An ontology-based approach supporting holistic structural design with the consideration of safety, environmental impact and cost

Early stage decision-making for structural design critically influences the overall cost and environmental performance of buildings and infrastructure. However, the current approach often fails to consider the multi-perspectives of structural design, such as safety, environmental issues and cost in a comprehensive way. This paper presents a holistic approach based on knowledge processing (ontology) to facilitate a smarter decision-making process for early design stage by informing designers of the environmental impact and cost along with safety considerations. The approach can give a reasoning based quantitative understanding of how the design alternatives using different concrete materials can affect the ultimate overall performance. Embodied CO2 and cost are both considered along with safety criteria as indicative multi-perspectives to demonstrate the novelty of the approach. A case study of a concrete structural frame is used to explain how the proposed method can be used by structural designers when taking multi performance criteria into account. The major contribution of the paper lies on the creation of a holistic knowledge base which links through different knowledge across sectors to enable the structural engineer to come up with much more comprehensive decisions instead of individual single objective targeted delivery

Insight in cognitive impairment assessed with the Cognitive Assessment Interview in a large sample of patients with schizophrenia

The Cognitive Assessment Interview (CAI) is an interview-based scale measuring cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZ). The present study aimed at assessing, in a large sample of SCZ (n = 601), the agreement between patients and their informants on CAI ratings, to explore patients' insight in their cognitive deficits and its relationships with clinical and functional indices. Agreement between patient- and informant-based ratings was assessed by the Gwet's agreement coefficient. Predictors of insight in cognitive deficits were explored by stepwise multiple regression analyses. Patients reported lower severity of cognitive impairment vs. informants. A substantial to almost perfect agreement was observed between patients' and informants' ratings. Lower insight in cognitive deficits was associated to greater severity of neurocognitive impairment and positive symptoms, lower severity of depressive symptoms, and older age. Worse real-life functioning was associated to lower insight in cognitive deficit, worse neurocognitive performance, and worse functional capacity. Our findings indicate that the CAI is a valid co-primary measure with the interview to patients providing a reliable assessment of their cognitive deficits. In the absence of informants with good knowledge of the subject, the interview to the patient may represent a valid alternative

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

The association between insight and depressive symptoms in schizophrenia: Undirected and Bayesian network analyses

Background. Greater levels of insight may be linked with depressive symptoms among patients with schizophrenia, however, it would be useful to characterize this association at symptom-level, in order to inform research on interventions. Methods. Data on depressive symptoms (Calgary Depression Scale for Schizophrenia) and insight (G12 item from the Positive and Negative Syndrome Scale) were obtained from 921 community-dwelling, clinically-stable individuals with a DSM-IV diagnosis of schizophrenia, recruited in a nationwide multicenter study. Network analysis was used to explore the most relevant connections between insight and depressive symptoms, including potential confounders in the model (neurocognitive and social-cognitive functioning, positive, negative and disorganization symptoms, extrapyramidal symptoms, hostility, internalized stigma, and perceived discrimination). Bayesian network analysis was used to estimate a directed acyclic graph (DAG) while investigating the most likely direction of the putative causal association between insight and depression. Results. After adjusting for confounders, better levels of insight were associated with greater self-depreciation, pathological guilt, morning depression and suicidal ideation. No difference in global network structure was detected for socioeconomic status, service engagement or illness severity. The DAG confirmed the presence of an association between greater insight and self-depreciation, suggesting the more probable causal direction was from insight to depressive symptoms. Conclusions. In schizophrenia, better levels of insight may cause self-depreciation and, possibly, other depressive symptoms. Person-centered and narrative psychotherapeutic approaches may be particularly fit to improve patient insight without dampening self-esteem

The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia

How to Clean and Safely Remove HF from Acid Digestion Solutions for Ultra-Trace Analysis: A Microwave-Assisted Vessel-Inside-Vessel Protocol

