From research to clinical practice: a systematic review of the implementation of psychological interventions for chronic headache in adults

Background: Psychological interventions have been proved to be effective in chronic headache (CH) in adults. Nevertheless, no data exist about their actual implementation into standard clinical settings. We aimed at critically depicting the current application of psychological interventions for CH into standard care exploring barriers and facilitators to their implementation. Secondarily, main outcomes of the most recent psychological interventions for CH in adults have been summarized. Methods: We conducted a systematic review through PubMed and PsycINFO in the time range 2008-2018. A quality analysis according to the QATSDD tool and a narrative synthesis were performed. We integrated results by: contacting the corresponding author of each paper; exploring the website of the clinical centers cited in the papers. Results: Of the 938 identified studies, 28 papers were selected, whose quality largely varied with an average %QATSDD quality score of 64.88%. Interventions included CBT (42.85%), multi-disciplinary treatments (22.43%), relaxation training (17.86%), biofeedback (7.14%), or other interventions (10.72%). Treatments duration (1 day-9 months) and intensity varied, with a prevalence of individual-basis implementation. The majority of the studies focused on all primary headaches; 4 studies focused on medication-overuse headache. Most of the studies suggest interventions as effective, with the reduction in frequency of attacks as the most reported outcome (46.43%). Studies were distributed in different countries, with a prevalent and balanced distribution in USA and Europe. Ten researches (35.71%) were performed in academic contexts, 11 (39.28%) in clinical settings, 7 (25%) in pain/headache centres. Interventions providers were professionals with certified experience. Most of the studies were funded with private or public funding. Two contacted authors answered to our e-mail survey, with only one intervention implemented in the routine clinical practice. Only in three out of the 16 available websites a reference to the implementation into the clinical setting was reported. Conclusion: Analysis of contextual barriers/facilitators and cost-effectiveness should be included in future studies, and contents regarding dissemination/implementation of interventions should be incorporated in the professional training of clinical scientists. This can help in filling the gap between the existing published research and treatments actually offered to people with CH

The Constitutional Considerations of Multiple Media Ownership Regulation by the Federal Communications Commission

Promoting the dissemination of diverse ideas with a minimum of governmental interference is the goal of the first amendment in protecting free press and free media. This goal is implicit in the public interest mandate of the Communications Act of 1934. A precise balance between restraint and diversity in first amendment policy appears impossible, but the process of decision should reflect both, with deference to restraint where possible. The Federal Communication Commission\u27s Order in Docket 18110 failed to strike such a balance; any future action regarding cross-ownership of broadcast stations by newspapers would benefit by an increased recognition of the importance of restraint

Dramatic mitigation of capacity decay and volume variation in vanadium redox flow batteries through modified preparation of electrolytes

Electrolyte imbalance caused by the undesired vanadium-ions cross-over and water transport through the membrane is one of the main critical issues of vanadium redox flow batteries, leading to battery capacity loss and electrolytes volume variation. In this work, the evolution of discharged capacity and electrolyte volume variation were firstly investigated adopting commercial electrolyte for hundreds of charge-discharge cycles in vanadium redox flow batteries employing different membranes, varying thickness and equivalent weight. Subsequently, with the support of a 1D physics-based model, the origin of the main phenomena regulating capacity decay and volume variation has been identified and different modifications in the preparation of electrolytes have been proposed. Electrolytes characterized by an equal proton concentration between the two tanks at the beginning of cycling operation turned out to limit capacity decay, while increasing electrolyte proton concentration was effective also in the mitigation of volume variation. The most promising electrolyte preparation combined the effect of high proton concentration and null osmotic pressure gradient between the two tanks: compared to commercial electrolyte this preparation reduced the capacity decay from 47.7% to 20.9%, increased the coulombic efficiency from 96.2% to 98.9% and the energy one from 79.9% to 83.4%, and also implied a negligible volume variation during cycles. The effectiveness of this electrolyte preparation has been verified with different membranes, increasing the range of validity of the results, that could be thus applied in a real system regardless of the adopted membrane

Diagnostic pitfalls in the assessment of congenital hypopituitarism.

