Fashion industry as a source of inspiration for the 'Mental Health Department 4.0': an overview

Objectives: To investigate the topic of creativity and innovation in psychiatry, with a focus on the Italian model of the mental health department. Methods: This overview is based on books and papers purposely extracted from the national and international literature, published in the fields of psychiatry and economics, in English and Italian, without time limits, concerning the following topics: mental health care; mental health department; big data; creativity; innovation; Industry 4.0; fashion industry. Results: The way data are collected, analysed and used to generate predictions in the fashion industry, namely in the fast fashion, may be a source of inspiration for Italian psychiatry, to innovate the model of the mental health department (MHD). This requires the ability to collect and process big data, by means of ad hoc data centers. Also, common software is required in each branch making up the MHD. The adoption of a broader approach to clinical practice based on projects (each project representing a user, and his/her family), rather than on problems/periods of life (i.e., childhood and adolescence vs adulthood, substance misuse vs psychiatric problems, psychological discomfort vs. psychiatric disorders, etc.) may help overcome some issues traditionally affecting psychiatry, e.g., the difficulty to close the gap between adult psychiatry and child and adolescent psychiatry, the difficult relationships between psychiatry and psychology, and the controversial concept of dual-diagnosis. A project-based approach may also foster the interplay with other Agencies and with Authorities. Conclusions: To implement the ‘mental health department 4.0’, at least four issues are required: the implementation of data centers; the use of the same Information and Communication Technology system in each branch of the department; the generation of just in time outputs and data driven ‘empirical responses’ to mental health needs; the shift from a patient-centered system to a project-centered system. All this requires liaison functions and skills, as well

Scaffold osteocondrali funzionalmente graduati: proof-of-concept, analisi CFD e progettazione di un sistema automatizzato per la loro realizzazione

