Immunoglobulin, glucocorticoid, or combination therapy for multisystem inflammatory syndrome in children: a propensity-weighted cohort study

Background Multisystem inflammatory syndrome in children (MIS-C), a hyperinflammatory condition associated with SARS-CoV-2 infection, has emerged as a serious illness in children worldwide. Immunoglobulin or glucocorticoids, or both, are currently recommended treatments. Methods The Best Available Treatment Study evaluated immunomodulatory treatments for MIS-C in an international observational cohort. Analysis of the first 614 patients was previously reported. In this propensity-weighted cohort study, clinical and outcome data from children with suspected or proven MIS-C were collected onto a web-based Research Electronic Data Capture database. After excluding neonates and incomplete or duplicate records, inverse probability weighting was used to compare primary treatments with intravenous immunoglobulin, intravenous immunoglobulin plus glucocorticoids, or glucocorticoids alone, using intravenous immunoglobulin as the reference treatment. Primary outcomes were a composite of inotropic or ventilator support from the second day after treatment initiation, or death, and time to improvement on an ordinal clinical severity scale. Secondary outcomes included treatment escalation, clinical deterioration, fever, and coronary artery aneurysm occurrence and resolution. This study is registered with the ISRCTN registry, ISRCTN69546370. Findings We enrolled 2101 children (aged 0 months to 19 years) with clinically diagnosed MIS-C from 39 countries between June 14, 2020, and April 25, 2022, and, following exclusions, 2009 patients were included for analysis (median age 8·0 years [IQR 4·2–11·4], 1191 [59·3%] male and 818 [40·7%] female, and 825 [41·1%] White). 680 (33·8%) patients received primary treatment with intravenous immunoglobulin, 698 (34·7%) with intravenous immunoglobulin plus glucocorticoids, 487 (24·2%) with glucocorticoids alone; 59 (2·9%) patients received other combinations, including biologicals, and 85 (4·2%) patients received no immunomodulators. There were no significant differences between treatments for primary outcomes for the 1586 patients with complete baseline and outcome data that were considered for primary analysis. Adjusted odds ratios for ventilation, inotropic support, or death were 1·09 (95% CI 0·75–1·58; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids and 0·93 (0·58–1·47; corrected p value=1·00) for glucocorticoids alone, versus intravenous immunoglobulin alone. Adjusted average hazard ratios for time to improvement were 1·04 (95% CI 0·91–1·20; corrected p value=1·00) for intravenous immunoglobulin plus glucocorticoids, and 0·84 (0·70–1·00; corrected p value=0·22) for glucocorticoids alone, versus intravenous immunoglobulin alone. Treatment escalation was less frequent for intravenous immunoglobulin plus glucocorticoids (OR 0·15 [95% CI 0·11–0·20]; p<0·0001) and glucocorticoids alone (0·68 [0·50–0·93]; p=0·014) versus intravenous immunoglobulin alone. Persistent fever (from day 2 onward) was less common with intravenous immunoglobulin plus glucocorticoids compared with either intravenous immunoglobulin alone (OR 0·50 [95% CI 0·38–0·67]; p<0·0001) or glucocorticoids alone (0·63 [0·45–0·88]; p=0·0058). Coronary artery aneurysm occurrence and resolution did not differ significantly between treatment groups. Interpretation Recovery rates, including occurrence and resolution of coronary artery aneurysms, were similar for primary treatment with intravenous immunoglobulin when compared to glucocorticoids or intravenous immunoglobulin plus glucocorticoids. Initial treatment with glucocorticoids appears to be a safe alternative to immunoglobulin or combined therapy, and might be advantageous in view of the cost and limited availability of intravenous immunoglobulin in many countries. Funding Imperial College London, the European Union's Horizon 2020, Wellcome Trust, the Medical Research Foundation, UK National Institute for Health and Care Research, and National Institutes of Health

Problems of quality of tourist space management

Presented collection of articles constitutes the summary of research undertaken by the editor and the authors within the scope of the project entitled “Tourism for the Region Integrated Program of Development for Doctoral Students”, financed from European Union funds within the scope of the European Social Fund. Articles present conclusions from research on the quality of tourism management in the region of Lodz. They were confronted with the assessment of the effectiveness of the process in the Norwegian Oppland County, performed during the execution of the aforementioned project, and mainly during a studio visit conducted in the first week of May 2012

