7 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

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    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

    Going Electric: Expert Survey on the Future of Battery Technologies for Electric Vehicles

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    The paper describes the results of a survey, carried out with leading EU experts, on the capacity of both fully electric and plug-in hybrid vehicles to reach commercial success in the next twenty years. The success of electric transport is hampered by a combination of low range, scarce efficiency and high costs of batteries. Costs are expected to decrease in response to increasing sales volume and technical improvements, and advances would result from adequate investments in research, development and demonstration (RD&D). Experts' judgements are collected to shed light on the inherently uncertain relationship between RD&D efforts and consequent technical progress, and to assess the complex dynamics that will hinder or support the widespread diffusion of electric vehicles. The analysis of the experts' data results in a number of important policy recommendations to guide future RD&D choices and target commitments both for the EU and its member states

    A genetic algorithm for the design of job rotation schedules considering ergonomic and competence criteria

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    Job rotation is an organizational strategy increasingly used in manufacturing systems as it provides benefits to both workers and management in an organization. Job rotation prevents musculoskeletal disorders, eliminates boredom and increases job satisfaction and morale. As a result, the company gains a skilled and motivated workforce, which leads to increases in productivity, employee loyalty and decreases in employee turnover. A multi-criteria genetic algorithm is employed to generate job rotation schedules, with considering the most adequate employee-job assignments to prevent musculoskeletal disorders caused by accumulation of fatigue. The algorithm provides the best adequacy available between workers and the competences needed for performing the tasks. The design of the rotation schedules is based not only on ergonomic criteria but also on issues related to product quality and employee satisfaction. 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