The Value of Literacy Practices

The concepts of literacy events and practices have received considerable attention in educational research and policy. In comparison, the question of value, that is, ‘which literacy practices do people most value?’ has been neglected. With the current trend of cross-cultural adult literacy assessment, it is increasingly important to recognise locally valued literacy practices. In this paper we argue that measuring preferences and weighting of literacy practices provides an empirical and democratic basis for decisions in literacy assessment and curriculum development and could inform rapid educational adaptation to changes in the literacy environment. The paper examines the methodological basis for investigating literacy values and its potential to inform cross-cultural literacy assessments. The argument is illustrated with primary data from Mozambique. The correlation between individual values and respondents’ socio-economic and demographic characteristics is explored

Information and vaccine hesitancy: Evidence from the early stage of the vaccine roll-out in 28 European countries.

The success of mass vaccination programs against SARS-CoV-2 hinges on the public's acceptance of the vaccines. During a vaccine roll-out, individuals have limited information about the potential side-effects and benefits. Given the public health concern of the COVID pandemic, providing appropriate information fast matters for the success of the campaign. In this paper, time-trends in vaccine hesitancy were examined using a sample of 35,390 respondents from the Eurofound's Living, Working and COVID-19 (LWC) data collected between 12 February and 28 March 2021 across 28 European countries. The data cover the initial stage of the vaccine roll-out. We exploit the fact that during this period, news about rare cases of blood clots with low blood platelets were potentially linked to the Oxford/AstraZeneca vaccine (or Vaxzeveria). Multivariate regression models were used to analyze i) vaccine hesitancy trends, and whether any trend-change was associated with the link between the AstraZeneca vaccine ii) and blood clots (AstraZeneca controversy), and iii) the suspension among several European countries. Our estimates show that vaccine hesitancy increased over the early stage of the vaccine roll-out (0·002, 95% CI: [0·002 to 0·003]), a positive shift took place in the likelihood of hesitancy following the controversy (0·230, 95% CI: [0·157 to 0·302]), with the trend subsequently turning negative (-0·007, 95% CI: [-0·010 to -0·005]). Countries deciding to suspend the AstraZeneca vaccine experienced an increase in vaccine hesitancy after the suspensions (0·068, 95% CI: [0·04 to 0·095]). Trust in institutions is negatively associated with vaccine hesitancy. The results suggest that SARS-CoV-2 vaccine hesitancy increased steadily since the beginning of the vaccine roll-out and the AstraZeneca controversy and its suspension, made modest (though significant) contributions to increased hesitancy

Reference Percentiles for Bioelectrical Phase Angle in Athletes

The present study aimed to develop reference values for bioelectrical phase angle in male and female athletes from different sports. Overall, 2224 subjects participated in this study [1658 males (age 26.2±8.9 y) and 566 females (age 26.9±6.6 y)]. Participants were categorized by their sport discipline and sorted into three different sport modalities: Endurance, velocity/power, and team sports. Phase angle was directly measured using a foot-to-hand bioimpedance technology at a 50 kHz frequency during the in-season period. Reference percentiles (5th, 15th, 50th, 85th, and 95th) were calculated and stratified by sex, sport discipline and modality using an empirical Bayesian analysis. This method allows for the sharing of information between different groups, creating reference percentiles, even for sports disciplines with few observations. Phase angle differed (men: P<0.001; women: P=0.003) among the three sport modalities, where endurance athletes showed a lower value than the other groups (men: Vs. velocity/power: P=0.010, 95% CI=−0.43 to −0.04; vs. team sports: P < 0.001, 95% CI=−0.48 to −0.02; women: Vs. velocity/power: P=0.002, 95% CI=−0.59 to −0.10; vs. team sports: P=0.015, 95% CI=−0.52 to−0.04). Male athletes showed a higher phase angle than female athletes within each sport modality (endurance: p<0.01, 95% CI=0.63 to 1.14; velocity/power: P<0.01, 95% CI=0.68 to 1.07; team sports: P<0.01, 95% CI=0.98 to 1.23). We derived phase angle reference percentiles for endurance, velocity/power, and team sports athletes. Additionally, we calculated sex-specific references for a total of 22 and 19 sport disciplines for male and female athletes, respectively. This study provides sex and sport-specific percentiles for phase angle that can track body composition and performance-related parameters in athletes

Conditional independence relations among biological markers may improve clinical decision as in the case of triple negative breast cancers

The associations existing among different biomarkers are important in clinical settings because they contribute to the characterisation of specific pathways related to the natural history of the disease, genetic and environmental determinants. Despite the availability of binary/linear (or at least monotonic) correlation indices, the full exploitation of molecular information depends on the knowledge of direct/indirect conditional independence (and eventually causal) relationships among biomarkers, and with target variables in the population of interest. In other words, that depends on inferences which are performed on the joint multivariate distribution of markers and target variables. Graphical models, such as Bayesian Networks, are well suited to this purpose. Therefore, we reconsidered a previously published case study on classical biomarkers in breast cancer, namely estrogen receptor (ER), progesterone receptor (PR), a proliferative index (Ki67/MIB-1) and to protein HER2/neu (NEU) and p53, to infer conditional independence relations existing in the joint distribution by inferring (learning) the structure of graphs entailing those relations of independence. We also examined the conditional distribution of a special molecular phenotype, called triple-negative, in which ER, PR and NEU were absent. We confirmed that ER is a key marker and we found that it was able to define subpopulations of patients characterized by different conditional independence relations among biomarkers. We also found a preliminary evidence that, given a triple-negative profile, the distribution of p53 protein is mostly supported in 'zero' and 'high' states providing useful information in selecting patients that could benefit from an adjuvant anthracyclines/alkylating agent-based chemotherapy

Pain and Frailty in Hospitalized Older Adults

Introduction: Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. Methods: In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. Results: The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38–2.07). Somatic pain (OR = 1.59, 95% CI 1.23–2.07) and widespread pain (OR = 1.60, 95% CI 0.93–2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28–0.85). Conclusions: Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features

Ruolo della chirurgia nell\u2019 occlusione intestinale nei pazienti affetti da malattia di Crohn.

