Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Measurement of hadronic event shapes in high-p T multijet final states at √s = 13 TeV with the ATLAS detector

A measurement of event-shape variables in proton-proton collisions at large momentum transfer is presented using data collected at s = 13 TeV with the ATLAS detector at the Large Hadron Collider. Six event-shape variables calculated using hadronic jets are studied in inclusive multijet events using data corresponding to an integrated luminosity of 139 fb−1. Measurements are performed in bins of jet multiplicity and in different ranges of the scalar sum of the transverse momenta of the two leading jets, reaching scales beyond 2 TeV. These measurements are compared with predictions from Monte Carlo event generators containing leading-order or next-to-leading order matrix elements matched to parton showers simulated to leading-logarithm accuracy. At low jet multiplicities, shape discrepancies between the measurements and the Monte Carlo predictions are observed. At high jet multiplicities, the shapes are better described but discrepancies in the normalisation are observed. [Figure not available: see fulltext.

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Jet energy scale and resolution measured in proton–proton collisions at √s = 13 TeV with the ATLAS detector

Jet energy scale and resolution measurements with their associated uncertainties are reported for jets using 36–81 fb−1 of proton–proton collision data with a centreof-mass energy of √s = 13 TeV collected by the ATLAS detector at the LHC. Jets are reconstructed using two different input types: topo-clusters formed from energy deposits in calorimeter cells, as well as an algorithmic combination of charged-particle tracks with those topo-clusters, referred to as the ATLAS particle-flow reconstruction method. The antikt jet algorithm with radius parameter R = 0.4 is the primary jet definition used for both jet types. This result presents new jet energy scale and resolution measurements in the high pileup conditions of late LHC Run 2 as well as a full calibration of particle-flow jets in ATLAS. Jets are initially calibrated using a sequence of simulation-based corrections. Next, several in situ techniques are employed to correct for differences between data and simulation and to measure the resolution of jets. The systematic uncertainties in the jet energy scale for central jets (|η| &lt; 1.2) vary from 1% for a wide range of high-pT jets (250 &lt; pT &lt; 2000 GeV), to 5% at very low pT (20 GeV) and 3.5% at very high pT (&gt; 2.5 TeV). The relative jet energy resolution is measured and ranges from (24 ± 1.5)% at 20 GeV to (6 ± 0.5)% at 300 GeV

Measurements of top-quark pair single- and double-differential cross-sections in the all-hadronic channel in pp collisions at s = 13 TeV using the ATLAS detector

Abstract: Differential cross-sections are measured for top-quark pair production in the all-hadronic decay mode, using proton-proton collision events collected by the ATLAS experiment in which all six decay jets are separately resolved. Absolute and normalised single- and double-differential cross-sections are measured at particle and parton level as a function of various kinematic variables. Emphasis is placed on well-measured observables in fully reconstructed final states, as well as on the study of correlations between the top-quark pair system and additional jet radiation identified in the event. The study is performed using data from proton-proton collisions at s = 13 TeV collected by the ATLAS detector at CERN’s Large Hadron Collider in 2015 and 2016, corresponding to an integrated luminosity of 36.1 fb−1. The rapidities of the individual top quarks and of the top-quark pair are well modelled by several independent event generators. Significant mismodelling is observed in the transverse momenta of the leading three jet emissions, while the leading top-quark transverse momentum and top-quark pair transverse momentum are both found to be incompatible with several theoretical predictions

Search for Higgs boson decays into two new low-mass spin-0 particles in the 4b channel with the ATLAS detector using pp collisions at √s = 13 TeV

This paper describes a search for beyond the Standard Model decays of the Higgs boson into a pair of new spin-0 particles subsequently decaying into b -quark pairs, H → a a → ( b ¯ b ) ( b ¯ b ) , using proton-proton collision data collected by the ATLAS detector at the Large Hadron Collider at center-of-mass energy √ s = 13     TeV . This search focuses on the range 15     GeV ≤ m a ≤ 30     GeV , where the decay products are collimated; it is complementary to a previous search in the same final state targeting the range 20     GeV ≤ m a ≤ 60     GeV , where the decay products are well separated. A novel strategy for the identification of the a → b ¯ b decays is deployed to enhance the efficiency for topologies with small separation angles. The search is performed with 36     fb − 1 of integrated luminosity collected in 2015 and 2016 and sets upper limits on the production cross section of H → a a → ( b ¯ b ) ( b ¯ b ) , where the Higgs boson is produced in association with a Z boson

Measurements of top-quark pair single- and double-differential cross-sections in the all-hadronic channel in pp collisions at s = 13 TeV using the ATLAS detector

Abstract: Differential cross-sections are measured for top-quark pair production in the all-hadronic decay mode, using proton-proton collision events collected by the ATLAS experiment in which all six decay jets are separately resolved. Absolute and normalised single- and double-differential cross-sections are measured at particle and parton level as a function of various kinematic variables. Emphasis is placed on well-measured observables in fully reconstructed final states, as well as on the study of correlations between the top-quark pair system and additional jet radiation identified in the event. The study is performed using data from proton-proton collisions at s = 13 TeV collected by the ATLAS detector at CERN’s Large Hadron Collider in 2015 and 2016, corresponding to an integrated luminosity of 36.1 fb−1. The rapidities of the individual top quarks and of the top-quark pair are well modelled by several independent event generators. Significant mismodelling is observed in the transverse momenta of the leading three jet emissions, while the leading top-quark transverse momentum and top-quark pair transverse momentum are both found to be incompatible with several theoretical predictions