and other staff occurred early and were substantially reduced as personal protective equipment protocols tightened. Wellness was compromised by anxiety and illness, with varying timelines. New, rich educational opportunities emerged. All programs declared ACGME pandemic status but remained able to maintain some educational offerings. Planning ahead for future surges can significantly reduce the real-time burden for residency leadership, which is particularly important as clinical demands on leadership may also increase with a surge.

Introduction: Commercial funding of randomized controlled trials (RCTs) is associated with positive results in other clinical areas. Methods: We searched the Evidence in Pediatric Intensive Care Database (epicc.mcmaster.ca). This database searches MEDLINE, EMBASE, LILACS and CENTRAL for pediatric critical care RCTs using comprehensive search strategies. We included RCTs published in English that compared two interventions and reported a primary outcome. We excluded cross-over and non-inferiority trials. Pairs of reviewers screened studies for eligibility and abstracted data. Discrepancies were resolved by consensus. Results: We included 151 trials, randomizing a total of 21 222 children, published between 1986 and July 4, 2013. 26 (17%) RCTs reported funding from a commercial source. The primary outcome results were positive in 58 (38%) trials, negative in 5 (3%), and not statistically significant in 64 (42%) of trials. Of 26 trials reporting commercial funding, 9 (35%) had positive results, which was not different from those that those that did not report commercial funding (49 of 125 (39%); p=0.66). Commercially funded trials were more often multicentered (46% vs. 21%; p=0.01) but were not more likely to study medications (58% in both groups), be stopped early (19% vs. 15%; p=0.61), or report blinding (73% vs. 54%; p=0.07) than those that did not report commercial funding. The median (IQR) number of participants enrolled was also not different (48 (35 to 181) vs. 60 (37 to 102) p=0.82). Using logistic regression, early stopping was independently associated with positive results (p=0.01) but commercial funding, year of publication, and use of a pharmaceutical intervention or blinding were not. Conclusions: Commercial funding is not common among pediatric critical care trials and does not appear to be associated with positive results in these trials. Introduction:Critically ill patients are a growing population in U.S. Emergency Departments (ED),requiring increasing physician time,higher intensity of treatments,and longer boarding times in the ED.The longer boarding times may be associated with increased mortality, as the patients are in a gray zone of uncertainty regarding the responsible physician team,management and communication.Inadequate communication between teams magnifies the potential for serious medical errors.Our project was designed to improve the quality of communication and safety of patient care by instituting a formal evaluation and handoff process between the ED physician/nurse team and the evaluating critical care team. The project goals were completion of an interdepartment handoff which includes identifying the responsible team, delineating exact management plans, and targeting the timeframe for ICU decision.The goal measures were