Efficacy of modified atkins ketogenic diet in chronic cluster headache. An open-label, single-arm, clinical trial

Introduction: Drug-resistant cluster headache (CH) is still an open clinical challenge. Recently, our group observed the clinical efficacy of a ketogenic diet (KD), usually adopted to treat drug-resistant epilepsies, on migraine. Aim: Here, we aim to detect the effect of KD in a group of drug-resistant chronic CH (CCH) patients. Materials and methods: Eighteen drug-resistant CCH patients underwent a 12-week KD (Modified Atkins Diet, MAD), and the clinical response was evaluated in terms of response (>= 50% attack reduction). Results: Of the 18 CCH patients, 15 were considered responders to the diet (11 experienced a full resolution of headache, and 4 had a headache reduction of at least 50% in terms of mean monthly number of attacks during the diet). The mean monthly number of attacks for each patient at the baseline was 108.71 (SD = 81.71); at the end of the third month of diet, it was reduced to 31.44 (SD = 84.61). Conclusion: We observed for the first time that a 3-month ketogenesis ameliorates clinical features of CCH

Three Essays on Innovation Performace, Aspirations and Strategic Decision Making

La recerca que he desenvolupat a la meva tesi doctoral està centrada en la comprensió del paper que desenvolupa el innovative performance per influir en la presa de decisions estratègiques a nivell individual i d’organitzacions, en un context intensiu de coneixement. La meva tesi doctoral s’articula en tres capítols principals, que corresponen a tres articles d’investigació de la meva línia de treball actual. Basant-me en la investigació prèvia sobre els nivells d’aspiració i presa de decisions a nivell de gerència, en el primer article s’examinaran les condicions en què les empreses farmacèutiques canvien el seu partnering behavior a través del temps. En línia amb el pensament actual en Behavioral Theory and Evolutionary Theory of the firm, sostenim que qualsevol canvi en partnering behavior és considerat de risc, i es posa en marxa per la diferència (o el gap existent) entre el rendiment actual i el rendiment desitjat. Hem estudiat una mostra de 988 empreses farmacèutiques entre 1990 i 2006 –els resultats confirmen la idea central del treball- que suggereixen que el tipus de performance (financer o innovador) té una marcada influencia en el associated feedback loop amb les subseqüents conseqüències a nivell organitzatiu de l’empresa. Quan la performance financera s’allunya de les expectatives (tan per sobre com per sota) les empreses farmacèutiques disminueixen la magnitud dels canvis en partnering behavior. Per contra, quan la innovative performance s’allunya de les expectatives (tan per sobre com per sota) les empreses farmacèutiques augmenten la magnitud de canvi en partnering behavior. El segon article, a partir d’investigacions anteriors i actuals de la mobilitat dels treballador, és un intent exploratori que busca construir sobre la Behavioral and Prospect theory més concretament sobre la literatura de managerial risk taking amb l’objectiu d’explorar les influències “motivacionals” sobre la mobilitat individual a través de les empreses de la industria farmacèutica –específicament com les desviacions del rendiment des de punts de referència específics expliquen la probabilitat de la mobilitat (una acció amb risc). En línia amb les teories del coneixement mencionades prèviament, els nostres resultats suggereixen que: quan un inventor performs per sobre del seu nivell d’aspiració/expectativa (tan històrica com social), trobem un recolzament pels arguments d’aversió de risc quan un inventor performs per sota les seves expectatives està més predisposat a participar en la mobilitat entre organitzacions, considerada com a acció arriscada, però només quan es compara la seva actuació amb les aspiracions socials (per exemple, considerant el risc del perfil). Finalment, en el tercer article s’intenta donar llum a les preguntes “per què els inventors es mouen?” Estudis recents proposen respostes a aquesta pregunta fonamental centrant-se principalment o bé en l’estructura d’incentius en els contractes d’inventors (mercat, és a dir laboral intern) o bé en les oportunitats externes del mercat laboral. Nosaltres creiem que aquestes teories econòmiques suposen una explicació parcial de per què els treballadors amb talent participen en la mobilitat entre organitzacions. De fet, no tenim una idea clara sobre els fonaments sociològics que caracteritzen la mobilitat, concretament desconeixem les raons que porten l’inventor a assumir aquests riscs/ que hi ha darrera de la inclinació dels inventors a assumir aquests riscs. Per tant, el present article és un intent d’oferir un model més comprensible per explicar els antecedents de mobilitat entre organitzacions. Prenent com a base la Behavioral and Prospect theories i més concretament, la literatura sobre managerial risk taking el document té com a objectiu principal el