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10. The Role of Metaphor in Serious Games Design: the BubbleMumble Case Study

Author

Allegra, Mario, Bongiovanni, Antonella, Città, Giuseppe, Cusimano, Antonella, Dal Grande, Valentina, Gentile, Manuel, Kisslinger, Annamaria, La Guardia, Dario, Liguori, Giovanna, Lo Presti, Fabrizio, Perna, Salvatore, Picciotto, Sabrina, Ottaviano, Simona, Sala, Carla, Signa, Alessandro, Goos, Gerhard, Founding Editor, Hartmanis, Juris, Founding Editor, Bertino, Elisa, Editorial Board Member, Gao, Wen, Editorial Board Member, Steffen, Bernhard, Editorial Board Member, Woeginger, Gerhard, Editorial Board Member, Yung, Moti, Editorial Board Member, de Rosa, Francesca, editor, Marfisi Schottman, Iza, editor, Baalsrud Hauge, Jannicke, editor, Bellotti, Francesco, editor, Dondio, Pierpaolo, editor, and Romero, Margarida, editor

Published
2021
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14. Myocardial Mechanics in Acromegaly: A Meta-Analysis of Echocardiographic Studies

Author

Gherbesi, E, Faggiano, A, Sala, C, Carugo, S, Grassi, G, Cuspidi, C, Tadic, M, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Carugo, Stefano, Grassi, Guido, Cuspidi, Cesare, Tadic, Marijana, Gherbesi, E, Faggiano, A, Sala, C, Carugo, S, Grassi, G, Cuspidi, C, Tadic, M, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Carugo, Stefano, Grassi, Guido, Cuspidi, Cesare, and Tadic, Marijana

Abstract

Introduction: Evidence on myocardial deformation, detected by speckle tracking echocardiography (STE), in patients with acromegaly is scanty. Aim: The aim of the present meta-analysis was to provide an updated information on left ventricular (LV) systolic function assessed by global longitudinal strain (GLS) in patients with acromegaly and preserved LVEF. Methods: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to June 30-2024. Clinical studies published in English reporting data on LV mechanics in patients with acromegaly and controls were included. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and global longitudinal strain (GLS) was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) by using random-effects models. Results: Seven studies including 288 patients with acromegaly and 294 healthy individuals were considered for the analysis. Pooled average LVEF values were 64.6 ± 1.5% in the healthy control group and 64.0 ± 1.3% in the acromegaly group (SMD: - 0.21 ± 0.22, CI -0.62/0.22, p = 0.34); the corresponding values of GLS were - 19.1.1 ± 1.2% and - 17.5 ± 1.2% (SMD: -0.52 ± 0.27, CI - 1.05/0.01, p = 0.05). No difference was found between the two groups for both global circumferential strain (GCS) and global radial strain (GRS). Conclusions: Our findings suggest that patients with acromegaly in which LVEF is completely comparable to healthy controls show an impairment in GLS of borderline statistical significance. Whether GLS assessment can actually unmask early alterations of systolic function in patients with acromegaly better than LVEF will need to be investigated by future studies.

Published
2024

15. Myocardial mechanics in anorexia nervosa: a systematic review and meta-analysis of speckle tracking echocardiographic studies

Author

Gherbesi, E, Faggiano, A, Sala, C, Carugo, S, Grassi, G, Cuspidi, C, Tadic, M, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Carugo, Stefano, Grassi, Guido, Cuspidi, Cesare, Tadic, Marijana, Gherbesi, E, Faggiano, A, Sala, C, Carugo, S, Grassi, G, Cuspidi, C, Tadic, M, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Carugo, Stefano, Grassi, Guido, Cuspidi, Cesare, and Tadic, Marijana

