Οι απόψεις των νηπιαγωγών και δασκάλων για τη μετάβαση στην πρώτη δημοτικού. Πρακτικές και προγράμματα μετάβασης

Σκοπός της παρούσας εργασίας είναι να μελετήσει το φαινόμενο της μετάβασης από το νηπιαγωγείο στην πρώτη τάξη του δημοτικού έτσι όπως βιώνεται σύμφωνα με τη γνώμη των εκπαιδευτικών των δυο βαθμίδων, προσχολικής και πρωτοβάθμιας εκπαίδευσης. Συγκεκριμένα, θέλαμε να εξετάσουμε τις γνώσεις των εκπαιδευτικών και των δύο βαθμίδων σχετικά με την έννοια της μετάβασης, πόσο σημαντική τη θεωρούν για την εξέλιξη των παιδιών και από ποιους παράγοντες επηρεάζεται η ομαλή μετάβαση των παιδιών. Επιπλέον, θέλαμε να εξετάσουμε την ύπαρξη συνεργασίας μεταξύ των εκπαιδευτικών και των γονιών και την εφαρμογή πρακτικών μετάβασης. Τέλος, θέλαμε να διερευνήσουμε την εικόνα των παιδιών και τα συναισθήματα των γονιών και των παιδιών κατά τη διάρκεια της μετάβασης σύμφωνα με τη γνώμη των εκπαιδευτικών. Για τους σκοπούς της έρευνας χρησιμοποιήθηκε η μέθοδος των ημιδομημένων συνεντεύξεων σε ένα δείγμα δεκατεσσάρων ατόμων που αποτελούνταν από επτά νηπιαγωγούς και επτά δασκάλους. Τα αποτελέσματα της έρευνας έδειξαν πόσο σημαντική είναι η συνεργασία μεταξύ των εκπαιδευτικών και των γονιών καθώς και την κοινή γραμμή που οφείλουν να ακολουθούν όλοι οι άμεσα εμπλεκόμενοι προκειμένου να καρπωθούν τα οφέλη μιας ομαλής μετάβασης. Επιπλέον, φάνηκε μια διαφορά στις πρακτικές ομαλής μετάβασης που εφαρμόζουν οι εκπαιδευτικοί. Ωστόσο και οι δύο θεωρούν τις πρακτικές βοηθητικές και απαραίτητες.The purpose of this survey is to study the transition period from the Nursery School to the first class of Primary School, based on both Nursery and Primary School teachers’ experiences. Specifically, we would like to examine how well informed the teachers of both grades are as far as the notion/meaning of this transition is concerned, how important for students’ development is and which factors influence this smooth transition. Furthermore, we would like to examine if there is cooperation between guardians and teachers and the transition practices application. Finally, we would like to investigate not only the children’s image but also parents and children’s feelings during the transition period according to the educators’ opinion. For the purpose of this survey, we applied the method of semi-structured interviews to a statistic pool of 14 people (consisting of 7 Nursery School and 7 Primary School teachers). The results of this survey showed how important cooperation between teachers and parents is as well as the fact that all the people involved in the survey should follow the same guidelines so as to reap the benefits of a smooth transition. In addition, a difference concerning the smooth transition policy the teachers apply was noticed. However, both groups regard these policies as supplementary and necessary

The step project:societal and political engagement of young people in environmental issues

Decisions on environmental topics taken today are going to have long-term consequences that will affect future generations. Young people will have to live with the consequences of these decisions and undertake special responsibilities. Moreover, as tomorrow’s decision makers, they themselves should learn how to negotiate and debate issues before final decisions are made. Therefore, any participation they can have in environmental decision making processes will prove essential in developing a sustainable future for the community.However, recent data indicate that the young distance themselves from community affairs, mainly because the procedures involved are ‘wooden’, politicians’ discourse alienates the young and the whole experience is too formalized to them. Authorities are aware of this fact and try to establish communication channels to ensure transparency and use a language that speaks to new generations of citizens. This is where STEP project comes in.STEP (www.step4youth.eu) is a digital Platform (web/mobile) enabling youth Societal and Political e-Participation in decision-making procedures concerning environmental issues. STEP is enhanced with web/social media mining, gamification, machine translation, and visualisation features.Six pilots in real contexts are being organised for the deployment of the STEP solution in 4 European Countries: Italy, Spain, Greece, and Turkey. Pilots are implemented with the direct participation of one regional authority, four municipalities, and one association of municipalities, and include decision-making procedures on significant environmental questions.</p

