Profiling residential water users’ routines by eigenbehavior modelling

Developing effective demand-side management strategies is essential to meet future residential water demands, pursue water conservation, and reduce the costs for water utilities. The effectiveness of water demand management strategies relies on our understanding of water consumers’ behavior and their consumption habits and routines, which can be monitored through the deployment of smart metering technologies and the adoption of data analytics and machine learning techniques. This work contributes a novel modeling procedure, based on a combination of clustering and principal component analysis, which allows performing water users’ segmentation on the basis of their eigenbehaviors (i.e., recurrent water consumption behaviors) automatically identified from smart metered consumption data. The approach is tested against a dataset of smart metered water consumption data from 175 households in the municipality of Tegna (CH). Numerical results demonstrate the potential of the method for identifying typical profiles of water consumption, which constitute essential information to support residential water demand management

L’INTEGRAZIONE FUNZIONALE PSICHIATRICO-FORENSE NELLA RISOLUZIONE DELLE “LISTE D’ATTESA”: L’ESPERIENZA DELLA REMS DEL VENETO

The transition from the old model of the Judicial Psychiatric Hospitals to the reformed system of the REMS (territorial residences forthe execution of detention security measures) has produced a decrease of about half the number of places available in Detention SecurityMeasures. Predictably, in these 4 years of operation of the new system, there has been an imbalance between demand and availability ofthese places, thus creating the phenomenon of so-called “waiting lists”. These are subjects already assigned to a custodial measure, whichthey await in prison or in the territory until a place is freed in the REMS.In this paper we will examine how the Veneto regional governmental health system has developed strategies to implement care pathwayswithin the detention security measures circuit during these years. First of all through the drafting of a Memorandum of Understandingbetween the judicial system and the mental health protection system. The first, partial data on the flows indicate the possibility of dealingwith the sustained request for the implementation of custodial Security Measures, as required by Law 81/2014, through a continuouswork to improve the regional network that involves all the interested parties.Il passaggio del vecchio modello degli OPG al riformato sistema delle REMS ha comportato una diminuzione di circa la metà dei postiletto in Misura di Sicurezza detentiva. Com’era prevedibile, in questi 4 anni di esercizio del nuovo sistema, si è venuto a creare unosquilibrio tra domanda e disponibilità di posti letto, venendosi così a creare il fenomeno delle cosiddette liste d’attesa. Si tratta di soggettigià destinati ad una misura detentiva, che attendono in carcere o sul territorio, di poter fare ingresso in REMS. In questo lavoro, esamineremocome il sistema governativo, sanitario e giuridico regionale del Veneto abbia sviluppato nel corso di questi anni strategie di implementazionedei percorsi di cura all’interno del circuito delle misure, attraverso in primo luogo la stesura di un protocollo d’intesa. Iprimi, parziali dati sui flussi indicano la possibilità di far fronte alla sostenuta richiesta di attuazione di Misure di Sicurezza nel rispettodelle indicazioni contenute nella Legge 81/2014, mediante un continuo e necessario lavoro di miglioramento del network regionale checoinvolge tutti gli interlocutori interessati

The individual experience of ageing patients and the current service provision in the context of Italian forensic psychiatry: a case-study

Introduction. Following the recent development of residential units for the execution of security measures (REMS) managed by the National Health Service and the closing down of forensic psychiatric hospitals, no study has been conducted to investigate the individual experience of ageing patients and to assess whether the new service is adequately meeting their needs. We aim to explore the experience of the service of a sample of patients aged 50 years old and above living in one of the Italian REMS. Methods. We adopted a case-study design and included a sample of five patients. We collected their basic demographic data, administered the Camberwell Assessment Need Forensic Short Version (CANFOR-S) and carried out in-depth qualitative semi-structured interviews. Results. Results from the CANFOR-S evidenced that met needs were more prevalent than unmet needs. The qualitative interviews evidenced high levels of satisfaction around accommodation, health care provision, activities, availability of benefits and company and lower levels of satisfaction around psychological and practical support. Discussion. This study gave voice to aging forensic psychiatric patients and provided through personal accounts based on their lived experience, preliminary evidence around the benefits and limitations of the Italian residential forensic psychiatric system for this age group. Implications for clinical nursing forensic practitioners operating within different service frameworks are discussed

The Mucosae-Associated Epithelial Chemokine (MEC/CCL28) Modulates Immunity in HIV Infection

BACKGROUND. CCL28 (MEC) binds to CCR3 and CCR10 and recruits IgA-secreting plasma cells (IgA-ASC) in the mucosal lamina propria (MLP). Mucosal HIV-specific IgA are detected in HIV-infection and exposure. The CCL28 circuit was analyzed in HIV-infected and-exposed individuals and in HIV-unexposed controls; the effect of CCL28 administration on gastrointestinal MLP IgA-ASC was verified in a mouse model. METHODOLOGY/FINDINGS. CCL28 was augmented in breast milk (BM) plasma and saliva of HIV-infected and –exposed individuals; CCR3+ and CCR10+ B lymphocytes were increased in these same individuals. Additionally: 1) CCL28 concentration in BM was associated with longer survival in HIV vertically-infected children; and 2) gastro-intestinal mucosal IgA-ASC were significantly increased in VSV-immunized mice receiving CCL28. CONCLUSIONS. CCL28 mediates mucosal immunity in HIV exposure and infection. CCL28-including constructs should be considered in mucosal vaccines to prevent HIV infection of the gastro-intestinal MLP via modulation of IgA-ASC.Istituto Superiore di Sanita' "Programma Nazionale di Ricerca sull' AIDS"; DG Right to Health and Solidarity Policy; EMPRO and AVIP EC WP6 Projects; Japan Health Science Foundation; National Institutes of Child Health and Human Development (HD 39611, HD 40777

