Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults

Background: This is an updated version of the original Cochrane review published in 2005 on selective serotonin re-uptake inhibitors (SSRIs) for preventing migraine and tension-type headache. The original review has been split in two parts and this review now only regards migraine prevention. Another updated review is under development to cover tension-type headache. Migraine is a common disorder. The chronic forms are associated with disability and have a high economic impact. In view of discoveries about the role of serotonin and other neurotransmitters in pain mechanisms, selective serotonin re-uptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been evaluated for the prevention of migraine. Objectives: To determine the efficacy and tolerability of SSRIs and SNRIs compared to placebo and other active interventions in the prevention of episodic and chronic migraine in adults. Search strategy: For the original review, we searched MEDLINE (1966 to January 2004), EMBASE (1994 to May 2003), the Cochrane Central Register of Controlled Trials (CENTRAL 2003, Issue 4), and Headache Quarterly (1990 to 2003). For this update, we applied a revised search strategy to reflect the broader type of intervention (SSRIs and SNRIs). We searched CENTRAL (2014, Issue 10), MEDLINE (1946 to November 2014), EMBASE (1980 to November 2014), and PsycINFO (1987 to November 2014). We also checked the reference lists of retrieved articles and searched trial registries for ongoing trials. Selection criteria: We included randomised controlled trials comparing SSRIs or SNRIs with any type of control intervention in participants 18 years and older of either sex with migraine. Data collection and analysis: Two authors independently extracted data (migraine frequency, index, intensity, and duration; use of symptomatic/analgesic medication; days off work; quality of life; mood improvement; cost-effectiveness; and adverse events) and assessed the risk of bias of trials. The primary outcome of this updated review is migraine frequency. Main results: The original review included eight studies on migraine. Overall, we now include 11 studies on five SSRIs and one SNRI with a total of 585 participants. Six studies were placebo-controlled, four compared a SSRI or SNRI to amitriptyline, and one was a head-to-head comparison (escitalopram versus venlafaxine). Most studies had methodological or reporting shortcomings (or both): all studies were at unclear risk of selection and reporting bias. Follow-up rarely extended beyond three months. The lack of adequate power of most of the studies is also a major concern. Few studies explored the effect of SSRIs or SNRIs on migraine frequency, the primary endpoint. Two studies with unclear reporting compared SSRIs and SNRIs to placebo, suggesting a lack of evidence for a difference. Two studies compared SSRIs or SNRIs versus amitriptyline and found no evidence for a difference in terms of migraine frequency (standardised mean difference (SMD) 0.04, 95% confidence interval (CI) -0.72 to 0.80; I2 = 72%), or other secondary outcomes such as migraine intensity and duration. SSRIs or SNRIs were generally more tolerable than tricyclics. However, the two groups did not differ in terms of the number of participants who withdrew due to adverse advents or for other reasons (one study, odds ratio (OR) 0.39, 95% CI 0.10 to 1.50 and OR 0.42, 95% CI 0.13 to 1.34). We did not find studies comparing SSRIs or SNRIs with pharmacological treatments other than antidepressants (e.g. antiepileptics and anti-hypertensives)

Validation of the Italian version of the Patient Reported Experience Measures for intermediate care services

