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Background Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. Methods Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. Findings 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. Interpretation Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. Funding The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. Study registration ClinicalTrials.gov Identifier: NCT04847336 This research was funded by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste Italy.

Questo contributo guarda al gioco come tecnologia per la comunicazione e l’apprendimento, analizzandolo in particolare come volto all’integrazione di migranti, tramite l’analisi del gioco urbano persuasivo A Hostile World e dei risultati di ricerca conseguiti in occasione della sua applicazione su due gruppi di adolescenti individuati per i loro comportamenti ostili nei confronti degli immigrati. Lo scopo del gioco è far immergere i partecipanti in situazioni inconsuete, per problematizzare e modificare attitudini mentali e preconcetti esistenti, promuovendo acquisizioni di saperi capaci di modificare comportamenti e aumentare l’empatia. Lo studio è una ricerca-azione condotta tramite questionari qualitativi somministrati pre-e post-esperienza, brevi interviste e focus group. L’analisi dei risultati rivela che i giocatori sono stati coinvolti in toccanti, scomodi processi di identificazione che hanno ridotto pregiudizi esistenti, incrementando la comprensione delle fatiche e fragilità altrui, con risultati rilevanti in termini di apprendimento trasformativo, che ancora persiste This contribution looks at games as a technology for communicating, sharing and learning, focusing specifically on play activity as a means to address cultural integration. The paper presents analysis and research outcomes gleaned through investigation of the persuasive urban game A Hostile World and its application to two groups of adolescents who manifested hostile feelings towards foreigners. The game immerses players in awkward situations so as to problematise and possibly modify their former mindset, prejudices and biases towards migrants, effectively generating learning outcomes capable of increasing empathy and affecting behaviours. The enquiry is an action research initiative conducted via pre-and post-experience qualitative questionnaires, short interviews and focus groups. The analysis reveals that players were involved in processes of moving and uncomfortable identification that lessened existing prejudices, increasing the comprehension of the conditions and fragility of immigrants, with relevant outcomes in terms of persisting transformative learning

Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered.Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known:• There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New:• Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease.• However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.

Gli ex voto dipinti sono un oggetto di culto dalla lunga storia. Esempi di questo tipo di ex-voto, largamente utilizzati fino alla fine dell'Ottocento nell'Italia meridionale e in altre regioni dell'Europa meridionale, sono infatti già attestati nel mondo classico (pinakes, tabellea pictae). Nel passaggio tra il mondo "pagano" e il mondo "cristiano", nel mutare dei referenti divini e delle teologie, si osserva una continuità dei simboli rituali e delle pratiche votive e, più in generale, una significativa persistenza di forme, funzioni e significati in campo religioso. The painted ex-votos are a cult object with a long history. Examples of this type of ex-voto, widely used up to the end of the 19th century in Southern Italy and in other regions of Southern Europe, are in fact already attested in the classical world (pinakes, tabellea pictae). In the passage between the "pagan" world and the "Christian" world, in the changing of the divine referents and theologies, we observe a continuity of the ritual symbols and votive practices and, more generally, a significant persistence of forms, functions and meanings in the religious field.

Data on the effective burden of the SARS-CoV-2 pandemic in the pediatric population are limited. We aimed at assessing the prevalence of SARS-CoV-2 IgG antibodies in children at three subsequent time-points. The study was conducted between January 2021 and July 2021 among children referring to the Research Institute for Maternal and Child Health “Burlo Garofolo” in Trieste, a referral regional hospital in Friuli Venezia Giulia, Italy. A multivariate analysis was conducted to assess factors independently associated with seroconversion. A total of 594 children were included. Anti-SARS-CoV-2 trimeric Spike protein IgG antibodies were found in 32 (15.4%) children tested in April-May and in 20 (11.8%) in June–July 2021, compared with 24 (11.1%) of those tested in January–February 2021 (p = 0.37, Armitage exact test for trend over time p = 0.76). A subgroup analysis and a multivariate logistic regression analysis were performed considering sociodemographic, clinical, and historical variables. Three categories of children showed statistically significant increased odds of positive anti-SARS-CoV-2 IgG antibodies: children previously positive to a nasopharyngeal swab (AdjOR 15.41, 95%CI 3.44–69.04, p < 0.001), cohabitant with a person with an history of a previous positive nasopharyngeal swab (AdjOR 9.95, 95%CI 5.35–18.52, p < 0.001), and children with a foreign citizenship (AdjOR 2.4, 95%CI 1.05–5.70, p = 0.002). The study suggests that seroprevalence studies may be of limited help in estimating the prevalence of the COVID-19 pandemic in children. Further studies are needed to identify other markers of previous SARS-CoV-2 infection in children, such as CD4+ T cells or memory B-cells.

