7 research outputs found
Assessing the full costs of floodplain buyouts
- Publication venue
- Springer Science and Business Media B.V.
- Publication date
- 01/01/2021
- Field of study
Get PDFGiven projected increases in flood damages, managed retreat strategies are likely to become more widespread. Voluntary buyouts, where governments acquire flood-damaged properties and return the sites to open space, have been the primary form of federally funded retreat in the USA to date. However, little attention has been paid to the cost structure of buyout projects. Using a transaction cost framework, we analyze the costs of activities that comprise floodplain buyouts. Federal data do not distinguish transaction costs, but they do suggest that the cost of purchasing properties often accounts for 80% or less of total project costs. Through a systematic review (n = 1103 publications) and an analysis of government budgets (across n = 859 jurisdiction-years), we find limited sources with relevant cost information, none of which reports transaction costs. The absence of activity-level cost data inhibits more targeted policy reform to support community-driven and efficient buyout programs. Better data collection and reporting can inform more impactful and equitable buyout policy
Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
- Author
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- Abdul Rasheed A.
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- Publication venue
- Springer Science and Business Media LLC
- Publication date
- 31/01/2024
- Field of study
Get PDFDimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome
Dimethyl fumarate in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
- Author
- Abbas M.
- Abdul Rasheed A.
- Abdul A.
- Abdul-Kadir R.
- Abdusamad K.
- Abernethy K.
- Aboelela H.
- Abouzaid M.
- Abraham M.
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- Abrams J.
- Abu H.
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- Acton C.
- Adam F.
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- Addo A.
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- Adewunmi E.
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- Al-Saadi Z.
- Al-Shahi Salman R.
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- Alegria A.
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- Central Coordinating Office (for the RECOVERY Collaborative Group)
- Century H.
- Chadwick J.
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- Chakraborty A.
- Chamberlain S.
- Chambers E.
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- Chauhan R.
- Chawla V.
- Chen F.
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- Chiswick C.
- Chivima B.
- Chmiel C.
- Chrisopoulou A.
- Christian P.
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- Christmas D.
- Church E.
- Cianci N.
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- Clifford S.
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- Coker O.
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- Collini Paul
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- Colton H.
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- Data Monitoring Committee of the RECOVERY Collaborative Group
- Daunt A.
- Dave V.
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- Duran B.
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- Duru I.
- Dymond H.
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- D’Mello A.
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- Elgohary A.
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- Evison L.
- Ezenduka C.
- Fairbairn I.
- Fairclough A.
- Falconer E.
- Faluyi D.
- Fancois V.
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- Farzana S.
- Fatemi A.
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- Ferenando G.
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- Health records (for the RECOVERY Collaborative Group)
- Hector G.
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- Local Clinical Centre staff (for the RECOVERY Collaborative Group)
- Lock S.
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Get PDFDimethyl fumarate (DMF) inhibits inflammasome-mediated inflammation and has been proposed as a treatment for patients hospitalised with COVID-19. This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing multiple treatments in patients hospitalised for COVID-19 (NCT04381936, ISRCTN50189673). In this assessment of DMF performed at 27 UK hospitals, adults were randomly allocated (1:1) to either usual standard of care alone or usual standard of care plus DMF. The primary outcome was clinical status on day 5 measured on a seven-point ordinal scale. Secondary outcomes were time to sustained improvement in clinical status, time to discharge, day 5 peripheral blood oxygenation, day 5 C-reactive protein, and improvement in day 10 clinical status. Between 2 March 2021 and 18 November 2021, 713 patients were enroled in the DMF evaluation, of whom 356 were randomly allocated to receive usual care plus DMF, and 357 to usual care alone. 95% of patients received corticosteroids as part of routine care. There was no evidence of a beneficial effect of DMF on clinical status at day 5 (common odds ratio of unfavourable outcome 1.12; 95% CI 0.86-1.47; p = 0.40). There was no significant effect of DMF on any secondary outcome
