Les directives psychiatriques anticipées (DPA) et le rôle de l’autonomie

Bien que les directives psychiatriques anticipées (DPA) soient ancrées dans l’éthique de l’autonomie, le lien entre les deux reste imprécis. Les DPA sont des documents juridiques qui permettent aux personnes qui vivent avec un problème de santé mentale de spécifier leurs préférences de traitement advenant une incapacité future. Le rapport entre l’autonomie et les DPA a été abordé en termes tant légaux et éthiques que philosophiques, mais il n’a pas été clairement opérationnalisé sur le plan clinique. L’autonomie est une valeur éthique fondamentale qui englobe la notion d’indépendance face à des influences contrôlantes externes, ainsi que la capacité mentale de prendre ses propres décisions. Les personnes qui vivent avec un problème de santé mentale ont parfois besoin d’aide pour bien comprendre leurs droits éthiques et juridiques en matière de choix autonome, alors que les intervenants professionnels doivent être mieux formés quant à l’importance de l’autonomie dans leur pratique clinique. La capacité de consentir au traitement est le préalable d’ordre mental qui assure que les personnes ayant des troubles mentaux sont en mesure de rédiger des DPA en toute connaissance de cause, alors que l’autonomie est la valeur qui leur donne le pouvoir de contribuer à leur rétablissement.Although psychiatric advance directives (PADs) are grounded in the ethics of autonomy, the relationship between the two is unclear. PADs are legal documents that allow individuals with mental illness to record their treatment preferences should they become incompetent in the future. The relationship between autonomy and PADs has been discussed in ethical, legal, and philosophical terms, but has not been clearly operationalized for clinical purposes. Autonomy is a fundamental ethical value that includes having the independence from outside controlling influences and the mental capacity to direct one’s personal actions. Individuals with mental illness sometimes require assistance to understand their ethical and legal rights with respect to autonomous choice, and professional stakeholders need education regarding the importance of autonomy for clinical practice. Competency to consent to treatment is the mental prerequisite that ensures individuals with mental illness are able to complete PADs with insight, whereas autonomy is the value that empowers individuals to work towards their recovery.Aunque las directivas psiquiátricas anticipadas (DPA) se encuentran ancladas en la ética de la autonomía, la relación entre ambas es imprecisa. Las DPA son documentos jurídicos que permiten a las personas que viven con un problema de salud mental especificar sus preferencias de tratamiento en el caso de una incapacidad futura. La relación entre la autonomía y las DPA se aborda en términos tanto legales y éticos como filosóficos, pero no ha sido claramente puesta en operación en el plan clínico. La autonomía es un valor ético fundamental que engloba la noción de independencia frente a las influencias controladoras externas, así como la capacidad mental de tomar sus propias decisiones. Las personas que viven con un problema de salud mental en ocasiones necesitan ayuda para comprender sus derechos éticos y jurídicos en materia de elección autónoma, mientras que los interventores profesionales deben tener una mejor formación en cuanto a la importancia de la autonomía en la práctica clínica. La capacidad de consentir al tratamiento es la condición mental previa que asegura que las personas con trastornos mentales están en condiciones de redactar las DPA con todo conocimiento de causa. La autonomía les otorga el poder de contribuir a su restablecimiento.Apesar das Diretrizes Psiquiátricas Antecipadas (DPA) estarem enraizadas na ética da autonomia, o elo entre os dois ainda é vago. As DPA são documentos jurídicos que permitem às pessoas, que vivem com um problema de saúde mental, especificar suas preferências de tratamento no caso de uma inaptidão futura. A relação entre a autonomia e as DPA foi abordada em termos tanto legais e éticos quanto filosóficos, mas não foi claramente operacionalizada no plano clínico. A autonomia é um valor ético fundamental que engloba a noção de independência diante das influências controladoras externas, assim como a capacidade mental de tomar suas próprias decisões. As pessoas que vivem com um problema de saúde mental precisam, às vezes, de ajuda para compreender bem seus direitos éticos e jurídicos no que diz respeito à escolha autônoma, ao passo que os profissionais devem ser melhor formados quanto à importância da autonomia em sua prática clínica. A capacidade de consentir no tratamento é o requisito de ordem mental que garante que as pessoas que possuem transtornos mentais sejam capazes de redigir suas DPA em conhecimento de causa, já que a autonomia é o valor que lhes dá o poder de contribuir para seu próprio restabelecimento

