19 research outputs found

    Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

    Get PDF
    IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

    Scoped types and aspects for real-time Java memory management

    No full text
    Abstract. Real-time systems are notoriously difficult to design and implement, and, as many real-time problems are safety-critical, their solutions must be reliable as well as efficient and correct. While higher-level programming models (such as the Real-Time Specification for Java) permit real-time programmers to use language features that most programmers take for granted (objects, type checking, dynamic dispatch, and memory safety) the compromises required for real-time execution, especially concerning memory allocation, can create as many problems as they solve. This paper presents Scoped Types and Aspects for Real-Time Systems (STARS) a novel programming model for real-time systems. Scoped Types give programmers a clear model of their programs ’ memory use, and, being statically checkable, prevent the run-time memory errors that bedevil the RTSJ. Adopting the integrated Scoped Types and Aspects approach can significantly improve both the quality and performance of a real-time Java systems, resulting in simpler systems that are reliable, efficient, and correct.

    Increasing risk of Amazonian drought due to decreasing aerosol pollution

    Get PDF
    The Amazon rainforest plays a crucial role in the climate system, helping to drive atmospheric circulations in the tropics by absorbing energy and recycling about half of the rainfall that falls on it. This region (Amazonia) is also estimated to contain about one-tenth of the total carbon stored in land ecosystems, and to account for one-tenth of global, net primary productivity. The resilience of the forest to the combined pressures of deforestation and global warming is therefore of great concern, especially as some general circulation models (GCMs) predict a severe drying of Amazonia in the twenty-first century. Here we analyse these climate projections with reference to the 2005 drought in western Amazonia, which was associated with unusually warm North Atlantic sea surface temperatures (SSTs). We show that reduction of dry-season (July–October) rainfall in western Amazonia correlates well with an index of the north–south SST gradient across the equatorial Atlantic (the 'Atlantic N–S gradient'). Our climate model is unusual among current GCMs in that it is able to reproduce this relationship and also the observed twentieth-century multidecadal variability in the Atlantic N–S gradient, provided that the effects of aerosols are included in the model. Simulations for the twenty-first century using the same model3, 8 show a strong tendency for the SST conditions associated with the 2005 drought to become much more common, owing to continuing reductions in reflective aerosol pollution in the Northern Hemisphere

    Observed climate change constrains the likelihood of extreme future global warming

    No full text
    If cooling due to present-day levels of atmospheric aerosol is suppressing global temperatures, future reductions in aerosols emissions would allow the full greenhouse gas induced warming to be realised. The many uncertainties in aerosol physics and chemistry mean that a large range of present-day aerosol cooling is possible which could imply a large climate sensitivity, extremely large future warming and the increased risk of catastrophic consequences. Despite large uncertainties in aerosol physics and chemistry, observed spatial and temporal patterns of past temperature change allow quantitative assessment of the strength of present-day aerosol cooling. Such observational constraints provide a probabilistic framework in which to assess the likelihood of extremely large warming if a very large suppression of global warming by aerosols were to be removed. The likelihoods of future warming extents are calculated assuming four scenarios of future anthropogenic emissions. While such results are still subject to uncertainty, they indicate that future warming by the end of the 21st century is likely to be between the extremes implied by very strong or very weak present-day aerosol cooling. It is very likely that present-day aerosol cooling is suppressing a major portion of current greenhouse warming

    First space-based observations of formic acid (HCOOH): Atmospheric Chemistry Experiment austral spring 2004 and 2005 Southern Hemisphere tropical-mid-latitude upper tropospheric measurements

    Full text link
    The first space-based measurements of upper tropospheric ( 110 - 300 hPa) formic acid (HCOOH) are reported from 0.02 cm(-1) resolution Atmospheric Chemistry Experiment (ACE) Fourier transform spectrometer solar occultation measurements at 16 degrees S - 43 degrees S latitude during late September to early October in 2004 and 2005. A maximum upper tropospheric HCOOH mixing ratio of 3.13 +/- 0.02 ppbv ( 1 ppbv = 10(-9) per unit volume), 1 sigma, at 10.5 km altitude was measured during 2004 at 29.97 degrees S latitude and a lower maximum HCOOH mixing ratio of 2.03 +/- 0.28 ppbv, at 9.5 km altitude was measured during 2005. Fire counts, back trajectories, and correlations of HCOOH mixing ratios with ACE simultaneous measurements of other fire products confirm the elevated HCOOH mixing ratios originated primarily from tropical fire emissions. A HCOOH emission factor relative to CO of 1.99 +/- 1.34 g kg(-1) during 2004 in upper tropospheric plumes is inferred from a comparison with lower mixing ratios measured during the same time period assuming HITRAN 2004 spectroscopic parameters
    corecore