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This article highlights two women important for pedagogy. María Montessori was a medical doctor who initially carried out research to alleviate the tensions generated by the poor sanitary conditions the children of this society experienced and under which they were educated through traditional strategies that had to be changed. Giuseppina Pizzigoni was a teacher who imagined a new school where children, the offspring of a brutally industrialized society, could be happy while learning. For both women the children’s education, being the task of adults, parents and teachers alike, should be carried out with responsibility and new methodologies they themselves constructed and proposed. For them, the future of humanity lies in the success of this task. Comparing Giuseppina Pizzigoni to Maria Montessori will allow us to point out some differences and similarities between the two schools of thought that go back to the contemporary Italian pedagogy of “new schools”. El presente artículo destaca dos figuras femeninas de la pedagogía. Maria Montessori fue una doctora en medicina que inicialmente realizó investigaciones para aliviar las tensiones generadas por las malas condiciones sanitarias en las que vivían los niños de su sociedad, y en las que debían educarse con estrategias tradicionales llamadas a cambiar. Giuseppina Pizzigoni era maestra y pensaba en una nueva escuela en la que los niños, hijos de una sociedad brutalmente industrializada, pudieran aprender facilmente. Para ambas, la formación de los niños y niñas como labor de adultos, padres y maestros, debía forjarse con responsabilidad y nuevas metodologías que ellas mismas construyeron y propusieron. En el éxito de esa labor, consideraron, se encontraba el futuro de la humanidad. La comparación entre Giuseppina Pizzigoni y Maria Montessori nos permitirá destacar algunas diferencias y semejanzas de dos escuelas de pensamiento que, sin embargo, se remontan al unísono a la pedagogía italiana contemporánea de las nuevas escuelas.

La Mostra pedagogica sul Palazzo del Podestà di Caspano nel Chiostro di S. Antonio a Morbegno, inaugurata il 19 aprile 2023, è rimasta aperta nei due giorni successivi permettendo la visita alle scuole e alla cittadinanza tutta. In una certa misura, ci si aspettava la vasta partecipazione delle classi e delle tante persone, studiosi, esperti ed Associazioni che, nel corso dei quindici mesi di azione formativa, avevano concorso alla migliore realizzazione del Progetto intitolato “Cultura e Formazione nel Palazzo del Podestà di Caspano”, presentato dall’Associazione per la diffusione del Fondo Pizzigoni, in partnership con l’Associazione La Centralina Onlus e con il contributo della Fondazione Pro Valtellina Ente filantropico. La presenza di circa 200 visitatori è stata una piacevole restituzione territoriale e soprattutto ha riconosciuto il merito alle insegnanti e, in modo particolare, a bambini, ragazzi, studenti che dai 3 ai 18 anni di età sono stati protagonisti di un percorso di crescita educativa unico nel suo genere. Una realizzazione di quel curricolo cosiddetto a cascata che si apre verticalmente su tutti i gradi di istruzione, capace quindi di mostrare come uno stesso centro di interesse potesse essere elaborato a livelli di sviluppo diversi e con attenzioni intense, in ogni momento della preparazione degli alunni e degli oggetti.

COVID-19 infection causes respiratory pathology with severe interstitial pneumonia and extra-pulmonary complications; in particular, it may predispose to thromboembolic disease. The current guidelines recommend the use of thromboprophylaxis in patients with COVID-19, however, the optimal heparin dosage treatment is not well-established. We conducted a multicentre, Italian, retrospective, observational study on COVID-19 patients admitted to ordinary wards, to describe clinical characteristic of patients at admission, bleeding and thrombotic events occurring during hospital stay. The strategies used for thromboprophylaxis and its role on patient outcome were, also, described. 1091 patients hospitalized were included in the START-COVID-19 Register. During hospital stay, 769 (70.7%) patients were treated with antithrombotic drugs: low molecular weight heparin (the great majority enoxaparin), fondaparinux, or unfractioned heparin. These patients were more frequently affected by comorbidities, such as hypertension, atrial fibrillation, previous thromboembolism, neurological disease, and cancer with respect to patients who did not receive thromboprophylaxis. During hospital stay, 1.2% patients had a major bleeding event. All patients were treated with antithrombotic drugs; 5.4%, had venous thromboembolism [30.5% deep vein thrombosis (DVT), 66.1% pulmonary embolism (PE), and 3.4% patients had DVT + PE]. In our cohort the mortality rate was 18.3%. Heparin use was independently associated with survival in patients aged ≥ 59 years at multivariable analysis. We confirmed the high mortality rate of COVID-19 in hospitalized patients in ordinary wards. Treatment with antithrombotic drugs is significantly associated with a reduction of mortality rates especially in patients older than 59 years.

Comparing and evaluating small area estimation (SAE) models for a given application is inherently difficult. Typically, we do not have enough data in many areas to check unit-level modeling assumptions or to assess unit-level predictions empirically; and there is no ground truth available for checking area-level estimates. Design-based simulation from artificial populations can help with each of these issues, but only if the artificial populations (a) realistically represent the application at hand and (b) are not built using assumptions that could inherently favor one SAE model over another. In this paper, we borrow ideas from random hot deck, approximate Bayesian bootstrap (ABB), and k nearest neighbor (kNN) imputation methods, which are often used for multiple imputation of missing data. We propose a kNN-based approximation to ABB (KBAABB) for a different purpose: generating an artificial population when rich unit-level auxiliary data is available. We introduce diagnostic checks on the process of building the artificial population itself, and we demonstrate how to use such an artificial population for design-based simulation studies to compare and evaluate SAE models, using real data from the Forest Inventory and Analysis (FIA) program of the US Forest Service. We illustrate how such simulation studies may be disseminated and explored interactively through an online R Shiny application.

