The spatial logic of fear

Peripersonal space (PPS) refers to the space surrounding the body. PPS is characterised by distinctive patterns of multisensory integration and sensory-motor interaction. In addition, facial expressions have been shown to modulate PPS representation. In this study we tested whether fearful faces lead to a different distribution of spatial attention, compared to neutral and joyful faces. Participants responded to tactile stimuli on the cheeks, while watching looming neutral, joyful (Experiment 1) or fearful (Experiment 2) faces of an avatar, appearing in far or near space. To probe spatial attention, when the tactile stimulus was delivered, a static ball briefly appeared central or peripheral in participant's vision, respectively ≈1° or ≈10° to the left or right of the face. With neutral and joyful faces, simple reactions to tactile stimuli were facilitated in near rather than in far space, replicating classic PPS effects, and in the presence of central rather than peripheral ball, suggesting that attention may be focused in the immediate surrounding of the face. However, when the face was fearful, response to tactile stimuli was modulated not only by the distance of the face from the participant, but also by the position of the ball. Specifically, in near space only, response to tactile stimuli was additionally facilitated by the peripheral compared to the central ball. These results suggest that as fearful faces come closer to the body, they promote a redirection of attention towards the periphery. Given the sensory-motor functions of PPS, this fear-evoked redirection of attention would enhance the defensive function of PPS specifically when it is most needed, i.e. when the source of threat is nearby, but its location has not yet been identified

Fearful faces modulate spatial processing in peripersonal space: An ERP study

Peripersonal space (PPS) represents the region of space surrounding the body. A pivotal function of PPS is to coordinate defensive responses to threat. We have previously shown that a centrally-presented, looming fearful face, signalling a potential threat in one's surroundings, modulates spatial processing by promoting a redirection of sensory resources away from the face towards the periphery, where the threat may be expected – but only when the face is presented in near, rather than far space. Here, we use electrophysiological measures to investigate the neural mechanism underlying this effect. Participants made simple responses to tactile stimuli delivered on the cheeks, while watching task-irrelevant neutral or fearful avatar faces, looming towards them either in near or far space. Simultaneously with the tactile stimulation, a ball with a checkerboard pattern (probe) appeared to the left or right of the avatar face. Crucially, this probe could either be close to the avatar face, and thus more central in the participant's vision, or further away from the avatar face, and thus more peripheral in the participant's vision. Electroencephalography was continuously recorded. Behavioural results confirmed that in near space only, and for fearful relative to neutral faces, tactile processing was facilitated by the peripheral compared to the central probe. This behavioural effect was accompanied by a reduction of the N1 mean amplitude elicited by the peripheral probe for fearful relative to neutral faces. Moreover, the faster the participants responded to tactile stimuli with the peripheral probe, relative to the central, the smaller was their N1. Together these results, suggest that fearful faces intruding into PPS may increase expectation of a visual event occurring in the periphery. This fear-induced effect would enhance the defensive function of PPS when it is most needed, i.e., when the source of threat is nearby, but its location remains unknown

Social inequalities in heat-attributable mortality in the city of Turin, northwest of Italy: a time series analysis from 1982 to 2018

Background: Understanding context specific heat-health risks in urban areas is important, especially given anticipated severe increases in summer temperatures due to climate change effects. We investigate social inequalities in the association between daily temperatures and mortality in summer in the city of Turin for the period 1982–2018 among different social and demographic groups such as sex, age, educational level, marital status and household occupants. Methods: Mortality data are represented by individual all-cause mortality counts for the summer months between 1982 and 2018. Socioeconomic level and daily mean temperature were assigned to each deceased. A time series Poisson regression with distributed lag non-linear models was fitted to capture the complex nonlinear dependency between daily mortality and temperature in summer. The mortality risk due to heat is represented by the Relative Risk (RR) at the 99th percentile of daily summer temperatures for each population subgroup. Results: All-cause mortality risk is higher among women (1.88; 95% CI = 1.77, 2.00) and the elderly (2.13; 95% CI = 1.94, 2.33). With regard to education, the highest significant effects for men is observed among higher education levels (1.66; 95% CI = 1.38, 1.99), while risks for women is higher for the lower educational level (1.93; 95% CI = 1.79, 2.08). Results on marital status highlighted a stronger association for widower in men (1.66; 95% CI = 1.38, 2.00) and for separated and divorced in women (2.11; 95% CI = 1.51, 2.94). The risk ratio of household occupants reveals a stronger association for men who lived alone (1.61; 95% CI = 1.39, 1.86), while for women results are almost equivalent between alone and not alone groups. Conclusions: The associations between heat and mortality is unequal across different aspects of social vulnerability, and, inter alia, factors influencing the population vulnerability to temperatures can be related to demographic, social, and economic aspects. A number of issues are identified and recommendations for the prioritisation of further research are provided. A better knowledge of these effect modifiers is needed to identify the axes of social inequality across the most vulnerable population sub-groups

