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

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

Compiling HPC Kernels for the REDEFINE CGRA

In this paper, we present a compilation flow for HPC kernels on the REDEFINE coarse-grain reconfigurable architecture (CGRA). REDEFINE is a scalable macro-dataflow machine in which the compute elements (CEs) communicate through messages. REDEFINE offers the ability to exploit high degree of coarse-grain and pipeline parallelism. The CEs in REDEFINE are enhanced with reconfigurable macro data-paths called HyperCells that enable exploitation of fine-grain and pipeline parallelism at the level of basic instructions in static dataflow order. Application kernels that exhibit regularity in computations and memory accesses such as affine loop nests benefit from the architecture of HyperCell 1], 2]. The proposed compilation flow aims at exposing high degree of parallelism in loop nests in HPC application kernels using polyhedral analysis and generates meta-data to effectively utilize the computational resources in HyperCells. Memory is explicitly managed through compiler's assistance. We address the compilation challenges such as partitioning with load balancing, mapping and scheduling computations and management of operand data while targeting multiple HyperCells in the REDEFINE architecture. The proposed solution scales well meeting the performance objectives of HPC computing

Energy Aware Synthesis of Application Kernels expressed in Functional Languages on a Coarse Grained Composable Reconfigurable Array

With transistor energy efficiency not scaling at the same rate as transistor density and frequency, CMOS technology has hit a utilization wall, whereby large portions of the chip remain underclocked. To improve performance, while keeping power dissipation at a realistic level, future computing devices will consist of heterogeneous application specific accelerators. The accelerators have to be synthesised from high level specifications and will be specialized for related classes of application kernels. In this paper we explore synthesizing application kernels expressed as functions, on a coarse grained composable reconfigurable array (CGCRA). The CGCRA consists of a set of reconfigurable datapaths called HyperCells, each of which can either compute an individual kernel, or can be composed together to compute a larger kernel. The proposed synthesis approach takes kernels expressed in a functional language, applies a sequence of well known program transformations, explores trade-offs between throughput and energy, and realizes the kernels on the CGCRA

Magnitude and pattern of hypertension among diabetics; risk prediction for stroke and myocardial infarction

Background: Hypertension and diabetes are closely related morbidities. Uncontrolled blood pressure in diabetic patients can pose severe threat to life. An attempt was made to screen for hypertension among diabetics and also to predict their risk for stroke or myocardial infarction. Material and Methods: Community-based cross-sectional study was conducted in an urban slum of Mysore. Data was collected between July and August 2011. Known diabetics residing in this area were included in the study. Socio-demographic information of diabetic patients, physician′s conduct in identifying hypertensives, advice for blood pressure check-up, and the extent of patient′s compliance to advice were assessed. Simultaneously subjects were screened for hypertension. Results: The study comprised of 104 patients. Only half of the subjects had an annual blood pressure recording by a physician. Prevalence of hypertension was 64.4% (67), with a known to unknown ratio of 1:2.5. Eleven (10.4%) diabetics with stage III hypertension have a very high risk of stroke and myocardial infarction. Conclusions: Timely diagnosis and management of hypertension among diabetics reduces the risk of cardiovascular complications. Physicians should adhere to guidelines and refocus on issues that influence patient′s compliance in monitoring their blood pressure

Energy aware synthesis of application kernels through composition of data-paths on a CGRA

Transistor supply voltages no longer scales at the same rate as transistor density and frequency of operation. This has led to the Dark Silicon problem, wherein only a fraction of transistors can operate at maximum frequency and nominal voltage, in order to ensure that the chip functions within the power and thermal budgets. Heterogeneous computing systems which consist of General Purpose Processors (GPPs), Graphic Processing Units (GPUs) and application specific accelerators can provide improved performance while keeping power dissipation at a realistic level. For the accelerators to be effective, they have to be specialized for related classes of application kernels and have to be synthesized from high level specifications. Coarse Grained Reconfigurable has been proposed as accelerators for a variety of application kernels. For CGRAs to be used as accelerators in the Dark Silicon era, a synthesis framework which focuses on optimizing energy efficiency, while achieving the target performance is essential. However, existing compilation techniques for CGRAs focuses on optimizing only for performance, and any reduction in energy is just a side-effect. In this paper we explore synthesizing application kernels expressed as functions, on a coarse grained composable reconfigurable array (CGCRA). The proposed reconfigurable array comprises HyperCells, which are reconfigurable macro-cells that facilitate modeling power and performance in terms of easily measurable parameters. The proposed synthesis approach takes kernels expressed in a functional language, applies a sequence of well known program transformations, explores trade-offs between throughput and energy using the power and performance models, and realizes the kernels on the CGCRA. This approach when used to map a set of signal processing and linear algebra kernels achieves resource utilization varying from 50% to 80%

