La scuola dopo l’emergenza: prospettive e riflessioni sulla didattica a partire dall’indagine nazionale SIRD

Following the first wave of the pandemic, which forced schools of all levels to implement Distance Learning, with the resumption of the new school year (2020/2021) we moved to the now well-known “Integrated Digital Didactics” (DDI). With this in mind, it is essential that educational research be oriented to identify with scientific methodology the aspects that have characterized Distance Learning in order to help define innovative teaching strategies and policies to be implemented during and after the emergency period. With these intentions, the Italian Society of Educational Research (SIRD) conducted a national study entitled “A comparison of distance learning methods adopted in Italian schools during the COVID-19 emergency period”. The study involved the completion of a questionnaire constructed upon ten thematic areas, intended for teachers throughout the country and to which more than 16,000 responded. The educational challenges do not end with the immediate crisis. With this paper, starting from a cross-sectional analysis of quantitative and qualitative data conducted on the Lazio unit of analysis, we aim to identify those aspects that could, potentially, become elements of quality in our school system in the future.A seguito della prima ondata della pandemia, che ha costretto le scuole di ogni ordine e grado ad attivare la Didattica a Distanza (DAD), con la ripresa del nuovo anno scolastico (2020/2021) si è passati all’ormai nota Didattica Digitale Integrata (DDI). In questa prospettiva, risulta fondamentale che la ricerca educativa si orienti ad inquadrare con metodologia scientifica gli aspetti che hanno caratterizzato la DAD al fine di con- tribuire a definire strategie didattiche e politiche innovative da attuare durante e dopo il periodo emergenziale. Con queste intenzioni è stata condotta la ricerca nazionale della Società Italiana di Ricerca Didattica (SIRD) “Per un confronto sulle modalità di didattica a distanza adottate nelle scuole italiane nel periodo di emergenza COVID-19”. La ricerca ha previsto la compilazione di un questionario costruito sulla base di dieci aree tematiche, destinato a docenti di tutto il territorio nazionale e al quale hanno risposto più di 16.000 insegnanti. Le sfide educative non finiscono con la crisi immediata: con il presente contributo si intende aprire una riflessione – a partire da un approfondimento trasversale sui dati quantitativi e qualitativi condotto sull’unità di analisi del Lazio – volta a identificare quegli aspetti che, potenzialmente, potranno diventare in futuro elementi di qualità del nostro sistema scolastico

Glutathione infusion before primary percutaneous coronary intervention: A randomised controlled pilot study

Objective: In the setting of reperfused ST-elevation myocardial infarction (STEMI), increased production of reactive oxygen species (ROS) contributes to reperfusion injury. Among ROS, hydrogen peroxide (H2O2) showed toxic effects on human cardiomyocytes and may induce microcirculatory impairment. Glutathione (GSH) is a water-soluble tripeptide with a potent oxidant scavenging activity. We hypothesised that the infusion of GSH before acute reoxygenation might counteract the deleterious effects of increased H2O2 generation on myocardium. Methods: Fifty consecutive patients with STEMI, scheduled to undergo primary angioplasty, were randomly assigned, before intervention, to receive an infusion of GSH (2500 mg/25 mL over 10 min), followed by drug administration at the same doses at 24, 48 and 72 hours elapsing time or placebo. Peripheral blood samples were obtained before and at the end of the procedure, as well as after 5 days. H2O2 production, 8-iso-prostaglandin F2α (PGF2α) formation, H2O2 breakdown activity (HBA) and nitric oxide (NO) bioavailability were determined. Serum cardiactroponin T (cTpT) was measured at admission and up to 5 days. Results: Following acute reperfusion, a significant reduction of H2O2 production (p=0.0015) and 8-iso-PGF2α levels (p=0.0003), as well as a significant increase in HBA (p<0.0001)and NO bioavailability (p=0.035), was found in the GSH group as compared with placebo. In treated patients, attenuated production of H2O2 persisted up to 5 days from the index procedure (p=0.009) and these changes was linked to those of the cTpT levels (r=0.41, p=0.023). Conclusion: The prophylactic and prolonged infusion of GSH seems to determine a rapid onset and persistent blunting of H2O2 generation improving myocardial cell survival. Nevertheless, a larger trial, adequately powered for evaluation of clinical endpoints, is ongoing to confirm the current finding

Going beyond children’s single-text comprehension:The role of fundamental and higher–level skills in 4th graders’ multiple-document comprehension