Supplemental material, sj-pdf-1-jva-10.1177_11297298231185222 for Peripherally inserted central venous catheter for pediatric acute leukemia: A retrospective 11-year single-center experience by Silvio Ligia, Salvatore Giacomo Morano, Francesca Kaiser, Alessandra Micozzi, Antonio Chistolini, Walter Barberi, Valentina Arena, Alfonso Piciocchi, Maurizio Forgione, Giulia Gasperini, Paola Berneschi and Anna Maria Testi in The Journal of Vascular Access

Supplemental material, sj-pdf-1-jva-10.1177_11297298231185222 for Peripherally inserted central venous catheter for pediatric acute leukemia: A retrospective 11-year single-center experience by Silvio Ligia, Salvatore Giacomo Morano, Francesca Kaiser, Alessandra Micozzi, Antonio Chistolini, Walter Barberi, Valentina Arena, Alfonso Piciocchi, Maurizio Forgione, Giulia Gasperini, Paola Berneschi and Anna Maria Testi in The Journal of Vascular Access

Naturmetaphern in Erziehung und Pädagogik Schon seit der Antike bilden naturalistische Metaphern einen festen Bestandteil des Redens über Erziehung.1 Auch in den großen Religionen stellen sie die Verbindung von Naturzustand und sittlicher Unterweisung her. Dabei eröffnen Metaphern als elementare Formen der Kommunikation unmittelbare Zugänge zum Verständnis von tieferen Zusammenhängen. Metaphern eröffnen dabei auch ein unverstelltes Verständnis von Person und Erziehung. Auf dem Weg über die Metapher erfolgt ein erster Schritt in Richtung auf ein epistemologisches Verständnis von Erziehung und Pädagogik. Dieser Text folgt den Spuren jener, welche die Metapher zu etwas Dunklem innerhalb des erzieherischen Diskurses gemacht haben, versteckt hinter einem Gesträuch aus Analogien. Den Aussagegehalt von Metaphern aufzuschließen kann aber auch als Beitrag angesehen werden, die Ziele der Erziehung in einem anderen Licht zu sehen und Erkenntniswege zu erschließen – vergessene oder auch innovative.

Purpose. Peripherally-inserted central catheters (PICCs) are successfully increasingly used in children in onco-hematologic setting. PICC insertion, especially in oncologic patients, can be associated with adverse events (thrombosis, obstruction and infections). Data regarding the use of PICC, as long-term access in pediatric patients with severe hematologic diseases, are still limited. Methods. We retrospectively evaluated the safety and efficacy of 218 PICC, inserted in 154 pediatric patients diagnosed and treated at Pediatric Hematology Unit, Sapienza University of Rome, for severe hematologic disease in a 11-year period (98 acute lymphoblastic leukemias, 20 acute myeloid leukemias, 20 Hodgkin lymphomas, 6 non-Hodgkin lymphomas, 8 severe aplastic anemias, 2 acquired thrombotic thrombocytopenias). Results. The 218 PICC analyzed were in situ for a median dwell time of 160 days (range 12–898). In 38 children, PICC was inserted twice and in 10, three times or more due to hematopoietic stem cell transplant, disease recurrence or PICC-related complications. The overall complication rate was 32%: central-line associated bloodstream infections (CLABSI) occurred in 21% of cases after a median time of 105 days; a catheter-related thrombosis (CRT) in 3% and mechanical complications in 8% of cases. Premature removal for complications occurred in 36.7% of PICC. No death related to PICC complications was observed. Conclusion. In our experience, PICC was a cheap, safe and reliable device for long-term intravenous access in children with severe hematologic illnesses. This has been possible with the help of dedicated PICC team.

Patients with Coronavirus-associated disease-2019 (COVID-19) display alterations of the hemostatic system and the presence of a prothrombotic status frequently leading to vascular complications. However, the impact of COVID-19 on platelet activity, aggregation and agglutination still needs to be clarified. We measured total levels of von Willebrand factor (vWF) and vWF binding to the platelet glycoprotein (Gp) complex (GPIb-IX-V), in a cohort of COVID-19 patients admitted to the intensive care unit of our Institution. Moreover, we evaluated platelet aggregation in response to agonists (ADP, collagen, arachidonic acid) and platelet agglutination in response to ristocetin. We found that levels of vWF antigen and the active form of vWF binding to platelets (vWF:RCo), were markedly increased in these patients. These results were associated with higher agglutination rates induced by ristocetin, thereby indirectly indicating an increased capability of vWF to bind to platelets. Conversely, we found that platelet aggregation in response to both ADP and collagen was lower in COVID-19 patients compared to healthy volunteers. This study shows that COVID-19 is associated with increased vWF-induced platelet agglutination but reduced platelet responsivity to aggregation stimuli. Our findings have translational relevance since platelet adhesion to vWF may represent a marker to predict possible complications and better delineate therapeutic strategies in COVID-19 patients. Electronic Supplementary Material The online version of this article (10.1007/s11239-020-02339-6) contains supplementary material, which is available to authorized users.

