Behavioral management of headache in children and adolescents

Headache is the most frequent neurological symptom and the most prevalent pain in children and adolescents, and constitutes a serious health problem that may lead to impairment in several areas. Psychosocial factors, social environment, life events, school and family stressors are all closely related to headaches. A multidisciplinary strategy is fundamental in addressing headache in children and adolescents. Applying such a strategy can lead to reductions in frequency and severity of the pain, improving significantly the quality of life of these children.It has been demonstrated that behavioral intervention is highly effective, especially in the treatment of paediatric headache, and can enhance or replace pharmacotherapy, with the advantage of eliminating dangerous side effects and or reducing costs. Behavioral interventions appear to maximize long-term therapeutic benefits and improve compliance with pharmacological treatment, which has proven a significant problem with child and adolescent with headache.The goal of this review is to examine the existing literature on behavioral therapies used to treat headache in children and adolescents, and so provide an up-to-date picture of what behavioral therapy is and what its effectiveness is

Resource Allocation in LTE Advanced for QoS and Energy Efficiency

Long Term Evolution (LTE) and LTE-Advanced (LTE-A) are establishing themselves as the new standard of 4G cellular networks in Europe and in several other parts of the world. Their success will largely depend on their ability to support Quality of Service for different types of users, at reasonable costs. The quality of service will depend on how effectively the cell bandwidth is shared among the users. The cost will depend – among many other factors – on how effectively we exploit the cell capacity. Being able to exploit bandwidth efficiently postpones the time when network upgrades are required. On the other hand, operation costs also depend on the energy efficiency of the cellular network, which should avoid wasting power when few users are connected. As for bandwidth efficiency, the recent LTE/LTE-A standards introduced MIMO (Multiple Input Multiple Output) transmission modes, which allow both reliability and efficiency to be increased. MIMO can increase the throughput significantly. In a MIMO system, the selection of the MIMO transmission modes (whether Transmission Diversity, Spatial Multiplexing, or Multi-User MIMO) plays a key feature in determining the achievable rate and the error probability experienced by the users. MIMO-unaware scheduling policies, which neglect the transmission mode selection problem, do not perform well under MIMO. In the current literature, few MIMO-aware LTE-A scheduling policies have been designed. However, despite being proposed for LTE-A, these solutions do not take into account some constraints inherent to LTE-A, hence leading to unfeasible allocations. In this work, we propose a new framework for Transmission Mode Selection and Frequency. Domain Packet Scheduling, which is compliant with the constraints of the LTE-A standard. The resource allocation framework accommodates real-time requirements and fairness on demand, while the bulk of the resources are allocated in an opportunistic fashion, i.e. so as to maximize the cell throughput. Our results show that our proposal provides real-time connections with the desired level of QoS, without utterly sacrificing the cell throughput. As far as energy efficiency is concerned, we studied the problem of minimizing the RF power used by the eNodeB, while maintaining the same level of service for the users. We devised a provisioning framework that exploits the Multicast/Broadcast over a Single Frequency Network (MBSFN) mechanism to deactivate the eNodeB on some Transmission Time Intervals (TTI), and computes the minimum-power activation required for guaranteeing a given level of service. Our results show that the provisioning framework is stable, and that it allows significant savings with respect to an always-on policy, with marginal impact on the latency experienced by the users

Immunoglobulin G subclass profile of anticitrullinated peptide antibodies specific for Epstein Barr virus-derived and histone-derived citrullinated peptides.

To the Editor: Studies have shown that the anticitrullinated peptide antibodies (ACPA) response is highly polyclonal, in terms of epitope specificity, V genes, and isotype usage1,2. Longitudinal studies of patients with rheumatoid arthritis (RA) have documented epitope spreading, and ACPA, specific for distinct citrullinated epitopes, have been described. By using different citrullinated antigens, ACPA from immunoglobulin (Ig)G, IgA, and IgM isotype have been detected3. ACPA are polyclonal in the usage of different IgG subclasses, but in this case the pattern is more heterogeneous. So far the studies conducted indicate the dominance of IgG1 and IgG4, while IgG3 have been detected with cyclic citrullinated peptide (CCP) and vimentin, but not with fibrinogen4,5. The production of specific IgG subclasses might help in deciphering the mechanisms eliciting B cell expansion in response to different antigens. Thus, it is of interest to explore the profile of IgG subclasses of antibodies reactive with novel citrullinated substrates, already known to be tools for ACPA detection. Ninety-three patients with RA, 25 with psoriatic arthritis, 15 with ankylosing spondylitis, and … Address correspondence to Professor P. Migliorini, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56126 – Pisa, Italy. E-mail: paola.migliorini{at}med.unipi.i

