Management of renin-angiotensinaldosterone system blockade in patients admitted in hospital with confirmed coronavirus disease (Covid-19) infection: The mcgill raas-covid-19 randomized controlled trial

Background: More data is needed on the cardiovascular impact of discontinuing versus continuing renin-angiotensin aldosterone system inhibitors (RAASi) among patients hospitalized with a severe acute respiratory syndrome coronavirus 2 infection (COVID-19). Methods: The McGill RAAS-COVID-19 trial was a randomized, open label trial in adult patients hospitalized with COVID-19, who were previously treated with RAASi (angiotensin converting enzyme inhibitors [ACEi]/angiotensin receptor blocker [ARB]) (NCT04508985;10/2020-03/2021). Participants were randomized 1:1 to discontinue or continue RAASi. The primary outcome was a global rank score calculated from baseline to day 7 (or discharge) incorporating clinical events and biomarker changes. Global rank scores were compared between groups using the Wilcoxon test statistic and the negative binomial test (using incident rate ratio [IRR]). All analyses were conducted using the intention-to-treat principle. Results: Overall, 21 participants were randomized to discontinue RAASi and 25 to continue. Patients' mean age was 71.5 years and 43.5% were female. Discontinuation of RAASi, versus continuation, resulted in a similar mean global rank score (discontinuation 6 [standard deviation [SD] 6.3] vs continuation 3.8 (SD 2.5);p= 0.60), but the negative binomial analysis identified that discontinuation increased the risk of adverse outcomes (IRR 1.7 [95% CI 1.1 to 2.6];p=0.03). Particularly, RAASi discontinuation increased brain natriuretic peptide (BNP) levels (% change from baseline: +16.7% vs.-27.5%;p= 0.02) and increased the incidence of acute heart failure (33% vs. 4.2%, p=0.03). Conclusion: Discontinuation of RAASi increased BNP levels and risk of acute heart failure in participants hospitalized with COVID-19;where possible, RAASi should be continued.

The impact of COVID-19 on global value chains: Disruption in nonessential goods production

Public health measures enacted to mitigate the spread of coronavirus disease 2019 (COVID-19) have dampened economic activity by shuttering businesses that provide ‘nonessential’ goods and services. Not surprisingly, these actions directly impacted demand for nonessential goods and services, but the full impact of this shock on the broader economy will depend on the nature and strength of value chains. In a world where production chains are increasingly fragmented, a shock in one industry (or a group of industries) in one country will affect other domestic industries as well as international trade, leading to impacts on production in other countries. We employ the World Input–Output Database to depict the interdependencies among both industries and countries, which provides a full representation of global value chains. By assuming a homogeneous impact on demand for nonessential goods and services around the world, we demonstrate asymmetric effects on production by industry and international trade, leading to asymmetric relative impacts on national economies. Our results indicate that if demand for nonessential goods and services decreases by 50%, the global gross domestic product will decline by 23%, leading to relative impacts that are larger in China, Indonesia, and some European countries. Also, international trade declines by almost 30%, largely due to a reduction in economic activity associated with the production of raw materials and certain types of manufacturing. This work highlights the relevancy of going beyond measuring the direct effects of COVID-19 and provides insights into how international trade linkages will induce broader economic impacts across the globe. © 2021 The Authors. Regional Science Policy & Practice © 2021 Regional Science Association International

Teachers’ preparedness to deliver remote adapted physical education from different european perspectives: updates to the european standards in adapted physical activity

When schools were closed due to the COVID-19 restrictions, teachers were challenged to engage children with Special Educational Needs (SEN) through remote teaching, particularly in physical education. The European standards in adapted physical activity (EUSAPA) have been used to define the competencies of adapted physical education (APE) teachers. Through a consensus building exercise, the standards were updated in this paper to include technologically supported pedagogy. Evidence from 125 APE teachers, who completed a technological communication inventory, modified versions of the technology, pedagogy and content knowledge scale (TPACK-21), and self-efficacy on including students with disabilities in physical education scale (SE-PETE-D), were used to inform experts to create technological indicators for the EUSAPA. Teachers used 3 to 4 technologies (email, phone, SMS, Whatsapp) to communicate with students and colleagues, and many reported low levels of technological content knowledge. Experts considered the need to add 13 new functions to the EUSAPA. Most of the functions were considered to be feasible to implement in existing practices and the other requiring extra resources or skills. As further training is planned, consideration of expertise is warranted when mapped against meeting standards. © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

“It’s hard to fear something we can’t see”: the representational work of Covid-19 and the pedagogy of fear between viruses and animacies

The most recent pandemic, characterized as SARS-CoV-2, is part of a known lineage of viral pathogens that can trigger severe respiratory infections. Despite the importance of advancing biomedical knowledge as a way to guarantee treatment and effectiveness in the supposed eradication of the disease, it is no less urgent to ref lect on the social circumstances that shape this new epidemiological situation. This essay analyzes how the representations of contagion and death imbricated in the health-disease dyad, as traditional phenomena, took on moral propositions, particularly between the months of January and March 2020, when the definitions of outbreak, epidemic and pandemic became inextricably mixed. In that context, and from the creation of a type of health apparatus animated by imperatives related to the deadliest form of the disease, Covid-19 gained materiality. Constituted at the conf luence of ethnic-racializing conceptions, this apparatus formed the first visual and linguistic images of the disease. Finally, this article examines that the work of reception, appointment and framing of Covid-19 depended on visibility regimes conditioned by traditional processes, related to the materialization and animation of the virus as a threat not only epidemiological and social, but political and moral.