Advancement in the child attachment interview and the child and adolescent reflective functioning scale using a PDM-2 framework: case reports

open5siThe Child Attachment Interview (CAI) is a well-established semi-structured interview, widely used to identify attachment representations in middle childhood and adolescence. The application of the Child and Adolescent Reflective Functioning Scale (CRFS) to CAI narratives allows for an assessment of child mentalization, considered a strong predictor of attachment security. The 2nd edition of the Psychodynamic Diagnostic Manual (PDM-2) includes CAI and CRFS as valid and reliable assessment measures in order to assess the dominion of the Mental Functioning axis. The aim of the present paper is to investigate the informative power of CAI and CRFS for the overall understanding of mental functioning and personality in a PDM-2 framework. The present report includes the discussion of two clinical cases of school-aged children in applying the Psychodiagnostic Chart-Second Edition (PDC-2) to the CAI transcript. The first case concerns a young male, aged 10, suffering from Oppositional-Provocative Disorder (externalizing disorder), while the second case concerns a young female, aged 15, suffering from Somatic Symptoms Disorder (internalizing disorder). PDC-2 for children and adolescents was used. Data from the scoring of CAI and CRFS were combined with a systematic evaluation of the qualitative contents emerging from CAI transcripts. A detailed analysis suggests that both the CAI and CRFS are useful attachment-oriented measures, able to explore a child's mental states, and together with the application of PDC-2 they provide an essential contribution in the understanding of developmental psychopathology. Implications of this innovative approach for clinical assessment, treatment design, and interventions are further discussed.openBizzi, Fabiola; Locati, Francesca; Parolin, Laura; Shmueli-Goetz Yael; Brusadelli, EmanuelaBizzi, Fabiola; Locati, Francesca; Parolin, Laura; Shmueli-Goetz, Yael; Brusadelli, Emanuel

The relation of 12 lead ECG to the cardiac anatomy: The normal CineECG.

Abstract Background The interpretation of the 12‑lead ECG is notoriously difficult and requires experts to distinguish normal from abnormal ECG waveforms. ECG waveforms depend on body build and electrode positions, both often different in males and females. To relate the ECG waveforms to cardiac anatomical structures is even more difficult. The novel CineECG algorithm enables a direct projection of the 12‑lead ECG to the cardiac anatomy by computing the mean location of cardiac activity over time. The aim of this study is to investigate the cardiac locations of the CineECG derived from standard 12‑lead ECGs of normal subjects. Methods In this study we used 6525 12‑lead ECG tracings labelled as normal obtained from the certified Physionet PTB XL Diagnostic ECG Database to construct the CineECG. All 12 lead ECGs were analyzed, and then divided by age groups (18–29,30-39,40-49,50-59,60-69,70–100 years) and by gender (male/female). For each ECG, we computed the CineECG within a generic 3D heart/torso model. Based on these CineECG's, the average normal cardiac location and direction for QRS, STpeak, and TpeakTend segments were determined. Results The CineECG direction for the QRS segment showed large variation towards the left free wall, whereas the STT segments were homogeneously directed towards the septal/apical region. The differences in the CineECG location for the QRS, STpeak, and TpeakTend between the age and gender groups were relatively small (maximally 10 mm at end T-wave), although between the gender groups minor differences were found in the 4 chamber direction angles (QRS 4°, STpeak 5°, and TpeakTend 8°) and LAO (QRS 1°, STpeak 13°, and TpeakTend 30°). Conclusion CineECG demonstrated to be a feasible and pragmatic solution for ECG waveform interpretation, relating the ECG directly to the cardiac anatomy. The variations in depolarization and repolarization CineECG were small within this group of normal healthy controls, both in cardiac location as well as in direction. CineECG may enable an easier discrimination between normal and abnormal QRS and T-wave morphologies, reducing the amount of expert training. Further studies are needed to prove whether novel CineECG can significantly contribute to the discrimination of normal versus abnormal ECG tracings

Time- and rate-dependent alterations of the QT interval precede the onset of torsade de pointes in patients with acquired QT prolongation.

Abstract Objectives. The purpose of this study was to determine whether the QT interval dynamics that precede torsade de pointes are consistent with the initiation of this arrhythmia by early afterdepolarization-induced triggered activity. Background. Early afterdepolarization-induced triggered activity has been suggested as an electrophysiologic mechanism for torsade de pointes. Consequently, the initiation of torsade de pointes should involve time- and rate-dependent alterations of ventricular repolarization similar to those known to modulate the development of early afterdepolarizations. Methods. RR and QT intervals were measured in digitized 24-h ambulatory electrocardiographic recordings obtained from seven patients with acquired prolongation of ventricular repolarization. Each patient had one or more episodes of torsade de pointes. The relation between RR and QT intervals was determined before, during and after multiple episodes of torsade de pointes. Results. In patients with multiple episodes of ventricular arrhythmias, the onset of the arrhythmias was associated with a critical prolongation of the QT interval. In some episodes, prolongation of the QT interval was associated with sudden prolongation of the sinus cycle length, whereas in other episodes, the QT interval prolonged progressively at a constant cycle length. Conclusions. The association between a critically prolonged QT interval and the onset of ventricular arrhythmias suggests that the initial complex of torsade de pointes is an early afterdepolarization-induced triggered response. However, prolongation of the QT interval itself was not sufficient to account for the initiation of torsade de pointes, suggesting that other, as yet unidentified factors are required. (J Am Coll Cardiol 1997;30:209–17

The 2015 version of the Italian Parametric Earthquake Catalogue (CPTI15)

The Italian Parametric Earthquake Catalogue (CPTI) represents the most extensive and reliable source of parameters for earthquakes in Italy and surrounding areas. Since its first introduction in 1999, CPTI benefits from the results of the 30-years-long Italian tradition in historical earthquake research that, still today, keeps on providing a wealth of studies and macroseismic data. Such data have been collected, homogenized and made available through several releases of the related macroseismic database (DBMI). In 2016, the fourth release of CPTI and DBMI, has been finalized. They provide the most advanced and updated sets of macroseismic and instrumental data and parameters, and cover the time-span 1000-2014 with earthquakes with maximum intensity I ≥ 5 or magnitude Mw ≥ 4.0. The catalogue lists 4574 events, 70% of which accompa- nied by intensity data points (about 125’000 as a whole). Macroseismic data derive from 185 studies, 54 of them are new with respect to the previous version CPTI11. Parameters related to historical earthquakes are completely re-assessed, and magnitudes from macroseismic data are derived with new intensity-to-Mw relationships. Such relationships are based on the same dataset that contributes updated instrumental magnitudes to the catalogue. Either Mw from moment tensor solutions or proxies calculated with new published conversion relationship are considered. If available, both macroseismic and instrumental parameters are provided, together with a set of “preferred ones”, which consist of a selection between the macroseismic and the instrumental epicentres, and the weighted average of the macroseismic and instrumental magnitudes.PublishedTrieste, Italy3T. Storia Sismica4T. Sismologia, geofisica e geologia per l'ingegneria sismica4IT. Banche dat

Age-Gender Influence on the Rate-Corrected QT Interval and the QT-Heart Rate Relation in Families With Genotypically Characterized Long QT Syndrome

AbstractObjectives. We sought to analyze age-gender differences in the rate-corrected QT (QTc) interval in the presence of a QT-prolonging gene.Background. Compared with men, women exhibit a longer QTc interval and an increased propensity toward torsade de pointes. In normal subjects, the QTc gender difference reflects QTc interval shortening in men during adolescence.Methods. QTc intervals were analyzed according to age (<16 or ≥16 years) and gender in 460 genotyped blood relatives from families with long QT syndrome linked to chromosome 11p (KVLQT1; n = 199), 7q (HERG; n = 208) or 3p (SCN5A; n = 53).Results. The mean QTc interval in genotype-negative blood relatives (n = 240) was shortest in men, but similar among women, boys and girls. For genotype-positive blood relatives, men exhibited the shortest mean QTc interval in chromosome 7q- and 11p-linked blood relatives (n = 194), but not in the smaller 3p-linked group (n = 26). Among pooled 7q- and 11p-linked blood relatives, multiple regression analysis identified both genotype (p < 0.001) and age-gender group (men vs. women/children; p < 0.001) as significant predictors of the QTc interval; and heart rate (p < 0.001), genotype (p < 0.001) and age-gender group (p = 0.01) as significant predictors of the absolute QT interval. A shorter mean QT interval in men was most evident for heart rates <60 beats/min.Conclusions. In familial long QT syndrome linked to either chromosome 7q or 11p, men exhibit shorter mean QTc values than both women and children, for both genotype-positive and -negative blood relatives. Thus, adult gender differences in propensity toward torsade de pointes may reflect the relatively greater presence in men of a factor that blunts QT prolongation responses, especially at slow heart rates.(J Am Coll Cardiol 1997;29:93–9)

The 2016–2017 earthquake sequence in Central Italy: macroseismic survey and damage scenario through the EMS-98 intensity assessment

