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Doubled Embodiment and the Temporal Experience of Illness in Comics
No full textThis contribution considers the centrality of pictorial embodiment in autobiographical comics. It begins by tracing pictorial embodiment’s connection to othering and then examines the popular practice of doubled embodiment in graphic illness narrative. Expanding upon theorizations of doubled embodiment as manifesting subjective experiences of illness, several examples will serve to trace how double embodiment in graphic illness narratives speaks to the ill subject’s personal experience of time. Ultimately, this contribution proposes that double embodiment can indicate how, in illness, time intersects with considerations of minds and emotional states. In the works of graphic illness studied below, doubles address how an ill life is often one “marked not by progress but by recurrence, repetition, and ellipses” (41), as comic critic Jared Gardner claims in relation to his own chronic illness
Stratigraphy of the Walk and Post-anthropocentric Narratives: The Case of Antonio Moresco
No full textDrawing on material ecocriticism, new materialism and eco-narratology, this article proposes an analysis of the narrative structure of the novel Gli increati by Antonio Moresco as a case of “Anthropocene storytelling”. Specifically, I consider the practice of walking as a prompt for the novel complex temporal and spatial dimensions. My discussion situates within a broader reflection on the recent challenges posed by the concept of the Anthropocene to traditional modern epistemologies, based on conceptual dichotomies and linearity. I propose that the novel serves as an example of a narrative organised not by the principle of causality, but by what I call “stratigraphic logic”
Review of Pierluigi Pellini, Tre grandi critici. Luigi Blasucci, Remo Ceserani, Francesco Orlando (Siké, 2023)
No full textReview of Pierliugi Pellini, Tre grandi critici. Luigi Blasucci, Remo Ceserani, Francesco Orlando. Siké, 2023.Rencesione di Pierliugi Pellini, Tre grandi critici. Luigi Blasucci, Remo Ceserani, Francesco Orlando. Siké, 2023
Czech Structuralists on Rhythm in Epic Literature
No full textCzech structuralism is closely linked to the Prague Linguistic Circle (or Prague School), but it also developed independently of this institution during the 20th century. The theoretical and methodological legacy of Czech structuralism can be studied regarding the way in which some Czech scholars dealt with the issue of rhythm in epic literature. This study aims to briefly introduce and summarize the most important contributions of Czech structuralists to this issue. The study focuses on the ideas of Vilém Mathesius, Jan Mukařovský, Felix Vodička, Miroslav Červenka and Milan Jankovič. The core of the study is an outline of the conception of Jan Mukařovský, who in his university lectures attempted to develop a systematic plan for narrative research. The paper concludes with a summary of the main approaches of Czech structuralists to rhythm in epic literature and a reflection on the influence of new terms and concepts introduced by M. Červenka and M. Jankovič (e.g. rhythmic focus, rhythmic vocabulary, stream, etc.) on the further development of this issue
Energy Spent in Orientation: Yuri Tynianov’s Motor-Forces Approach to Rhythm
No full textThis article presents some synthetic reflections on the notion of rhythm developed in Yuri Tynianov’s The Problem of Verse Language (1924), with particular attention to the relationship between the conception of the work unity and its peculiar space-time configuration, the status of flow and energy, the role of reception, and the copresence of the motoric and the phenomenological approaches.This article presents some synthetic reflections on the notion of rhythm developed in Yuri Tynianov’s The Problem of Verse Language (1924), with particular attention to the relationship between the conception of the work unity and its peculiar space-time configuration, the status of flow and energy, the role of reception, and the copresence of the motoric and the phenomenological approaches
Il ruolo della health literacy nella patient experience pediatrica
Get PDFL\u27attenzione alla patient experience in pediatria, tenendo conto della health literacy di adolescenti e genitori in particolare, può fornire importanti spunti per migliorare la qualità delle cure e dei servizi sanitari. Questo approccio consente di personalizzare interventi informativi, educativi e assistenziali favorendo una partecipazione efficace dei giovani pazienti e delle loro famiglie al processo di assistenza, migliorando così la loro esperienza complessiva.