Background: Intermediate care (IC) services are a key component of integrated care for elderly people, providing a link between hospital and home through provision of rehabilitation and health and social care. The Patient Reported Experience Measures (PREMs) are designed to measure user experience of care in IC settings. Objective: To examine the feasibility and the scaling properties of the Italian version of PREMs questionnaires for use in IC services. Methods: A cross-sectional survey was conducted on consecutive users of 1 home-based and 4 bed-based IC services in Emilia-Romagna (Italy). The main outcome measure was the PREMs questionnaire results. PREMs for each home- and bed-based IC services were translated, back-translated, and adapted through consensus among the members of the advisory board and pilot testing of face validity in 15 patients. A total of 199 questionnaires were returned from users of bed-based services and 185 were returned by mail from users of home-based services. The return rates and responses were examined. Mokken analysis was used to examine the scaling properties of the PREMs. Results: Analysis performed on the bed-based PREMs (N=154) revealed that 13 items measured the same construct and formed a moderate-strength scale (Loevinger H=0.488) with good reliability (Cronbach’s alpha =0.843). Analysis of home-based PREMs (N=134 records) revealed that 15 items constituted a strong scale (Loevinger H=0.543) with good reliability (Cronbach’s alpha =0.875). Conclusion: The Italian versions of the bed- and home-based IC-PREMs questionnaires proved to be valid and reliable tools to assess patients’ experience of care. Future plans include monitoring user experience over time in the same facilities and in other Italian IC settings for between-service benchmarking

Three-years of SO2 flux measurements of Mt. Etna using an automated UV scanner array: comparison with conventional traverses and uncertainties in flux retrieval

Routine measurements of SO2 flux using the traverse method on Mt. Etna (Italy) were augmented in late 2004 when an array of automatic scanning ultraviolet spectrometers was installed. Each instrument allows one SO2 scan to be recorded every ~6 min. Here we report the methods that we developed to automatically and robustly transform SO2 profiles into SO2 flux data. Radian geometry and Fast Fourier Transform algorithm were used for reducing plume cross sections and for discriminating between volcanic plumes from those produced by water vapour clouds. Uncertainty in flux measurements depends on the accuracy of plume-height estimation, on assumptions concerning plume-geometry, and on the quality of the retrieved SO2 amounts. We compare 3 years of flux measurements made using both the automated network and “conventional” traverse methods beneath the plume. We found a good agreement between the datasets, both in terms of magnitude and in temporal variations. These results validate the Etna SO2 flux monitoring system. Emission rates are available to the 24-hour manned operations room via intranet, providing real-time information on degassing rates and plume location

Benders decomposition for local access network design with two technologies

We have worked with the local access network design problem with two cable technologies. This is an optimization problem in graphs that consists of linking an origin node to a set of terminal nodes which have a flow demand. There are also a set of Steiner or transshipment nodes which do not have demand. Each arc of the graph has two associated costs: a variable cost depending on the flow through the arc and a fixed cost associated with the installation of the arc. Moreover, in each arc we can install one of two available technologies: optical fiber or copper (we can also use radio links with any other cable technology). Each one of these technologies has different variable and fixed costs. To be more precise, the fixed cost of the optical fiber is greater than that of the copper, but its variable cost is much smaller. The problem was modeled using a multicommodity flow formulation in which we added some structural constraints. This model was used to apply the Benders decomposition method. The structural constraints have the objective of trying to guarantee that the master problem of the Benders decomposition will yield a tree. The Benders subproblems are trivial network flow problems. The dual variables have commodity meaningfull values and are evaluated in a systematic form. The algorithm was implemented in C++ with CPLEX 3.0 callable library. We have tested the algorithm with some test instances obtained by a generator of problems that we developed

Novel retrieval of volcanic SO2 abundance from ultraviolet spectra

The recent development of fixed networks of scanning ultraviolet spectrometers for automatic determination of volcanic SO2 fluxes has created tremendous opportunities for monitoring volcanoes but has brought new challenges in processing of the substantial data flow they produce. A particular difficulty in standard implantation of differential optical absorption (DOAS) methods is the requirement for a clear-sky (plume-free) background spectrum. Our experience after four years of measurements with two UV scanner networks on Etna and Stromboli shows that wide plumes are frequently observed precluding simple selection of clear-sky spectra. We have therefore developed a retrieval approach based on simulation of the background spectrum. We describe the method here and tune it empirically by collecting clear, zenith sky spectra using calibration cells containing known amounts of SO2. We then test the performance of this optimised retrieval using clear-sky spectra collected with the same calibration cells but for variable scan angles, time of day, and season (through the course of 1 year). We find in all cases acceptable results (maximum ~12% error) for SO2 column amounts. The method is therefore very suitable for automated SO2-plume monitoring