Power-aware allocation of MBSFN subframes using Discontinuous Cell Transmission in LTE systems

In LTE and its evolutions, energy efficiency is a critical aspect, also in view of the dramatic traffic growth foreseen for the next years. Cell Discontinuous Transmission (DTX) techniques can be important tools to achieve the needed efficiency in the networks, and one possibility is to implement the DTX by switching off the eNB at some subframes (MBSFN subframes) and not in others (where reference signals are also transmitted). Switching schedules in LTE are made for larger periods (e.g., 40/80ms or even more). We present an algorithm that i) estimates how many resources will be needed in a period, and ii) shows how many resource blocks to activate in each subframe so as to maximize the power efficiency. The problem is formulated as an integer linear problem and solved heuristically. Numerical results show that the power saving is significant, close to the theoretical minimum at low loads, and it comes with a tolerable extra dela

Throughput-optimal Resource Allocation in LTE-Advanced with Distributed Antennas

Distributed antennas are envisaged for LTE-Advanced deployments in order to improve the coverage and increase the cell throughput. The latter in turn depends on how resources are allocated to the User Equipments (UEs) at the MAC layer. In this paper we discuss how to allocate resources to UEs so as to maximize the cell throughput, given that UEs may re-ceive from several antennas simultaneously. We first show that the problem is both NP-hard and APX-hard, i.e. no polynomial-time algorithm exists that approximates the opti-mum within a constant factor. Hence, we pro-pose and evaluate two polynomial-time heuristics whose complexity is feasible for practical purposes. Our simulative analysis shows that, in practical scenarios, the two heuristics are highly accurate

Influence of Antisynthetase Antibodies Specificities on Antisynthetase Syndrome Clinical Spectrum TimeCourse

Introduction: Increased cardiovascular (CV) morbidity and mortality is observed in inflammatory joint diseases (IJDs) such as rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis. However, the management of CV disease in these conditions is far from being well established.Areas covered: This review summarizes the main epidemiologic, pathophysiological, and clinical risk factors of CV disease associated with IJDs. Less common aspects on early diagnosis and risk stratification of the CV disease in these conditions are also discussed. In Europe, the most commonly used risk algorithm in patients with IJDs is the modified SCORE index based on the revised recommendations proposed by the EULAR task force in 2017.Expert opinion: Early identification of IJD patients at high risk of CV disease is essential. It should include the use of complementary noninvasive imaging techniques. A multidisciplinary approach aimed to improve heart-healthy habits, including strict control of classic CV risk factors is crucial. Adequate management of the underlying IJD is also of main importance since the reduction of disease activity decreases the risk of CV events. Non-steroidal anti-inflammatory drugs may have a lesser harmful effect in IJD than in the general population, due to their anti-inflammatory effects along with other potential beneficial effects.This research was partially funded by FOREUM—Foundation for Research in Rheumatolog

Rationale and design of an independent randomised controlled trial evaluating the effectiveness of aripiprazole or haloperidol in combination with clozapine for treatment-resistant schizophrenia