Objectives To evaluate the imaging features of routine admission chest X-ray in patients referred for novel Coronavirus 2019 infection. Methods All patients referred to the emergency departments, RT-PCR positive for SARS-CoV-2 infection were evaluated. Demographic and clinical data were recorded. Two radiologists (8 and 15 years of experience) reviewed all the X-ray images and evaluated the following findings: interstitial opacities, alveolar opacities (AO), AO associated with consolidation, consolidation and/or pleural effusion. We stratified patients in groups according to the time interval between symptoms onset (cut-off 5 days) and X-ray imaging and according to age (cut-off 60 years old). Computed tomography was performed in case of a discrepancy between clinical symptoms, laboratory and X-ray findings, and/or suspicion of complications. Results A total of 468 patients were tested positive for SARS-CoV-2. Lung lesions primarily manifested as interstitial opacities (71.7%) and AO opacities (60.5%), more frequently bilateral (64.5%) and with a peripheral predominance (62.5%). Patients admitted to the emergency radiology department after 5 days from symptoms onset, more frequently had interstitial and AO opacities, in comparison to those admitted within 5 days, and lung lesions were more frequently bilateral and peripheral. Older patients more frequently presented interstitial and AO opacities in comparison to younger ones. Sixty-eight patients underwent CT that principally showed the presence of ground-glass opacities and consolidations. Conclusions The most common X-ray pattern is multifocal and peripheral, associated with interstitial and alveolar opacities. Chest X-ray, compared to CT, can be considered a reliable diagnostic tool, especially in the Emergency setting., Highlights • SARS-CoV-2 pulmonary findings are typically bilateral and subpleural. • Symptoms onset time of 5 days is a reliable cut-off. • Pulmonary findings are age-related.

BACKGROUND: The management of rectal cancer patients is mainly based on the use of the magnetic resonance imaging (MRI) technique as a diagnostic tool for both staging and restaging. After treatment, to date, the evaluation of complete response is based on the histopathology assessment by using different tumor regression grade (TRG) features (e.g., Dworak or Mandard classifications). While from the radiological point of view, the main attention for the prediction of a complete response after chemotherapy treatment focuses on MRI and the potential role of diffusion-weighted images and perfusion imaging represented by dynamic-contrast enhanced MRI. The main aim is to find a reliable tool to predict tumor response in comparison to histopathologic findings. AIM: To investigate the value of dynamic contrast-enhanced perfusion-MRI parameters in the evaluation of the healthy rectal wall and tumor response to chemo-radiation therapy in patients with local advanced rectal cancer with histopathologic correlation. METHODS: Twenty-eight patients with biopsy-proven rectal adenocarcinoma who underwent a dynamic contrast-enhanced MR study performed on a 1.5T MRI system (Achieva, Philips), before (MR1) and after chemoradiation therapy (MR2), were enrolled in this study. The protocol included T1 gadolinium enhanced THRIVE sequences acquired on axial planes. A dedicated workstation was used to generate color permeability maps. Region of interest was manually drawn on tumor tissue and normal rectal wall, hence the following parameters were calculated and statistically analyzed: Relative arterial enhancement (RAE), relative venous enhancement (RVE), relative late enhancement (RLE), maximum enhancement (ME), time to peak and area under the curve (AUC). Perfusion parameters were related to pathologic TRG (Mandard's criteria; TRG1 = complete regression, TRG5 = no regression). RESULTS: Ten tumors (36%) showed complete or subtotal regression (TRG1-2) at histology and classified as responders; 18 tumors (64%) were classified as non-responders (TRG3-5). Perfusion MRI parameters were significantly higher in the tumor tissue than in the healthy tissue in MR1 (P < 0.05). At baseline (MR1), no significant difference in perfusion parameters was found between responders and non-responders. After chemo-radiation therapy, at MR2, responders showed significantly (P < 0.05) lower perfusion values [RAE (%) 54 ± 20; RVE (%) 73 ± 24; RLE (%): 82 ± 29; ME (%): 904 ± 429] compared to non-responders [RAE (%): 129 ± 45; RVE (%): 154 ± 39; RLE (%): 164 ± 35; ME (%): 1714 ± 427]. Moreover, in responders group perfusion values decreased significantly at MR2 [RAE (%): 54 ± 20; RVE (%): 73 ± 24; RLE (%): 82 ± 29; ME (%): 904 ± 429] compared to the corresponding perfusion values at MR1 [RAE (%): 115 ± 21; RVE (%): 119 ± 21; RLE (%): 111 ± 74; ME (%): 1060 ± 325]; (P < 0.05). Concerning the time-intensity curves, the AUC at MR2 showed significant difference (P = 0.03) between responders and non-responders [AUC (mm2 × 10-3) 121 ± 50 vs 258 ± 86], with lower AUC values of the tumor tissue in responders compared to non-responders. In non-responders, there were no significant differences between perfusion values at MR1 and MR2. CONCLUSION: Dynamic contrast perfusion-MRI analysis represents a complementary diagnostic tool for identifying vascularity characteristics of tumor tissue in local advanced rectal cancer, useful in the assessment of treatment response.

