| 1. |
- 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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| 2. |
- Lotekar, Ajay, et al.
(författare)
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Kinetic-scale Current Sheets in Near-Sun Solar Wind : Properties, Scale-dependent Features and Reconnection Onset
- 2022
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Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 929:1
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Tidskriftsartikel (refereegranskat)abstract
- We present statistical analysis of 11,200 proton kinetic-scale current sheets (CS) observed by the Parker Solar Probe during 10 days around the first perihelion. The CS thickness lambda is in the range from a few to 200 km with the typical value around 30 km, while current densities are in the range from 0.1 to 10 mu A m(-2) with the typical value around 0.7 mu A m(-2). These CSs are resolved thanks to magnetic field measurements at 73-290 samples s(-1) resolution. In terms of proton inertial length lambda(p), the CS thickness lambda is in the range from about 0.1 to 10 lambda(p) with the typical value around 2 lambda(p). The magnetic field magnitude does not substantially vary across the CSs, and accordingly the current density is dominated by the magnetic-field-aligned component. The CSs are typically asymmetric with statistically different magnetic field magnitudes at the CS boundaries. The current density is larger for smaller-scale CSs, J(0) approximate to 0.15 x (lambda/100 km)(-0.76) mu A m(-2), but does not statistically exceed the Alfven current density J(A) corresponding to the ion-electron drift of the local Alfven speed. The CSs exhibit remarkable scale-dependent current density and magnetic shear angles, J(0)/J(A) approximate to 0.17 x (lambda/lambda(p))(-0.67) and Delta theta approximate to 21 degrees x (lambda/lambda(p))(0.32). Based on these observations and comparison to recent studies at 1 au, we conclude that proton kinetic-scale CSs in the near-Sun solar wind are produced by turbulence cascade, and they are automatically in the parameter range, where reconnection is not suppressed by the diamagnetic mechanism, due to their geometry dictated by turbulence cascade.
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| 3. |
- Wang, R., et al.
(författare)
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Multisatellite Observations of Ion Holes in the Earth's Plasma Sheet
- 2022
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Ingår i: Geophysical Research Letters. - : American Geophysical Union (AGU). - 0094-8276 .- 1944-8007. ; 49:8
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Tidskriftsartikel (refereegranskat)abstract
- We present the first observations of electrostatic solitary waves with electrostatic potential of negative polarity around a fast plasma flow in the Earth's plasma sheet. The solitary waves are observed aboard four Magnetospheric Multiscale spacecraft, which allowed accurately estimating solitary wave properties. Based on a data set of 153 solitary waves, we show that they are locally one-dimensional Debye-scale structures with amplitudes up to 20% of local electron temperature and they propagate at plasma frame speeds ranging from a tenth to a few ion-acoustic speeds at arbitrary angles to the local magnetic field. The solitary waves are associated with multi-component proton distributions and their velocities are around those of a beam-like proton population. We argue that the solitary waves are ion holes, nonlinear structures produced by ion-streaming instabilities, and conclude that once ions are not magnetized, ion holes can propagate oblique to local magnetic field.
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| 4. |
- Chattopadhyay, Tanmoy, et al.
(författare)
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Sub-MeV spectroscopy with AstroSat-CZT imager for gamma ray bursts
- 2021
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Ingår i: Journal of astrophysics and astronomy. - : Springer Nature. - 0250-6335 .- 0973-7758. ; 42:2
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Tidskriftsartikel (refereegranskat)abstract
- Cadmium-Zinc-Telluride Imager (CZTI) onboard AstroSat has been a prolific Gamma-Ray Burst (GRB) monitor. While the 2-pixel Compton scattered events (100-300 keV) are used to extract sensitive spectroscopic information, the inclusion of the low-gain pixels (similar to 20% of the detector plane) after careful calibration extends the energy range of Compton energy spectra to 600 keV. The new feature also allows single-pixel spectroscopy of the GRBs to the sub-MeV range which is otherwise limited to 150 keV. We also introduced a new noise rejection algorithm in the analysis ('Compton noise'). These new additions not only enhances the spectroscopic sensitivity of CZTI, but the sub-MeV spectroscopy will also allow proper characterization of the GRBs not detected by Fermi. This article describes the methodology of single, Compton event and veto spectroscopy in 100-900 keV combined for the GRBs detected in the first year of operation. CZTI in last five years has detected similar to 20 bright GRBs. The new methodologies, when applied on the spectral analysis for this large sample of GRBs, has the potential to improve the results significantly and help in better understanding the prompt emission mechanism.
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| 5. |
- Ganesh, Viswanathan, et al.
(författare)
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Role Of Green Buildings in Sustainable Living: Implementation and Impacts
- 2022
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Ingår i: ECS Transactions. - : The Electrochemical Society. - 1938-5862 .- 1938-6737. ; 107:1, s. 189-197
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Konferensbidrag (refereegranskat)abstract
- The rise in the number of carbon footprint has led to various new challenges and opportunities to reduce the rate of global warming and carbon footprint present in the atmosphere similarly the amount of global warming caused by the modern buildings and electrical devices which are required for the purpose of cooling and heating have played a key role in the higher concentration of temperature in the urban areas. On the other hand, the temperature levels in rural areas are comparatively lower than the urban areas due to large bare land available for the free movement of air and the effect of trees have reduced the temperature with the help of natural shades and oxygen production. Therefore, the concept of green building and Net zero building have been incorporated to enable the concept of nature into the buildings where the people can be more interconnected to the nature and get benefited to reduce the overall temperature and global warming effect in the coming future in accordance with the Sustainable development goal 7 under affordable and clean energy.
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