ABSTRACT
With the COVID-19 pandemic, efforts focusing on student engagement in science, technology, engineering, and math (STEM) courses have shifted towards engagement in online instruction, resulting in a need for increased understanding of how instructors adapt active learning from in person instruction to online learning. Active learning occurs in many different formats across different classrooms. Despite these broadly different formats, a common thread across all active learning is that using it in classrooms results in greater student engagement as compared to passive listening to lectures. Educational researchers have found that active learning has a positive impact on student outcomes, especially for underrepresented students in STEM.The research outlined in this paper seeks to understand how instructors are adapting from in person courses and the strategies they use to engage students in online STEM courses. To do this, we interviewed 20 instructors who were using active learning in teaching an online STEM course about the strategies they were using to engage their students in online activities. We coded these interviews using a grounded theory approach. After several rounds of coding, we found six overarching themes about how instructors viewed active learning in their online classrooms: Instructor Emotion, Instructor Strategy, Instructor Goal, Active Learning Example, Instructor Barrier, and Student Behavior. This paper focuses on the instructor strategy theme and its 55 individual codes. © 2022 IEEE.
ABSTRACT
Objetivos: Infecções relacionada à fraturas (IRF) têm sido umas das principais complicações em paciente vítima de trauma ortopédico e na maioria das vezes estão associadas a um desfecho não favorável. No contexto da pandemia de COVID-19 ocorreu um remodelamento do perfil de pacientes e readequação de fluxo cirúrgico de pacientes com fraturas ortopédicas. O objetivo do estudo é avaliar o impacto da pandemia no desfecho clínico e cirúrgico em pacientes submetidos a correção cirúrgica de fraturas fechadas e expostas. Material e métodos: Estudo de coorte prospectivo e unicêntrico conduzido de Dezembro 2019 a Fevereiro 2021 em São Paulo - Brasil com pacientes vítimas de trauma que apresentaram fraturas ortopédicas com necessidade de abordagem cirúrgica para correção das fraturas, o objetivo de analisar o desfecho clínico e cirúrgico, avaliando a taxa de incidência e prevalência de infecção relacionada à fratura. Resultados: Foram avaliados 132 pacientes e desses, 75% eram do sexo masculino, com média de idade igual a 50,4 anos. A taxa de infecção geral foi de 15,9% sendo que 12,9% de forma tardia e 3% de forma precoce. As variáveis de risco associados à IAF, utilizando-se a análise univariada, que mostraram significância estatística foram: uso recente de antibióticos no pré-operatório (p = 0,002), tipo de fratura (exposta vs. fechada, p < 0,001), uso de fixador externo (com vs. sem, p = 0,015), osteossíntese com placa e parafuso (p = 0,006), mecanismo da lesão (acidente automobilístico vs outros, p = 0,023), infecção por COVID (p = 0,028). Todavia, após análise conjunta de forma multivariada, o uso recente e pré-operatório de antibiótico e a presença de neoplasia foram fatores de risco independente para IAF. Na análise de sobrevida para identificar os fatores de risco relacionados ao tempo até o diagnóstico de IAF e ao óbito, as variáveis que demonstraram significância estatística foram: uso de antibiótico prévio, tabagismo e as fraturas expostas. O microorganismo mais comumente isolado foi a Klebsiella pneumoniae (23,50%). Conclusão: Uso recente e pré-operatório de antibiótico, uso de fixador externo, fratura exposta, queda de altura, osteossíntese com placa e parafuso, neoplasia e infecção por Covid-19 são fatores de riscos associados ao desfecho infecção no tratamento cirúrgico de fraturas ortopédicas.
