Gioco d'azzardo patologico: Monitoraggio e prevenzione in Trentino

La ricerca presenta i risultati di pi\uf9 studi sul fenomeno del gioco d'azzardo patologico. Nel volume \ue8 contenuta anche un'analisi delle misure di prevenzione e di trattamento adottate per prevenire e contenere il fenomeno del gioco d'azzardo patologico

Providing a nurse-led complex nursing INtervention FOcused on quality of life assessment on advanced cancer patients: The INFO-QoL pilot trial.

PURPOSE Unmet needs for advanced-disease cancer patients are fatigue, pain, and emotional support. Little information is available about the feasibility of interventions focused on patient-reported outcome measurement developed according to the Medical Research Council (MRC) Framework in advanced-disease cancer patients. We aimed to pilot a nurse-led complex intervention focused on QoL assessment in advanced-disease cancer patients. METHODS The INFO-QoL study was based on an exploratory, nonequivalent comparison group, pre-test-post-test design. Study sites received either the INFO-QoL intervention or usual care. Adult advanced-disease cancer patients admitted to hospice inpatient units that gave their informed consent were included in the study. Subjects were 187 patients and their families and 19 healthcare professionals. We evaluated feasibility, acceptability, and patients' outcomes using the Integrated Palliative Care Outcome Scale. RESULTS Nineteen healthcare professionals were included. The mean competence score increased significantly over time (p < 0.001) and the mean usefulness score was high 8.63 (±1.36). In the post-test phase, 54 patients were allocated to the experimental unit and 36 in the comparison unit. Compared to the comparison unit, in the experimental unit anxiety (R2 = 0.07; 95% CI = -0.06; 0.19), family anxiety (R2 = 0.22; 95% CI = -0.03; 0.41), depression (R2 = 0.31; 95% CI = -0.05; 0.56) and sharing feelings (R2 = 0.09; 95% CI = -0.05; 0.23), were improved between pre-test and post-test phase. CONCLUSIONS The INFO-QoL was feasible and potentially improved psychological outcomes. Despite the high attrition rate, the INFO-QoL improved the quality and safety culture for patients in palliative care settings

The Athena X-ray Integral Field Unit: a consolidated design for the system requirement review of the preliminary definition phase

The Athena X-ray Integral Unit (X-IFU) is the high resolution X-ray spectrometer, studied since 2015 for flying in the mid-30s on the Athena space X-ray Observatory, a versatile observatory designed to address the Hot and Energetic Universe science theme, selected in November 2013 by the Survey Science Committee. Based on a large format array of Transition Edge Sensors (TES), it aims to provide spatially resolved X-ray spectroscopy, with a spectral resolution of 2.5 eV (up to 7 keV) over an hexagonal field of view of 5 arc minutes (equivalent diameter). The X-IFU entered its System Requirement Review (SRR) in June 2022, at about the same time when ESA called for an overall X-IFU redesign (including the X-IFU cryostat and the cooling chain), due to an unanticipated cost overrun of Athena. In this paper, after illustrating the breakthrough capabilities of the X-IFU, we describe the instrument as presented at its SRR, browsing through all the subsystems and associated requirements. We then show the instrument budgets, with a particular emphasis on the anticipated budgets of some of its key performance parameters. Finally we briefly discuss on the ongoing key technology demonstration activities, the calibration and the activities foreseen in the X-IFU Instrument Science Center, and touch on communication and outreach activities, the consortium organisation, and finally on the life cycle assessment of X-IFU aiming at minimising the environmental footprint, associated with the development of the instrument. Thanks to the studies conducted so far on X-IFU, it is expected that along the design-to-cost exercise requested by ESA, the X-IFU will maintain flagship capabilities in spatially resolved high resolution X-ray spectroscopy, enabling most of the original X-IFU related scientific objectives of the Athena mission to be retained. (abridged).Comment: 48 pages, 29 figures, Accepted for publication in Experimental Astronomy with minor editin

The Athena X-ray Integral Field Unit: a consolidated design for the system requirement review of the preliminary definition phase

