Recurrent pain in a child with cerebral palsy: Questions

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Recurrent pain in a child with cerebral palsy: Answers

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A Pragmatic Approach to Assessment of Chronic and Recurrent Pain in Children with Severe Neurologic Impairment

The term "severe neurologic impairment" (SNI) is used to describe a group of disorders of the central nervous system which arise in childhood, resulting in motor impairment, cognitive impairment and medical complexity. As a result, much assistance is required with activities of daily living. Since these patients are often unable to self-report pain, or they may exhibit uncommon behaviors when suffering, pain manifestations may go unrecognized. In this article, the basic principles of how to approach pain in children with SNI are discussed

Puzzling over spurdogs : molecular taxonomy assessment of the Squalus species in the Strait of Sicily

The actual occurrence of Squalus megalops in the Mediterranean Sea has recently been questioned. Several research works which sought to assess available morphological and meristic features that differentiate S. megalops from other Squalus species in the Mediterranean Sea, revealed poor discriminatory power and high variability of the assessed characters, especially when comparing S. megalops and S. blainville. The application of molecular tools does not support the presence of S. megalops. In the present study, we screened spurdog species from the Strait of Sicily using a molecular taxonomy approach based on two mitochondrial DNA markers and we report the occurrence of two Squalus lineages characterizing specimens collected from the stretch of sea between Tunisia, southern Sicily, Malta and Libya. The results support the hypothesis that a common species, S. blainville, currently inhabits the Mediterranean Sea, while a second and rare species is probably an occasional visitor with high morphological similarity to the S. megalops and S. blainville but is genetically distinct from both. Within this perspective, the occurrence of S. megalops in the Mediterranean Sea is not confirmed and our study highlights the taxonomic uncertainties in relation to the occurrence and distribution of Squalus species in this region. We encourage the establishment of a coordinated international effort to implement a comprehensive and integrated taxonomic assessment on this genus which represents an irreplaceable component of the biodiversity of the area.peer-reviewe

A Pragmatic Approach to Assessment of Chronic and Recurrent Pain in Children with Severe Neurologic Impairment

The term “severe neurologic impairment” (SNI) is used to describe a group of disorders of the central nervous system which arise in childhood, resulting in motor impairment, cognitive impairment and medical complexity. As a result, much assistance is required with activities of daily living. Since these patients are often unable to self-report pain, or they may exhibit uncommon behaviors when suffering, pain manifestations may go unrecognized. In this article, the basic principles of how to approach pain in children with SNI are discussed

Pediatric Adrenal Insufficiency: Challenges and Solutions

5noAdrenal insufficiency is an insidious diagnosis that can be initially misdiagnosed as other life-threatening endocrine conditions, as well as sepsis, metabolic disorders, or cardiovascular disease. In newborns, cortisol deficiency causes delayed bile acid synthesis and transport maturation, determining prolonged cholestatic jaundice. Subclinical adrenal insufficiency is a particular challenge for a pediatric endocrinologist, representing the preclinical stage of acute adrenal insufficiency. Although often included in the extensive workup of an unwell child, a single cortisol value is usually difficult to interpret; therefore, in most cases, a dynamic test is required for diagnosis to assess the hypothalamic-pituitary-adrenal axis. Stimulation tests using corticotropin analogs are recommended as first-line for diagnosis. All patients with adrenal insufficiency need long-term glucocorticoid replacement therapy, and oral hydrocortisone is the first-choice replacement treatment in pediatric. However, children that experience low cortisol concentrations and symptoms of cortisol insufficiency can take advantage using a modified release hydrocortisone formulation. The acute adrenal crisis is a life-threatening condition in all ages, treatment is effective if administered promptly, and it must not be delayed for any reason.openopenNisticò, Daniela; Bossini, Benedetta; Benvenuto, Simone; Pellegrin, Maria Chiara; Tornese, GianlucaNisticò, Daniela; Bossini, Benedetta; Benvenuto, Simone; Pellegrin, Maria Chiara; Tornese, Gianluc

