Transition Between Sensitive Delusion of Reference and Mood Disorder: A Case Report

The Sensitive Delusion of Reference is a clinical entity described by Ernst Kretschmer and never integrated into mainstream nosographic systems. It represents the possibility of developing psychosis starting from a personality characterized by sensitivity, scrupulousness, and fear of judgment of others. The presentation of the following clinical case highlights how the overlap between this clinical entity and mood disorders leads to characteristic psychopathology, which has not been sufficiently detailed. In particular, the delusions, which always starts from the idea of reference and the shame in the face of the judgment of others, takes on characteristics of guilt during the depressive phases and persecutory themes during the activation phases. This clinical observation, which obviously needs to be confirmed on a larger scale, encourages a renewed interest in the concept of Kretschmer's Sensitive Delusion of Reference and creates the possibility of intersecting multiple psychopathological levels, for a more complete perspective on the individual case

What is it like for a middle manager to take safety into account? Practices and challenges

Aviation today is seen as a very safe industry, yet recent accidents have shown that vulnerabilities still exist. The literature has often drawn attention to the role played by top managers/CEO in running their businesses profitably, and at the same time keeping them safe from threats. Research has also investigated the way people at the sharp-end of organisations are ‘mindful’ of the possible threats that can occur in their day-to-day activities, and how they can anticipate (most of) them. But what about the role played by middle managers in ensuring safety in every organisational operation? Even if researchers now agree that middle managers’ actions are a valuable asset for organisations and central to pursuing key organisational outcomes, very little is known about how middle managers take safety into account in their daily operations, and the challenges they face. This paper reports on the safety-related practices and challenges of middle managers of the civil aviation industry. Within the Future Sky Safety project, over a two-year research activity, 48 middle managers from a range of aviation organisations agreed to talk about the strategies and actions they put in place on a routine basis, to embed safety in the daily operations. Methodologically, semi-structured interviews were conducted and the qualitative content analysis (QCA) method was used to make sense of the raw material, through a data-driven coding frame. The findings of this research suggest that the practices middle managers identify as central in relation to their role in the management of safety can be grouped into three high-level categories: (1) making decisions, (2) influencing key stakeholders to get the job done, and (3) managing information. This research adds knowledge in relation to the middle managers’ role in the management of safety, in particular shedding light on the competency that middle managers from the civil aviation industry rely on to get the job done when it comes to contributing to safety

“Braking bad”:The influence of haptic feedback and tram driver experience on emergency braking performance

Trams are experiencing a resurgence with worldwide network expansion driven by the need for sustainable and efficient cities. Trams often operate in shared or mixed-traffic environments, which raise safety concerns, particularly in hazardous situations. This paper adopts an international, mixed-methods approach, conducted through two interconnected studies in Melbourne (Australia) and Birmingham (UK). The first study involved qualitative interviews, while the second was an experimental study involving a virtual reality (VR) simulator and haptic master controller (i.e., speed lever). In tram operations, master controllers play a critical role in ensuring a smooth ride, which directly influences passenger safety and comfort. The objective was to understand how a master control system, enhanced with additional haptic feedback, could improve tram driver braking performance and perceptions in safety-critical scenarios. Interview results indicate that the use of the emergency brake is considered the final or ultimate choice by drivers, and their driving experience is a moderating factor in limiting its application. Combined with the experimental results, this paper highlights how implementing haptic feedback within a master controller can reduce the performance disparity between novice and experienced tram drivers.</p

Adaptive Automation and the Third Pilot

Currently, automation does not take into consideration the cognitive and emotional state of the crew. Rather, automation provides assistance based on explicit and static task assignments, with no adaptive capabilities, even though it is capable of providing higher or lower levels of support depending on the crew state and/or complexity of the operational situation. This chapter presents a new adaptive automation concept which offers an innovative ‘team’ centred approach to solving crew awareness/workload management problems and enhancing flight safety. Partnership underpins the ‘Third Pilot’ approach. The crew (pilot flying and pilot monitoring), automation and the ‘Third Pilot’ are in charge together. Overall, partnership is proposed. This replaces existing paradigms involving dynamic changes in control function, where changes can be autonomously controlled by the system. Moreover, a new multimodal cockpit concept is advanced providing enhanced assessment of crew state/workload

