ABSTRACT
This paper discusses the results of a research' that integrates Digital Interactive Storytelling (DIST), competence-oriented mathematical activities, and argumentation called DIST-M. The general aim is to support a reflective knowledge of mathematical concepts by implementing a digital educational device based on collaborative and dialogical activities proposed by researchers. Within a dialogical dimension of interactions (Bakhtin, 1981), argumentative practice is considered a social activity, where the acquisition and elaboration of new knowledge take place within a social space with multiple interlocutors in a dynamic process. The participants are engaged in constructing and negotiating mathematical meanings within a specific context. This dialogical approach to argumentation tends to create an authentic argumentative culture that is a system of implicit and explicit rules where the exchanges and interactions among participants require a joint elaboration of new meanings, within a given mathematical context, through a dialogical exchange. Learning and development result from a dialogical negotiation process during which new knowledge is developed and those already possessed are re-organized and systematized (Bakhtin, 1981;Vygotskij, 1978). In the current pandemic circumstances, technologies are the main tools to uphold the educational processes. Despite the fact that the DIST-M was implemented and tested before the Covid-19 era, its epistemic bases of dialogism mediated by technology could significantly keep alive the dialogic interaction in educational settings that have been heavily affected by the social distancing and promote mathematical thinking. The articles focus on the United Nations Sustainable Development Goal n. 4," Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all."
ABSTRACT
Background: The management of acute myeloid leukemia (AML) patients usually requires long inpatient treatments that can affect the limited care facilities, the quality of life, and increases healthcare costs. Additionally, leukemia treating centers in developing countries face limited sources to deliver high-dose chemotherapies as inpatient treatments. Therefore, several reports have established the feasibility and safety of outpatient consolidation. We aimed to implement a high-dose cytarabine outpatient program for AML in a limited-source institution at a public center in Peru.Methods: We conducted a prospective pilot study starting in January 2019 and ending before the COVID-19 Pandemic in March 2020. Eligible patients were ≥ age 14, met inclusion criteria for inpatient induction regimens, were without active infection, and had the following: normal chest x-ray and biochemistry, complete remission after one cycle of 7+3 induction. Logistical requirements included a 3-hours distance residence near the treatment center, caregiver support, trained nursing staff, infusion room capacity, and participation in follow-up. Patients received prophylactic antimicrobials such as oral levofloxacin, fluconazole, and acyclovir and were admitted to the hospital for predetermined complications of therapy (fever, G3-4 toxicity, febrile neutropenia, bleeding or refractory thrombocytopenia). Risk stratification was based on conventional cytogenetics and multiplex PCR using Leukemia.net criteria. Results: Forty-two patients were included during the study period. The median age was 38 years (16-63) and Female/Male ratio 4:3. According to Leukemia.net, 24% were classified as high, 50% intermediate and 26% as low risk group. Including FLT3 mutations in 26% of cases. Twenty-two and 20 subjects received 1-2 and 3-4 cycles of ambulatory HiDAC, respectively. About one-third of cases had emergency admissions during consolidation and 74% complete at least 3 cycles of cytarabine. Only 4 patients underwent sibling-donor allo-SCT. Sixty-four percent experienced relapses, and at 2 years follow-up only 21 subjects were alive. Median OS was 15 months, a better survival was shown among patients who received 3-4 cycles of ambulatory HiDAC (2-year OS 18 vs 23%, p=0.031). Conclusion: Our pilot study shows the feasibility to deliver HiDAC as outpatient consolidation in selected AML cases in a limited setting. Additionally, a high rate of relapses and poor survival was noted in our cohort that requires further consideration. Disclosures: No relevant conflicts of interest to declare.