d’explorar i subratllar les influencies motivacionals sobre la mobilitat individual a través de les empreses de la industria farmacèutica –específicament es centra en com la desviació del “rendiment” respecte punts de referència específics (aspiracions socials) explica la probabilitat (la inclinació a la) mobilitat (una acció arriscada). Els resultats de la nostra investigació confirmen i amplien els estudis anteriors sobre la mobilitat; juntament amb l’estructura d’incentius d’empresa per retenir els empleats i inventors amb talent, el mercat laboral explica la inclinació a la mobilitat, la desviació en la performance dels inventors des de social aspiration levels i també pot predir a tendència a la mobilitat dels inventors. En conclusió, a la meva tesi doctoral intento millorar la comprensió, i per tant oferir a la comunitat acadèmica de managment, de com organitzacions i individus aprenen de les seves accions en el passat i prenen (decisions basades en la subseqüent strategic decision-making) com a resposta a la interpretació de la performance necessària per millorar la performance i aconseguir competitivitat exitosa.La investigación que he desarrollado durante mi tesis doctoral se centra en la comprensión del papel que desempeña el rendimiento innovador para influir en las decisiones estratégicas a nivel organizacional e individual en contextos intensivos en conocimiento. Mi tesis doctoral se articula en tres capítulos principales, que representan tres papeles de trabajo actuales. Basándose en la investigación previa sobre los niveles de aspiración y toma de decisiones gerenciales, en el primer documento de trabajo se examinará las condiciones en que las empresas farmacéuticas cambian su partnering behavior a través del tiempo. Usando fundamentos de Behavioral Theory y Evolutionary Theory of the firm, sostenemos que cualquier cambio en el partnering behavior se considera riesgoso, y es accionado por la brecha entre el rendimiento real y el rendimiento de aspiración. Prueba de una muestra de 988 empresas farmacéuticas a partir de 1990 a 2006, nuestros resultados confirman la idea central del trabajo - que el tipo de desempeño (financiero o innovador) tiene una fuerte influencia en el circuito de retorno correspondiente y la acción organizativa posterior: cualquier desvío de desempeño financiero de aspiraciones predice risk aversión behavior (i.e. menos cambio en partnering behavior) mientras cualquier desvío de desempeño innovador de aspiraciones predice risktaking behavior (i.e. mas cambio en partnering behavior). El segundo documento de trabajo, a partir de investigaciones anteriores y actuales de la movilidad de los empleados, es un intento exploratorio que busca construir sobre Behavioral Theory y la perspectiva, sobre todo, en la literatura de managerial risk taking con el fin de explorar las influencias motivacionales sobre la movilidad individual a través de las empresas de la industria farmacéutica - específicamente cómo las desviaciones del rendimiento desde los puntos de referencia específicos (aspiraciones) explican la probabilidad de movilidad (una acción arriesgada). De acuerdo con las tradiciones teóricas mencionadas anteriormente, nuestros resultados sugieren que: cuando un inventor realiza por encima de su nivel de aspiración (tanto histórica como social), encontramos apoyo para los argumentos de aversión al riesgo (es decir, menos propensos a cambiar de empleador), cuando un inventor realiza a continuación sus niveles de aspiración es más probable que participen en la movilidad entre organizaciones, como la acción arriesgada, pero sólo cuando se compara su desempeño con las aspiraciones sociales (es decir, teniendo riesgo de perfil). Finalmente, en el tercer documento de trabajo se intenta responder a las preguntas "¿por qué los inventores se mueven?" Estudios recientes que proponen respuesta a esta pregunta fundamental se centran principalmente en la estructura de incentivos en los contratos de inventor (es decir, mercado laboral interno) o oportunidades externas del mercado laboral. Nosotros creemos que estas tradiciones económicas teóricas presentar una representación parcial de por qué los empleados talentosos participan en la movilidad entre organizaciones. De hecho, no tenemos una idea clara sobre los fundamentos sociológicos que caracterizan a la movilidad, en particular, las razones motivacionales del inventor detrás de la participación en tal toma de riesgo (es decir, movilidad). Por lo tanto, el presente articulo es un intento que busca ofrecer un modelo más amplio para explicar los antecedentes de la movilidad entre organizaciones. Sobre la base de Behavioral Theory y tomando la perspectiva, sobre todo, de la literatura managerial risk taking, el documento tiene como objetivo principal de explorar y llamar la atención a las influencias motivacionales sobre la movilidad individual a través de las empresas de la industria farmacéutica - específicamente cómo las desviaciones de rendimiento de los