55 research outputs found

    Masked pedagogy : negotiating self, topic and expertise in conversation-for-learning

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    The research examines interaction between unacquainted teachers and students of English as a foreign language in the conversation lounge of a private university in Japan. It draws its primary data from an assigned task in which students were asked to make conversation with on-duty teachers. Such institutionalized conversation practice, or 'conversation-for-learning' (Kasper 2004), is problematized in the thesis of research, as it is taken to paradoxically blend elements of institutionality with the interpersonal goals of conversation making. Focussing on the role of the teacher, the research aims to illustrate the way in which such tensions are resolved at the level of self construction in the supposedly conversational event. In the Japanese context of English language learning, the 'native speaking' teacher may often be portrayed as the authentic embodiment of an Anglophone culture. It is here argued that the problematics of such 'authenticity' are compounded by the staged normativity of conversation-for-learning, in which the teachers appear to be 'playing' themselves to a heightened degree of reflexivity. The self is thus seen to be interactionally emergent in a dialectic of conversationality and institutionality. In the current setting of the research, the 'English-only' policy and official recommendation that students pre-select a topic of interaction prior to approaching a teacher present two significant elements of institutionality which are explored through discourse analysis. The participants' negotiation of topic and expertise further provides an interactional means of analyzing the interpersonal and intercultural facets of self construction in the first-time educational encounters. In addition, the research draws on ethnographic methods of data generation, as it seeks to qualitatively ground the interactional events in the voiced experience of the participants. The thesis concludes with some suggestions which may help both teachers and students to overcome the challenges of non-acquaintanceship and constraints of institutionality to the pursuit of conversation-for-learning

    Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

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    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
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