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

An analysis of feed-in tariff remuneration models: Implications for renewable energy investment

Recent experience from around the world suggests that feed-in tariffs (FITs) are the most effective policy to encourage the rapid and sustained deployment of renewable energy. There are several different ways to structure a FIT policy, each with its own strengths and weaknesses. This paper presents an overview of seven different ways to structure the remuneration of a FIT policy, divided into two broad categories: those in which remuneration is dependent on the electricity price, and those that remain independent from it. This paper examines the advantages and disadvantages of these different FIT models, and concludes with an analysis of these design options, with a focus on their implications both for investors and for society.Renewable energy Renewable energy policy Feed-in tariffs

How to achieve 100% renewable energy

HOW TO ACHIEVE 100% RENEWABLE ENERGY How to achieve 100% renewable energy / Couture, Toby D. (Public Domain) ( -

A Policymaker’s Guide to Feed-in Tariff Policy Design

Office of Energy Efficiency and Renewable Energy, operated by the Alliance for Sustainable Energy, LLC. On the Cover Feed-in tariff (FIT) policies can apply to several renewable energy technologies and their applications including (top to bottom) solar photovoltaics (PV) on commercial buildings (Art Institute of Chicago – Chicago, Illinois); on-site wind energy (Great Lakes Science Center – Cleveland, Ohio); rooftop PV on residences (Glastonbury, Connecticut); solar power tower (Solar One –Barstow, California); and dry-steam geothermal plant (The Geysers – Calistoga, California)

Diffusiophoresis-Driven Stratification in Pressure-Sensitive Adhesive Films from Bimodal Waterborne Colloids

The uses of pressure-sensitive adhesives (PSAs) are wide ranging, with applications including labels, tapes, and graphics. To achieve good adhesion, a PSA must exhibit a balance of viscous and elastic properties. Previous research has found that a thin, elastic surface layer on top of a softer, dissipative layer resulted in greater tack adhesion compared with the single layers. Superior properties were achieved through a bilayer obtained via successive depositions, which consume energy and time. To achieve a multilayered structure via a single deposition process, we have stratified mixtures of waterborne colloidal polymer particles with two different sizes: large poly(acrylate) adhesive particles (ca. 660 nm in diameter) and small poly(butyl acrylate) (pBA) particles (ca. 100 nm). We used two types of pBA within the particles: either viscoelastic pBA without an added cross-linker or elastic pBA with a fully cross-linked network. Stratified surface layers of deuterium-labeled pBA particles with thicknesses of at least 1 μm were found via elastic recoil detection and qualitatively verified via the analysis of surface topography. The extent of stratification increased with the evaporation rate; films that were dried slowest exhibited no stratification. This result is consistent with a model of diffusiophoresis. When the elastic, cross-linked pBA particles were stratified at the surface, the tack adhesion properties made a transition from brittle failure to tacky. For pBA without an added cross-linker, all adhesives showed fibrillation during debonding, but the extent of fibrillation increased when the films were stratified. These results demonstrate that the PSA structure can be controlled through the processing conditions to achieve enhanced properties. This research will aid the future development of layered or graded single-deposition PSAs with designed adhesive properties