Role of Blood Pressure Management in Stroke Prevention: A Systematic Review and Network Meta-Analysis of 93 Randomized Controlled Trials

Background and Purpose The present study aimed to compare the efficacy and tolerability of different blood pressure (BP)-lowering strategies.Methods Randomized controlled trials that compared various antihypertensive treatments and stroke outcomes were included. Eligible trials were categorized into three scenarios: single or combination antihypertensive agents against placebos; single or combination agents against other agents; and different BP-lowering targets. The primary efficacy outcome was the risk reduction pertaining to strokes. The tolerability outcome was the withdrawal of drugs, owing to drug-related side effects (PROSPERO registration number CRD42018118454 [20/12/2018]).Results The present study included 93 trials (average follow-up duration, 3.3 years). In the pairwise analysis, angiotensin-converting enzyme inhibitors (ACEis) and beta-blockers (BBs) were inferior to calcium channel blockers (CCBs) (odds ratio [OR], 1.123; 95% confidence interval [CI], 1.008 to 1.252) (OR, 1.261; 95% CI, 1.116 to 1.425) for stroke prevention, BB was inferior to angiotensin II receptor blockers (ARB) (OR, 1.361; 95% CI, 1.142 to 1.622), and diuretics were superior to ACEi (OR, 0.871; 95% CI, 0.771 to 0.984). The combination of ACEi+CCB was superior to ACEi+diuretic (OR, 0.892; 95% CI, 0.823 to 0.966). The network meta-analysis confirmed that diuretics were superior to BB (OR, 1.34; 95% CI, 1.11 to 1.58), ACEi+diuretic (OR, 1.47; 95% CI, 1.02 to 2.08), BB+CCB (OR, 2.05; 95% CI, 1.05 to 3.79), and renin inhibitors (OR, 1.87; 95% CI, 1.25 to 2.75) for stroke prevention. Regarding the tolerability profile, the pairwise analysis revealed that ACEi was inferior to CCB and less tolerable, compared to the other treatments.Conclusions Monotherapy using diuretics, CCB, or ARB, and their combinations could be employed as first-line treatments for stroke prevention in terms of efficacy and tolerability.

Identifying Heating Technologies suitable for Historic Churches, Taking into Account Heating Strategy and Conservation through Pairwise Analysis

As a result of difficulty meeting energy efficiency through fabric alteration, historic churches must focus on heating systems and operational strategy as key to reducing carbon emissions. Strategies can be defined as local or central heating. Local heating strives to heat occupants, while central heating aims to heat the building fabric and therefore the occupants. Each strategy requires a different approach to control and technology in response to priorities such as conservation, comfort and cost. This paper reviews current and emerging technologies in the context of church heating. The fuel source, heat generation technology and heat emitter are arranged in a matrix, with pairwise analysis undertaken to create weightings for each assessment criteria. The process of constructing the matrix and undertaking pairwise analysis using personas is discussed. The result is a ranking of fuels and technologies appropriate to the main priorities and individual preferences. Some desirable technologies are inherently more damaging to historic church environments due to invasive installation. These technologies score poorly when the aim is fabric preservation. Greener fuels, like biomass, may rank lower than fossil fuels, due in part to operational differences.

Restructuring with Moora and Measuring Code Smells

The paper presents measuring various code smells by finding critical code smells and thereby concentration is increased in those parts through Structural Modeling for arranging those code smells. Arranging the code smells in the way that they will not produce a new smell on their detection and removal is very necessary. Structural modeling helps in clarifying Interrelationship among these code smells. The code smells that contains high driving effects are ordered as optimized code which resulted in the increase in the overall code maintenance of the software code which will be used afterwards for achieving the concept of re-usability. In addition to this we have added a technique for restructuring technology for the purpose to achieve high accuracy. It involves more objectives related to the performance and the code smells are implemented with the concept called as pairwise analysis based on the priority method. Pairwise analysis based on the weights attained by the bad smells provides a better optimized results since more problematic areas are neglected here. This work gives optimized results for the process of overall code maintainability by applying restructuring before the refactoring process with Fuzzy technique and it is followed by finding the code smells which results in high ripple effects and then removing them. Still more research ideologies are needed for removing the bad smells in the code.