The Athena X-ray Integral Unit (X-IFU) is the high resolution X-ray spectrometer studied since 2015 for flying in the mid-30s on the Athena space X-ray Observatory. Athena is a versatile observatory designed to address the Hot and Energetic Universe science theme, as selected in November 2013 by the Survey Science Committee. Based on a large format array of Transition Edge Sensors (TES), X-IFU aims to provide spatially resolved X-ray spectroscopy, with a spectral resolution of 2.5 eV (up to 7 keV) over a hexagonal field of view of 5 arc minutes (equivalent diameter). The X-IFU entered its System Requirement Review (SRR) in June 2022, at about the same time when ESA called for an overall X-IFU redesign (including the X-IFU cryostat and the cooling chain), due to an unanticipated cost overrun of Athena. In this paper, after illustrating the breakthrough capabilities of the X-IFU, we describe the instrument as presented at its SRR (i.e. in the course of its preliminary definition phase, so-called B1), browsing through all the subsystems and associated requirements. We then show the instrument budgets, with a particular emphasis on the anticipated budgets of some of its key performance parameters, such as the instrument efficiency, spectral resolution, energy scale knowledge, count rate capability, non X-ray background and target of opportunity efficiency. Finally, we briefly discuss the ongoing key technology demonstration activities, the calibration and the activities foreseen in the X-IFU Instrument Science Center, touch on communication and outreach activities, the consortium organisation and the life cycle assessment of X-IFU aiming at minimising the environmental footprint, associated with the development of the instrument. Thanks to the studies conducted so far on X-IFU, it is expected that along the design-to-cost exercise requested by ESA, the X-IFU will maintain flagship capabilities in spatially resolved high resolution X-ray spectroscopy, enabling most of the original X-IFU related scientific objectives of the Athena mission to be retained. The X-IFU will be provided by an international consortium led by France, The Netherlands and Italy, with ESA member state contributions from Belgium, Czech Republic, Finland, Germany, Poland, Spain, Switzerland, with additional contributions from the United States and Japan.The French contribution to X-IFU is funded by CNES, CNRS and CEA. This work has been also supported by ASI (Italian Space Agency) through the Contract 2019-27-HH.0, and by the ESA (European Space Agency) Core Technology Program (CTP) Contract No. 4000114932/15/NL/BW and the AREMBES - ESA CTP No.4000116655/16/NL/BW. This publication is part of grant RTI2018-096686-B-C21 funded by MCIN/AEI/10.13039/501100011033 and by “ERDF A way of making Europe”. This publication is part of grant RTI2018-096686-B-C21 and PID2020-115325GB-C31 funded by MCIN/AEI/10.13039/501100011033

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Dentro il casinò: quando il gioco si fa “malato”

Con questo contributo si intende porre in luce l'affinità fra la concezione tipicamente clinica del gioco d'azzardo eccessivo e quella “pratica” – seppur scevra da ogni conoscenza teorica specifica – di alcuni lavoratori di gioco, specificamente alcuni impiegati di un Casinò italiano. L'obiettivo dell'analisi è dunque quello di porre in luce come alcuni lavoratori che operano nell'ambiente del gioco d'azzardo possano essere considerati portatori di una particolare conoscenza nell'ambito della diagnostica clinica del PG (Pathological Gambling), “esperti del settore” alla stregua di medici, psicologi e psichiatri. L'analisi condotta mira inoltre a rilevare come tale “esperienza” nell'individuazione di soggetti con problematiche connesse ad una pratica di gioco eccessiva o non equilibrata non venga utilizzata, poiché l'individuazione e l'eventuale allontanamento dalla Casa da Gioco di tali soggetti si pone in contrasto con gli interessi economici dell'azienda e dei singoli lavoratori. Le but de cet article est de mettre en lumière les similitudes entre la conception typiquement clinique de jeu excessif et celle « pratique » - bien que sans aucune connaissance théorique spécifique - de certains travailleurs du secteur des jeux de hasard, particulièrement de certains travailleurs d'un casino en Italie. L'objectif de l'analyse est de montrer comment certains travailleurs de jeu peuvent être considéré comme porteurs de connaissances nécessaires pour établir un diagnostic clinique de PG (Pathological Gambling, jeu pathologique), comme « experts dans le secteur » de la même manière que les médecins, psychologues et psychiatres. L'analyse vise également à souligner que cette « expérience » de l'identification de personnes ayant une pratique inadaptée, persistante et répétée du jeu n'est jamais utilisée pour l'identification et la possible expulsion de ces joueurs de la Maison de Jeu, car il serait contraire aux intérêts économiques aussi bien de l'entreprise que des travailleurs. The purpose of this contribution is to highlight similarities between the pure clinical conception of excessive gambling and the “practical” side of it – though free from any specific theoretical knowledge – as witnessed by employees in the gambling field, specifically employees of one Italian casino. The aim of the analysis is to highlight how workers in the gambling field can be considered as bearers of a particular knowledge in the clinical diagnosis of PG (Pathological Gambling) “experts of the industry” in the same way as doctors, psychologists and psychiatrists. The analysis also aims at revealing how this “experience” in identifying patients with problems related to excessive or unbalanced gambling is not, in any way, used for identifying and possibly expelling these subjects from the Gambling House because it would be in contrast with the economic interests of the company and of individual workers

