| 1. |
- Granholm, Anders, et al.
(författare)
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Empirical meropenem versus piperacillin/tazobactam for adult patients with sepsis (EMPRESS) trial : Protocol
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Piperacillin/tazobactam may be associated with less favourable outcomes than carbapenems in patients with severe bacterial infections, but the certainty of evidence is low. Methods: The Empirical Meropenem versus Piperacillin/Tazobactam for Adult Patients with Sepsis (EMPRESS) trial is an investigator-initiated, international, parallel-group, randomised, open-label, adaptive clinical trial with an integrated feasibility phase. We will randomise adult, critically ill patients with sepsis to empirical treatment with meropenem or piperacillin/tazobactam for up to 30 days. The primary outcome is 30-day all-cause mortality. The secondary outcomes are serious adverse reactions within 30 days; isolation precautions due to resistant bacteria within 30 days; days alive without life support and days alive and out of hospital within 30 and 90 days; 90- and 180-day all-cause mortality and 180-day health-related quality of life. EMPRESS will use Bayesian statistical models with weak to somewhat sceptical neutral priors. Adaptive analyses will be conducted after follow-up of the primary outcome for the first 400 participants concludes and after every 300 subsequent participants, with adaptive stopping for superiority/inferiority and practical equivalence (absolute risk difference <2.5%-points) and response-adaptive randomisation. The expected sample sizes in scenarios with no, small or large differences are 5189, 5859 and 2570 participants, with maximum 14,000 participants and ≥99% probability of conclusiveness across all scenarios. Conclusions: EMPRESS will compare the effects of empirical meropenem against piperacillin/tazobactam in adult, critically ill patients with sepsis. Due to the pragmatic, adaptive design with high probability of conclusiveness, the trial results are expected to directly inform clinical practice.
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| 2. |
- Andersen, Maj Munch, et al.
(författare)
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Green Nanotechnology in Nordic Construction: Eco-innovation Strategies and Dynamics in Nordic Window Value Chains
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This project analyzes Nordic trends in the development and industrial uptake of green nanotechno-logy in construction. The project applies an evolutionary economic perspective in analyzing the innovation dynamics and firm strategies in the window value chains in three Nordic countries, Denmark, Finland and Sweden. Hence the project investigates two pervasive parallel market trends: The emergence of the green market and the emergence of nanotechnology. The analysis investigates how a traditional economic sector such as the construction sector reacts to such major trends.Conclusions are multiple, but among the most important are: Eco-innovation has become the perhaps most important driver for innovation in the construction sector. Search into eco-innovative business opportunities is intense among all companies along the three analyzed Nordic window chains. While we generally find a low uptake of nanotechnology in the construction sector in the Nordic countries we do find quite a high number of nanotech applications in the Nordic window chains. Eco-innovation is influencing strongly on the nanotech development. We see several examples of nano-enabled smart, multifunctional green solutions in the Nordic window chains already or about to having a commercial impact. Currently, it seems the greening of markets is beginning to affect the roles different companies play in the chain. We see a marked shift towards more sys-temic, smart eco-innovative solutions which fit well with nanotech opportunities. Overall, the recent greening of the market seems to be opening a window of opportunity for nanotechnology in the Nordic countries but the widespread discreet firm strategizing towards nanotechnology may reduce the exploitation of these.
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| 3. |
- Mont, Oksana, et al.
(författare)
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Systemic changes and sustainable consumption and production : Cases from product-service systems
- 2008. - 1
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Ingår i: System Innovation for Sustainability 1 : Perspectives on Radical Changes to Sustainable Consumption and Production - Perspectives on Radical Changes to Sustainable Consumption and Production. - 9781906093037 - 9781351280204 - 9781351280198 ; , s. 391-404
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Bokkapitel (refereegranskat)abstract
- Central to the sustainable production and consumption (SCP) agenda is the need for radical changes not only in the ways we produce but also in the ways we consume. The SCP agenda emerged within the understanding that it is not possible to reach the necessary reductions in environmental impact and resource consumption purely by technical solutions directed at improving the efficiency of production processes and ‘greening’ products. Research demonstrates that aggregate environmental impact continues to rise because of an increasing population and increasing levels of affluence. It was hoped that technological improvements could compensate for increases in these factors. However, to keep within the limits of environmental impact of the year 1990, some commentators argue that a Factor 10, 20 or higher improvement in material and energy efficiency is needed by 2025 (Jensen 1993; Schmidt-Bleek 1995).
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| 4. |
- Munch, Marie W., et al.
(författare)
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Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia The COVID STEROID 2 Randomized Trial
- 2021
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Ingår i: Journal of the American Medical Association (JAMA). - : AMER MEDICAL ASSOC. - 0098-7484 .- 1538-3598. ; 326:18, s. 1807-1817
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Tidskriftsartikel (refereegranskat)abstract
- Question What is the effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support at 28 days in patients with COVID-19 and severe hypoxemia? Findings In this randomized trial that included 1000 patients with COVID-19 and severe hypoxemia, treatment with 12 mg/d of dexamethasone resulted in 22.0 days alive without life support at 28 days compared with 20.5 days in those receiving 6 mg/d of dexamethasone. This difference was not statistically significant. Meaning Compared with 6 mg of dexamethasone, 12 mg of dexamethasone did not statistically significantly reduce the number of days alive without life support at 28 days. This multicenter randomized clinical trial compares the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia. IMPORTANCE A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease. OBJECTIVE To assess the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia. DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial was conducted between August 2020 and May 2021 at 26 hospitals in Europe and India and included 1000 adults with confirmed COVID-19 requiring at least 10 L/min of oxygen or mechanical ventilation. End of 90-day follow-up was on August 19, 2021. INTERVENTIONS Patients were randomized 1:1 to 12 mg/d of intravenous dexamethasone (n = 503) or 6 mg/d of intravenous dexamethasone (n = 497) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was the number of days alive without life support (invasive mechanical ventilation, circulatory support, or kidney replacement therapy) at 28 days and was adjusted for stratification variables. Of the 8 prespecified secondary outcomes, 5 are included in this analysis (the number of days alive without life support at 90 days, the number of days alive out of the hospital at 90 days, mortality at 28 days and at 90 days, and >= 1 serious adverse reactions at 28 days). RESULTS Of the 1000 randomized patients, 982 were included (median age, 65 [IQR, 55-73] years; 305 [31%] women) and primary outcome data were available for 971 (491 in the 12 mg of dexamethasone group and 480 in the 6 mg of dexamethasone group). The median number of days alive without life support was 22.0 days (IQR, 6.0-28.0 days) in the 12 mg of dexamethasone group and 20.5 days (IQR, 4.0-28.0 days) in the 6 mg of dexamethasone group (adjusted mean difference, 1.3 days [95% CI, 0-2.6 days]; P = .07). Mortality at 28 days was 27.1% in the 12 mg of dexamethasone group vs 32.3% in the 6 mg of dexamethasone group (adjusted relative risk, 0.86 [99% CI, 0.68-1.08]). Mortality at 90 days was 32.0% in the 12 mg of dexamethasone group vs 37.7% in the 6 mg of dexamethasone group (adjusted relative risk, 0.87 [99% CI, 0.70-1.07]). Serious adverse reactions, including septic shock and invasive fungal infections, occurred in 11.3% in the 12 mg of dexamethasone group vs 13.4% in the 6 mg of dexamethasone group (adjusted relative risk, 0.83 [99% CI, 0.54-1.29]). CONCLUSIONS AND RELEVANCE Among patients with COVID-19 and severe hypoxemia, 12 mg/d of dexamethasone compared with 6 mg/d of dexamethasone did not result in statistically significantly more days alive without life support at 28 days. However, the trial may have been underpowered to identify a significant difference.
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