Equity factors during the COVID-19 pandemic: Difficulties in emergency remote teaching (ert) through online learning

Since the onset of the COVID-19 pandemic, Emergency Remote Teaching through Online Learning (ERT-OL) has become the prevalent form of learning at many universities worldwide. At the same time, voices around the world have pointed to difficulties in online learning in general and to concerns regarding educational equity in particular. The current study sought to increase knowledge about specific hindering elements in ERT-OL and about the relationships between these elements from the standpoint of the following equity factors-socioeconomic status, language, and juggling among students who are also parents or working. To this end, the study analyzed 154 open-ended textual statements concerning the difficulties perceived by students at a university in Israel. The qualitative thematic analysis generated a map of hindering elements categorized in terms of a) processes: technology, pedagogy, content, situation and individual characteristics, and b) outcomes: cognitive, affective, social, and physical. The map revealed a mesh of intricate mediating and moderating links whose effect can intensify for each equity factor. On the positive side, seeds of mitigating strategies emerged as well. The study advances knowledge regarding ERT-OL hindering elements and their relationships and provides a better understanding of how these debilitating relationships may be exacerbated when equity factors are considered. Researchers and teachers interested in ERT-OL or in "normal" online learning in the future can use the map as a research and teaching framework to identify inequities and prevent further gaps.

P4640Validation of the PRECISE-DAPT Score in a real-world cohort of patients undergoing coronary stent implantation

Background

The optimal duration of dual antiplatelet treatment (DAPT) following percutaneous coronary interventions (PCI) should be tailored to patient characteristics. The DAPT score is one of two risk scores recommended for use by the European practice guidelines to aid in decision making on DAPT duration. To date, it's decision rule has not undergone external validation

Methods

A retrospective cohort study using a prospective all comers PCI registry.

Results

The PRECISE-DAPT score could be calculated for 6413/12,162 patients (52.7%). Of whom, 1,072 received DAPT for 3–6 months and 5,341 received DAPT for 12–24 months post PCI. The distribution of the score was similar to that in the original PRECISE-DAPT cohort.

During 24 months follow up, there were 254 (4.0% 95 CI 3.6–4.4%) actionable bleeding events. Higher PRECISE-DAPT quartiles were associated with higher risk for bleeding: 2.5% (95% CI 1.7–3.3%), 3.1% (95% CI 2.3–3.9%), 4.2% (95% CI 3.2–5.2%), and 6.7% (95% CI 5.5–7.9%), for Q1 through 4, respectively (p<0.001). however, within each quartile the risk for bleeding was similar in patients treated with long vs. short DAPT: 10.7 vs. 8.7%, (p=0.292); 10.6 vs. 8.5%, (p=0.282); 11.0 vs. 9.6%, p=(0.549) and 11.0 vs. 9.6%, (p=0.498) for PRECISE-DAPT quartiles 1 through 4, respectively. The PRECISE-DAPT score was not associated with the risk for myocardial infarction (MI)/Cerebrovascular accident (CVA)/Target vessel revascularization (TVR). The Absolute risk difference (ARD) for overall benefit (bleeding+ischaemic events) was not statistically significant for long vs. short DAPT in any of the quartiles: 1.4% (95% CI −1.0 to 3.8%); 1.4% (95% CI −0.6 to 4.6%); 0.9% (95% CI −2.3 to 5.3%) and 0.4% (95% CI −2.2 to 3.0%) for PRECISE-DAPT quartiles 1 through 4, respectively

Conclusions

In a large cohort of real world PCI patients, higher PRECISE-DAPT score were associated with increased risk for bleeding. However, the PRECISE-DAPT decision rule was not able to identify patients more/less likely to benefit from extended vs. standard DAPT duration. The findings indicate that the PRECISE-DAPT score and its decision rule for DAPT duration may not be generalizable to real-world population, stress the need forphysicians makng decisions regarding DAPT duration be aware of the score's limitations and use sound clinical judgement, when making decisions regarding DAPT duration. Our results also highlight the yet unmetneed for a simple, reproducible and valid tool to aid in choosing optimal DAPT duration for patients undergoing PCI.

Alpha-1 Adrenoceptor Agonists Generate a “Fast” NMDA Receptor-Independent Motor Rhythm in the Neonatal Rat Spinal Cord

