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

Developing the Organization\u27s Sensemaking Capability: Precursor to an Adaptive Strategic Marketing Response

Effective strategic planning demands that organizations develop an understanding of the forces shaping the situation by engaging the collective efforts and interpretive capabilities of various representatives of the organization. This study investigates the mechanisms by which such an understanding develops and, subsequently, shapes marketing strategy. Specifically, organizations are examined as sensemaking units stimulated by perceived environmental turbulence, cultural open-mindedness, and team functional diversity. These factors are modeled as determinants of an organization\u27s sensemaking capability, which is comprised of communicative, interpretive, and analytical dimensions. This study argues that a developed sensemaking capability increases the potential range of strategic responses and, ultimately, enhances customer-based performance. The results from a sample of wholesale distributors suggest that organizations that maintain greater internal variety are better able to sense and respond to the environment

Stereotypes about Compassion Across the Political Spectrum

To what extent are ideological differences in compassion real or exaggerated, and who is more likely to engage in stereotyping about such differences? In five studies, including three online studies and two field studies of voters at the Iowa Caucus and U.S. Presidential Election in 2016, we find evidence for political stereotyping about compassion. Although Democratic and Republican participants did not consistently rate themselves as feeling different amounts of compassion on a single-item self-assessment, there was a stereotype that the average Democrat/liberal is more compassionate than the average Republican/conservative. Importantly, this stereotype exaggerated the extent of self-reported differences in compassion across parties in these samples, and Democratic participants engaged in stronger stereotype exaggeration. These results suggest that although there can be ideological variability in compassion, the perceived difference may exaggerate this reality

Supplemental Material, SPPS771890_suppl_mat - Intentional and Unintentional Empathy for Pain Among Physicians and Nonphysicians

<p>Supplemental Material, SPPS771890_suppl_mat for Intentional and Unintentional Empathy for Pain Among Physicians and Nonphysicians by Victoria L. Spring, C. Daryl Cameron, Stephanie McKee, and Andrew R. Todd in Social Psychological and Personality Science</p