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

Studies of human relations in the teaching-learning process. v. final report: Evaluation of laboratory human relations training for classroom teachers,

"The research reported ... was performed pursuant to Contract no. 8143 with the cooperative research Branch, United States Office of Education, Department of Health, Education, and Welfare."Mode of access: Internet

Investigation of submerged arc welding application parameter at vertical position on steel material and modelling of application

Günümüzde yaygın olarak kullanılan birleştirme yöntemlerinden biri olan kaynak işlemi, endüstrinin önemli uygulama alanlarından biridir. Kaynak uygulamasının diğer birleştirme yöntemlerine göre önemli üstünleri bulunmaktadır. Kaynak problemlerini doğru tanımlamak, kaynaklı birleştirme sonrası konstrüksiyonun güvenilirliğini kontrol altında tutabilmek için çok önemlidir. Kaynak prosesinin en önemli problemleri kaynak sonrası meydana gelen artık gerilme ve distorsiyonlardır. Artık gerilmeler, konstrüksiyonun güvenirliğini olumsuz yönde etkiler. Distorsiyonlar ise, parçanın boyut hassasiyetini olumsuz yönde etkiler. Bu sebeple, kaynak prosesini daha iyi anlamak, kaynak sonrası oluşan artık gerilme ve distorsiyonların etkilerini önceden tahmin etmek önemli bir araştırma konusu olmuştur. Sonlu elemanlar yöntemi ile modelleme, kaynak işlemini fiziksel kurallara göre simule edebilmek için önemli bir araçtır.Bu çalışmada, tozaltı kaynağının dik (saat 3 yönünde) pozisyonda kaynağının, termo-mekanik analizi sonlu elemanlar yöntemi ile gerçekleştirilmiştir. İlk olarak 2 boyutlu termal analiz ısıl çevrime göre gerçekleştirilmiştir. Kaynak edilmiş parça üzerindeki sıcaklık dağılımı zamana bağlı olarak bulunmuştur. Termal analiz sonuçları kaynak sonrası parça üzerinde oluşan kalıntı gerilmeri ve distorsiyonların belirlenmesi amacıyla mekanik analize girdi olarak kullanılmıştır. Sonlu elemanlar modeli, yapılan deneysel çalışma ile doğrulanmıştır.Modelleme ile malzemenin kaynak sonrası davranışları önceden tahmin edilebilmektedir. Kaynak parametrelerinin optimizasyonu da gerçekleştirilebilmektedir.Welding process, which is one of widespreadly utilised joining process, is one of the important application area for industry. Welding process has some important advantages from other joining application. Identification of welding problem is very important to take under control of structure reliability after welding. The most important problems of welding are residual stress and distortion after welding application. Residual stresses are negatively impact to reliability of structure.Distortions are negatively impact to accuracy of weldment. In this reason, In order to better understand the welding process and its effects on structure, is an important research subject. Finite Element Modelling is a special tool to do simulation of welding.In this study, thermo-mechanic analysis of submerged arc welding at vertical position (3 o?clock direction) has been made using finite element method. First, 2D thermal analysis has been made by the thermal cycle that occurs in welding process. Thermal analysis has been made as transient analysis. Then the results those obtained from thermal analysis have been used in mechanical analysis as input to define residual stress and distortion after welding. Model has been comfirmed by experimental results.The situation of the material after welding can be estimated by modelling. The optimisation of welding parameters can be made.BAYKAL MAKİNA A.Ş

Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports:Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia)

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research

European Resuscitation Council Guidelines for Resuscitation 2015. Section 10. Education and implementation of resuscitation

SCOPUS: ar.jinfo:eu-repo/semantics/publishe