Highlights • Covid-19 lesions manifested as bilateral and subpleural lung opacities (reticular and alveolar). • Lung abnormalities typically involved less than 50% of lung parenchyma. • Chest X ray sensitivity was higher after 5 days of symptoms., Purpose To evaluate the diagnostic accuracy and the imaging features of routine admission chest X-ray in patients suspected for novel Coronavirus 2019 (SARS-CoV-2) infection. Method We retrospectively evaluated clinical and X-ray features in all patients referred to the emergency department for suspected SARS-CoV-2 infection between March 1st and March 13th. A single radiologist with more than 15 years of experience in chest-imaging evaluated the presence and extent of alveolar opacities, reticulations, and/or pleural effusion. The percentage of lung involvement (range 5 days) and according to age (≤ 50 and > 50 years old). Results A total of 518 patients were enrolled. Overall 314 patients had negative and 204 had positive RT-PCR results. Lung lesions in patients with SARS-Cov2 pneumonia primarily manifested as alveolar and interstitial opacities and were mainly bilateral (60.8%). Lung abnormalities were more frequent and more severe by symptom duration and by increasing age. The sensitivity and specificity of chest X-ray at admission in the overall cohort were 57% (95% CI = 47-67) and 89% (83-94), respectively. Sensitivity was higher for patients with symptom onset > 5 days compared to ≤ 5 days (76% [62-87] vs 37% [24-52]) and in patients > 50 years old compared to ≤ 50 years (59% [48-69] vs 47% [23-72]), at the expense of a slightly lower specificity (68% [45-86] and 82% [73-89], respectively). Conclusions Overall chest X-ray sensitivity for SARS-CoV-2 pneumonia was 57%. Sensitivity was higher when symptoms had started more than 5 days before, at the expense of lesser specificity, while slightly higher in older patients in comparison to younger ones.

BackgroundDespite long-standing clinical use of sodium polystyrene sulphonate (SPS) for hyperkalaemia management in chronic kidney disease (CKD), its safety profile remains poorly investigated.MethodsWe undertook an observational analysis of nephrology-referred adults with incident CKD Stage 4+ in Sweden during 2006–16 and with no previous SPS use. We studied patterns of use and adverse events associated to SPS initiation during follow-up. Patterns of SPS use were defined by chronicity of treatment and by prescribed dose. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) associated with SPS initiation (time-varying exposure) for the risk of severe (intestinal ischaemia, thrombosis or ulceration/perforation) and minor (de novo dispensation of laxatives or anti-diarrheal drugs) gastrointestinal (GI) events.ResultsOf 19 530 SPS-naïve patients with CKD, 3690 initiated SPS during follow-up. A total of 59% took SPS chronically, with an average of three dispensations/year. The majority (85%) were prescribed lower dosages than specified on the product label. During follow-up, 202 severe and 1149 minor GI events were recorded. SPS initiation was associated with a higher incidence of severe adverse events [adjusted HR 1.25 95% CI 1.05–1.49)], particularly in those receiving per label doses [1.54 (1.09–2.17)] and mainly attributed to ulcers and perforations. SPS initiation was also associated with higher incidence of minor GI events [adjusted HR 1.11 (95% CI 1.03–1.19)], regardless of dose, and mainly accounted for by de novo dispensation of laxatives.ConclusionsInitiation of SPS in patients with advanced CKD is associated with a higher risk of severe GI complications as well as the initiation of GI-related medications, particularly when prescribed at per label doses.

