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

Teaching/learning Action Research and Connecting with the Internship in the Bachelor of Education (Primary)

The question of connecting what is learned at university and within school sites has always been considered problematic. In the Teaching Project unit. we address this through the issue of the problematic of knowledge production. specifically the work of Gibbons et al. (1994) and Lee, Green and Brennan (2000). In this paper we set out the theoretical frameworks of the unit, including its position as the final unit in the Bachelor of Education (Primary) (BEd(P)) in a developmental continuum. We also show our pedagogical approach using combinations of an online learning management system (WebeT) both on and off campus. We examine the connection between the preparatory workshops and the online work in the first semester and the action research project completed while on internship in second semester. Additionally, the articulation between the Teaching Project unit and professional experience within the Internship unit is discussed

Enhancing the link between university and schools through action research on teaching practicum

The question of student teachers connecting what is learned at university and within school sites has always been considered problematic. At the University of New England (UNE), in New South Wales, Australia, this issue is addressed through an action research project undertaken by fourth year Bachelor of Education (BEd) primary students during their final professional experience component, i.e. an internship. This article sets out the theoretical framework for the project, which is grounded on previous work on the problems of knowledge production. Additionally, the articulation between the action research project and professional experience within the internship is discussed. Although this article reports on a project designed within the context of the Australian teacher education system, the concept may well be of interest to a much wider audience

Bush Tracks - Transience and Teaching: Place and the New Psychoanalytic Sociologies of Teaching: Paper 4 of the Bush Tracks Symposium

Ask any teacher about their life as a teacher and they will begin with their experience of place. 'First I taught there and then I moved there', the matter of time often hazy or more peripheral to the story of place. As Deleuze and Guattari (1987) argue, becomings are matters of geography more than history, our lives punctuated by entries and exits and the challenges of territorialisation and displacement. Becoming is a dynamic of space and place. Swept up by or leaping in to the flow, we move across the folds of the map rather than occupying its fixed points. Teacher-becoming, in a Deleuzian sense, is a series of lines of flight, journeys through both exterior and interior spaces. The rural sociologist Urry (2000) suggests that the rate of flow, the volume of movements – of people, things and ideas – is more a feature of the current century than previous. Tied up with the commodification of things, space produces and consumes objects, including teachers. Hence through Deleuze's social geography and Urry's mobility sociology it is possible to reframe the notion of teacher movements in new ways, not as a problem for education, but an increasing phenomenon linked with teacherliness in the contemporary era

Bush Tracks: Exploring Rural Teaching Transitions

Rural teaching is a phenomenon often characterised by transitions: transitions from urban or regional universities to rural communities, between rural teaching posts and others, and from classroom teaching to leadership responsibilities. In the last century many Australian teachers have begun their careers, that is, they have undertaken the transition from student teacher to beginning teacher, in a rural school. Rural teacher mobility is a phenomenon that has been well documented over many decades and the impacts in terms of staffing dilemmas are the focus of strategic policy reforms in most Australian states. Usually perceived as a problem for education, particularly in times of rural teacher shortages and leadership succession crises, the Bush Tracks Research Collective is seeking to understand the nature of rural teaching transitions in new ways. Through a research collaboration between educational researchers and rural teachers, central to our focus is an understanding of how people become good rural teachers, specifically, how they learn rural pedagogies and rural leadership strategies. This paper presents a preliminary analysis of our surveys and case studies of the transitional experiences of rural teachers

Bush Tracks - Exploring Rural Teaching Transitions: Paper 1 of the Bush Tracks Symposium

Rural teaching is a phenomenon often characterised by transitions: transitions from urban or regional universities to rural communities, between rural teaching posts and others, and from classroom teaching to leadership responsibilities. In the last century many Australian teachers have begun their careers, that is, they have undertaken the transition from student teacher to beginning teacher, in a rural school. Rural teacher mobility is a phenomenon that has been well documented over many decades and the impacts in terms of staffing dilemmas are the focus of strategic policy reforms in most Australian states. Usually perceived as a problem for education, particularly in times of rural teacher shortages and leadership succession crises, the Bush Tracks Research Collective is seeking to understand the nature of rural teaching transitions in new ways. Through a research collaboration between educational researchers and rural teachers, central to our focus is an understanding of how people become good rural teachers, specifically, how they learn rural pedagogies and rural leadership strategies. This paper presents a preliminary analysis of our surveys and case studies of the transitional experiences of rural teachers