Abstract

Background: Clinical complications of anorexia nervosa (AN) include cardiac structural and functional alterations. Available evidence on impaired myocardial deformation in AN patients without overt systolic dysfunction as assessed by left ventricular ejection fraction (LVEF) is scanty and based on a few studies. The aim of the present meta-analysis was to provide comprehensive and updated information on this issue. Methods: Following the PRISMA guidelines, systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) to identify eligible studies from inception up to 31 January 2024. Searches were limited to clinical investigations published in English reporting data on left ventricular (LV) mechanics (i.e. global longitudinal strain) in patients with anorexia and controls. The statistical difference of the echocardiographic variables of interest between groups such as LVEF and global longitudinal strain (GLS) was calculated by standardized mean difference (SMD) with 95% confidence interval (CI) by using random-effects models. Results: Five studies including 171 AN and 147 healthy normal-weight individuals were considered for the analysis. Pooled average LVEF values were 63.2 ± 0.4% in the healthy control group and 64.6 ± 1.0% in the AN group (SMD -0.08 ± 0.11, CI: -0.15/0.30, P = 0.51); the corresponding values of GLS were -20.1 ± 0.9% and -20.2 ± 0.9% (SMD 0.07 ± 0.3, CI: -0.46/0.60, P = 0.80). Unlike GLS, apical strain (data from three studies) was higher in AN than in controls (-23.1 ± 1.8 vs. -21.3 ± 1.8; SMD: -0.42 ± 0.17, CI: -0.08/-0.76, P = 0.01). Conclusions: The results of the present meta-analysis do not support the view that myocardial deformation as assessed by GLS is impaired in patients with AN and preserved LVEF. The role of STE in detecting subclinical cardiac damage in this clinical condition deserves to be evaluated in future studies including regional LV strain.

Published
2024

21. Nocturnal Hypertension

Author

Cuspidi, Cesare, Sala, Carla, Tadic, Marijana, Grassi, Guido, Mancia, Giuseppe, Series editor, Agabiti Rosei, Enrico, Series editor, and Berbari, Adel E., editor

Published
2018
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24. Learning cross-functionality and the power of identity : a case study of an Italian automotive organization

Author

Sala, Carla

Subjects
658, HD Industries. Land use. Labor
Abstract

This thesis discusses the relationship between identity and learning in cross-functional teams (CFTs). It focuses on how aspects of members’ identity affect the process of developing cross-functional (CF) teamwork and examines how emerging identity issues can account for different outcomes in the learning of CF teamwork. More specifically, the research focuses on what these emerging identity issues entail in terms of underlying and action-orienting meanings, and on how this can favour or hinder the learning of CF teamwork. This study argues that the collective process of learning how to operate as a CFT is influenced by relational, social and contextual issues. Theoretically, the thesis offers a number of contributions. A critique of current approaches to CF teamwork is provided, where a review of the relevant literature reveals a largely functionalist stance, with a main focus on researching the factors contributing to the effectiveness of CFTs. The thesis advocates an alternative interpretative stance to investigating the role of identity in learning cross-functionality, offering the possibility of an interpretation which is situated in the specific context and which is open to the understanding of emerging, possibly revealing issues. Furthermore, this thesis argues that, within this interpretative approach, by studying what favours or hinders the learning of CF teamwork, it may be possible to deepen our understanding of CFT dynamics. The learning of CF teaming has also been identified as one of the gaps in the relevant literature. The situated learning theory (SLT) and community of practice approach (Lave and Wenger, 1991) is thus adopted as an appropriate theoretical framework for researching the learning of CF teamwork, which is understood here as a practice. SLT suggests that individual learning should be thought of as emergent, involving opportunities to participate in the practices of the community as well as the development of a social identity which provides a sense of belonging and commitment (Lave and Wenger, 1991; Wenger, 1998). Theoretically and empirically justified, the new insight and main focus of this research consists of the consideration of events occurring not only within a CFT, but also beyond and before it, which are able to shape the identities involved, at different levels. This is beneficial, since it explains the different ways of engaging with the practice of cross-functionality and consequently the different learning outcomes. Within the situated learning literature there is surprisingly little explicit reference to theories of identity construction (Handley et al., 2006). A conceptualization of identity is thus derived by tapping into theories of identity which have not yet been developed in SLT, but which represent a useful theoretical development in this arena of studies. These gaps and issues were addressed by conducting qualitative research in a medium-sized Italian firm manufacturing car parts. In particular, an ethnographic study was carried out, using complementary methods such as direct observation, semi-structured interviews and documentary data. Investigations concerned two skilled workers’ CFTs devoted to developing the product ranges respectively of joints and pumps, and a managers’ CFT whose task was to design a new pump for a particular client. Three identities emerged as especially significant for the meanings they entailed and for the influence they proved to have on learning this practice: the sense of identity derived from relationships characterized by paternalism with significant others at work (i.e. the leaders), and the sense of identity derived from being a worker from Brescia, the specific geographical location of the study, and from being a worker or a manager, understood in terms of occupation and social class.

