Analysis of practices to promote reproducibility and transparency in anesthesiology research: Are important aspects "hidden behind the drapes?"

Introduction: Reliable, high quality research is essential to the field of anesthesiology. Investigating reproducibility and transparency has been accomplished broadly in the biomedical domain and in the social sciences; however, practices that promote reproducibility and transparency have never been evaluated in the anesthesiology research community. In this study, we applied 14 indicators of reproducibility to evaluate the current climate of the anesthesiology research community.Methods: We used the National Library of Medicine (NLM) catalog to search for all journals using the subject terms tag Anesthesiology[ST]. The inclusion criteria required that journals provided full-text publications in English and were MEDLINE indexed. The list of journals in the NLM catalog fitting the inclusion criteria were then extracted using the electronic International Standard Serial Number (ISSN). This series of ISSN were used in a PubMed search to identify all publications within these journals. We then limited the sample to publications from January 1, 2014 to December 31, 2018. Subsequently, we randomly sampled 300 publications that fit the inclusion criteria for our analysis. Data extraction was then conducted in a blinded, duplicate fashion using a pilot-tested Google form.Results: The PubMed search of these journals identified 171,441 publications, with 28,310 being within the time-frame. From the 300 publications sampled, 296 (296/300, 98% [97% to 99%]) full text publications were obtained, while 4 (4/300, 1% [0% to 3%]) only showed the abstract or could not be accessed. Most (104/107, 97% [95% to 99%]) of the studies did not include material availability statements or protocol availability statements. For the analysis scripts, the majority of publications (121/122, 99% [98% to 100%]) did not provide a data analysis script statement. The majority (94/122, 77% [72% to 81%]) of the publications did not contain a pre-registration statement. Other study characteristics were found to be insufficient.Conclusion: Anesthesiology research needs to drastically improve with regards to reproducibility and transparency. By making research easily accessible online and by improving the accessibility of detailed components (raw data, materials and protocols, analysis scripts) primary research can be reproduced in subsequent studies and help contribute to the development of new practice guidelines, helping change patient care through evidence-based conclusions

A Sustainable Mobility Solution for Persons Living with Disability in Burkina Faso

The Sustainable Mobility project of the Collaboratory empowers people living with a disability in rural West Africa to more fully participate in family and community life and makes possible the pursuit of educational and work opportunities. Our 3-wheeled off-road wheelchair has transformed the lives of dozens of clients through partnerships with the Center for the Advancement of the Handicapped in Mahadaga, Burkina Faso and the Center of Hope in Fada, Burkina Faso. Now, to reach more people in new locations and with more partners, Sustainable Mobility is working to reduce manufacturing time and cost, author image-driven fabrication guides to enable local fabricators to build trikes, and develop supply chains to bring parts and materials to build sites. We seek to put local fabricators to work building tricycles wherever they are needed.https://mosaic.messiah.edu/engr2020/1004/thumbnail.jp

University of Missouri- St. Louis Comprehensive School Safety Initiative (UMSL CSSI)

View the website for this project here: https://www.umsl.edu/ccj/research/cssi.htm

Sheep Updates 2007 - part 3

This session covers seven papers from different authors: PROFITABILITY 1. Benchmarking demonstrates both the potential and realised productivity gains in the sheep and wool industry, Andrew Ritchie, Edward Riggall and James Hall, ICON Agriculture, Darkan 2. Improving sheep genetics will increase farm profitability, Gus Rose, Johan Greeff Department of Agriculture and Food Western Australia, John Young Farming Systems Analysis Service, WA 3. Meat, Merinos and making money in WA Pastoral Zone, M. Alchin, M. Young and T. Johnson, Department of Agriculture and Food Western Australia, GRAZING 4. Nitrogen - farmers\u27 friend or foe? John Lucy and Martin Staines, Department of Agriculture and Food Western Australia 5. Drought proofing grazing systems - a case study from Binnu 2006/7, Tim Wiley & Rob Grima, Department of Agriculture & Food Western Australia 6. Minimising \u27Esperance Storm\u27 livestock losses, Sandra Prosser and Matt Ryan, Department of Agriculture and Food Western Australia 7. Sub-tropical grasses in WA - what is their potential? Geoff Moore, Tony Albertsen, Department of Agriculture & Food Western Australia, Phil Barrett-Lennard, Evergreen Farming, George Woolston, John Titterington, Department of Agriculture and Food Western Australia, Sarah Knight, Irwin-Mingenew Group, Brianna Peake, Liebe Group, Buntine, W