Focusing on the patient experience in pediatrics, considering adolescents\u27 health literacy and parents\u27 particular can provide essential insights for improving the quality of care and health services. This approach makes it possible to tailor information, education, and care interventions by promoting the effective participation of young patients and their families in the care process, thus improving their overall experience
QUADAS-3: Updated Tool to Evaluate Risk of Bias and Applicability Concerns in Diagnostic Test Accuracy Studies
No full textIntroduction: The QUADAS‐2 tool, published in 2011, was designed to evaluate the risk of bias and applicability of diagnostic test accuracy (DTA) studies. The publication reporting QUADAS-2 has been cited over 12, 000 times and it is the recommended tool to assess risk of bias and applicability of studies for major HTA organizations. Although feedback on QUADAS-2 has generally been positive, some signaling questions have been identified as problematic and the tool could be improved based on features included in more recently developed tools.
Objectives: To update QUADAS-2 to develop the new QUADAS-3 tool.
Methods: We established a core-group of methodological experts to lead the development of the QUADAS-3 tool supported by a wider steering group.
We followed the following steps:
Summarised modifications made to QUADAS-2 for the Cochrane Handbook
Web-based survey of reviewers that have used QUADAS-2
Considered developments from more recent tools in terms of tool structure and implementation
Undertook a review of methodological studies that had evaluated QUADAS-2
Undertook a review of 50 Cochrane DTA reviews to highlight challenges with the assessment of applicability
We have produced a draft tool which has undergone piloting. The results of the piloting, which also included a comparison of the use of signalling questions with signalling statements, was used to inform the final version of the tool.
Results
The new tool follows a similar structure to the QUADAS-2 tool but with some major updates. Key changes include:
An option to define separate synthesis questions rather than just a single review question
A new section on defining the ideal test accuracy trial for each synthesis question
Assessment of risk of bias and applicability at the accuracy estimate level rather than the study level
A change in answers to signaling questions to include options of “probably yes” and “probably no” and to replace “unclear” with “no information”
Replacement of “Flow and Timing domain” with new “Analysis” domain
Changes to some signaling questions
Inclusion of a section for judging overall risk of bias and applicability (across domains)
Conclusions: The QUADAS-3 tool incorporates several changes compared to the previous version (QUADAS-2) which we hope will improve its validity, usability, and usefulness. QUADAS-3 will be introduced at the conference and the results of piloting discussed
Cangrelor in Patients with Percutaneous Coronary Intervention (PCI) After out-of-Hospital Cardiac Arrest (OHCA): A Propensity Score Matchig Analysis
No full textIntroduction: Propensity Score Matching (PSM) is used in observational studies to measure the effect of a treatment by removing the bias of confounders, as randomisation is not possible. A multivariable logistic regression is performed to estimate the association of previously selected variables with the treatment administration, whilst the coefficients estimated from this regression are used to calculate a predicted probability of each patient receiving the treatment. Each patient in the treatment group is then matched to one or more patients in the untreated group based on the PS [1]. There are several ways to check whether PSM is successful or not: the two groups can be compared to confirm that there are no significant differences in covariate characteristics or the distribution graph of PS in both groups can be compared to ensure that they are similar. Once PSM is performed, unmatched patients are removed and analysis can be performed to test the treatment effect [1][2]. Out of Hospital Cardiac Arrest (OHCA) is defined as a sudden cessation of cardiac function with loss of consciousness and circulation occurred in out of hospital setting and acute coronary syndrome is the most common cause of OHCA. Emergent invasive coronary angiography (ICA) and percutaneous coronary intervention (PCI) has been shown to improve outcome in patients with ACS. Survivors of OHCA undergoing PCI are at higher risk of thrombotic and bleeding complications and cangrelor use has been shown to induce a faster, higher and more sustained inhibition of platelet aggregation function compared to all three P2Y12-inhibitors [3]. However, few data are available regarding OHCA victims.
Aim: The aim of this work is to apply PSM based analysis to investigate survival at hospital discharge of cangrelor use in OHCA survivors undergoing PCI.
