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

The role of Attachment Insecurity in the emergency of anxiety symptoms in children and adolescent with migraine: an empirical study

Background: It is widely recognised that there are associations between headache, psychiatric comorbidity and attachment insecurity in both adults and children. The aims of this study were: 1) to compare perceived attachment security and anxiety in children and adolescents with migraine without aura and a healthy control group; 2) to test whether the child’s perceived security of attachment to the mother and the father mediated the association between migraine and anxiety. Methods: One hundred children and adolescents with Migraine without Aura were compared with a control group of 100 children without headache. The Security Scale (measures perceived security of attachments) and the Self-Administered Psychiatric Scales for Children and Adolescents, a measure of anxiety symptoms, were administered to all participants. Results: The clinical group had lower attachment security than the control group and higher scores on all anxiety scales. Anxiety was negatively correlated with attachment. Children’s attachment to their mother mediated the increase in global anxiety in the clinical group. Insecure paternal attachment was associated with greater insecurity in maternal attachment, suggesting that there is a complex pathway from migraine to anxiety symptoms mediated by perceived insecurity of paternal attachment and hence also by perceived insecurity of maternal attachment. Conclusion: These results suggest that insecure parental attachment may exacerbate anxiety in children and adolescents with migraine and point to the importance of multimodal interventions, perhaps taking account of family relationships, for children and adolescents with migraine

Decision Support System for smart urban management: resilience against natural phenomena and aerial environmental assessment

A new concept of Decision Support System (DSS) is presented. It is able to account for and support all phases of the risk analysis process: event forecast, prediction of reliable and accurate damage scenarios, estimate of their impact on Critical Infrastructures (CI), estimate of the possible consequences. It also provides an estimate of the consequences in terms of service degradation and of impact on citizens, on urban area and on production activities, essential for the mitigation of the adverse events. It can be used in two different modes, either in an operational mode (on a 24/7 basis) or in a simulation mode to produce risk analysis, setting up synthetic natural hazards and assessing the resulting chain of events (damages, impacts and consequences). Among the various possible external data sources an aerial, drone based one is presented. The system may capture both thermal and visual images of CI, processing them into 3D models or collect chemical pollutants concentrations for the monitoring of dangerous air quality due to catastrophic events such as volcano eruptions or large fires. The obtained models and the chemical data can be easily displayed within the framework of the DSS

Direct Evidence of a Slow‐Slip Transient Modulating the Spatiotemporal and Frequency‐Magnitude Earthquake Distribution: Insights From the Armutlu Peninsula, Northwestern Turkey

Earthquakes and slow‐slip events interact, however, detailed studies investigating their interplay are still limited. We generate the highest resolution microseismicity catalog to date for the northern Armutlu Peninsula in a ∼1‐year period to perform a detailed seismicity distribution analysis and correlate the results with a local, geodetically observed slow‐slip transient within the same period. Seismicity shows a transition of cluster‐type behavior from swarm‐like to burst‐like, accompanied by an increasing relative proportion of clustered (non‐Poissonian) relative to background (Poissonian) seismicity and gradually decreasing b‐value as the geodetically observed slow‐slip transient ends. The observed slow‐slip transient decay correlates with gradually increasing effective‐stress‐drop values. The observed correlation between the b‐value and geodetic transient highlights the influence of aseismic deformation on seismic deformation and the impact of slow‐slip transients on local seismic hazard

Evaluating the impact of hydrometeorological conditions on E. coli concentration in farmed mussels and clams: experience in Central Italy.

Abstract Highly populated coastal environments receive large quantities of treated and untreated wastewater from human and industrial sources. Bivalve molluscs accumulate and retain contaminants, and their analysis provides evidence of past contamination. Rivers and precipitation are major routes of bacteriological pollution from surface or sub-surface runoff flowing into coastal areas. However, relationships between runoff, precipitation, and bacterial contamination are site-specific and dependent on the physiographical characteristics of each catchment. In this work, we evaluated the influence of precipitation and river discharge on molluscs' Escherichia coli concentrations at three sites in Central Italy, aiming at quantifying how hydrometeorological conditions affect bacteriological contamination of selected bivalve production areas. Rank-order correlation analysis indicated a stronger association between E. coli concentrations and the modelled Pescara River discharge maxima (r = 0.69) than between E. coli concentration and rainfall maxima (r = 0.35). Discharge peaks from the Pescara River caused an increase in E. coli concentration in bivalves in 87% of cases, provided that the runoff peak occurred 1–6 days prior to the sampling date. Precipitation in coastal area was linked to almost 60% of cases of E. coli high concentrations and may enhance bacterial transportation offshore, when associated with a larger-scale weather system, which causes overflow occurrence

E-Debitum: managing software energy debt

35th IEEE/ACM International Conference on Automated Software Engineering Workshops (ASEW ’20) - International Workshop on Sustainable Software Engineering (SUSTAIN-SE)This paper extends previous work on the concept of a new software energy metric: Energy Debt. This metric is a reflection on the implied cost, in terms of energy consumption over time, of choosing an energy flawed software implementation over a more robust and efficient, yet time consuming, approach. This paper presents the implementation a SonarQube tool called E-Debitum which calculates the energy debt of Android applications throughout their versions. This plugin uses a robust, well defined, and extendable smell catalogue based on current green software literature, with each smell defining the potential energy savings. To conclude, an experimental validation of E-Debitum was executed on 3 popular Android applications with various releases, showing how their energy debt fluctuated throughout releases.This work is financed by National Funds through the Portuguese funding agency, FCT -Fundação para a Ciência e a Tecnologia within project UIDB/50014/2020

SPELLing out energy leaks: Aiding developers locate energy inefficient code

Although hardware is generally seen as the main culprit for a computer's energy usage, software too has a tremendous impact on the energy spent. Unfortunately, there is still not enough support for software developers so they can make their code more energy-aware.This paper proposes a technique to detect energy inefficient fragments in the source code of a software system. Test cases are executed to obtain energy consumption measurements, and a statistical method, based on spectrum-based fault localization, is introduced to relate energy consumption to the source code. The result of our technique is an energy ranking of source code fragments pointing developers to possible energy leaks in their code. This technique was implemented in the SPELL toolkit.Finally, in order to evaluate our technique, we conducted an empirical study where we asked participants to optimize the energy efficiency of a software system using our tool, while also having two other groups using no tool assistance and a profiler, respectively. We showed statistical evidence that developers using our technique were able to improve the energy efficiency by 43% on average, and even out performing a profiler for energy optimization. (C) 2019 Elsevier Inc. All rights reserved.This work is funded by the ERDF -European Regional Development Fund through the Operational Programme for Competitiveness and Internationalization -COMPETE 2020 Programme within project POCI-01-0145-FEDER-006961, and by National Funds through the Portuguese funding agency, FCT -Fundacao para a Ciencia e a Tecnologia within project POCI010145FEDER016718, UID/EEA/50014/2013, and by FCT grant SFRH/BD/132485/2017. This work is also supported by operation Centro010145FEDER000019 -C4 -Centro de Competencias em Cloud Computing, cofinanced by the European Regional Development Fund (ERDF) through the Programa Operacional Regional do Centro (Centro 2020), in the scope of the Sistema de Apoio a Investigacao Cientifica e Tecnologica -Programas Integrados de IC&DT, and the first author was financed by post-doc grant referencia C4_SMDS_L1-1_D

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701