Climate change adaptation cycle for pilot projects development in small municipalities: The northwestern Italian regions case study

More than half of the European population live in small and medium size municipalities, where climate adaptation planning is an under-researched topic within the climate change field. Many constraints might hinder the implementation of adaptation pilot projects due to lack of economic, knowledge, and technical available resources. Local institutions find difficulties in building a coherent local adaptation planning and design processes with international and national frameworks. In this context, this article proposes a methodology based on the available international frameworks to support the small communities with the aim to implement adaptation pilot projects within different sectors. In doing so, this paper tests a climate change adaptation cycle for pilot projects development in small municipalities; the first in Italy for small municipalities under 20.000 inhabitants. The proposed methodology could lead local adaptation initiatives in climate change risk assessment by supporting the research communities in developing a coherent vision for the local territories and to identify proper oriented measures to enhance demonstrative pilot projects and to increase the level of resilience in small municipalities, avoiding maladaptation

Acute stress affects peripersonal space representation in cortisol stress responders.

Peripersonal space is the representation of the space near the body. It is implemented by a dedicated multisensory-motor network, whose purpose is to predict and plan interactions with the environment, and which can vary depending on environmental circumstances. Here, we investigated the effect on the PPS representation of an experimentally induced stress response and compared it to a control, non-stressful, manipulation. We assessed PPS representation in healthy humans, before and after a stressful manipulation, by quantifying visuotactile interactions as a function of the distance from the body, while monitoring salivary cortisol concentration. While PPS representation was not significantly different between the control and experimental group, a relation between cortisol response and changes in PPS emerged within the experimental group. Participants who showed a cortisol stress response presented enhanced visuotactile integration for stimuli close to the body and reduced for far stimuli. Conversely, individuals with a less pronounced cortisol response showed a reduced difference in visuotactile integration between the near and the far space. In our interpretation, physiological stress resulted in a freezing-like response, where multisensory-motor resources are allocated only to the area immediately surrounding the body

Experiencia de implementación de una Historia Clínica Electrónica en el servicio de Internación de un Hospital Polivalente de Córdoba, Argentina

La implementación de un sistema de registro médico informatizado presenta una serie de ventajas que permiten mejorar la calidad de la atención médica brindada y a la vez reducir los costos de prestar estos servicios. En este trabajo se presenta la experiencia del desarrollo e implementación de un sistema de Historia Clínica Electrónica en el Servicio de Internación de un Hospital General Polivalente donde coexistían una Historia Clínica Electrónica para el servicio ambulatorio y una Historia Clínica única por paciente en papel para el Internado. Se relata la experiencia de desarrollo, integración con los sistemas existentes, la capacitación e implementación, el manejo del cambio cultural necesario y la transición entre el uso de la historia clínica en papel y la electrónica.Sociedad Argentina de Informática e Investigación Operativ

Experiencia de implementación de un Kardex electrónico de Enfermería en un Hospital Polivalente de Córdoba, Argentina

La implementación de un sistema de registro médico informatizado presenta una serie de ventajas que permiten mejorar la calidad de la atención médica brindada y a la vez reducir los costos de prestación de estos servicios. Para llegar al objetivo mayor se deben trazar líneas estratégicas que disminuyen la complejidad de los pasos subsiguientes. En este trabajo se presenta la experiencia del desarrollo e implementación de un sistema Kardex Electrónico de Enfermería para el servicio de Internación como paso estratégico para el éxito de las sub siguientes fases del proyecto HCE para Internación. Se encuentra desarrollado en un Hospital General Polivalente donde coexistían una Historia Clínica Electrónica para el servicio ambulatorio y funcionalidad parcial de HCE para el servicio de internación. Se relata la experiencia de desarrollo, integración con los sistemas existentes, adquisición y distribución del equipamiento tecnológico, capacitación e implementación, manejo del cambio cultural necesario y transición entre el uso de registros en papel y el formato digital.Sociedad Argentina de Informática e Investigación Operativ

Experiencia de codificación con grd en el servicio de internación de un hospital polivalente

Las organizaciones del sector de la salud tienen una gran necesidad de contar con información para su gestión que sea de utilidad tanto desde el punto de vista médico como administrativo, pero en la práctica surgen grandes dificultades para su obtención. En este trabajo se presenta la experiencia del desarrollo inicial y evolución en el tiempo de un sistema de codificación en el servicio de Internación de un Hospital General Polivalente utilizando los Grupos Relacionados de Diagnósticos y se analiza el impacto que tuvo la implementación de un sistema de Historia Clínica Electrónica en la disponibilidad y calidad de los resultados del proceso de codificación.Sociedad Argentina de Informática e Investigación Operativ