The closing of forensic psychiatric hospitals in Italy: determinants, current status and future perspectives: a scoping review

Introduction. Italy is the only country in the world to have closed forensic psychiatric hospitals and converted to fully-residential services. The international interest around this reform has not been matched by research. This scoping review aims to report the determinants of the reform, the most updated information on how the system operates, its benefits and its challenges. We further aim to discuss the implications for policy, research and practice. Methods. 1. Selection of relevant sources through electronic search on four databases, Google, relevant printed materials and personal communication with practitioners currently working in REMS. 2. Study quality monitoring. 3. Data extraction onto NVivo 4. Data synthesis through content analysis. Results. 43 papers were selected for inclusion in our review. Two main themes were identified: 1. Historical chronology of the closure of forensic psychiatric hospitals; 2. The current model of residential forensic psychiatric care. Conclusions. The closing down of Italian forensic psychiatric hospitals represented a fundamental step for human rights. Further work is required to improve the current service, including potential reforming of the penal code, improved referral/admission processes and consistent monitoring to reduce service inequality across regions. Further research is crucial to test the effectiveness of the Italian model of care against traditional ones

Six nations: a clinical scenario comparison of systems for prisoners with psychosis in Australia, Bolivia and four European nations

This paper compares across six nations the mental health systems available to prisoners with the highest acuity of psychosis and risk combined with the lowest level of insight into the need for treatment. Variations were observed within and between nations. Findings highlight the likely impact of factors such as mental health legislation and the prison mental health workforce on a nation's ability to deliver timely and effective treatment close to home for prisoners who lack capacity to consent to treatment for their severe mental illness. The potential benefits of addressing the resulting inequalities are noted

Forensic mental health in Europe: some key figures

Purpose. While the number of forensic beds and the duration of psychiatric forensic psychiatric treatment have increased in several European Union (EU) states, this is not observed in others. Patient demographics, average lengths of stay and legal frameworks also differ substantially. The lack of basic epidemiological information on forensic patients and of shared indicators on forensic care within Europe is an obstacle to comparative research. The reasons for such variation are not well understood. Methods. Experts from seventeen EU states submitted data on forensic bed prevalence rates, gender distributions and average length of stay in forensic in-patient facilities. Average length of stay and bed prevalence rates were examined for associations with country-level variables including Gross Domestic Product (GDP), expenditure on healthcare, prison population, general psychiatric bed prevalence rates and democracy index scores. Results. The data demonstrated substantial differences between states. Average length of stay was approximately ten times greater in the Netherlands than Slovenia. In England and Wales, 18% of patients were female compared to 5% in Slovenia. There was a 17-fold difference in forensic bed rates per 100,000 between the Netherlands and Spain. Exploratory analyses suggested average length of stay was associated with GDP, expenditure on healthcare and democracy index scores. Conclusion. The data presented in this study represent the most recent overview of key epidemiological data in forensic services across seventeen EU states. However, systematically collected epidemiological data of good quality remain elusive in forensic psychiatry. States need to develop common definitions and recording practices and contribute to a publicly available database of such epidemiological indicators

Clinical features and comorbidity pattern of HCV infected migrants compared to native patients in care in Italy: A real-life evaluation of the PITER cohort

Background: Direct-acting antivirals are highly effective for the treatment of hepatitis C virus (HCV) infection, regardless race/ethnicity. We aimed to evaluate demographic, virological and clinical data of HCV-infected migrants vs. natives consecutively enrolled in the PITER cohort. Methods: Migrants were defined by country of birth and nationality that was different from Italy. Mann-Whitney U test, Chi-squared test and multiple logistic regression were used. Results: Of 10,669 enrolled patients, 301 (2.8%) were migrants: median age 47 vs. 62 years, (p < 0.001), females 56.5% vs. 45.3%, (p < 0.001), HBsAg positivity 3.8% vs. 1.4%, (p < 0.05). Genotype 1b was prevalent in both groups, whereas genotype 4 was more prevalent in migrants (p < 0.05). Liver disease severity and sustained virologic response (SVR) were similar. A higher prevalence of comorbidities was reported for natives compared to migrants (p < 0.05). Liver disease progression cofactors (HBsAg, HIV coinfection, alcohol abuse, potential metabolic syndrome) were present in 39.1% and 47.1% (p > 0.05) of migrants and natives who eradicated HCV, respectively. Conclusion: Compared to natives, HCV-infected migrants in care have different demographics, HCV genotypes, viral coinfections and comorbidities and similar disease severity, SVR and cofactors for disease progression after HCV eradication. A periodic clinical assessment after HCV eradication in Italians and migrants with cofactors for disease progression is warranted