Industry 4.0 and its decentralized technologies: organisational economies (and diseconomies) in the new emerging landscape

Abstract Purpose – This paper focuses on the Industry 4.0 decentralized technologies with the aim of highlighting their economic-organisational dimensions. In particular, the contribution first presents a deeper understanding of the nature and the dynamic of the economies and diseconomies that arise from the adoption and diffusion of decentralized technologies. Second, it aims to shed light on the increasing tension between the hierarchy-based model of production and self-organising model, which involves the pervasive diffusion of decentralized technologies. Design/methodology/approach – Adopting an economic-organizational perspective, deeply rooted in the related extant literature, an analytically consistent model is developed to simultaneously take into account the following variables: adoption density independent variable) and economies of knowledge integration and organizational diseconomies (the costs of a loss of control and the costs of organizational decoupling and recoupling) as dependent variables. Findings- Decentralized technologies allow access to a large quantity and a wide variety of cognitive slacks that have not been possible until now. In doing so, they are leading the transition towards Industry 4.0 multiplying the (unpredictable) opportunities to innovate (i.e. by exaptation and bricolage). Industry 4.0 is an emerging production paradigm that is characterized – with respect to mass production - by a shift of the relative importance of cognitive slack in comparison with tangible slack. Nevertheless, the unrestrainable diffusion of decentralized technologies is not neutral for organizations. On the one hand, these technologies allow for the integration of economies of knowledge, and on the other hand, they involve organizational diseconomies that should not be ignored by managers and researchers. Originality/value- This paper fills a gap in the literature by developing a consistent analytical framework that simultaneously takes into account the economies of knowledge integration (opportunities bricolage and exaptation) and potential organizational diseconomies (the costs of coordination and the loss of control) that arise from the adoption and diffusion of decentralized technologies

Individual and organizational capabilities endowment for the Industry 4.0 landscape: the T-shaped model

Problem under focus: The main features and challenges of the 4th Industrial Revolution the need for T-shaped capabilities in the rising 4th Industrial Revolution Theoretical and conceptual background: Information variety Viable System Approach (VSA) (Dynamic) capabilities/competences Findings: Individual level: content and nature of T-shaped profile Organizational level: a nesting architecture of T-Shaped capabilities Subsequent issues to address Organizational conditions for developing and managing T-shaped capabilities based structures Managerial and policy implications and future researc

WORKSHOP on Emerging landscapes. New jobs, new skills, new technologies and new organizational challenges in the Industry 4.0 revolution