Background: Uncertainties remain about the role of common thrombophilia markers as determinants of the ischemic stroke (IS) risk. Polymorphism His1299Arg in the FV gene, named R2 haplotype (FVHR2), has been poorly investigated. The aim of the present study was to assess the prevalence of common thrombophilia markers and of FVHR2 in a cohort of IS patients compared to a nonmatched group of healthy individuals. Methods: We studied 156 consecutive patients survivors of a first ever IS and 124 healthy controls. All subjects were investigated for the gene polymorphisms factor V (FV) Leiden, prothrombin (PTH) G20210A, MTHFR C677T, and FVHR2. Protein C (PC), protein S (PS), antithrombin (ATIII), and lupus anticoagulant (LAC) activity was measured. Homocysteinemia was assessed within 48 hours and after 30 days from stroke onset. Univariate and multivariate analyses were performed. Results: Compared with controls, patients were significantly older (mean [SD] age, 50.5 [12.9] vs 37.5 [15.5] years, P < .001), less frequently females (48.1% vs 67.7%, P = .001) and had more frequently hyperhomocysteinemia (45.9% vs 11.0%) only in the acute phase (OR 6.899, CI 95% 2.993-15.899; P < .001). No differences were found in the prevalence of FV Leiden, PTH G20210A, and MTHFR C677T between patients and controls, whereas FVHR2 was present in 34/156 (22%) stroke patients and in 5/124 (4%) controls (OR 6.632, 95% CI 2.509-17.535, P < .001). In a multivariate logistic regression analysis, the FVHR2 resulted independently associated with the occurrence of IS (OR 6.071, 95% CI 1.762-20.923; P = .004). Conclusions: In our study, hyperhomocysteinemia was confirmed to be a transient consequence of the thrombotic event. FVHR2 seems to be a possible candidate prothrombotic condition related to arterial IS irrespective of age and sex in an Italian sample population.

In questo articolo vengono proposte alcune riflessioni sul significato della crisi adottiva, con specifica attenzione alla definizione, alle cause e alle strategie di intervento. In particolare si intende presentare un'esperienza condotta dall'autore relativa alla conduzione di un gruppo di genitori adottivi con figli adolescenti o giovani adulti, in situazioni di grave crisi che hanno comportato il coinvolgimento dei Servizi Sociali e del Tribunale per i minorenni con la disposizione, in numerosi casi, dell'allontanamento del ragazzo dalla famiglia e l'inserimento in comunita. L'articolo si sofferma sui contenuti emersi nel gruppo e sui criteri che possono essere utilizzati sia per dare senso a quanto avviene in queste situazioni, sia per stabilire come intervenire per affrontarle.

The technological development of hardware heading toward universal fault-tolerant quantum computation requires a large-scale processing unit with high performance. While fluxonium qubits are promising with high coherence and large anharmonicity, their scalability has not been systematically explored. In this work, we propose a superconducting quantum information processor based on compact high-coherence fluxoniums with suppressed crosstalk, reduced design complexity, improved operational efficiency, high-fidelity gates, and resistance to parameter fluctuations. In this architecture, the qubits are readout dispersively using individual resonators connected to a common bus and manipulated via combined on-chip RF and DC control lines, both of which can be designed to have low crosstalk. A multi-path coupling approach enables exchange interactions between the high-coherence computational states and at the same time suppresses the spurious static ZZ rate, leading to fast and high-fidelity entangling gates. We numerically investigate the cross resonance controlled-NOT and the differential AC-Stark controlled-Z operations, revealing low gate error for qubit-qubit detuning bandwidth of up to 1 GHz. Our study on frequency crowding indicates high fabrication yield for quantum processors consisting of over thousands of qubits. In addition, we estimate low resource overhead to suppress logical error rate using the XZZX surface code. These results promise a scalable quantum architecture with high performance for the pursuit of universal quantum computation., Comment: 29 pages, 15 figures

Over the last 2 years, different cases of immune thrombocytopenia (ITP) in patients affected by SARS-CoV2 have been reported. The management of SARS-CoV2 in subjects with simultaneous or previous ITP can be challenging because of the great involvement of the haemostatic system in this viral infection. In this report, we describe the management and outcome of patients with newly diagnosed (ND), chronic and previous ITP, infected by COVID-19, referred to the Haematology Institute of University Hospital Policlinico Umberto I in Rome. Steroids + immunoglobulins for ND or relapsed ITP and continuation of home therapy for chronic ITP are advised, although further knowledge is required.

Background. Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare syndrome of unclear aetiology occurring after DNA-based vaccinations against COVID-19. The aim of this study was to investigate the DNA vaccine-encoded Sars-cov-2 soluble spike protein (SP). as a potential trigger of platelet activation in VITT. Methods. We studied three VITT patients and seven healthy controls (HCs) within 3 weeks from the first dose of ChAdOx1 nCoV-19, and one non vaccinated HC. Serum levels of SP and soluble angiotensin-converting enzyme 2 (sACE2), ACE2 expression in platelets and platelet response to VITT serum stimulation were studied. A thrombus retrieved during mechanical thrombectomy from one VITT patients, was analysed by immunohistochemistry for SP and ACE2. Neutrophil extracellular traps (NETs) markers and coagulation parameters were also measured. Results. We detected serum SP (up to 35 days post-vaccination) and sACE2 in all VITT patients, and respectively in two and three out of 7 vaccinated HCs. Only platelets from one non-vaccinated HC expressed ACE2. VITT sera markedly activated platelets and this activation was inhibited by both anti-SP and anti-FcγRIIA blocking antibodies. The thrombus showed positive immunohistochemical labelling of platelets using an anti-SP antibody with reduced ACE2 expression, compared to a thrombus from a pre-pandemic stroke patient. Markers of endothelial dysfunction, NETs and hypercoagulability state were present in all VITT sera. Conclusions. The present data provides first evidence that DNA vaccine-encoded Sars-cov-2 SP is detectable in VITT sera (several weeks post-vaccination) and in a platelet-rich thrombus, and that may contribute to the initial platelet stimulation in VITT patients.

