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According to the socio-constructivist theories of learning, collaborative learning allows negotiation of shared meanings and co-construction of new knowledge among peers. This approach fits particularly well with healthcare professional education needs, as these professionals often face challenging issues that require the ability to fully understand the complexity of the patients' health conditions through working with others. However, while collaborative learning approaches are widely used in face-to-face nurse education contexts, their online equivalent still seem to be understudied, in spite of their great potential for the field. This systematic literature review investigates: (1) to what extent are online collaborative learning activities being adopted and investigated in formal nurse education, (2) What kind of online collaborative learning activities/techniques are proposed and what team structures are employed, (3) what technologies are used to run these learning activities, and (4) what methods are used to evaluate the impact of these activities. Studies were included if they presented online collaborative learning activities proposed by Universities or VET (Vocational Education and Training) providers. Articles published in 2015 or later were collected in November 2022 from Scopus, Web of Science and Medline. A total of 1059 records were retrieved, selected and analysed by four coders, resulting in a final dataset of 75 papers that were coded for type of collaborative approach, study characteristics, research methodology used, strength of evidence, and relevance to the research questions. Most of them described the use of activities like Discussions, Case Studies and Peer Reviews, sometimes in association with Role Play. In terms of technologies, Learning Managements Systems, forums and social media were already common pre-pandemic, but during the lockdown synchronous communication tools -- often used to support simulations -- took over. Data collection was carried out quantitatively, qualitatively or using mixed methods, but in many cases data reporting is weak or absent at all. The majority of the retrieved papers illustrate activities where collaboration was not structured in any way and there was no joint assignment or common objective/artefact that learners needed to reach/produce. In case of blended interventions, often collaboration is limited to the face-to-face sessions, while the digital setting is used for individual work. In terms of social structure, most of the time small groups or plenaries are used. In summary, the review reveals that studies on online collaborative learning for nurses are limited, especially in Europe, and the design of online collaborative activities often clashes with the principles put forward by the Computer Supported Collaborative Learning (CSCL) research community. Based on the results of the review we put forth some key recommendations, such as ensuring that online collaboration involves the creation of a shared artefact and striving to make virtual simulations actually collaborative, rather than limited to envisage student interactions in the debriefing phase. The paper also proposes a number of research areas seldom investigated and that would deserve further attention in the future.

Abstract Background Medial intracranial carotid artery calcifications (ICAC) are associated with impaired vascular physiology, increased arterial stiffness and pulse pressure. Their presence might therefore be associated with increased risk of intracerebral hemorrhage (ICH) expansion, according to the avalanche model. We explored the association between ICAC presence and pattern and hematoma expansion (HE). Methods Retrospective analysis of a monocentric, prospectively collected cohort of ICH patients admitted between June 2017 and October 2023. ICAC pattern was determined by Kockelkoren's rating scale on admission CT; medial ICAC were defined with a >6 points cutoff. A follow‐up CT scan was performed within 72 h. HE was analyzed as a dichotomous (≥6 mL and/or ≥33%) and as a categorical (none/mild/moderate/severe) variable, and its predictors were explored with logistic and ordinal regression respectively, accounting for baseline volume, onset‐to‐CT time, and anticoagulation. All the analyses were stratified by ICH location (supratentorial deep vs lobar ICH). Results A total of 201 patients were included (median age 78, 42% females, 59% deep ICH). Medial ICAC were significantly more common in deep ICH with HE compared with non‐expanders (72% vs 49%, p = 0.03), whereas there was no association between ICAC and HE in lobar ICH (53% vs 52%, p = 0.85). This association between medial ICAC and HE in deep ICH remained significant in logistic (aOR 3.11, 95% CI [1.19–9.06], p = 0.03) and ordinal regression (acOR 2.42, 95% CI [1.19–4.99], p = 0.01). Interpretation Ipsilateral medial ICAC are associated with higher odds of HE in deep ICH. Our findings are best interpreted as hypothesis generating, requiring prospective validation and further research to characterize the underlying biological mechanisms.

