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The dynamic interaction effects of railway tunnels: Crossrail and the Grand Central Recording Studios
In cities around the world, underground railways offer an environmentally friendly solution to societyâs increasing demand for mass transport. However, they are often constructed close to sensitive buildings, where the resulting ground-borne noise and vibration can cause disturbance to both the occupants and the equipment. Such a scenario occurred in central London, where the new twin tunnels of Crossrail were bored beneath the Grand Central Recording Studios, causing an immediate concern. As a result, vibration in the studiosâ building was monitored throughout the Crossrail construction period. Since Crossrail is yet to operate, the resulting data provide a unique opportunity to investigate the effect of new tunnels, acting as passive buried structures, on the existing vibration environment. This paper presents the results of such an investigation, together with complementary results from a theoretical four-tunnel boundary-element model. The data analysis, presented in the first half of the paper, indicates that the construction of the second Crossrail tunnel has led to an overall reduction in the noise and vibration levels beneath the studios, due to the operation of the nearby Central line trains of London Underground. This is predominantly due to a reduction of approximately 6âdB in the 63âHz band-limited levels but accompanied by a slight increase, of approximately 2âdB, in the 125âHz band. Further analysis indicates that any seasonal variations in vibration levels over the measurement period are negligible, adding weight to the conclusion that the observed changes are a causal effect of the tunnel. The second half of the paper presents results from the model, which aims to simulate the dynamic interaction between the Central line tunnels and those of Crossrail. With nominal parameter values, the results demonstrate qualitative similarities with the measurement findings, thereby adding to the growing body of evidence that dynamic interaction between neighbouring tunnels can be significant. </jats:p
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 nonâcritically 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 (nâ=â257), ARB (nâ=â248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; nâ=â10), or no RAS inhibitor (control; nâ=â264) for up to 10 days.
MAIN OUTCOMES AND MEASURES The primary outcome was organ supportâfree 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 supportâfree days among critically ill patients was 10 (â1 to 16) in the ACE inhibitor group (nâ=â231), 8 (â1 to 17) in the ARB group (nâ=â217), and 12 (0 to 17) in the control group (nâ=â231) (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 supportâfree 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
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