Un ejemplo de cooperación de área vasta. La experiencia y las perspectivas de desarrollo en la Eurorregión Adriática

El artículo analiza el caso de estudio de la Eurorregión Adriática (EA) para ejemplificar la emergencia de la cooperación de área vasta. Este modelo se considera el último desafío de la cooperación transnacional en Europa, puesto que se requieren motivaciones sólidas para cooperar, y la dimensión y el número de participantes conlleva problemas. Empezaremos introduciendo las características y las perspectivas de la EA, luego, entraremos en el core business, destacando tres puntos principales de él: el lobbying de los presidentes, la articulación operacional y la programación estratégica. En el texto, se resalta el papel del mar Adriático como factor de ventaja absoluta para la cooperación, y se termina destacando las condiciones (necesarias pero no suficientes) para la sostenibilidad de dicha cooperación a largo plazo.L'article analitza el cas d'estudi de l'Euroregió Adriàtica (EA), amb l'objectiu d'exemplificar l'emergència de la cooperació d'àrea àmplia. Aquest model és considerat el darrer desafiament de la cooperació transnacional a Europa, atès que es demanen motivacions sòlides per cooperar, i la dimensió i el nombre de participants comporta problemes. Començarem introduint-hi les característiques i les perspectives de l'EA, després, entrarem al core business destacant-ne tres aspectes principals: el lobbying dels presidents, l'articulació operacional i la programació estratègica. Al text, s'hi subratlla el paper de la mar Adriàtica com a factor d'avantatge absolut per a la cooperació, i es clou destacant les condicions (necessàries però no suficients) per a la sostenibilitat d'aquesta cooperació a llarg termini.L'article analyse le cas d'étude de l'Eurorégion Adriatique (EA) pour illustrer l'urgence de la «coopération de zone vaste». Ce modèle de coopération est considéré le dernier défi de la coopération transnationale en Europe: on exige des motivations solides pour coopérer et la dimension et le nombre de participants entraînent des problèmes. Nous commencerons à introduire les caractéristiques et les perspectives de l'EA, ensuite nous entrerons dans le coeur business en soulignant trois points principaux: le lobbying des Présidents, l'articulation opérationnelle et la programmation stratégique. On remarque le rôle de la mer Adriatique comme facteur d'avantage absolu pour la coopération et on termine en soulignant les conditions (nécessaires mais non suffisantes) pour le soutien à long terme de cette coopération.The article analyzes the case study of the Adriatic Euroregion (AE) to exemplify the emergence of «vast area cooperation». This kind of cooperation is considered to be the last challenge of transnational cooperation in Europe; solid motivations are needed to cooperate, and the dimension and number of participants is a source of problems. We will start by introducing the characteristics and perspectives of the AE, and then we will enter the core business, emphasizing three main points: the lobbying of Presidents, operational articulation and strategic programming. The role of the Adriatic Sea as a factor of absolute advantage for cooperation is highlighted. We conclude by emphasizing the conditions (necessary but not sufficient) for long-term sustainability of the above-mentioned cooperation

La polarizzazione sul mercato del lavoro in Italia

Il presente articolo analizza i cambiamenti intercorsi in Italia tra il 2011 e il 2018 sul mercato del lavoro. La base dati informativa è quella ISTAT, “Ricerche sulle forze di lavoro”. Le 20 regioni italiane sono state riaggregate nelle cinque macro-ripartizioni Nordovest, Nord-est, Centro, Sud e Isole. La variabile utilizzata nell’analisi è la classificazione italiana delle occupazioni a una cifra (CP2011), compatibile con la classificazione 1/8 internazionale standard delle professioni (ISCO-08). La classificazione riporta le professioni aggregate in nove macro-gruppi, omogenei per livello di abilità/competenze richiesto, a loro volta riaggregati in tre blocchi secondo i livelli bassi, medi e alti delle competenze richiest

Moving into the wide clinical spectrum of consciousness disorders: Pearls, perils and pitfalls

The last few years have been characterized by a growing interest of the medical and scientific world for the field of consciousness and its related disorders. Medically speaking, conscious- ness can be defined as the state of awareness of self and environment and the alertness to external stimulation, besides responsiveness to inner need. Transient loss of consciousness can be due to alterations in cerebral blood flow leading to fainting or syncope, migraine, metabolic dysfunctions, unexpected intracranial pressure increases, epileptic seizures, and sleep disorders. Chronic disorders of consciousness are a tragic success of high-technology treatment, in an attempt to maintain or reestablish brain function, which is to be considered as the main goal of therapeutics. Management of vegetative or a minimally conscious state individuals involves charily getting the right diagnosis with an evidence-based prognosis, also taking into account the medical, ethical, and legal key factors of the ideal treatment. This paper is aimed at exploring the wide spectrum of consciousness disorders and their clinical differential diagnosis, with particular regards to those with a negative impact on patient and their caregiver quality of life, including epilepsy, sleep disorders, and vegetative/minimally conscious state