La perdita o il danneggiamento di organi o tessuti a causa di traumi o di invecchiamento, rappresentano una delle principali preoccupazioni nel settore sanitario in quanto sono un problema costoso e devastante. Questo ha portato allo sviluppo dell’Ingegneria dei Tessuti (TE), che mira a creare sostituti biologici per riparare o sostituire gli organi ed i tessuti danneggiati. Uno degli approcci più promettenti in TE è far crescere cellule su scaffold biodegradabili, che agiscono come supporti temporanei per l’adesione cellulare, la proliferazione e la differenziazione, dopodiché tali scaffold degradano lasciando il tessuto sano rigenerato. La principale sfida negli scaffold per TE risiede nella progettazione e nella fabbricazione di costrutti biodegradabili con proprietà tali da favorire l'adesione cellulare e supportarne la crescita, la proliferazione, la differenziazione, e facilitare la formazione di matrice extra cellulare (ECM). Criteri di fondamentale importanza nella progettazione e fabbricazione degli scaffold per TE includono la scelta di materiali con appropriate architettura interna e proprietà superficiali, proprietà meccaniche simili a quelle del tessuto ospite, tra cui modulo elastico, resistenza a compressione ed a fatica, biocompatibilità con tasso di degradazione prevedibile e sterilizzabilità. I tessuti in natura, inclusi i tessuti umani, mostrano gradienti all’interno del loro volume spaziale, ed ogni strato ha specifiche funzioni affinché il tessuto/organo possa crescere normalmente. Questi gradienti sono detti gradienti funzionali e vengono osservati e descritti da tre punti di vista: biologico, meccanico e anatomico. La combinazione dei precedenti tre punti fornirà il corretto ambiente richiesto per la crescita e la proliferazione cellulare allo scopo di rigenerare organi e tessuti. Un buono scaffold ingegnerizzato riproduce tali gradienti, che soddisfano i requisiti biologici e meccanici del tessuto target. A tal proposito si parla di Functionally Graded Scaffold (FGS), il cui processo di progettazione e fabbricazione diviene molto complesso e l’introduzione di sistemi computerizzati aiuta a superare tali difficoltà. Il capitolo 1 del presente lavoro di tesi descrive i gradienti funzionali (biologici, meccanici ed anatomici) presenti nelle strutture naturali e l’importanza di riprodurli all’interno degli scaffold per l’Ingegneria Tissutale. In tale capitolo viene presentato anche lo stato dell’arte sui materiali (naturali e sintetici) ed i metodi (tradizionali ed avanzati) utilizzati per realizzare FGS, mettendone in evidenza sia i punti di forza che le problematiche da superare. Dopo il primo capitolo introduttivo, la trattazione si incentra esclusivamente sullo scopo del presente lavoro di tesi, ovvero studiare un sistema automatizzato per creare scaffold osteocondrali funzionalmente graduati (FGS osteocondrali). Naturalmente è impensabile giungere al prodotto finito commercializzabile, piuttosto verranno indagati in primis i materiali da utilizzare e verrà proposta una metodologia per realizzare i suddetti scaffold. Qualora si debbano rigenerare più tessuti, come osso e cartilagine, sarà necessario più di un tipo cellulare. Questi tipi di cellule diverse hanno ovviamente ambienti diversi in vivo, e quindi avranno requisiti diversi per lo scaffold. Generalmente i gradienti spaziali possono essere classificati come gradienti continui o discreti. Strutture a gradiente continuo mostrano un cambiamento continuo nella loro microstruttura in funzione della posizione spaziale, mentre strutture a gradiente discreto consistono in più strati separati da interfacce. Da un punto di vista meccanico, i gradienti discreti sono caratterizzati da disallineamenti, incompatibilità e concentrazione di sforzi alle interfacce tra gli strati, che, quindi, possono distaccarsi, indebolendo la struttura. Nel capitolo 2 vengono presentati i materiali e la metodologia proposta (proof-of-concept) per la realizzazione di FGS osteocondrali sia a gradiente discreto che continuo, corredata da fotografie delle strutture ottenute. Gli scaffold a gradiente realizzati per lo studio di fattibilità sono composti essenzialmente da gelatina in soluzione acquosa al 5% peso/volume alla quale vengono addizionati idrossiapatite (HA) in forma granulare e genepina (GP) in polvere, utilizzata come agente cross-linkante naturale. Si noti sin d’ora che nella loro accezione più generale i gradienti nei FGS sono sia di materiale che di porosità. I gradienti indagati nello studio di fattibilità di questo lavoro di tesi sono principalmente gradienti di materiale, in quanto non viene utilizzato alcun agente porogeno. La porosità, comunque, è ottenibile come effetto secondario di un gradiente di materiale, ovvero il dilavamento dell’agente porogeno. Le porosità osservate nelle strutture ottenute saranno pertanto non note a priori, in quanto derivanti dal processo di realizzazione degli scaffold e non al dilavamento di un agente porogeno a concentrazione nota. Il gradiente di materiale indagato nei proof-of-concept è il gradiente di idrossiapatite in forma granulare. La metodologia proposta si basa sulla miscelazione tra la soluzione acquosa di gelatina, l’idrossiapatite e la genepina, e su un processo di sedimentazione della fase apatitica granulare. L’elemento principale del sistema automatizzato per la realizzazione di scaffold a gradiente sia discreto che continuo sarà quindi la camera di miscelazione: a seguito dell’agitazione meccanica fornita dalle pale della sua girante, ci aspettiamo che la fase granulare apatitica si disperda uniformemente all’interno della soluzione acquosa di gelatina. Dato che la geometria della suddetta camera influenza significativamente il processo di miscelazione, questa andrà correttamente dimensionata al fine di ottenere il risultato desiderato. Per ridurre i costi ed i tempi necessari allo sviluppo ed al design della camera di miscelazione, si è deciso di ricorrere alla modellistica CFD (Computational Fluid Dynamics). Rispetto all’approccio puramente sperimentale, tramite un modello CFD è possibile capire se la miscelazione sarà ottimale o meno all’interno della camera progettata, senza dover realizzare varie camere di miscelazione con differenti geometrie. Naturalmente ci saranno sempre delle differenze rispetto alla realtà, in quanto per modellare un qualsiasi fenomeno introduciamo inevitabilmente delle semplificazioni (ad esempio, considerare solo gli aspetti “principali” e trascurare gli altri di “secondaria importanza”, per non appesantire il modello), pertanto la modellistica computazionale non potrà mai sostituire del tutto le prove sperimentali durante la progettazione di un nuovo dispositivo, di qualunque genere esso sia. Vista la presenza di più fasi (in particolare la soluzione gelatina+GP e l’idrossiapatite granulare), nel capitolo 3 vengono mostrati gli aspetti teorici dei modelli CFD per i flussi multifase e l’ambiente ANSYS FLUENT, scelto per il presente lavoro di tesi. A seguire, nel capitolo 4, viene descritta l’implementazione dei modelli CFD della camera di miscelazione per lo studio della fluidodinamica allo stato stazionario e del transiente del problema di miscelazione. In primis viene illustrata la geometria di tale camera, per poi mostrare il modello CFD per la risoluzione della fluidodinamica allo stato stazionario del problema monofase Gel-GP. La soluzione fornita da questo primo modello verrà in seguito utilizzata come condizione iniziale per il campo di moto di un secondo modello, multifase nel transitorio, che permetterà lo studio dei tempi per la completa miscelazione tra due composti (Gel-GP/HA, con rapporto HA/Gel pari a 70/30, e Gel-GP). Tale scelta permette di ottenere una migliore convergenza durante il processo risolutivo di quest’ultimo modello. Infine, nel capitolo 5, viene discussa la progettazione di un sistema automatizzato per la realizzazione di scaffold osteocondrali funzionalmente graduati, i cui gradienti (discreti o continui) vengono ottenuti con la procedura proposta nel capitolo 2 del presente lavoro di tesi. In particolare verrà studiato un possibile design della struttura di tale sistema automatizzato descrivendone i vari componenti, mentre non si farà alcun cenno agli aspetti di controllo in quanto la metodologia proposta per la realizzazione di FGS osteocondrali è derivante da uno studio preliminare (proof-of-concept), pertanto potrebbe subire alcune modifiche (ad esempio, nelle tempistiche o nelle temperature in gioco) al fine di essere ottimizzata. In primis verranno analizzati i requisiti del sistema automatizzato in studio (sulla base di quanto mostrato nel capitolo 2), dopodiché verrà discusso il suo funzionamento per realizzare gli FGS osteocondrali a gradiente sia discreto che continuo e proposta una possibile struttura, mostrandone i disegni tecnici e le rappresentazioni tridimensionali (realizzati in SolidWorks 2010) dei componenti e dell’assieme. Seguono conclusioni e sviluppi futuri

