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

Boletín Oficial de la Provincia de Oviedo: Número 260 - 1971 noviembre 13

Since the eruption of Surtsey (1963 - 1965) many studies have been made of the resulting island, but the pre-emergent base remains submarine, un-incised and little studied. The same is true for many recently studied Surtseyan volcanoes, and means the pre-emergent parts of subaqueous eruptions are not well documented. This thesis presents an in depth study of the superb deposits of Surtseyan-style eruptions preserved in the South Island of New Zealand in Otago sea-cliffs along the coastline between Oamaru and Moeraki. These Eocene-Oligocene intraplate basaltic field deposits erupted in Surtseyan-style onto a submerged continental shelf and have since been exposed above sea level. They are inferred to be typical products of submarine processes such as those that built Surtsey to the sea surface. Volcanic fields typically include many small, monogenetic, volcanoes formed by single eruptions fed by short-lived magma plumbing systems that solidify after eruption. However, the stratigraphy of Cape Wanbrow suggests that eruptions produced multiple volcanoes whose edifices overlapped within a small area, but separated by millions of years. The small Cape Wanbrow highland is shown to include the remnants of 6 volcanoes that are distinguished by discordant to locally concordant inter-volcano contacts marked by biogenic accumulations or other slow-formed features. This discovery challenges the traditional view of monogenetic volcanoes and calls for researchers in monogenetic fields to start evaluating both unstudied and previously studied monogenetic volcanoes with this in mind. The 6 volcanoes contain several lithofacies associations: (a) the dominantly pyroclastic E1 comprising well-bedded tuff and lapilli-tuff, emplaced by traction dominated unsteady, turbulent high-density currents; (b) E2, massive to diffusely laminated block-rich tuff deposited by grain-dominant cohesionless debris flows; (c) E3, broadly cross stratified tuff with local lenses of low to high-angle cross-stratification which was deposited by either subaerial pyroclastic currents or subaqueously by unstable antidune and chute-and-pool forming supercritical flows; (d) E4, very-fine- to medium-grained tuff deposited by turbidity currents; (e) E5, bedded bioclast-rich tuff with increasing glaucony content upward, emplaced by debris flows; (f) E6, pillow lava and inter-pillow bioclastic sediment; and (g) E7, hyaloclastite breccia. These lithofacies associations aid interpretation of the eruptive evolution of each separate volcano, which in turn grew and degraded during build-up of the overall volcanic pile. Sedimentary processes played a prominent role in the evolution of the volcanic pile with both syn- and post-eruptive remobilization of debris from the growing pile of primary pyroclastic deposits of multiple volcanoes separated by time. An increase in bioclastic detritus up-sequence suggests that the stack of deposits from overlapping volcanoes built up into shallow enough waters for colonization to occur. This material was periodically shed from the top of the edifice to form bioclast-rich debris flow deposits of volcanoes 4, 5 and 6. Bedform geometries of volcanogenic sedimentary structures produced in both subaqueous and subaerial environments can be incredibly similar, if not identical, and this has resulted in a long history of difficulties in unambiguously distinguishing primary from reworked deposits, and gas-deposited from water-deposited ones. Sedimentary structures such as dunes and low- and high-angle cross-stratification produced by numerous flow types make interpretation of setting difficult. In particular the architecture of such deposits and often field observations of contextual detail can be extremely difficult to interpret based on their ubiquitous presence in many settings and flow types. This is made increasingly difficult when structures are poorly preserved, exposures are limited and independent palaeoenvironmental indicators are absent or ambiguous. However correct interpretation of such sedimentary structures along with the deposits they are part of can be crucial to understanding the host volcanic sequences. The origins of dunes and associated structures that occur within the pyroclastic deposits at Cape Wanbrow serve as an example, and have long been debated. To determine the depositional setting of dune-bearing deposits, careful analysis of contextual information has been completed along with the examination of well-described examples of; (1) subaerial dry pyroclastic deposits, (2) subaerial moist pyroclastic deposits, (3) deposits of gaseous fluid-gravity flow (e.g. eolian currents), (4) unidirectional fluid-gravity water flow deposits (e.g. rivers, tides) and (5) aqueous sediment-gravity flow deposits split into those comprising pyroclastic material and those with non-pyroclastic material. This includes examination of the physical controls that shape each example and the factors controlling bedform deposition in that environment with the aim of being able to distinguish between major flow types in each environment. For Cape Wanbrow, this analysis showed that ambiguous bedforms were formed subaerially, which thus provides direct evidence for emergence and subaerial growth of one of the the volcanoes represented in the succession. To understand multiple eruptions of monogenetic volcanoes at one site at Cape Wanbrow a study of peridotite xenoliths from Kakanui and Boatmans Harbour revealed that the peridotitic portions of sub-continental lithospheric mantle (SCLM) beneath North Otago contains a degree of compositional variation but is relatively fertile. The origins of the xenoliths indicate that the magmas are from either the base of the spinel facies lithosphere, from within the predicted narrow zone of garnet facies lithosphere or from within the asthenosphere. The xenoliths indicate that the magma source was fairly deep, and therefore the process that led to multiple eruptions over a small geographical area has to be one that affected the asthenosphere or the lower lithosphere

