Plato’s Later Moral Epistemology

This Ph.D. thesis aims to provide a comprehensive account of the relationship between ethics and epistemology in Plato’s late dialogues (specifically, Sophist, Statesman, Philebus, and Laws). While scholars have been concerned with understanding the extent to which Plato’s middle dialogues resonate with his early theory of ethical intellectualism (according to which knowledge is a necessary and sufficient condition for virtue), Plato’s later moral epistemology has received much less attention. The few scholars who have worked on the subject have argued that Plato’s late dialogues present a radical transformation of the epistemological and ethical ideas displayed in Plato’s earlier works. The scholarly debate has almost unanimously concluded that Plato’s late dialogues heavily revise the theory of ethical intellectualism that, arguably, features in the earlier works. Through an in-depth analysis of the late dialogues’ textual evidence, this thesis will show that the so-called Socratic theory of ethical intellectualism has not been abandoned by Plato in his late works. To this end, I will contend that the Sophist, the Statesman, the Philebus, and the Laws suggest that (philosophical) knowledge is the ultimate condition that a moral agent has to meet to be fully virtuous. In addition, taking for granted that philosophers alone can achieve a full and philosophical virtue, I will also show that Plato’s later moral epistemology extends beyond philosophers. For, while achieving philosophical knowledge is presented as a necessary and sufficient condition for being virtuous, I will argue that Plato’s late dialogues establish that opinion, if true, is sufficient for acting virtuously

Drag Reduction by Riblets on a Commercial UAV

Riblets are micro-grooves capable of decreasing skin-friction drag, but recent work suggests that additional benefits are possible for other components of aerodynamic drag. The effect of riblets on a fixed-wing, low-speed Unmanned Aerial Vehicle (UAV) on the total aerodynamic drag are assessed here for the first time by means of RANS simulations. Since the microscopic scale of riblets precludes their direct representation in the geometric model of the UAV, we model riblets via a homogenised boundary condition applied on the smooth wall. The boundary condition consists in a suitably tuned partial slip, which assumes riblets to be locally aligned with the flow velocity, and to possess optimal size. Several configurations of riblets coverage are considered to extract the potential for drag reduction of different parts of the aircraft surface. Installing riblets with optimal size over the complete surface of the UAV leads to a reduction of 3% for the drag coefficient of the aircraft. In addition to friction reduction, analysis shows a significant additional form of drag reduction localised on the wing. By installing riblets only on the upper surface of the wing, total drag reduction remains at 1.7%, with a surface coverage that is only 29%, thus yielding a significant improvement in the cost–benefit ratio

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

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\u2014Behavioral 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\u2014Stroke 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 paper

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

THE CAPSAICIN MODEL TO EXPLORE PAIN SENSORY PROFILES AND FUNCTIONAL CONNECTIVITY IN HUMANS. A COMBINED PSYCHOPHYSICAL AND fMRI STUDY IN NORMAL CONTROLS.

