BEHIND AN EYE BLINK: A NEW EMPIRICAL PERSPECTIVE ON INTENTIONAL ACTION

Il \u201cblink\u201d o \u201cbatter d\u2019occhi\u201d \ue8 un movimento di rapida chiusura e riapertura delle palpebre. Il \u201cblink\u201d pu\uf2 essere un movimento spontaneo, riflesso o volontario. \u201cBlink\u201d con identiche caratteristiche cinematiche possono avere differenti origini e significati. Per esempio, un blink pu\uf2 essere spontaneo quando ha la funzione fisiologica di creare un film lacrimale evitando la seccazione della cornea, pu\uf2 essere riflesso in riposta a stimoli esterni ed infine pu\uf2 essere volontario per comunicare un messaggio attraverso un canale comunicativo preservato, per esempio quando un paziente locked in cerca di comunicare gioia, accordo o disaccordo, frustrazione attraverso gli occhi (Laureys et al., 2005). Lo scopo principale di questo studio \ue8 stato quello di trovare una misura oggettiva relativa alla distinzione tra un blink spontaneo e uno volontario: il \u201cpotenziale di preparazione\u201d (Readiness Potential). Il presente studio \ue8 quindi rilevante per due ragioni: 1. Nei soggetti sani, i blink spontanei appaiono con una frequenza di circa 1 ogni 5 secondi. Allo stesso tempo, i soggetti sani possono \u201ccontrollare\u201d il movimento spontaneo e riprodurlo in maniera intenzionale se opportunamente istruiti. In questo modo, il \u201cblink\u201d o \u201cammiccamento oculare\u201d offre un contrasto ideale tra atto conscio e inconscio, a parit\ue0 di cinematica. In questa prospettiva, l\u2019analisi dell\u2019attivit\ue0 cerebrale che precede un atto spontaneo o automatico messa a confronto con l\u2019attivit\ue0 che precedere un \u201cblink\u201d volontario pu\uf2 offrire uno sguardo unico sui correlati neurali di un atto cosciente. 2. Nei pazienti con gravi cerebrolesioni, il \u201cblink\u201d \ue8 spesso l\u2019unico atto motorio che pu\uf2 essere individuato. \uc8 infatti impossibile per molti pazienti effettuare movimenti pi\uf9 complessi. Per questo motivo, attraverso un condizionamento operante in cui ad uno specifico comportamento viene associato un rinforzo positivo, il nostro scopo \ue8 quello di indirizzare i pazienti ad associare un determinato tipo di \u201cblink\u201d, opportunamente selezionato, con un rinforzo positivo rappresentato da voci familiari/amiche che si suppone possano avere una valenza emotiva positiva per il paziente. Nella prima parte della tesi verranno introdotte le premesse teorico/sperimentali alla base dello studio e verranno presentati i materiali e metodi e i risultati relativi alla popolazione di controllo (soggetti sani). Nella seconda parte, verr\ue0 introdotto il \u201cdisturbo di coscienza\u201d dal punto di vista clinico, il nuovo protocollo sperimentale applicato ai pazienti con disturbo di coscienza e i risultati preliminari. In conclusione, verranno valutate le potenzialit\ue0 dello studio da un punto di vista teorico, da un punto di vista clinico/riabilitativo ed infine da un punto di vista etico.Blinking is a rapid closing and opening of the eyelid. Eye blinks with identical kinematical features can have different origins and meanings. For example, one can blink automatically, due to a simple reflex arc \u2013 such as when moistening the cornea \u2013 or one can blink voluntarily to communicate a fundamental message \u2013 such as when a locked-in patient communicates that he/she is happy or frustrated (Laureys, et al., 2005) The main aim of the present project is to find a brain-based objective way to know whether a given blink is a meaningless automatic neural event or the endpoint of a complex conscious process. The proposal builds up on the empirical work by Kornhuber & Deecke and Benjamin Libet, who showed that the awareness of intention to move is preceded by a recordable cerebral activity called \u201cReadiness Potential\u201d. The present proposal is relevant for two reasons: 1. In healthy subjects, automatic blinking occurs spontaneously every 5 seconds, or so. At the same time, healthy subjects can be instructed to blink voluntarily in a controlled fashion. In this way, blinking offers the ideal contrast between unconscious and conscious acts \u2013 the physical, kinematic aspects of the movement being equal. In this perspective, analyzing brain activity prior to automatic and voluntary blinks may offer a unique insight on the neural correlates of a conscious act. 2. In patients with severe brain injuries blinking is often the only motor act that can be reliably detected. By employing operant conditioning, we aim at training patients on the association between a specific eyelid closure and a positive reinforcement. Specifically, Readiness Potential like activity will be computed on the cortical activity preceding eye blinking as a measure of \u201cvolition,\u201d first in healthy controls and then in vegetative and minimally conscious state patients undergoing operant conditioning. In healthy controls, we will contrast spontaneous blinks against voluntary blinks. The results of this experiment are meant to explore the dynamic range of the changes in brain activity that underlies voluntary vs. spontaneous blinks in controlled conditions. In patients, detecting a progressive increase in the strength or complexity of brain activity (up to the levels obtained in healthy subjects during voluntary blinks) during the course of the conditioning sessions will indicate that their blinking might reflect a voluntary act. Ultimately, this project, if successful, will link operant conditioning to the long-standing topic of the neural substrates of a wilful decision to act, bearing important scientific/ethical implications. The novelty of this project rests on: a. Exploring, empirically, the relationships between brain activity and the will. The underlying hypothesis guiding this project is that a wilful act should be reflected, to some measurable degree, in high levels of anticipatory brain dynamics. b. Taking Libet\u2019s work one-step forward, by using slow cortical potentials such as the \u201cReadiness Potential\u201d as a neural marker of volition. c. Using the \u201cReadiness Potential\u201d to distinguish between spontaneous and voluntary blinks. d. Answering the critical question of whether the blinks produced by vegetative patients after a conditioning protocol are voluntary or not