Abstract Background Phelan-McDermid syndrome (PMS) is caused by monoallelic loss or inactivation at the SHANK3 gene, located in human chr 22q13.33, and is often associated with Autism Spectrum Disorder (ASD). Objectives To assess the clinical and developmental phenotype in a novel sample of PMS patients, including for the first time auxometric trajectories and serotonin blood levels. Methods 70 Italian PMS patients were clinically characterized by parental report, direct medical observation, and a thorough medical and psychodiagnostic protocol. Serotonin levels were measured in platelet-rich plasma by HPLC. Results Our sample includes 59 (84.3%) cases with chr. 22q13 terminal deletion, 5 (7.1%) disruptive SHANK3 mutations, and 6 (8.6%) ring chromosome 22. Intellectual disability was present in 69 (98.6%) cases, motor coordination disorder in 65 (92.9%), ASD in 20 (28.6%), and lifetime bipolar disorder in 12 (17.1%). Prenatal and postnatal complications were frequent (22.9%-48.6%). Expressive and receptive language were absent in 49 (70.0%) and 19 (27.1%) cases, respectively. Decreased pain sensitivity was reported in 56 (80.0%), hyperactivity in 49 (80.3%), abnormal sleep in 45 (64.3%), congenital dysmorphisms in 35 (58.3%), chronic stool abnormalities and especially constipation in 29 (41.4%). Parents reported noticing behavioral abnormalities during early childhood immediately after an infective episode in 34 (48.6%) patients. Brain MRI anomalies were observed in 53 (79.1%), EEG abnormalities in 16 (23.5%), kidney and upper urinary tract malformations in 18 (28.1%). Two novel phenotypes emerged: (a) a subgroup of 12/44 (27.3%) PMS patients displays smaller head size at enrollment (mean age 11.8 yrs) compared to their first year of neonatal life, documenting a deceleration of head growth (p

Abstract During embryonic and neonatal development, mitochondria have essential effects on metabolic and energetic regulation, shaping cell fate decisions and leading to significant short- and long-term effects on embryonic and offspring health. Therefore, perturbation on mitochondrial function can have a pathological effect on pregnancy. Several shreds of evidence collected in preclinical models revealed that severe mitochondrial dysfunction is incompatible with life or leads to critical developmental defects, highlighting the importance of correct mitochondrial function during embryo-fetal development. The mechanism impairing the correct development is unknown and may include a dysfunctional metabolic switch in differentiating cells due to decreased ATP production or altered apoptotic signalling. Given the central role of mitochondria in embryonic and fetal development, the mitochondrial dysfunction typical of Mitochondrial Diseases (MDs) should, in principle, be detectable during pregnancy. However, little is known about the clinical manifestations of MDs in embryonic and fetal development. In this manuscript, we review preclinical and clinical evidence suggesting that MDs may affect fetal development and highlight the fetal and maternal outcomes that may provide a wake-up call for targeted genetic diagnosis.

Abstract Background Dilated cardiomyopathy (DCM) is an etiologically heterogeneous group of diseases of the myocardium. With the rapid evolution in laboratory investigations, genetic background is increasingly determined including many genes with variable penetrance and expressivity. Biallelic NEXN variants are rare in humans and associated with poor prognosis: fetal and perinatal death or severe DCMs in infants. Case presentation We describe two male infants with prenatal diagnosis of dilated cardiomyopathy with impaired ventricular contractility. One of the patients showed hydrops and polyhydramnios. Postnatally, a DCM with severely reduced systolic function was confirmed and required medical treatment. In patient 1, Whole Exome Sequencing (WES) revealed a homozygous NEXN variant: c.1156dup (p.Met386fs) while in patient 2 a custom Next Generation Sequencing (NGS) panel revealed the homozygous NEXN variant c.1579_1584delp. (Glu527_Glu528del). These NEXN variants have not been previously described. Unlike the unfavorable prognosis described for biallelic NEXN variants, we observed in both our patients a favorable clinical course over time. Conclusion This report might help to broaden the present knowledge regarding NEXN biallelic variants and their clinical expression. It might be worthy to consider the inclusion of the NEXN gene sequencing in the investigation of pediatric patients with DCM.

Cinzia Bragato,1 Andrea Persico,1 Guillem Ferreres,2 Tzanko Tzanov,2 Paride Mantecca1 1POLARIS Research Center, Department of Earth and Environmental Sciences, University of Milano-Bicocca, Milan, 20126, Italy; 2Group of Molecular and Industrial Biotechnology, Universitat Politècnica de Catalunya, Terrassa, 08222, SpainCorrespondence: Cinzia Bragato, Piazza della Scienza 1, Milan, 20126, Italy, Tel +39 0264482928,, Email cinzia.bragato@unimib.itPurpose: Lignin is the most abundant source of aromatic biopolymers and has gained interest in industrial and biomedical applications due to the reported biocompatibility and defense provided against bacterial and fungal pathogens, besides antioxidant and UV-blocking properties. Especially in the form of nanoparticles (NPs), lignin may display also antioxidant and anti-inflammatory activities.Methods: To evaluate these characteristics, sonochemically nano-formulated pristine lignin (LigNPs) and enzymatically-phenolated one (PheLigNPs) were used to expose zebrafish embryos, without chorion, at different concentrations. Furthermore, two different zebrafish inflammation models were generated, by injecting Pseudomonas aeruginosa lipopolysaccharide (LPS) and by provoking a wound injury in the embryo caudal fin. The inflammatory process was investigated in both models by qPCR, analyzing the level of genes as il8, il6, il1β, tnfα, nfkbiaa, nfk2, and ccl34a.4, and by the evaluation of neutrophils recruitment, taking advantage of the Sudan Black staining, in the presence or not of LigNPs and PheLigNPs. Finally, the Wnt/β-catenin pathway, related to tissue regeneration, was investigated at the molecular level in embryos wounded and exposed to NPs.Results: The data obtained demonstrated that the lignin-based NPs showed the capacity to induce a positive response during an inflammatory event, increasing the recruitment of cytokines to accelerate their chemotactic function. Moreover, the LigNPs and PheLigNPs have a role in the resolution of wounds, favoring the regeneration process.Conclusion: In this paper, we used zebrafish embryos within 5 days post fertilization (hpf). Despite being an early-stage exemplary, the zebrafish embryos have proven their potential as predicting models. Further long-term experiments in adults will be needed to explore completely the biomedical capabilities of lignin NPs. The results underlined the safety of both NPs tested paved the way for further evaluations to exploit the anti-inflammatory and pro-healing properties of the lignin nanoparticles examined. Keywords: bio-based nanoparticles, zebrafish embryo, inflammation, LPS, wound

