Piracy and Quality Choice in Monopolistic Markets

We study the impact of piracy on the quality choices of a monopolist. In the absence of piracy, the monopolist has no incentive to differentiate its products. With piracy the monopolist might instead produce more than one quality, so that differentiation arises as the optimal strategy. This is because the producer wants to divert consumers from the pirated good to the original one. Differentiation involves either producing a new, low-quality good such that piracy is either eliminated or still observed in equilibrium

Acute effects of high-frequency microfocal vibratory stimulation on the H reflex of the soleus muscle. A double-blind study in healthy subjects

This study in healthy subjects examined the effects of a system delivering focal microvibrations at high frequency (Equistasi®) on tonic vibration stimulus (TVS)-induced inhibition of the soleus muscle H reflex. Highfrequency microvibrations significantly increased the inhibitory effect of TVS on the H reflex for up to three minutes. Moreover, Equistasi® also significantly reduced alpha-motoneuron excitability, as indicated by the changes in the ratio between the maximumamplitude H reflex (Hmax reflex) and the maximumamplitude muscle response (Mmax response); this effect was due to reduction of the amplitude of the H reflex because the amplitude of muscle response remained unchanged. The present findings indicate that Equistasi® has a modulatory effect on proprioceptive reflex circuits. Therefore, Equistasi® might interfere with some mechanisms involved in both physiological and pathophysiological control of movement and of posture

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

What is the role of the placebo effect for pain relief in neurorehabilitation? Clinical implications from the Italian consensus conference on pain in neurorehabilitation

Background: It is increasingly acknowledged that the outcomes of medical treatments are influenced by the context of the clinical encounter through the mechanisms of the placebo effect. The phenomenon of placebo analgesia might be exploited to maximize the efficacy of neurorehabilitation treatments. Since its intensity varies across neurological disorders, the Italian Consensus Conference on Pain in Neurorehabilitation (ICCP) summarized the studies on this field to provide guidance on its use. Methods: A review of the existing reviews and meta-analyses was performed to assess the magnitude of the placebo effect in disorders that may undergo neurorehabilitation treatment. The search was performed on Pubmed using placebo, pain, and the names of neurological disorders as keywords. Methodological quality was assessed using a pre-existing checklist. Data about the magnitude of the placebo effect were extracted from the included reviews and were commented in a narrative form. Results: 11 articles were included in this review. Placebo treatments showed weak effects in central neuropathic pain (pain reduction from 0.44 to 0.66 on a 0-10 scale) and moderate effects in postherpetic neuralgia (1.16), in diabetic peripheral neuropathy (1.45), and in pain associated to HIV (1.82). Moderate effects were also found on pain due to fibromyalgia and migraine; only weak short-term effects were found in complex regional pain syndrome. Confounding variables might have influenced these results. Clinical implications: These estimates should be interpreted with caution, but underscore that the placebo effect can be exploited in neurorehabilitation programs. It is not necessary to conceal its use from the patient. Knowledge of placebo mechanisms can be used to shape the doctor-patient relationship, to reduce the use of analgesic drugs and to train the patient to become an active agent of the therapy

A Short-Term Water Demand Forecasting Model Using a Moving Window on Previously Observed Data

In this article a model for forecasting water demands over a 24-hour time window using solely a pair of coefficients whose value is updated at every forecasting step is presented. The first coefficient expresses the ratio between the average water demand over the 24 hours that follow the time the forecast is made and the average water demand over the 24 hours that precede it. The second coefficient expresses the relationship between the average water demand in a generic hour falling within the 24-hour forecasting period and the average water demand over that period. These coefficients are estimated using the information available in the weeks prior to the time of forecasting and therefore the model does not require any actual calibration process. The length of the time series necessary to implement the model is thus just a few weeks (3-4 weeks) and the model can be parameterized and used without there being any need to collect hourly water demand data for long periods