Applications of the best piecewise monotonic approximation to peak estimation of NMR data

Το πρόβλημα εκτίμησης κορυφών εμφανίζεται εγγενώς στη φασματοσκοπία. Στη φασματοσκοπία πυρηνικού μαγνητικού συντονισμού (NMR), για παράδειγμα, ο μαγνητικός συντονισμός βασίζεται στην ιδιότητα της ύλης ανάλλογα μέσω της έκθεσης του δείγματος σε συγκεκριμένη συχνότητα ραδιοκυμάτων. Παράγεται ηλεκτρικό σήμα και φαίνεται από το ύψος των κορυφών. Φασματοσκοπία NMR είναι μια από τις πιο κοινές τεχνικές φασματοσκοπίας μοριακής δόμησης για την αξιολόγηση των μοριακών κινήσεων σε πολύ υψηλές στάθμες δόνησης και των ειδών δακτυλικών αποτυπωμάτων. Για αυτά τα φάσματα, η θέση των κορυφών και οι εντάσεις τους είναι η ένδειξη μιας οργανικής ή ανόργανης ένωσης ή ιστού. Η μέθοδος προσέγγισης τμηματικών μονοτονικών δεδομένων σε σειρά κάνει τη μικρότερη αλλαγή στα δεδομένα, έτσι ώστε οι πρώτες διαφορές των αλλαγών των εξομαλυνσμένων τιμών να είναι ανάλογες ενός προκαθορισμένου αριθμού. Οι αλγόριθμοι που έχουν αναπτυχθεί για αυτόν τον δύσκολο συνδυαστικό υπολογισμό είναι πολύ αποτελεσματικοί παρέχοντας βέλτιστες λύσεις σε τετραγωνική πολυπλοκότητα σε σχέση με τον αριθμό των δεδομένων. Πρόκειται να διερευνήσουμε την αποδοτικότητα και την αποτελεσματικότητα της μεθόδου κατά προσέγγιση μονοτονικών δεδομένων για την εκτίμηση κορυφών των δεδομένων NMR που θα ληφθούν από τις βάσεις δεδομένων που σχετίζονται με τον μεταβολισμό Στόχος μας είναι να παρουσιάσουμε τα αποτελέσματα της τμηματικής μονοτονικής μεθόδου σε ένα φάσμα NMR. Επομένως, τα αποτελέσματά μας είναι χρήσιμα για να δείξουμε ότι η τμηματική μονοτονική μέθοδος είναι ιδιαίτερα κατάλληλη για εκτίμηση αιχμής σε δεδομένα NMR.Peak estimation problems appear inherently in spectroscopy. In nuclear magnetic resonance (NMR) spectroscopy, for example, magnetic resonance is based on matter property by analyzing the sample at a specific frequency of radio waves. An electrical signal is produced and is shown by the height of the peaks. NMR spectroscopy is the most common vibrational spectroscopy techniques for assessing molecular motion and fingerprinting species. For these spectra, the location of peaks and their intensities are the signature of a sample of an organic or an inorganic compound or a tissue. Piecewise monotonic data approximation method makes the smallest change to the data such that the first differences of the smoothed values change sign a prescribed number of times. The algorithms that have been developed for this challenging combinatorial calculation are very efficient providing optimal solutions in quadratic complexity with respect to the number of data. We are going to investigate the efficiency and the efficacy of the piecewise monotonic data approximation method to peak estimation of NMR data that will be received from metabolomics data bases. Our intention is to present results of the piecewise monotonic method on a muter of NMR spectrum. Therefore, our results are helpful in showing that piecewise monotonic method is particularly suitable for peak estimation in NMR data

Adolescent polycystic ovary syndrome according to the international evidence-based guideline