Proton imaging apparatus for protontherapy application

Radiotherapy with protons, due to the physical properties of these particles, offers several advantages for cancer therapy as compared to the traditional radiotherapy with photons. In the clinical use of proton beams, a pCT (proton Computed Tomography) apparatus can contribute to improve the accuracy of the patient positioning and dose distribution calculation. In this paper a pCT apparatus built by the PRIMA (PRoton IMAging) Italian Collaboration will be presented and the preliminary results will be discussed

ACAP-A/B Are ArfGAP Homologs in Dictyostelium Involved in Sporulation but Not in Chemotaxis

Arfs and Arf GTPase-activating proteins (ArfGAPs) are regulators of membrane trafficking and actin dynamics in mammalian cells. In this study, we identified a primordial Arf, ArfA, and two ArfGAPs (ACAP-A/B) containing BAR, PH, ArfGAP and Ankyrin repeat domains in the eukaryote Dictyostelium discoideum. In vitro, ArfA has similar nucleotide binding properties as mammalian Arfs and, with GTP bound, is a substrate for ACAP-A and B. We also investigated the physiological functions of ACAP-A/B by characterizing cells lacking both ACAP-A and B. Although ACAP-A/B knockout cells showed no defects in cell growth, migration or chemotaxis, they exhibited abnormal actin protrusions and ∼50% reduction in spore yield. We conclude that while ACAP-A/B have a conserved biochemical mechanism and effect on actin organization, their role in migration is not conserved. The absence of an effect on Dictyostelium migration may be due to a specific requirement for ACAPs in mesenchymal migration, which is observed in epithelial cancer cells where most studies of mammalian ArfGAPs were performed

Minimum Liquid Discharge desalination: a pilot study in Lampedusa island

During the last decades, a rising interest has been focused on the recovery of valuable products from non-conventional sources, such as waste brine or seawater. Seawater can be exploited in order to recover fresh water and many other valuable products such as Mg and Ca compounds, sodium chloride, etc. In the framework of the Horizon 2020 European project WATER MINING, a novel integrated demo plant has been designed, installed and operated, aiming at the production of fresh water, magnesium and chemicals, such as sodium hydroxide and hydrochloric acid. The demo plant integrates several units, namely: (i) NanoFiltration (NF), (ii)Multiple Feed Plug Flow Reactor (MF-PFR), (iii) Multi-Effect Distillation (MED), (iv) ElectroDialysis with Bipolar Membrane (EDBM) and (v) evaporative ponds. In the integrated process scheme, seawater is fed to the NF, producing a concentrated stream enriched in bivalent ions and a permeate stream containing monovalent ones, such as sodium and chlorides. The concentrate stream is fed to the MF-PFR crystallizer, selectively recovering magnesium, as magnesium hydroxide, and then calcium, in the form of hydroxide. The precipitation of both hydroxides occurs by adding an alkaline solution at 1M. The produced slurry is directed to a thickener in order to separate the solids from the liquid. After magnesium and calcium removal, the clarified solution is used to feed the EDBM unit, producing a de-salty solution, an alkaline solution and a hydrochloric acid solution exploiting electrical energy and special ion exchange membranes. The NF permeate, conversely, is fed into a MED unit producing almost distilled water and a highly concentrated sodium chloride brine, which is finally fed into the evaporative ponds to produce food-grade sodium chloride. Demonstrated key performance indicators of pilot scale installation, range from: a bivalent ions rejection of the NF higher than 90%; a purity of produced magnesium hydroxide up to 97-98%; alkaline and acidic solution produced at 1M; high-quality grade freshwater (conductivity below 20 μS/cm); and sodium chloride with a purity higher than 97%