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To provide a comprehensive review of past and current implementation of coercive measures in Italy.
Literature review (cross-referencing in PubMed, Embase, and Index Medicus) concerning the application of coercive measures in Italy. Description of the past and current regulations as well as of the routine implementation of coercive measures in Italy has been also empirically summarized.
The Italian 1978 reform law on mental health care clearly established that medical treatment and tests are mainly voluntary. Only under special circumstances, the medical authority can order a patient involuntary admission and the physician is obliged to provide necessary tests and medical treatment. However, even if coercive measures are usually placed without patient's consent, the first objective should remain to protect patient's interest and rights, in accordance to the Italian Constitution. In Italy, there are no officially recognised protocols on coercive measures for acute inpatient care and each psychiatric ward adopts its own rules and internal norms.
In Italy, patients with aggressive or dangerous behaviours are approached by the staff according to a “de-escalating” model, in which physical and mechanical restraint should be adopted only when any other therapeutic options previously failed. Proposals aimed to improve the implementation of coercive measures in clinical practice will be provided.
a) the socio-demographic characteristics of patients with schizophrenia who were using cannabis at time of first appearing of psychotic symptoms;
b) the impact of cannabis on the duration of untreated psychosis (DUP) and on pathways to care;
c) the influence of cannabis on the clinical onset and on the first three years of the disorder.
Twenty-two patients with a recent onset (< 3 years) of schizophrenia were consequently recruited at the Department of Psychiatry of the University of Naples SUN. Socio-demographic characteristics, pathways to care and DUP were investigated by ad-hoc schedules.
About 60% of patients were using cannabis at onset of schizophrenia. All of them were male and did not have a job and with a lower education level. “Cannabis users” had a first contact with general practitioners earlier than “non cannabis users”, but their DUP was longer, as a consequence of significant delays in access to mental health care. Cannabis users showed higher rates of suicide attempts and relapses in the first three years, suggesting a more severe course of the disorder in the “critical period” of schizophrenia in this population.
The results of the study emphasize the need:
a) to carry out sensitization campaigns among young people in order to reduce the use of cannabis and other illicit drugs;
b) to promote information on schizophrenia for general practitioners.
Pathways to care and duration of untreated psychosis (DUP) strongly influence the long-term outcome of schizophrenia.
To investigate pathways to care, duration of untreated psychosis (DUP) and treatments received by a sample of individuals aged between 18 and 35 years meeting diagnostic criteria for psychosis.
Pathways to care and DUP were explored by an “ad-hoc” schedule administered to patients and caregivers.
The sample consists of 30 patients. The first episode of psychosis, which occurred at 19.7 (± 4.7) years, was characterized by negative symptoms and disorganized behaviours in more than half of the sample, suicide attempts (28%) and hospital admissions (26%). DUP was 41.6 ± 60.4 weeks, being longer than that reported in international literature. In 76% of cases patients’ relatives asked for a first contact with health professionals, referring the patients to psychiatrists (34% of cases), general practitioners (31%), neurologists (21%) or psychologists (13%). When professionals other than psychiatrists were contacted, the interval between the contact and receipt of appropriate psychiatric treatment (according to the current guidelines) was particularly long (15.2 ± 32.1 weeks). 34% of patients were treated with a monotherapy of psychotropic drugs: 24% with antipsychotics, 7% with anxiolytics and 3% with antidepressants; 48% received a poly-pharmacotherapy. 35% were treated with psychotherapy (in most of the cases cognitive-behavioural therapy), which was the only treatment for 18% of patients.
These results emphasize the need to train health professionals on diagnosis and treatment of first episode psychosis. DUP may be reduced by anti-stigma campaigns among general population.
Mass media have become the main source of information on mental illness. In recent years, numerous studies documented a relationship between a stigmatizing presentation of psychiatric disorders and negative perception of mental illness by general population. This paper aims at analyzing how mental illness is described in scientific articles published by journals and magazines and delineating the average portrait of a psychiatric patient offered by media to the general population.
Scientific articles published from 1957 until August 2010 were reviewed, collecting positive and negative expressions commonly associated to mental illness; a qualitative assessment method of these was then applied.