ABSTRACT
Background: Severe aplastic anemia (SAA) is a rare bone marrow failure disorder associated with significant morbidity and mortality. SAA is characterized by severe pancytopenia and a hypocellular (<25%) bone marrow. The standard of care treatment is hemopoietic stem cell transplant or immunosuppressive therapy (IST) for patients (pts) who are ineligible for transplant. IST usually comprises an antithymocyte globulin (ATG) derived from horse or rabbit, and cyclosporine A (CsA). Although IST can be an effective treatment, individual intolerance, insufficient response, relapse, and clonal evolution remain significant limitations. The lack of global availability of the more effective horse ATG also leaves many pts with limited treatment options and poorer outcomes. In addition, pts with SAA often require transfusions which can be burdensome and negatively impact their quality of life. Eltrombopag (ETB) is indicated for use in pts with SAA who have had an insufficient response to IST (FDA PI, 2014) or are refractory to IST (EMA SmPC, 2015). More recently in the USA, ETB may also be used in combination with IST as first-line (1L) treatment (FDA PI, 2018). Aims: To assess the efficacy and safety of ETB + CsA (without ATG) as 1L therapy in adult pts with SAA. Methods: SOAR (NCT02998645) is a Phase 2, single-arm, multicenter, open-label study. Treatment-naive pts with SAA received ETB + CsA for 6 months;responders continued CsA therapy for an additional 24 months (later reduced to 18 months). The primary efficacy endpoint was overall response rate (ORR) by 6 months. ORR was defined as the proportion of pts with complete response ([CR] = absolute neutrophil count [ANC] ≥1000/μL AND platelet count ≥100,000/μL AND hemoglobin ≥10 g/dL) plus the proportion of pts with partial response ([PR] = any 2 of the following counts: ANC ≥500/μL;platelet count ≥20,000/μL;automated reticulocyte count ≥60,000/μL, but not sufficient for a CR). CR and PR were confirmed by 2 assessments ≥7 days apart;transfusion restrictions were also applied. For the primary endpoint to be considered ‘clinically meaningful’ at least 17/54 pts treated were required to have a response. Other endpoints included ORR by 3 months, ORR at 6 months (ie, confirmed response at the 6-month visit), and transfusion independence, which was defined as transfusion not being required in a period of ≥28 days for platelet transfusions and ≥56 days for red blood cell (RBC) transfusions. Results: Pts (N=54) had a median (interquartile range [IQR]) age of 55.0 (40.0-67.0) years and 63.0% were male. The majority of pts were White (40.7%) or Asian (40.7%). The median (IQR) duration of exposure to ETB and CsA was 5.7 (2.5-5.8) months and 5.7 (2.4-8.1) months, respectively, and the median (IQR) daily ETB dose was 150.0 (100.0-150.0) mg/day. In the full analysis set, the primary endpoint was met, with 25/54 pts having a CR or PR by 6 months (ORR 46.3%;95% confidence interval [CI], 32.6-60.4%). Of the 25 responders, 2 (3.7%) achieved a CR by 6 months. ORR by 3 months was 40.7% (95% CI, 27.6-55.0%;n=22/54), and ORR at 6 months was 37.0% (95% CI, 24.3-51.3%;n=20/54). 70.4% of all pts qualified for ≥1 period of RBC and/or platelet transfusion independence by 6 months, including all 25 (100%) responders and 13/29 (44.8%) non-responders (Fig. 1). 40.7% of all pts (responders: 68.0%;non-responders: 17.2%) qualified for ≥1 period of RBC transfusion independence (corresponding percentages for platelet transfusion independence were the same as for the combined RBC and/or platelet endpoint). Adverse events (AEs) occurred in 52/54 (96.3%) pts;45 (83.3%) pts experienced treatment-related AEs (TAEs), 23 (42.6%) of whom had a grade ≥3 TAE. The most common all-grade AEs were increased blood bilirubin (40.7%), nausea (29.6%), increased alanine aminotransferase (22.2%), and diarrhea (22.2%). Seven (13.0%) pts discontinued treatment due to grade ≥3 AEs. There were 8 on-treatment deaths (aplastic anemia [n=3];COVID-19, hemorrhage, multi-organ dysfunction syndrom , pyrexia, and thrombosis [all n=1]);no deaths were considered treatment-related. Conclusion: Data from the SOAR study indicate that ETB + CsA may be beneficial for pts with SAA ineligible for transplant who cannot access or tolerate ATG. All responders and almost half of non-responders qualified for ≥1 period of transfusion independence by 6 months, suggestive of a decreased transfusion burden. No new safety signals were identified. [Formula presented] Disclosures: Vallejo: Novartis: Honoraria;Sanofi: Honoraria;Pfizer: Honoraria. Finelli: Takeda: Consultancy;Celgene BMS: Consultancy, Research Funding, Speakers Bureau;Novartis: Consultancy, Speakers Bureau. Calado: Agios: Membership on an entity's Board of Directors or advisory committees;AA&MDS International Foundation: Research Funding;Alexion Brasil: Consultancy;Instituto Butantan: Consultancy;Novartis Brasil: Honoraria;Team Telomere, Inc.: Membership on an entity's Board of Directors or advisory committees. Peffault De Latour: Novartis: Consultancy, Honoraria, Research Funding;Pfizer: Consultancy, Honoraria, Research Funding;Amgen: Research Funding;Alexion: Consultancy, Honoraria, Research Funding;Apellis Pharmaceuticals Inc: Consultancy, Honoraria;Swedish Orphan Biovitrum AB: Consultancy, Honoraria. Kriemler-Krahn: Novartis: Current Employment. Haenig: Novartis: Current Employment. Maier: Novartis: Current Employment. Scheinberg: Alexion pharmaceuticals: Consultancy, Honoraria, Speakers Bureau;Novartis: Consultancy, Honoraria, Speakers Bureau;BioCryst Pharmaceuticals: Consultancy;Roche: Consultancy;Abbvie: Consultancy. OffLabel Disclosure: In the United States, eltrombopag is a thrombopoietin receptor agonist indicated in combination with standard immunosuppressive therapy (ATG + CsA) for the first-line treatment of adult and pediatric patients aged 2 years and older with severe aplastic anemia (SAA). It is also indicated for the treatment of patients with SAA who have had an insufficient response to immunosuppressive therapy. The SOAR trial aims to assess the efficacy and safety of eltrombopag + CsA (without ATG) as first-line therapy in adult patients with SAA.