Development of an observational protocol for reducing and mitigating workload and the risk of Retained Foreign Objects

Retained Foreign Objects are an uncommon but costly problem in today's healthcare. It regards the outcome after an unintended item is left behind in a patient after an invasive procedure. This paper presents the development of an observational protocol used for surgical observations in the FOR_RaM Project. The FOR_RaM or Foreign Object Retention - Reduction and Mitigation project aims to analyze and understand the problem of retained foreign objects in surgery and maternity settings in Ireland, develop hospital specific foreign object management processes and implementation roadmaps, with a focus on reducing and mitigating the risk of foreign object retention. This paper discusses the methodology used for developing an observational protocol as part of a socio-technical multi-methods approach in order to gain a better understanding of the existing practices that take place in these settings, including workload, operational processes and collaboration. Emphasis is placed on the observational template development and design, observational tasks, critical points, procedures and protocols followed throughout. This observation protocol has facilitated the collection of critical data and been successful in identifying good practices and potential areas for improvement

Evaluation of Important Treatment Parameters in Supraphysiological Thermal Therapy of Human Liver Cancer HepG2 Cells

This study was aimed at simulating the effect of various treatment parameters like heating rate (HR), peak temperature (PT) and hold/total treatment time on the viability of human liver cancer HepG2 cells subjected to different thermal therapy conditions. The problem was approached by investigating the injury kinetics obtained using experimentally measured viability of the cells, heated to temperatures of 50–70°C for 0–9 min at HRs of 100, 200, 300 and 525°C min(−1). An empirical expression obtained between the activation energy (E) and HR was extended to obtain the E values over a broad range of HRs from 5 to 600°C min(−1) that mimic the actual conditions encountered in a typical thermal therapy protocol. Further, the effect of the HR (5–600°C min(−1)) and PT (50–85°C) on the cell survival was studied over a range of hold times. A significant drop in survival from 90% to 0% with the simultaneous increase in HR and PT was observed as the hold time increased from 0 to 5 min. For complete cell death, the hold time increased with the increase in the HR for a given PT, while the total time showed presence of minima for 60, 65 and 70°C at HRs of 50, 100 and 200°C min(−1), respectively

Breakthrough SARS-CoV-2 infections after COVID-19 mRNA vaccination in MS patients on disease modifying therapies during the Delta and the Omicron waves in Italy

Background In this study we aimed to monitor the risk of breakthrough SARS-CoV-2 infection in patients with MS (pwMS) under different DMTs and to identify correlates of reduced protection.Methods This is a prospective Italian multicenter cohort study, long-term clinical follow-up of the CovaXiMS (Covid-19 vaccine in Multiple Sclerosis) study. 1855 pwMS scheduled for SARS-CoV-2 mRNA vaccination were enrolled and followed up to a mean time of 10 months. The cumulative incidence of breakthrough Covid-19 cases in pwMS was calculated before and after December 2021, to separate the Delta from the Omicron waves and to account for the advent of the third vaccine dose.Findings 1705 pwMS received 2 m-RNA vaccine doses, 21/28 days apart. Of them, 1508 (88.5%) had blood assessment 4 weeks after the second vaccine dose and 1154/1266 (92%) received the third dose after a mean interval of 210 days (range 90-342 days) after the second dose. During follow-up, 131 breakthrough Covid-19 infections (33 during the Delta and 98 during the Omicron wave) were observed. The probability to be infected during the Delta wave was associated with SARS-CoV-2 antibody levels measured after 4 weeks from the second vaccine dose (HR=0.57, p &lt; 0.001); the protective role of antibodies was preserved over the whole follow up (HR=0.57, 95%CI=0.43-0.75, p &lt; 0.001), with a significant reduction (HR=1.40, 95%CI=1.01-1.94, p=0.04) for the Omicron cases. The third dose significantly reduced the risk of infection (HR=0.44, 95%CI=0.21-0.90,p=0.025) during the Omicron wave.Interpretation The risk of breakthrough SARS-CoV-2 infections is mainly associated with reduced levels of the virus-specific humoral immune response. Copyright (c) 2022 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/