The Anesthetic Soundscape

"Synapsis: A Health Humanities Journal" was founded in 2017 by Arden Hegele, a literary scholar, and Rishi Goyal, a physician. Its mission is to develop conversations among diverse people thinking about medical and humanistic ways of knowing ... as a “Department Without Walls” that connects scholars and thinkers from different spheres

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

In and On the Clinic

"Synapsis: A Health Humanities Journal" was founded in 2017 by Arden Hegele, a literary scholar, and Rishi Goyal, a physician. Its mission is to develop conversations among diverse people thinking about medical and humanistic ways of knowing ... as a “Department Without Walls” that connects scholars and thinkers from different spheres

Reframing the Cultural Clash: A Literary, Disability Studies Reading of "The Spirit Catches You and You Fall Down"

"Synapsis: A Health Humanities Journal" was founded in 2017 by Arden Hegele, a literary scholar, and Rishi Goyal, a physician. Its mission is to develop conversations among diverse people thinking about medical and humanistic ways of knowing ... as a “Department Without Walls” that connects scholars and thinkers from different spheres

Baseline Endometrial Thickness or Endometrial Thickness Change in Response to Estrogen Is Not Predictive of Frozen Embryo Transfer Success in Medicated Cycles

There is some consensus that endometrial thickness (EMT) needs to be at least 7 mm on day of embryo transfer. However, the predictive role of baseline EMT and EMT change in response to estrogen is largely unknown. The objective of this study was to evaluate the role of endometrial thickness in frozen embryo transfer (FET) cycles. We analyzed the association of baseline endometrial thickness (EMTb-Day 3 of cycle) and endometrial thickness change (EMTΔ-from baseline to start of progesterone supplementation) with FET success in 121 cycles. We also investigated whether baseline estradiol levels and body mass index (BMI) are associated with EMTb. No difference was observed in EMTb and EMTΔ in cycles resulting in clinical pregnancy compared to unsuccessful transfers (5.1 ± 2.2 mm vs 5.0 ± 1.9 mm; p = 0.92, and 4.7 ± 2.4 mm vs. 4.4 ± 2.4 mm; p = 0.56). When 7 mm cut-off was used, endometrial thickness on the day of start of progesterone supplementation (EMTp) was also not different between groups (9.8 ± 2.9 mm vs. 9.4 ± 2.5 mm; p = 0.50). Multivariable logistic regression models did not demonstrate any predictive value of EMTb, EMTp, or EMTΔ in predicting success of FET cycles (p = 0.92, p = 0.80, and p = 0.84, respectively). There was no significant correlation between EMTb and baseline estradiol levels (r = -0.001; p = 0.985). BMI showed statistically significant weak positive linear relationship with EMTb (r = +0.29; p = 0.002). Our study did not demonstrate any significant relationship between baseline endometrial thickness or endometrial thickness change and clinical pregnancy rates in frozen embryo transfer cycles. Significant positive linear relationship of BMI with baseline endometrial thickness, despite no correlation between baseline estradiol and EMTb, points to the role of possible other mechanism affecting EMT besides estradiol in obese patients

What Makes a Study Strategy Intervention Impactful? An Interview-Based Study

The purpose of the present study was to understand students’ perceptions of the impact of a study strategy workshop intervention. For decades, researchers and higher education practitioners have used workshops as a method to buffer against the challenges that college students face. Prior research has supported the value of such interventions; however, the features that underlie effective workshop interventions are not fully understood. We conducted 20 semi-structured interviews to identify nuance and subjective details related to students’ experiences with a study strategies workshop intervention in an undergraduate biology course. Based on thematic codebook analysis, findings pointed to three themes related to features that allowed the intervention to have an impact on students’ study strategies: receptivity to workshop content, motivation and ability to change, and conditions for sustained change

Thermostable, Dissolvable Buccal Film Rotavirus Vaccine Is Highly Effective in Neonatal Gnotobiotic Pig Challenge Model

Difficulties related to storage and transport of currently available live oral rotavirus vaccines can have detrimental consequences on the efficacy of the vaccines. Thus, there is a great need for thermostable vaccines that can eliminate the necessity for cold chain storage or reconstitution before administration. In this study, we developed a dissolvable oral polymeric film comprised of a live attenuated thermostable tetravalent rhesus-human reassortant rotavirus vaccine (RRV-TV) powder and antacid (CaCO3). Immunogenicity and protective efficacy of the vaccine after buccal delivery was evaluated in the gnotobiotic pig model of human rotavirus (HRV) infection and diarrhea. Two doses of the vaccine were highly immunogenic and conferred strong protection against virus shedding and diarrhea upon challenge with a high dose of a virulent G1 HRV in gnotobiotic pigs. Those pigs vaccinated with the preserved film vaccine had significantly delayed onset of diarrhea; reduced duration and area under the curve of diarrhea; delayed onset of fecal virus shedding; and reduced duration and peak of fecal virus shedding titers compared to pigs in both the placebo and the reconstituted liquid oral RRV-TV vaccine groups. Associated with the strong protection, high titers of serum virus neutralization antibodies against each of the four RRV-TV mono-reassortants and G1 HRV-specific serum IgA and IgG antibodies, as well as intestinal IgA antibodies, were induced by the preserved film vaccine. These results demonstrated the effectiveness of our thermostable buccal film rotavirus vaccine and warrant further investigation into the promise of the novel technology in addressing drawbacks of the current live oral HRV vaccines

Is Metacognition Enough? Comparing Two Workshop Interventions in College Biology

Background. College introductory biology places high expectations on the quality and quantity of learning (Yazedjian et al., 2008). There has been a growing focus on developing metacognitive abilities to support success in college science courses (Dye & Stanton, 2017; Sebesta & Speth, 2017; Stanton et al., 2015). Workshop-style metacognition interventions can make a positive impact on academic outcomes (Hoffmann & McGuire, 2010; McGuire, 2015), yet an emphasis on metacognition alone may be incomplete. Although metacognition is an important component of self-regulated learning, it is just one of the areas that effective learners regulate; other areas include motivation, behavior, and context (Kim et al., 2020; Panadero, 2017). Engaging in effective time management invokes a fuller range of self-regulatory processes, as it involves devoting time and effort toward academic work, managing distractions in the environment, and generating the motivation not to procrastinate (Claessens et al., 2007; Wolters & Brady, 2020). Prior research on academic workshops suggests their academic benefits, but the studies also have shortcomings such as no pre-test strategy/belief measures or lack of a comparison group (Cook et al., 2013; Zhao et al., 2014). Aims & Methods. In this study, a team of researchers and educators from a student learning center and life sciences education center collaborated to design and compare two workshop-style interventions delivered in an undergraduate biology class. Because embedding learning strategy training within a specific context may lead to deeper understanding of the target strategy (Hattie & Donoghue, 2016), both workshops took place in students’ regularly scheduled laboratory class soon after students had received their first exam results. The seventeen laboratory sections were randomly assigned to one of two workshop interventions. The baseline workshop (“Metacognition,” n = 133) taught students about metacognitive learning strategies, while the extended workshop added content on time management and procrastination (“Metacognition+TM,” n = 116). All participating students also completed a pre-survey (prior to intervention) and post-survey (end of semester) that included self-reported measures of academic beliefs and strategies (e.g., Davidson et al., 2009). Students’ demographics (see Table 1), academic backgrounds, and grades were gathered from university records. Findings. Using an SEM residualized change approach that included academic, demographic, and pre-test covariates, we found statistically significant differences in students’ exam scores and pre-post levels of self-reported commitment toward earning a college degree, with greater increases for students who participated in the Metacognition+TM workshop (see Table 2). In addition, race/ethnicity moderated the effect of the intervention, with the Metacognition+TM intervention being especially effective in increasing the self-reported use of time management tools by students from minoritized groups (see Table 3 and Figure 1). Significance. The study provides evidence of the academic value of teaching college students how to regulate their learning, particularly the aspects associated with time management. Our discussion of implications will address the need for further research that includes additional assessments of students’ strategies, as well as instructional practices that approach study strategies from the perspective of creating equity and fostering inclusion (Asai, 2020; Matthews & López, 2020)

EnVision: a Nominal Science Phase Spanning Six Venus Sidereal Days

International audiencenVision was selected as ESA’s 5th M-class mission, targeting a launch in the early 2030s. The mission is a partnership between ESA and NASA, where NASA provides the Synthetic Aperture Radar payload. The scientific objective of EnVision is to provide a holistic view of the planet from its inner core to its upper atmosphere. The mission phase B1 started in December 2021 to complete trade-offs, consolidate requirements, interfaces and system specifications. Phase B1 will be concluded with the Mission Adoption Review planned in fall 2023, followed by Mission Adoption in 2024. To meet its science objectives, the EnVision mission needs to return a significant volume of science data to Earth, with a large distance-to-Earth dynamic range (from 0.3 to 1.7 AU), from a low Venus polar orbit, in the hot Venus environment (exacerbated by the operation of highly dissipative units), while operating three spectrometers in an almost cryogenic level environment. This needs to be achieved within constraints on the spacecraft mass as well as Agency programmatic boundaries. Achieving the science objectives under these multiple constraints without oversizing the spacecraft calls for a careful planning of science operations, making the science planning strategy a critical driver in the design of the whole mission, against which the spacecraft and ground segment are then sized.The payload reference operations scenario simulation demonstrates that all identified surface targets can be imaged with VenSAR, with a performance fully compliant with the science requirements. The first two cycles allow imaging once 80% of the identified Regions of Interest (RoIs) at 30 m resolution. The following two cycles are mostly devoted to 2nd observations of these areas for stereo-topography mapping and the two last cycles to 3rd observations of the “activity” type. Dual polarization and high resolution SAR observations can be performed at any longitude at least once across the 6 cycles. Our strategy is to obtain the widest range of data types that enables us to put the highest resolution datasets into regional and global context. Similarly, understanding atmospheric processes requires a combination of global-scale mapping with targeted observations resolving smaller-scale processes