puntos de referencia específicos (aspiraciones sociales) explican la probabilidad de movilidad (una acción arriesgada). Los resultados de nuestra investigación confirman y amplían los estudios anteriores sobre la movilidad: junto con la estructura de incentivos de la empresa para retener a los empleados talentosos y a las dinámicas de mercado de laboral externo que explican los inventores la posibilidad de la movilidad, las desviaciones del inventor de su rendimiento desde los niveles de aspiración sociales también predicen la probabilidad de inventor de la movilidad. En conclusión, en mi tesis doctoral intento de comprender mejor, y por lo tanto ofrecer a la comunidad académica de administración de empresa, como las organizaciones y los individuos aprenden de sus acciones pasadas y deciden posteriores tomas de decisiones estratégicas como respuesta a la interpretación del rendimiento, necesario para mejorar el rendimiento y reunir el éxito competitivo.The research I developed during my doctoral dissertation focuses on the understanding of the role that innovative performance plays in influencing strategic decision-making at the organizational and individual level in knowledge intensive contexts. My doctoral dissertation is articulated in three main chapters, which represent three current working papers. Building on the prior research on aspiration levels and managerial decision making, in the first working paper we examine the conditions under which pharmaceutical firms change their partnering behavior across time. Using insights drawn from behavioral theory and evolutionary theory of the firm, we argue that any change in partnering behavior is considered risky, and is triggered by the gap between actual performance and aspirational performance. Testing a sample of 988 pharmaceutical firms from 1990 to 2006, our results confirm the central idea of the paper - that the type of performance (financial or innovative) has a strong influence on the associated feedback loop and subsequent organizational action: any deviation of financial performance from aspirations predicts risk aversion behavior (i.e. less change in partnering behavior) while any deviation of innovative performance from aspirations predicts risk taking behavior (i.e. more change in partnering behavior). The second working paper, building on previous and current research of employees’ mobility, is an exploratory attempt that seeks to build on behavioral and prospect theory, particularly, on the literature of managerial risk taking in order to explore the motivational influences on individual mobility across firms in the pharmaceutical industry - specifically how performance deviations from specific reference points (aspirations) explain the likelihood of mobility (a risky action). In line with the theoretical traditions mentioned above, our results suggest that: when an inventor performs above her aspiration level (both historical and social), we found support for risk adversity arguments (i.e. less likely to change employer); when an inventor performs below her aspiration levels is more likely to engage in inter-organizational mobility, such as risky action, but only when comparing her performance to the social aspirations (i.e. risk taking profile). Finally, in the third working paper we attempt to answer to the questions “why do inventors move?” Recent studies propose answer to this fundamental question focusing mainly either on incentives structure in inventor’s contracts (i.e. internal labor market) or external labor market opportunities. We believe that these theoretical economic traditions present a partial representation of why talented employees engage in inter-organizational mobility. In fact, we do not have a clear understanding on the sociological underpinnings characterizing mobility, in particular about the inventor’s motivational rationales behind the engagement in such risky decision. Building on behavioral and prospect theory, particularly, on the literature of managerial risk taking, the paper mainly aims to explore and to bring attention to the motivational influences on individual mobility across firms in the pharmaceutical industry - specifically how performance deviations from specific reference points (social aspirations) explain the likelihood of mobility (a risky action). The results of our research confirm and extend previous studies on mobility: along with firm’s incentive structure to retain talented employees and inventors’ labor market explain the likelihood of mobility, inventor’s performance deviations from social aspiration levels also predict inventor’s likelihood of mobility. In conclusions, in my doctoral dissertation I attempt to better understand, and therefore offer to the academic management community, how organizations and individuals learn from their past actions and decide on subsequent strategic decision-making as a response to performance interpretation necessary to improve performance and gather competitive success