<p>Abstract</p> <p>Background</p> <p>One third to two thirds of people with schizophrenia have persistent psychotic symptoms despite clozapine treatment. Under real-world circumstances, the need to provide effective therapeutic interventions to patients who do not have an optimal response to clozapine has been cited as the most common reason for simultaneously prescribing a second antipsychotic drug in combination treatment strategies. In a clinical area where the pressing need of providing therapeutic answers has progressively increased the occurrence of antipsychotic polypharmacy, despite the lack of robust evidence of its efficacy, we sought to implement a pre-planned protocol where two alternative therapeutic answers are systematically provided and evaluated within the context of a pragmatic, multicentre, independent randomised study.</p> <p>Methods/Design</p> <p>The principal clinical question to be answered by the present project is the relative efficacy and tolerability of combination treatment with clozapine plus aripiprazole compared with combination treatment with clozapine plus haloperidol in patients with an incomplete response to treatment with clozapine over an appropriate period of time. This project is a prospective, multicentre, randomized, parallel-group, superiority trial that follow patients over a period of 12 months. Withdrawal from allocated treatment within 3 months is the primary outcome.</p> <p>Discussion</p> <p>The implementation of the protocol presented here shows that it is possible to create a network of community psychiatric services that accept the idea of using their everyday clinical practice to produce randomised knowledge. The employed pragmatic attitude allowed to randomly allocate more than 100 individuals, which means that this study is the largest antipsychotic combination trial conducted so far in Western countries. We expect that the current project, by generating evidence on whether it is clinically useful to combine clozapine with aripiprazole rather than with haloperidol, provides physicians with a solid evidence base to be directly applied in the routine care of patients with schizophrenia.</p> <p>Trial Registration</p> <p><b>Clincaltrials.gov Identifier</b>: NCT00395915</p

Enabling planetary science across light-years. Ariel Definition Study Report

Ariel, the Atmospheric Remote-sensing Infrared Exoplanet Large-survey, was adopted as the fourth medium-class mission in ESA's Cosmic Vision programme to be launched in 2029. During its 4-year mission, Ariel will study what exoplanets are made of, how they formed and how they evolve, by surveying a diverse sample of about 1000 extrasolar planets, simultaneously in visible and infrared wavelengths. It is the first mission dedicated to measuring the chemical composition and thermal structures of hundreds of transiting exoplanets, enabling planetary science far beyond the boundaries of the Solar System. The payload consists of an off-axis Cassegrain telescope (primary mirror 1100 mm x 730 mm ellipse) and two separate instruments (FGS and AIRS) covering simultaneously 0.5-7.8 micron spectral range. The satellite is best placed into an L2 orbit to maximise the thermal stability and the field of regard. The payload module is passively cooled via a series of V-Groove radiators; the detectors for the AIRS are the only items that require active cooling via an active Ne JT cooler. The Ariel payload is developed by a consortium of more than 50 institutes from 16 ESA countries, which include the UK, France, Italy, Belgium, Poland, Spain, Austria, Denmark, Ireland, Portugal, Czech Republic, Hungary, the Netherlands, Sweden, Norway, Estonia, and a NASA contribution

Design and analysis of a cross-layer algorithm for multi-service downlink traffic scheduling in IEEE 802.16 wireless networks

Lo standard IEEE 802.16 è una delle più importanti tecnologie wireless che offre accesso alla banda larga (Broadband Wireless Access, BWA) sia in modalità fissa che in modalità mobile. In un'era dove sempre più utenti necessitano un accesso alla banda larga per usufruire di servizi differenti come voce, video e Web in completa mobilità, si crea la necessità di sviluppare scheduler che garantiscano un'adeguata QoS (Quality of Service) e allo stesso tempo che gestiscano in maniera efficiente le limitate risorse radio. In questo lavoro di tesi si è quindi progettato un nuovo scheduler multi servizio per sistemi IEEE 802.16. Questo scheduler, chiamato BoostedLB, è stato sviluppato al fine di offrire ai vari utenti la QoS negoziata all'inizio della connessione garantendogli un rate minimo. Le risorse radio sono suddivise in zone e ad ogni zona viene allocata staticamente una potenza in trasmissione differente. In concomitanza allo scheduling i vari utenti vengono allocati nelle varie zone rispettando determinate regole, una di queste può essere quella di allocare gli utenti a bordo cella nelle zone con più alta potenza in trasmissione, in modo da rendere la comunicazione più affidabile. Alla progettazione e implementazione è seguita una fase di analisi delle prestazioni confrontando i risultati con scheduler noti in letteratura. A margine dell'attività principale di tesi è stato sviluppato e analizzato un meccanismo di adattamento della velocità di trasmissione al fine di minimizzare l'utilizzo di messaggi espliciti per il reporting della qualità del canale