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

Control of UFG microstructure in welded carbon steel tubes by cold drawing and annealing

The present study is made to develop ultra fine grained microstructure in welded steel tubes, through multiple cold drawing passes followed by an annealing treatment. The average ferrite grain size is reduced from 16 to 1.9 μm. SAE 1019M steel grade used for a typical automotive driveline component is studied. Strains between 0.3 and 1.4 followed by annealing at 400, 450 and 500° C are considered to optimize the combination of cold drawing strain and temperature required to produce ultra fine grained microstructure in steel tubes. At a strain value of 1.4 and annealing temperature, 500°C, polygonal ferrite grains and fine carbide particles are obtained. This microstructure is found to be suitable owing to its combination of high strength and good ductility in steel tubes. Tensile strength as high as 1,061 MPa and 9% elongation is obtained due to microstructural refinement. The strength is increased by 350 MPa compared to the strength of conventional cold-drawn welded tubes

EMOTION AND SARCASM IDENTIFICATION OF POSTS FROM FACEBOOK DATA USING A HYBRID APPROACH

Facebook has become the most important source of news and people’s feedback and opinion about almost every daily topic. Facebook represents one of the largest and most dynamic datasets of user generated content. Facebook posts can express opinions on different topics. With this massive amount of information in Facebook, there has to be an automatic tool that can categorize these information based on emotions. The proposed system is to develop a prototype that help to come to an inference about the emotions of the posts namely anger, surprise, happy, fear, sorrow, trust, anticipation and disgust with three sentic levels in each. This helps in better understanding of the posts when compared to the approaches which senses the polarity of the posts and gives just their sentiments i.e., positive, negative or neutral. The posts handling these emotions might be sarcastic too. When detecting sarcasm in social media posts, the various features that are especially inherent to Facebook must be considered with importance

Influence of counterbody material on fretting wear behaviour of surface mechanical attrition treated Ti-6Al-4V

Surface mechanical attrition treatment (SMAT) was carried out on Ti-6Al-4V. Fretting wear tests were conducted using two counterbody materials (alumina and steel). SMAT resulted in surface nanocrystallization. Due to high hardness, low tangential force coeffl{ligature}cient (TFC) and more TiO 2 layer, fretting wear resistance of SMAT treated samples was higher than that of the untreated samples. TFC values obtained with alumina counterbody were higher than those obtained with steel counterbody. The fretting wear resistance of untreated and treated samples fretted against alumina was lower than that of the samples fretted against steel due to tribochemical reactions at the contact zone. © 2012 Elsevier Ltd

Fretting wear behaviour of surface mechanical attrition treated alloy 718

Alloy 718 was subjected to surface mechanical attrition treatment (SMAT) using SAE 52100 steel balls of a 5 mm diameter for four different treatment durations (15, 30, 45 and 60 min). Fretting wear tests were conducted at different normal loads on untreated and treated samples for 25,000 cycles using alumina as a counterbody material. Microstructural features of the surface layer of samples treated by SMAT were characterized by cross-sectional optical microscopy and transmission electron microscopy. Hardness, surface roughness and residual stress were determined using a nano-indenter, surface roughness tester and X-ray residual stress analyzer respectively. SMAT resulted in the formation of nanocrystallites on the surface and near surface regions, increased hardness, increased surface roughness and compressive residual stress at the surface. Treated samples exhibited lower tangential force coefficient (TFC) compared to untreated samples. Samples treated for 60 min exhibited higher grain refinement, higher hardness, lower surface roughness and higher TFC compared to the samples treated for 30 min. The wear volume and wear rate of samples treated for 30 min were lower compared to those of the untreated samples, which may be attributed to an optimum combination of hardness and toughness and a low work hardening rate of the nanocrystalline structure at the surface of the treated samples. In contrast, the wear volume and wear rate of the samples treated for 60 min were higher than those of untreated samples, presumably due to the higher hardness and reduced toughness of the samples treated for 60 min