La spirale dell’azzardo: una subcultura del gioco che “evapora” le relazioni

Nel presente contributo vengono analizzate le caratteristiche di quella che ho definito “subcultura dell'azzardo”, rilevabile in determinati ambienti ludici e in sotto-gruppi di giocatori particolarmente “accaniti”. Di queste forme di subcultura sono state individuate norme e sanzioni, valori, comportamenti consolidati, caratterizzazione delle relazioni e delle interazioni, giungendo alla conclusione che quello che viene costruito negli spazi di gioco rappresenta un universo separato, un “extraluogo”, nel quale vengono scritte nuove regole e nel quale cambiano i valori rispetto al mondo “esterno”. È stato possibile inoltre concludere che l'adesione all'“universo gioco” – l'interiorizzazione delle sue norme, la condivisione dei suoi valori, lo sviluppo di relazioni al suo interno – rappresenta un fattore di mantenimento della condotta ludica, poiché permette di considerare “normale” il proprio comportamento grazie ai rinforzi positivi che giungono dal gruppo dei compagni-giocatori e alla neutralizzazione dei possibili rinforzi negativi che provengono invece dai “non-giocatori”. Dans cet article, l’auteur analyse les caractéristiques de ce qu’elle a appelé « sous-culture des jeux de hasard », décelable dans certains milieux de loisirs et dans les sous-groupes de joueurs particulièrement « acharnés ». Parmi ces formes de sous-culture, l’article va identifier les règles et les sanctions, les valeurs, les comportements durables, la caractérisation des relations et des interactions, en concluant que ce qui est construit dans l'espace du jeu est un univers séparé, une «réalité extérieure» dans laquelle des nouvelles règles sont écrites et où les valeurs changent par rapport au «monde extérieur» . Il a également été possible de conclure que l'adhésion à l' «univers du jeu» - l'internalisation de ses normes, le partage de ses valeurs, le développement des relations en son sein - est un facteur de maintenance de la conduite du jeu, car cette adhésion permet d'envisager comme «normal» son propre comportement grâce à des réactions positives provenant des compagnons de jeu et à la neutralisation d’éventuelles réactions négatives provenant des «non joueurs» . In this paper I have analysed the characteristics of what I define the “gambling subculture”, which is detectable in certain gaming environments and in subgroups of particularly “rabid” players. Within these subcultures there have been identified rules and sanctions, values, consolidate behaviours, characterization of relationships and interactions, and the conclusion is that what is built within the gambling environment is a separate universe, an “outer reality”, in which the values of the world “outside” change. It was also possible to conclude that, to join the gambling world for a gambler – learning its rules, sharing its values, developing relations inside it – represents a stimulus for gambling habits, as it allows to consider as “normal” their behaviour thanks to positive feedback from their groups of fellow players, and to the neutralization of possible negative feedback from “non-players”

Dentro il casinò: quando il gioco si fa “malato” / Dans le casino : quand le jeu devient pathologie / Inside the casino: when the game becomes “pathological”

The purpose of this contribution is to highlight similarities between the pure clinical conception of excessive gamblingand the “practical” side of it – though free from any specific theoretical knowledge – as witnessed by employees in thegambling field, specifically employees of one Italian casino. The aim of the analysis is to highlight how workers in thegambling field can be considered as bearers of a particular knowledge in the clinical diagnosis of PG (PathologicalGambling) “experts of the industry” in the same way as doctors, psychologists and psychiatrists. The analysis also aimsat revealing how this “experience” in identifying patients with problems related to excessive or unbalanced gambling isnot, in any way, used for identifying and possibly expelling these subjects from the Gambling House because it wouldbe in contrast with the economic interests of the company and of individual workers.Con questo contributo si intende porre in luce l'affinità fra la concezione tipicamente clinica del gioco d'azzardoeccessivo e quella “pratica” – seppur scevra da ogni conoscenza teorica specifica – di alcuni lavoratori di gioco,specificamente alcuni impiegati di un Casinò italiano. L'obiettivo dell'analisi è dunque quello di porre in luce comealcuni lavoratori che operano nell'ambiente del gioco d'azzardo possano essere considerati portatori di una particolareconoscenza nell'ambito della diagnostica clinica del PG (Pathological Gambling), “esperti del settore” alla stregua dimedici, psicologi e psichiatri. L'analisi condotta mira inoltre a rilevare come tale “esperienza” nell'individuazione disoggetti con problematiche connesse ad una pratica di gioco eccessiva o non equilibrata non venga utilizzata, poichél'individuazione e l'eventuale allontanamento dalla Casa da Gioco di tali soggetti si pone in contrasto con gli interessieconomici dell'azienda e dei singoli lavoratori.Le but de cet article est de mettre en lumière les similitudes entre la conception typiquement clinique de jeu excessif etcelle « pratique » - bien que sans aucune connaissance théorique spécifique - de certains travailleurs du secteur des jeuxde hasard, particulièrement de certains travailleurs d'un casino en Italie. L'objectif de l'analyse est de montrer commentcertains travailleurs de jeu peuvent être considéré comme porteurs de connaissances nécessaires pour établir undiagnostic clinique de PG (Pathological Gambling, jeu pathologique), comme « experts dans le secteur » de la mêmemanière que les médecins, psychologues et psychiatres. L'analyse vise également à souligner que cette « expérience »de l'identification de personnes ayant une pratique inadaptée, persistante et répétée du jeu n'est jamais utilisée pourl'identification et la possible expulsion de ces joueurs de la Maison de Jeu, car il serait contraire aux intérêtséconomiques aussi bien de l'entreprise que des travailleurs