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

Differentiation practices in grade 2 and 3:Variations in teacher behavior in mathematics and reading comprehension lessons

This study focused on the differentiation practices of second- and third-grade teachers in mathematics and reading comprehension lessons. Preconditions for differentiation, classroom organization, and how teachers dealt with students of different ability levels were investigated through observations, using a time-sampling instrument. Data of 43 teachers, from 18 schools, show the importance of taking context factors into account. The study also focused on how students of four different performance levels were addressed by their teachers. It was found that teachers mostly adapted teaching to the relatively weak performing students in their class by addressing them more often, in a content-related way. Relatively advanced students received additional attention less often

The relation between teacher-set performance goals and students' mathematical achievement

The relation between teacher-set performance goals for 361 individual students and these students' mathematics achievement was investigated. High performance goals were found to strongly relate to student performance, with an effect size of d= 0.80. The performance goals were set by the teachers at the end of a step-by-step procedure, consisting of initial teacher expectations, the use of data, and team input. This procedure was expected to decrease negative expectancy bias. Higher teacher performance goals than teachers' initial expectations, so-called positive changes, were positively associated with the performance of initially low achievers. Initially high achievers, for whom the teachers made a positive change, performed worse than comparable students for whom initial expectation and final goal were the same. (C) 2016 Elsevier Ltd. All rights reserved

Goals, data use, and instruction:the effect of a teacher professional development program on reading achievement

In this paper, we investigated whether student reading comprehension could be improved with help of a teacher Professional Development (PD) program targeting goals, data use, and instruction. The effect of this PD program on 2nd- and 3rd-grade student achievement was examined using a pretest-posttest control group design. Applying propensity score matching, 35 groups in the experimental condition were matched to 35 control groups. Students in the experimental condition (n = 420) scored significantly higher on a standardized assessment than the control condition (n = 399), the effect size being d = .37. No differential effects of the PD program were found in relation to initial reading performance or grade. Different model specifications yielded similar albeit smaller effect sizes (d = .29 and d = .30). At the end of the program, students in the experimental condition were more than half a year ahead of students in the control condition

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc