Alien Registration- Mercier, Emma M. (Madison, Somerset County)

https://digitalmaine.com/alien_docs/7099/thumbnail.jp

The effects of room design on computer-supported collaborative learning in a multi-touch classroom.

While research indicates that technology can be useful for supporting learning and collaboration, there is still relatively little uptake or widespread implementation of these technologies in classrooms. In this paper, we explore one aspect of the development of a multi-touch classroom, looking at two different designs of the classroom environment to explore how classroom layout may influence group interaction and learning. Three classes of students working in groups of four were taught in the traditional forward-facing room condition, while three classes worked in a centered room condition. Our results indicate that while the outcomes on tasks were similar across conditions, groups engaged in more talk (but not more off-task talk) in a centered room layout, than in a traditional forward-facing room. These results suggest that the use of technology in the classroom may be influenced by the location of the technology, both in terms of the learning outcomes and the interaction behaviors of students. The findings highlight the importance of considering the learning environment when designing technology to support learning, and ensuring that integration of technology into formal learning environments is done with attention to how the technology may disrupt, or contribute to, the classroom interaction practices

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

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

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Group goals: Their influence on interaction patterns and learning

The use of collaborative projects has increased across college campuses, and there are continued calls for a further increase in this type of instruction (NSF, 1996). However, there is a growing recognition that while there is a rich research history on collaboration, there is not sufficient knowledge about how to construct tasks, support interactions and assess outcomes in a meaningful way (NAE, 2005). This problem is echoed in the collaboration literature, which recently has moved towards suggesting the need for more complex understandings of the relationships between the context and task, collaborative interactions and outcomes (e.g. Akkerman et al., 2007). This dissertation begins to address this problem by examining how the framing of a task influenced interaction patterns and outcomes. The task was framed using either a learning or performance goal, drawing on many years of research that indicate that achievement goals influence the learning behavior and outcomes of individuals (e.g. Dweck, 1999). The task was adapted from Azmitia and Crowley (2001) who designed a task in which participants built structures on a shake table and determined the principles that are necessary for the structure to stand. Dyads in the learning condition were told that their task was to understand and define the principles; dyads in the performance condition were told that they were to build the tallest structure that stood for the longest time. Ninety undergraduate students participated in the study, in 45 gender matched dyads. It was hypothesized that there would be difference in performance and learning outcomes, and that dyads in the learning condition would test more structures, would reflect more on their tests, would use more resources, create more representations and engage in more social conversation than dyads in the performance condition. Quantitative results indicated that there were no differences between conditions on performance on a building task. Differences between conditions were found on dyad-level scores on the stability judgment task—a task where participants saw photographs of structures, judged whether they thought the structure would withstand an earthquake and explained their reasoning. On both the judgment and explanation part of this task, average scores from dyads in the learning condition were higher than scores for dyads in the performance condition, indicating that framing the task with a learning goal improved the learning outcomes of participants. Analysis of knowledge convergence—the amount of knowledge dyads had in common—also showed evidence of an advantage for dyads in the learning condition. This can be explained by evidence for more teaching and creation of new knowledge within the learning condition. Dyads in the learning condition also tested more structures, created slightly more representations and were more likely to engage in social conversation than dyads in the performance condition; engaging in social conversation was the only behavior that correlated positively with knowledge convergence. These findings again indicate that framing the task with a learning goal improved the learning outcomes, and also changed how dyads interacted. Case study analysis showed that the interactions between dyads in the learning and performance conditions were different in terms of amount of reflecting on trials, explanations and summarizing ideas. Dyads in the learning condition also showed a much more explicit pattern of engagement with the task than dyads in the performance condition. These results provide evidence for how the different goals resulted in different outcomes. This study suggests that the framing of a task is an important factor in determining the quality of interactions, and the outcomes that dyads experience. This is important in light of standard assessment procedures at the college level, which frequently use the quality of the product as the measure of success—a performance measure. This study suggests that assessing a project's quality can influence whether dyads engage in the types of behaviors that lead to learning, affecting the amount that they learn from the process. The study also indicates that making efforts to understand how the context and task effect interaction patterns, and how that leads to different outcomes is a productive and necessary direction for the field to pursue. Additionally, understanding why social conversation and high knowledge convergence were found to correlate in this study needs further examination, to explain how the relational side of interactions influences learning

Alien Registration- Mercier, Emma M. (Madison, Somerset County)

https://digitalmaine.com/alien_docs/7099/thumbnail.jp