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Background Acquired Haemophilia A (AHA) patients show a high response rate to immunosuppressive therapy (IST) but few information about predictors of response and outcome are reported. Aims We describe a large single-centre AHA cohort, investigating prognostic variables for the 'best response' (BR), time to BR (TTBR) and overall survival (OS). Methods A total of 61 patients were included, collecting data from clinical charts. Results A progressive increase in diagnoses, from 1978 to 2019, was observed. Fifty/56 patients (89%) underwent haemostatic therapy (rFVIIa 46%, aPCC 34%) with no significant differences in the response (rFVIIa 92.3% vs aPCC 100%) and no thromboembolic events. Sixty/61 patients underwent first-line IST with an initial response rate of 58.4%. The 12-months OS was 85%, the bleeding associated mortality rate 3% (2/61). The response rates at last observation were: CR 64%, PR 8%. We evaluated the influence of age, gender, associated conditions, IST, haemoglobin levels, FVIII:C, inhibitor titre on BR, TTBR and OS: post-partum AHA achieved the BR after a longer time than AHA related to other aetiologies or idiopathic (p = .05); in univariate analysis female sex (p = .03) and the achievement of BR (p = .001) had a positive impact on the OS while AHA secondary to neoplasms showed a shorter survival (p = .04); only the BR achievement remained significant in multivariate analysis (p = .02). Conclusions Our data on response and survival confirmed those from the main registries. Post-partum AHA and BR achievement were significantly associated to a longer TTBR and a longer OS, respectively. Other predictors of outcome deserve to be explored in prospective studies.

Pregnancy carries a high risk of thromboembolic complications, especially in the postpartum period. This risk is particularly high in women with inherited thrombophilias, among these antithrombin deficiency seems to carry the highest risk. In this case, the use of low molecular weight heparin (LMWH) is recommended, while the use of antithrombin concentrate is controversial. We report our experience of seven pregnancies occurred in five women: two, with a personal and familiar history negative for venous thromboembolism, were treated with LMWH during pregnancy and antithrombin concentrate immediately before and after the delivery. The other three women had a personal and familiar history positive for venous thromboembolism and were treated with LMWH and antithrombin concentrate during all the pregnancy and the postpartum period. No thromboembolic or hemorrhagic complications were observed in both groups, demonstrating that our strategy could be safe and effective.

Microplastic particles are of concern to aquatic environments because their size enables them to be easily ingested by animals and they may become vectors of potentially harmful chemicals. This study focused on understanding the impact of plastic size and plastic types on adsorption and adsorption kinetics of commonly found contaminants of emerging concern (CECs). We exposed macro- and micro-sized polyethylene (PE), polystyrene (PS), and polyvinyl chloride (PVC) to six CECs: diclofenac (DCF), atenolol (ATN), ibuprofen (IBU), 4-acetamidophenol (ACE), bisphenol A (BPA), and 2-mercaptobenzothiazole (MBT). Our results showed that the pseudo-first order model described the adsorption kinetics better than the pseudo-second order model. The rate of adsorption ACE onto macro-PS was the fastest rate of adsorption for all CECs and microplastics evaluated. Generally, the mass fraction of CECs sorbed at equilibrium did not depend on the size of the plastic and chemical hydrophobicity. With a relatively low Kow among the CECs studied here, ACE had the most mass fraction sorbed onto all the plastics in this study. DCF was also consistently sorbed onto all the plastics. The mechanism van der Waals interaction may have dominated in all the adsorptions in this study, but π-π interaction could also be a major mechanism in the adsorption of DCF, IBP, and ACE. Fast adsorption of ATN, IBP, and ACE may occur during wastewater treatment, but slow adsorption may still continue in the wastewater effluent. Our study highlights an ecotoxicological concern for plastics being a vector of commonly found CECs that are not highly hydrophobic.

Vaccine induced thrombotic thrombocytopenia is a new syndrome recently described in young adults within two weeks from the first dose of the ChAdOx1 nCoV-19 vaccine and characterized by cerebral venous thrombosis. We report two cases of malignant middle cerebral artery (MCA) infarct and thrombocytopenia within 10 days after vaccination with ChAdOx1 nCoV-19. Patient 1 was a 57-year-old woman who underwent decompressive craniectomy despite two successful mechanical thrombectomies. Patient 2 was a 55-year-old woman who developed a fatal bilateral malignant MCA infarct. Both the patients had pulmonary and portal vein thrombosis and high level of antibodies to platelet factor 4-polyanion complexes.