Background Diagnosing polycystic ovary syndrome (PCOS) during adolescence is challenging because features of normal pubertal development overlap with adult diagnostic criteria. The international evidence-based PCOS Guideline aimed to promote accurate and timely diagnosis, to optimise consistent care, and to improve health outcomes for adolescents and women with PCOS. Methods International healthcare professionals, evidence synthesis teams and consumers informed the priorities, reviewed published data and synthesised the recommendations for the Guideline. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied to appraise the evidence quality and the feasibility, acceptability, cost, implementation and strength of the recommendations. Results This paper focuses on the specific adolescent PCOS Guideline recommendations. Specific criteria to improve diagnostic accuracy and avoid over diagnosis include: (1) irregular menstrual cycles defined according to years post-menarche; > 90 days for any one cycle (> 1 year post-menarche), cycles 45 days (> 1 to  35 days (> 3 years post-menarche) and primary amenorrhea by age 15 or > 3 years post-thelarche. Irregular menstrual cycles (< 1 year post-menarche) represent normal pubertal transition. (2) Hyperandrogenism defined as hirsutism, severe acne and/or biochemical hyperandrogenaemia confirmed using validated high-quality assays. (3) Pelvic ultrasound not recommended for diagnosis of PCOS within 8 years post menarche. (4) Anti-Müllerian hormone levels not recommended for PCOS diagnosis; and (5) exclusion of other disorders that mimic PCOS. For adolescents who have features of PCOS but do not meet diagnostic criteria an ‘at risk’ label can be considered with appropriate symptomatic treatment and regular re-evaluations. Menstrual cycle re-evaluation can occur over 3 years post menarche and where only menstrual irregularity or hyperandrogenism are present initially, evaluation with ultrasound can occur after 8 years post menarche. Screening for anxiety and depression is required and assessment of eating disorders warrants consideration. Available data endorse the benefits of healthy lifestyle interventions to prevent excess weight gain and should be recommended. For symptom management, the combined oral contraceptive pill and/or metformin may be beneficial. Conclusions Extensive international engagement accompanied by rigorous processes honed both diagnostic criteria and treatment recommendations for PCOS during adolescence

Tildacerfont in Adults With Classic Congenital Adrenal Hyperplasia: Results from Two Phase 2 Studies

Context: Congenital adrenal hyperplasia due to 21-hydroxylase deficiency (21OHD) is typically treated with lifelong supraphysiologic doses of glucocorticoids (GCs). Tildacerfont, a corticotropin-releasing factor type-1 receptor antagonist, may reduce excess androgen production, allowing for GC dose reduction. Objective: Assess tildacerfont safety and efficacy. Design and setting: Two Phase 2 open-label studies. Patients: Adults with 21OHD. Intervention: Oral tildacerfont 200 to 1000 mg once daily (QD) (n = 10) or 100 to 200 mg twice daily (n = 9 and 7) for 2 weeks (Study 1), and 400 mg QD (n = 11) for 12 weeks (Study 2). Main outcome measure: Efficacy was evaluated by changes from baseline at 8 am in adrenocorticotropic hormone (ACTH), 17-hydroxyprogesterone (17-OHP), and androstenedione (A4) according to baseline A4 ≤ 2× upper limit of normal (ULN) or A4 > 2× ULN. Safety was evaluated using adverse events (AEs) and laboratory assessments. Results: In Study 1, evaluable participants with baseline A4 > 2× ULN (n = 11; 19-67 years, 55% female) had reductions from baseline in ACTH (-59.4% to -28.4%), 17-OHP (-38.3% to 0.3%), and A4 (-24.2% to -18.1%), with no clear dose response. In Study 2, participants with baseline A4 > 2× ULN (n = 5; 26-63 years, 40% female) had ~80% maximum mean reductions in biomarker levels. ACTH and A4 were normalized for 60% and 40%, respectively. In both studies, participants with baseline A4 ≤ 2× ULN maintained biomarker levels. AEs (in 53.6% of patients overall) included headache (7.1%) and upper respiratory tract infection (7.1%). Conclusions: For patients with 21OHD, up to 12 weeks of oral tildacerfont reduced or maintained key hormone biomarkers toward normal

Guidelines for the Development of Comprehensive Care Centers for Congenital Adrenal Hyperplasia: Guidance from the CARES Foundation Initiative

Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH) often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA), New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC), and National Newborn Screening and Genetics Resource Center (NNSGRC) also participated. Thus, this document should serve as a “roadmap” for the development phases of comprehensive care centers (CCC) for individuals and families affected by CAH

Guidelines for the Development of Comprehensive Care Centers for Congenital Adrenal Hyperplasia: Guidance from the CARES Foundation Initiative

