Emotional Prosody Processing in the Schizophrenia Spectrum.

THESIS ABSTRACT Emotional prosody processing impairment is proposed to be a main contributing factor for the formation of auditory verbal hallucinations in patients with schizophrenia. In order to evaluate such assumption, five experiments in healthy, highly schizotypal and schizophrenia populations are presented. The first part of the thesis seeks to reveal the neural underpinnings of emotional prosody comprehension (EPC) in a non-clinical population as well as the modulation of prosodic abilities by hallucination traits. By revealing the brain representation of EPC, an overlap at the neural level between EPC and auditory verbal hallucinations (AVH) was strongly suggested. By assessing the influence of hallucinatory traits on EPC abilities, a continuum in the schizophrenia spectrum in which high schizotypal population mirrors the neurocognitive profile of schizophrenia patients was established. Moreover, by studying the relation between AVH and EPC in non-clinical population, potential confounding effects of medication influencing the findings were minimized. The second part of the thesis assessed two EPC related abilities in schizophrenia patients with and without hallucinations. Firstly, voice identity recognition, a skill which relies on the analysis of some of the same acoustical features as EPC, has been evaluated in patients and controls. Finally, the last study presented in the current thesis, assessed the influence that implicit processing of emotional prosody has on selective attention in patients and controls. Both patients studies demonstrate that voice identity recognition deficits as well as abnormal modulation of selective attention by implicit emotion prosody are related to hallucinations exclusively and not to schizophrenia in general. In the final discussion, a model in which EPC deficits are a crucial factor in the formation of AVH is evaluated. Experimental findings presented in the previous chapters strongly suggests that the perception of prosodic features is impaired in patients with AVH, resulting in aberrant perception of irrelevant auditory objects with emotional prosody salience which captures the attention of the hearer and which sources (speaker identity) cannot be recognized. Such impairments may be due to structural and functional abnormalities in a network which comprises the superior temporal gyrus as a central element

Managing chronic conditions: lessons learnt from a comparative analysis of seven years’ policies for chronic care patients in Italy

This policy paper aims to compare what policies are developed in Italy for the management of chronic patients in order to improve population health, quality of care and patient experience and reduce per-capita cost. The paper also aims to identify the key trends and evolutionary trajectories across the Country. Methodology: The analysis focuses on 10 Italian Regions and the time span of observation is 7 years (from 2014 to 2020). Data collection and analysis adopts mixed methods in order to have a more in-depth picture of the contextual factors, mechanisms and outcomes. It includes a desk research of the literature and documentary analysis; semi-structured interviews; a theory driven evaluation of 12 programmes identified at the regional level; and a Consensus Conference to discuss and validate the results with an Expert Panel Group. Conclusions: The paper firstly describes the main policies developed in Italy in the last seven years; secondly, it discusses six main trends and clusters them into three strategies: demand management strategies; strategies to improve the management of comorbid and frail patients; and strategies to improve the coordination between levels of care and the patient journey; thirdly, it discusses eight trends and evolutionary trajectories which are now emerging

The transition of patients with rare diseases between providers: the patient journey from the patient perspective

Background: Rare diseases are a group of more than 6000 disorders that on the whole may affect 30 million European Union citizens. Most rare diseases are of genetic origin, are often chronic and life-threatening. Patients living with rare diseases typically receive care from many providers and move frequently within health care settings, so high-quality transitional care is especially important for them, as well as for their family caregivers. Poor communications, incomplete transfer of information, inadequate education of health professionals, limited access to expertise services, and the absence of a single point person to ensure continuity of care all contribute to gaps in care during transitions. The research project focuses on four rare Lysosomal storage disease - LSDs (Pompe disease, Anderson-Fabry disease, Gaucher disease and Mucopolysaccharidosis type 1) featured by the availability of treatments that allow for a good quality of life for patients and aims to gather information on the real patient journey and on the health and social services used in order to analyse and identify the key conditions for improving the care management of rare and ultra-rare diseases (RD). Methods: We conducted a national survey, distributed to patients and caregivers from the 1st of June 2016 to the 7th of August 2016. Data were gathered through questionnaires disseminated online (through the patient associations' websites, Facebook pages and other online networks) or administered directly to patients through the patients' associations, to maintain the privacy and anonymity. The questionnaire consisted of 70 questions related to history and pattern of referrals to specialist, time to diagnosis, core medical tests, disciplines and specialists, time and type of treatment. The questionnaire was developed based on 16 in-depth interviews to patients sampled to cover the 4 LSDs, different ages and residence at the national level and further tested through the support of patients' associations. Data were analysed by descriptive and analytical statistics. Results: Of the survey participants, 177 patients provided evaluable data. The sample covered the national territory, was mainly composed of adult patients (average 40 age), who were diagnosed with rare LSDs 13 years ago. According to the survey patients living with rare LSD diseases visited an average of 2.4 centres before receiving an accurate diagnosis and the mean length of time from symptom onset to accurate diagnosis was around 7.3 years, however, there was a significant relationship between mean length of time for diagnosis and age (P >0.001), the mean length of time was reduced to 1.5 years for young patients (under 20 age), while was around 12 years for the older ones (over 65 age), indicating therefore the clear improvement in the diagnostic phase and in the access to reference centres. The analysis revealed the variability in tackling rarity and complexity, the wide number and specialization of professionals involved and the difficulty to provide integrated care pathways (ICPs) due to the lack of scalability and standardisation of care processes. Conclusion: The combination of rarity, complexity and lack of effective treatment creates huge obstacles to the provision of holistic care and in many cases significant medical, psychological and social needs remain unmet. Rare and ultra-rare disease challenge the most traditional care management models, indeed, people with a RD often need follow up care and support from different categories of health professionals, often from several different medical specialities, as well as by social workers and other social and local service providers which requires a level of coordination not easy to organise in most health care systems

