Levetiracetam in clinical practice: efficacy and tolerability in epilepsy.

BACKGROUND: The aim of this study was to evaluate efficacy and tolerability of levetiracetam (LEV) in patients with different epilepsy syndromes. METHODS: We evaluated epileptic patients seen in the previous 18 months, including all patients with present or past exposure to LEV. Tolerability of LEV therapy was evaluated in all patients; efficacy was evaluated only in patients who had received LEV for at least six months. Two hundred and two patients were included in the study. Patients were considered responsive when showing a > 50% reduction in seizures frequency and non-responders when seizure frequency was unchanged, worsened or showed a reduction < 50%. RESULTS: Thirty patients did not complete six months of LEV treatment and dropped out. 57.4% of the patients with uncontrolled seizures treated for at least six months were responders, with 27.7% seizure free. Adverse effects were observed in 46 patients (23%) and were responsible for early drop out in 26. Adverse effects occurred significantly more often in females than in males (30.6% vs 13.2%); moreover, nearly 30% of women with adverse effects complained of more than one adverse effect, while this was never observed in male patients. CONCLUSIONS: Our study shows LEV as a well tolerated and effective treatment, both in monotherapy and as an add-on. Further investigations on larges samples are needed to investigate the issue of gender-related tolerability

Transient epileptic amnesia: an emerging late-onset epileptic syndrome.

Transient epileptic amnesia (TEA) is a distinct neurologic condition occurring in late-middle/old age and presenting with amnesic attacks of epileptic nature and interictal memory disturbances. For many years this condition has been associated with the nonepileptic condition of transient global amnesia (TGA) and still today is poorly recognized by clinicians. Despite the clinical and laboratory findings that distinguish TEA from TGA, differential diagnosis may be difficult in the individual patient. Every effort must be employed for an early diagnosis, since antiepileptic treatment may readily control both ictal episodes and memory disturbances

Analysing occupational safety culture through mass media monitoring

In the last years, a group of researchers within the National Institute for Insurance against Accidents at Work (INAIL) has launched a pilot project about mass media monitoring in order to find out how the press deal with the culture of safety and health at work. To monitor mass media, the Institute has created a relational database of news concerning occupational injuries and diseases, that was filled with information obtained from the newspaper articles about work-related accidents and incidents, including the text itself of the articles. In keeping with that, the ultimate objective is to identify the major lines for awareness-raising actions on safety and health at work. In a first phase of this project, 1,858 news articles regarding 580 different accidents were collected; for each injury, not only the news texts but also several variables were identified. Our hypothesis is that, for different kind of accidents, a different language is used by journalists to narrate the events. To verify it, a text clustering procedure is implemented on the articles, together with a Lexical Correspondence Analysis; our purpose is to find language distinctions connected to groups of similar injuries. The identification of various ways in reporting the events, in fact, could provide new elements to describe safety knowledge, also establishing collaborations with journalists in order to enhance the communication and raise people attention toward workers' safety

simulation for change management an industrial application

Abstract This paper describes an application of change management in the context of a growing company: the ABC enterprise. The first step of the proposed methodological framework involves the construction of the As-is process model, adopting the standard BPMN language. The model is based on an accurate analysis of the data concerning the resources and activities of the company being analyzed, in order to perform a computational simulation of its business processes. After examining existing solutions for business challenges and technological opportunities, several scenarios can be proposed that include possible changes to existing processes. By simulating these scenarios, the results can suggest to analysts useful information to evaluate possible restructuring actions in a quantitative way, comparing the values of an appropriate set of indicators before and after the model's restructuring

Monicelli e la memoria della Grande Guerra

In my essay, I examine Mario Monicelli's La Grande Guerra, in order to verify if its comic and anti-heroic perspective really leads to a new concept of WWI. I first retrace the director's previous filmography, where the characters, genres and patterns which will recur in La Grande Guerra originally take shape. I then reconstruct the movie's genesis, focusing on the sources the screenwriters refer to: not only WWI movies and memories, such as Kubrick's Paths of Glory and Lussu's Un anno sull'Altipiano, but also, quite unexpectedly, La vita militare by De Amicis. On this basis, I analyse the representation of the war, in its figurative and narrative elements. In many senses, it's a war seen from the ground, and indeed the scenography and script take inspiration from the soldiers' pictures of the front and their military songs. In this realistic context, Monicelli develops the plot of two cowardly privates, from a poor, undisciplined background, who ultimately identify with their nation enough to sacrifice themselves for their compatriots. The purpose of highlighting the unacknowledged war contribution of the mass, however, is somehow contradicted by the army's image. The comic and anti-heroic aspects, indeed, concern only the low-ranked soldiers, while the Command is represented in a sentimental way. In this respect, Monicelli confirms a rhetoric coming from De Amicis, and later inherited by Fascism: the army as an image of a model society, where North and South, rich and poor, educated and illiterate unite, and where everyone deserves his hierarchical rank

Complex phenotype in an Italian family with a novel mutation in SPG3A.