Red nucleus structure and function: from anatomy to clinical neurosciences

The red nucleus (RN) is a large subcortical structure located in the ventral midbrain. Although it originated as a primitive relay between the cerebellum and the spinal cord, during its phylogenesis the RN shows a progressive segregation between a magnocellular part, involved in the rubrospinal system, and a parvocellular part, involved in the olivocerebellar system. Despite exhibiting distinct evolutionary trajectories, these two regions are strictly tied together and play a prominent role in motor and non-motor behavior in different animal species. However, little is known about their function in the human brain. This lack of knowledge may have been conditioned both by the notable differences between human and non-human RN and by inherent difficulties in studying this structure directly in the human brain, leading to a general decrease of interest in the last decades. In the present review, we identify the crucial issues in the current knowledge and summarize the results of several decades of research about the RN, ranging from animal models to human diseases. Connecting the dots between morphology, experimental physiology and neuroimaging, we try to draw a comprehensive overview on RN functional anatomy and bridge the gap between basic and translational research

In vivo probabilistic atlas of white matter tracts of the human subthalamic area combining track density imaging and optimized diffusion tractography

The human subthalamic area is a region of high anatomical complexity, tightly packed with tiny fiber bundles. Some of them, including the pallidothalamic, cerebello-thalamic, and mammillothalamic tracts, are relevant targets in functional neurosurgery for various brain diseases. Diffusion-weighted imaging-based tractography has been suggested as a useful tool to map white matter pathways in the human brain in vivo and non-invasively, though the reconstruction of these specific fiber bundles is challenging due to their small dimensions and complex anatomy. To the best of our knowledge, a population-based, in vivo probabilistic atlas of subthalamic white matter tracts is still missing. In the present work, we devised an optimized tractography protocol for reproducible reconstruction of the tracts of subthalamic area in a large data sample from the Human Connectome Project repository. First, we leveraged the super-resolution properties and high anatomical detail provided by short tracks track-density imaging (stTDI) to identify the white matter bundles of the subthalamic area on a group-level template. Tracts identification on the stTDI template was also aided by visualization of histological sections of human specimens. Then, we employed this anatomical information to drive tractography at the subject-level, optimizing tracking parameters to maximize between-subject and within-subject similarities as well as anatomical accuracy. Finally, we gathered subject level tracts reconstructed with optimized tractography into a large-scale, normative population atlas. We suggest that this atlas could be useful in both clinical anatomy and functional neurosurgery settings, to improve our understanding of the complex morphology of this important brain region

A study of the olfactory tract with 3D rendering, f-MRI and CSD fiber tractography in healty and PD subjects

In this study we report an optimized single-shot diffusion-weighted echo planar imaging sequence that can visualize the olfactory tracts with CSD fiber tracking, 3D volume rendering and f-MRI. The olfactory tracts are localized in the olfactory grooves of the ethmoidal bone, running posteriorly through the olfactory sulci connecting to the inferior surfaces of the frontal lobes. Distally the tracts are enlarged into the olfactory bulbs and proximally they split into medial, intermediate and lateral striae and from here the axon projecting to the olfactory cortex, divided into five main areas: the anterior olfactory nucleus, which connects the two olfactory bulbs through a portion of the anterior commissure; the piriform cortex; parts of the amigdala, the olfactory tubercle and entorinal cortex; not all of these connections through the thalamus. Moreover, olfactory information is transmitted from the amygdala to the hypothalamus and from the entorinal area to the hippocampus.The olfactory tracts are difficult to depict with MRI diffusion-weighted imaging due to the high sensitivity to susceptibility artifacts at the base of the skull (Duprez and Rombaux, 2010). Ten subjects were examined; in five healthy subjects the olfactory tracts could be fiber tracked with the diffusion-weighted sequence, while in five anosmic PD patients, altered olfactory tracts were visualized. Furthermore, olfactory stimuli were applied during fMRI scanning to show the area BOLD activation to advance our understanding of olfactory dysfunction in PD patients compared to control. Olfactory function was established using the “Sniffin’ Sticks” test battery.This study of the olfactory tracts promise to visualize the anatomic organization and to facilitate the identification of different hyposmic and anosmic entities caused by neurodegenerative disorders or post-traumatic and congenital disfunctions

Topo-pathological re-wiring in brain structural connectomes of de novo Parkinson’s Disease patients