RHyMe: REDEFINE HyperCell Multicore for Accelerating HPC Kernels

In this paper, we present an architecture named REDEFINE HyperCell Multicore (RHyMe) designed to efficiently realize HPC application kernels, such as loops. RHyMe relies on the compiler to generate the meta-data for its functioning. Most of the orchestration activity for executing kernels is governed by compiler generated meta-data made use of at runtime. In RHyMe, macro operations can be realized as a hardware overlay of MIMO operations on hardware structures called HyperCells. While a HyperCell enables exploiting fine-grain instruction level and pipeline parallelism, coarse-grain parallelism is exploited among multiple HyperCells. Regularity exhibited by computations such as loops results in efficient usage of simple compute hardware such as HyperCells as well as memory structures that can be managed explicitly

PERCEPTION AND PRACTICES REGARDING PHYSICAL ACTIVITY AMONG TEACHING FACULTY IN EDUCATIONAL INSTITUTIONS OF MYSORE

Background: An individual's diet and physical activity practices are largely influenced by his knowledge and attitudes towards these behaviors. Exploration of these variables in a population provides an insight into the factors that may be mediators of motivation to change behavior. Objective: To assess the perception and practices of physical activity among teaching faculty in selected educational institutions of Mysore. Material and Method: This cross sectional study was conducted among three teaching institutions which were selected using stratified random sampling technique. Eighty teaching staff available and gave consent for the study from high school, PU college and degree college were included. Method of data collection: A pretested semi structured questionnaire was used to interview the study subjects, which included details regarding socio-demographic characteristics and questions related to the perception and practice regarding physical activity. Results: Among eighty participants included in the study, only 56.7% were aware of importance of physical activity. Only 7.7% of study subjects were indulged in aerobics and jogging. Lacks of time and work commitment were the two major barriers for regular physical activity as perceived by the study subjects. 67.9% of the study subjects prefer home for their regular physical activity and 10.3% prefer it at workplace. BMI status revealed that 43.6% were overweight and 45.9% were found to be obese. Conclusion: Majority of study subjects perceive that regular physical activity is necessary for good health, but the practice of the same was not regular and up to the recommended level. © Copy Right, IJRSR, 2014, Academic Journals. All rights reserved. Key words: xxxxxxx INTRODUCTION Regular physical activity is associated with positive health gain and it has been suggested that promoting physical activity is a "Public Health's best buy". Physical activity is defined as any bodily movement produced by skeletal muscles that require energy expenditure. Regular moderate intensity physical activity such as walking, cycling, or participating in sports has significant benefits for health. For instance, it can reduce the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression. Moreover adequate levels of physical activity will decrease the risk of a hip or vertebral fracture and help control weight. WHO developed the "Global Recommendations on Physical Activity for Health" with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of physical activity needed for the prevention of NCDs. Overweight and physical inactivity are risk factors for increased disease burden and health care expenditure (Wong ND et al, 2000). An individual's diet and physical activity habits are influenced by their knowledge and attitudes towards these behaviors. Investigation of these variables in a population provides an insight into the factors that may be mediators of motivation to change behavior MATERIAL AND METHOD A list of all the high schools, PU colleges and degree colleges in Mysore city which come under the school health program of department of Community Medicine, JSS Medical College were obtained. From each of existing three strata one institution was randomly selected. After obtaining permissions from the head of the institution all the eighty teaching faculty members who were available on the day of visit and consenting to participate in the study were interviewed using a pretested semi-structured questionnaire. After briefing the purpose of the study demographic details of each subject was collected and questions regarding their perceptions and practice of physical activity were asked. Anthropometric measurements like height, weight and BMI were done among all the study subjects using standardized techniques. Statistical analysis Data collected was entered in MS excel version 2010 and analyzed using the same. Descriptive statistical measures like percentages mean and standard deviations were applied

Synthesis of Instruction Extensions on HyperCell, a Reconfigurable Datapath

In this paper we present HyperCell as a reconfigurable datapath for Instruction Extensions (IEs). HyperCell comprises an array of compute units laid over a switch network. We present an IE synthesis methodology that enables post-silicon realization of IE datapaths on HyperCell. The synthesis methodology optimally exploits hardware resources in HyperCell to enable software pipelined execution of IEs. Exploitation of temporal reuse of data in HyperCell results in significant reduction of input/output bandwidth requirements of HyperCell

Task Allocation of Safety-Critical Applications on Reconfigurable Multi-Core Architectures

With the onset of multi-core chips, the single-core market is closing down. Developing avionics systems hosted on multi-core chips that enforce safety-criticality constraints constitutes a challenge for the aerospace industry. This paper presents a reconfigurable multi-core architecture and studies its suitability for hosting safety-critical embedded applications. A task allocation algorithm for this specific architecture is proposed, and the last section demonstrates its behavior and analyzes its efficiency