Crowdsourcing Cognitive Presence: A Quantitative Content Analysis of a K12 Educator MOOC Discussion Forum

Massively Open Online Courses (MOOCs) offer participants opportunities to engage with content and discussion forums similar to other online courses. Pedagogical components of MOOCs and the nature of learning are worth of examining due to issues involving scale, interaction and the role of the instructor (Ross, Sinclair, Know, Bayne & McLeod, 2014). The Community of Inquiry (CoI) framework provides a basis for measuring cognitive presence in online discussion forums. As voluntary point of entry to a community of learners, it is important to consider the nature of participant contributions in terms of cognitive presence. This study focused on an educator MOOC because MOOCs have been proposed as an efficient vehicle for providing professional development due to the significant self-identification of participants as educators (Ho et al. 2014). Participant attributes have been categorized, however the discussion forum is difficult to study on a massive scale (Kizilcec, Piech, & Schulz, 2013). Automated measures of cognitive presence may not provide the full view of learning behaviors implicit in messages posted to the forums (Wong, Pursel, Divinsky & Jansen, 2015). To address this gap, the forum messages were hand-coded and analyzed using quantitative content analysis (Neuendorf, 2002). The study found that the measure of exploration increased over the duration of the course. Viewing cognitive presence over time provided a new metaphor for explaining the proportions of cognitive presence in the discussion forum of an educator MOOC. This finding suggests that increased instructor presence during the later stages of the course may increase cognitive presence over time (Akyol & Garrison, 2007; Garrison & Cleveland-Innes, 2005)

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