22 research outputs found
The MAGIC trial: a pragmatic, multicentre, parallel, noninferiority, randomised trial of melatonin versus midazolam in the premedication of anxious children attending for elective surgery under general anaesthesia
\ua9 2023 The Author(s)Background: Child anxiety before general anaesthesia and surgery is common. Midazolam is a commonly used premedication to address this. Melatonin is an alternative anxiolytic, however trials evaluating its efficacy in children have delivered conflicting results. Methods: This multicentre, double-blind randomised trial was performed in 20 UK NHS Trusts. A sample size of 624 was required to declare noninferiority of melatonin. Anxious children, awaiting day case elective surgery under general anaesthesia, were randomly assigned 1:1 to midazolam or melatonin premedication (0.5 mg kg−1, maximum 20 mg) 30 min before transfer to the operating room. The primary outcome was the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes included safety. Results are presented as n (%) and adjusted mean differences with 95% confidence intervals. Results: The trial was stopped prematurely (n=110; 55 per group) because of recruitment futility. Participants had a median age of 7 (6–10) yr, and 57 (52%) were female. Intention-to-treat and per-protocol modified Yale Preoperative Anxiety Scale-Short Form analyses showed adjusted mean differences of 13.1 (3.7–22.4) and 12.9 (3.1–22.6), respectively, in favour of midazolam. The upper 95% confidence interval limits exceeded the predefined margin of 4.3 in both cases, whereas the lower 95% confidence interval excluded zero, indicating that melatonin was inferior to midazolam, with a difference considered to be clinically relevant. No serious adverse events were seen in either arm. Conclusion: Melatonin was less effective than midazolam at reducing preoperative anxiety in children, although the early termination of the trial increases the likelihood of bias. Clinical trial registration: ISRCTN registry: ISRCTN18296119
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The computational and energy cost of simulation and storage for climate science: lessons from CMIP6
The Coupled Model Intercomparison Project (CMIP) is one of the biggest international efforts aimed at better understanding the past, present, and future of climate changes in a multi-model context. A total of 21 model intercomparison projects (MIPs) were endorsed in its sixth phase (CMIP6), which included 190 different experiments that were used to simulate 40 000 years and produced around 40 PB of data in total. This paper presents the main findings obtained from the CPMIP (the Computational Performance Model Intercomparison Project), a collection of a common set of metrics, specifically designed for assessing climate model performance. These metrics were exclusively collected from the production runs of experiments used in CMIP6 and primarily from institutions within the IS-ENES3 consortium. The document presents the full set of CPMIP metrics per institution and experiment, including a detailed analysis and discussion of each of the measurements. During the analysis, we found a positive correlation between the core hours needed, the complexity of the models, and the resolution used. Likewise, we show that between 5 %–15 % of the execution cost is spent in the coupling between independent components, and it only gets worse by increasing the number of resources. From the data, it is clear that queue times have a great impact on the actual speed achieved and have a huge variability across different institutions, ranging from none to up to 78 % execution overhead. Furthermore, our evaluation shows that the estimated carbon footprint of running such big simulations within the IS-ENES3 consortium is 1692 t of CO2 equivalent.
As a result of the collection, we contribute to the creation of a comprehensive database for future community reference, establishing a benchmark for evaluation and facilitating the multi-model, multi-platform comparisons crucial for understanding climate modelling performance. Given the diverse range of applications, configurations, and hardware utilised, further work is required for the standardisation and formulation of general rules. The paper concludes with recommendations for future exercises aimed at addressing the encountered challenges which will facilitate more collections of a similar nature
The MAGIC trial: a pragmatic, multicentre, parallel, noninferiority, randomised trial of melatonin versus midazolam in the premedication of anxious children attending for elective surgery under general anaesthesia
BACKGROUND: Child anxiety before general anaesthesia and surgery is common. Midazolam is a commonly used premedication to address this. Melatonin is an alternative anxiolytic, however trials evaluating its efficacy in children have delivered conflicting results. METHODS: This multicentre, double-blind randomised trial was performed in 20 UK NHS Trusts. A sample size of 624 was required to declare noninferiority of melatonin. Anxious children, awaiting day case elective surgery under general anaesthesia, were randomly assigned 1:1 to midazolam or melatonin premedication (0.5 mg kg-1, maximum 20 mg) 30 min before transfer to the operating room. The primary outcome was the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF). Secondary outcomes included safety. Results are presented as n (%) and adjusted mean differences with 95% confidence intervals. RESULTS: The trial was stopped prematurely (n=110; 55 per group) because of recruitment futility. Participants had a median age of 7 (6-10) yr, and 57 (52%) were female. Intention-to-treat and per-protocol modified Yale Preoperative Anxiety Scale-Short Form analyses showed adjusted mean differences of 13.1 (3.7-22.4) and 12.9 (3.1-22.6), respectively, in favour of midazolam. The upper 95% confidence interval limits exceeded the predefined margin of 4.3 in both cases, whereas the lower 95% confidence interval excluded zero, indicating that melatonin was inferior to midazolam, with a difference considered to be clinically relevant. No serious adverse events were seen in either arm. CONCLUSION: Melatonin was less effective than midazolam at reducing preoperative anxiety in children, although the early termination of the trial increases the likelihood of bias. CLINICAL TRIAL REGISTRATION: ISRCTN registry: ISRCTN18296119