A Struggling Nation Since Its Founding? Liberal Italy and the Cost of Neglecting Primary Education

This chapter investigates the impact of the Casati Law (1859) on the development of Italy’s national school system before the Fascist era (1861–1922). Unified Italy inherited large regional education disparities: literacy rates among children ranged from 60 percent in the northwest to 10 percent in the south. The Casati Law aimed to provide for a uniform education system; however, the funding and management of primary schools were left to the municipalities. The analysis shows that this arrangement hampered regional convergence and the diffusion of schooling within the country. When the system became more centralized in 1911, literacy rates started to grow more rapidly and to converge across regions. Despite this convergence, Italy’s comparative human-capital disadvantages and educational regional inequalities have persisted to the present day

Pentraxin 3 in patients with severe sepsis or shock: the ALBIOS trial

Background: The long pentraxin PTX3 is a key component of the humoral arm of innate immunity related to sepsis severity and mortality. We evaluated the clinical and prognostic significance of circulating PTX3 in the largest cohort ever reported of patients with severe sepsis or septic shock. Materials and methods: Plasma PTX3 was measured on days 1, 2 and 7 after randomization of 958 patients to albumin or crystalloids for fluid resuscitation in the multicentre Albumin Italian Outcome Sepsis (ALBIOS) trial. We tested the association of PTX3 and its changes over time with clinical severity, prevalent and incident organ dysfunctions, 90-day mortality and treatment. Results: PTX3 was high at baseline (72 [33\u2013186] ng/mL) and rose with the severity and number of organ dysfunctions (P < 0\ub7001) and the incidence of subsequent new failures. The PTX3 concentration dropped from day 1 to 7, but this decrease was less pronounced in patients with septic shock (P = 0\ub70004). Higher concentrations of PTX3 on day 1 predicted incident organ dysfunctions. Albumin supplementation was associated with lower levels of PTX3 in patients with septic shock (P = 0\ub7005) but not in those without shock. In a fully adjusted multivariable model, PTX3 on day 7 predicted 90-day mortality. Smaller drops in PTX3 predicted higher 90-day mortality. Conclusions: In severe sepsis and septic shock, early high PTX3 predict subsequent new organ failures, while a smaller drop in circulating PTX3 over time predicts an increased risk of death. Patients with septic shock show lower levels of PTX3 when assigned to albumin than to crystalloids