On quantum and relativistic mechanical analogues in mean field spin models

Conceptual analogies among statistical mechanics and classical (or quantum) mechanics often appeared in the literature. For classical two-body mean field models, an analogy develops into a proper identification between the free energy of Curie-Weiss type magnetic models and the Hamilton-Jacobi action for a one dimensional mechanical system. Similarly, the partition function plays the role of the wave function in quantum mechanics and satisfies the heat equation that plays, in this context, the role of the Schrodinger equation in quantum mechanics. We show that this identification can be remarkably extended to include a wide family of magnetic models classified by normal forms of suitable real algebraic dispersion curves. In all these cases, the model turns out to be completely solvable as the free energy as well as the order parameter are obtained as solutions of an integrable nonlinear PDE of Hamilton-Jacobi type. We observe that the mechanical analog of these models can be viewed as the relativistic analog of the Curie-Weiss model and this helps to clarify the connection between generalised self-averaging and in statistical thermodynamics and the semi-classical dynamics of viscous conservation laws.Comment: Dedicated to Sandro Graffi in honor of his seventieth birthda

The use of indocyanine green in bariatric surgery: A systematic review

Fluorescence-guided surgery is a recently developed technique in minimally invasive surgery in which a fluorescent dye is used to complement the surgeon’s judgment in making real-time intraoperative assessment of organ vascularization and proper tissue perfusion. This technique has been adopted in several different surgical subspecialties with positive results, particularly in hepatobiliary and colorectal surgery. More recently, it has also been applied in bariatric surgery, with the aim of reducing the incidence of leaks. This paper reviews the relevant literature on the topic

Excitability of the motor cortex in patients with migraine changes with the time elapsed from the last attack

BACKGROUND: Motor-evoked potentials (MEPs) produced by single-pulse transcranial magnetic stimulation (TMS) of the motor cortex can be an objective measure of cortical excitability. Previously, MEP thresholds were found to be normal, increased, or even reduced in patients with migraine. In the present study, we determined whether the level of cortical excitability changes with the time interval from the last migraine attack, thereby accounting for the inconsistencies in previous reports. METHODS: Twenty-six patients with untreated migraine without aura (MO) underwent a MEP study between attacks. Their data were then compared to the MEP data collected from a group of 24 healthy volunteers (HVs). During the experiment, the TMS figure-of-eight coil was positioned over the left motor area. After identifying the resting motor threshold (RMT), we delivered 10 single TMS pulses (rate: 0.1 Hz, intensity: 120% of the RMT) and averaged the resulting MEP amplitudes. RESULTS: The mean RMTs and MEP amplitudes were not significantly different between the MO and HV groups. In patients with MO, the RMTs were negatively correlated with the number of days elapsed since the last migraine attack (rho = -0.404, p = 0.04). CONCLUSION: Our results suggest that the threshold for evoking MEPs is influenced by the proximity of an attack; specifically, the threshold is lower when a long time interval has passed after an attack, and is higher (within the range of normative values) when measured close to an attack. These dynamic RMT variations resemble those we reported previously for visual and somatosensory evoked potentials and may represent time-dependent plastic changes in brain excitability in relation to the migraine cycle

Thalamo-cortical network activity between migraine attacks. Insights from MRI-based microstructural and functional resting-state network correlation analysis

