Phantom Restless Legs Syndrome

Background: Amputees often experience a phantom limb consisting in the vivid impression that the limb is not only still present, but in many cases, painful. These patients may also become restless legs syndrome (RLS) sufferers; conversely, a preexisting RLS may persist after limb amputation. Summary: In this brief essay, papers on phantom RLS (pRLS) are reviewed in order to provide clinical elements for the diagnosis and treatment of this peculiar condition. It is relevant that dopamine receptor agonists yielded a marked reduction of the RLS symptoms in all cases reported. Key Messages: pRLS indirectly confirms the innate capacity of the central nervous system to retain a primordial internal body image responsible of phantom sensations. Moreover, it has been hypothesized that pRLS may provide clues for a better comprehension of some mechanisms underlying phantom pain and for the development of new treatment strategies

On primordial groups for the Green ring

Consider the Mackey functor assigning to each finite group G the Green ring of finitely generated kG-modules, where k is a field of characteristic p>0. Thevenaz foresaw in 1988 that the class of primordial groups for this functor is the family of k-Dress groups. In this paper we prove that this is true for the subfunctor defined by the Green ring of finitely generated kG-modules of trivial source.Comment: 13 pages, changed conten

Social life cycle assessment of an innovative industrial wastewater treatment plant

Abstract Background The social impacts generated by industrial waste treatment processes have not been studied enough, as shown in the literature. Social life cycle assessment studies have mainly focused on the assessment of products and less on industrial waste, especially wastewater, although potentially relevant from an environmental point of view, and also from a social one for various stakeholders. Purpose This case study concerns the social assessment of an innovative technology to treat the wastewater of a microelectronics company. In order to produce electronic components and semiconductors, the company has to treat and dispose of relevant wastewater streams containing various toxic substances. The wastewater streams need to be treated in order to protect the eco-system, representing a high cost for the company and a potential impact on the environment. For this reason, the company developed a LIFE project to demonstrate the viability to decrease the burdens on water bodies. The positive outcome of the test on the pilot plant paved the way for the construction of the full-scale plant that will treat all the wastewater generated by the company. The objective of this paper is the socio-economic assessment of a full-scale plant designed to treat three different kinds of wastewater. Methods The assessment of socio-economic potential impacts of a new technology has been carried out through the PSILCA (Product Social Impact Life Cycle Assessment) database implementation to evaluate 65 social indicators of a wastewater treatment plant. Results The line with the highest impact is the one which treats tetramethylammonium hydroxide; this is because this wastewater flow is the most abundant (14 and 43 times greater than the other wastewaters, respectively). The most affected stakeholder is the Local Community, followed by the Actors of the Value Chain; in fact, the results referred to the functional unit considered exceed 300,000 medium risk hours in both cases. For the Local Community this result arises from the indicator "Contribution to environmental load," which is understandable considering the object of the study since this indicator includes health effects. As far as the Value Chain Actors stakeholder is concerned, the two indicators most impacted are "Corruption" and "Social responsibility along the supply chain". The analysis conducted has also shown that upstream has a fundamental relevance for the social risks detected. Conclusions Considering the current lack of studies on both environmental and social impacts of wastewater treatment, and the fact that Social Life Cycle Assessment has not been widely used in this field, as emerged from literature review, this work is the first use of the PSILCA database to assess an industrial wastewater plant. The use of a social life cycle assessment database allows the value chain of a product system to be considered: the results show that most of the overall social risk derives from upstream sectors

The International Classification of Functioning Disability and Health, version for children and youth as a roadmap for projecting and programming rehabilitation in a neuropaediatric hospital unit.

Objective To test the impact of introducing a format based on the International Classification of Functioning Disability and Health, version for children and youth (ICF-CY) as a road-map for in-hospital paediatric neuro-rehabilitation on target definition, intra-team communication and workload as perceived by involved professionals. Design Single-centre pilot testing with impact assessment. Patients Team members of a tertiary care paediatric neurorehabilitation unit included 15 consecutive patients with severe neurological conditions. Methods An ICF-CY based format for rehabilitation projection and programming was constructed and tested for 12 months. The format comprises 3 sections: project, programme, and follow-up. Impact on the rehabilitation team was assessed with a questionnaire. Results All cases were described according to their specific needs with appropriate ICF-CY codes, and the interventions were linked to needs and targets. ICF-CY was judged an efficient tool in providing a road-map for rehabilitation in this setting, although concern was voiced about timing and workload. Conclusion ICF-CY may work as a road-map for in-hospital paediatric neuro-rehabilitation. Its implementation results in perceived improvements in the process. Training requirements and accurate evaluation of timing, workload and organizational context are critical issues that should be addressed before results from the present experience are generalized

A Population Survey in Italy Based on the ICF Classification: Recognizing Persons with Severe Disability

Aim of this paper is to describe functioning of subjects with “severe disability” collected with a protocol based on the International Classification of Functioning, Disability, and Health. It included sections on body functions and structures (BF and BS), activities and participation (A&P), and environmental factors (EF). In A&P, performance without personal support (WPS) was added to standard capacity and performance. Persons with severe disability were those reporting a number of very severe/complete problems in BF or in A&P-capacity superior to mean + 1SD. Correlations between BF and A&P and differences between capacity, performance-WPS, and performance were assessed with Spearman's coefficient. Out of 1051, 200 subjects were considered as severely disabled. Mild to moderate correlations between BF and A&P were reported (between 0.148 and 0.394 when the full range of impairments/limitations was taken into account; between 0.198 and 0.285 when only the severe impairments/limitations were taken into account); performance-WPS was less similar to performance than to capacity. Our approach enabled identifying subjects with “severe disability” and separating the effect of personal support from that of devices, policies, and service provision

