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

Effects of congruent perceptions on student achievement in freshman English classes

The problem. Much recent research on teaching has emphasized classroom climate, classroom focus (on the student as an active participant in instruction or on the instructor as an information giver), patterns of teacher-student verbal interaction, and cognitive levels of learning tasks. Though these are clearly relevant dimensions of instruction, their relationships to student learning have not been demonstrated definitively enough to provide a firm basis for the improvement of instruction. The unique contribution of this study to educational research literature was the analysis of instructional conditions (above) according to the degree of congruence between instructor and student assessment of their emphases in class. Procedures. Fourteen instructors in second semester freshman English at Texas A&M University comprised the teacher sample. One class of each instructor was randomly selected for this study. Since classes were computer-scheduled without regard to student characteristics, the 348 students are believed to be representative of the whole university's freshman population. The Class Activities Questionaire (CAQ) was administered to classes during the fourteenth week of the semester. Parallel Class Activities Questionnaire (PCAQ) forms were given to instructors two weeks later. The CAQ assessed cognitive levels and affective conditions receiving emphasis in class by relatively low-inference student judgments. By the PCAQ, instructors assessed each individual student along the same dimensions as those of the CAQ, with parallel items, thus providing the basis for comparing instructor and student perceptions of emphases. ..

Effects of congruent perceptions on student achievement in freshman English classes

The problem. Much recent research on teaching has emphasized classroom climate, classroom focus (on the student as an active participant in instruction or on the instructor as an information giver), patterns of teacher-student verbal interaction, and cognitive levels of learning tasks. Though these are clearly relevant dimensions of instruction, their relationships to student learning have not been demonstrated definitively enough to provide a firm basis for the improvement of instruction. The unique contribution of this study to educational research literature was the analysis of instructional conditions (above) according to the degree of congruence between instructor and student assessment of their emphases in class. Procedures. Fourteen instructors in second semester freshman English at Texas A&M University comprised the teacher sample. One class of each instructor was randomly selected for this study. Since classes were computer-scheduled without regard to student characteristics, the 348 students are believed to be representative of the whole university's freshman population. The Class Activities Questionaire (CAQ) was administered to classes during the fourteenth week of the semester. Parallel Class Activities Questionnaire (PCAQ) forms were given to instructors two weeks later. The CAQ assessed cognitive levels and affective conditions receiving emphasis in class by relatively low-inference student judgments. By the PCAQ, instructors assessed each individual student along the same dimensions as those of the CAQ, with parallel items, thus providing the basis for comparing instructor and student perceptions of emphases. ..

Archaeozoological records for the Highlands of New Guinea: A review of the current evidence

Archaeozoological records for seven occupation sites in the highlands of New Guinea are presented and reviewed. The sites were originally excavated between 1959 and 1981. More recent excavations have not documented comparable archaeozoological records. This paper aims to summarise unpublished research, together with some previously published results, for a broader audience, and elicit general trends within the data. Of significance are methodological insights, observations on Pleistocene and Holocene extinctions and the introduction of exotic fauna, and implications for understanding land-use and socio-economic histories during the late Holocene

In vivo tissue engineering chamber supports human induced pluripotent stem cell survival and rapid differentiation

Pluripotent stem cells are a potential source of autologous cells for cell and tissue regenerative therapies. They have the ability to renew indefinitely while retaining the capacity to differentiate into all cell types in the body. With developments in cell therapy and tissue engineering these cells may provide an option for treating tissue loss in organs which do not repair themselves. Limitations to clinical translation of pluripotent stem cells include poor cell survival and low cell engraftment in vivo and the risk of teratoma formation when the cells do survive through implantation. In this study, implantation of human induced-pluripotent stem (hiPS) cells, suspended in Matrigel, into an in vivo vascularized tissue engineering chamber in nude rats resulted in substantial engraftment of the cells into the highly vascularized rat tissues formed within the chamber. Differentiation of cells in the chamber environment was shown by teratoma formation, with all three germ lineages evident within 4. weeks. The rate of teratoma formation was higher with partially differentiated hiPS cells (as embryoid bodies) compared to undifferentiated hiPS cells (100% versus 60%). In conclusion, the in vivo vascularized tissue engineering chamber supports the survival through implantation of human iPS cells and their differentiated progeny, as well as a novel platform for rapid teratoma assay screening for pluripotency