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

Teaching Systems Thinking Through Game Design

In this mixed-methods study, we examined if students benefitted from a game design course offered during an enrichment hour in terms of gains in their system analysis and design skills. Students at a rural middle school in Southeast US (n = 19) attended a 1-hour game design course offered weekly during an academic enrichment class period, for the duration of a school year, learning basics of digital game-design and practicing system design skills such as making flowcharts. The results of quasi-experimental data indicated that the treatment group’s pretest–posttest system analysis and design skills, compared to the control group, which did not receive any training, further improved, F(1,33) = 16.516, p \u3c 0.001. Results from the interviews showed that the participants were able to verbalize how they applied system analysis and design skills developed during the course to problem-solving in different contexts. We discussed the instructional aspects of learning game-design that align with systems thinking. We also explored the possible influence of initial cognitive skills on student learning outcomes from such interventions

Still Polishing the Diamond: School Library Research over the Last Decade

In 2003 Delia Neuman wrote “Research in School Library Media for the Next Decade: Polishing the Diamond.” One of the most influential pieces on school library research written in the last twenty years, the article provided a map for school library research by defining areas of concern and importance. Neuman developed questions grounded in the research and scholarship of the field at that time. These questions served as a charge for researchers to address in the next ten years. Neuman called on researchers to “polish the diamond and make it shine more brightly in its own right and sparkle more valuably in the larger field of education” (2003, 504). This study uses Neuman’s model of the diamond to examine school library research and scholarship from 2004 through 2014. Following Neuman’s guiding questions through a systematic review of the literature from the past ten years, this study finds that there is still much “polishing” to be done by school library researchers, and like Neuman, defines new “facets” that provide future direction to “move forward both the field’s research agenda and its effective practice” (Neuman 2003, 505)

Still Polishing the Diamond: School Library Research over the Last Decade

In 2003 Delia Neuman wrote “Research in School Library Media for the Next Decade: Polishing the Diamond.” One of the most influential pieces on school library research written in the last twenty years, the article provided a map for school library research by defining areas of concern and importance. Neuman developed questions grounded in the research and scholarship of the field at that time. These questions served as a charge for researchers to address in the next ten years. Neuman called on researchers to “polish the diamond and make it shine more brightly in its own right and sparkle more valuably in the larger field of education” (2003, 504). This study uses Neuman’s model of the diamond to examine school library research and scholarship from 2004 through 2014. Following Neuman’s guiding questions through a systematic review of the literature from the past ten years, this study finds that there is still much “polishing” to be done by school library researchers, and like Neuman, defines new “facets” that provide future direction to “move forward both the field’s research agenda and its effective practice” (Neuman 2003, 505)

Integrating Student Generated Vodcasts into English Language Learner K-12 Classrooms

K-12 English as a Second Language K-12 environments are severely under-represented in Web 2.0 and second language acquisition research. This study was designed using qualitative methodology to explore the integration of vodcasts as student-generated products in a middle school ESL Reading classroom located in the southwestern United States. Data was collected through observations, student artifacts, semi-structured interviews and reflexive researcher journaling so as to inform the research questions. Sixteen participants were observed while completing a project based learning instructional unit. Collaboration contributed to student linguistic development by promoting negotiation of meaning, enriched when students rotated roles and responsibilities

School Librarians Fully Online: Preparing the Twenty-First Century Professional

Online learning, already an essential component of the higher-education and professional landscape, has now developed a more ubiquitous presence in K–12 learning due to educational trends such as flipped education and use of tools such as Google Classroom. Despite the increasingly important role of online learning in K–12 education, little evidence indicates that graduates of school library preparation programs enter the profession with the knowledge, skills, and dispositions required to design and deliver online learning experiences for K–12 students, experiences that take advantage of available resources and platforms. A mixed-method national survey of programs in the United States was conducted to examine the ways that school library preparation programs prepare candidates to design digital learning spaces that include fully online courses for K–12 students. Results indicate that preparation of future school librarians for the design and delivery of online instruction to K–12 students is not yet seen as an integral component of these graduate programs