Peer Pressure, Incentives, and Gender: an Experimental Analysis of Motivation in the Workplace

We present results from a real-effort experiment, simulating actual work-place conditions, comparing the productivity of workers under fixed wages and piece rates. Workers, who were paid to enter data, were exposed to different degrees of peer pressure under both payment systems. The peer pressure was generated in the form of private information about the productivity of their peers. We have two main results. First, we find no level of peer pressure for which the productivity of either male or female workers is significantly higher than productivity without peer pressure. Second, we find that very low and very high levels of peer pressure can significantly decrease productivity (particularly for men paid fixed wages). These results are consistent with models of conformism and self-motivation.Peer effects, fixed wages, piece rates, gender

CD40-stimulated B Lymphocytes Pulsed with Tumor Antigens Are Effective Antigen-presenting Cells That Can Generate Specific T Cells

Although they are considered as antigen presenting cells (APC), the role of antigen-unspecific B-lymphocytes in antigen presentation and T lymphocyte stimulation remains controversial. In this paper, we tested the capacity of normal human peripheral activated B cells to stimulate T cells using melanoma antigens or melanoma cell lysates. B lymphocytes activated through CD40 ligation and then pulsed with tumor antigens efficiently processed and presented MHC class II restricted peptides to specific CD4+ T cell clones. This suggests that CD40-activated B cells have the functional and molecular competence to present MHC class II epitopes when pulsed with exogenous antigens, thereby making them a relevant source of APC to generate T cells. To test this hypothesis, CD40-activated B cells were pulsed with a lysate prepared from melanoma cells and used to stimulate peripheral autologous T cells. Interestingly, T cells specific to melanoma antigens were generated. Further analysis of these T cell clones revealed that they recognized MHC class II restricted epitopes from tyrosinase, a known melanoma tumor antigen. The efficient antigen presentation by antigen-unspecific activated B cells was correlated with a down-regulation in the expression of HLA-DO, a B cell specific protein known to interfere with HLA-DM function. Because HLA-DM is important in MHC class II peptide loading, the observed decrease in HLA-DO may partially explain the enhanced antigen presentation following B-cell activation. Results globally suggest that when they are properly activated, antigen-unspecific B-lymphocytes can present exogenous antigens by MHC class II molecules and stimulate peripheral antigen-specific T cells. Antigen presentation by activated B cells could be exploited for immunotherapy by allowing the in vitro generation of T cells specific against antigens expressed by tumors or viruses.Intramural National Institutes of Health (NIH) progra

Entraînement fractionné de haute intensité: effets sur l'activité de la maladie et les risques de maladies cardiovasculaires chez les adultes atteints de polyarthrite rhumatoïde : travail de Bachelor

Introduction : La polyarthrite rhumatoïde (PR) est une des maladies inflammatoires chroniques les plus répandues. En plus de provoquer des déficiences fonctionnelles importantes, elle augmente aussi le risque de maladies cardiovasculaires. L’activité physique à dominance aérobie permet de réduire la mortalité liée aux maladies cardiovasculaires (CVD) chez les personnes atteintes de PR. Il se pourrait que l’entraînement fractionné de haute intensité (HIIT) soit efficace dans la diminution du risque de CVD, sans effets délétères sur l’activité de la maladie. Objectif : Evaluer si le HIIT diminue le risque de maladies cardiovasculaires et améliore les capacités fonctionnelles sans aggraver la maladie chez des adultes souffrants de PR. Méthode : Les recherches ont été effectuées sur les bases de données PubMed, PEDro, Cochrane et Embase. Trois études ont été sélectionnées : une RCT et deux études pilotes. Ces études ont été évaluées à l’aide de la grille d’évaluation d’études quantitatives “McMaster”. Résultats : Au regard du niveau d’invalidité, de l’activité de la maladie et de l’inflammation, les trois études sélectionnées montrent que le HIIT n’est pas néfaste pour les personnes atteintes de PR. Elles démontrent également que la capacité aérobie est améliorée significativement par cet entraînement. Les résultats sont plus mitigés par rapport aux capacités fonctionnelles. Conclusion : Le HIIT semble prometteur pour le traitement non-pharmaceutique de la PR. Notre revue montre une augmentation de la capacité aérobie (VO2max et VO2pic), corrélée à une diminution des risques de CVD. La maladie n’est pas péjorée par cet entraînement. Les résultats sont plus mitigés concernant les capacités fonctionnelles. Ces résultats sont à prendre avec prudence au vus des biais de cette revue