Background: Children's comprehension of single texts relies on both foundational and higher-level skills. These are also assumed to support multiple-document comprehension, but their relative importance has not been examined, to date. Multiple-document comprehension additionally requires the identification and use of information about each document's source. Aims: This study examined multiple-document comprehension in primary school-aged children. It sought to determine the relative importance of skills proposed to be common to both single-text and multiple-document comprehension (word reading fluency, verbal working memory, comprehension monitoring) and specific to the latter (source use). Single-text comprehension and prior topic knowledge were considered as moderator and control. Sample: Participants were 94 children in the fourth year (mean age = 9; 7 years; 52% females). Methods: Children read three documents on each of two topics (chocolate and video games). Multiple-document comprehension and source use were assessed through short essays. Independent measures of the fundamental and higher-level skills were used. Results: There was a significant direct and indirect influence of word reading fluency on comprehension of multiple documents on videogames and also an indirect influence of comprehension monitoring. Indirect influences of word reading fluency and comprehension monitoring on multiple-document comprehension for both topics were also apparent. Verbal working memory was not a unique predictor. When source information was identified, it was included to support the argument in the composition. Conclusions: Efficient word reading, comprehension monitoring, and single-text comprehension are important for multiple-document comprehension in young readers. Implications of these findings and differences between the two document sets are discussed

Gluten-Free Bread : Influence of Sourdough and Compressed Yeast on Proofing and Baking Properties

The use of sourdough is the oldest biotechnological process to leaven baked goods, and it represents a suitable technology to improve traditional bread texture, aroma, and shelf life. A limited number of studies concerning the use of sourdough in gluten-free (GF) breadmaking have been published in comparison to those on traditional bread. The aim of this study was to compare the properties of GF breads obtained by using a previously in-lab developed GF-sourdough (SD), compressed yeast (CY; Saccharomyces cerevisiae) or their mixture (SDCY) as leavening agents; more specifically, it aims to confirm the findings of a previous studies and to further improve (both in terms of recipe and process) the features of the resulting GF breads. Dough pH and rheological properties were measured. Fresh and stored breads were characterized for weight, height, specific volume, crust and crumb color, moisture, water activity, crumb hardness, and porosity. The combination SDCY was effective in improving bread volume and softness when compared to SD only. Furthermore, SD- and SDCY-crumbs exhibited a less crumbly behavior during storage (69 h, 25 \ub0C, 60% of relative humidity) in comparison to CY-breads. This study confirms the positive effect of SD in GF breadmaking, in particular when used in combination with CY

The risk stratification of adverse neonatal outcomes in women with gestational diabetes (STRONG) study

Aims: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. Methods: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed. The main outcome measure was the occurrence of adverse neonatal outcomes in pregnancies complicated by GDM. Results: Among study participants (median age 36.8 years, pre-gestational BMI 24.8 kg/m2), six miscarriages, one neonatal death, but no maternal death was recorded. The occurrence of the cumulative adverse outcome (OR 2.48, 95% CI 1.59–3.87), large for gestational age (OR 3.99, 95% CI 2.40–6.63), fetal malformation (OR 2.66, 95% CI 1.00–7.18), and respiratory distress (OR 4.33, 95% CI 1.33–14.12) was associated with previous macrosomia. Large for gestational age was also associated with obesity (OR 1.46, 95% CI 1.00–2.15). Small for gestational age was associated with first trimester glucose levels (OR 1.96, 95% CI 1.04–3.69). Neonatal hypoglycemia was associated with overweight (OR 1.52, 95% CI 1.02–2.27) and obesity (OR 1.62, 95% CI 1.04–2.51). The RECPAM analysis identified high-risk subgroups mainly characterized by high pre-pregnancy BMI (OR 1.68, 95% CI 1.21–2.33 for obese; OR 1.38 95% CI 1.03–1.87 for overweight). Conclusions: A deep investigation on the factors associated with adverse neonatal outcomes requires a risk stratification. In particular, great attention must be paid to the prevention and treatment of obesity

Physical performance and clinical outcomes in dialysis patients: a secondary analysis of the EXCITE trial.

