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Item does not contain fulltext, IMPORTANCE: Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. OBJECTIVE: To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS: In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non-critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS: Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES: The primary outcome was organ support-free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS: On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support-free days among critically ill patients was 10 (-1 to 16) in the ACE inhibitor group (n = 231), 8 (-1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support-free days compared with control were 94.9% and 95.4%, respectively. Hospital surv

A review of batch lead refining is presented.it is concluded that only a limited amount of work has been published on the process engineering aspects of lead refining, whereas there is a great deal of information on the chemistry and metallurgical practice. An analysis of the two main refining techniques: decoppering and causticising has been undertaken with a view to modelling and simulating the processes in order to optimise design and performance., A review of batch lead refining is presented.it is concluded that only a limited amount of work has been published on the process engineering aspects of lead refining, whereas there is a great deal of information on the chemistry and metallurgical practice. An analysis of the two main refining techniques: decoppering and causticising has been undertaken with a view to modelling and simulating the processes in order to optimise design and performance.

A brief technical description of a pilot-scale furnace facility designed, constructed and operated at Warren Spring Laboratory is presented and the scope of this technique in the development of new and improved processes in non-ferrous extractive metallurgy for the treatment of ores and secondary materials is discussed. Applications include refining of impure copper, smelting of tin concentrates, cupellation of lead-silver bullion and the smelting and refining of lead from battery scrap., A brief technical description of a pilot-scale furnace facility designed, constructed and operated at Warren Spring Laboratory is presented and the scope of this technique in the development of new and improved processes in non-ferrous extractive metallurgy for the treatment of ores and secondary materials is discussed. Applications include refining of impure copper, smelting of tin concentrates, cupellation of lead-silver bullion and the smelting and refining of lead from battery scrap.

A review of batch lead refining is presented. It is concluded that only a limited amount of work has beenpublished on the process engineering aspects of lead refining, whereas there is a great deal of information on the chemistry and metallurgical practice. An analysis of the two main refining techniques: decoppering andcausticising has been undertaken with a view to modelling and simulating the processes in order to optimise design and performance., A review of batch lead refining is presented. It is concluded that only a limited amount of work has beenpublished on the process engineering aspects of lead refining, whereas there is a great deal of information on the chemistry and metallurgical practice. An analysis of the two main refining techniques: decoppering andcausticising has been undertaken with a view to modelling and simulating the processes in order to optimise design and performance.

Background: Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. Objective: To describe IHCA demographics during three day/time periods - weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59) - and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. Methods: We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Results: Risk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and nighttime (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/ time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. Conclusions: IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially w