Mental Health in the Coronavirus Disease 2019 Emergency - The Italian Response

Importance: This article briefly reports the experience of mental health services and the lessons learned during the coronavirus disease 2019 (COVID-19) crisis. In particular, this report offers opportunities to build on experience gained in managing the COVID-19 emergency in the Departments of Mental Health and Addiction (DMHAs) in Lombardy, the wealthiest Italian region, which has approximately 10 million inhabitants. Observations: Italy has a National Mental Health System divided into 134 DMHAs, 27 of which are in Lombardy. In the 4 weeks after the epidemic started, important changes occurred in the management of DMHAs in Lombardy. Many challenges have occurred in the management of health services. In many hospitals, entire wards, including some psychiatric wards, have been reorganized to admit patients with COVID-19, and many physicians and nurses have been diverted to wards managing patients with COVID-19. Most day facilities for patients with psychiatric needs have been temporarily closed, whereas in residential facilities, patients who usually are free to come and go during the day have had to be confined in the facilities with very limited or no leave. These changes have produced considerable stresses on people with severe mental disorders. Many outpatient clinics have limited appointments to those with the most urgent cases, and home visits, a common practice in most DMHAs, have been drastically reduced with potentially detrimental consequences for patients' well-being. Another potential detrimental consequence of being forced to stay at home has been an increase in the hours spent face to face with families with high amounts of conflict. Conclusions and Relevance: Departments of Mental Health need to be equipped with appropriate e-health technologies and procedures to cope with situations such as the COVID-19 pandemic. Additionally, interventions are needed to mitigate the potentially harmful consequences of quarantine. Departments of Mental Health should be able to assume a leadership position in the psychosocial management of disasterlike situations, and this requires the acquisition of new skills, notably how to correctly inform the population about risk, train and disseminate effective preventive and management procedures for disasters, support health personnel and rescuers, and support those experiencing bereavement

A 17 GHz inductorless low-pass filter based on a quasi-Sallen–Key approach

In this paper, an evolution of the Sallen-Key biquad architecture is presented, suitable for applications at very high frequency. The pole of the buffer amplifier is exploited as one of the poles of the biquad, therefore overcoming the constraints it poses on the maximum resonance frequency that can be achieved. This allows designing low-pass filters with cutoff frequencies above 10 GHz without using bulky inductors and with good linearity performance provided by the use of feedback. This approach has been exploited to design a biquad in a commercial SiGe BiCMOS technology with maximum fT$${f}_T$$ of about 320 GHz. The biquad has been designed to provide a resonance frequency f0$${f}_0$$ of 12 GHz and a quality factor Q of 1.9; postlayout simulations show a cutoff frequency in excess of 17 GHz, 15.75 mW of power consumption, an equivalent input noise below 1 & mu; \upmu Vrms, and -52 dB of total harmonic distortion (THD) for a 640 mVpp input signal, with a very limited area consumption

Robust body biasing techniques for dynamic comparators

Forward body biasing (FBB) is among the simplest and most effective techniques that can be leveraged to improve the performance of dynamic comparators, as previous works have demonstrated. However, none of these works puts emphasis on comparing different FBB schemes and their robustness against large differential input swings. This is especially important when considering circuits that operate at supply voltages above 0.5 V, where several approaches can be adopted for biasing the substrates without causing the body-source junctions to turn on. This paper compares three different techniques: the clocked FBB (CFBB) proposed in [1], an improvement of CFBB and a new hybrid approach that achieves the best performance in terms of delay. For the sake of brevity, the scope of our experiments has been limited to the Strong Arm latch. All simulations were carried out in a 55 nm CMOS technology at 1 V supply and 2.4 GHz clock frequency

A novel ultra-low voltage fully synthesizable comparator exploiting NAND gates

In this work a novel ultra-low voltage, ultra-low power fully synthesizable comparator is presented. The proposed architecture exploits only 2-input NAND gates, that allow minimization of the area footprint and scalability up to extremely low supply voltages. An extensive simulation campaign in a 130 nm CMOS technology has shown state-of-the-art performance in terms of power-delay-product for supply voltages down to 0.3V. Simulations also show good robustness under mismatch and PVT variations, proving the feasibility of the approach

A 2.5 GHz, 0.6 V body driven dynamic comparator exploiting charge pump based dynamic biasing

In this paper a novel 0.6 V dynamic biased, body driven Strong Arm latch is presented. The proposed topology exploits a charge pump based dynamic biasing configuration that boosts the effective supply headroom. In addition, the body terminals are used to drive the input pair while the gates are driven by the clock signal to allow for the removal of the tail transistor, resulting in larger peak currents and smaller parasitic capacitances. This reduces power consumption and delay. Moreover, the body driven approach enables rail-to-rail input common mode range (ICMR). As a result, the proposed topology is capable of high-speed operation (up to 2.5 GHz) despite the low supply voltage. At 2.5 GHz the comparator shows a competitive energy-delay product (EDP) of 2.98 fJ/GHz

Psychiatric hospitalization rates in italy before and during covid-19: Did they change? an analysis of register data

ObjectivesTo assess admission rates to 7 General Hospital Psychiatric Wards (GHPWs) located in the Lombardy Region in the 40 days after the start of COVID-19 epidemic, compared to similar periods of 2020 and 2019.MethodsAnonymized data from the regional psychiatric care register have been obtained and analyzed. The seven GHPWs care for approximately 1.4 million inhabitants and have a total of 119 beds.ResultsIn the 40-day period (February 21st-March 31st 2020) after the start of the COVID-19 epidemic in Italy, compared to a similar 40-day period prior to 21 February, and compared to two 40-day periods of 2019, there has been a marked reduction in psychiatric admission rates. The reduction was explained by voluntary admissions, while there was not a noticeable reduction for involuntary admissions. The reduction was visible for all diagnostic groups, except for a group of 'Other' diagnoses, which includes anxiety disorders, neurocognitive disorders, etc.ConclusionsLarge-scale pandemics can modify voluntary admission rates to psychiatric facilities in the early phases following pandemic onset. We suggest that the reduction in admission rates may be due to fear of hospitals, seen as possible sites of contagion, as well as to a change in thresholds of behavioural problems acting as a trigger for admission requests from family relatives or referrals from treating clinicians. It is unclear from the study whether the reduction in admissions was contributed to most by the current pandemic or the lockdown imposed due to the pandemic.