La pandemia Covid-19 ha comportato conseguenze e trasformazioni prefigurando scenari inediti sul piano economico, sociale e personale, determinando anche nel campo della ricerca l’urgenza di esplorarne le ricadute. Il volume dà quindi conto delle indagini svolte e in corso, sin dai primi giorni del lockdown, dai docenti e dai collaboratori del Dipartimento di Scienze della Formazione dell’Università Roma Tre, toccando i temi più diversi: dalla didattica a distanza, all’università e nei diversi ordini di scuola, al futuro dei servizi di orientamento, dal lavoro socio-educativo nelle varie tipologie di servizi all’impatto della pandemia sulle comunità, dalle narrazioni ai linguaggi artistici a contrasto di quest’emergenza non solo sanitaria. Si sono così esplorate le diverse educazioni possibili, riassegnando centralità ai processi formativi e al benessere delle persone, provando a tratteggiare nuovi paradigmi e prospettive., La pedagogia generale e sociale è stata completamente rivisitata durante l’emergenza epidemiologica da COVID-19, sia dal punto di vista epistemologico che dal punto di vista metodologico. È ancora in pieno svolgimento l’aggiornamento della formulazione del lessico pedagogico e delle scienze dell’educazione con riferimento a concetti e significati intesi a rispondere al progetto fondamentale di formazione completa e integrale della persona umana. Il divenire dell’educazione viene sensibilmente riorientano nell’era della pandemia, tra postmodernità e globalizzazione. Il contributo della scienza medica è tale da fornire parole che si associano ai processi educativi, ancora da decifrare. Nella lettura interpretativa dell’educazione i neologismi rappresentano momenti di conoscenza da leggere con la decodifica dei contenuti destinati a diventare epistemologia rinnovata e anche metafora del tempo in cui viviamo. Una recente ricerca condotta nella scuola e nell’università evidenzia le dinamiche in atto coagulate intorno alla definizione dell’identità professionale del docente. L’ipotesi da verificare, costruita per l’analisi degli effetti del distanziamento sociale sull’identità professionale del docente, non ha permesso di rilevare una perdita di comunicazione. Si è rafforzato il sentimento di partecipazione sociale, in termini di acquisizione di norme di comportamento valutate come indispensabili per il bene della famiglia, della scuola, della comunità, della società più ampia. La costatazione della risorgente emergenza educativa ha condotto a riformulare i sentieri dell’educazione etica, alla salute, sociale, civile. Ne sono nate azioni di prevenzione e tutela che si sarebbero meglio pianificate nel ritorno a scuola dopo il lockdown., La Ricerca dipartimentale ai tempi del COVID-19

In the last decades, the chronic myeloid leukemia (CML) therapeutic landscape has changed dramatically with the introduction of tyrosine kinase inhibitors (TKIs), with 10-year survival rates improving to up to 80%. Long-lasting TKI treatment, in particular with second-generation TKIs, has enabled clinicians to manage the onset of several side effects and other co-morbidities, such as atrial fibrillation or venous thromboembolism (VTE). We retrospectively evaluated nine CML patients treated with TKIs between 2017 and 2020 who experienced atrial fibrillation or VTE and received concomitant administration of TKIs and direct oral anticoagulants (DOACs) outside clinical trials, to evaluate the efficacy and safety of this combination. Median age was 66 years at CML diagnosis (range 52–73 years) and 69 years at the time of starting DOACs. A female predominance was observed. The median follow-up of concomitant DOAC and TKI administration was 8.5 months; edoxaban was administered in six patients and apixaban in two patients, and one patient received rivaroxaban. Regarding CML treatment, four patients received imatinib, two patients bosutinib, and three nilotinib. In eight patients DOACs were started for atrial fibrillation and in one patient for VTE. In none of the patients treated with the combination were additional symptomatic thrombotic adverse events or major bleedings reported. In this small case series, the use of DOACs in CML patients seemed feasible. Additional data on long-term outcomes including a larger cohort of CML patients treated with DOACs are, however, needed.

Background Splanchnic vein thrombosis (SVT) is an uncommon but potentially life-threatening disease usually related to different underlying clinical conditions. The risk of SVT recurrences is high over time in patients with an underlying permanent prothrombotic condition. Vitamin K antagonists (VKA) represent the mainstay of treatment for SVT. Data about the efficacy and safety of direct oral anticoagulants (DOACs) are reported in the literature for the treatment of acute SVT, but less is known about their application for the secondary prophylaxis of venous thromboembolism (VTE). The aim of this study was to assess the efficacy and safety of long-term DOACs therapy in patients at high-risk of thrombosis, compared to VKA. Methods This is a retrospective single-centre study including 70 patients with SVT on long-term anticoagulant treatment with VKA followed-up at our Units between January 2017 and December 2019. All the patients were at high thrombotic risk defined as the presence of a permanent prothrombotic condition requiring long-term anticoagulation. During follow-up, 28 patients were shifted to DOACs and their clinical outcomes were compared to those of the patients who continued VKA therapy. All the arterial and venous thrombotic events of the splanchnic and extra-splanchnic districts as well as the haemorrhagic adverse events occurring during follow-up were recorded. Results Of the seventy patients enrolled in the study, 36 patients (51.4%) had a single-segment involvement thrombosis (28.5% of portal vein, 7.1% of superior mesenteric vein, 4.3% of splenic vein, 11.5% of hepatic veins) and 34 patients (48.6%) had multi-segment involvement at the time of diagnosis. 42 patients (60%) continued VKA therapy and 28 (40%) were switched to DOACs. Median follow-up was 6 years (range 2-8) during VKA and 1.9 years (range 1-5.2) during DOACs. The incidence of thrombotic events was similar between patients on VKA and those on DOACs. Patients on VKA developed deep vein thrombosis (DVT), and of the patients on DOACs 1 developed NSTEMI and 1 DVT. No major haemorrhagic events occurred. Minor bleedings occurred in 26% of patients on VKA and in none of the DOACs patients (P: 0.09). Conclusions Our results highlight that DOACs could represent an effective and safe alternative to the VKA for secondary prophylaxis in SVT patients at high risk of thrombosis.

Mondor’s disease is a rare condition and usually treated with low-molecular weight heparin and non-steroidal anti-inflammatory drugs. Because of paucity of cases and for the usually spontaneous resolution, there is not a standard treatment strategy and the use of oral anticoagulation in controversial. We reported the efficacy of direct oral anticoagulants in the recurrent Mondor’s disease refractory to standard therapy.