Imaging of the acute female pelvis

University of Genoa, Genoa, Italy, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Female patients with acute abdomino/pelvic symptoms are a relatively common problem in the Emergency Department. The diagnostic approach to them is based first on clinical ground (which symptoms, which age), then on lab tests (especially a serum beta-hCG assessment) and imaging. Content: Ultrasound (US) is the preferred imaging technique when clinical findings suggest an acute pelvic condition; however, symptoms are not always specific and also computed tomography (CT) and magnetic resonance imaging (MRI) are frequently employed. Although, ideally, imaging examinations should be performed with full knowledge of both clinical and laboratory situation, this is not always the case, since some lab tests are time-consuming and emergency studies have to be performed before knowing their results. Conclusion: A large variety of conditions may cause acute pelvic symptoms but the most common and ”dangerous” ones are adnexal torsion, pelvic inflammatory disease (PID) and ectopic pregnancy. This presentation will describe the imaging findings observed in them and will underline the need for integration of clinical information with imaging findings to reach the correct diagnosis

Lithiasis-induced acute kidney injury: Is ultrasonography enough?

Obstructive acute kidney injury(AKI) is relatively common, reported in 8% to 17% of cases presenting with community-acquired AKI. It is more frequent in males of advanced age, usually from bladder outlet obstruction. Guidelines recommend imaging, namely a renal tract ultrasound (US), within 24 hours from admission to rule-out obstruction and guarantee recovery of renal function. Lithiasis is not a common cause of AKI (1\u20132% of obstructive cases) and it is reported that only 0.72% of patients with urinary calculi develop AKI from stones. It is known that US may have difficulties in demonstrating stones-related obstructionand that unenhanced CT ismost sensitive and specific for this purpose. We report therefore the imaging findings in a series of patients with lithiasis-induced AKI to understand the respective roles of these techniques

Management Control for Corporate Sustainability Execution: The Role of Employee Compensation