L\u2019occlusione rappresenta la pi\uf9 frequente indicazione all\u2019intervento chirurgico (30-40%), che, ogniqualvolta possibile, va eseguito in elezione o almeno in urgenza differita per ridurre l\u2019incidenza delle complicanze postoperatorie I pazienti che non rispondono alla terapia conservativa, con segni di sofferenza vascolare o di pericolo di incipiente perforazione, devono essere operati in urgenza. Un intervento in elezione trova giustificazione nei casi di ostruzione persistente nonostante una adeguata terapia medica, specialmente se si tratta di una stenosi di vecchia data con prevalente componente fibrotica. In fase preoperatoria \ue8 utile un approfondimento diagnostico clinico, laboratoristico e strumentale. La TC e la RM consentono di escludere ascessi concomitanti, di precisare la localizzazione e l\u2019estensione e di definire il grado di attivit\ue0 della malattia (lieve, moderata, severa); in caso di assenza di importanti segni di flogosi (> calprotectina, > vascolarizzazione e contrast enhancement) la chirurgia precoce \ue8 valida alternativa alla terapia medica. Nei pazienti destinati alla chirurgia precoce \ue8 importante valutare la terapia in atto prima dell\u2019evento occlusivo; gli steroidi > il rischio di complicanze postoperatorie e pertanto vanno scalati. I biologici, peraltro indicati quale terapia conservativa nei pazienti non destinati alla chirurgia immediata, determinerebbero un incremento delle complicanze postoperatorie (ma non delle infezioni). L\u2019intervento di scelta \ue8 la resezione. La ricostruzione del transito \ue8 di frequente protetta da una ileostomia. La concomitanza di un ascesso impone il drenaggio chirurgico o, preferibilmente, TC-guidato in fase di studio e di preparazione preoperatoria. Una stenosi, se raggiungibile dall\u2019endoscopio, pu\uf2 essere trattata in maniera conservativa (dilatazione, endoprotesi). L\u2019anastomosi meccanica L-L a lume ampio \ue8 la migliore, poich\ue9 presenta bassi tassi di complicanze e forse di RPO, se confrontata con quella manuale. Questo caso (paz giovane, plurioperata) illustra l\u2019importanza di risparmiare quanto pi\uf9 possibile un intestino gi\ue0 resecato: \ue8 stato conservato l\u2019ileo terminale, sede di riassorbimento attivo di Vit B 12 e di sali biliari, per evitare il conclamarsi della SBS. Attenzione \ue8 stata posta per evitare cul di sacchi, che, con la conseguente iperproliferazione batterica, aggraverebbero la SBS. Le stricturoplastiche (Mikuliks, Finney, Taschieri, Fazio) sono riservate a pochi casi selezionati con stenosi del piccolo intestino

Surgical timing in the management of Crohn's disease in the era of biological drugs.

Background The indications and the timing for surgery are obviously related to the type of complications; but a key role, in choosing the most appropriate time to perform surgery, is played not only by factors related to patient but also by the evaluation of disease intrinsic characteristics: stenosing/penetrating/inflammatory disease, disease activity, extension, prevalent localization and the response to medical therapy. Methods The authors analyzed the literature of the past two decades by integrating it with their personal experience. The authors have paid attention above all to Crohn\u2019s disease management. Results Advances in medical therapy over the past two decades have substantially altered the management of patients with IBD. The introduction of more aggressive regimens (top down strategy) resulted in a change of surgery, which is no longer seen as \u201ca last resort\u201d, to be reserved for the treatment of a longstanding disease with more serious complications, but should also be seen as \u201cearly surgery\u201d, able to induce remissions faster and perhaps more durable, at least in the short to medium term. It is logical to wonder whether this is also a result of a change in the natural history of the disease under the influence of new therapies. Biological drugs have proved to be able to induce remission (60%), to keep it free from steroids for short-medium periods and to return the integrity of the mucosa, which is important to control the disease. Mucosal healing leads to a decrease of complications\u2019 rate, fewer hospitalizations and thus a possible reduction in the rate of surgical interventions. There are still doubts about the real reduction of the need for surgery. Biological drugs have positive response only in 60% of cases and it is also possible to develop antibody reactions and resistance to the drug (10%). In addition, the disease often presents as a stenosing form, for which biologics are little or no effective and so surgery, even early, is required. Prolonged periods of remission are achieved only in 15% of cases. Borrowing the positive effects of antiTNF in the treatment of rheumatic diseases, we wondered if the use of biologics in Crohn\u2019s disease may result in a change of the natural history of the disease. This problem remains unsolved. Doubts also remain about the actual reduction in the rate of hospitalization and in the need for surgery. Conflicting data emerge from randomized trials and observational studies. Conclusions There is still no evidence of a real reduction in the rate of interventions. Even today, the ideal treatment of Crohn\u2019s disease is an unclear argument. Surgery plays a leading role and should not be considered only as \u201ca last resort\u201d; early surgery may indeed allow faster and more lasting remission