The concept of digitizing everything is already a reality. Automation, artificial intelligence, IoT, machine learning and other advanced technologies are capturing and analyzing a wealth of data that gives us sizable amount and types of information to work from. One of the major challenges we face is to change the way we think, train and work with data in order to create value through advanced technologies. The term Industry 4.0 was first introduced in 2011 during the Hannover Fair, as a project in high-tech German Industry. The German Working Group on Industry 4.0 was created in the following year. The group delivered its final report in April 2013 again at the Hannover Fair. In this report the Industry 4.0 was defined as an environment characterized by the strong customization of products and by manufacturing ecosystems with autonomic self-properties, such as self-configuration, self-monitoring, and self-healing. Thus, the term was definitely adopted at the 2015 World Economic Forum (WEF) Annual Meeting held in January 2015 in Davos (Switzerland) to indicate the rise of a new industrial revolution: the fourth. This revolution is occurring where countless elements comprising industrial systems and services are being interfaced with internet communication technologies to form the smart future factories and manufacturing organizations. Industry 4.0 and its associated key technologies (cloud-based design, Mobile Devices, Big Data, smart manufacturing systems, the Internet of Things (IoT), the Industrial Internet of Things (IIoT), 3D printing) are currently being driven by disruptive innovation that promises to bring countless new value creation opportunities across all major market sectors. Its vision of ecosystems of smart factories with intelligent and autonomous shop-floor entities is inherently decentralized. This, in turn, entails new complexities within platforms, metaplatforms and socio-technological ecosystems, constantly creating new challenges and opportunities (i.e. responding to customer demands for tailored products and/or creating new products for new customers) for technology enablers, users and users/enablers. Industry 4.0 seems to dictate the end of consolidated models (mental, educational, managerial, organizational, cultural, social etc.) and, at the same time, it asks for new “lenses” and interpretative paradigms enabling old and new actors to succeed in such magmatic landscape. Despite the significant hype around the topic, there is extant research regarding the exact consequences for people, companies and institutions involved. For example, millions of workplaces are being vaporized in a rhythm never seen before, while others are emerging towards becoming of billion-dollar companies (i.e. unicorn companies), which are managed by a reduced number of highly skilled professionals. Industry 4.0 environments are made of diverse technologies spread across many disciplines with many different types of subject matter experts. However, there are few standards and processes designed to assist each entity to speak a common language and think systemically. Academics and practitioners are trying to deeply comprehend the consequences of Industry 4.0 revolution for employees, businesses, technology users/enablers and the society at large. This is particularly challenging in the newly emerging socio-technological context where organizational boundaries and the distinction between services and manufacturing are getting fuzzier than ever. The workshop aims to critically analyze the state-of-the-art about the Industry 4.0 context, its pros and cons and its challenges in terms of: • new competitive rules; • new skills, new jobs, new educational programs; • new labor organization and new organizational models; • new technologies; • new paradigms for the value co-creation; • new models of interactions among human beings, machines and virtual world. Under this perspective, atoms and bits interpenetrate more and more like a fluid and virtuosic dance. These key issues will be debated in the workshop as forerunner ideas for future research on this emerging landscape. Keywords: industry 4.0; value-co-creation; industrial revolution; IoT; industrial metaplatfor

Prevalence of SARS-CoV-2 infection in Italian pediatric population: a regional seroepidemiological study

Background: Data on the effective burden of the SARS-CoV-2 pandemic in pediatric population are very limited, mostly because of the higher rate of asymptomatic or paucisymptomatic cases among children. Updated data on COVID-19 prevalence are needed for their relevance in public health and for infection control policies. In this single-centre cross-sectional study we aimed to assess prevalence of SARS-CoV-2 infection through IgG antibodies detection in an Italian pediatric cohort. Methods: The study was conducted in January 2021 among both inpatients and outpatients referring to Research Institute for Maternal and Child Health "Burlo Garofolo" in Trieste, Friuli Venezia-Giulia, Italy, who needed for blood test for any reason. Collected samples were sent to Italian National Institute of Health for analysis through chemiluminescent immunoassay (CLIA). Results: One hundred sixty-nine patients were included in the study, with a median age of 10.5 \ub1 4.1 years, an equal distribution for sex (49.7% female patients), and a 55.6% prevalence of comorbidities. Prevalence of anti-SARS-CoV-2 trimeric Spike protein IgG antibodies was 9.5% (n = 16), with a medium titre of 482.3 \ub1 387.1 BAU/mL. Having an infected cohabitant strongly correlated with IgG positivity (OR 23.83, 95% CI 7.19-78.98, p < 0.0001), while a cohabitant healthcare worker wasn't associated with a higher risk (OR 1.53, 95% CI 0.4-5.86, p 0.46). All of the 5 patients who had previously tested positive to a nasopharyngeal swab belonged to the IgG positive group, with a 3-month interval from the infection at most. Conclusion: We assessed a 9.5% SARS-CoV-2 seroprevalence in a pediatric cohort from Friuli Venezia-Giulia region in January 2021, showing a substantial increase after the second peak of the pandemic occurred starting from October 2020, compared to 1% prevalence observed by National Institute of Statistics (ISTAT) in July 2020