Organic electrochemical transistors (OECTs) are bioelectronic devices able to bridge electronic and biological domains with especially high amplification and configurational versatility and thus stand out as promising platforms for healthcare applications and portable sensing technologies. Here, we have optimized the synthesis of two pH-sensitive composites of PEDOT (poly(3,4-ethylenedioxythiophene)) doped with pH dyes (BTB and MO, i.e., Bromothymol Blue and Methyl Orange, respectively), showing their ability to successfully convert the pH into an electrical signal. The PEDOT:BTB composite, which exhibited the best performance, was used as the gate electrode to develop an OECT sensor for pH monitoring that can reliably operate in a two-fold transduction mode with super-Nernstian sensitivity. When the OECT transconductance is employed as analytical signal, a sensitivity of 93 ± 8 mV pH unit-1is achieved by successive sampling in aqueous electrolytes. When the detection is carried out by dynamically changing the pH of the same medium, the offset gate voltage of the OECT shifts by (1.1 ± 0.3) × 102mV pH unit-1. As a further step, the optimized configuration was realized on a PET substrate, and the performance of the resulting flexible OECT was assessed in artificial sweat within a medically relevant pH range.

Michel de Certeau in the book “The Practice of Everyday Life” proposes the dimension of creativity as a widespread and multidirectional process, fueled by social dynamics and individual “tactics”, able to evade and transform the sense and the objectives of knowledge and institutional powers. The text sets out some elements of the complex thought of the French scholar, useful to enrich the debate, the language and the visions of contemporary design. In fact nowadays the notions of “invention” and “everyday life” are recurrent in the design discourse, especially with reference to the emergence of a society founded on the diffusion of network technologies, data accumulation, artificial intelligence. “Circumscribe the place” generated by this combination allows us to highlight the creative ability of people “in their social interaction” and the relevance of the socio-cultural and territorial contexts in which daily “inventions” are activated, generated by knowledge and practices that are not formalized. Moreover, the design culture has developed a broad reflection around the often exemplary quality of anonymous objects; it may be interesting to add the point of view of an author who has pointed out that even the anonymous consumer is actually also a designer and producer, capable of expressing invention and innovation in the use and interpretation of things. Today it is evident that the designer’s planning is changing in open and participatory design situations and in the creative processes activated by forms of collective and connective intelligence (Lévy, de Kerkhove, Mulgan, Manzini), especially in relation to some collaborative and systemic experiences developed around the themes of sustainability and able to produce “contextual value”, of which some illustrative readings are proposed.

Storytelling is a particular kind of action because it is made up of words. So it seems to bring together the different principles of doing and knowing. I try to approach storytelling to other performing arts, in particular theater, because I think it is a peculiarity of performing arts to hold together mind and body, praxis and theories, and to overcome old categories and fictional opposition between them. Theater is a meeting between actor and spectator with a language made up of signs and symbols, performed by a body-mind. In this sense performing arts are sweeping and advanced fields in which theoretical and philosophical theories can become wider. The roots of theater are the same as those of religion and rituals. Theater was born as a way to represent the conflict between opposite forces and opposite gods, Apollo and Dionysus, as Nietzsche taught. The birth of theater was involved in the relationship between good and evil, as a way to understand and represent them, in order to tell and to act, this kind of cosmic conflict with performances. In this sense I think theater could preserve an ancient, but still actual, way of social innovation. Theater and its forms, tragedy and comedy, and its deep research in active culture, could help storytellers to deeply penetrate the negative aspects of a social concern, in order to represent it, act it and lay the foundation to draw forth the best part of it.