Writing Committee for the REMAP-CAP Investigators IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive.OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTSThe ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONSThe immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURESThe primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, −1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11...

Nearly half of female youth experiencing homelessness (YEH) become pregnant due to myriad individual, family, community, and structural factors. In response, our team developed and tested Wahine (“woman”) Talk, a multilevel, trauma-informed sexual and reproductive health intervention created with and for female YEH aged 14 to 22. After Wahine Talk, youth were invited to participate in a participatory action PhotoVoice project regarding experiences of the program, waiting to start or expand their families, and homelessness. Photographs were taken and captioned by youth, and then further examined through Thematic Analysis. Final project themes include (a) Youth-Driven Birth Timing Decisions; (b) A Sense of Place: Finding Safe Spaces; and (c) Glimpsing Hope. Because YEH live under society’s radar, it is critical to understand their experiences from their own perspectives to improve interventions at multiple levels. Implications for meeting the needs of YEH in the areas of reproductive justice, financial stability, and affordable housing are discussed.

This study examines predictors of abandonment of evidence-based practices through descriptive analyses of extant state-level training data, fidelity of implementation data, and nationally reported school demographic data across 915 schools in three states implementing school-wide positive behavioral interventions and supports (SWPBIS). Schools included in this study were tracked for a 5-year period after initial training, yet some elected to abandon SWPBIS at various times during implementation. Results showed that a small proportion of schools in the sample abandoned SWPBIS (7%). Logistic regression analysis identified school locale as the only statistically significant predictor of SWPBIS abandonment with schools located in cities being more likely to abandon. Results are discussed in terms of addressing types of schools at greater risk for abandonment and the importance of state-level training and coaching support.

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Check-In, Check-Out (CICO) is one of the most widely implemented Tier 2 behavior interventions in a school-wide system of Positive Behavior Interventions and Supports (PBIS). Much literature has documented implementation of CICO across individual schools or districts. The Illinois PBIS Network, currently known as the Midwest PBIS Network, has provided extensive training and technical assistance (TA) on CICO with more than 400 schools in more than 125 districts. The purpose of this descriptive study was to detail the training process for implementation of CICO across 441 schools, evaluate student success based on Daily Progress Reports (DPRs), and document fidelity and implementation on a subset of 41 elementary and 13 middle schools. Results indicated more than 80% of students earned at least 80% of their DPR points, the majority of schools implemented CICO with more than 70% fidelity, and schools were able to support between 7% and 12% of student population on CICO. Implications for practice and suggestions for future research are included.