BACKGROUND: Resting state magnetic resonance imaging allows studying functionally interconnected brain networks. Here we were aimed to verify functional connectivity between brain networks at rest and its relationship with thalamic microstructure in migraine without aura (MO) patients between attacks. METHODS: Eighteen patients with untreated MO underwent 3 T MRI scans and were compared to a group of 19 healthy volunteers (HV). We used MRI to collect resting state data among two selected resting state networks, identified using group independent component (IC) analysis. Fractional anisotropy (FA) and mean diffusivity (MD) values of bilateral thalami were retrieved from a previous diffusion tensor imaging study on the same subjects and correlated with resting state ICs Z-scores. RESULTS: In comparison to HV, in MO we found significant reduced functional connectivity between the default mode network and the visuo-spatial system. Both HV and migraine patients selected ICs Z-scores correlated negatively with FA values of the thalamus bilaterally. CONCLUSIONS: The present results are the first evidence supporting the hypothesis that an abnormal resting within networks connectivity associated with significant differences in baseline thalamic microstructure could contribute to interictal migraine pathophysiology

A comparative study between paired and unpaired Image Quality Assessment in Low-Dose CT Denoising

The current deep learning approaches for low-dose CT denoising can be divided into paired and unpaired methods. The former involves the use of well-paired datasets, whilst the latter relaxes this constraint. The large availability of unpaired datasets has raised the interest in deepening unpaired denoising strategies that, in turn, need for robust evaluation techniques going beyond the qualitative evaluation. To this end, we can use quantitative image quality assessment scores that we divided into two categories, i.e., paired and unpaired measures. However, the interpretation of unpaired metrics is not straightforward, also because the consistency with paired metrics has not been fully investigated. To cope with this limitation, in this work we consider 15 paired and unpaired scores, which we applied to assess the performance of low-dose CT denoising. We perform an in-depth statistical analysis that not only studies the correlation between paired and unpaired metrics but also within each category. This brings out useful guidelines that can help researchers and practitioners select the right measure for their applications

The Contribution of Small Modular Reactors to the Resilience of Power Supply

In recent years, there has been a growing interest in the design, development and commercialization of nuclear power Small Modular Reactors (SMRs). Actual SMR designs cover the full spectrum of nuclear reactor technologies, including water-, gas-, liquid-metal-, and molten-salt-cooled. Despite physical and technological differences, SMRs share some relevant design features, such as small size, modularity, inherent and passive safety systems. These features are expected to enhance availability, recoverability, promptness and robustness, thereby contributing to the resilience of power supply. Thanks to the peculiar design features of SMRs, they are likely to satisfy a number of Functional Requirements (FRs) for this objective, namely: (i) low vulnerability to external hazards; (ii) natural circulation of primary coolant; (iii) prompt, unlimited and independent core cooling under shutdown conditions; (iv) shutdown avoidance in response to variations of the offsite power supply quality and electrical load; (v) island mode operation; (vi) robust load-following; (vii) independent, self-cranking start. These make advanced Nuclear Power Plants (aNPPs) comprised of SMRs perfect candidates to withstand a broader range of natural disruptions and to recover faster from them, compared to conventional Nuclear Power Plants (cNPPs), thus rendering them a major potential asset for guaranteeing resilience and security of power supply. The review focuses on Natural Technological (NaTech) events that impact a typical Integrated Energy System (IESs) within which SMRs are embedded: IESs are, indeed, being developed to integrate different power generation plants with gas facilities, through gas and electricity infrastructures, because they are expected to bring increased security and resilience of power supply, as shown in the qualitative case study presented

Goal-Oriented Communication for Edge Learning based on the Information Bottleneck

Whenever communication takes place to fulfil a goal, an effective way to encode the source data to be transmitted is to use an encoding rule that allows the receiver to meet the requirements of the goal. A formal way to identify the relevant information with respect to a goal can be obtained exploiting the information bottleneck (IB) principle. In this paper, we propose a goal-oriented communication system, based on the combination of IB and stochastic optimization. The IB principle is used to design the encoder in order to find an optimal balance between representation complexity and relevance of the encoded data with respect to the goal. Stochastic optimization is then used to adapt the parameters of the IB to find an efficient resource allocation of communication and computation resources. Our goal is to minimize the average energy consumption under constraints on average service delay and accuracy of the learning task applied to the received data in a dynamic scenario. Numerical results assess the performance of the proposed strategy in two cases: regression from Gaussian random variables, where we can exploit closed-form solutions, and image classification using deep neural networks, with adaptive network splitting between transmit and receive sides.Comment: Accepted at ICASSP 202