Published
2013

30. Targeting Hypertensive Response to Exercise and the Association of Masked Hypertension With Subclinical Organ Damage: A Mini-Review and Meta-Analysis.

Author

Cuspidi, Cesare, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Grassi, Guido, Carugo, Stefano, and Tadic, Marijana

Subjects
LEFT ventricular hypertrophy, HEART function tests, BLOOD pressure, PULSE wave analysis, HYPERTENSION
Abstract

BACKGROUND Emerging evidence suggests that a hypertensive response to exercise (HRE) during dynamic or isometric stress tests assessing cardiac function is predictive of hypertension and cardiovascular events such coronary artery disease, heart failure and stroke. Whether HRE represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. This is also the case for the association between MH and hypertension-mediated organ damage (HMOD) in the HRE setting. METHODS We addressed this issue through a review and a meta-analysis of studies providing data on this topic in normotensive individuals undergone both to dynamic or static exercise and to 24-h blood pressure monitoring (ABPM). A systematic search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception up to February 28th 2023. RESULTS Six studies including a total of 1,155 untreated clinically normotensive individuals were considered for the review. Data provided by the selected studies can be summarized as follows: (i) HRE is a BP phenotype linked to a high prevalence of MH (27.3% in the pooled population); (ii) MH is, in turn, associated with a greater, consistent likelihood of echocardiographic left ventricular hypertrophy (OR: 4.93, CI: 2.16–12.2, P  < 0.0001) and vascular organ damage, as assessed by pulse wave velocity, (SMD: 0.34 ± 0.11, CI: 0.12–0.56, P  = 0002). CONCLUSIONS On the basis of this, albeit limited, evidence, the diagnostic work-up in individuals with HRE should primarily be addressed to look for MH as well as for markers of HMOD, a highly prevalent alteration in MH. [ABSTRACT FROM AUTHOR]

Published
2024
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39. Masked Hypertension and Exaggerated Blood Pressure Response to Exercise: A Review and Meta-Analysis

Author

Cuspidi, C, Gherbesi, E, Faggiano, A, Sala, C, Carugo, S, Grassi, G, Tadic, M, Cuspidi, Cesare, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Carugo, Stefano, Grassi, Guido, Tadic, Marijana, Cuspidi, C, Gherbesi, E, Faggiano, A, Sala, C, Carugo, S, Grassi, G, Tadic, M, Cuspidi, Cesare, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Carugo, Stefano, Grassi, Guido, and Tadic, Marijana

Abstract

Aim: Whether exaggerated blood pressure response (EBPR) to exercise represents a marker of masked hypertension (MH) in individuals with no prior history of hypertension is still unclear. We investigated this issue through a review and a meta-analysis of studies providing data on this association in normotensive individuals undergone both to dynamic or static exercise and to 24 h blood pressure monitoring (ABPM). Design: A systematic search was performed using Pub-Med, OVID, EMBASE, and Cochrane library databases from inception up to 31 December 2022. Studies were identified by using the following search terms: “masked hypertension”, “out-of-office hypertension”, “exercise blood pressure”, “exaggerated blood pressure exercise”, “exercise hypertension”. Results: Nine studies including a total of 387 participants with MH and 406 true normotensive controls were considered. Systolic BP (SBP) and diastolic BP (DBP) at rest were significantly higher in MH individuals than in sustained normotensives: 126.4 ± 1.4/78.5 ± 1.8 versus 124.0 ± 1.4/76.3 ± 1.3 mmHg (SMD: 0.21 ± 0.08, CI: 0.06–0.37, p = 0.007 for SBP; 0.24 ± 0.07, CI: 0.08–0.39, p = 0.002 for DBP). The same was true for BP values at peak exercise: 190.0 ± 9.5/96.8 ± 3.7 versus 173.3 ± 11.0/88.5 ± 1.8 mmHg (SMD 1.02 ± 0.32, CI: 0.39–1.65, p = 0.002 for SBP and 0.97 ± 0.25, CI: 0.47–1.96, p < 0.0001 for DBP). The likelihood of having an EBPR was significantly greater in MH than in their normotensive counterparts (OR: 3.33, CI: 1.83–6.03, p < 0.0001). Conclusions: Our meta-analysis suggests that EBPR reflects an increased risk of MH and that BP measurement during physical exercise aimed to assess cardiovascular health may unmask the presence of MH. This underscores the importance of BP measured in the medical setting at rest and in dynamic conditions in order to identify individuals at high cardiovascular risk due to unrecognized hypertension.