ABSTRACT
Background: Severe aplastic anemia (SAA) is a life-threatening bone marrow failure disorder characterized by pancytopenia and a hypocellular bone marrow. The standard of care for patients that are ineligible for hemopoietic stem cell transplant is immunosuppressive therapy (IST), comprising antithymocyte globulin (ATG) and cyclosporine A (CsA). Horse (h-) ATG is considered more effective than rabbit ATG;however, lack of response, relapse, and clonal evolution remain significant limitations. Expense, individual intolerance, and a lack of global availability of h-ATG also leave many patients (pts) with more limited treatment options and poorer outcomes. Eltrombopag (ETB) is indicated for use in patients with SAA who have had an insufficient response to IST (FDA PI, 2014) or are refractory to IST (EMA SmPC, 2015). More recently in the USA, ETB may also be used in combination with IST as first-line treatment (FDA PI, 2018). Aims: To assess the efficacy and safety of an ATG-free regimen (ETB + CsA) in treatment-na.ve pts with SAA. Methods: SOAR (NCT02998645) is a Ph2, single-arm, multicenter, open-label study. Adult pts with SAA received ETB + CsA as first-line therapy for 6 months;responders continued CsA therapy for an additional 24 months (subsequently reduced to 18 months). The primary efficacy endpoint was overall response rate (ORR) by 6 months. ORR was defined as the proportion of pts with complete response ([CR] = absolute neutrophil count [ANC] ≥1000/μL AND platelet count ≥100,000/μL AND hemoglobin ≥10 g/dL) plus the proportion of pts with partial response ([PR] = any 2 of the following counts: ANC ≥500/μL;platelet count ≥20,000/μL;automated reticulocyte count ≥60,000/μL, but not sufficient for a CR). CR and PR were confirmed by 2 assessments ≥7 days apart;transfusion restrictions were applied. Based on historical data, an ORR of ≥30% was considered clinically meaningful. Results: A total of 54 pts were enrolled. The median (interquartile range [IQR]) age was 55.0 (40.0-67.0) years, 63.0% were male, and the majority of pts were White (40.7%) or Asian (40.7%). The median (IQR) duration of exposure to ETB and CsA were 5.7 (2.5-5.8) months and 5.7 (2.4-8.1) months, respectively, and the median (IQR) daily ETB dose was 150.0 (100.0-150.0) mg/day. In the full analysis set, the primary endpoint was met with an ORR by 6 months of 46.3% (25/54);95% CI, 32.6-60.4% (Fig. 1). Of the 25 responders, 2 (3.7%) achieved CR by 6 months. ORR by 6 months is also shown by age group (<65 and ≥65 years) (Fig. 1). Secondary endpoints included ORR by 3 months (40.7% [22/54];95% CI, 27.6-55.0%), and ORR at 6 months (ie, patients with confirmed response at 6-month visit: 37.0% [20/54];95% CI, 24.3- 51.3%). Adverse events (AEs) occurred in 52/54 pts;45 (83.3%) pts experienced treatment-related AEs (TAEs), 23 (42.6%) of whom had a grade ≥3 TAE. The most common all-grade AEs were increased blood bilirubin (40.7%), nausea (29.6%), increased alanine aminotransferase (22.2%), and diarrhea (22.2%). Seven (13.0%) pts discontinued study due to AEs. There were 8 on-treatment deaths (aplastic anemia [n=3];COVID-19, hemorrhage, multi-organ dysfunction syndrome, pyrexia, and thrombosis [all n=1]);no deaths were considered treatment-related. Summary/Conclusion: Data from the SOAR study indicate that ETB + CsA therapy may be beneficial as first-line treatment for SAA pts who cannot use ATG. The ORR is particularly notable, given the median age of this pt cohort (55.0 years). No new safety signals were identified.