Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

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 survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

The relationship between sex-role development and classification skills in young children

Includes bibliographical references.Includes illustrations.The present study was an examination of the cognitive-developmental approach to sex-role development, as measured by toy preferences. Three classification tasks were used to assess the development of conceptual abilities, both physical and sex-role related. The first classification task was a free classification procedure involving circles and triangles, both large and small. The second free classification task used pictures of toys previously rated as to their sex-appropriateness. These pictures were mounted on two different background colors. The last classification task, which was given to the children after their preferences had been assessed, was more structured. Using the same stimuli as in the toy free classification task, children were asked to sort them into "boys" and "girls" toys. The findings indicated an increase in sex-appropriate preference and all classification skills with age. Boys had stronger sex-appropriate preferences than girls. The frequency of children at each age who could classify did not differ significantly among classification measures. Developmental level, as measured by classification patterns showed the same relationship to sex-appropriate preference as did age. In addition, boy/girl classification was related to sex-appropriate preference within sex and age groups. Children who had this skill had stronger sex-appropriate preferences. These findings were related to recent research and theoretical positions.M.A. (Master of Arts

The importance of didactic toys in kindergarten educational process

The aim of this study is to identify preschool children’s strategies in choice and play with didactic toys. The research was based on participatory observation of children with the set of original didactic toys. In total, 77 children aged 2 to 6 years from four different kindergartens were observed, with children always in small groups. The data obtained in the form of video recordings and field notes was then transcribed and analyzed using qualitative methods. The results point out the teacher’s influence, usually determined what the toy serves or what task have to accomplished. We also point out the possible conditionality of the child’s interest in the toy. Findings highlights the child’s strategy in the play, especially the modification of the toy that arises just when the child has the opportunity to independently explore the toys. The importance is to support the didactic thinking of kindergarten’s teachers including pre-service teachers. © 2020, Springer Nature Switzerland AG

Représentations liées aux catégories de sexe chez les enfants en contexte scolaire

International audienceEn France, la question de l’éducation à l’égalité filles/garçons à l’école et la luttecontre les inégalités entre les catégories de sexe est une question vive et cette rechercheest à contextualiser au regard de la lutte contre les stéréotypes en contexte scolaire.Nous nous intéressons aux connaissances que les enfants développent, au coursde la petite enfance et de l’enfance, au sujet des jouets, perçus ici comme médiasde la socialisation de genre. Les résultats indiquent une connaissance précoce desstéréotypes associés à certains jouets mais aussi des variations selon le type de jouetet l’âge des enfants. Les expériences de socialisation en contexte scolaire peuventfournir, de par l’action des enseignants à travers les interactions pédagogiques etles supports ludiques, des expériences plus hétérogènes