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- Axfors, Cathrine, et al.
(författare)
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Association between convalescent plasma treatment and mortality in COVID-19 : a collaborative systematic review and meta-analysis of randomized clinical trials
- 2021
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Ingår i: BMC Infectious Diseases. - : BioMed Central (BMC). - 1471-2334. ; 21:1
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Forskningsöversikt (refereegranskat)abstract
- Background: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, ). Methods: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I-2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.
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| 2. |
- Koussis, A. D., et al.
(författare)
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Cost-efficient management of coastal aquifers via recharge with treated wastewater and desalination of brackish groundwater: Application to the Akrotiri Basin and Aquifer, Cyprus
- 2010
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Ingår i: Hydrological Sciences Journal. - : Informa UK Limited. - 0262-6667 .- 2150-3435. ; 55:7, s. 1234-1245
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Tidskriftsartikel (refereegranskat)abstract
- We investigate the general methodology for an intensive development of coastal aquifers, described in a companion paper, through its application to the management of the Akrotiri aquifer, Cyprus. The Zakaki area of that aquifer, adjacent to Lemessos City, is managed such that it permits a fixed annual agricultural water demand to be met, as well as and a fraction of the water demand of Lemessos, which varies according to available surface water. Effluents of the Lemessos wastewater treatment plant are injected into the aquifer to counteract the seawater intrusion resulting from the increased pumping. The locations of pumping and injection wells are optimized based on least-cost, subject to meeting the demand. This strategy controls sea intrusion so effectively that desalting of only small volumes of slightly brackish groundwater is required over short times, while ∼2.3 m3 of groundwater is produced for each 1 m3 of injected treated wastewater. The cost over the 20-year period 2000-2020 of operation is ∼40 M€ and the unit production cost of potable water is under 0.2 €/m3. The comparison between the deterministic and stochastic analyses of the groundwater dynamics indicates the former as conservative, i.e. yielding higher groundwater salinity at the well. The Akrotiri case study shows that the proposed aquifer management scheme yields solutions that are preferable to the widely promoted seawater desalination, also considering the revenues from using the treated wastewater for irrigation.
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| 3. |
- Koussis, A. D., et al.
(författare)
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Cost-efficient management of coastal aquifers via recharge with treated wastewater and desalination of brackish groundwater: General framework
- 2010
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Ingår i: Hydrological Sciences Journal. - : Informa UK Limited. - 0262-6667 .- 2150-3435. ; 55:7, s. 1217-1233
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Tidskriftsartikel (refereegranskat)abstract
- Semi-arid coastal zones often suffer water-stress, as water demand is high and markedly seasonal, due to agriculture and tourism. Driven by scarcity of surface water, the communities in semi-arid coastal regions turn to aquifers as prime water source; but intensive exploitation of coastal aquifers causes seawater intrusion, which degrades the quality of groundwater. The cost-efficient and sustainable development of coastal aquifers can be achieved through a holistic management scheme which combines two non-traditional water sources: (a) saltwater, to be treated to the desired quality, and (b) wastewater, to be re-claimed to augment aquifer recharge for control of seawater intrusion, and also to meet certain demands. This management scheme is based on the idea that it is cost-advantageous to: (i) desalt brackish groundwater, instead of seawater, as the former requires far less energy, and (ii) to re-use wastewater at only the differential cost to any treatment already practiced. In this paper, we present the general framework of the proposed management scheme, and a decision aid tool (DAT) which has been developed to assist decision makers to explore the scheme's decision space. The DAT uses cost as optimization criterion to screen various management scenarios, via modelling of the dynamic natural-engineered system behaviour, and identifies those cost-efficient ones that meet the water demand and achieve aquifer protection.
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