Although several studies in the last decades have challenged our understanding of Parkinson’s Disease (PD) pathophysiology, an important gap at a network and system level still remains to be filled in order to understand the fundamental changes in high-order motor and non-motor circuits underlying PD symptoms. The wide spectrum of both motor and non-motor symptoms suggests that Parkinson’s Disease may reflect extended alterations of the global brain network, thus justifying the onset of this heterogeneous symptomatology. Such hypothesis would be suitable with the idea of an “associationist” brain, which goes beyond the classic cortical “localizationist” theory. According to the former, the brain might consist of several, segregated and parallel distributed networks around critical and participating cortical epicenters. To the best of our knowledge, only few studies attempted to improve our understanding on structural MRI networks in PD. With the aim of detecting altered topological rewiring of brain networks in early stage de novo PD patients, we reconstructed tractography-based brain structural connectomes [1] in a pilot population of 10 PD patients and 13 controls. Topological features of structural connectomes were computed and compared between the healthy controls group and the group with PD at different level of cut-off. Significant group differences were showed at certain cut-off in the structural connectivity from the measurement of the Local Community Paradigm-correlation (LCPcorr), Characteristic Path Length, Betweenness Centrality and Edge Betweenness Centrality. Increased value of LCPcorr in the pathological group reflects a topological (and not spatial) network local community re-organization of structural interactions between common neighbors nodes [2]. As a result, the PD group has an increased correlation between the number of common neighbors and the number of their internal-interactions across all the structural local communities in the networks. On the other hand, decreased values in Characteristic Path Length, Betweenness Centrality and Edge Betweenness Centrality suggest also a global topological network re-wiring. Taken together these findings strongly indicate altered topological rewiring in de novo PD brain connectome and could shed new light on the pathophysiology of the disease and in the definition of network-based markers for a more quantitative and precise diagnosis

An Internet- and Kinect-Based Multiple Sclerosis Fitness Intervention Training With Pilates Exercises: Development and Usability Study

background: balance impairments are common in people with multiple sclerosis (MS), with reduced ability to maintain position and delayed responses to postural adjustments. Pilates is a popular alternative method for balance training that may reduce the rapid worsening of symptoms and the increased risk of secondary conditions (eg, depression) that are frequently associated with physical inactivity.objective: In this paper, we aimed to describe the design, development, and usability testing of MS Fitness Intervention Training (MS-FIT), a Kinect-based tool implementing Pilates exercises customized for MS. methods: MS-FIT has been developed using a user-centered design approach (design, prototype, user feedback, and analysis) to gain the target user's perspective. a team composed of 1 physical therapist, 2 game programmers, and 1 game designer developed the first version of MS-FIT that integrated the knowledge and experience of the team with MS literature findings related to pilates exercises and balance interventions based on exergames. MS-FIT, developed by using the Unity 3D (Unity Technologies) game engine software with kinect Sensor V2 for Windows, implements exercises for breathing, posture, and balance. Feedback from an Italian panel of experts in MS rehabilitation (neurologists, physiatrists, physical therapists, 1 statistician, and 1 bioengineer) and people with MS was collected to customize the tool for use in MS. The context of MS-FIT is traveling around the world to visit some of the most important cities to learn the aspects of their culture through pictures and stories. At each stay of the travel, the avatar of a Pilates teacher shows the user the exercises to be performed. Overall, 9 people with MS (n=4, 44% women; mean age 42.89, SD 11.97 years; mean disease duration 10.19, SD 9.18 years; Expanded Disability Status Scale score 3.17, SD 0.75) were involved in 3 outpatient user test sessions of 30 minutes; MS-FIT's usability was assessed through an ad hoc questionnaire (maximum value=5; higher the score, higher the usability) evaluating easiness to use, playability, enjoyment, satisfaction, and acceptance.Results: A user-centered design approach was used to develop an accessible and challenging tool for balance training. all people with MS (9/9, 100%) completed the user test sessions and answered the ad hoc questionnaire. the average score on each item ranged from 3.78 (SD 0.67) to 4.33 (SD 1.00), which indicated a high usability level. The feedback and suggestions provided by 64% (9/14) of people with MS and 36% (5/14) of therapists involved in the user test were implemented to refine the first prototype to release MS-FIT 2.0. Conclusions: The participants reported that MS-FIT was a usable tool. It is a promising system for enhancing the motivation and engagement of people with MS in performing exercise with the aim of improving their physical status

Study of“Shaken Baby Syndrome”: Morphological and Diffusion MRI Data

Shaken baby syndrome (SBS) is the most common cause of death related to child abuse; nonfatal consequences of SBS include varying degrees of visual, motor and cognitive impairment due to severe brain damage in almost 30% of infants with SBS. Brain damage occurs from the biomechanical forces, swelling, ischemia and altered vascular autoregulation and from additionally axonal damage[1].In the present study we want to examine a cohort of 7 patient affected by SBS and compare their data with controls choosen by same range of age, 19 months till 60. Using MRI techniques we define a new paradigm for demonstrating, through voxel based morphometry, deficiencies, connected to white and grey matter regions, in the prefrontal cortex and also in the hippocampus, amygdala, corpus callosum and optical radiation. Adding diffusion tensor imaging technique by constrained spherical deconvolution[2] our study put in evidence connectivity between investigated areas, suggesting neural network abnormalities. With this “state of art” studies we can show a correlation between childhood abuse and brain structures modification. Our aim is to make a longitudinal study on the anatomical data of these patients following their clinical evolution