545 research outputs found
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Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.
BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700
A Descriptive Catalogue of the Latin Manuscripts in the John Rylands Library at Manchester
Title from publisher's bibliographic system (viewed on 25 Nov 2014)
A Descriptive Catalogue of the Manuscripts in the Library of Gonville and Caius College
Title from publisher's bibliographic system (viewed on 25 Nov 2014)
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Unpublished description by M.R. James of Cambridge, University Library, MS Ll.5.15 (Petrus Riga, Aurora)
Between 1926 and 1930, M.R. James was employed by Cambridge University Library to prepare descriptions of its medieval manuscripts, with a view to superseding the information provided by the five-volume catalogue published between 1856 and 1867. In all, James prepared descriptions of over 1,200 of the Library's manuscripts. However, the unfinished (and often hurried) state of his work, together with the difficulty of deciphering his handwriting, meant that plans to publish his work in the years immediately after his death in 1936 had to be abandoned. Between 2002 and 2011, transcriptions of James's notes were compiled piecemeal by University Library staff, with a view to making them more widely available, but also to aid the preservation of the originals (now accessioned into the University Archives as UA ULIB 7/3/74). This transcription was prepared by Dr Martin Blake. For further information, see: James Freeman, 'Unpublished descriptions of western medieval manuscripts at Cambridge University Library', Transactions of the Cambridge Bibliographical Society (2020); James Freeman, 'M.R. James's descriptions', Cambridge University Library Special Collections Subject Guide (https://www.lib.cam.ac.uk/collections/departments/manuscripts-university-archives/subject-guides/medieval-manuscripts-2/mr); Jayne Ringrose, 'The legacy of M.R. James in Cambridge University Library', in The legacy of M.R. James: Papers from the 1995 Cambidge Symposium, ed. by Lynda Dennison (Donington: Shaun Tyas, 2001), pp. 23-36
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Unpublished description by M.R. James of Cambridge, University Library, MS Dd.8.2 (Book of Hours, Use of Sarum)
Between 1926 and 1930, M.R. James was employed by Cambridge University Library to prepare descriptions of its medieval manuscripts, with a view to superseding the information provided by the five-volume catalogue published between 1856 and 1867. In all, James prepared descriptions of over 1,200 of the Library's manuscripts. However, the unfinished (and often hurried) state of his work, together with the difficulty of deciphering his handwriting, meant that plans to publish his work in the years immediately after his death in 1936 had to be abandoned. Between 2002 and 2011, transcriptions of James's notes were compiled piecemeal by University Library staff, with a view to making them more widely available, but also to aid the preservation of the originals (now accessioned into the University Archives as UA ULIB 7/3/74). This transcription was prepared by Dr Martin Blake. For further information, see: James Freeman, 'Unpublished descriptions of western medieval manuscripts at Cambridge University Library', Transactions of the Cambridge Bibliographical Society (2020); James Freeman, 'M.R. James's descriptions', Cambridge University Library Special Collections Subject Guide (https://www.lib.cam.ac.uk/collections/departments/manuscripts-university-archives/subject-guides/medieval-manuscripts-2/mr); Jayne Ringrose, 'The legacy of M.R. James in Cambridge University Library', in The legacy of M.R. James: Papers from the 1995 Cambidge Symposium, ed. by Lynda Dennison (Donington: Shaun Tyas, 2001), pp. 23-36
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Unpublished description by M.R. James of Cambridge, University Library, MS Ll.2.16 (L. Annaeus Seneca, Tragoediae)