Methods: This is a multicentric, prospective, observational study involving all OHCA patients enrolled in the LombardiaCARe Registry from January 1, 2015, to December 31, 2022, who underwent PCI in seven centers in Lombardy region, Italy. Categorical variables were described as number and percentage and compared with the chi-squared test or Fisher exact test depending on the expected frequencies. Continuous variables were described as mean ± standard deviation and compared with the t-test or described as median and interquartile range (IQR) and compared with the Mann-Whitney test and according to their normal distribution tested with Shapiro Wilk test. All the variables that differed significantly between patients treated with cangrelor and patients in whom cangrelor was not administered were included in a multivariable logistic model for cangrelor administration. Model goodness of fit was assessed with Pearson test. The Area under the ROC Curve (AUC) was also computed. From the resulting coefficients PS was calculated. Patients were randomly matched according to the PS to generate random samples. The number of needed samples was established according to the convergence of the median chi-squared. The goodness of PSM was evaluated in term of balance of the baseline characteristics comparing the propensity distribution graph in the unmatched population and matched population and Kolmogorov-Smirnov test [2]. For each sample, considering only matched patients, chi-squared test and logistic regression were performed to test the association between cangrelor administration and patient in-hospital survival. The median chi-squared test and the overall odds ratio (OR) derived from each sample were taken into account to confirm the association between cangrelor administration and survival at discharge. Statistical analyses were performed with STATA 17. A two-sided p-value of < 0.05 was considered statistically significant.
Results: A total of 612 patients were admitted to the seven centres after OHCA and 414 (67.4%) underwent PCI. Among those patients 34 (8.2%) were treated with cangrelor. In the cangrelor group, 82.4% of patients were alive at discharge, compared to 65.3% in the no-cangrelor group (chi-square: 4.1; p-value: 0.04). A multivariable logistic regression model for the probability of receiving cangrelor was performed with all the significantly different variables between cangrelor and no-cangrelor group. (p-value: 0.001; PseudoR2: 0.2; AUC: 0.8). The model showed a good goodness of fit (Pearson chi2: 128.7; p-value: 0.8). Patients were randomly matched 25 times according to the PS to generate 25 random samples with 20 patients per each group, as indicated by the convergence of the median chi-squared (fig.1.a). Figure 1a demonstrates how the median Chi2s and ORs resulted from the Chi2 test and logistic regression for survival at discharge converge after 25 repetitions of PSM. The propensity distribution graph and Kolmogorov-Smirnov test showed a good PSM (p-value>0.05) in all 25 samples. The resulting ORs from the 25 samples with their 95% confidence interval are plotted in Figure 1b which shows that in all samples OR was OR>1 and an overall OR of 2.1 (95% CI 1.2-3.0) of survival at discharge, confirming the association between cangrelor administration and survival at discharge.
Conclusion: The multivariable logistic model for the association with cangrelor administration showed a good AUC and a good goodness of fit. The low number of patients treated with cangrelor prompted us to perform a random PSM to generate 25 random samples. The PSM was able to balance the baseline characteristics, making the two groups comparable. Moreover, repeating the PSM could help to achieve significant results in case of low numbers of patients and to overcome the limitation of PSM that leads to a reduction of the number of patients that can be included in the analysis due to the matching itself
Data Harmonization of Psychosocial Questionnaires across Population Cohorts: A Differential Item Functioning Analysis
No full textIntroduction
Data harmonization is the process of achieving comparability of similar measures collected by separate cohorts by aligning their definitions and measurement formats [1]. In epidemiologic research, and in particular in predictive modelling for chronic noncommunicable diseases, it may facilitate the identification of derivation and external validation cohorts [2]. This process may be particularly challenging when psychosocial variables are amongst the predictors of interest, as different self-report questionnaires measuring the same psychosocial variable might capture different aspects, and even small differences in item wording affect responses [3]. Therefore, measurement invariance; i.e.; whether respondents from different populations (e.g.; at different time periods, or different cultures) with the same latent trait (e.g. depression) level respond similarly, should be preliminarily established to avoid bias in subsequent analyses [4]. Currently, there is little guidance on how to assess this property for data harmonization purposes. A promising framework is Item Response Theory (IRT), a probabilistic approach for modelling the relationship between a latent trait and observed item responses [5].