Un nuovo metodo non iterativo per simulazioni pressure-driven in Epanet

• Nuovo metodo per la risoluzione Pressure Driven di una rete in pressione utilizzando il software EPANET da interfaccia mediante l’uso di una particolare sequenza di dispositivi da collegare a ogni nodo. • Nella sequenza di dispositivi viene fatto uso della valvola GPV (General Purpose Valve) mediante la quale è possibile definire una generica relazione tra portata erogata e carico disponibile al nodo. • L’applicazione a due casi studio e il confronto con altri metodi di letteratura evidenziano la validità del metodo

A new non-iterative method for pressure-driven snapshot simulations with EPANET

This study compares different recently proposed methods for Pressure-Driven snapshot simulations of water distribution networks using the EPANET software interface and proposes a new one. The proposed method is based on the insertion of a sequence of devices consisting of a General Purpose Valve (GPV), a fictitious junction, a reach with a check valve and a reservoir at each water demand node. The proposed method differs from other methods previously proposed in the literature – and similarly based on the insertion of sequences of devices consisting of a valve and a reservoir or emitter – in that it uses a GPV. In fact the GPV allows the user to define the relationship between the flow (i.e. supplied demand) and available pressure, making the proposed sequence of devices capable of representing different relationships among these variables, unlike the other non-iterative methods already proposed in the scientific literature, in which the relationship is implicitly fixed by the structure of the sequence of devices used. Applications to two case studies and comparison with the results of the non-iterative methods already proposed in the scientific literature highlight the accuracy and flexibility of the proposed method and show, by contrast, the unreliability and limits, in terms of precision, of some of the methods previously proposed in the literature

Heterogeneity of regional inflection points from pressure-volume curves assessed by electrical impedance tomography

Background: The pressure-volume (P-V) curve has been suggested as a bedside tool to set mechanical ventilation; however, it reflects a global behavior of the lung without giving information on the regional mechanical properties. Regional P-V (PVr) curves derived from electrical impedance tomography (EIT) could provide valuable clinical information at bedside, being able to explore the regional mechanics of the lung. In the present study, we hypothesized that regional P-V curves would provide different information from those obtained from global P-V curves, both in terms of upper and lower inflection points. Therefore, we constructed pressure-volume curves for each pixel row from non-dependent to dependent lung regions of patients affected by acute hypoxemic respiratory failure (AHRF) and acute respiratory distress syndrome (ARDS). Methods: We analyzed slow-inflation P-V maneuvers data from 12 mechanically ventilated patients. During the inflation, the pneumotachograph was used to record flow and airway pressure while the EIT signals were recorded digitally. From each maneuver, global respiratory system P-V curve (PVg) and PVr curves were obtained, each one corresponding to a pixel row within the EIT image. PVg and PVr curves were fitted using a sigmoidal equation, and the upper (UIP) and lower (LIP) inflection points for each curve were mathematically identified; LIP and UIP from PVg were respectively called LIPg and UIPg. From each measurement, the highest regional LIP (LIPr MAX ) and the lowest regional UIP (UIPr MIN ) were identified and the pressure difference between those two points was defined as linear driving pressure (ΔP LIN ). Results: A significant difference (p < 0.001) was found between LIPr MAX (15.8 [9.2-21.1] cmH 2 O) and LIPg (2.9 [2.2-8.9] cmH 2 O); in all measurements, the LIPr MAX was higher than the corresponding LIPg. We found a significant difference (p < 0.005) between UIPr MIN (30.1 [23.5-37.6] cmH 2 O) and UIPg (40.5 [34.2-45] cmH 2 O), the UIPr MIN always being lower than the corresponding UIPg. Median ΔP LIN was 12.6 [7.4-20.8] cmH 2 O and in 56% of cases was < 14 cmH 2 O. Conclusions: Regional inflection points derived by EIT show high variability reflecting lung heterogeneity. Regional P-V curves obtained by EIT could convey more sensitive information than global lung mechanics on the pressures within which all lung regions express linear compliance. Trial registration: Clinicaltrials.gov, NCT02907840. Registered on 20 September 2016