Noradrenaline, a potent activator of rhythmogenic networks in adult mammals has not been reported to produce functional rhythmic patterns in isolated spinal cords of newborn rats. We now show that a “fast” (cycle time: 1–4 s) transient rhythm was induced in sacrococcygeal (SC) and rostral-lumbar spinal segments of the neonatal rat by bath-applied noradrenaline. The fast rhythm was blocked by 1 μM of the α1-adrenoceptor antagonist prazosin but not by 1–20 μM of the α2-adrenoceptor blocker yohimbine, it could be initiated and maintained by α1-adrenoceptor agonists, and it was accompanied by a slow nonlocomotor rhythm. Transection at the lumbosacral junction abolished the fast-thoracolumbar (TL) rhythm while the fast-SC and slow-TL rhythms were unaffected. The N-methyl-d-aspartate (NMDA) receptor antagonist 2-amino-5-phosphonopentanoic acid (AP5) abolished the slow- and did not interrupt the fast rhythm. Thus α1-adrenoceptor agonists induce an NMDA receptor-independent rhythm in the SC cord and modulate NMDA receptor-dependent rhythmicity in TL segments. Injection of current steps into S2 and flexor-dominated L2 motoneurons during the fast rhythm revealed a 20–30% decrease in input-resistance ( RN), coinciding with contralateral bursting. The RN of extensor-dominated L5 motoneurons did not vary with the fast rhythm. The rhythmic fluctuations of RN in L2 motoneurons were abolished, but the alternating left-right pattern of the fast rhythm was unchanged in midsagittally split TL cords. We suggest that the locomotor generators were not activated during the fast rhythm, that crossed-inhibitory pathways activated by SC projections controlled the rhythmic decrease in RN in L2 motoneurons, and that the alternating pattern of the split TL cord was maintained by excitatory SC projections.

Pattern generation in caudal-lumbar and sacrococcygeal segments of the neonatal rat spinal cord

The rhythmogenic capacity of the tail-innervating segments (L4-Co3) of the spinal cord was studied in isolated spinal cord and tail-spinal cord preparations of neonatal rats. Bath-applied serotonin/N-methyl-D-aspartate (NMDA) failed to produce a robust sacrococcygeal rhythmicity following midlumbar transection of the spinal cord. By contrast, a regular alternating left-right rhythm could be induced in the sacrococcygeal segments by application of noradrenaline (NA) or NA and NMDA before and after midlumbar transection of the cord. This rhythm was accelerated with the concentration of NMDA and was blocked by alpha1 or alpha2 adrenoceptor antagonists. The efferent bursts induced by NA/NMDA were accompanied by rhythmic tail movements produced by alternating activation of the left and right tail muscles and by coactivation of flexors, extensors, and abductors on a given side of the tail. This coactivation implies that reciprocal inhibitory pathways were not activated during the rhythm. Lesion experiments revealed that the rhythmogenic circuitry is distributed along all or most of the sacrococcygeal segments. The NA/NMDA-induced rhythm persisted in the isolated sacrococcygeal (S1-Co3), sacral (S1-S4), coccygeal (Co1-Co3), and smaller isolated regions of the sacrococcygeal cord. The rhythm also could be maintained in longitudinally split sacrococcygeal hemicords in which flexor, extensor, and abductor motoneurons are coactivated. This finding indicates that neither left/right nor flexor/extensor inhibitory interactions are required for rhythmogenesis in the sacrococcygeal cord. A slow rhythm lacking the alternating left-right pattern was induced by NA/NMDA in tail-innervating caudal lumbar segments of isolated L4-Co3 preparations. This rhythm was independent of the concurrent sacrococcygeal rhythm and the activity pattern of the tail musculature and it does not seem to contribute to rhythmic tail movements under these conditions. Comparative studies of the rhythm produced in the isolated caudal lumbar, sacrococcygeal cord, and caudal thoracic-rostral lumbar segments revealed that the S1-Co3 rhythm was faster than the L4-L6 pattern and slower than the T6-L3 rhythm. It is suggested that the caudal lumbar and sacrococcygeal segments of the cord are normally driven by the faster rostral lumbar central pattern generators. The relevance of the findings described above to pattern generation in the mammalian spinal cord is discussed.

The Motor Output and Behavior Produced by Rhythmogenic Sacrocaudal Networks in Spinal Cords of Neonatal Rats

The characteristics of the rhythmic motor output and behavior produced by intrinsic sacrocaudal networks were studied in isolated tail-spinal cord preparations of neonatal rats. An alternating left-right rhythm could be induced in the sacral cord by stimulus trains applied to sacrocaudal afferents at various intensities. Strengthening the stimulation intensity enhanced the rhythmic efferent firing and accelerated the rhythm by ≤30%. High stimulation intensities induced tonic excitation or inhibition and thereby perturbed the rhythm. Increasing the stimulation frequency from 1 to 10 Hz decreased the cycle time of the rhythm by 36%. The rhythm was blocked during prolonged afferent stimulation but could be restored by stimulation of contralateral afferents. Sacrocaudal afferent activation produced ventroflexion accompanied by either low- or high-amplitude rhythmic abduction of the tail. The low-amplitude abductions were produced by alternating flexor bursts during long stimulus trains. The activity of abductors and extensors was substantially reduced during these trains, their recruitment lagged after that of the flexors, and their activity bursts were much shorter. It is suggested that tail extensor/abductor motoneurons were suppressed during the stimulus train by inhibitory afferent projections. The high-amplitude abductions appeared after cessation of stimulus trains. Alternating left-right activation of the tail muscles, and coactivation of the principal muscles on each side of the tail were observed during these abductions. It is suggested that flexors and extensors assist the abductors to produce the high-amplitude abductions. This suggestion is supported by the finding that tail abduction could be produced by direct unilateral stimulation of any of the principal tail muscles. The relevance of the findings described in the preceding text to the use of regional sacral circuits in generation of stereotypic motor behaviors and to future studies of rhythmogenic sacrocaudal networks is discussed.