BACKGROUND: The diagnosis of congenital hypopituitarism is difficult and oftendelayed because its symptoms are nonspecific.AIM: To describe the different clinical presentations of children with congenitalhypopituitarism to reduce the time for diagnosis and to begin a precocious andappropriate treatment.STUDY DESIGN: We analyzed a cohort of five children with congenitalhypopituitarism, describing their clinical, biochemical and radiologicalcharacteristics from the birth to diagnosis.RESULTS: As first sign of the disease, all of five patients presented a neonatal hypoglycemia, associated in four cases with jaundice. In all these four cases,the clinicians hypothesized a metabolic disease delaying the diagnosis, which wasperformed in only two cases within the neonatal period. In the other three cases,the diagnosis was formulated at 2, 5 and 8 years of life because there was severeand precocious growth impairment.CONCLUSIONS: It is important to suspect congenital hypopituitarism in thepresence of persistent neonatal hypoglycemia associated with jaundice and of aprecocious and severe reduction of the growth velocity in childhood. In all thesecases, it is necessary to undertake a hypothalamic-pituitary magnetic resonanceimaging scan as soon as possible, and to start appropriate treatment

a versatile system for in situ speckle and thermography based diagnostics of artifacts

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Classification of schizophrenia using feature-based morphometry

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Transient expression of reck under hepatic ischemia/reperfusion conditions is associated with mapk signaling pathways

In this study, we demonstrated the involvement of matrix metalloproteinases (MMPs) in hepatic ischemia/reperfusion (I/R) injury. Our aim is to evaluate the impact of reperfusion on I/R-related changes in RECK, an MMP modulator, and mitogen-activated protein kinase (MAPKs) pathways (ERK, p38, and JNK). Male Wistar rats were either subjected to 60 min partial-hepatic ischemia or sham-operated. After a 60 min or 120 min reperfusion, liver samples were collected for analysis of MMP-2 and MMP-9 by zymography and RECK, TIMP-1, and TIMP-2 content, MAPKs activation (ERK1/2, JNK1/2, and p38), as well as iNOS and eNOS by Western blot. Serum enzymes AST, ALT, and alkaline-phosphatase were quantified. A transitory decrease in hepatic RECK and TIMPs was associated with a transitory increase in both MMP-2 and MMP-9 activity and a robust activation of ERK1/2, JNK1/2, and p38 were detected at 60 min reperfusion. Hepatic expression of iNOS was maximally upregulated at 120 min reperfusion. An increase in eNOS was detected at 120 min reperfusion. I/R evoked significant hepatic injury in a time-dependent manner. These findings provide new insights into the underlying molecular mechanisms of reperfusion in inducing hepatic injury: a transitory decrease in RECK and TIMPs and increases in both MAPK and MMP activity suggest their role as triggering factors of the organ dysfunction

Right ventricular function in AL amyloidosis: characteristics and prognostic implication

AIM: The importance of right ventricle (RV) dysfunction in AL amyloidosis has been underestimated. This study was designed to comprehensively evaluate RV function and its prognostic role in patients with AL amyloidosis with and without echocardiographic evidence of cardiac involvement. METHOD AND RESULTS: Fifty-two biopsy-proven AL amyloidosis patients underwent a thorough echocardiographic evaluation. Twenty-seven patients (CA) met the international echocardiographic criteria for cardiac involvement [left ventricular (LV) wall thickness >/= 12 mm] and 25 patients had no cardiac amyloidosis features (NCA). Patients were compared with a sex- age-matched control group. Patients and controls underwent traditional, tissue Doppler (TDI), speckle-tracking left and RV echocardiographic evaluation. No difference was observed between groups in RV diastolic diameter, whereas CA patients showed increased RV free wall thickness (P< 0.0001). Compared with controls and NCA patients, traditional echocardiography, TDI, and speckle-tracking evaluation detected significantly (P< 0.0001) depressed RV longitudinal systolic function in CA patients. No difference was observed between groups at Doppler diastolic evaluation, whereas at tricuspidal annulus TDI analysis, CA subject showed significantly lower E' and A' values with increased E/E' ratio (P< 0.0001). Over a 19 months median follow-up period, 18 patients died. Cox multivariate analysis showed that N-terminal pro-Brain natriuretic peptide and RV longitudinal strain were the strongest death predictor. CONCLUSION: Our data show that in patients with AL amyloidosis, RV involvement develops later than LV amyloid deposition but when it occurs, prognosis dramatically worsens. Moreover RV longitudinal strain was the only echocardiographic predictor of prognosis. We suggest that RV function analysis should be performed routinely as a part of echocardiographic evaluation in these patients