Mechanical exposures research of S-60M Cannon

W artykule omówiono modernizację systemów sterowania powszechnie stosowanych w wojsku polskim armat przeciwlotniczych S-60. Opisano sposób przeprowadzenia badań poligonowych w celu wyznaczenia wartości przyspieszeń i czasów w dwunastu punktach na armacie, podczas strzelania ogniem pojedynczym i seriami. Podano wyniki pomiarów. Omówiono charakter przebiegu drgań.Control systems modernizing S-60 anti-aircraft cannons, generally used in the Polish Army, are discussed in this paper. A method of military field tests to determine accelerations in twelve points of cannon, during single and series shooting fire is described. Measurement results are presented. Character of the vibrations process is discussed

Financing the development of tourism in the Łódź Voivodeship and Oppland county (Norway)

In this paper, the authors determined the specific features of the construction of budgets in Poland and Norway and showed areas of tourism occurrence in the budget classifications of both countries. Then, thoroughly analysed the expenditures made by municipalities and counties of the Lodz region, booked in the financial accounts which content was strongly connected with tourism. Authors had focused on direct relationship, as well as indirect effects on the development of tourism through promotion, development of culture and sport. The obtained results were compared with corresponding values observed in the Norwegian county of Oppland and its municipalities. It should be emphasized that by completing the research project, authors gained knowledge to identify strengths and weaknesses of the of local budgets in Poland and Norway. Flexibility of classification and the high comparability of local government units\\\' budgets at all levels are the main advantages of Polish budgets. On the other hand, the precise description of budgets and high quality of official statistics are undoubtedly advantages of Norwegian local government budgets. The fact is that the resources available to the Norwegian local authorities, even after taking into account the difference between purchasing power of the Norwegian krone and Polish zloty, are objectively higher. It is worth noting that the amount of funds allocated to finance specific activities, such as those related to the development of tourism, cannot be equated with the efficiency of their spending. However this question was not the subject of research undertaken by the authors. Described research project gives the authors the ability to assess the position of tourism in the Polish and Norwegian budget classification. Although the Polish classification revealed a dedicated account that was directly connected with tourism, at the same time it was diagnosed to have minor importance in planning and constructing local budgets. Therefore, the problem with both Polish and Norwegian budgets is the lack of possibilities to perform simple estimations of the amount of resources assigned to the areas of tourism development. The authors suggest to perform a specific study within this range and develop a diagnosis of individual tasks financed by the government and determine the degree of their impact on the development of tourism in the municipalities or counties. Therefore they hope that this article will be a contribution to make further research on the importance of tourism in local government budgets

Regional transport network as a determinant of the location of logistics centres in the Łódź voivodeship

Artykuł określa wpływ lokalizacji i znaczenia węzłów transportowych, przebiegu sieci drogowej na rozmieszczenie centrów logistycznych. Analiza oparta była na danych dotyczących istniejącej i aktualnie rozwijanej sieci drogowej o znaczeniu regionalnym, krajowym i międzynarodowym. Dzięki zrealizowanym badaniom możliwe było wskazanie, w jakim zakresie rzeczywiście uwzględniono wagę węzłów sieci transportowej oraz międzynarodową i lokalną politykę transportową w dotychczasowych decyzjach lokalizacyjnych. Pod względem metodycznym udało się wskazać lokalizacje optymalne. Przede wszystkim udało się jednak ocenić podjęte dotąd decyzje lokalizacyjne, w tym wskazać znaczenie różnych determinant owych decyzji. Na podstawie uzyskanych wyników autorzy sformułowali uniwersalne rekomendacje dotyczące rozwoju regionalnej sieci transportowej. Realizacja tematu wynikała z badań podjętych przez autorów na zlecenie Urzędu Miasta Łodzi. Badania dotyczyły charakterystyki i kierunków rozwoju intermodalnych centrów logistycznych w kontekście funkcjonowania Transeuropejskich Sieci Transportowych (TEN-T) w województwie łódzkim, a w szczególności w Łódzkim Obszarze Metropolitalnym.The main focus of the paper is to indicate the impact and significance of the location of transport hubs and road’s network for the location of logistics centres. The analysis was based on existing and constructed roads’ (regional, national and international level) data. Therefore, it was possible to determine the influence of the transport hubs, international and local transport policy on previous location decisions. Authors identified optimal locations of logistic centres in the Łódź region. Furthermore, authors assessed the location decisions and their determinants. Finally, universal recommendations for the development of the regional transport network have been formulated. This work was partially founded by the Municipality of Łódź. The study focused on the characteristics and trends of development of intermodal logistics centres in the context of the operation of the Trans-European Transport Network (TEN-T) in the Łódź region, particularly in the Łódź Metropolitan Area