Il dolore neuropatico viene definito dall' International Association for the Study of Pain (IASP) come diretta conseguenza di una lesione o di una malattia che colpisce il sistema somatosensoriale. Questa tipologia di dolore spesso include nella sintomatologia fenomeni come l' allodinia e l' iperalgesia. I modelli animali offrono una grande quantit\ue0 di dati sperimentali che tuttavia sono difficili da riprodurre in ambito clinico. Al contrario, i meccanismi neurofisiologici che sottendono il dolore neuropatico negli esseri umani non sono ancora ben compresi e inoltre i relativi farmaci sono spesso inefficaci. Data tale difficolt\ue0, \ue8 essenziale poter disporre di un efficace modello sperimentale di dolore neuropatico nell'uomo. Inoltre \ue8 risaputo che vi \ue8 una elevata variabilit\ue0 nella percezione del dolore negli esseri umani e questo pu\uf2 spiegare gran parte della variabilit\ue0 riscontrata nella risposta ai farmaci. E di questo aspetto se ne deve tener conto anche nello sviluppo di nuove sostanze analgesiche. Il modello sperimentale che si basa sulla capsaicina, una sostanza che deriva dal peperoncino, viene utilizzato per esplorare i profili sensoriali nell'uomo. La capsaicina permette lo studio sia dei sintomi che prevedono un incremento di funzione come l'iperalgesia e l'allodinia sia fenomeni legati a perdita di funzione come l'ipoalgesia. Il bersaglio della capsaicina \ue8 il recettore TRPV1, che \ue8 espresso nelle fibre C e A\u3b4. In questo studio, abbiamo testato soggetti umani sani nei quali \ue8 stato indotto sperimentalmente un dolore cutaneo acuto mediante l'applicazione topica di un cerotto ad alta concentrazione di capsaicina (8%). Altri studi hanno gi\ue0 utilizzato la capsaicini tuttavia a concentrazioni pi\uf9 basse (0,025-3%). Il primo obiettivo di questo studio \ue8 stato quello di indagare la variabilit\ue0 della percezione del dolorein soggeti sani, studiando i profili somatosensoriali prima e durante una condizione sperimentale di dolore (capsaicina 8%) utilizzando il Quantitative Sensory Testing (QST). Un altro obiettivo \ue8 stato quello di indagare le varizioni e la connettivit\ue0 tra i resting-state Networks utilizzando la risonanza magnetica funzionale prima e durante una condizione sperimentale di dolore (cerotto alla capsaicina, 8%) in soggetti sani. Abbiamo combinato l'uso di un test psicofisico applicato perifericamente sulla pelle nel sito di stimolazione (avambraccio destro) con un metodo di imaging del sistema nervoso centrale per esplorare la "via del dolore" dai recettori periferici fino ai networks cerebrali. Nella prima parte dello studio \ue8 stato eseguito un protocollo standardizato di QST in un gruppo di 32 volontari sani prima (T0) e dopo l'applicazione di capsaicina topica (3x3 cm, 30 ') sull'avambraccio destro (a T1: per esplorare l'iperalgesia e l'allodinia primaria e secondaria; e a T2 dopo 24 ore: per esplorare l'ipoalgesia tardiva). Nel secondo studio, 18 volontari sani sono stati sottoposti ad un protocollo di resting-state fMRI prima e durante l'applicazione di capsaicina topica sull'avambraccio destro per esplorare i resting-state Networks e la connettivit\ue0 funzionale, utilizzando i software FSL e CONN per l'elaborazione dei dati. I risultati del primo esperimento indicano che la capsaicina influenza sia le soglie termiche e meccaniche del QST con un pattern complessivo di incremento di funzione (iperalgesia termica e meccanica e allodinia meccanica dinamica). I risultati hanno anche mostrato diversi pattern di variabilit\ue0 inter-individuale dei parametri del QST; alcuni parametri appaiono pi\uf9 stabili di altri. Per quanto riguarda il secondo esperimento, abbiamo trovato, durante l'applicazione di capsaicina, una maggiore connettivit\ue0 funzionale che coinvolge diverse aree cerebrali. Abbiamo anche dimostrato una ridotta connettivit\ue0 funzionale che riguarda una coppia di regioni. Questo modello potrebbe essere utile per sviluppare nuovi farmaci analgesici, potendoli testare in un numero pi\uf9 limitato ma selezionato di soggetti.Neuropathic pain is defined by the International Association for the Study of Pain as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system and it frequently may include allodynia and hyperalgesia. Animal models offer a large amount of experimental data, which are difficult to translate in the clinical setting. In contrast, the neurophysiological mechanisms underlying neuropathic pain in humans are not yet well understood and drugs are often ineffective. Given the pitfalls in translating animal data to humans, it is essential to have an experimental model of neuropathic pain in humans. Moreover there is a high variability in pain perception in humans and this may account for much of the variability in response to neuropathic pain drugs. The capsaicin model is used to explore sensory profiles in humans. Capsaicin is the pungent ingredient of chili peppers. Capsaicin allows the study of both gain-of-function (hyperalgesia and allodynia: similar to the chronic sensory symptoms of a patient with neuropathic pain) and loss-of-function (hypalgesia) phenomena. Capsaicin target is the transient receptor potential vanilloid 1 channel (TRPV1) which is expressed in the polymodal C and A\u3b4 nociceptive fibers and it is a key molecolar component of the pain pathway. In the present study, we tested healthy human subjects in whom acute cutaneous pain is induced experimentally by topical application of high-concentration capsaicin (8%, patch) unlike other studies that used lower concentrations (0,025-3%). The first aim of this study was to investigate the variability of experimental pain perception in normal controls by studying somatosensory profiles before and during an experimental pain condition (8% capsaicin patch) using quantitative sensory testing (QST). Another aim was to investigate the changes and the connectivity in the resting state networks using BOLD functional magnetic resonance imaging before and during an experimental pain condition (8% capsaicin patch) in healthy subjects. We have combined the use of a psychophysical test applied peripherally in the skin stimulation site with a method of central nervous system imaging to explore the \u201cpain pathway\u201d from the peripheral receptors up to brain connections. In the first part of the study a standardized QST protocol was performed in a group of 32 normal volunteers prior to (T0) and after topical capsaicin application (3 x 3 cm, 30\u2019) on the forearm (T1: early primary and secondary hyperalgesia/allodynia; T2: late hypalgesia). In the second experimental design, 18 healthy volunteers were submitted to a resting state fMRI protocol before and after capsacin path application to explore the Resting State Networks and functional connectivity, using FSL and CONN to process the data. Results of first experiment indicate that capsaicin affect both thermal and mechanical QST thresholds resulting in a pattern of \u201cgain of function\u201d with heat and pinprick hyperalgesia and dynamic mechanical allodynia. Results also showed different patterns of inter-individual variability with some more stable parameters than others. Regarding the second experiment we found greater and positive resting-state functional connectivity involving different brain areas in capsaicin condition compared to pre-capsaicin condition. We also found a reduced connectivity only for a couple of regions. This model might be useful to profiling novel analgesic agents in more limited numbers of subjects than required in patient efficacy studies

Cingulate gyrus tumor presenting as panic attacks

[no abstract available

The status of zero in the semantic system: a neuropsychological study

4nonenoneCACCIATORI E; GRANÀ A; GIRELLI L; SEMENZA C.Cacciatori, E; Granà, A; Girelli, L; Semenza, Carl