Background/Aims: Scarce physical activity predicts shorter survival in dialysis patients. However, the relationship between physical (motor) fitness and clinical outcomes has never been tested in these patients. Methods: We tested the predictive power of an established metric of motor fitness, the Six-Minute Walking Test (6MWT), for death, cardiovascular events and hospitalization in 296 dialysis patients who took part in the trial EXCITE (ClinicalTrials.gov Identifier: NCT01255969). Results: During follow up 69 patients died, 90 had fatal and non-fatal cardiovascular events, 159 were hospitalized and 182 patients had the composite outcome. In multivariate Cox models - including the study allocation arm and classical and non-classical risk factors - an increase of 20 walked metres during the 6MWT was associated to a 6% reduction of the risk for the composite end-point (P=0.001) and a similar relationship existed between the 6MWT, mortality (P<0.001) and hospitalizations (P=0.03). A similar trend was observed for cardiovascular events but this relationship did not reach statistical significance (P=0.09). Conclusions: Poor physical performance predicts a high risk of mortality, cardiovascular events and hospitalizations in dialysis patients. Future studies, including phase-2 EXCITE, will assess whether improving motor fitness may translate into better clinical outcomes in this high risk populatio

Effect of a Behavioural Intervention for Adoption and Maintenance of a Physically Active Lifestyle on Psychological Well-Being and Quality of Life in Patients with Type 2 Diabetes: The IDES_2 Randomized Clinical Trial

Background: Psychological well-being and quality of life (QoL) are important outcomes of lifestyle interventions, as a positive impact may favour long-term maintenance of behaviour change. Objective: This study investigated the effect of a behavioural intervention for adopting and maintaining an active lifestyle on psychological well-being and health-related QoL in individuals with type 2 diabetes. Methods: Three hundred physically inactive and sedentary patients were randomized 1:1 to receive 1 month’s theoretical and practical counselling once a year (intervention group, INT) or standard care (control group, CON) for 3 years. Psychological well-being and QoL, assessed using the World Health Organization (WHO)-5 and the 36-Item Short Form (SF-36) questionnaire, respectively, were pre-specified secondary endpoints. The primary endpoint was sustained behaviour change, as assessed by accelerometer-based measurement of physical activity (PA) and sedentary time. Results: WHO-5 and SF-36 physical and mental component summary (PCS and MCS) scores increased progressively in the INT group and decreased in the CON group, resulting in significant between-group differences (WHO-5: mean difference 7.35 (95% confidence interval (CI) 3.15–11.55), P = 0.0007; PCS 4.20 (95% CI 2.25–6.15), P 150 min·wk−1 of moderate-to-vigorous intensity PA versus those who did not (13.06 (95% CI 7.51–18.61), P < 0.0001), whereas no relationship was detected for QoL. Conclusion: A counselling intervention that was effective in promoting a sustained change in PA and sedentary behaviour significantly improved psychological well-being and QoL. Trial Registration: ClinicalTrials.gov; NCT01600937; 10 October 2012

How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction? Insights from the EYESHOT Post-MI Study

Background: Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis: We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods: We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results: Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions: Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI

Effect of a home based, low intensity, physical exercise program in older adults dialysis patients: A secondary analysis of the EXCITE trial

Background: Older adults dialysis patients represent the frailest subgroup of the End Stage Renal Disease (ESRD) population and physical exercise program may mitigate the age-related decline in muscle mass and function. Methods: Dialysis patients of the EXCITE trial aged > 65 years (n = 115, active arm, n = 53; control arm, n = 62) were submitted in random order to a home based, low intensity physical exercise program. At baseline and 6 months after exercise training 6-min walking distance (6MWD) and 5-time sit-to-stand test (5STS) were performed, and quality of life (QoL) was tested. Results: The training program improved both the 6MWD (6-months: 327 \ub1 86 m versus baseline: 294 \ub1 74 m; P < 0.001) and the 5STS time (6-months: 19.8 \ub1 5.6 s versus baseline: 22.5 \ub1 5.1 s; P < 0.001) in the exercise group whereas they did not change in the control group (P = 0.98 and 0.25, respectively). The between-arms differences (6 months-baseline) in the 6MWD (+ 34.0 m, 95% CI: 14.4 to 53.5 m) and in the 5STS time changes (- 1.9 s, 95% CI: -3.6 to - 0.3 s) were both statistically significant (P = 0.001 and P = 0.024, respectively). The cognitive function dimension of QoL significantly reduced in the control arm (P = 0.04) while it remained unchanged in the active arm (P = 0.78) (between groups difference P = 0.05). No patient died during the trial and the training program was well tolerated. Conclusions: This secondary analysis of the EXCITE trial shows that a home-based, exercise program improves physical performance and is well tolerated in elderly ESRD patients. Trial registration: The trial was registered in ClinicalTrials.Gov (Clinicaltrials.gov identifier: NCT01255969) on December 8, 2010