Neuro-hormonal effects of physical activity in the elderly.

Thanks to diagnostic and therapeutic advances, the elderly population is continuously increasing in the western countries. Accordingly, the prevalence of most chronic age-related diseases will increase considerably in the next decades, thus it will be necessary to implement effective preventive measures to face this epidemiological challenge. Among those, physical activity exerts a crucial role, since it has been proven to reduce the risk of cardiovascular diseases, diabetes, obesity, cognitive impairment and cancer. The favorable effects of exercise on cardiovascular homeostasis can be at least in part ascribed to the modulation of the neuro-hormonal systems implicated in cardiovascular pathophysiology. In the elderly, exercise has been shown to affect catecholamine secretion and biosynthesis, to positively modulate the renin-angiotensin-aldosterone system and to reduce the levels of plasma brain natriuretic peptides. Moreover, drugs modulating the neuro-hormonal systems may favorably affect physical capacity in the elderly. Thus, efforts should be made to actually make physical activity become part of the therapeutic tools in the elderly. © 2013 Femminella, de Lucia, Iacotucci, Formisano, Petraglia, Allocca, Ratto, DAmico, Rengo, Pagano, Bonaduce, Rengo and Ferrara

Cognition, Emotion and Behaviour: Addressing the Relationship Between Executive Functions and Decision-Making

Executive functions are a complex and heterogeneous group of concepts that refer to a set of diverse cognitive abilitiessuch as working memory, cognitive flexibility, planification, reasoning, problem-solving and inhibition. Moreover, decision-making maybe described as a pattern that a person uses when he or she is facing a situation where they must lean towards an option: people tendto choose one or another option considering the risks and benefits these options offer. There is evidence supporting that executivefunctions are associated with the way people make their decisions. The main aim of the present study is to review and update theseconcepts reporting evidence from the literature on the association between the cognitive, emotional, and behavioral aspects of decisionmaking.Fil: Gonzalez Aguilar, Maria Josefina. Universidad Austral. Facultad de Ciencias Biomédicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rodriguez Lopez, Sofia. Universidad Austral. Facultad de Ciencias Biomédicas; ArgentinaFil: Lynch, Sofia. Universidad Austral. Facultad de Ciencias Biomédicas; ArgentinaFil: Mennella, Paula. Universidad Austral. Facultad de Ciencias Biomédicas; ArgentinaFil: Alba Ferrara, Lucia M. Universidad Austral. Facultad de Ciencias Biomédicas; Argentina. Universidad Nacional Arturo Jauretche. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Unidad Ejecutora de Estudios en Neurociencias y Sistemas Complejos; Argentin