In this paper we describe the macroseismic effects produced by the long and destructive seismic sequence that hit Central Italy from 24 August 2016 to January 2017. Starting from the procedure adopted in the complex field survey, we discuss the characteristics of the building stock and its classification in terms of EMS-98 as well as the issues associated with the intensity assessment due to the evolution of damage caused by multiple shocks. As a result, macroseismic intensity for about 300 localities has been determined; however, most of the intensities assessed for the earthquakes following the first strong shock on 24 August 2016, represent the cumulative effect of damage during the sequence. The earthquake parameters computed from the macroseismic datasets are compared with the instrumental determinations in order to highlight critical issues related to the assessment of macroseismic parameters of strong earthquakes during a seismic sequence. The results also provide indications on how location and magnitude computation can be strongly biased when dealing with historical seismic sequences.Presidenza del Consiglio dei Ministri - Dipartimento della Protezione Civile (DPC)Published2407–24314T. Sismicità dell'Italia1SR TERREMOTI - Sorveglianza Sismica e Allerta Tsunami2SR TERREMOTI - Gestione delle emergenze sismiche e da maremoto5SR TERREMOTI - Convenzioni derivanti dall'Accordo Quadro decennale INGV-DPCJCR Journa

Long QT Syndrome and Pregnancy

ObjectivesThis study was designed to investigate the clinical course of women with long QT syndrome (LQTS) throughout their potential childbearing years.BackgroundOnly limited data exist regarding the risks associated with pregnancy in women with LQTS.MethodsThe risk of experiencing an adverse cardiac event, including syncope, aborted cardiac arrest, and sudden death, during and after pregnancy was analyzed for women who had their first birth from 1980 to 2003 (n = 391). Time-dependent Kaplan-Meier and Cox proportional hazard methods were used to evaluate the risk of cardiac events during different peripartum periods.ResultsCompared with a time period before a woman’s first conception, the pregnancy time was associated with a reduced risk of cardiac events (hazard ratio [HR] 0.28, 95% confidence interval [CI] 0.10 to 0.76, p = 0.01), whereas the 9-month postpartum time had an increased risk (HR 2.7, 95% CI 1.8 to 4.3, p < 0.001). After the 9-month postpartum period, the risk was similar to the period before the first conception (HR 0.91, 95% CI 0.55 to 1.5, p = 0.70). Genotype analysis (n = 153) showed that women with the LQT2 genotype were more likely to experience a cardiac event than women with the LQT1 or LQT3 genotype. The cardiac event risk during the high-risk postpartum period was reduced among women using beta-blocker therapy (HR 0.34, 95% CI 0.14 to 0.84, p = 0.02).ConclusionsWomen with LQTS have a reduced risk for cardiac events during pregnancy, but an increased risk during the 9-month postpartum period, especially among women with the LQT2 genotype. Beta-blockers were associated with a reduction in cardiac events during the high-risk postpartum time period

Risk Factors for Recurrent Syncope and Subsequent Fatal or Near-Fatal Events in Children and Adolescents With Long QT Syndrome

ObjectivesWe aimed to identify risk factors for recurrent syncope in children and adolescents with congenital long QT syndrome (LQTS).BackgroundData regarding risk assessment in LQTS after the occurrence of the first syncope episode are limited.MethodsThe Prentice-Williams-Peterson conditional gap time model was used to identify risk factors for recurrent syncope from birth through age 20 years among 1,648 patients from the International Long QT Syndrome Registry.ResultsMultivariate analysis demonstrated that corrected QT interval (QTc) duration (≥500 ms) was a significant predictor of a first syncope episode (hazard ratio: 2.16), whereas QTc effect was attenuated when the end points of the second, third, and fourth syncope episodes were evaluated (hazard ratios: 1.29, 0.99, 0.90, respectively; p < 0.001 for the null hypothesis that all 4 hazard ratios are identical). A genotype-specific subanalysis showed that during childhood (0 to 12 years), males with LQTS type 1 had the highest rate of a first syncope episode (p = 0.001) but exhibited similar rates of subsequent events as other genotype-sex subsets (p = 0.63). In contrast, in the age range of 13 to 20 years, long QT syndrome type 2 females experienced the highest rate of both first and subsequent syncope events (p < 0.001 and p = 0.01, respectively). Patients who experienced ≥1 episodes of syncope had a 6- to 12-fold (p < 0.001 for all) increase in the risk of subsequent fatal/near-fatal events independently of QTc duration. Beta-blocker therapy was associated with a significant reduction in the risk of recurrent syncope and subsequent fatal/near-fatal events.ConclusionsChildren and adolescents who present after an episode of syncope should be considered to be at a high risk of the development of subsequent syncope episodes and fatal/near-fatal events regardless of QTc duration

Prossimi Passi

Documento conclusivo e programmatico del Primo convegno nazionale del gruppo di lavoro Openscience della Consulta dei presidenti degli enti pubblici di ricerca. https://agenda.infn.it/e/ConvegnoOpenscienceCoPER202