Published
2023

40. Unmasking left ventricular systolic dysfunction in masked hypertension: looking at myocardial strain. A review and meta-analysis

Author

Cuspidi, C, Gherbesi, E, Faggiano, A, Sala, C, Grassi, G, Tadic, M, Cuspidi, Cesare, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Grassi, Guido, Tadic, Marijana, Cuspidi, C, Gherbesi, E, Faggiano, A, Sala, C, Grassi, G, Tadic, M, Cuspidi, Cesare, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Grassi, Guido, and Tadic, Marijana

Abstract

Background and Aim: A growing body of evidence supports the view that masked hypertension (MH) (i.e. normal office and elevated out-of-office BP) is a blood pressure (BP) phenotype associated with increased risk of subclinical organ damage, cardiovascular disease and death as compared to true normotension. Whether left ventricular (LV) systolic function is impaired in individuals with MH is still a poorly defined topic. Therefore, we aimed to provide a new piece of information on LV systolic dysfunction in the untreated MH setting, focusing on speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of systolic function than conventional LV ejection fraction (LVEF). Methods: A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception until June 30, 2022. Full articles reporting data on LV GLS in MH, as assessed by ambulatory BP monitoring (ABPM), and normotensive controls were considered suitable for the purposes of review and meta-analysis. Results: A total of 329 untreated individuals with MH and 376 normotensive controls were included in six studies. While pooled average LVEF was not different between groups [64.5 ± 1.5 and 64.5 ± 1.3%, respectively, standard means difference (SMD): -0.002 ± 0.08, confidence interval (CI): 0.15/-0.15, P = 0.98), LV GLS was worse in MH patients than in normotensive counterparts (-18.5 ± 0.70 vs. -20.0 ± 0.34%, SMD: 0.68 ± 0.28, CI: 0.12/1.24, P < 0.01). Conclusions: Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the MH setting can be unmasked by STE and that its implementation of STE in current practice may improve the detection of subclinical organ damage of adverse prognostic significance.

Published
2023

49. Unmasking left ventricular systolic dysfunction in masked hypertension: looking at myocardial strain. A review and meta-analysis

Author

Cuspidi, Cesare, Gherbesi, Elisa, Faggiano, Andrea, Sala, Carla, Grassi, Guido, Tadic, Marijana, Cuspidi, C, Gherbesi, E, Faggiano, A, Sala, C, Grassi, G, and Tadic, M

Subjects
left ventricular global longitudinal strain, systolic function, Physiology, Internal Medicine, left ventricular ejection fraction, masked hypertension, Cardiology and Cardiovascular Medicine
Abstract

Background and Aim: A growing body of evidence supports the view that masked hypertension (MH) (i.e. normal office and elevated out-of-office BP) is a blood pressure (BP) phenotype associated with increased risk of subclinical organ damage, cardiovascular disease and death as compared to true normotension. Whether left ventricular (LV) systolic function is impaired in individuals with MH is still a poorly defined topic. Therefore, we aimed to provide a new piece of information on LV systolic dysfunction in the untreated MH setting, focusing on speckle tracking echocardiography (STE) studies investigating LV global longitudinal strain (GLS), a more sensitive index of systolic function than conventional LV ejection fraction (LVEF). Methods: A computerized search was performed using Pub-Med, OVID, EMBASE and Cochrane library databases from inception until June 30, 2022. Full articles reporting data on LV GLS in MH, as assessed by ambulatory BP monitoring (ABPM), and normotensive controls were considered suitable for the purposes of review and meta-analysis. Results: A total of 329 untreated individuals with MH and 376 normotensive controls were included in six studies. While pooled average LVEF was not different between groups [64.5 ± 1.5 and 64.5 ± 1.3%, respectively, standard means difference (SMD): -0.002 ± 0.08, confidence interval (CI): 0.15/-0.15, P = 0.98), LV GLS was worse in MH patients than in normotensive counterparts (-18.5 ± 0.70 vs. -20.0 ± 0.34%, SMD: 0.68 ± 0.28, CI: 0.12/1.24, P < 0.01). Conclusions: Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the MH setting can be unmasked by STE and that its implementation of STE in current practice may improve the detection of subclinical organ damage of adverse prognostic significance.

Published
2022

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