Negative descriptions of mental illness resulted by far more common than positive ones; generally, the tone and the negative attitude that describes mental illness are in the titles and in short articles, often sensational and dramatic, put on the front page, referring to stories of crime and danger. The titles are often inconsistent with the contents of the article. Moreover, there is a discriminatory and derogative language or a language of derision or pity. If there are positive descriptions, they are associated with the involvement of mental health experts, the active role of the psychiatric patient in the mass media or the effect produced by anti-stigma campaigns towards journalists.
Although negative and stigmatizing depictions predominate, there are still opportunities for improving media reporting of mental illness, which should be taken up in future media strategies.
A reliable evaluation of crop nutritional status is crucial for supporting fertilization aiming at maximizing qualitative and quantitative aspects of production and reducing the environmental impact of cropping systems. Most of the available simulation models evaluate crop nutritional status according to the nitrogen (N) dilution law, which derives critical N concentration as a function of above-ground biomass. An alternative approach, developed during a project carried out with students of the Cropping Systems Masters course at the University of Milan, was tested and compared with existing models (N dilution law and approaches implemented in EPIC and DAISY models). The new model (MAZINGA) reproduces the effect of leaf self-shading in lowering plant N concentration (PNC) through an inverse of the fraction of radiation intercepted by the canopy. The models were tested using data collected in four rice (Oryza sativa L.) experiments carried out in Northern Italy under potential and N-limited conditions. MAZINGA was the most accurate in identifying the critical N concentration, and therefore in discriminating PNC of plants growing under N-limited and non-limited conditions, respectively. In addition, the present work proved the effectiveness of crop models when used as tools for supporting education.
Within the framework of laboratory astrophysics, we form a qualified multidisciplinary group in radiative hydrodynamics. Since 10 years, we have developed laboratory experiments as radiative shocks and plasma jets in connection to astrophysics. Such laboratory experiments provide a unique opportunity to validate models and numerical schemes introduced in radiative hydrodynamics codes. Here we summarize our experimental researches about plasma jets. Laboratory astrophysical experiments have been performed using LULI2000 (France), VULCAN (UK) and GEKKO XII (Japan) intense lasers. The goal of these experiments is to investigate some of the complex features of jets from Young Stellar Objects (YSO), and in particular its interaction with the interstellar medium (ISM).
Active pulmonary tuberculosis was diagnosed in a 4-month-old infant 16 days after hospitalization; 186 exposed individuals were traced and one conversion detected. Although the risk of tuberculosis transmission in paediatric hospitals is low, paediatricians in low-incidence countries should maintain a high level of alert for timely identification of cases.
Children with attention-deficit hyperactivity disorder (ADHD) have difficulties with executive function and impulse control which may improve with age.
To map the brain correlates of executive function in ADHD and determine age-related changes in reaction times and brain volumes.
Attention-deficit hyperactivity disorder and control groups were compared on the change task measures of response inhibition (stop signal reaction time, SSRT) and shifting (change response reaction time, CRRT). Voxel-wise magnetic resonance imaging (MRI) correlations of reaction times and grey matter volume were determined, along with bivariate correlations of reaction times, brain volumes and age.
Individuals in the ADHD group had longer SSRTs and CRRTs. Anterior cingulate, striatal and medial temporal volumes highly correlated with SSRT. Striatal and cerebellar volumes strongly correlated with CRRT. Older children had faster reaction times and larger regional brain volumes. In controls, orbitofrontal, medial temporal and cerebellar volumes correlated with CRRT but not SSRT. Neither reaction times nor regional brain volumes were strongly age-dependent.
Our evidence supports delayed brain maturation in ADHD and implies that some features of ADHD improve with age.
Nanopatterned sapphire substrates offer the potential for improved performance of devices based on III-V nitrides, e.g., light-emitting diodes and laser diodes. Due to the chemical stability and hardness of sapphire, however, surface patterning is a time-consuming and expensive process. Therefore, a novel method was utilized, whereby a surface coating of Al was deposited on a sapphire substrate and patterned into an array of square mesas using e-beam lithography. The lateral dimensions of each mesa were approximately 400 × 400 nm, and the average height was approximately 100 nm. The metallic film was subsequently subjected to an oxidation treatment at 450 °C for 24 h (a heat treatment which had previously been shown to minimize hillock formation). For the second heat treatment, which is necessary to induce migration of the sapphire interface and hence achieve solid state conversion, a range of temperatures (800–1350 °C) was explored. Results showed that for a heat-treatment time of 1 h, pattern retention was achieved for annealing temperatures less than or equal to 1250 °C. Successful epitaxial conversion of the patterned mesas to sapphire was confirmed using electron backscatter diffraction.