The research described in this thesis examines the characteristics, the benefits and the challenges associated with the implementation of management accounting systems in the field of Corporate Social Responsibility (CSR). Applied to the CSR context, management accounting relates to the identification, elaboration and communication of information about an organization's interactions with the society and the environment. Based on this information, firms are able to make decisions to achieve social and environmental objectives and provide evidence justifying the benefits and the costs of such actions. The study begins by focusing on green management and exploring the characteristics of Environmental Management Accounting (EMA) systems within firms. The first chapter informs the reader about the growing body of EMA research and reveals unexplored relevant aspects that need to be further investigated. The work also emphasizes the importance of developing new theoretical hypotheses and appropriate research designs to empirically tackle new aspects of EMA and gain understanding on the use of these practices. Subsequently, given the acknowledged importance of control systems in influencing the behaviour of individuals within organizations, the remaining two chapters of the dissertation focus on the functioning of CSR-linked incentives assigned to employees in the form of compensation plans. The second chapter examines the determinants influencing corporate provision of incentives for the attainment of environmental targets. Empirical analysis of a sample of international firms reveals that companies are likely to use green incentives as mechanisms to increase the efficacy in contracting with their employees as well as to respond to social influences. Finally, the third chapter investigates the effectiveness of contracting associated with the use of CSR-linked executive compensation. Empirical analysis of a sample of US-based companies shows that corporate choice to tie senior executives' pay to CSR targets promotes the firm's CSR performance. Cette thèse examine les caractéristiques, avantages et défis associés à l'utilisation des systèmes de contrôle de gestion dans le domaine de la Responsabilité Sociale des Entreprises (RSE). Dans le contexte de la RSE, les activités du contrôle de gestion impliquent l'identification, l'élaboration et la communication d'informations qui concernent les interactions des organisations avec la société et l'environnement. Avec ces informations les entreprises sont en mesure de prendre des décisions visant à atteindre les objectifs sociaux et environnementaux de l'organisation et de documenter les bénéfices et coûts de ces actions. Dès le début, la thèse se concentre sur les caractéristiques des systèmes de contrôle de gestion environnementale au sein des entreprises. Le premier chapitre passe en revue la littérature existante et révèle des aspects inexplorés. Pour ce faire, le travail suggère le développement de nouvelles théories ainsi que l'utilisation de méthodes appropriées. Ces dernières doivent permettre d'aborder empiriquement de nouveaux aspects des systèmes de contrôle environnemental et faciliter la compréhension sur l'utilisation de ces pratiques. Considérant l'importance des systèmes de contrôle pour influencer le comportement des individus au sein des organisations, la suite du travail se concentre sur le fonctionnement des contrats de rémunération des employées liées aux résultats de la RSE. Plus particulièrement, le deuxième chapitre examine les facteurs qui influencent la décision des entreprises d'assigner des objectifs environnementaux aux employées. L'analyse empirique d'un échantillon d'entreprises internationales montre que les entreprises sont susceptibles d'utiliser des mécanismes incitatifs écologiques pour augmenter l'efficacité des contrats ainsi que pour répondre aux influences sociales. Finalement, le troisième chapitre analyse l'efficacité des contrats de rémunération des dirigeants liés aux résultats de la RSE. L'analyse empirique d'un échantillon de sociétés américaines indique que le choix de l'entreprise de lier la rémunération des dirigeants à des objectifs de la RSE favorise la performance RSE de l'organisation

Minimally invasive prosthetic procedures in the rehabilitation of a bulimic patient affected by dental erosion

The population affected by dental erosion due to bulimia is generally very young. This population group has a high aesthetic requirement; the dentition in these patients is severely damaged, especially in the anterior maxillary quadrant. In terms of treatment, it is still controversial whether an adhesive rehabilitation is preferable to a longer-lasting but more aggressive conventional treatment, such as full-crown coverage of the majority of teeth. This case report describes the prosthetic rehabilitation of a young female patient previously affected by bulimia nervosa and presenting erosion of the maxillary teeth. The prosthetic rehabilitation was performed through indirect adhesive restorations of the anterior teeth and direct restorations of the posterior teeth. A clinical follow-up after 4 years showed that the occlusion remained satisfactorily restored. Posterior direct composite resin restorations and anterior indirect adhesive composite restorations proved to be an effective time and money-saving procedure to rehabilitate patients affected by dental erosion. Adhesive rehabilitation provides a functional and good aesthetic result while preserving tooth structure

Indirect composite restorations luted with two different procedures: a ten years follow up clinical trial

Objectives: The aim of this clinical trial was to evaluate posterior indirect composite resin restoration ten years after placement luted with two different procedures. Study Design: In 23 patients 22 inlays/onlays (Group A) were luted using a dual-cured resin composite cement and 26 inlays/onlays (Group B) were luted using a light cured resin composite for a total of 48 Class I and Class II indirect composite resin inlays and onlays. The restorations were evaluated at 2 time points: 1) one week after placement (baseline evaluation) and 2) ten years after placement using the modified USPHS criteria. The Mann- Whitney and the Wilcoxon tests were used to examine the difference between the results of the baseline and 10 years evaluation for each criteria. Results: Numerical but not statistically significant differences were noted on any of the recorded clinical parameters ( p >0.05) between the inlay/onlays of Group A and Group B. 91% and 94 % of Group A and B respectively were rated as clinically acceptable in all the evaluated criteria ten years after clinical function. Conclusions: Within the limits of the study the results showed after ten years of function a comparable clinical performance of indirect composite resin inlays/onlays placed with a light cure or dual cure luting procedures