Hadronic centrality dependence in nuclear collisions

The kaon number density in nucleus+nucleus and p+p reactions is investigated for the first time as a function of the initial energy density $\epsilon$ and is found to exhibit a discontinuity around $\epsilon$=1.3 GeV/fm$^3$. This suggests a higher degree of chemical equilibrium for $\epsilon >$ 1.3 GeV/fm$^3$. It can also be interpreted as reflection of the same discontinuity, appearing in the chemical freeze out temperature (T) as a function of $\epsilon$. The $N^{\alpha \sim 1}$ dependence of (u,d,s) hadrons, whith N the number of participating nucleons, also indicates a high degree of chemical equilibrium and T saturation, reached at $\epsilon >$1.3 GeV/fm$^3$. Assuming that the intermediate mass region (IMR) dimuon enhancement seen by NA50 is due to open charm ($D \bar{D}$), the following observation can be made: a) Charm is not equilibrated. b) $J/\Psi/D \bar{D}$ suppression -unlike $J/\Psi/DY$- appears also in S+A collisions, above $\epsilon$ $\sim$1 GeV/fm$^3$. c) Both charm and strangeness show a discontinuity near the same $\epsilon$. d) $J/\Psi$ could be formed mainly through $c \bar{c}$ coalescence. e) The enhancement factors of hadrons with u,d,s,c quarks may be connected in a simple way to the mass gain of these particles if they are produced out of a quark gluon plasma (QGP). We discuss these results as possible evidence for the QCD phase transition occuring near $\epsilon \sim$1.3 GeV/fm$^3$.Comment: 4 pages, 4 figures, proceedings of Vth International Conference on Strangeness in Quark Matter, 20-25 July 2000, Berkeley, California. To appear in Journal of Physics G: Nuclear and Particle Physic

ESSAYS ON THE INTERACTIONS BETWEEN CREDIT DEFAULT SWAP AND BOND MARKETS

This Ph.D. thesis consists of three research papers which are the result of my studies at the Lombardy Advanced School of Economic Research, University of Milan. Part of this work was accomplished during my visiting period at the Market Operations Analysis division at the European Central Bank. Abstract I: Since the issuance of the first credit default swap (CDS) contract in 1994, trading volume in CDS has been growing exponentially, transforming a niche market into a multi-trillion-dollar market. The subprime crisis in the US and the sovereign crisis in the EU contributed to raise concerns on the potential destabilising role of such an instrument. Thus, also the academic literature started to hotly debate the benefits and costs that trading in CDSs has on both the financial market and the real economy. The aim of this study is to review some segments of the literature on CDSs, and to identify existing gaps and room for further research. After discussing the features of CDSs and the relative welfare implications, we survey theoretical studies which model CDS pricing, empirical literature exploring the determinants of CDS spreads, and papers which study the relationship between CDSs and their underlying assets. Abstract II: This study performs two empirical analyses to address (i) whether credit default swaps (CDS) written on European banks lead the price of their underlying bonds and (ii) the implications of the leading role of the CDS market on the determinants of banks' credit risk. The results of the first analysis show that the CDS market leads bonds' prices for nearly half of the banks in our sample. To assess the impact of this phenomenon on banks' credit risk, the sample is split into two groups, and the explained part of CDS spread changes is decomposed according to various risk drivers. It is shown that the home country sovereign risk has a different impact on the two groups, revealing a stronger transaction mechanism of risk when the CDS market is in the lead. Abstract III: Using a continuous-time, stochastic, and dynamic framework, this study derives a closed-form solution for the optimal investment problem for an agent with hyperbolic absolute risk aversion preferences for maximising the expected utility of his or her final wealth. The agent invests in a frictionless, complete market in which a riskless asset, a (defaultable) bond, and a credit default swap written on the bond are listed. The model is calibrated to market data of six European countries and assesses the behaviour of an investor exposed to different levels of sovereign risk. A numerical analysis shows that it is optimal to issue credit default swaps in a larger quantity than that of bonds, which are optimally purchased. This speculative strategy is more aggressive in countries characterised by higher sovereign risk. This result is confirmed when the investor is endowed with a different level of risk aversion

Stereopsis in sports: Visual skills and visuomotor integration models in professional and non-professional athletes

Visual skills in sport are considered relevant variables of athletic performance. However, data on the specific contribution of stereopsis—as the ability to perceive depth—in sport performance are still scarce and scattered in the literature. The aim of this review is therefore to take stock of the effects of stereopsis on the athletic performance, also looking at the training tools to improve visual abilities and potential differences in the visuomotor integration processes of professional and non-professional athletes. Dynamic stereopsis is mainly involved in catching or interceptive actions of ball sports, whereas strategic sports use different visual skills (peripheral and spatial vision) due to the sport-specific requirements. As expected, professional athletes show better visual skills as compared to non-professionals. However, both non-professional and professional athletes should train their visual skills by using sensory stations and light boards systems. Non-professional athletes use the visual inputs as the main method for programming motor gestures. In contrast, professional athletes integrate visual information with sport expertise, thus, they encode the match (or the athletic performance) through a more complex visuomotor integration system. Although studies on visual skills and stereopsis in sports still appear to be in their early stages, they show a large potential for both scientific knowledge and technical development

Videoconferencing analytic psychodrama in treating young adults’ psychological suffering : preliminary results

