Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. Methods: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. Findings: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30–30·30 million) new cases of TBI and 0·93 million (0·78–1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331–412) per 100 000 population for TBI and 13 (11–16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40–57·62 million) and of SCI was 27·04 million (24·98–30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (−0·2% [–2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (−3·6% [–7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0–10·4 million) YLDs and SCI caused 9·5 million (6·7–12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82–141) per 100 000 for TBI and 130 (90–170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. Interpretation: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments. Funding: Bill & Melinda Gates Foundation

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

BACKGROUND: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. METHODS: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). FINDINGS: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29-146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0- 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25-1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39-1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65-1·60]; p=0·92). INTERPRETATION: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention. FUNDING: British Heart Foundation

Operational Resilience of the Indian IT-BPM Industry during the COVID-19 Pandemic – A Case Study

The whole world witnessed the COVID-19 outbreak in the initial months of the year 2020,including India that announced a nationwide lockdown to break the virus transmission chain.Total lockdown imposed in India laid restrictions not only on how people commute but alsofunctioning of all government, private and commercial establishments, except emergency andessential services. Travel and tourism, aviation, hospitality sectors and other industrialestablishments incurred a heavy loss throughout this lockdown period while only a fewIndustries were able to continue their functioning without violating the laws of the land.However, Information Technology and Business Process Management (IT-BPM) is one suchIndustry, which could exhibit operational resiliency in the wake of COVID-19 by providingwork from home option, which was indeed not a new concept for this technology industry. Itplayed a major role in creating a virtual workplace that could continue its operations byenabling one to be at a safe and comfort zone of their homes. Work from home would not havebeen successful without employee co-operation, relaxation in government regulations,technology advancement, etc. Over 32,000 registered information technology (IT) firmsoperate in the country. 7.9% of India's Gross domestic product (GDP) is contributed by the ITand BPM industries and about 41 lakh professionals are employed. Transitioning from aconventional work model to work from home model was not a simple task as it involved a lotof challenges like Information security threat, work life imbalance, psychological disorder, etcassociated with it. This paper examines the way how IT-BPM industry enabled the work fromhome model during initial days of pandemic. Further operational resilience, influencingaspects, financial status and latest industrial developments related to IT-BPM Industry havealso been studied. A systematic SWOC analysis has been conducted to understand thestrengths, weaknesses, opportunities and challenges to the IT-BPM industry during work fromhome model. Some recommendations are also made based on the SWOC analysis

Open Source Intelligence and its Applications in Next Generation Cyber Security - A Literature Review

Purpose: Research serves as a springboard for new ideas, and every scholarly research begins with a review of the literature. This literature review to familiarize oneself with the domain of research and to establish the credibility of the work. It also aids in the integration and summarization of the subject. Methodology: The necessary literature on the chosen topic have been gathered from multiple secondary data sources such as journals, conference proceedings, books, research papers published in various reputable publications, and then shortlisted the literature which are relevant for the work. The shortlisted literatures were carefully evaluated by reading each paper and taking notes as needed. The information gathered is then analyzed in order to identify the problem areas that may exist in the chosen topic. Findings/Result: It has been observed that the chosen topic, Opensource Intelligence (OSINT) practice requires more robust and intelligent solutions from AI and its subfields. The capability of OSINT for intelligent analysis strengthens tightly integrating machine learning and automated reasoning techniques. To avoid human errors, the dependency on humans in decision-making ought to reduce. To eradicate any incorrect information, a truth discovery process is mandatory. OSINT is able to discover new knowledge by correlating intelligence from other OSINT sources. Even though Artificial Intelligence has entered the OSINT field, there is still a long way to go before OSINT fully prepares for the much-anticipated Web 3.0. Originality: A literature review have had been carried out using secondary data gathered from various online sources, and new knowledge in the form of findings was derived in order to construct a theoretical framework and methodology for future research. It has been ensured that no judgments or decisions are made with a biased mindset or under the influence of any predetermined mentality. A concerted effort has been made to identify a research topic for further investigation. Paper Type: Literature Review

E-Commerce to Multinational Conglomerate: Journey of Alibaba Group – A Case Study

The late 20th century witnessed a massive growth in the usage of Internet worldwide. Many eCommerce companies blossomed during this era. Realizing the need of having e-commercebusiness in China, Alibaba.com got established by former English teacher Ma Yun, popularlyknown as Jack Ma, along with 17 other partners. During the dot com bubble burst, many of theUS based e-commerce companies’ either had to shut down or went bankrupts except Chinesebased Alibaba.com as Chinese market was immune to the recession. Clear vision and intelligentleadership quality of Jack Ma turned e-commerce Company into a largest online commercecompany of China within a short span of time. Alibaba continued its journey of growth bothorganically and inorganically by acquiring other companies. Later in 2009 Alibaba groupentered into cloud computing business, and started to develop artificial intelligence solutionsto support its own platform and to solve complex real-world problems. Alibaba diversified itsrevenue sources by expanding business to different domains within two decades of its inceptionto reach US $72 billion. Presently, the Alibaba group has pioneered in consulting, e-commerce,finance, technology, artificial intelligence and many more. The study in this paper describeshow the Alibaba group continued its journey towards success along with business model, majorbusinesses, financial status and corporate social responsibility. To understand the strengths,weaknesses, opportunities and challenges of the Alibaba group, a methodical SWOC analysiswas conducted. Based on the SWOC analysis, some recommendations are also provided

Open Source Intelligence and its Applications in Next Generation Cyber Security - A Literature Review

Purpose: Research serves as a springboard for new ideas, and every scholarly research begins with a review of the literature. This literature review to familiarize oneself with the domain of research and to establish the credibility of the work. It also aids in the integration and summarization of the subject. Methodology: The necessary literature on the chosen topic have been gathered from multiple secondary data sources such as journals, conference proceedings, books, research papers published in various reputable publications, and then shortlisted the literature which are relevant for the work. The shortlisted literatures were carefully evaluated by reading each paper and taking notes as needed. The information gathered is then analyzed in order to identify the problem areas that may exist in the chosen topic. Findings/Result: It has been observed that the chosen topic, Opensource Intelligence (OSINT) practice requires more robust and intelligent solutions from AI and its subfields. The capability of OSINT for intelligent analysis strengthens tightly integrating machine learning and automated reasoning techniques. To avoid human errors, the dependency on humans in decision-making ought to reduce. To eradicate any incorrect information, a truth discovery process is mandatory. OSINT is able to discover new knowledge by correlating intelligence from other OSINT sources. Even though Artificial Intelligence has entered the OSINT field, there is still a long way to go before OSINT fully prepares for the much-anticipated Web 3.0. Originality: A literature review have had been carried out using secondary data gathered from various online sources, and new knowledge in the form of findings was derived in order to construct a theoretical framework and methodology for future research. It has been ensured that no judgments or decisions are made with a biased mindset or under the influence of any predetermined mentality. A concerted effort has been made to identify a research topic for further investigation. Paper Type: Literature Review.</jats:p