The added value of simultaneous palpation during scrotal ultrasound

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Maxillary sinus augmentation with three different biomaterials: Histological, histomorphometric, clinical, and patient-reported outcomes from a randomized controlled trial

Background: Lateral maxillary sinus augmentation (MSA) is a predictable bone regeneration technique in case of atrophy of the posterior-upper maxilla. Aimed at obtaining quantity and quality of bone suitable for receiving osseointegrated implants, its success is largely due to the skill of the surgeon, but also to the characteristics of the biomaterial used. Methods: Twenty-four patients needing MSA were included in the study. The patients were randomly allocated to three different groups: anorganic bovine bone mineral as control, tricalcium phosphate with or without hyaluronic acid (HA) as test groups. Nine months after MSA, bone biopsies were harvested for the histomorphometric analysis. Secondary outcomes were mean bone gain, intraoperative and postoperative complications, implant insertion torque, implant failure, and patient-reported outcome measures. Results: Although the percentage of new bone was not statistically different between the three groups (P =.191), the percentages of residual biomaterial was significantly higher (P <.000) and nonmineralized tissue significantly lower (P <.000) in the control than in the test groups. Test groups did not differ significantly from each other for all histomorphometric parameters. The implant insertion torque was significantly higher in the control group (P <.0005). The rest of the secondary outcomes were not significantly different between the groups. Conclusion: MSA is a safe and predictable procedure in terms of histological, clinical, and PROAMs, regardless of the biomaterial used. The addition of HA did not influence the outcomes

Aesthetic bite for the management of temporomandibular disorders: A case series review

Background: Oral appliances (OA) are the most widely used treatment approach for temporomandibular disorders (TMDs): They are designed to relieve or prevent degenerative forces on the joint, the articular disk, and dentition. Classical OAs, however, are cumbersome and esthetically unpleasing: A more esthetic and functional appliance might improve treatment efficacy and shorten treatment time. Aim: The aim of this case series is to introduce an esthetical device for the management of TMD. Methodology: Three adults between 43 and 60 years old with a diagnosis of intra-articular TMD were included and were instructed to apply the device throughout the day and night. The patients were recruited at the same private dental clinic and each one signed an informed consent for both treatment and inclusion in the study. We evaluated and compared four clinical parameters (mandibular excursion, mandibular opening pattern, muscular and articular pain, and TMJ noises) between time 0 (T0) and 1, 2, 3, 6, and 12 months of using the device following the protocol of diagnostic criteria for temporomandibular joint disorders (DC/TMD). A magnetic resonance imaging exam was conducted to investigate tissue changes between T0 and 3 and 12 months of therapy. Conclusions: For all four parameters, we observed considerable improvements in all patients, who noticed the positive effects of the therapy themselves. The results suggest that this esthetic device was an effective treatment to manage TMD in the described cases, also increasing patients’ quality of life. However, studies on a larger scale are required to prove the effectiveness of this device. Clinical Significance: This case series aims to highlight the potentiality of an esthetic device used for the management of TMDs. This is because a more esthetically pleasant and comfortable device increases the time of usage, thus improving the positive effects of the device on the TMD

Multiple, Synchronous Lesions of Differing Histology Within the Same Testis: Ultrasonographic and Pathologic Correlations

Objective: To describe ultrasound (US) and pathologic findings in 11 patients with multiple, synchronous lesions of different histology within the same testis. Materials and methods: We reviewed US and pathologic findings in 11 patients with multiple, synchronous lesions of different histology within the same testis. Lesions were classified as separate or adjacent one to another and attempt was made to predict tumor type on their US textures. Pathologic review assessed presence of normal tissue between adjacent lesions and of Germ Cell Neoplasia In Situ in surrounding parenchyma. Nine cases were from files specifically dedicated to testicular tumors and estimated prevalence was calculated. Results: Two nodules were seen in nine patients and 3 in remaining two. Nine had tumors of different histology; two had one malignancy and one focal benign lesion. Germ Cell Neoplasia In Situ was seen in 7/11 cases. In dedicated archives, these lesions had 1.83% prevalence. Conclusion: Multiple focal lesions identified at imaging within the testis are not always of the same histology. This can be suspected in some cases basing on US texture. Recognition that lesions are multiple and an indication of their locations within the testis is the most important role of imaging and may help pathologists correctly sample the specimen to establish nature of each of them. Presence of multiple lesions is regarded as a contraindication to testicular sparing surgery. In two of our patients, one lesion was benign. Then, when the procedure is indicated all lesions have to be sampled and assessed by pathologists before deciding between conservative or radical technique