Students’ Experiences of English-Medium Instruction at the Postgraduate Level: Challenges and Sustainable Support for Success

More and more students are exploring overseas destinations and English-Medium Instruction (EMI) environments for their postgraduate studies. While it is known that students can often struggle in an EMI environment, the challenges faced by postgraduate students, and the support they receive or need, are not fully understood. By adopting a two-stage qualitative sequential data collection approach, this study explored the experiences and perceptions of full-time postgraduate students from Mainland China studying in a one-year Master of Education programme at a Hong Kong university during their first semester. Data were collected through an online survey (N = 73) and three in-depth group interviews (N = 12). The analysis of data offered a holistic understanding of the students’ challenges, needs, and struggles. The findings provide suggestions for support that teachers and programmes can provide to postgraduate students, as well as student self-help support strategies. Several sustainable support strategies are proposed to assist students in adjusting and succeeding in the EMI context at the postgraduate level

Blending asynchronous and synchronous digital technologies and instructional approaches to facilitate remote learning

This two-stage qualitative-dominant sequential mixed-method study, using an online survey of elementary and secondary school English language teachers (N = 73) and follow-up interviews (N = 10), collectively explores how teachers in Hong Kong adapted their instruction to online teaching in responses to COVID-19. The findings indicate that teachers used a variety of asynchronous and synchronous digital technologies and instructional approaches to facilitate students’ learning, assess learning, and communicate with students and parents remotely. The findings suggest that a blend of asynchronous and synchronous modes are seen as optimum to support student learning online. A model is proposed on how teachers can blend asynchronous and synchronous digital technologies and instructional approaches within a sequence of learning

The Impact of Social Uncertainty, Protests, and COVID-19 on Hong Kong Teachers

Teachers in Hong Kong endured an unprecedented 2019–2020 school year with widespread civil unrest followed by the COVID-19 pandemic. These events placed a great deal of stress on teachers as they navigated them with students in face-to-face and virtual environments. The current study examines how social uncertainty impacted ten primary and secondary school teachers in Hong Kong through semi-structured interviews. Findings indicated that the challenging events strengthened teacher motivation as they demonstrated greater commitment to teaching, a strong desire to journey with students through hardship, and a motivation to equip students with tools to navigate uncertain circumstances in the future

Exploring generative artificial intelligence preparedness among university language instructors: A case study

The integration of generative artificial intelligence (AI) in English language teaching presents opportunities and challenges for instructors. This study explores the attitudes of higher education English language instructors towards generative AI tools, their intentions to use them and the institutional support and professional development necessary to teach and learn with them. As the field continues to evolve rapidly, it is essential to comprehend the readiness of front-line language instructors. This qualitative interpretive study seeks to identify the digital competencies and pedagogical knowledge required to implement generative AI in education and provide guidance for the design of professional development programmes that address the challenges and concerns associated with adopting AI. Drawing on semi-structured interviews with twelve instructors at a higher education institution in Hong Kong, the findings reveal the significance of familiarity and confidence with using AI-driven teaching tools, the challenges and concerns language instructors face and the need for tailored support and professional development. The study offers ten practical implications to cultivate language instructors’ digital competencies, pedagogical knowledge and positive attitudes towards integrating AI to enhance their students’ learning experiences

Generative AI tools and assessment: Guidelines of the world's top-ranking universities

The public release of generative artificial intelligence (GAI) tools (e.g., ChatGPT) has had a disruptive effect on the assessment practices of higher education institutions (HEIs) worldwide. Concerns have largely been associated with academic integrity, cheating and plagiarism. HEIs have had to develop guidelines in response to GAI. As many of these guidelines were developed in haste and could affect a large number of instructors and students, there is a need to examine their content, coverage and suitability. This review examines the extent to which the world's 50 top-ranking HEIs have developed or modified their assessment guidelines to address GAI use and, where guidelines exist, the primary content and advice given to guide instructors in their GAI assessment design and practices. The findings show that just under half of the institutions have developed publicly available guidelines. The guidelines cover three main areas: academic integrity, advice on assessment design and communicating with students. Amongst the suggestions for teachers on assessment design, two appear particularly pertinent in helping develop effective assessment tasks and developing learners’ AI literacy: first, running assessment tasks through GAI to check the extent to which the tool can accomplish the task and, second, having students use GAI as part of the assessment process. Overall, the review suggests that HEIs have come to accept the use of GAI and drafted assessment guidelines to advise instructors on its use. In the article, we argue that it may be beneficial to embrace GAI as a part of the assessment process since this is the reality of today's educational and job landscape. This will require instructors to develop a new competence - generative artificial intelligence assessment literacy - which is conceptualised in this article