CFD modelling of a mixing chamber for the realisation of functionally graded scaffolds

Biological tissues are characterised by spatially distributed gradients, intricately linked with functions. It is widely accepted that ideal tissue engineered scaffolds should exhibit similar functional gradients to promote successful tissue regeneration. Focusing on bone, in previous work we proposed simple methods to obtain osteochondral functionally graded scaffolds (FGSs), starting from homogeneous suspensions of hydroxyapatite (HA) particles in gelatin solutions. With the main aim of developing an automated device to fabricate FGSs, this work is focused on designing a stirred tank to obtain homogeneous HA-gelatin suspensions. The HA particles transport within the gelatin solution was investigated through computational fluid dynamics (CFD) modelling. First, the steady-state flow field was solved for the continuous phase only. Then, it was used as a starting point for solving the multi-phase transient simulation. CFD results showed that the proposed tank geometry and setup allow for obtaining a homogeneous suspension of HA micro-particles within the gelatin solution

Unemployment and suicide in Italy: evidence of a long-run association mitigated by public unemployment spending

From the mid-1990s on, the suicide rate in Italy declined steadily, then apparently rising again after the onset of the Great Recession, along with a sharp increase in unemployment. The aim of this study is to test the association between the suicide rate and unemployment (i.e., the unemployment rate for males and females in the period 1977-2015 and the long-term unemployment rate in the period 1983-2012) in Italy, by means of co-integration techniques. The analysis was adjusted for public unemployment spending (referring to the period 1980-2012). The study identified a long-run relationship between the suicide rate and long-term unemployment. On the other hand, an association between the suicide and unemployment rate stemmed out, though statistically weaker. A 1% increase in long-term unemployment increases the suicide rate by 0.83%, with a long-term effect lasting up to eighteen years. Public unemployment spending (as percentage of the Italian Gross Domestic Product) may mitigate this association: when its annual growth rate is higher than 0.18%, no impact of unemployment on suicide in detectable. A decrease in the suicide rate is expected for higher amounts of social spending, which may be able to compensate for the reduced level of social integration resulting from unemployment, helping the individual to continue to integrate into society. A corollary of this is that austerity in times of economic recession may exacerbate the impact of the economic downturn on mental health. However, a specific ‘‘flexicurity’’ system (intended as a combination of high employment protection, job satisfaction and labour-market policies) may have a positive impact on health

Micro-mechanical viscoelastic properties of crosslinked hydrogels using the nano-epsilon dot method

Engineering materials that recapitulate pathophysiological mechanical properties of native tissues in vitro is of interest for the development of biomimetic organ models. To date, the majority of studies have focused on designing hydrogels for cell cultures which mimic native tissue stiffness or quasi-static elastic moduli through a variety of crosslinking strategies, while their viscoelastic (time-dependent) behavior has been largely ignored. To provide a more complete description of the biomechanical environment felt by cells, we focused on characterizing the micro-mechanical viscoelastic properties of crosslinked hydrogels at typical cell length scales. In particular, gelatin hydrogels crosslinked with different glutaraldehyde (GTA) concentrations were analyzed via nano-indentation tests using the nano-epsilon dot method. The experimental data were fitted to a Maxwell Standard Linear Solid model, showing that increasing GTA concentration results in increased instantaneous and equilibrium elastic moduli and in a higher characteristic relaxation time. Therefore, not only do gelatin hydrogels become stiffer with increasing crosslinker concentration (as reported in the literature), but there is also a concomitant change in their viscoelastic behavior towards a more elastic one. As the degree of crosslinking alters both the elastic and viscous behavior of hydrogels, caution should be taken when attributing cell response merely to substrate stiffness, as the two effects cannot be decoupled