The study aims to explore the effects that videoconferencing Analytic Psychodrama (AP) has on the psychological wellbeing and emotional competence of young adults who are suffering from mental health problems. Twenty-two undergraduate students, asking for help at the Psychological Counselling Service of the University of Bologna for anxiety-depressive problems, took part in the three online groups that met weekly from October 2020 to July 2021. The Clinical Outcomes in Routine Evaluation Outcome Measure, the Trait Emotional Intelligence Questionnaire Short Form, the Toronto Alexithymia Scale, the Interpersonal Reactivity Index, and the Group Climate Questionnaire were used as test-retest questionnaires for clinical outcomes, emotional competence, and group climate evaluations. There was a statistically significant difference between the pre-test and 10-month scores for patients in clinical outcomes. Alexithymia significantly decreased and emotional intelligence and group engagement increased post-intervention. Videoconferencing AP sounds promising for alleviating psychological problems and to improve young adults' emotional competence

Fully Automatic and Real-Time Catheter Segmentation in X-Ray Fluoroscopy

Augmenting X-ray imaging with 3D roadmap to improve guidance is a common strategy. Such approaches benefit from automated analysis of the X-ray images, such as the automatic detection and tracking of instruments. In this paper, we propose a real-time method to segment the catheter and guidewire in 2D X-ray fluoroscopic sequences. The method is based on deep convolutional neural networks. The network takes as input the current image and the three previous ones, and segments the catheter and guidewire in the current image. Subsequently, a centerline model of the catheter is constructed from the segmented image. A small set of annotated data combined with data augmentation is used to train the network. We trained the method on images from 182 X-ray sequences from 23 different interventions. On a testing set with images of 55 X-ray sequences from 5 other interventions, a median centerline distance error of 0.2 mm and a median tip distance error of 0.9 mm was obtained. The segmentation of the instruments in 2D X-ray sequences is performed in a real-time fully-automatic manner.Comment: Accepted to MICCAI 201

High expression of beta-adrenergic receptor kinase in human peripheral blood leukocytes. Isoproterenol and platelet activating factor can induce kinase translocation.

Receptor phosphorylation is a key step in the process of desensitization of the beta-adrenergic and other related receptors. A selective kinase (called beta-adrenergic receptor kinase, beta ARK) has been identified which phosphorylates the agonist-occupied form of the receptor. Recently the bovine beta ARK cDNA has been cloned and the highest levels of specific mRNA were found in highly innervated tissues. It was proposed that beta ARK may be primarily active on synaptic receptors. In the present study, the cDNA of human beta ARK was cloned and sequenced. The sequence was very similar to that of the bovine beta ARK (the overall amino acid homology was 98%). Very high levels of beta ARK mRNA and kinase activity were found in peripheral blood leukocytes and in several myeloid and lymphoid leukemia cell lines. Since agonist-induced beta ARK translocation is considered the first step involved in beta ARK-mediated homologous desensitization, we screened a number of G-protein-coupled receptor agonists for their ability to induce beta ARK translocation. In human mononuclear leukocytes, beta-AR agonist isoproterenol and platelet-activating factor were able to induce translocation of beta ARK from cytosol to membrane. After 20 min of exposure to isoproterenol (10 microM), the cytosolic beta ARK activity decreased to 61% of control, while membrane-associated beta ARK activity increased to 170%. 20-min exposure to platelet-activating factor (1 microM) reduced the cytosolic beta ARK activity to 42% of control with concomitant increase in membrane beta ARK activity to 214% of control. The high levels of beta ARK expression in human peripheral blood leukocytes together with the ability of isoproterenol and platelet-activating factor to induce beta ARK translocation, suggest a role for beta ARK in modulating some receptor-mediated immune functions

“I Can’t Do without You”: Treatment Perspectives for Affective Dependence: A Scoping Review

Affective Dependence (AD) is a problematic model of the love relationship that is becoming increasingly prevalent and evident in the context of couple relationships. Similarly, the phenomenon is being observed with growing frequency in daily clinical practice, making it increasingly neces sary to identify treatment guidelines that can help clinicians in dealing with AD, while waiting for the literature to reach a consensus on its definition and nosographic profile. The main objective of this work is to explore the existing evidence of effectiveness regarding feasible treatments for Affective Dependence through a scoping review of the international literature carried out using the main scientific databases and following the PRISMA-ScR (PRISMA Extension for Scoping Reviews) guidelines. Seven studies were included in this review, and the results show that several pharmaceu ticals, as well as different types of individual and group therapies, are proposed as treatment plans for AD. However, there is a lack of clinical trials that can verify the efficacy of the AD treatments reported so far in the literature. Some reflections that may help to distinguish a “healthy” addiction from a dysfunctional or markedly pathological one are considered alongside potential prevention perspectives

Calculation Of Secondary Particles In Atmosphere And Hadronic Interactions

Calculation of secondary particles produced by the interaction of cosmic rays with the nuclei of Earth's atmosphere pose important requirements to particle production models. Here we summarize the important features of hadronic simulations, stressing the importance of the so called ``microscopic'' approach, making explicit reference to the case of the FLUKA code. Some benchmarks are also presented.Comment: 10 pages, 4 figures. Extended version of report given at the IInd Workshop on Matter and anti-Matter, Trento, Oct. 200