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

How do Religious Congregations Affect the Attitudes Toward Homosexuality of Their Congregants?

Using a stratified random sample of 338 participants nested in 20 congregations within 3 denominations, we examined the relationship between religious service attendance, affirmation of lesbian, gay, bisexual, and queer (LGBQ) identities, their interaction, and attitudes toward lesbian women and gay men (ATLG) to better understand the potential role that congregational-level variables may play in the formation of ATLG. Hierarchical linear models indicated that 29% variation in ATLG could be explained by congregation-level variables. Religious service attendance on an individual level was related to more rejecting ATLG. The relationship between religious service attendance and ATLG on a congregational level (i.e., average frequency of attendance within a congregation) was marginally significant. Affirmation of LGBQ identities on a congregational level (i.e., policies and procedures empowering individuals in same-sex relationships) was related to more affirming ATLG. Congregation-level predictors evidenced substantially larger effects than individual-level predictors. Interactions between service attendance and congregational affirmation were nonsignificant, indicating that increased engagement with a “less-affirming” congregation has no effect on ATLG. Results indicate that individuals may select a congregation whose ATLG mirrors their own. Further research examining the role of congregations in influencing congregants’ ATLG is encouraged

Homonegativity and the Black Church: Is Congregational Variation the Missing Link?

The Black church in the United States has historically functioned as a bastion for civil rights; however, it may also be a source of pain and suffering for sexual minorities. To examine the influence of individual and congregational variables on attitudes toward same-sex sexuality in the Black church, we collected a sample of 219 participants from 15 randomly selected congregations. Results of three hierarchical linear models indicated that congregation- and individual-level variables emerged as equally important predictors of individuals’ attitudes toward same-sex sexuality. Individual-level religiousness and congregation-level education emerged as significant predictors of homonegativity. Our results suggest that congregations may play a role in enacting homonegative attitudes. We encourage counseling psychologists working with religious Black sexual minority clients to help clients consider characteristics of congregations (e.g., education) and individual religious practices (e.g., overzealous service attendance) that may signal homonegativity. We encourage further work examining the influence of congregational factors on congregants’ attitudes

Psychological Strategies for Winning a Geopolitical Forecasting Tournament

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Psychological strategies for winning a geopolitical forecasting tournament.

Five university-based research groups competed to recruit forecasters, elicit their predictions, and aggregate those predictions to assign the most accurate probabilities to events in a 2-year geopolitical forecasting tournament. Our group tested and found support for three psychological drivers of accuracy: training, teaming, and tracking. Probability training corrected cognitive biases, encouraged forecasters to use reference classes, and provided forecasters with heuristics, such as averaging when multiple estimates were available. Teaming allowed forecasters to share information and discuss the rationales behind their beliefs. Tracking placed the highest performers (top 2% from Year 1) in elite teams that worked together. Results showed that probability training, team collaboration, and tracking improved both calibration and resolution. Forecasting is often viewed as a statistical problem, but forecasts can be improved with behavioral interventions. Training, teaming, and tracking are psychological interventions that dramatically increased the accuracy of forecasts. Statistical algorithms (reported elsewhere) improved the accuracy of the aggregation. Putting both statistics and psychology to work produced the best forecasts 2 years in a row

Synthesis and styrene copolymerization of novel ring-substituted isobutyl phenylcyanoacrylates

Novel ring-substituted isobutyl phenylcyanoacrylates, RPhCH=C(CN)CO2CH2CH(CH3)2 , where R is 2-ethyl, 4-(4-bromophenoxy), 2-(4-chlorophenoxy), 2-(4-fluorophenoxy), 4-(4-methoxyphenoxy), 3-(4-methylphenyl), 4-(4-methylphenyl), 4-acetoxy, 2,5-dimethyl were synthesized by the piperidine catalyzed Knoevenagel condensation of ring-substituted benzaldehydes and isobutyl cyanoacetate and characterized by CHN analysis, IR, 1H and 13C NMR. The acrylates were copolymerized with styrene in solution with radical initiation (ABCN) at 70C. The compositions of the copolymers were calculated from nitrogen analysis