Student Perspectives on how Trauma Experiences Manifest in the Classroom: Engaging Court-Involved Youth in the Development of a Trauma-Informed Teaching Curriculum

This study explores how the lived experience of court-involved youth impacts learning and school culture, and solicits youth voice in creating a trauma-informed intervention to improve student educational well-being. Thirty-nine female students, ages 14 to 18, participated in focus groups to describe externalizing behaviors that they have both witnessed and personally struggled with in the classroom, discuss the perceived causes of these behaviors, and their suggestions for improving school culture to reduce these behavior manifestations in the classroom. Two major categories of behavior were identified, including: “anger emotions” and “aggressive actions.” Students described the causes of behavior as, “environmental influences” and “triggers.” The most common solutions that students gave to reduce externalizing behaviors in school settings included “encouraging respect of others” and “improving behavior management to enhance student engagement.” An additional solution suggested by the students included the “monarch room as support.” The Monarch Room is an alternative intervention to traditional suspension/expulsion polices that provides students in need of specific emotional support an opportunity to redirect/de-escalate externalizing behavior or mood in the school setting. This study highlights the need for trauma-informed approaches in school settings, and the importance of the inclusion of a youth voice in developing and implementing these intervention models

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

Student perspectives on how trauma experiences manifest in the classroom: Engaging court-involved youth in the development of a trauma-informed teaching curriculum

This study explores how the lived experience of court-involved youth impacts learning and school culture, and solicits youth voice in creating a trauma-informed intervention to improve student educational well-being. Thirty-nine female students, with ages 14 to 18, participated in focus groups to describe externalizing behaviors that they have both witnessed and personally struggled with in the classroom, discuss the perceived causes of these behaviors, and their suggestions for improving school culture to reduce these behavior manifestations in the classroom. Two major categories of behavior were identified, including: "anger emotions" and "aggressive actions." Students described the causes of behavior as, "environmental influences" and "triggers." The most common solutions that students gave to reduce externalizing behaviors in school settings included "encouraging respect of others" and "improving behavior management to enhance student engagement." An additional solution suggested by the students included the "monarch room as support." The Monarch Room is an alternative intervention to traditional suspension/expulsion polices that provides students in need of specific emotional support an opportunity to redirect/de-escalate externalizing behavior or mood in the school setting. This study highlights the need for trauma-informed approaches in school settings, and the importance of the inclusion of a youth voice in developing and implementing these intervention models

Student perspectives on how trauma experiences manifest in the classroom: Engaging court-involved youth in the development of a trauma-informed teaching curriculum

This study explores how the lived experience of court-involved youth impacts learning and school culture, and solicits youth voice in creating a trauma-informed intervention to improve student educational well-being. Thirty-nine female students, with ages 14 to 18, participated in focus groups to describe externalizing behaviors that they have both witnessed and personally struggled with in the classroom, discuss the perceived causes of these behaviors, and their suggestions for improving school culture to reduce these behavior manifestations in the classroom. Two major categories of behavior were identified, including: "anger emotions" and "aggressive actions." Students described the causes of behavior as, "environmental influences" and "triggers." The most common solutions that students gave to reduce externalizing behaviors in school settings included "encouraging respect of others" and "improving behavior management to enhance student engagement." An additional solution suggested by the students included the "monarch room as support." The Monarch Room is an alternative intervention to traditional suspension/expulsion polices that provides students in need of specific emotional support an opportunity to redirect/de-escalate externalizing behavior or mood in the school setting. This study highlights the need for trauma-informed approaches in school settings, and the importance of the inclusion of a youth voice in developing and implementing these intervention models

Student Perspectives on how Trauma Experiences Manifest in the Classroom: Engaging Court-Involved Youth in the Development of a Trauma-Informed Teaching Curriculum