Abstract Background Unhealthy lifestyles represent a key element fueling Non-alcoholic fatty liver disease (NAFLD) onset and worsening. We aimed to evaluate the effects of forced acute lifestyle changes on NAFLD evolution. Methods 187 NAFLD patients were followed two years pre- and two years during the lockdown social restrictions in three Italian medical centers. For each patient, biochemical, clinical, non-invasive liver fibrosis, nutritional, and body composition data were collected. Results An increase in fats and carbohydrate intake associated with impaired weekly physical activity during the lockdown was demonstrated as well as an increase in body mass index and waist-hip-ratio (p

Abstract Background Severe overcrowding of emergency departments (EDs) affects the quality of healthcare. One factor of overcrowding is precariousness, but it has rarely been considered a key factor in designing interventions to improve ED care. Health mediation (HM) aims to facilitate access to rights, prevention, and care for the most vulnerable persons and to raise awareness among healthcare providers about obstacles in accessing healthcare. The primary aim was to determine whether HM intervention for frequent users of EDs (FUED) living in precarious conditions could reduce the readmission rate at 90 days. Methods Between February 2019 and May 2022, we enrolled and interviewed 726 FUED in four EDs of southeastern France in this randomised controlled trial. The HM intervention started in the ED and lasted 90 days. In addition to the primary endpoint (first readmission at 90 days), secondary endpoints (readmission at 30 and 180 days, number of hospitalisations at 30, 90, 180 days, admissions for the same reasons as the first admission) were also studied. The outcomes were measured in the ED information systems. Statistical methods included an intention-to-treat analysis and a per-protocol analysis. Comparisons were adjusted for gender, age, ED, and health mediator. Results 46% of patients reported attending the ED because they felt their life was in danger, and 42% had been referred to the ED by the emergency medical dispatch centre or their GP; 40% of patients were considered to be in a serious condition by ED physicians. The proportion of patients who were readmitted at 90 days was high but did not differ between the control and the HM intervention groups (31.7% vs. 36.3%, p = 0.23). There was no significant difference in any of the secondary outcome measures between the control and HM intervention groups. Per-protocol analysis also showed no significant difference for the primary and secondary endpoints. Conclusions This randomised controlled trial did not show that our health mediation intervention was effective in reducing the use of emergency services by FUED living in precarious conditions. Some limitations are discussed: the duration of the intervention (90 days), the long-term effects (> 6 months), the involvement of the ED staff. Trial registration Registered on clinicaltrials.gov as NCT03660215 on 4th September 2018.

Since the European Green Deal was launched (European Commission, 2019), social media and especially Twitter (now X) has become the one main socio-political virtual space where the European Commission is promoting the European Union’s twinned (Just, Green, and Digital) Transitions. This multidisciplinary exploratory research crosscuts Spatial Planning & Territorial Governance (Nadine et al., 2018; Berisha, et al, 2021), and Social Media Studies and Digital Methods (Rogers, 2018; 2019), investigating the existence of the term “Just Green Transitions” on Twitter, highlighting the potential benefits that social media analysis could add to the disciplines of Governance and Policymaking. Utilizing Social Network Analysis, both Mention Analysis and Co-hashtag- Analysis were applied to capture and analyse three million original tweets over the first twenty months since the Just Transition Mechanism entered into force (European Parliament, 2021). The results highlighted the fragmentation of the terminologies and Twitter user communities, discussing the expected transitions of Europe which are expected to be Just and Green (European Commission, 2021).

Il saggio vuole riflettere sul rapporto tra la simulazione e il cinema, ragionando sul genere storico. L’obiettivo è da un lato dimostrare come il cinema lavori con la Storia attraverso un processo di simulazione complessa dell’evento rappresentato, e dall’altro come l’implementazione stessa della messa in scena del cinema storico implichi la perdita della Storia vera e propria, sostituita dal suo simulacro. Vengono presi in esame due importanti biopic incentrati sulla figura di Napoleone, il capolavoro impressionista di Abel Gance e lo spettacolare film hollywoodiano di Ridley Scott.