The anticoagulant treatment for patients with hematologic malignancies is low molecular weight heparin (LMWH), considered the safest in this particular patients setting. Although direct oral anticoagulants (DOACs) have proven their efficacy and safety in patients with cancer, their use can be challenging in patients with hematologic malignancies due to the peculiarity of these neoplasms: high thrombotic risk, possible onset of thrombocytopenia and concomitant anticancer therapies. The aim of our study was to evaluate the efficacy and safety of DOACs for venous thromboembolism or atrial fibrillation in patients with hematologic malignancies and plasmatic DOACs level during anticancer therapy and at time of bleeding or thrombotic complications. We evaluated patients with hematologic malignancies treated with DOACs for venous thromboembolism or atrial fibrillation; therapy was maintained until the platelet count was ≥50x109 /L. In case of concomitant anticancer treatment and hemorrhagic or thrombotic events, we checked DOACs plasma levels (trough and peak). The patients evaluated were 135:104/135 were on anticancer therapy. We did not observe either thrombotic or major hemorrhagic adverse events. Minor bleedings occurred in 10 patients and clinical relevant non major (CRNM) in 2 patients. There was a statistically significant correlation between bleedings and myelodysplastic syndrome. DOACs resulted effective and safe in patients with hematologic malignancies. DOACs plasma level can be helpful in suggesting an early dose adjustment to prevent hemorrhagic adverse event in patients on concomitant anticancer therapy. Larger prospective studies including hematologic patients are warranted to confirm the safety and efficacy of DOACs. This article is protected by copyright. All rights reserved.

Prospective adoptive parents need to develop adequate knowledge of adoptive parenthood and adoptable children before child placement. Pre-adoption preparation has been considered a predictor of positive outcomes both for parents and children, while unrealistic expectations towards adoptive parenthood are related to difficulties in facing the adoptive parenting process, especially those that may arise from the child’s emotional, psychological and behavioural problems. Despite the importance of prospective adoptive parents’ expectations for the positive outcomes of adoption, few studies have examined the expectations of couples awaiting adoption. This article investigates the expectations concerning adoptive parenting in a group of 60 Italian prospective adoptive parents who completed an open-ended questionnaire aimed at understanding their expectations regarding adoptable children and their wishes and fears about adoptive parenting. The thematic analysis highlighted prospective adoptive parents’ expectations of more desirable qualities of children and underestimation of the difficulties they may encounter during the adoptees’ adjustment process. The results offer insights to adoption professionals with a view to enhancing the quality of prospective adoptive parents’ preparation before child placement.

Venous thoracic outlet syndrome (VTOS) is a manifestation of venous symptoms that occurs when the subclavian vein is compressed and it may present clinically with acute venous thrombosis of the axillo-subclavian vein. Evidence for the optimal approach to the management of this condition is sparse and actually anticoagulation alone is not considered an option. Herein we reported our experience with direct oral anticoagulants in patients with upper extremities deep vein thrombosis, due to VTOS, who refused endovascular approach or surgery.

Central venous catheters (CVC) are essential for the management of patients with hematologic malignancies, facilitating chemotherapy infusion, antibiotics, parenteral nutrition, blood products, and blood samples collection. In this population, peripherally inserted central catheters (PICC) seem to be associated with lower complications, compared with conventional percutaneously inserted devices (CICC). Data on the PICC in allogeneic hematopoietic stem cell recipients (allo-HSCT) are limited. We have prospectively evaluated the safety and efficacy of 100 polyurethanes or silicone PICC, inserted into 100 adult allo-HSCT recipients, at the Hematology of Sapienza University of Rome (Italy), between October 2012 and August 2017. The median duration of PICC placement was 117 days. Overall, 68% of patients maintained the device for the entire transplant procedure and PICC were removed after day 100 from allo-HSCT; of these, 44% did not experienced any PICC-related complications. Catheter-related bloodstream infections (CRBSI) occurred in 32% of patients (2.5/1000 PICC days), associated with thrombosis in 8 cases. CRBSI were observed in 42% of patients with polyurethane and 20% with silicone PICC (p = 0.02). Catheter-related thrombosis occurred in 9% of patients, never requiring anticipated PICC removal. Mechanical complications occurred in 15% of cases (1.2/1000 PICC days). On the whole, adverse events were manageable and did not affect transplant outcome. No deaths related to PICC-complications were observed. PICC are a safe and reliable long-term venous access in allo-HSCT recipients.

Balanced walking involves freely swinging the limbs like pendula. However, children immediately begin to carry objects as soon as they can walk. One possibility for this early skill development is that whole body coordination during walking may be re-organized into loosely coupled collections of body parts, allowing children to use their arms to perform one function, while the legs perform another. Therefore, this study examines: 1) how carrying an object affects the coordination of the arms and legs during walking, and 2) if carrying an object influences stride length and width. Ten healthy toddlers with 3–12 months of walking experience were recruited to walk barefoot while carrying or not carrying a small toy. Stride length, width, speed, and continuous relative phase (CRP) of the hips and of the shoulders were compared between carrying conditions. While both arms and legs demonstrated destabilization and stabilization throughout the gait cycle, the arms showed a reduction in intra-subject coordination variability in response to carrying an object. Carrying an object may modify the function of the arms from swinging for balance to maintaining hold of an object. The observed period-dependent changes of the inter-limb coordination of the hips and of the shoulders also support this interpretation. Overall, these findings support the view that whole-body coordination patterns may become partitioned in particular ways as a function of task requirements.

