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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.


2021 ◽  
Vol 268 ◽  
pp. 59-70
Author(s):  
Carmen S.S. Latenstein ◽  
Aafke H. van Dijk ◽  
Sarah Z. Wennmacker ◽  
Joost P.H. Drenth ◽  
Gert P. Westert ◽  
...  

2021 ◽  
Author(s):  
Yong Ge ◽  
Wenbin Zhang ◽  
Xilin Wu ◽  
Corrine Ruktanonchai ◽  
Haiyan Liu ◽  
...  

Abstract Non-pharmaceutical interventions (NPIs) and vaccination are two fundamental approaches to mitigate the coronavirus disease 2019 (Covid-19) pandemic. Vaccination strategies are generally less costly and socially/economically disruptive than NPI strategies, such as business closures, social distancing, and face mask mandates, as evidenced by highly vaccinated countries generally rolling back NPIs. However, the respective real-world impact of an NPI strategy versus vaccination strategy, or the combination of both, on mitigating Covid-19 transmission remains uncertain. To address this, we built a Bayesian inference model to explore the changing effectiveness of NPIs and vaccination based on the assembled large-scale dataset, including epidemiological parameters, variants, vaccines, and control variable. Here we show that NPIs were still considerably complementary or even synergistic to vaccination in the effort to curb the Covid-19 infection before reaching herd immunity. We found that (1) the synergistic effect of NPIs and vaccination was 46.9% (reduction in reproduction number) in September 2021, whereas the effects of NPIs and vaccination alone were 20.7% and 28.8%, respectively; (2) effectiveness of NPIs is less sensitive to emerging COVID-19 variants but decreases with vaccination progress, as NPIs may unnecessarily restrict the vaccinated population. The effectiveness of NPIs alone declined approximately 23% since the introduction of vaccination strategies, where the relaxation of NPIs promoted the decline from May 2021. Our results demonstrate that the decision to relax NPIs should consider the real-world vaccination rate of the relevant population, which is determined by the observed vaccine efficacy in relation to extant and emerging variants.


2021 ◽  
Vol 5 (3) ◽  
pp. 34
Author(s):  
Marco Fisichella ◽  
Andrea Ceroni

A majority of current work in events extraction assumes the static nature of relationships in constant expertise knowledge bases. However, in collaborative environments, such as Wikipedia, information and systems are extraordinarily dynamic over time. In this work, we introduce a new approach for extracting complex structures of events from Wikipedia. We advocate a new model to represent events by engaging more than one entities that are generalizable to an arbitrary language. The evolution of an event is captured successfully primarily based on analyzing the user edits records in Wikipedia. Our work presents a basis for a singular class of evolution-aware entity-primarily based enrichment algorithms and will extensively increase the quality of entity accessibility and temporal retrieval for Wikipedia. We formalize this problem case and conduct comprehensive experiments on a real dataset of 1.8 million Wikipedia articles in order to show the effectiveness of our proposed answer. Furthermore, we suggest a new event validation automatic method relying on a supervised model to predict the presence of events in a non-annotated corpus. As the extra document source for event validation, we chose the Web due to its ease of accessibility and wide event coverage. Our outcomes display that we are capable of acquiring 70% precision evaluated on a manually annotated corpus. Ultimately, we conduct a comparison of our strategy versus the Current Event Portal of Wikipedia and discover that our proposed WikipEvent along with the usage of Co-References technique may be utilized to provide new and more data on events.


2021 ◽  
Vol 161 ◽  
pp. S180-S181
Author(s):  
L. Claude ◽  
V. Isnardi ◽  
C. Schiffler ◽  
S. Metzger ◽  
I. Martel-Lafay ◽  
...  

2021 ◽  
pp. 1-31
Author(s):  
Dara Kay Cohen ◽  
Sabrina M. Karim

Abstract Recent world events, such as the rise of hypermasculine authoritarian leaders, have shown the importance of both sex and gender for understanding international politics. However, quantitative researchers of conflict have long relegated the study of sex and gender inequality as a cause of war to a specialized group of scholars, despite overwhelming evidence that the connections are profound and consequential. In this review essay, we demonstrate the tremendous progress made in this field by analyzing a wave of research that examines the relationships between sex and gender inequality and war. We divide this work into theories that emphasize strategy versus those that analyze structures. In addition, we focus on two aspects of this research agenda—specifying mechanisms that link sex and gender inequality to war, and leveraging data at multiple levels of analysis—to outline fruitful pathways forward for the broader international security research agenda. Ultimately, we argue that the study of the nexus of sex and gender inequality and war will enliven theoretical debates, illuminate new hypotheses, and enrich the policy discourse with robust evidence.


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