Between 1926 and 1930, M.R. James was employed by Cambridge University Library to prepare descriptions of its medieval manuscripts, with a view to superseding the information provided by the five-volume catalogue published between 1856 and 1867. In all, James prepared descriptions of over 1,200 of the Library's manuscripts. However, the unfinished (and often hurried) state of his work, together with the difficulty of deciphering his handwriting, meant that plans to publish his work in the years immediately after his death in 1936 had to be abandoned. Between 2002 and 2011, transcriptions of James's notes were compiled piecemeal by University Library staff, with a view to making them more widely available, but also to aid the preservation of the originals (now accessioned into the University Archives as UA ULIB 7/3/74). This transcription was prepared by Dr Martin Blake. For further information, see: James Freeman, 'Unpublished descriptions of western medieval manuscripts at Cambridge University Library', Transactions of the Cambridge Bibliographical Society (2020); James Freeman, 'M.R. James's descriptions', Cambridge University Library Special Collections Subject Guide (https://www.lib.cam.ac.uk/collections/departments/manuscripts-university-archives/subject-guides/medieval-manuscripts-2/mr); Jayne Ringrose, 'The legacy of M.R. James in Cambridge University Library', in The legacy of M.R. James: Papers from the 1995 Cambidge Symposium, ed. by Lynda Dennison (Donington: Shaun Tyas, 2001), pp. 23-36
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Unpublished description by M.R. James of Cambridge, University Library, MS Dd.10.44 (Iohannes Platearius, Practica breuis; Synonyma herbarum; receipts for pills and electuaries)
Between 1926 and 1930, M.R. James was employed by Cambridge University Library to prepare descriptions of its medieval manuscripts, with a view to superseding the information provided by the five-volume catalogue published between 1856 and 1867. In all, James prepared descriptions of over 1,200 of the Library's manuscripts. However, the unfinished (and often hurried) state of his work, together with the difficulty of deciphering his handwriting, meant that plans to publish his work in the years immediately after his death in 1936 had to be abandoned. Between 2002 and 2011, transcriptions of James's notes were compiled piecemeal by University Library staff, with a view to making them more widely available, but also to aid the preservation of the originals (now accessioned into the University Archives as UA ULIB 7/3/74). This transcription was prepared by Dr Martin Blake. For further information, see: James Freeman, 'Unpublished descriptions of western medieval manuscripts at Cambridge University Library', Transactions of the Cambridge Bibliographical Society (2020); James Freeman, 'M.R. James's descriptions', Cambridge University Library Special Collections Subject Guide (https://www.lib.cam.ac.uk/collections/departments/manuscripts-university-archives/subject-guides/medieval-manuscripts-2/mr); Jayne Ringrose, 'The legacy of M.R. James in Cambridge University Library', in The legacy of M.R. James: Papers from the 1995 Cambidge Symposium, ed. by Lynda Dennison (Donington: Shaun Tyas, 2001), pp. 23-36
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Unpublished description by M.R. James of Cambridge, University Library, MS Dd.11.78 (Henry of Avranches, Vita et passio S. Thomae, De translatione eiusdem et de quodam Roberto, De quibusdam reuelationibus post martyrum beati Thomae, and other texts)
Between 1926 and 1930, M.R. James was employed by Cambridge University Library to prepare descriptions of its medieval manuscripts, with a view to superseding the information provided by the five-volume catalogue published between 1856 and 1867. In all, James prepared descriptions of over 1,200 of the Library's manuscripts. However, the unfinished (and often hurried) state of his work, together with the difficulty of deciphering his handwriting, meant that plans to publish his work in the years immediately after his death in 1936 had to be abandoned. Between 2002 and 2011, transcriptions of James's notes were compiled piecemeal by University Library staff, with a view to making them more widely available, but also to aid the preservation of the originals (now accessioned into the University Archives as UA ULIB 7/3/74). This transcription was prepared by Dr Martin Blake. For further information, see: James Freeman, 'Unpublished descriptions of western medieval manuscripts at Cambridge University Library', Transactions of the Cambridge Bibliographical Society (2020); James Freeman, 'M.R. James's descriptions', Cambridge University Library Special Collections Subject Guide (https://www.lib.cam.ac.uk/collections/departments/manuscripts-university-archives/subject-guides/medieval-manuscripts-2/mr); Jayne Ringrose, 'The legacy of M.R. James in Cambridge University Library', in The legacy of M.R. James: Papers from the 1995 Cambidge Symposium, ed. by Lynda Dennison (Donington: Shaun Tyas, 2001), pp. 23-36
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