The Italian ICD-11 field trial: clinical utility of diagnostic guidelines for schizophrenia and related disorders

Background The 11th revision of the International Classification of Diseases and Related Disorders (ICD-11) has been released. In order to test the clinical consistency and the clinical utility of the proposed guidelines the World Health Organization (WHO) has carried out the Ecological Implementation Field Studies in various countries. In this paper the results of the Italian field trials on the clinical utility of the ICD-11 diagnostic guideline concerning schizophrenia and related disorders will be presented. Methods In Italy, field trials have been carried out at the Department of Psychiatry of the University of Campania “L. Vanvitelli”. All patients showing any psychotic symptom and referring to the outpatient and inpatient units have been recruited. Patients were interviewed by two clinicians with whom they had not had any prior clinical contact. At the end of each interview, clinicians were asked to complete 12 questions about the clinical utility of the diagnostic guidelines as applied to each patient. Results Fourteen clinicians and 100 patients have been involved. The ICD-11 clinical guidelines were perceived as easy to use, with an adequate goodness of fit, clear and understandable and with an adequate level of details and specificity to describe the essential features of the diagnoses. Clinicians rated very positively their usefulness in describing the threshold between patient’s disorder and normality. Despite still very positive, the guidelines have been perceived as less useful to select a treatment, to assess patients’ prognosis and to communicate with other mental health professionals. Conclusions The 11th revision of the chapter on Mental, Behavioural and Neurodevelopmental Disorders has made substantive changes to the conceptualization of mental disorders which could have impacted on their reliability and clinical utility. Results of the Italian field studies, in line with those reported by the international sample, highlight that ICD-11 has been rated as highly clinically useful by participating clinician, more than the ICD-10. This could be considered a good reason to be optimistic about the implementation of the ICD-11 among global clinicians. Trial registration The study has been approved by the Ethical Review Board of the University of Campania “L. Vanvitelli” (N. 416, 2016

The 21 August 2017 Ischia (Italy) Earthquake Source Model Inferred From Seismological, GPS, and DInSAR Measurements

The causative source of the first damaging earthquake instrumentally recorded in the Island of Ischia, occurred on 21 August 2017, has been studied through a multiparametric geophysical approach. In order to investigate the source geometry and kinematics we exploit seismological, Global Positioning System, and Sentinel-1 and COSMO-SkyMed differential interferometric synthetic aperture radar coseismic measurements. Our results indicate that the retrieved solutions from the geodetic data modeling and the seismological data are plausible; in particular, the best fit solution consists of an E-W striking, south dipping normal fault, with its center located at a depth of 800 m. Moreover, the retrieved causative fault is consistent with the rheological stratification of the crust in this zone. This study allows us to improve the knowledge of the volcano-tectonic processes occurring on the Island, which is crucial for a better assessment of the seismic risk in the area.Published2193-22023T. Sorgente sismicaJCR Journa

Withdrawal of mechanical ventilation in amyotrophic lateral sclerosis patients: a multicenter Italian survey

Background: Law 219/2017 was approved in Italy in December 2017, after a years-long debate on the autonomy of healthcare choices. This Law, for the first time in Italian legislation, guarantees the patient's right to request for withdrawal of life-sustaining treatments, including mechanical ventilation (MV). Objective: To investigate the current status of MV withdrawal in amyotrophic lateral sclerosis (ALS) patients in Italy and to assess the impact of Law 219/2017 on this practice. Methods: We conducted a Web-based survey, addressed to Italian neurologists with expertise in ALS care, and members of the Motor Neuron Disease Study Group of the Italian Society of Neurology. Results: Out of 40 ALS Italian centers, 34 (85.0%) responded to the survey. Law 219/2017 was followed by an increasing trend in MV withdrawals, and a significant increase of neurologists involved in this procedure (p 0.004). However, variations across Italian ALS centers were observed, regarding the inconsistent involvement of community health services and palliative care (PC) services, and the intervention and composition of the multidisciplinary team. Conclusions: Law 219/2017 has had a positive impact on the practice of MV withdrawal in ALS patients in Italy. The recent growing public attention on end-of-life care choices, along with the cultural and social changes in Italy, requires further regulatory frameworks that strengthen tools for self-determination, increased investment of resources in community and PC health services, and practical recommendations and guidelines for health workers involved