The relationship between credit and suicide in Italy

OBJECTIVES: to analyse the association between suicide rates and credit to the economy in Italy, and the potential role of social protection measures (SPMs) as buffering mechanism. DESIGN: descriptive study. SETTING AND PARTICIPANTS: data were derived from the Italian National Institute of Statistics and from the Organisation for Economic Co-operation and Development. Fixed-effects panel regressions were run to test the association between male and female suicide rates and the rate of growth of the credit-to-GDP (CTG) ratio. The buffering role of social protection measures was investigated. The observation period was from 1990 to 2014. MAIN OUTCOME MEASURES: regional male and female rates of suicide. RESULTS: male suicide rate is influenced by the rate of growth of the CTG ratio: a one-unit decrease in the latter is associated with 1.26 more suicides every 10,000 people. This marginal effect was significant at 1% for men, but not significant for women. Unemployment rate and periods of mass job loss were not associated with the outcome. With respect to SPMs, only public unemployment spending was able to moderate the association between suicide rate and rate of growth of the CTG ratio. A one-unit increase in the rate of growth of public unemployment spending was associated with 0.12 less suicides every 10,000 people, but only among men. Younger and older men were more affected by credit reduction, namely those aged 15-44 years and 75 years or more. Differently, women were not influenced by credit reduction, but only by increased UR in the group aged 55-64 years. CONCLUSIONS: access to credit is a major determinant of psychological well-being for men, but not for women. The rate of growth of the CTG ratio may be more useful than other macroeconomic indicators at identifying the mental health outcomes of economic crises

Mental health, work and care: the value of multidisciplinary collaboration in psychiatry and occupational medicine

Objectives To investigate the relation between work and mental health in a multidisciplinary fashion. Methods This overview is based on books and articles purposely extracted from national and international literature published in the fields of psychiatry, occupational medicine, economics and labor law, written in Italian and English, without time limits; it is part of the BUDAPEST-RP Project launched in 2010 to study the effects of the economic crisis on the Italian population. Results Some features of work and the labour market in the context of the Fourth Industrial Revolution (desynchronization of time, increased external control, need of orderliness in the work relationships-i.e., decreased tolerance of work-conflicts, e.g., between the employer and the Unions-, hypernomia and heteronomy) mirror some psychopathological aspects of the pre-morbid personality prone to develop depression, and may act as environmental risk factors. This, coupled with increased unemployment and precariousness, especially affecting the young, prompt to finding evidence-based strategies to promote employment of people affected by mental disorders, seriously hit by unemployment in the years following the Great Recession. Conclusions Work organization is the common denominator between the work environment conceived as a risk or protective factor for psychiatric disorders and the use of work in the field of psychiatric rehabilitation, by means of vocational rehabilitation programs. Given the intrinsic complexity of this common ground, networking is required between professionals of different backgrounds, to develop a multidisciplinary approach in the fields of care, research and education, and to foster a better integration between occupational health and psychiatry

Impact of a day hospital facility on type and length of hospital stay: a cost-effectiveness analysis

We evaluated whether participation in rehabilitation activities carried out at the Community Mental Health Center (CMHC) of Castelfranco Emilia (Modena, Italy) is associated with an improvement in relevant clinical outcomes measures. Also, we performed a cost-effectiveness analysis to estimate any reduction in admission costs related to the intervention.d female patients, aged ≥18, from the caseload ofthe CMHC of Castelfranco Emilia. The study was approved by the Local Ethical Committee of the Province of Modena and by the Local Health Agency of Modena. The sample was divided into two groups. The firstgroup was made up of patients attending the day hospital facility between January 1, 2008 and December 31, 2017. This group was compared with a non-experimental control group, made up of patients that did not attend the day hospital facility in the same period. Statistical analysis was performed by means of linear and logistic regressions, both univariate and multivariate. Also, Student’s t-test and Wilcoxon-Mann-Whitney’s Test were used, when appropriate.The sample was made up of 126 users (women: 57%),61 attending and 65 not attending the day hospital facility. Mean age was 49±14 years. The most common diagnoses were schizophrenic spectrum disorders (57%) and mood disorders (20%). The statistical analysis showed a reduction in the number of admissions in patients who attended the day hospital facility (z=2.79, P<0.01). By comparing attending and not attending patients, increased odds of voluntary admissions were noticeable among the former at the 10% significance level (OR=2.49, P=0.07). Compulsory admissions were more common in the control group rather than among patients attending the day hospital facility (38% vs. 19%, P=0.05). Also, though not confirmed at the multiple regression analysis, a trend towards an increase of the use of non-scheduled interventions and a reduction in the number of days as inpatients were noticeable among patients attending the day hospital facility. As far as the cost-effectiveness analysis is concerned, the estimated reduction in hospitalization costs was € 56.135 over 10 year