Sheep Updates 2005 - Part 6

This session covers seven papers from different authors: PASTURES/GRAZING 1. New annual pastures - quality and quantity for fodder conservation?, Sarah Pugh and Giles Glasson, Department of Agriculture Western Australia 2. Saltland Pastures: Dispelling some Myths, Ed Barrett-Lennard1,3, Hayley Norman2,3, Matt Wilmat2,3, Meir Altman,3, Kelly Pearce2,3, Sally Phelan4, David Masters2,3, 1. Department of Agriculture, Western Australia, 2 CSIRO Livestock Industries, Floreat, WA, 3. CRC for Plant-based Management of Dryland Salinity 4. Saltland Pastures Association 3. Pastures: Putting profit back into sandplain, Nadine Eva, Department of Agriculture Western Australia. 4. Pastures from Space R - Can be used to make profitable strategic and tactical management decisions on farm, Brad Wooldridge, Farmer Wagin WA, Stephen Gherardi, Lucy Anderton, Department of Agriculture Western Australia, Gonzalo Mata, CSIRO Livestock Industries, Wembley, WA 5. Are new farming systems based on perenial pastures in south west Australia more profitable?, P. Sanford, Department of Agriculture Western Australia, J. Young, Farm Systems Analysis, Kojonup WA 6. Sown fodders, rotational grazing and Merinos make money in a drought, Tim Wiley, Department of Agriculture Western Australia, Richard Quinlan, Planfarm, Geraldton 7. Lifetime Wool - The \u27best bet\u27 optimum condition score profile for Merino ewes lambing in winter. Chris Oldham, Mike Hyder, Mandy Curnow, Samantha Giles, Department of Agriculture Western Australia, John Young, Farming Systems Analysis Service, Kojonup, Andrew Thompson, DPI Victoria, Hamilton

Timed sequential chemotherapy with concomitant Granulocyte Colony-Stimulating Factor for high-risk acute myelogenous leukemia: a single arm clinical trial

BACKGROUND: The timed-sequential chemotherapy regimen consisting of etoposide, mitoxantrone and cytarabine (EMA) is an effective therapy for relapsed or refractory acute myelogenous leukemia (AML). We postulated that granulocyte colony-stimulating factor (G-CSF) might enhance the cytotoxicity of EMA by increasing the proportion of leukemic blasts in S-phase. We added G-CSF to EMA (EMA-G) for therapy of advanced high-risk AML patients. METHODS: High-risk AML was defined as refractory, relapsed or secondary to either an antecedent hematologic disorder or exposure to cytotoxic agents. The patients were treated with one course of EMA-G consisting of mitoxantrone and cytarabine on days 1–3, and etoposide and cytarabine on days 8–10. G-CSF was started on day 4 and continued until absolute neutrophil count recovered. RESULTS: Thirty patients were enrolled. The median age was 51 years (range, 25–75). Seventeen (61%) patients had unfavorable cytogenetic karyotypes. Twenty (69%) patients had secondary AML. Ten (34%) had relapsed disease. Four (14%) had refractory AML. Three (10%) patients died from febrile neutropenia and sepsis. Major non-hematologic toxicity included hyperbilirubimenia, renal insufficiency, mucositis, diarrhea, nausea and vomiting, skin rash. A complete remission was achieved in 13 (46%) patients. Median overall survival was 9 months (range, 0.5–66). Median relapse-free survival (RFS) for those who had a CR was 3 months (range, 0.5–63) with RFS censored at the time of allogeneic bone marrow transplantation or peripheral stem cell transplantation for 6 of the patients. CONCLUSIONS: EMA-G is a safe and efficacious option for induction chemotherapy in advanced, high-risk AML patients. The activity of EMA may be increased if applied in patients with less advanced disease

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

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