Abstract This study explores how the lived experience of court-involved youth impacts learning and school culture, and solicits youth voice in creating a trauma-informed intervention to improve student educational well-being. Thirty-nine female students, ages 14 to 18, participated in focus groups to describe externalizing behaviors that they have both witnessed and personally struggled with in the classroom, discuss the perceived causes of these behaviors, and their suggestions for improving school culture to reduce these behavior manifestations in the classroom. Two major categories of behavior were identified, including: "anger emotions" and "aggressive actions." Students described the causes of behavior as, "environmental influences" and "triggers." The most common solutions that students gave to reduce externalizing behaviors in school settings included "encouraging respect of others" and "improving behavior management to enhance student engagement." An additional solution suggested by the students included the "monarch room as support." The Monarch Room is an alternative intervention to traditional suspension/expulsion polices that provides students in need of specific emotional support an opportunity to redirect/de-escalate externalizing behavior or mood in the school setting. This study highlights the need for trauma-informed approaches in school settings, and the importance of the inclusion of a youth voice in developing and implementing these intervention models

Intravenous vitamin C for patients hospitalized with COVID-19 : two harmonized randomized clinical trials

Abstract: Importance The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain.Objective To determine whether vitamin C improves outcomes for patients with COVID-19.Design, Setting, and Participants Two prospectively harmonized randomized clinical trials enrolled critically ill patients receiving organ support in intensive care units (90 sites) and patients who were not critically ill (40 sites) between July 23, 2020, and July 15, 2022, on 4 continents.InterventionsPatients were randomized to receive vitamin C administered intravenously or control (placebo or no vitamin C) every 6 hours for 96 hours (maximum of 16 doses).Main Outcomes and Measures The primary outcome was a composite of organ support-free days defined as days alive and free of respiratory and cardiovascular organ support in the intensive care unit up to day 21 and survival to hospital discharge. Values ranged from -1 organ support-free days for patients experiencing in-hospital death to 22 organ support-free days for those who survived without needing organ support. The primary analysis used a bayesian cumulative logistic model. An odds ratio (OR) greater than 1 represented efficacy (improved survival, more organ support-free days, or both), an OR less than 1 represented harm, and an OR less than 1.2 represented futility.Results Enrollment was terminated after statistical triggers for harm and futility were met. The trials had primary outcome data for 1568 critically ill patients (1037 in the vitamin C group and 531 in the control group; median age, 60 years [IQR, 50-70 years]; 35.9% were female) and 1022 patients who were not critically ill (456 in the vitamin C group and 566 in the control group; median age, 62 years [IQR, 51-72 years]; 39.6% were female). Among critically ill patients, the median number of organ support-free days was 7 (IQR, -1 to 17 days) for the vitamin C group vs 10 (IQR, -1 to 17 days) for the control group (adjusted proportional OR, 0.88 [95% credible interval {CrI}, 0.73 to 1.06]) and the posterior probabilities were 8.6% (efficacy), 91.4% (harm), and 99.9% (futility). Among patients who were not critically ill, the median number of organ support-free days was 22 (IQR, 18 to 22 days) for the vitamin C group vs 22 (IQR, 21 to 22 days) for the control group (adjusted proportional OR, 0.80 [95% CrI, 0.60 to 1.01]) and the posterior probabilities were 2.9% (efficacy), 97.1% (harm), and greater than 99.9% (futility). Among critically ill patients, survival to hospital discharge was 61.9% (642/1037) for the vitamin C group vs 64.6% (343/531) for the control group (adjusted OR, 0.92 [95% CrI, 0.73 to 1.17]) and the posterior probability was 24.0% for efficacy. Among patients who were not critically ill, survival to hospital discharge was 85.1% (388/456) for the vitamin C group vs 86.6% (490/566) for the control group (adjusted OR, 0.86 [95% CrI, 0.61 to 1.17]) and the posterior probability was 17.8% for efficacy.Conclusions and Relevance In hospitalized patients with COVID-19, vitamin C had low probability of improving the primary composite outcome of organ support-free days and hospital survival