The complete dissolution of silicate-containing materials, often necessary for elemental determination, is generally performed by microwave-assisted digestion involving the forced use of hydrofluoric acid (HF). Although highly efficient in dissolving silicates, this acid exhibits many detrimental effects (e.g., formation of precipitates, corrosiveness to glassware) that make its removal after digestion essential. The displacement of HF is normally achieved by evaporation in open-vessel systems: atmospheric contamination or loss of analytes can occur when fuming-off HF owing to the non-ultraclean conditions necessarily adopted for safety reasons. This aspect strongly hinders determination at the ultra-trace level. To overcome this issue, we propose a clean and safe microwave-assisted procedure to induce the evaporative migration of HF inside a sealed “vessel-inside-vessel” system: up to 99.9% of HF can be removed by performing two additional microwave cycles after sample dissolution. HF migrates from the digestion solution to a scavenger (ultrapure H2O) via a simple physical mechanism, and then, it can be safely dismissed/recycled. The procedure was validated by a soil reference material (NIST 2710), and no external or cross-contamination was observed for the 27 trace elements studied. The results demonstrate the suitability of this protocol for ultra-trace analysis when the utilization of HF is mandatory

How to Clean and Safely Remove HF from Acid Digestion Solutions for Ultra-Trace Analysis: A Microwave-Assisted Vessel-Inside-Vessel Protocol

The complete dissolution of silicate-containing materials, often necessary for elemental determination, is generally performed by microwave-assisted digestion involving the forced use of hydrofluoric acid (HF). Although highly efficient in dissolving silicates, this acid exhibits many detrimental effects (e.g., formation of precipitates, corrosiveness to glassware) that make its removal after digestion essential. The displacement of HF is normally achieved by evaporation in open-vessel systems: atmospheric contamination or loss of analytes can occur when fuming-off HF owing to the non-ultraclean conditions necessarily adopted for safety reasons. This aspect strongly hinders determination at the ultra-trace level. To overcome this issue, we propose a clean and safe microwave-assisted procedure to induce the evaporative migration of HF inside a sealed “vessel-inside-vessel” system: up to 99.9% of HF can be removed by performing two additional microwave cycles after sample dissolution. HF migrates from the digestion solution to a scavenger (ultrapure H2O) via a simple physical mechanism, and then, it can be safely dismissed/recycled. The procedure was validated by a soil reference material (NIST 2710), and no external or cross-contamination was observed for the 27 trace elements studied. The results demonstrate the suitability of this protocol for ultra-trace analysis when the utilization of HF is mandatory.publishedVersio

Cerebral palsy rehabilitation: comparison between italian child centred and canadian family centred healthcare models

