Developing scholarship through collaboration in an online roleplay-simulation: Mekong eSim, a case study

Mekong e-Sim was designed to create an authentic learning environment in which students from different disciplines work together to learn about the complexities of environmental decision-making. The version of Mekong e-Sim that is reported here involved students of the subjects Asia-Pacific Development (geography), Technology Assessment (technological developments and impacts in engineering) and Environmental Engineering. During the Mekong e-Sim, students collaborated to adopt different stakeholder roles and initiate and respond to major events relating to economic and environmental development in the Mekong region. Key tasks included responding to topical news events, making submissions to public planning inquiries, writing reports and debating development issues in the Mekong region. Through their participation in Mekong e-Sim, students developed understanding of the complexities of decision-making, appreciation of the range of perspectives associated with environmental management and developed subject specific skills and understandings. A description of the design and evaluation of the Mekong e-Sim is provided in McLaughlan et al. (2001). The development of the teaching project was a collaborative, cross-institutional teaching development that brought together staff with a range of skills and expertise. Despite the fact that there has been increasing attention to scholarly values in universities in recent years there has been little consideration of what this might look like. This paper uses the case of the development and teaching of Mekong e-Sim to investigate scholarly teaching, particularly the process and practice of scholarship and teaching in a team situation

Using Online Roleplay/Simulations for Creating Learning Experiences

Over 140 geography and engineering students from across Australia and overseas spent 4 weeks participating in an online roleplay-simulation set in the Mekong region of South East Asia. The online environment provides a setting for the construction of alternative points of view and a lively debate and creates an authentic context for student collaboration. The roleplay-simulation involves decision-making and conflict resolution regarding natural resource development. The Mekong e-Sim (electronic simulation) has been designed to support the learning of students studying subjects in the subjects Technology Assessment, Environmental Engineering or Asia Pacific Development Studies at different universities. The students share the online roleplay simulation experience, which is then utilised differently within each of the geography or engineering subjects at the institution where the students are enrolled. Student and staff response has been very positive. Students report that the e-Sim provides a realistic experience, is engaging, develops their information technology and communication skills and increases their awareness of multiple perspectives on the issues involved

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

Academic and institutional issues related to the planning and implementation of a multi-disciplinary roleplay-simulation involving collaboration across institutions

The Mekong e-Sim involved more than 140 students across Australia and overseas participating in an online roleplay-simulation over a four-week period. Set in the Mekong region of South East Asia, it allowed for highly charged debates over development issues arising from clear-cut differences and conflicts in values and interests. The geography and engineering students who participated were enrolled in three different subjects at four institutions. The e-Sim was the product of a ‘grassroots’ alliance between four collaborators at different institutions. The drivers for forming the alliance were the development of subject specific learning outcomes, promoting linkages between students, internationalisation of the curricula and educational research. The e-Sim design created a high level of student interdependence for pedagogic reasons, which also led to a high degree of interdependence among staff. This created a need to negotiate and agree to common practices for teaching and assessment in specific areas. Issues regarding access to institutional resources for students across different institutions also arose. An awareness of these issues is needed to ensure that ‘grassroots’ collaborative educational activities are designed to meet their objectives and can evolve to be sustainable

A Bayesian reanalysis of the Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial

Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney injury and found neutral results for 90-day all-cause mortality. Probabilistic exploration of the trial endpoints may enable greater understanding of the trial findings. We aimed to perform a reanalysis using a Bayesian framework. Methods We performed a secondary analysis of all 2927 patients randomized in multi-national STARRT-AKI trial, performed at 168 centers in 15 countries. The primary endpoint, 90-day all-cause mortality, was evaluated using hierarchical Bayesian logistic regression. A spectrum of priors includes optimistic, neutral, and pessimistic priors, along with priors informed from earlier clinical trials. Secondary endpoints (KRT-free days and hospital-free days) were assessed using zero–one inflated beta regression. Results The posterior probability of benefit comparing an accelerated versus a standard KRT initiation strategy for the primary endpoint suggested no important difference, regardless of the prior used (absolute difference of 0.13% [95% credible interval [CrI] − 3.30%; 3.40%], − 0.39% [95% CrI − 3.46%; 3.00%], and 0.64% [95% CrI − 2.53%; 3.88%] for neutral, optimistic, and pessimistic priors, respectively). There was a very low probability that the effect size was equal or larger than a consensus-defined minimal clinically important difference. Patients allocated to the accelerated strategy had a lower number of KRT-free days (median absolute difference of − 3.55 days [95% CrI − 6.38; − 0.48]), with a probability that the accelerated strategy was associated with more KRT-free days of 0.008. Hospital-free days were similar between strategies, with the accelerated strategy having a median absolute difference of 0.48 more hospital-free days (95% CrI − 1.87; 2.72) compared with the standard strategy and the probability that the accelerated strategy had more hospital-free days was 0.66. Conclusions In a Bayesian reanalysis of the STARRT-AKI trial, we found very low probability that an accelerated strategy has clinically important benefits compared with the standard strategy. Patients receiving the accelerated strategy probably have fewer days alive and KRT-free. These findings do not support the adoption of an accelerated strategy of KRT initiation