Patients with rare and complex diseases such as congenital adrenal hyperplasia (CAH) often receive fragmented and inadequate care unless efforts are coordinated among providers. Translating the concepts of the medical home and comprehensive health care for individuals with CAH offers many benefits for the affected individuals and their families. This manuscript represents the recommendations of a 1.5 day meeting held in September 2009 to discuss the ideal goals for comprehensive care centers for newborns, infants, children, adolescents, and adults with CAH. Participants included pediatric endocrinologists, internal medicine and reproductive endocrinologists, pediatric urologists, pediatric surgeons, psychologists, and pediatric endocrine nurse educators. One unique aspect of this meeting was the active participation of individuals personally affected by CAH as patients or parents of patients. Representatives of Health Research and Services Administration (HRSA), New York-Mid-Atlantic Consortium for Genetics and Newborn Screening Services (NYMAC), and National Newborn Screening and Genetics Resource Center (NNSGRC) also participated. Thus, this document should serve as a “roadmap” for the development phases of comprehensive care centers (CCC) for individuals and families affected by CAH

Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome

Study Question What is the recommended assessment and management of women with polycystic ovary syndrome (PCOS), based on the best available evidence, clinical expertise, and consumer preference? Summary Answer International evidence-based guidelines including 166 recommendations and practice points, addressed prioritized questions to promote consistent, evidence-based care and improve the experience and health outcomes of women with PCOS. What Is Known Already Previous guidelines either lacked rigorous evidence-based processes, did not engage consumer and international multidisciplinary perspectives, or were outdated. Diagnosis of PCOS remains controversial and assessment and management are inconsistent. The needs of women with PCOS are not being adequately met and evidence practice gaps persist. Study Design, Size, Duration International evidence-based guideline development engaged professional societies and consumer organizations with multidisciplinary experts and women with PCOS directly involved at all stages. Appraisal of Guidelines for Research and Evaluation (AGREE) II-compliant processes were followed, with extensive evidence synthesis. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework was applied across evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength. Participants/Materials, Setting, Methods Governance included a six continent international advisory and a project board, five guideline development groups, and consumer and translation committees. Extensive health professional and consumer engagement informed guideline scope and priorities. Engaged international society-nominated panels included pediatrics, endocrinology, gynecology, primary care, reproductive endocrinology, obstetrics, psychiatry, psychology, dietetics, exercise physiology, public health and other experts, alongside consumers, project management, evidence synthesis, and translation experts. Thirty-seven societies and organizations covering 71 countries engaged in the process. Twenty face-to-face meetings over 15 months addressed 60 prioritized clinical questions involving 40 systematic and 20 narrative reviews. Evidence-based recommendations were developed and approved via consensus voting within the five guideline panels, modified based on international feedback and peer review, with final recommendations approved across all panels. Main Results and the Role of Chance The evidence in the assessment and management of PCOS is generally of low to moderate quality. The guideline provides 31 evidence based recommendations, 59 clinical consensus recommendations and 76 clinical practice points all related to assessment and management of PCOS. Key changes in this guideline include: i) considerable refinement of individual diagnostic criteria with a focus on improving accuracy of diagnosis; ii) reducing unnecessary testing; iii) increasing focus on education, lifestyle modification, emotional wellbeing and quality of life; and iv) emphasizing evidence based medical therapy and cheaper and safer fertility management. Limitations, Reasons for Caution Overall evidence is generally low to moderate quality, requiring significantly greater research in this neglected, yet common condition, especially around refining specific diagnostic features in PCOS. Regional health system variation is acknowledged and a process for guideline and translation resource adaptation is provided. Wider Implications of the Findings The international guideline for the assessment and management of PCOS provides clinicians with clear advice on best practice based on the best available evidence, expert multidisciplinary input and consumer preferences. Research recommendations have been generated and a comprehensive multifaceted dissemination and translation program supports the guideline with an integrated evaluation program. Study Funding/Competing Interest(S) The guideline was primarily funded by the Australian National Health and Medical Research Council of Australia (NHMRC) supported by a partnership with ESHRE and the American Society for Reproductive Medicine. Guideline development group members did not receive payment. Travel expenses were covered by the sponsoring organizations. Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline in the Register of disclosures of interest. Of named authors, Dr Costello has declared shares in Virtus Health and past sponsorship from Merck Serono for conference presentations. Prof. Laven declared grants from Ferring, Euroscreen and personal fees from Ferring, Euroscreen, Danone and Titus Healthcare. Prof. Norman has declared a minor shareholder interest in an IVF unit. The remaining authors have no conflicts of interest to declare. The guideline was peer reviewed by special interest groups across our partner and collaborating societies and consumer organizations, was independently assessed against AGREEII criteria and underwent methodological review. This guideline was approved by all members of the guideline development groups and was submitted for final approval by the NHMRC