Contribuer à un projet d’aménagement par l’analyse ergonomique du travail : le cas d’une bibliothèque publique

L’ergonomie est de plus en plus intégrée à la conception de situations de travail, que ce soit dans le cadre de projets industriels ou de projets architecturaux. Dans ce dernier cas, en participant à la définition des espaces, les ergonomes contribuent également à influencer, en partie, l’organisation du travail future. Lors d’une intervention dans un projet de construction d’une nouvelle bibliothèque, des ergonomes chercheurs ont accompagné le déroulement du projet, aux phases concours d’architecture, études de concepts et études préliminaires. C’est en s’appuyant essentiellement sur l’analyse ergonomique du travail effectuée dans la bibliothèque existante, de même que dans des sites de référence que les ergonomes ont pu analyser les propositions architecturales et élaborer, avec un groupe de travail, des suggestions de modifications au cadre futur de travail. Cet article rend compte des activités mises en œuvre par les ergonomes au cours de leur intervention, notamment l’analyse ergonomique du travail, et de la manière dont l’intervention a pu influencer l’espace et l’organisation du travail. La trajectoire de la conception de deux des trois étages du bâtiment de la nouvelle bibliothèque illustrera ce propos et nous amènera à discuter de la portée et des limites de l’intervention ergonomique d’accompagnement et des conditions qui en rendent possible une issue positive pour le travail futur.Ergonomic considerations are increasingly being factored into work situation design, in both industrial and architectural projects. In the latter case, by participating in the definition of spaces, ergonomists also have an impact, in part, on future work organisation. Ergonomic researchers accompanied the construction of a new library in the architectural competition, design study and preliminary study phases. Basing themselves primarily on the ergonomic work analysis of the existing library and reference sites, the ergonomists analyzed the architectural proposals and then developed, with a working group, suggestions for modifying the future work framework. This article discusses the intervention activities implemented by the ergonomists during their intervention, namely ergonomic work analysis, and how the intervention was able to affect the work space and work organization. The design trajectory of two of the new library’s three floors will illustrate this and lead to a discussion of the scope and limitations of the accompanying ergonomic intervention and the conditions necessary for a positive outcome for future work.Se integra cada vez más la ergonomía a la concepción de situaciones de trabajo, que sea como parte de proyectos industriales o de proyectos arquitectónicos. En este caso, al participar a la definición de los espacios, los ergonomistas también contribuyen a influir en parte sobre la organización del trabajo venidero. Mientras intervinieron en un proyecto de construcción de una nueva biblioteca, los investigadores ergonomistas acompañaron el desarrollo del proyecto hasta las fases del concurso de arquitectura, estudios de conceptos y estudios preliminares. Los ergonimistas pudieron analizar las proposiciones arquitectónicas y elaborar, con un grupo de trabajo, sugerencias de modificaciones en el contexto futuro del trabajo, basándose esencialmente sobre el análisis ergonómico del trabajo efectuado en la biblioteca existente así como en los sitios de referencia. Este artículo informa sobre las actividades puestas en práctica por los ergonomistas a lo largo de su intervención como el análisis ergonómico del trabajo, y sobre la manera con la cual la intervención pudo influir sobre el espacio y la organización del trabajo. La trayectoria del diseño de dos de los tres pisos del edificio de la nueva biblioteca ilustrará este estudio y nos llevará a debatir el alacance y los límites de la intervención ergonómica de apoyo y las condiciones que hacen posible una solución positiva para el trabajo venidero

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

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