Use of ultrasonographic examination in sheep veterinary practice

This review describes the current, emerging and potential applications of ultrasonography in the field of first-opinion sheep veterinary practice. The most widespread application is pregnancy diagnosis, where both transrectal and transabdominal ultrasonography offer a highly sensitive tool for, among others, detection of pregnancy, identification of foetal number and diagnosis of uterine abnormalities, e.g., metritis. The diagnostic applications of ultrasonography for imaging the lungs, heart, male genitourinary system and superficial swellings are also described. Through review of recent research in sheep and by analogy from applications in other animal species, the potential role of ultrasonography in screening programmes for cystic echinococcosis or ovine pulmonary adenocarcinoma, diagnosis of ocular and laryngeal disease and localisation of Coenurus cysts is explored

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Use of ultrasonographic examination in sheep veterinary practice

This review describes the current, emerging and potential applications of ultrasonography in the field of first-opinion sheep veterinary practice. The most widespread application is pregnancy diagnosis, where both transrectal and transabdominal ultrasonography offer a highly sensitive tool for, among others, detection of pregnancy, identification of foetal number and diagnosis of uterine abnormalities, e.g., metritis. The diagnostic applications of ultrasonography for imaging the lungs, heart, male genitourinary system and superficial swellings are also described. Through review of recent research in sheep and by analogy from applications in other animal species, the potential role of ultrasonography in screening programmes for cystic echinococcosis or ovine pulmonary adenocarcinoma, diagnosis of ocular and laryngeal disease and localisation of Coenurus cysts is explored. © 2016 Elsevier B.V

Impact of imposed mode 2 laser drive asymmetry on inertial confinement fusion implosions

Low-mode asymmetries have emerged as one of the primary challenges to achieving high-performing inertial confinement fusion implosions. These asymmetries seed flows in the implosions, which will manifest as modifications to the measured ion temperature (Tion) as inferred from the broadening of primary neutron spectra. The effects are important to understand both to learn to control and mitigate low-mode asymmetries, and to experimentally more closely capture thermal Tion used as input in implosion performance metric calculations. In this paper, results from and simulations of a set of experiments with a seeded mode 2 in the laser drive are described. The goal of this intentionally asymmetrically driven experiment was to test our capability to predict and measure the signatures of flows seeded by the low-mode asymmetry. The results from these experiments (first discussed in M Gatu Johnson et al, Phys. Rev. E 98, 051201(R) (2018)) demonstrate the importance of interplay of flows seeded by various asymmetry seeds. In particular, measured Tion and self-emission x-ray asymmetries are expected to be well captured by interplay between flow seeded by the imposed mode 2 and the capsule stalk mount. Measurements of areal density asymmetry also indicate the importance of the stalk mount as an asymmetry seed in these implosions. The simulations brought to bear on the problem (1D LILAC, 2D xRAGE, 3D ASTER and 3D Chimera) show how thermal Tion is expected to be significantly lower than Tion as inferred from the broadening of measured neutron spectra. They also show that the electron temperature is not expected to be the same as Tion for these implosions

Hospital’s activity-based financing system and manager: physician interaction

Hospital’s financing system, Strategic interaction, Activity-based payment system, I1, D4, D2,

Establishing reference values for central blood pressure and its amplification in a general healthy population and according to cardiovascular risk factors

Estimated central systolic blood pressure (cSBP) and amplification (Brachial SBP-cSBP) are non-invasive measures potentially prognostic of cardiovascular (CV) disease. No worldwide, multiple-device reference values are available. We aimed to establish reference values for a worldwide general population standardizing between the different available methods of measurement. How these values were significantly altered by cardiovascular risk factors (CVRFs) was then investigated.AtCor Medical via an unrestricted gran