Variables associated with bleeding and thrombotic outcomes among patients admitted to the hospital with COVID-19 and elevated D-dimer: insights from the ACTION randomised clinical trial

Background: In the ACTION trial, therapeutic anticoagulation did not show benefit on mortality, days of hospitalization and oxygens therapy at 30 days among patients with COVID19. However, this strategy was associated with higher rate of bleeding and a potential reduction in the rate of clinical thrombotic events. The current analysis evaluated which variables were independently associated with both outcomes in order to help the identification of the risk for thrombotic and hemorrhagic events among patients with COVID19. Methods: A total of 615 patients hospitalized with COVID-19 and elevated D-dimer levels were randomly assigned to prophylactic anticoagulation (mainly in-hospital heparin) or a therapeutic strategy that used in-hospital rivaroxaban 20 mg daily for stable patients, or enoxaparin 1 mg/kg twice daily for unstable patients, followed by rivaroxaban through 30 days. One patient withdrew consent and was not included in the analysis. The current analysis tested baseline clinical characteristics and laboratorial exams one by one with independent logistic regressions for the composite of bleeding (major bleeding and clinically relevant nonmajor bleeding) and thrombotic events (venous thromboembolism, myocardial infarction, stroke, systemic embolism, and major adverse limb events). Significant variables (p<0.05) were selected to adjust several multiple logistic models. Final models were chosen based on Akaike information criterion and therapeutic anticoagulation was included in the final model based on the primary results of the trial. Results: The model for bleeding events showed an accuracy of area under the curve (AUC) of 0.635 (table 1) while the model for thrombotic events had an AUC of 0.725 (table 2). Level of respiratory support (especially invasive ventilation) was associated with both outcomes in the multivariable analysis (tables 1 and 2). Beyond respiratory support, level of creatinine and history of coronary disease were also independently associated to the risk of thrombotic events. When the utilization of therapeutic anticoagulation (mainly with rivaroxaban) was included in the multivariable analysis, this variable was strongly associated with higher risk of bleeding (model AUC of 0.718) but was not associated with lower rate of thrombotic events (Tables 1 and 2). Conclusion: Since the variables associated with higher risk of thrombotic events are similar to the variables associated to bleeding complications, the selection of patients with better balance of risk vs. benefit to use therapeutic anticoagulation in COVID-19 still a challenging decision. Coronary disease and creatine may help to identify patients at higher risk of thrombotic complications while the use of therapeutic dose of direct oral anticoagulant increased the risk of bleeding in almost 4 times among patients hospitalized due to COVID19. Funding Acknowledgement: Type of funding sources: Private company. Main funding source(s): Investigator initiated research with financial support of Bayer

The implementation of an educational policy in the context of the Covid-19 pandemic: REANP in Minas Gerais

This study analyzes the implementation of remote education in the state of Minas Gerais in the context of the Covid-19 pandemic, based on an emergency public educational policy - the Regime Especial de Atividades Nao Presenciais [Special Regime for Non-Attendance Activities] (REANP). The concept of institutional implementation arrangement is used as a theoretical-methodological framework in the analysis of educational policy. The methodological approach is qualitative and consists of document analysis, through content analysis, based on legislation and REANP manuals. It is also complemented by an exploration of quantitative data from the Pesquisa Nacional por Amostra de Domicilios Continua [Continuous National Household Sample Survey] (Continuous PNAD). The results show a difficulty in implementing the REANP public policy due to the significant digital inequality with regard to access to the internet, open TV channel and ownership of equipment, which are essential resources for the implementation of REANP and can accentuate educational inequalities in public schools of the state of Minas Gerais.

SCIENCE TEACHING IN PANDEMIC TIMES: REFLECTIONS FROM TRAINING TEACHERS

The pandemic caused by the new coronavirus has caused significant impacts in all social segments, including Science Education. We developed this article of qualitative character, to understand the perceptions and implications of graduate students in Education for Science and Mathematics about the consequences of the pandemic for Science Education and teacher training. For this, we used as an instrument of collection an online questionnaire, with three open questions on the theme. The answers obtained were categorized and analyzed through content analysis, based on studies by Bardin (2011), from which two very evident reflective categories emerged: Science Teaching and technological innovations and transformations in the teacher training process. The results obtained in this study demonstrated several interpretations of the participants about this historical moment, the difficulties, challenges, and possibilities that can guide the theoretical, epistemological and practical discussions and reflections of the readers on the theme.

“The Great Equalizer”? The Long-Term Effects of the COVID-19 Pandemic on Poverty, Inequality, and the 2030 Agenda in Latin America

All over Latin America (LA), preexisting urban inequalities and vulnerabilities have shaped the spread of COVID-19. However, the pandemic is likely to increase vulnerabilities in the long term. The objective of the chapter is to discuss the long-term effects of the COVID-19 pandemic on sustainable development, particularly on poverty and inequality, with a special focus on cities. The chapter raises issues for future public policy interventions in order to fulfill sustainable development objectives. The chapter begins with an introduction, followed by a section on the 2030 Agenda and the social indicators for LA before the pandemic. The third section discusses preliminary data on how the COVID-19 pandemic impacted LA, followed by the fourth section on the long-term social impact of the pandemic in LA regarding poverty, inequality, and the 2030 Agenda. Finally, the fifth section discusses the challenges faced by the region to reach the 2030 Agenda targets amid the new situation. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.