Integration of epitaxical and colloidal semiconductor nanostructures into hybrid structures can potentially open unprecedented functionalities and applications. We present here some results of a study of the structural and optical nature of adsorbed InAs nanocrystal quantum dots (NCQDs) on GaAs(001) substrates containing buried nanostructures, providing the first evidence of excitation transfer from NCQDs to the substrate. Results are also presented for the overgrowth of GaAs on the InAs NCQDs, addressing the all important issue of approach to removal of the chemical contamination left behind by the solvent during adsorption of the NCQDS. It is shown that high structural and optical quality buried integrated structures are feasible, thus opening a new field of investigation.
In this study, we observed that the MILC behavior changed when the amorphous silicon active pattern width was changed abruptly and explain that phenomena with novel MILC mechanism model. The 10nm thick Ni layers were deposited on glass substrate that has various amorphous silicon patterns on it. Then we annealed the sample at 550 °C with RTA (rapid thermal annealing) machine and measured the crystallized length with optical microscope. The MILC rate was reduced dramatically and stopped for several hours (incubation time). After the incubation time, the MILC started again and the incubation time increased as the amorphous silicon pattern width difference getting larger. We can explain these phenomena with the tensile stress that was caused by volume shrinkage due to the phase transform from amorphous silicon to crystalline silicon.
In situ transmission electron microscopy analysis is used to study the stability of nanograined and ultra-fine grained thin films at elevated temperatures. In the free-standing Au and Cu films, grain growth was dependent on annealing temperature and time with growth observed in both materials at temperatures greater than 373K. Both materials exhibited abnormal grain growth although it was more prevalent in Au than in Cu, which may be a consequence of pinning of the Cu grain boundaries by impurities. The formation and destruction of twins was observed to play a critical role in the grain growth, with the twins retarding the growth in gold, but not in Cu. In constrained Au films no grain growth was observed on annealing at temperatures below 636 K. At 636 K, the eutectic temperature, the microstructure transformed to the eutectic structure with the first stage being the annihilation of the grain structure.
A 2D analytic result is presented for the penetration distance P of grain boundary grooves as a function of time t during heating and straining of polycrystalline multilayer thin films with immiscible phases. These grooves can ultimately pinch off individual layers. The result shows that P ∼ t0.25 initially and P ∼ t at longer time. This new analysis contrasts single- versus multilayer thin film response.
We investigate the formation of (In, Ga)As self assembled quantum structures grown on different orientations of a GaAs substrate along one side of the stereographic triangle between (100) and (111)A surfaces. The samples were grown by Molecular Beam Epitaxy, monitored by Reflection High-Energy Electron Diffraction during the growth and characterized by in-situ Scanning Tunneling Microscopy and Atomic Force Microscopy. A systematic transition from zero dimensional (In, Ga)As quantum dots to one dimensional quantum wires was observed as the substrate was varied along the side of the triangle within 25° miscut from the (100) toward (111)A, which includes several high index surfaces. We propose an explanation for the role of the substrate in determining the type of the nanostructure that is formed.
Mesa structures fabricated on Si(111) surfaces have been found experimentally to develop step arrays with large spacing of the order of a micron or more after annealing at temperatures where sublimation becomes important. Ridges around the edges initially develop during annealing and form barriers to step motion before eventually breaking down. This produces an array of steps of the same sign with a few wide terraces. Computer simulations using one dimensional Burton, Cabrera and Frank (BCF) theory including attachment-detachment rates and step-step repulsion for this configuration show that the terraces evolve under different dynamics depending on the terrace widths. For large terrace widths, sublimation dominates the step dynamics and the Ehrlich-Schwoebel effect is negligible. Sinusoidal terrace width distributions result in this case. The experimentally measured step distribution has such a sinusoidal shape suggesting that the step dynamics is sublimation dominated on the mesas after ridge breakdown.