Seismic vulnerability assessment of classes of reinforced concrete structures

Dottorato Scienza e Tecnica “Bernardino Telesio”, Ciclio XXVIII, a.a. 2015-2016The modern seismic design is based on the concept to meet different performance levels, for each of which the structure should not exceed the predetermined degrees of damage. The analysis of elastic-linear benefit from the simplicity of use and theoretical understanding, but are not able to predict the inelastic deformation capacity offered by a structure, for that reason they are unsuitable for a modern seismic design (based on the concept of performance), where the non-linear behavior and the conditions close to the collapse are investigated. To achieve an accurate and realistic prediction of the seismic response of a structure is necessary to have analytical tools that allow to figure out the nonlinear behavior and its evolution over time. The IDA, the Incremental Dynamic Analysis (designed by Prof. D. Vamvatsikos - foreign tutor's writer - and Professor C. A. Cornell), addresses the need to want to investigate the dynamic behavior of a structure at various levels of seismic intensity. Given an accelerogram, different dynamic analyzes on the same structure but with a seismic increasingly scaled input are performed, up to the collapse of the structure or until a predetermined level of deformation or displacement takes place. The incremental dynamic analyzes are clearly preferable like nonlinear analysis, because only with the previous is possible to grasp the dynamic behavior of the structure resulting in potential savings in terms of actions to be pursued. This is the concept on which is based the study carried out during this period: the evaluation of seismic vulnerability, especially of reinforced concrete structures, using the analysis above described Very significant and useful for the purpose of the research was the period spent abroad, during which a probabilistic and a statistical technique to assess losses caused by earthquakes of entire urban areas was developed. The used approach is "multi-level", for classes of buildings that represent the building types that are in the examined area. The starting point was the observation of an area inside the City Hall of Zografou, the district within which the NTUA (National Technic University of Athens) is located, by detecting some significant features of 305 surveyed buildings (such as number of floors, irregularities in height and in plant, year of construction). Each of these characteristics has been considered as discriminatory for the belonging of the particular building to a specific group. Homogeneous groups were then treated with techniques of statistical type, including the Clustering method, by which the number of the models (12 models) is resulted much lower than the number of the buildings analyzed, representative of the structures present in the whole area examined. Taking as a reference the legislation in force at time of the construction of each model to designing it (making choices about the statistical characteristics of the materials used), the results related to static analysis and IDA, have been considered for the assessment of seismic losses the whole area they represent. The approach based on "damage factor" compared to other models for which are known seismic losses, led to further evaluation in terms of statistical dispersion of results. The steps are repeatable, with the necessary precautions, in other areas, and they give the opportunity to describe the seismic fragility of the heritage of entire cities. The results are useful to provide valuable information to organizations such as the Civil Protection and / or insurance agenciesUniversità della Calabri

Research of the Critical Capitalization Rate in Building Damage Appraisal

From the perspective of building health monitoring and property management, this research proposes some parametric measures of the capitalization rate, in order to define a range of significant values to be used in a cash flow analysis intended for monetary evaluation in partial building damage assessment. If criteria and methods for appraising partial damage to buildings are widely shared in the scientific and professional communities, the identification of the most appropriate capitalization rate is rather more controversial, and certainly more complex. The proposed approach borrows the logical principles of cash flow analysis based on the yield capitalization approach, considering both recovery costs and loss of incomes when building partial damage occurs. The procedure is a differential valuation that considers a situation before and a situation after the damage, basing on the cost approach and the income approach. In particular, two distinct conditions are considered: the case of recovery interventions and that of improvement

Automated Valuation Methods through the Cost Approach in a BIM and GIS Integration Framework for Smart City Appraisals

The principle behind sustainable city movements is represented by the idea of “good living”, which is the possibility of having solutions and services that allow citizens to live in an easy, simple, and enjoyable way. Policies for urban quality play a central role in the slow cities manifesto, often suggesting the use of Information and Communication Technologies (ITC) in the development of interactive services for citizens. Among these, an interesting possibility is to offer citizens digital real estate consultancy services through the implementation of automated evaluation methods. An automated appraisal action—which is already complex in itself owing to the need to collect data in a consistent, standardized, but also differentiated way so as to require the adoption of real estate due diligence—collides on the operational level with the concrete difficulty of acquiring necessary data, much more so since the reference market is dark, atypical, and viscous. These operational difficulties are deepened by the epistemological nature of the appraisal discipline itself, which bases its methodology on the forecast postulate, recalling the need to objectify as much as possible the evaluation from the perspective of an intersubjective sharing argument. These circumstances have led, on the one hand, to the definition of internationally accepted uniform evaluation rules (IVS, 2017) and, on the other, to the testing of automated valuation methods aimed at returning computer-based appraisals (AVM). Starting from the awareness that real estate valuation refers essentially to information and georeferences, this paper aims to demonstrate how real estate appraisal analysis can be further improved through information technology (IT), directing real estate valuation towards objectivity in compliance with international valuation standards. Particularly, the paper intends to show the potential of combining geographic information systems (GISs) and building information models (BIMs) in automated valuation methods through the depreciated reproduction cost. The paper also proposes a BIM-GIS semi-automatic prototype based on the depreciated reconstruction cost through an experimentation in Rende (Italy)