Thigh-length compression stockings and DVT after stroke
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- Publication venue
- 'Elsevier BV'
- Publication date
- 01/07/1994
- Field of study
Get PDFControversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease
Mechanism of hERG inhibition by gating-modifier toxin, APETx1, deduced by functional characterization
- Author
- A Arcangeli
- AJ Agwa
- B Chagot
- B Webb
- CW Lee
- DJ Elliott
- DM Roden
- E Vargas
- F Atalar
- F Bezanilla
- F Delaglio
- FAA Mulder
- GCP van Zundert
- H Shen
- H Xu
- J Ebbinghaus
- J Herrington
- J Jehle
- J Liu
- J Sun
- J Sun
- JA Apud
- JH Morais Cabral
- JI Vandenberg
- JM Wang
- JR Groome
- JR Whicher
- JW Warmke
- K Nakajo
- KB Pointer
- KJ Swartz
- KJ Swartz
- KJ Swartz
- LR Phillips
- M Milescu
- M Schubert
- M Zhang
- M Zhang
- MC Sanguinetti
- MC Sanguinetti
- ME Curran
- N Kobayashi
- N Kobayashi
- N Kobayashi
- N Kobayashi
- P Guntert
- P Hidalgo
- R Koradi
- S Diochot
- S He
- S Kume
- S Peigneur
- SB Long
- SI Börjesson
- SJ Huffaker
- VR Rao
- W Wang
- X Chen
- Y Li
- Y Li-Smerin
- Y Shen
- Publication venue
- 'Springer Science and Business Media LLC'
- Publication date
- Field of study
No full textColorectal Endoscopic Stenting Trial (CReST) for obstructing left-sided colorectal cancer: randomized clinical trial
- Author
- Abercrombie J.F.
- Acheson A.
- Adams C.
- Agarwal A.K.
- Ahmad A.
- Ahmad F.
- Ahmad S.M.
- Akula J.
- Alderson D.
- Alderson D.
- Aldous J.
- Aldred L.
- Allison A.
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- Publication venue
- Oxford University Press
- Publication date
- 14/11/2022
- Field of study
No full textBackground
Colorectal cancer often presents with obstruction needing urgent, potentially life-saving decompression. The comparative efficacy and safety of endoluminal stenting versus emergency surgery as initial treatment for such patients is uncertain.
Methods
Patients with left-sided colonic obstruction and radiological features of carcinoma were randomized to endoluminal stenting using a combined endoscopic/fluoroscopic technique followed by elective surgery 1–4 weeks later, or surgical decompression with or without tumour resection. Treatment allocation was via a central randomization service using a minimization procedure stratified by curative intent, primary tumour site, and severity score (Acute Physiology And Chronic Health Evaluation). Co-primary outcome measures were duration of hospital stay and 30-day mortality. Secondary outcomes were stoma formation, stenting completion and complication rates, perioperative morbidity, 6-month survival, 3-year recurrence, resource use, adherence to chemotherapy, and quality of life. Analyses were undertaken by intention to treat.
Results
Between 23 April 2009 and 22 December 2014, 245 patients from 39 hospitals were randomized. Stenting was attempted in 119 of 123 allocated patients (96.7 per cent), achieving relief of obstruction in 98 of 119 (82.4 per cent). For the 89 per cent treated with curative intent, there were no significant differences in 30-day postoperative mortality (3.6 per cent (4 of 110) versus 5.6 per cent (6 of 107); P = 0.48), or duration of hospital stay (median 19 (i.q.r. 11–34) versus 18 (10–28) days; P = 0.94) between stenting followed by delayed elective surgery and emergency surgery. Among patients undergoing potentially curative treatment, stoma formation occurred less frequently in those allocated to stenting than those allocated to immediate surgery (47 of 99 (47.5 per cent) versus 72 of 106 (67.9 per cent); P = 0.003). There were no significant differences in perioperative morbidity, critical care use, quality of life, 3-year recurrence or mortality between treatment groups.
Conclusion
Stenting as a bridge to surgery reduces stoma formation without detrimental effects. Registration number: ISRCTN13846816 (http://www.controlled-trials.com)
Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial
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- Zullo C
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/02/2021
- Field of study
Get PDFBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19. Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) were eligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was 65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomly allocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall, 561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days (rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median 10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days (rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, no significant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilation or death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24). Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or other prespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restricted to patients in whom there is a clear antimicrobial indication. Funding UK Research and Innovation (Medical Research Council) and National Institute of Health Research
