Violence in forensic psychiatric facilities. A risk management perspective

Violence against healthcare workers is a global phenomenon. Psychiatric settings are among the places at greatest risk of being a victim of aggression. Several strategies aimed at preventing violence in healthcare settings and implement protective measures have been proposed. Nevertheless, forensic psychiatric settings have been poorly investigated from the point of view of clinical risk management, especially in Italy. The recent process of deinstitutionalization of forensic psychiatric patients in Italy, with the replacement of former forensic psychiatric hospitals with small regional-based community structures (REMS), deserves particular attention in terms of clinical risk management. We propose in the following contribution a methodology that allows to measure the risk of violent behavior in different psychiatric forensic settings, from the point of view of clinical risk management. This includes a proposed adaptation of the Modified Overt Aggression Scale (MOAS) for the specific purpose. The use of such approach, including the calculation of a structure’s “risk score” could allow comparisons between different facilities as well as the implementation of strategies aimed at minimizing the frequency of violent acts, as well as activating the most suitable measures to prevent the

Tutela della salute in carcere, durante la pandemia Covid-19

Being detained in jail is an acknowledged risk factor for physical and psychiatric morbidity. The impact of COVID-19 pandemicon the penitentiary system, already characterized by criticalities in terms of healthcare, including high infectious risk, has beenconsidered a source of further danger within the prison and for the community. This problem has been raised by several observers, in the absence of a shared approach between states. The Italian Government enacted a series of measures aimed at penitentiary structures, to contain and manage health and safety risks. General precautions for infections prevention have been used, including frequent hands washing and environmental cleaning and disinfection procedures. Physical distancing in jail is extremely challenging, and we deem that it was still impossible to apply it, despite the release of almost 8000 detainees, among those at greater health risk. Measures have been also ordered to limit external contacts with detainees, including a substantial or absolute suspension of visits from relatives, operators and lawyers, replaced by video meetings. Quarantine and isolation of suspect cases has also been ordered, including new prisoners. Despite unfavorable premises the analysis we did on available data indicates lower infection rate and lethality rate in prison than in general population. In this paper a synthetic framework of the sanitary problems in detention will be provided, then the data will be analyzed, providing possible interpretations potentially useful for the management of the pandemic at the community level. Infectious surveillance, compliance with sanitation standards, early treatment of suspected cases, lower mean age, efficacious isolation and quarantine strategies may explain the better outcomes in Italian penitentiary system, also in the impossibility to systematically apply physical distancing. La restrizione in ambiente intramurario è un noto fattore di rischio in termini di morbidità per patologie fisiche e psichiche. L’impatto di una pandemia quale la COVID-19 sul sistema penitenziario, caratterizzato da plurime criticità in termini di gestione sanitaria, rischia potenzialmente di determinare gravi effetti sulla salute di detenuti e operatori. A livello internazionale tale problematica è stata sollevata e descritta, in assenza di un approccio condiviso tra gli stati dell’Unione Europea. In Italia, uno dei paesi maggiormente colpiti in termini di contagi e mortalità, si è assistito all’applicazione di una serie di misure dirette alle strutture penitenziarie, atte al contenimento ed alla gestione dei rischi per la salute e la sicurezza. L’ambiente carcerario, tuttavia, notoriamente caratterizzato da sovraffollamento e gravato da fattori di rischio specifici, rende problematico adottare una serie di misure che sono state invece previste per la popolazione generale. Il distanziamento fisico in carcere è estremamente problematico, e riteniamo che sia stato impossibile applicarlo, nonostante il rilascio di quasi 8000 detenuti, tra quelli a maggior rischio per la salute. Sono state inoltre disposte misure per limitare i contatti esterni con i detenuti, compresa una sospensione sostanziale o assoluta delle visite di parenti, operatori e avvocati, sostituita da videoconferenze. Sono stati ordinati anche la quarantena e l'isolamento dei casi sospetti, compresi i nuovi detenuti. Nonostante tali sfavorevoli premesse, l’analisi dei dati da noi effettuata circa i contagi ed i decessi in carcere, sino al 1° maggio 2020, indicano un tasso di infezione paragonabile alla popolazione generale, ed un tasso di letalità significativamente inferiore. Nel presente lavoro, dopo aver fornito un inquadramento sintetico delle problematiche sanitarie in ambito detentivo, si discuteranno i dati fornendo possibili interpretazioni di potenziale utilità per la gestione a livello comunitario.&nbsp

Lunar Propellant Factory Mission Design To Sustain Future Human Exploration

The International Space Exploration Coordination Group (ISECG) Global Exploration Roadmap (GER) is the standard document reflecting the current focus of the leading space agencies that envision space exploration missions beyond Low Earth Orbit (LEO), returning to the Moon and going to Mars in the upcoming years. The roadmap showcases the Moon as a stepping-stone for further human space exploration, by setting up a sustainable space infrastructure on its surface an orbit. Inspired from this vision, we present the result of a phase A study about a lunar propellant factory near the Shackleton south-pole crater relying on In-Situ Resources Utilization (ISRU) to produce and sell Liquid Oxygen (LOX) on the moon surface and in orbit. The overall timeline of the mission is in line with the ISECG exploration roadmap Moon phase, based on realistic technologies of advanced-enough Technology Readiness Levels (TRL). It is a second iteration on the Lunar Propellant Outpost (LUPO) mission architecture, presented during IAC 2018. We preserved and reviewed the original building blocks (Habitats, Crew Mobility Elements, ISRU Facilities, and Lunar Spaceport) of the LUPO mission architecture, and further improved the mission design, supported by trade-off analysis on different mission scenarios. An extensive analysis and optimisation have been performed on ISRU processes and surface electrical power management, the core of our infrastructure. The mission architecture also includes crew on the lunar surface, so life support systems and habitat, as well as operations concepts, have been studied in-depth, and a synthesis of all results is presented. The main aim of this iteration was to improve and refine the baseline infrastructural and technological design architecture of LUPO and reflect on missions going beyond the Moon by providing refuelling services, with sustainability and economic viability in mind