BACKGROUNDAmong disabling pathologies, that affect children from birth, Cerebral Palsy (CP) is the most important for frequency and multiplicity of associated disorders. Care of CP requires a long and complex rehabilitation process that involves healthcare services, educational facilities, and social agencies, but above all family members (SCPE 2000).In Canada, families have decision-making power in childcare, which includes rehabilitation treatments and socio-educational interventions. This family-centered approach presupposes a shared responsibility between caregivers and family in planning and applying child rehabilitation therapies. In Italy, “Recommendations for cerebral palsy rehabilitation” provide for a drafting of an Individual Rehabilitation Plan (PRI), according to the ICF-CY model. Designing the therapeutic project (PRI) is the physician’s responsibility, who subsequently involves the family in reaching objectives, timing interventions, realizing setting modalities and measuring outcomes. This approach is child-centered, however with the participatory involvement of family.The aim of this study is to compare the perception of Italian and Canadian families regarding these two different healthcare models in CP rehabilitation.MethodsData from 219 MPOC-20 and 75 MPOC-SP questionnaires were collected from child healthcare services in Emilia Romagna Region and compared to Ontario province data published by CanChild.ResultsBy comparing MPOC-20 and MPOC-SP results obtained in Emilia Romagna and Ontario, we found that average values of various domains reveal few differences. The only domain showing lower results for Emilia Romagna concerned child-specific information supply (Emilia Romagna average is 4.69, Ontario is 5.23). On the contrary, for all the remaining domains, Emilia Romagna had higher averages. Considering physiotherapist questionnaires, we found higher satisfaction levels regarding treatment in Ontario. The greatest difference related to the “Providing General Information” domain: parental perception; Emilia Romagna average was 3.74, while Ontario’s average was 4.68. For the domain “Showing Interpersonal Sensitivity”, satisfaction was high for both countries: 5.76 in Emilia Romagna, 5.83 in Ontario.DiscussionCommunication regarding general aspects, pathology and treatment information must be improved in Emilia Romagna in order to increase satisfaction and cooperation between families and healthcare professionals.ConclusionsThe study results allow us to conclude that Italian and Canadian family satisfaction of healthcare quality is quite similar, and that the Italian model of CP rehabilitation, with a few slight modifications, could be judged competitive. An organizational model focused on the child, constantly involving the family in care programs, which we could coin "Child and Family Centre approach", would seem to be the key to a higher quality, efficacy and efficiency service.BACKGROUNDAmong disabling pathologies, that affect children from birth, Cerebral Palsy (CP) is the most important for frequency and multiplicity of associated disorders. Care of CP requires a long and complex rehabilitation process that involves healthcare services, educational facilities, and social agencies, but above all family members (SCPE 2000).In Canada, families have decision-making power in childcare, which includes rehabilitation treatments and socio-educational interventions. This family-centered approach presupposes a shared responsibility between caregivers and family in planning and applying child rehabilitation therapies. In Italy, “Recommendations for cerebral palsy rehabilitation” provide for a drafting of an Individual Rehabilitation Plan (PRI), according to the ICF-CY model. Designing the therapeutic project (PRI) is the physician’s responsibility, who subsequently involves the family in reaching objectives, timing interventions, realizing setting modalities and measuring outcomes. This approach is child-centered, however with the participatory involvement of family.The aim of this study is to compare the perception of Italian and Canadian families regarding these two different healthcare models in CP rehabilitation.MethodsData from 219 MPOC-20 and 75 MPOC-SP questionnaires were collected from child healthcare services in Emilia Romagna Region and compared to Ontario province data published by CanChild.ResultsBy comparing MPOC-20 and MPOC-SP results obtained in Emilia Romagna and Ontario, we found that average values of various domains reveal few differences. The only domain showing lower results for Emilia Romagna concerned child-specific information supply (Emilia Romagna average is 4.69, Ontario is 5.23). On the contrary, for all the remaining domains, Emilia Romagna had higher averages. Considering physiotherapist questionnaires, we found higher satisfaction levels regarding treatment in Ontario. The greatest difference related to the “Providing General Information” domain: parental perception; Emilia Romagna average was 3.74, while Ontario’s average was 4.68. For the domain “Showing Interpersonal Sensitivity”, satisfaction was high for both countries: 5.76 in Emilia Romagna, 5.83 in Ontario.DiscussionCommunication regarding general aspects, pathology and treatment information must be improved in Emilia Romagna in order to increase satisfaction and cooperation between families and healthcare professionals.ConclusionsThe study results allow us to conclude that Italian and Canadian family satisfaction of healthcare quality is quite similar, and that the Italian model of CP rehabilitation, with a few slight modifications, could be judged competitive. An organizational model focused on the child, constantly involving the family in care programs, which we could coin "Child and Family Centre approach", would seem to be the key to a higher quality, efficacy and efficiency service

Riabilitazione della paralisi cerebrale infantile: confronto tra il modello italiano centrato sul bambino e il modello canadese centrato sulla famiglia