We designed an international project pooling Italian and German cohorts with recruitment time spanning over a 10-year period, with the aim to identify a restricted set of psychosocial items able to increase the predictive power of established risk prediction models for Cardiovascular Diseases (CVD). Here, we leverage IRT to assess Differential Item Functioning (DIF) in harmonised items, thereby testing whether item characteristics are invariant across the Italian cohorts.
Aims
To harmonise two questionnaires used in different cohorts to assess depressive symptoms and to evaluate the measurement invariance of the harmonised items across cohorts.
Methods
The MONICA Brianza study includes three independent cohorts recruited from the Brianza population, Lombardy region, over a 10-year period (MONICA87: 1986–1987; MONICA90: 1989–1990; MONICA93: 1993–1994). Each cohort includes a 10-year age- and gender-stratified random sample of the target 25- to 64-years old population. Overall, 4932 individuals participated to the study (69% of invited). Depressive symptoms were measured in the MONICA87 cohort using the Beck Depression Inventory (BDI) [6], a 22-item instrument with a 0 (absence of symptom) to 4 (severe symptom) response format, and in the MONICA90-93 cohorts using a 14-item version of the Maastricht Vital Exhaustion Questionnaire (EX) [7], coded on a scale of 0 (“No”) – 1 (“Not sure”) – 2 (“Yes”).
Protocol steps for data harmonization and analysis
We developed an a priori protocol for data harmonization based on the following steps. First, the content of the BDI and EX items were analysed to select item pairs measuring the same depressive symptoms. Second, for each item pair, the response format was dichotomised ensuring that the collapsed response categories have the most similar possible frequencies of endorsement across cohorts. Third, the resulting scale was analysed through a unidimensional Confirmatory Factor Analysis and, in case of departures from unidimensionality, a minimum residual exploratory factor analysis (EFA) to identify subscales. Fourth, a 2-parameter logistic IRT model was fitted on the resulting subscales to estimate for each item a discrimination parameter (ability to differentiate between individuals with close levels of the latent trait), and a difficulty parameter (level of the latent trait at which the item has a 50% probability of endorsement). Item fit was evaluated through S-X2 statistics [8]. Finally, DIF analyses were conducted to evaluate whether item parameters were invariant across cohorts through Likelihood ratio tests comparing nested models with increasing equality constraints on discrimination and difficulty parameters.
Results
525 individuals in the MONICA87 and 48 individuals in the MONICA90-93 cohorts were excluded due to unavailability of the questionnaires at baseline date. The final sample (51% female, mean age ±SD: 45.9±11.3) included 1134 subjects from MONICA87 and 3225 from MONICA90-93.
The item content analysis led to the selection of 10 item pairs, which were used to form a harmonised scale of depressive symptoms (Dep). One item pair was discarded due to overlap with another item pair, both assessing sleep disturbance (tetrachoric correlation: 0.78). Standard fit indices from the CFA suggested departures from unidimensionality. EFA identified two latent variables, one underpinning a “Neurovegetative and arousal disturbance” subscale (4 items; e.g., sleep problems; loss of energy), and one an “Affective and cognitive disturbance” subscale (5 items; e.g., suicidal thoughts). Both subscales met the assumptions for the IRT model and all items showed adequate model fit. DIF analysis (Figure 1) confirmed measurement invariance for six items (e.g.; Dep03, panel A). Items Dep02 (panel B) and Dep05 (panel C) exhibited different discrimination and difficulty parameters across cohorts, suggesting non-uniform DIF. Finally, the different difficulty parameters for Dep10 (panel D), indicating uniform DIF, suggests that people from different cohorts with the same latent trait have different probability to endorse the item.