Obesity Is a Marker of Reduction in QoL and Disability

The purpose of this paper is to verify the association between outcome measures of health-related quality of life (HRQoL) and disability, BMI, gender, and age. Adult obese patients were clustered using HRQoL (IWQoL-Lite) and disability (WHO-DAS II) scores into three groups: mild, moderate, and high. One-way ANOVA with Bonferroni post hoc test was used to evaluate differences in age and BMI between subjects from different clusters, contingency coefficient to test the relationship between cluster groups and gender. In total, 117 patients were enrolled: subjects with higher disability and HRQoL decrement were older and had higher BMI. Women were more likely to present moderate disability and reduction in HRQoL, while men more likely presented mild disability and HRQoL reduction. Our data further confirm the connection between disability and HRQoL, high BMI and older age. These data obtained with outcomes measures might better address rehabilitation programs

Stability of Auditory Discrimination and Novelty Processing in Physiological Aging

Complex higher-order cognitive functions and their possible changes with aging are mandatory objectives of cognitive neuroscience. Event-related potentials (ERPs) allow investigators to probe the earliest stages of information processing. N100, Mismatch negativity (MMN) and P3a are auditory ERP components that reflect automatic sensory discrimination. The aim of the present study was to determine if N100, MMN and P3a parameters are stable in healthy aged subjects, compared to those of normal young adults. Normal young adults and older participants were assessed using standardized cognitive functional instruments and their ERPs were obtained with an auditory stimulation at two different interstimulus intervals, during a passive paradigm. All individuals were within the normal range on cognitive tests. No significant differences were found for any ERP parameters obtained from the two age groups. This study shows that aging is characterized by a stability of the auditory discrimination and novelty processing. This is important for the arrangement of normative for the detection of subtle preclinical changes due to abnormal brain aging

Comparison of a Minimally Invasive Tissue-Sparing Posterior Superior (TSPS) Approach and the Standard Posterior Approach for Hip Replacement

Purpose. The purpose of this study is to compare the functional and clinical outcomes, blood loss, complication rate, and hospital length of stay (LOS) of total hip replacement (THR) using a minimally invasive tissue-sparing posterior superior (TSPS) approach and the standard posterior approach. Materials and Methods. This retrospective, observational, double-centered study included 38 patients undergoing hip replacement. The patents were divided into two groups: control group (19 patients), who underwent surgery with the standard posterior approach, and treatment group (19 patients), who received the same type of implant with ceramic-on-ceramic bearing via the TSPS approach. Hemoglobin level was assessed preoperatively, on first and second postoperative days, and on discharge day. Harris hip score and Western Ontario and McMaster Universities Arthritis Index were used to measure the clinical and functional outcomes. Hospital LOS and incidence of early and late complications were assessed in both groups. Postoperative anteroposterior pelvis X-ray was performed to assess the correct positioning of implants. Results. Better early clinical outcomes (p=0.0155), lesser blood loss (p < 0.0001), and reduced hospital LOS (p < 0.0001) were observed in the TSPS group than in the control group. No major adverse effects occurred in both groups, and a satisfactory implant orientation was achieved in all patients. Conclusions. The TSPS approach is a reliable minimally invasive procedure for THR as it allows an accurate orientation of the components and provides better early postoperative functional outcomes, faster recovery, significantly lower blood loss, and shorter hospital LOS than the standard posterior approach. However, further research is needed to confirm the promising results and cost-effectiveness of the TSPS approach in larger cohorts with a longer follow-up period

Structured headache services as the solution to the ill-health burden of headache. 3. Modelling effectiveness and cost-effectiveness of implementation in Europe: findings and conclusions

Background: There have been several calls for estimations of costs and consequences of headache interventions to inform European public-health policies. In a previous paper, in the absence of universally accepted methodology, we developed headache-type-specific analytical models to be applied to implementation of structured headache services in Europe as the health-care solution to headache. Here we apply this methodology and present the findings. Methods: Data sources were published evidence and expert opinions, including those from an earlier economic evaluation framework using the WHO-CHOICE model. We used three headache-type-specific analytical models, for migraine, tension-type-headache (TTH) and medication-overuse-headache (MOH). We considered three European Region case studies, from Luxembourg, Russia and Spain to include a range of health-care systems, comparing current (suboptimal) care versus target care (structured services implemented, with provider-training and consumer-education). We made annual and 5-year cost estimates from health-care provider and societal perspectives (2020 figures, euros). We expressed effectiveness as healthy life years (HLYs) gained, and cost-effectiveness as incremental cost-effectiveness-ratios (ICERs; cost to be invested/HLY gained). We applied WHO thresholds for cost-effectiveness. Results: The models demonstrated increased effectiveness, and cost-effectiveness (migraine) or cost saving (TTH, MOH) from the provider perspective over one and 5 years and consistently across the health-care systems and settings. From the societal perspective, we found structured headache services would be economically successful, not only delivering increased effectiveness but also cost saving across headache types and over time. The predicted magnitude of cost saving correlated positively with country wage levels. Lost productivity had a major impact on these estimates, but sensitivity analyses showed the intervention remained cost-effective across all models when we assumed that remedying disability would recover only 20% of lost productivity. Conclusions: This is the first study to propose a health-care solution for headache, in the form of structured headache services, and evaluate it economically in multiple settings. Despite numerous challenges, we demonstrated that economic evaluation of headache services, in terms of outcomes and costs, is feasible as well as necessary. Furthermore, it is strongly supportive of the proposed intervention, while its framework is general enough to be easily adapted and implemented across Europe