BACKGROUNDAmong disabling pathologies, that affect children from birth, Cerebral Palsy (CP) is the most important for frequency and multiplicity of associated disorders. Care of CP requires a long and complex rehabilitation process that involves healthcare services, educational facilities, and social agencies, but above all family members (SCPE 2000).In Canada, families have decision-making power in childcare, which includes rehabilitation treatments and socio-educational interventions. This family-centered approach presupposes a shared responsibility between caregivers and family in planning and applying child rehabilitation therapies. In Italy, “Recommendations for cerebral palsy rehabilitation” provide for a drafting of an Individual Rehabilitation Plan (PRI), according to the ICF-CY model. Designing the therapeutic project (PRI) is the physician’s responsibility, who subsequently involves the family in reaching objectives, timing interventions, realizing setting modalities and measuring outcomes. This approach is child-centered, however with the participatory involvement of family.The aim of this study is to compare the perception of Italian and Canadian families regarding these two different healthcare models in CP rehabilitation.MethodsData from 219 MPOC-20 and 75 MPOC-SP questionnaires were collected from child healthcare services in Emilia Romagna Region and compared to Ontario province data published by CanChild.ResultsBy comparing MPOC-20 and MPOC-SP results obtained in Emilia Romagna and Ontario, we found that average values of various domains reveal few differences. The only domain showing lower results for Emilia Romagna concerned child-specific information supply (Emilia Romagna average is 4.69, Ontario is 5.23). On the contrary, for all the remaining domains, Emilia Romagna had higher averages. Considering physiotherapist questionnaires, we found higher satisfaction levels regarding treatment in Ontario. The greatest difference related to the “Providing General Information” domain: parental perception; Emilia Romagna average was 3.74, while Ontario’s average was 4.68. For the domain “Showing Interpersonal Sensitivity”, satisfaction was high for both countries: 5.76 in Emilia Romagna, 5.83 in Ontario.DiscussionCommunication regarding general aspects, pathology and treatment information must be improved in Emilia Romagna in order to increase satisfaction and cooperation between families and healthcare professionals.ConclusionsThe study results allow us to conclude that Italian and Canadian family satisfaction of healthcare quality is quite similar, and that the Italian model of CP rehabilitation, with a few slight modifications, could be judged competitive. An organizational model focused on the child, constantly involving the family in care programs, which we could coin "Child and Family Centre approach", would seem to be the key to a higher quality, efficacy and efficiency service.BACKGROUNDTra le patologie disabilitanti che possono colpire i bambini fin dalla nascita, la Paralisi Cerebrale Infantile (PCI) occupa il primo posto, sia per la frequenza, sia per la molteplicità di disturbi intercorrenti. La cura della PCI richiede quindi un percorso riabilitativo lungo e complesso, che investe i servizi sanitari, le strutture educative, le agenzie sociali ma anche e soprattutto il contesto famigliare.Da circa trent’anni in Canada viene proposto un approccio centrato sulla famiglia definito Family Centered Care. Questo tipo di approccio presuppone una responsabilità condivisa tra i portatori di cure e le famiglie nella progettazione, pianificazione e applicazione delle cure rivolte al bambino. In Italia, Le Linee Guida prevedono la stesura del Piano Riabilitativo Individuale (PRI) che prevede il consenso informato della famiglia all’atto medico; la responsabilità del progetto terapeutico è assunta unicamente dal medico riabilitatore che informerà la famiglia e concordare con essa e gli altri operatori socio sanitari dell’equipe gli obiettivi riabilitativi, le modalità, le misure di esito attese e le tempistiche degli interventi attraverso la stesura di programmi terapeutici condivisi in un modello che si presenta così “child centered” ma con un coinvolgimento partecipativo costante della famiglia.Lo scopo di questo studio è confrontare la percezione delle famiglie Italiane e Canadesi riguardo ai due differenti modelli di assistenza sanitaria nella riabilitazione delle patologie neuromotorie infantili.MetodiSono stati raccolti i dati di 219 questionari MPOC-20 e di 75 MPOC-SP, provenienti dai servizi territoriali infantili della regione Emilia Romagna, e comparati con i dati della provincia dell’Ontario pubblicati dal gruppo CanChild.RisultatiConfrontando i risultati dei questionari MPOC-20 e MPOC-SP ottenuti in Emilia Romagna e in Ontario, abbiamo riscontrato che le valutazioni medie nei diversi domini presentano poche differenze. L’unico dominio che mostra un valore più basso nei dati italiani riguarda "Fornire le informazioni specifiche riguardanti il bambino" (in Emilia Romagna la media è 4.69, in Ontario 5.23). Al contrario, per tutti gli altri domini, in Emilia Romagna la media è più alta rispetto all'Ontario. Se invece consideriamo il questionario compilato dai Fisioterapisti, riscontriamo un più alto livello di soddisfazione per quanto riguarda il trattamento in Ontario. La media in Emilia Romagna, infatti, risulta 3.74, mentre in Ontario 4.68. La differenza maggiore viene riscontrata nel dominio “Fornire le Informazioni generali”. Al contrario, la media è più alta in Emila Romagna quando il fisioterapista valuta la sensibilità interpersonale. Nel dominio “Mostrare Sensibilità Interpersonale” la soddisfazione è alta in entrambe le nazioni: 5.76 in Emilia Romagna, 5.83 in Ontario.DiscussioneIn Emilia Romagna, la comunicazione tra famiglie ed operatori sanitari riguardante le informazioni generali, la patologia e il trattamento dovrebbe essere migliorata per aumentare la soddisfazione e la collaborazione, limitare le problematiche sociali e psicologiche riducendo così la richiesta di trattamenti complementari o alternativi.ConclusioniI risultati dello studio ci permettono di concludere che la soddisfazione delle famiglie italiane e canadesi riguardo la qualità dell’assistenza è abbastanza simile e che, con alcune lievi modifiche, il modello italiano di riabilitazione nella PCI potrebbe rimanere competitivo.Un modello dei servizi che ponga al centro il bambino coinvolgendo in maniera costante la famiglia nel suo programma di cure che potremmo così definire “child and family centered” sembra essere la chiave di lettura per proporre servizi di qualità, efficacia ed efficienza