Our present time is characterised by many contradictions and the aspect of uncertainty indicates a sense of our deep loss of values. Education is the traditional space, in which generations create meanings and adults prefigure the future. Despite the idea of liquid modernity, which dominates our existence, we are convinced that we inherit meaningful testimonies of schools born in the spirit of the Reform from the pedagogic culture of the last two centuries. Schools, such as Dalton, Jena Plan, Decroly and Freinet, are still alive and bringing us a new message of citizenship education coherent with the impulse of their founders. Following our field study to investigate the reality of the Schools of Method in the areas of the Flanders and Brussels we were able to draw a solid concept of community. In the 500th anniversary of the Reformation, we assume that the modern western culture reaches its task to convert the dispute into tolerance. Citizenship education wishes to overcome any separations and indicates the road to peace and harmony. It is not by chance that Reform Schools are now reaffirming the original impulse. They are transforming the contradictions of our postmodern society into the management of daily education. Headmasters and teachers are seriously opting for movement and variety of the curriculum against school stereotypes of the disciplines. Children become protagonists of the reformation, using the methodology of dialogue, development and discovery. Teachers and parents appear to be fundamental parts of the process, and learning democracy in school begins with the practice of a council of pupils: discussing, deciding, doing. The external world actively enters schools to shape life. History is composed of the biographies of senior citizens, mainly grandfathers, and languages are matter of pride for children from families with migrant backgrounds.

Since 2008-2009, the discipline "Citizenship and Constitution" was introduced by the Law 169/2008, in all Italian schools. From pre-primary to upper secondary school, the intention has been to promote the formation of social awareness and critical consciousness to educate good citizens. The culture of Citizenship and Constitution has assumed then a permanent, structural character in schools. The concept of citizenship has gone through various definitions, it is prevailing the idea of uniting citizenship with the content of the Constitution, thereby reinvigorating the map of common values. More recent is the concept of active citizenship, interpreted in terms of participation and social and civil action in the local, national and European community. The university curriculum of teacher education contemplates the discipline ‘Intercultural Pedagogy and Citizenship Education’ in order to prepare students to become responsible teachers towards social critical themes such as the question of human rights. This article presents results on the cultural relevance of learning Citizenship values as part of curricula both in school and at University and gives the essential reasons to prepare students to become teachers for a school able to orienting children towards democratic citizenship.Keywords: citizenship education, italian constitution, teacher education, human rights, university curriculum

In questo articolo viene discussa la tematica della valutazione delle competenze parentali nel caso di genitori stranieri sottoposti a provvedimento del Tribunale per i Minorenni. Si tratta di un argomento complesso e scarsamente esplorato nella letteratura italiana del settore, nonostante siano ormai numerosi i casi di genitori provenienti da altri paesi che giungono all’attenzione dei servizi deputati alla tutela dei minori. La riflessione su alcune delle specificita che questo tipo di intervento comporta, si basa sull’esperienza clinica realizzata con la casistica del Programma di Psicologia dell’Unita Sanitaria Locale della Romagna, sede di Forli, nel triennio 2008-2010 e propone alcune ipotesi di lavoro potenzialmente utili per migliorare l’efficacia e l’efficienza del percorso di valutazione delle competenze genitoriali con questa tipologia di persone.

Background Antiphospholipid syndrome (APS) is an autoimmune disease characterised by thrombotic events and/or pregnancy morbidity in combination with persistent positivity for antiphospholipid antibodies (aPL) [lupus anticoagulant (LA), anticardiolipin (aCL), anti b2 glycoprotein I (anti-β2GPI) in medium/high titers]. These antibodies could be identified not only in other pathological conditions (i.e. autoimmune diseases), but also in healthy subjects (aPL carriers). In this subset, the risk of developing thrombotic events or pregnancy morbidity ranges from 0% to 3.8%, and it is higher in subjects with LA positivity, triple positivity (LA+aCL+anti-β2GPI) and aCL positivity at high/medium titer. Nonetheless, 70% of aPL carriers described so far showed a concomitant autoimmune disease, being itself a risk factor for thrombotic events. Objectives We longitudinally followed up a cohort of healthy subjects persistently positive for aPL to evaluate the risk of developing thrombotic events. Methods Healthy subjects positive for aPL in at least 2 consecutive determinations (aPL carriers) were enrolled. Medical history was recorded and the following parameters were registered: presence of traditional risk factors (smoking, diabetes mellitus, hypertension, dyslipidemia, hormone therapy); obstetric history (infertility, miscarriages); family history of autoimmune and cardiovascular diseases with an early onset; recent infectious episodes. Laboratory evaluation was performed, including aCL IgG/IgM, anti-β2GPI IgG/IgM, LA, antinuclear antibody, C3/C4 serum levels, thrombophilia screening. All subjects were evaluated every 6 months. Results We enrolled 47 aPL carriers (M/F 9/38, median age at first visit 45.5 years, IQR 17). Thirty-six subjects (76.6%) were aCL+ (30.5% at medium/high titer), 30 (63.8%) anti-β2GPI+ (36.7% at medium/high titer), 24 (51.1%) LA+. Thirty-one subjects (65.9%) were positive for more than one aPL and 12 (25.5%) showed a triple positivity. The aPL carriers were longitudinally followed up for a median of 60 months (IQR 48). Twenty-four subjects were treated with low dose aspirin (LDA) and 3 with hydroxychloroquine. During this observational period, 5 subjects were lost to follow-up and 5 became persistently negative for aPL after a median of 54 months (IQR 39). Considering the remaining 37 aPL carriers, 3 (1F, 2M) experienced a thrombotic event (2 arterial and 1 venous). This patients were treated with LDA at the time of the event and were all LA+. In one case, the episode was preceded by a flu-like event. Interestingly, the LA prevalence resulted significantly higher in the subjects experiencing thrombotic events in comparison with those who did not (p=0.0001). We observed an absolute risk of thrombotic events of 0.08 (CI: 0.02 to 0.2) and an incidence rate of 1.1 (CI: 0.3 to 2.9). Conclusions In this prospective study, specifically designed to evaluate the incidence of APS related clinical manifestations in aPL positive healthy subjects, LA positivity resulted the most important risk factor of thrombotic events. Disclosure of Interest None declared