Conclusions
The harmonization of two depression questionnaires identified 6 items with measurement invariance and revealed DIF in items that could have biased subsequent analyses if undetected. In epidemiological research, measurement invariance of psychosocial questionnaires should be thoroughly checked using comprehensive methods. Analysis of DIF within an IRT framework offers a promising approach, and can be further evaluated for cross-cultural evaluations
Sleep Disorders, Smartphone Use and Mental Health: A Cross-Sectional Study on a Sample of Students from the University of Palermo – MORPHEO
No full textIntroduction
Sleep disorders constitute a significant public health concern recognized by the World Health Organization (WHO) in the ICD (International Classification of Diseases), with notable implications for young populations. Research demonstrates that disrupted sleep patterns significantly impair mental recovery processes and emotional stability [1]. Poor sleep quality contributes to mental health deterioration through disruption of emotional regulation and neurobiological mechanisms. Inadequate sleep compromises hypothalamic-pituitary-adrenal axis function, increasing cortisol production and stress perception, potentially leading to depressive symptoms [2]. Young adults represent the population stratum with the highest smartphone and electronic device usage rates, sometimes developing behavioural dependencies. Studies show that light exposure to these devices before falling asleep significantly disrupts sleep quality [3]. Moreover, excessive smartphone use is associated with reduced cognitive performance, negatively affecting work efficiency and academic achievement [4].
This study investigates the interactions between sleep disorders, mental health, electronic device usage, and academic performance among university students. We specifically examine how sleep quality and quantity influence students\u27 psychological functioning, with particular attention to psychological distress.
Methods
The Pittsburgh Sleep Quality Index (PSQI) [5], the Kessler Psychological Distress Scale (K10) [6] and the Smartphone Application-Based Addiction Scale (SABAS) [7] were used to assess sleep quality, mental distress and problematic smartphone use, respectively. Descriptive statistics were expressed as Mean (SD), for continuous variables, and as count/percentages for categorical variables. “Good sleepers” and “Poor sleepers” were compared using Chi-square test or Fisher\u27s exact test for categorical variables, and Student\u27s t-test or the Wilcoxon-Mann-Whitney test for continuous variables, with significance at P < 0.05. Logistic regression identified independent predictors of poor sleep quality (PSQI > 5). Variables with significant univariate association (p < 0.05) were included in the multivariate model, with results expressed as odds ratios (OR) with 95% confidence intervals (95% CI).
Results
This cross-sectional study involved 208 students from the University of Palermo, with 58.7% (n=122) enrolled in medical degree programs. The average age of the sample was 22±1.99 years, and 71.6% were female.
The analysis revealed that 61.54% (n=128) of students had inadequate sleep quality. Univariate analysis showed that their exam completion rate (80.1%) was lower than that one reported for good sleepers (83.5%) (p < 0.05). On average, daily smartphone use was higher among poor sleepers (6.46±3.03 vs 5.57±2.22 hour/day, p < 0.05), and a significant association was found between poor sleep quality and the risk of problematic smartphone use (OR=2.83, 95%CI [ 1.27-7.00], p < 0.05). Furthermore, results from K10 revealed that reporting severe psychological distress was significantly associated to poor sleep quality (OR=13.25, 95%CI= [5.34-37.28], p < 0.001).
The multivariate analysis confirmed that higher daily smartphone usage, measured in hours, is associated with poor sleep quality (AdjOR=1.21; 95% CI [1.02-1.45]) and, notably, subjects with high probability of severe psychological distress have significantly higher likelihood of being classified as poor sleepers (AdjOR = 9.59, 95% CI = [3.57-28.82]).
Discussion
Our analysis revealed a strong association between psychological distress (K10 scale) and poor sleep quality among university students. Students experiencing significant psychological distress showed markedly higher likelihood of being poor sleepers, confirming bidirectional relationships between mental health and sleep, as documented in previous research. Daily smartphone uses also emerged as a significant predictor of poor sleep quality, aligning with literature on electronic devices\u27 detrimental effects on sleep hygiene. Smartphone light emissions, particularly blue light, suppress melatonin production and disrupt circadian rhythms [8]. These findings emphasize the importance of addressing sleep health within university mental health and academic support initiatives. The strong psychological distress-sleep quality association suggests interventions targeting either aspect may benefit the other. Universities should consider implementing screening programs to identify students at risk of sleep disorders, especially those reporting psychological distress symptoms. Additionally, digital hygiene education should be incorporated into student wellness programs to mitigate electronic devices\u27 negative impact on sleep.
Conclusions
The study highlights the link between psychological distress, smartphone use, and sleep quality in university students. The strong connection between mental health struggles and sleep issues underscores the need to integrate sleep health into mental health services. Universities should promote well-being and responsible technology use to enhance academic performance and overall student health