Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm.

BACKGROUND: Single-centre series of the management of patients with ruptured abdominal aortic aneurysm (AAA) are usually too small to identify clinical factors that could improve patient outcomes. METHODS: IMPROVE is a pragmatic, multicentre randomized clinical trial in which eligible patients with a clinical diagnosis of ruptured aneurysm were allocated to a strategy of endovascular aneurysm repair (EVAR) or to open repair. The influences of time and manner of hospital presentation, fluid volume status, type of anaesthesia, type of endovascular repair and time to aneurysm repair on 30-day mortality were investigated according to a prespecified plan, for the subgroup of patients with a proven diagnosis of ruptured or symptomatic AAA. Adjustment was made for potential confounding factors. RESULTS: Some 558 of 613 randomized patients had a symptomatic or ruptured aneurysm: diagnostic accuracy was 91·0 per cent. Patients randomized outside routine working hours had higher operative mortality (adjusted odds ratio (OR) 1·47, 95 per cent confidence interval 1·00 to 2·17). Mortality rates after primary and secondary presentation were similar. Lowest systolic blood pressure was strongly and independently associated with 30-day mortality (51 per cent among those with pressure below 70 mmHg). Patients who received EVAR under local anaesthesia alone had greatly reduced 30-day mortality compared with those who had general anaesthesia (adjusted OR 0·27, 0·10 to 0·70). CONCLUSION: These findings suggest that the outcome of ruptured AAA might be improved by wider use of local anaesthesia for EVAR and that a minimum blood pressure of 70 mmHg is too low a threshold for permissive hypotension

Pharmacokinetic/pharmacodynamic modelling approaches in paediatric infectious diseases and immunology.

Pharmacokinetic/pharmacodynamic (PKPD) modelling is used to describe and quantify dose-concentration-effect relationships. Within paediatric studies in infectious diseases and immunology these methods are often applied to developing guidance on appropriate dosing. In this paper, an introduction to the field of PKPD modelling is given, followed by a review of the PKPD studies that have been undertaken in paediatric infectious diseases and immunology. The main focus is on identifying the methodological approaches used to define the PKPD relationship in these studies. The major findings were that most studies of infectious diseases have developed a PK model and then used simulations to define a dose recommendation based on a pre-defined PD target, which may have been defined in adults or in vitro. For immunological studies much of the modelling has focused on either PK or PD, and since multiple drugs are usually used, delineating the relative contributions of each is challenging. The use of dynamical modelling of in vitro antibacterial studies, and paediatric HIV mechanistic PD models linked with the PK of all drugs, are emerging methods that should enhance PKPD-based recommendations in the future

The Effects of Characteristics of the Board of Commissioners and Audit Committee on the Level of Risk Disclosure in Financial Sector Service Companies in the Banking Sector Listed on the Indonesia Stock Exchange in the Period 2015-2017

The aim of this study is to examine the effects of the board of commissioners and audit committee characteristics such as the proportion of independent commissioners, the board of commissioner size, frequency of board meetings, audit committee size, the proportion of independent audit committee and frequency of audit committee meetings on the level of risk disclosures. The results show that the frequency of board meetings, the proportion of independent audit committee and frequency of audit committee meetings significantly affect the level of risk disclosures, while the proportion of independent commissioners, the board of commissioner size, and audit committee size do not significantly affect the level of risk disclosures. The results show that the proportion of independent commissioners, the board of commissioner size, frequency of board meetings, audit committee size, the proportion of independent audit committee and frequency of audit committee meetings simultaneously have significant effects on the level of risk disclosures. The results of the study provide investors the information regarding the risk that companies could have, and they are also useful as a basis for making decision

Voting for Committees in Agreeable Societies

We examine the following voting situation. A committee of $k$ people is to be formed from a pool of n candidates. The voters selecting the committee will submit a list of $j$ candidates that they would prefer to be on the committee. We assume that $j \leq k < n$. For a chosen committee, a given voter is said to be satisfied by that committee if her submitted list of $j$ candidates is a subset of that committee. We examine how popular is the most popular committee. In particular, we show there is always a committee that satisfies a certain fraction of the voters and examine what characteristics of the voter data will increase that fraction.Comment: 11 pages; to appear in Contemporary Mathematic