The Erasmus mobility of teachers between Portugal and Italy was a relevant opportunity to innovate our higher systems of education according to the European recommendations. We had the real experience of learning how to develop new streams in our demand and offer of education taking into consideration the cultural heritage in which Pedagogy and Didactics are rooted. Both countries convey ideas of renovation in terms of contents, strategies, methods. We learned politics in school and society about problems of migration and refugees, distress of families and children bringing enormous hopes for the future. From consolidated pedagogical theories and experimented workshops we shared knowledge helpful to prepare our students to be self-confident for a very high level of teaching performance and social participation. The purpose of this contribution is to discuss our mutual academic results achieved., Le ragioni di Erasmus, 1

Many proteins belonging to the amyloid family share the tendency to misfold and aggregate following common steps, and display similar neurotoxicity. In the aggregation pathway different kinds of species are formed, including several types of oligomers and eventually mature fibers. It is now suggested that the pathogenic aggregates are not the mature fibrils, but the intermediate, soluble oligomers. Many kinds of aggregates have been described to exist in a metastable state and in equilibrium with monomers. Up to now it is not clear whether a specific structure is at the basis of the neurotoxicity. Here we characterized, starting from the early aggregation stages, the oligomer populations formed by an amyloid protein, salmon calcitonin (sCT), chosen due to its very slow aggregation rate. To prepare different oligomer populations and characterize them by means of photoinduced cross-linking SDS-PAGE, Energy Filtered-Transmission Electron Microscopy (EF-TEM) and Circular Dichroism (CD) spectroscopy, we used Size Exclusion Chromatography (SEC), a technique that does not influence the aggregation process leaving the protein in the native state. Taking advantage of sCT low aggregation rate, we characterized the neurotoxic potential of the SEC-separated, non-crosslinked fractions in cultured primary hippocampal neurons, analyzing intracellular Ca2+ influx and apoptotic trend. We provide evidence that native, globular, metastable, prefibrillar oligomers (dimers, trimers and tetramers) were the toxic species and that low concentrations of these aggregates in the population was sufficient to render the sample neurotoxic. Monomers and other kind of aggregates, such as annular or linear protofibers and mature fibers, were totally biologically inactive.

Thirty-five patients with Ph+ CML aged more than 60 years were treated with imatinib. Twenty-four patients (group A) were in late chronic phase (CP) and eleven patients (group B) were in accelerated/blastic phase (AP/BP). In group A, complete haematological response (CHR) was achieved by all patients; seventeen patients (70.8%) attained a complete cytogenetic response (CCR), one (4.1%) attained a partial CR, one (4.1%) a minor CR (Ph+ 70%) and five (21%) were resistant (Ph+ 100%), toxicity was mild: seven patients had a transient cytopenia, three a skin reaction, one a moderate oedema and one muscular pain. After a median follow-up of 15 months, 1 patient died in progression and 23 patients are alive (2 in BP and 21 in persisting response). In group B, one patient died after 3 months in aplastic phase from sepsis, three patients were resistant and seven patients (63.7%) achieved CHR; of these, four obtained CCR. After a median follow-up of 17 months, 4 patients have died from progressive disease, 6 are alive; 1 in AP and 5 in CHR (4 of them being in CCR). Present data indicate that imatinib is safe also in elderly with clinical results as good as in younger patients.

International Survey in Eight Countries about Teachers and Teaching Profession An international team of experts from Belgium, Italy, Poland, Slovakia, Turkey and the USA employed a questionnaire to identify the deontology of teachers from infant to secondary school in eight countries. The survey was implemented between 2004 and 2007. The socio-cultural concept of Verstehen (understanding) as described in the work of Max Weber, points to the clear significance of being a teacher at this time in history. Qualitative and quantitative analysis allow for an understanding that the teacher is exactly that, in any context. The ideal typology of the teacher is the result of training at a university level and working in the school system. Phenomenal differentiations characterise the various situations and broaden the perspective of the study, including an identification of the shared features of the profession. The strong, common core is the responsibility towards fellow teachers balanced out by a weak, yet common note of regret regarding the scant social prestige of being a teacher. There seems to be a lack of communication between the personal and social aspects involved in shaping the professional identity. The social image of teachers weighs heavily on their professional status due to the inevitable political implications it results in and the considerable effect on institutional behaviour. Teachers listen, but they are not heard; teachers are committed, but remain unrecognised; teachers evaluate, but are evaluated in turn. The issue of the social importance of the profession of teachers in our societies emerges as a crucial point in the perspective of educating young generations.

The recognition of the enantiomeric couples of ditryptophan in Langmuir films of N -hexadecanoyl- l -proline was investigated by surface pressure–area ( π – A ) isotherm measurements and Brewster angle microscopy experiments. The π – A isotherms relative to the films including the enantiomeric dipeptides show small differences whereas an evident enantiodiscrimination is observed by Brewster angle microscopy images.