COT tra indicazioni nazionali e declinazioni territoriali

Il tema delle Centrali Operative Territoriali (COT) appare quello più controverso sul piano definitorio rispetto alle altre innovazioni territoriali proposte dal PNRR e dal DM 77/22, con premesse alla progettazione delle COT tra loro molto diverse nei vari contesti regionali e aziendali. La ricerca persegue quindi l’obiettivo di approfondire le scelte che realtà aziendali con diverso background esperienziale stanno adottando per l’attivazione delle COT. Il capitolo verte sull’analisi di otto casi aziendali, da cui emerge eterogeneità di modello di servizio, funzioni e condizioni organizzative nelle esperienze di Centrali pre-pandemia, mentre nelle aziende che non avevano attivato Centrali pre-pandemia risultano in via di estensione le esperienze delle USCA. Laddove era già presente un’esperienza di Centrale è attualmente in corso una riprogettazione per adeguare le esperienze sviluppate alle previsioni normative, mentre in assenza di esperienza pregressa il tema della COT sembra essere l’ultimo dei «cantieri» di lavoro del PNRR attivati. In alcuni casi le aziende sanitarie attendono gli indirizzi regionali per avviare la progettazione, mentre in altri i tempi aziendali di progettazione sono più veloci di quelli regionali. La progettazione delle Centrali emerge come espressione dell’autonomia aziendale e della contingenza dei fabbisogni di integrazione della filiera, con un diverso atteggiamento rispetto ai processi di formulazione delle COT nei diversi contesti aziendali. Si osserva, inoltre, un uso inappropriato del termine Centrale, oltre che un tentativo di far convergere molteplici fabbisogni di integrazione sulla Centrale, minando la sua efficacia potenziale. La distribuzione delle COT tra livello aziendale e distrettuale, un doppio livello spesso presente nelle esperienze analizzate, dipende dalla gestione dei flussi di transizione e dalla messa in gerarchia della COT. Le USCA suggestionano la progettazione delle COT, che si sottolinea essere un servizio interno all’azienda, che spesso non agisce la presa in carico. La COT rappresenta infine un’occasione per rafforzare la committenza dell’azienda sugli erogatori

Política urbana e acesso à habitação social em regiões metropolitanas da América Latina e Europa

O texto é uma reflexão produzida a partir de diversos estudos desenvolvidos pela equipe do Laboratório de Habitação e Assentamentos Humanos da Faculdade de Arquitetura e Urbanismo da Universidade de São Paulo – LABHAB FAUUSP. Seu principal conteúdo e dados utilizados advêm de trabalho sobre as cidades de São Paulo (Br), Rosário (Ar), Barcelona (Es), Florença (It), realizado no âmbito do Programa URB-AL, que consiste em síntese produzida pela equipe, de diagnósticos locais de cada cidade e da análise comparativa, por continente e geral. Abrange as condições de carência habitacional ou dificuldade de acesso à moradia e a um lugar na cidade, bem como as políticas públicas aplicadas para enfrentar a questão. Considera aspectos institucionais, financiamento, marco legal e organização social presente em cada país e relaciona, na América Latina, a implementação de projetos e ações não só a diretrizes e programas nacionais, mas também ao projeto político-ideológico dos governos municipais.El presente texto es una reflexión producida a partir de diversos estudios desarrollados por el equipo del Laboratório de Habitação e Assentamentos Humanos da Faculdade de Arquitetura e Urbanismo da Universidade de São Paulo – LABHAB FAUUSP. Su contenido principal y los datos utilizados provienen del trabajo realizado, en el ámbito del Programa URB-AL, sobre las ciudades de São Paulo (Br), Rosario (Ar), Barcelona (España) y Florencia (IT). Consiste en una síntesis, un análisis comparativo por continente y a nivel general producida por el equipo de diagnóstico local de cada ciudad. La investigación abarca las condiciones de carencia habitacional, o dificultad de acceso a la vivienda y a un lugar en la ciudad, tanto como a las políticas públicas aplicadas para enfrentar esta cuestión. Considera aspectos institucionales, financiamiento, marco legal y de organización social presente en cada país y relaciona, en América Latina, la implementación de proyectos y acciones no sólo en las directrices y programas nacionales, sino también en el proyecto político-ideológico de los gobiernos municipales.Peer Reviewe

Gravitational Lensing Effects on High Redshift Type II Supernova Studies with NGST

We derive the expected Type II SN differential number counts, N(m), and Hubble diagram for SCDM and LCDM cosmological models, taking into account the effects of gravitational lensing (GL) produced by the intervening cosmological mass. The mass distribution of dark matter halos (ie the lenses) is obtained by means of a Monte Carlo method applied to the Press-Schechter mass function. The halos are assumed to have a NFW density profile, in agreement with recent simulations of hierarchical cosmological models. Up to z=15, the (SCDM, LCDM) models predict a total number of (857, 3656) SNII/yr in 100 surveyed 4' times 4' fields of the Next Generation Space Telescope. NGST will be able to reach the peak of the N(m) curve, located at AB approx 30(31) for SCDM(LCDM) in J and K wavelength bands and detect (75%, 51%) of the above SN events. This will allow a detailed study of the early cosmic star formation history, as traced by SNIIe. N(m) is only very mildly affected by the inclusion of lensing effects. In addition, GL introduces a moderate uncertainty in the determination of cosmological parameters from Hubble diagrams, when these are pushed to higher $z$. For example, for a ``true'' LCDM with (Omega_M= 0.4, Omega_Lambda=0.6), without proper account of GL, one would instead derive (Omega_{M}=0.36^{+0.15}_{-0.12}, Omega_{Lambda}=0.60^{+0.12}_{-0.24}). We briefly compare our results with previous similar work and discuss the limitations of the model.Comment: 19 pages including 6 figures. Accepted for publication in MNRA