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

Characterization of semi-polar (20(2)over-bar1) InGaN microLEDs

In this paper, semi-polar (202¯1) InGaN blue light-emitting diodes (LEDs) were fabricated and compared the performance with those of LEDs grown on c-plane sapphire substrate. LEDs with different chip sizes of 100 μm × 100 μm, 75 μm × 75 μm, 25 μm × 25 μm, and 10 μm × 10 μm were used to study the influence of chip size on the device performance. It was found that the contact behavior between the n electrode and the n-GaN layer for the semi-polar (202¯1) LEDs was different from that for the LEDs grown on the c-plane device. Concerning the device performance, the smaller LEDs provided a larger current density under the same voltage and presented a smaller forward voltage. However, the sidewall’s larger surface to volume ratio could affect the IQE. Therefore, the output power density reached the maximum with the 25 μm × 25 μm chip case. In addition, the low blue-shift phenomenon of semi-polar (202¯1) LEDs was obtained. The larger devices exhibited the maximum IQE at a lower current density than the smaller devices, and the IQE had a larger droop as the current density increased for the LEDs grown on c-plane sapphire substrate

User friendliness, efficiency & spray quality of stirrup pumps versus hand compression pumps for indoor residual spraying.

BACKGROUND & OBJECTIVES Indoor residual spraying (IRS) is a proven tool to reduce visceral leishmaniasis vectors in endemic villages. In India IRS is being done with stirrup pumps, whereas Nepal, Bangladesh, and other countries use compression pumps. The present study was conducted with the objectives to compare the efficiency, cost and user friendliness of stirrup and compression pumps. METHODS The study was carried out in Gorigawan village of the Vaishali district in north Bihar and included a total population of 3259 inhabitants in 605 households. Spraying with 50 per cent DDT was done by two teams with 6 persons per team under the supervision of investigators over 5 days with each type of pump (10 days in total using 2 stirrup pumps and 3 compression pumps) by the same sprayers in an alternate way. The spraying technique was observed using an observation check list, the number of houses and room surfaces sprayed was recorded and an interview with sprayers on their satisfaction with the two types of pumps was conducted. RESULTS On average, 65 houses were covered per day with the compression pump and 56 houses were covered with the stirrup pump. The surface area sprayed per squad per day was higher for the compression pump (4636 m²) than for the stirrup pump (4102 m²). Observation showed that it was easy to maintain the spray swath with the compression pump but very difficult with the stirrup pump. The wastage of insecticide suspension was negligible for the compression pump but high for the stirrup pump. INTERPRETATION & CONCLUSIONS The compression pump was found to be more user friendly due to its lower weight, easier to operate, lower operation cost, higher safety and better efficiency in terms of discharge rate and higher area coverage than the stirrup pump. A A 

User friendliness, efficiency & spray quality of stirrup pumps versus hand compression pumps for indoor residual spraying

Background & objectives: Indoor residual spraying (IRS) is a proven tool to reduce visceral leishmaniasis vectors in endemic villages. In India IRS is being done with stirrup pumps, whereas Nepal, Bangladesh, and other countries use compression pumps. The present study was conducted with the objectives to compare the efficiency, cost and user friendliness of stirrup and compression pumps. Methods: The study was carried out in Gorigawan village of the Vaishali district in north Bihar and included a total population of 3259 inhabitants in 605 households. Spraying with 50 per cent DDT was done by two teams with 6 persons per team under the supervision of investigators over 5 days with each type of pump (10 days in total using 2 stirrup pumps and 3 compression pumps) by the same sprayers in an alternate way. The spraying technique was observed using an observation check list, the number of houses and room surfaces sprayed was recorded and an interview with sprayers on their satisfaction with the two types of pumps was conducted. Results: On average, 65 houses were covered per day with the compression pump and 56 houses were covered with the stirrup pump. The surface area sprayed per squad per day was higher for the compression pump (4636 m) than for the stirrup pump (4102 m). Observation showed that it was easy to maintain the spray swath with the compression pump but very difficult with the stirrup pump. The wastage of insecticide suspension was negligible for the compression pump but high for the stirrup pump. Interpretation & conclusions: The compression pump was found to be more user friendly due to its lower weight, easier to operate, lower operation cost, higher safety and better efficiency in terms of discharge rate and higher area coverage than the stirrup pump

Exploring Subpixel Learning Algorithms for Estimating Global Land Cover Fractions from Satellite Data Using High Performance Computing

Land cover (LC) refers to the physical and biological cover present over the Earth’s surface in terms of the natural environment such as vegetation, water, bare soil, etc. Most LC features occur at finer spatial scales compared to the resolution of primary remote sensing satellites. Therefore, observed data are a mixture of spectral signatures of two or more LC features resulting in mixed pixels. One solution to the mixed pixel problem is the use of subpixel learning algorithms to disintegrate the pixel spectrum into its constituent spectra. Despite the popularity and existing research conducted on the topic, the most appropriate approach is still under debate. As an attempt to address this question, we compared the performance of several subpixel learning algorithms based on least squares, sparse regression, signal–subspace and geometrical methods. Analysis of the results obtained through computer-simulated and Landsat data indicated that fully constrained least squares (FCLS) outperformed the other techniques. Further, FCLS was used to unmix global Web-Enabled Landsat Data to obtain abundances of substrate (S), vegetation (V) and dark object (D) classes. Due to the sheer nature of data and computational needs, we leveraged the NASA Earth Exchange (NEX) high-performance computing architecture to optimize and scale our algorithm for large-scale processing. Subsequently, the S-V-D abundance maps were characterized into four classes, namely forest, farmland, water and urban areas (in conjunction with nighttime lights data) over California, USA using a random forest classifier. Validation of these LC maps with the National Land Cover Database 2011 products and North American Forest Dynamics static forest map shows a 6% improvement in unmixing-based classification relative to per-pixel classification. As such, abundance maps continue to offer a useful alternative to high-spatial-resolution classified maps for forest inventory analysis, multi-class mapping, multi-temporal trend analysis, etc

Asymptomatic Infection with Visceral Leishmaniasis in a Disease-Endemic Area in Bihar, India

A prospective study was carried out in a cohort of 355 persons in a leishmaniasis-endemic village of the Patna District in Bihar, India, to determine the prevalence of asymptomatic persons and rate of progression to symptomatic visceral leishmaniasis (VL) cases. At baseline screening, 50 persons were positive for leishmaniasis by any of the three tests (rK39 strip test, direct agglutination test, and polymerase chain reaction) used. Point prevalence of asymptomatic VL was 110 per 1,000 persons and the rate of progression to symptomatic cases was 17.85 per 1,000 person-months. The incidence rate ratio of progression to symptomatic case was 3.36 (95% confidence interval [CI] = 0.75–15.01, P = 0.09) among case-contacts of VL compared with neighbors. High prevalence of asymptomatic persons and clinical VL cases and high density of Phlebotomus argentipes sand flies can lead to transmission of VL in VL-endemic areas

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc