avoidance strategy
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2022 ◽  
Vol 9 ◽  
pp. 205435812110692
Author(s):  
Amit X. Garg ◽  
Meaghan Cuerden ◽  
Hector Aguado ◽  
Mohammed Amir ◽  
Emilie P. Belley-Cote ◽  
...  

Background: Most patients who take antihypertensive medications continue taking them on the morning of surgery and during the perioperative period. However, growing evidence suggests this practice may contribute to perioperative hypotension and a higher risk of complications. This protocol describes an acute kidney injury substudy of the Perioperative Ischemic Evaluation-3 (POISE-3) trial, which is testing the effect of a perioperative hypotension-avoidance strategy versus a hypertension-avoidance strategy in patients undergoing noncardiac surgery. Objective: To conduct a substudy of POISE-3 to determine whether a perioperative hypotension-avoidance strategy reduces the risk of acute kidney injury compared with a hypertension-avoidance strategy. Design: Randomized clinical trial with 1:1 randomization to the intervention (a perioperative hypotension-avoidance strategy) or control (a hypertension-avoidance strategy). Intervention: If the presurgery systolic blood pressure (SBP) is <130 mmHg, all antihypertensive medications are withheld on the morning of surgery. If the SBP is ≥130 mmHg, some medications (but not angiotensin receptor blockers [ACEIs], angiotensin receptor blockers [ARBs], or renin inhibitors) may be continued in a stepwise manner. During surgery, the patients’ mean arterial pressure (MAP) is maintained at ≥80 mmHg. During the first 48 hours after surgery, some antihypertensive medications (but not ACEIs, ARBs, or renin inhibitors) may be restarted in a stepwise manner if the SBP is ≥130 mmHg. Control: Patients receive their usual antihypertensive medications before and after surgery. The patients’ MAP is maintained at ≥60 mmHg from anesthetic induction until the end of surgery. Setting: Recruitment from 108 centers in 22 countries from 2018 to 2021. Patients: Patients (~6800) aged ≥45 years having noncardiac surgery who have or are at risk of atherosclerotic disease and who routinely take antihypertensive medications. Measurements: The primary outcome of the substudy is postoperative acute kidney injury, defined as an increase in serum creatinine concentration of either ≥26.5 μmol/L (≥0.3 mg/dL) within 48 hours of randomization or ≥50% within 7 days of randomization. Methods: The primary analysis (intention-to-treat) will examine the relative risk and 95% confidence interval of acute kidney injury in the intervention versus control group. We will repeat the primary analysis using alternative definitions of acute kidney injury and examine effect modification by preexisting chronic kidney disease, defined as a prerandomization estimated glomerular filtration rate <60 mL/min/1.73 m2. Results: Substudy results will be analyzed in 2022. Limitations: It is not possible to mask patients or providers to the intervention; however, objective measures will be used to assess acute kidney injury. Conclusions: This substudy will provide generalizable estimates of the effect of a perioperative hypotension-avoidance strategy on the risk of acute kidney injury.


Author(s):  
Ирина Ивановна Ковалевская

В статье рассматриваются стратегии юридического перевода в дискурсивно-диалогической перспективе. К ним относятся форенизация и доместикация, направленные на десубъективизацию содержания дискурса; стратегии контроля и вербального уклонения, использующиеся для «сохранения лица»; а также адаптация темпоральных смыслов к принимающей культуре, реализующаяся посредством их точной, тождественной и гармоничной трансляции. The article consideres the strategies of legal translation in the discursive dialogic perspective. They include foreignizing and domesticating aimed at the desubjectivization of the discourse contents; control strategy and verbal communication avoidance strategy used to save face; as well as adaptation of temporal meanings to the target culture that is achieved through their accurate, adequate and harmonic communication.


2021 ◽  
Author(s):  
LinWen Yu ◽  
TongHui Qian ◽  
Xi Ye ◽  
Fang ZHOU ◽  
Zhigang LUO ◽  
...  

2021 ◽  
Vol 9 (12) ◽  
pp. 1321
Author(s):  
Lifei Song ◽  
Xiaoqian Shi ◽  
Hao Sun ◽  
Kaikai Xu ◽  
Liang Huang

Dynamic collision avoidance between multiple vessels is a task full of challenges for unmanned surface vehicle (USV) movement, which has high requirements on real-time performance and safety. The difficulty of multi-obstacle collision avoidance is that it is hard to formulate the optimal obstacle avoidance strategy when encountering more than one obstacle threat at the same time; a good strategy to avoid one obstacle sometimes leads to threats from other obstacles. This paper presents a dynamic collision avoidance algorithm for USVs based on rolling obstacle classification and fuzzy rules. Firstly, potential collision probabilities between a USV and obstacles are calculated based on the time to the closest point of approach (TCPA). All obstacles are given different priorities based on potential collision probability, and the most urgent and secondary urgent ones will then be dynamically determined. Based on the velocity obstacle algorithm, four possible actions are defined to determine the basic domain in the collision avoidance strategy. After that, the Safety of Avoidance Strategy and Feasibility of Strategy Adjustment are calculated to determine the additional domain based on fuzzy rules. Fuzzy rules are used here to comprehensively consider the situation composed of multiple motion obstacles and the USV. Within the limited range of the basic domain and the additional domain, the optimal collision avoidance parameters of the USV can be calculated by the particle swarm optimization (PSO) algorithm. The PSO algorithm utilizes both the characteristic of pursuance for the population optimal and the characteristic of exploration for the individual optimal to avoid falling into the local optimal solution. Finally, numerical simulations are performed to certify the validity of the proposed method in complex traffic scenarios. The results illustrated that the proposed method could provide efficient collision avoidance actions.


2021 ◽  
Author(s):  
Gareth S. Powell ◽  
Natalie A. Saxton ◽  
Yelena Pacheco ◽  
Kathrin F. Stanger-Hall ◽  
Gavin J. Martin ◽  
...  

Bioluminescence is found across life and has many functions. Yet we understand very little about its timing and origins, particularly as a predator avoidance strategy. Understanding the timing between bioluminescence and predator origins has yet to be examined and can help elucidate the evolution of the ecologically important signal aposematism. Using the most prevalent bioluminescent group, fireflies, where bioluminescence primarily functions as aposematic and sexual signals, the timing for the origins of both potential predators of fireflies and bioluminescence is explored. Divergence time estimations were performed using a genomic-scale phylogenetic reconstruction Lampyridae, and multiple fossil calibration points, allowing for a robust estimate for the origin of beetle bioluminescence as both a terrestrial and aerial signal. Our results recover the origins of terrestrial beetle bioluminescence at 141 mya and aerial bioluminescence at 133 mya. These ages predate the origins of all known extant aerial predators (i.e., bats and birds) and support the much older terrestrial predators (frogs, ground beetles, lizards, snakes, and hunting spiders) as the most likely drivers of bioluminescence in beetles.


2021 ◽  
Author(s):  
Stefan van der Veeken ◽  
Jamie Wubben ◽  
Carlos T. Calafate ◽  
Juan-Carlos Cano ◽  
Pietro Manzoni ◽  
...  

2021 ◽  
Vol 301 ◽  
pp. 117459
Author(s):  
Hualin Xiong ◽  
Mònica Egusquiza ◽  
Poul Alberg Østergaard ◽  
Juan I. Pérez-Díaz ◽  
Guoxiu Sun ◽  
...  

2021 ◽  
Author(s):  
Ziwei Wang ◽  
Guodong Yin ◽  
Shangjie Li ◽  
Min Qian ◽  
Pai Peng ◽  
...  

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