The Policy Implications of Interactions Among Financial Aid Programs

Various gift-aid, loan, and work-study programs help college students fill the gap between educational costs and their financial resources. Previous research generally has examined the effects of a given program by itself. What is missing are studies that investigate interactions among programs, such as how state or university grants reinforce or offset the targeting policies that are embedded in the Pell program. This article draws on research conducted on colleges in Indiana to describe how federal, state, private, and college-based financial aid programs and practices interact with each other to determine the total amount of gift-aid a student receives. It discusses how these relationships can dilute or enhance a program\u27s implicit targeting policies. The lessons learned from this experience provide important insights for developing a fuller appreciation of how current and future gift-aid programs may affect each other

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

Indigenous Relationality and Kinship and the Professionalization of a Health Workforce

We, as a group of academic learners, argue the professionalization of healthcare service providers reinforces hierarchies of knowledge that results in the exclusion of Indigenous Peoples. Through decolonizing theory and Indigenous methodology, we applied Indigenous understandings of relationality and kinship to examine the professionalization of the health workforce. Relationality is a philosophy that describes the interconnections between all of creation and kinship consists of family, community, and all extended human and more-than-human relations. Indigenous health knowledges reflect relationality and kinship and are practiced by midwives, doulas, and Comadronas. Within the Euro-Western biomedical model, these healers are often incorporated into maternity care services for the purposes of professionalizing their roles. Professionalization, however, reinforces power differentiations between healthcare providers and advances biomedical hegemony and hierarchies of knowledge, all of which exclude Indigenous kinship and relationality. The dangers of professionalization of the health workforce result in the omission of Indigenous knowledges, because the Euro-Western biomedical model of health is built on the philosophies of colonialism and capitalism. To counter professionalization, Indigenous relationality and kinship must be prioritized in the provision of healthcare so that it is inclusive to Indigenous Peoples and their knowledges, the results of which will benefit us all

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

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