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

Service users and carers as co-educators of social work students

This paper considers issues related to the requirement by the Scottish Social Services Council (SSSC) and the Scottish Government that service users and carers are partners and stakeholders in social work education. This requirement is one of many used by the SSSC in the approval of Scottish universities to deliver social work courses.This paper explains and reflects on the experiences of including service users and carers as co-educators with the social work courses at the Robert Gordon University (RGU) making particular reference to one module. It examines the issues around the process of their involvement with the education of social work students, and considers student evaluations of this module. Lastly it discusses the broader implications for partnership working in relation to the education and training of students for professional practice. The focus is on the role that service users and carers can play as partners in the classroom through the use of personal narratives. The experience of presenting as a service user or carer is discussed and the contributions highlight how such presentations can heighten student awareness as to the lived experience of a disability or a mental health problem

The First Physical Therapy Summit on Global Health: Implications and Recommendations for the 21st century

The First Physical Therapy Summit on Global Health was convened at the 2007 World Confederation for Physical Therapy (WCPT) Congress to vision practice in the 21st century and, in turn, entry-level education and research, as informed by epidemiological indicators, and consistent with evidence-based noninvasive interventions, the hallmark of physical therapy. The Summit and its findings were informed by WHO data and validated through national databases of the countries of the five WCPT regions. The health priorities based on mortality were examined in relation to proportions of physical therapists practicing in the areas of regional priorities and of the curricula in entry-level programs. As a validation check and to contextualize the findings, input from members of the 800 Summit participants was integrated and international consultants refined the recommendations. Lifestyle-related conditions (ischemic heart disease, smoking-related conditions, hypertension, stroke, cancer, and diabetes) were leading causes of premature death across regions. Contemporary definitions of physical therapy support that the profession has a leading role in preventing, reversing, as well as managing lifestyle-related conditions. The proportions of practitioners practicing primarily in these priority areas and of the entry-level curricula based on these priorities were low. The proportions of practitioners in priority areas and entry-level curricula devoted to lifestyle-related conditions warrant being better aligned with the prevalence of these conditions across regions in the 21st century. A focus on clinical competencies associated with effective health education and health behavior change formulates the basis for The Second Physical Therapy Summit on Global Health. © Informa Healthcare USA, Inc

Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants

Procedural pain in the neonatal intensive care unit triggers a cascade of physiological, behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm, who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development. The aim of this study was to examine relationships between cumulative procedural pain (number of skin-breaking procedures from birth to term, adjusted for early illness severity and overall intravenous morphine exposure), and later cognitive, motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age (CCA), and further, to evaluate the extent to which parenting factors modulate these relationships over time. Participants were N = 211 infants (n = 137 born preterm ≤32 weeks gestational age [GA] and n = 74 full-term controls) followed prospectively since birth. Infants with significant neonatal brain injury (periventricular leucomalacia, grade 3 or 4 intraventricular hemorrhage) and/or major sensori-neural impairments, were excluded. Poorer cognition and motor function were associated with higher number of skin-breaking procedures, independent of early illness severity, overall intravenous morphine, and exposure to postnatal steroids. The number of skin-breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation. In general, greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months, but not at 18 months CCA, however, specific protocols for morphine administration were not evaluated. Lower parenting stress modulated effects of neonatal pain, only on cognitive outcome at 18 months

Diversity Dimensions in Mathematics and Language Learning Perspectives on Culture, Education and Multilingualism

Extensive research is available on language acquisition and the acquisition of mathematical skills in early childhood. But more recently, research has turned to the question of the influence of specific language aspects on acquisition of mathematical skills. This anthology combines current findings and theories from various disciplines such as (neuro- )psychology, linguistics, didactics and anthropology. Wie hängen sprachliche und mathematische Entwicklung zusammen? Dieser Frage wird derzeit mit großem Interesse aus unterschiedlichen Perspektiven nachgegangen.Dieser Sammelband vereint Erkenntnisse aus Psychologie, Neurowissenschaften, Mathematikdidaktik, (Psycho-)Linguistik und Mehrsprachigkeitsforschung. Der interdisziplinäre Ansatz bietet einen umfassenden Blick auf den aktuellen Forschungsstand, dargestellt von national und international renommierten Forschenden.Das Buch gliedert sich in drei Teile. Der erste Teil "Modelle und Theorien" fasst theoretische Überlegungen zusammen und stellt Strukturen für Forschung und Praxis bereit. Dieser Teil dient dazu, den Grundstein für die anderen Teile sowie für zukünftige Forschung zu legen. Der zweite Teil "Kindergartenalter" sowie der dritte Teil "Grundschulalter" decken empirische Befunde über die Korrelation zwischen Sprache und mathematischem Lernen in der jeweiligen Altersgruppe ab. Ein besonderer Fokus liegt hierbei auf dem Aspekt der Mehrsprachigkeit.Damit bietet dieser Sammelband eine große Bandbreite fachspezifischen Wissens für Bildungswissenschaftler*innen, Lehramtsstudierende, Psycholog*innen und Forschende zur Mehrsprachigkeit

Modeling tools for risk management in reclaimed wastewater reuse systems: Focus on contaminants of emerging concern (CECs)

Reuse of reclaimed wastewater (RWW) for agricultural irrigation is becoming an essential practice in many arid and semi-arid regions of the world to save fresh water. Additionally, RWW contains essential plant nutrients (e.g., P, N, K), thus limiting the use of chemical fertilizers by farmers, who in the next years would need to substantially intensified their agriculture capacity to meet the increasing food demand. However, as consequences of human activities, other chemicals such as pharmaceuticals and biocides, currently referred to as “contaminants of emerging concern (CECs),” end up in RWW and subsequently in edible part of the crops, posing a risk for the environment and human health. This chapter aims at illustrating how modeling tools can help water managers in the identification of both effective monitoring campaigns and optimal RWW management strategies to minimize risk associated to conventional pollutants and especially to CECs. In fact, models can support the selection among the many hundred chemicals present in wastewater those of highest concern, but also address proper barrier identification once that a desired tolerable risk is set for specific CECs. The chapter illustrates how a RWW reuse system can be conceptualized into mathematical models, with a level of detail allowing to fully understand the processes taking place in each element of the system (wastewater treatment plant, distribution network, soil/plant) and to correctly interpret the simulation results. Two practical examples are also reported, showing the advantages of using modeling tools in risk management in complex RWW reuse systems