Mutations in the SPG3A gene represent a significant cause of autosomal dominant hereditary spastic paraplegia with early onset and pure phenotype. We describe an Italian family manifesting a complex phenotype, characterized by cerebellar involvement in the proband and amyotrophic lateral sclerosis-like syndrome in her father, in association with a new mutation in SPG3A. Our findings further widen the notion of clinical heterogeneity in SPG3A mutations

Human Factors Issues and the Risk of High Voltage Equipment: Are Standards Sufficient to Ensure Safety by Design?

High voltage equipment is mostly designed according to technically prescriptive standards requirements based on electrical engineering safety principles. However a more risk-based approach to standards and regulation may be advisable to enable designer and user to take an active role in establishing that their installation is inherently safe. The use of Gas Insulated Switchgear (GIS) for instance is enabling the new substation to be housed indoors and condensed into around one quarter of the space. The manufacturers argue that design improvements in GIS make it virtually “maintenance free”, comply with all the relevant standards. However some of these improvements have implications for the operators that need to be taken into account. Commissioning, operational checks and inspections and the occasional maintenance interventions are activities during which the technicians need to interface with the equipment, the issues regarding the interfaces provided have been analysed to identify their relevance in the overall risk assessment of the equipment. The paper reports about a study aimed at verifying through a risk analysis the impacts that the issues related to deficit in ergonomic design may present for the overall availability and safety of the plant. Those issues are not tackled in the technical standards and/or designers current practice

Total Safety Management: What Are the Main Concerns in the Integration of Best Available Methods and Tools

“BP released findings from its own internal investigation of the oil spill in the Gulf of Mexico, revealed inefficient Organization interfaces among BP management, the rig crew and well site leader. Also according to the investigation, one important contributor to the accident was inadequate guidelines for critical tests and operations”. (Pires and Mosleh 2011) Over the recent past, the accumulation of major mishaps, crises and accidents have made it clear that organisations must still improve their capabilities to address safety “not as a stand-alone activity that is separate from the main activities and processes of the organization” but as an integrated part of total performance management. The requirements for safety management in existing and upcoming standards and regulations, as for example the ISO 31000 and or the Seveso II directive, call for a proactive strategic approach, anticipating risks and demonstrating a capacity to keep safety at the centre of changes driven by commercial competition, and ensuring that safety evidence itself becomes an effective driver of change. However there is often a gap between the state principles and an actual roadmap to their implementation. Furthermore organisations, especially the one dealing with safety critical operations, find it difficult to integrate their different functional units in a common programme of operations management or change; there is no clear consensus about what it means to be ‘proactive’; there is no integrated framework for analysing or managing all the human related functions in an operational system. Innovation may rely on assembling the best practices, tools and methods already available for functional analysis, risk assessment, interactive emergency scenarios analysis, performance monitoring, design review, training and knowledge management, in an integrated framework able to address safety management in the main aspects of a product or process lifecycle the cornerstone of which is the building of a common operational picture to support the capacity to perform more participatory and dynamic risk identification and solutions loops in: - Design (new plants, processes /procedures availing new visualization tools) - Ad hoc critical activities (management of change or scheduled overhaul) - Operations management (establishing of dynamic risk registers). This is the scope of a new EU funded research project called TOSCA and the present paper will introduce the current framework being built

Separate digestion of liquid and solid fractions of thermally pretreated secondary sludge. Assessment and global evaluation

Producción CientíficaThe fractioning into separate liquid and solid fractions obtained by centrifugation of thickened fresh and thermally pretreated (170 ºC, 50 minutes) secondary sludge showed that 30% of the particulate organic matter was released during the pretreatment, correspondingly increasing the methane production of the particulate matter by 30% (from 259 to 329 mL CH4/g VSfed). The responsible of this enhancement was the liquid fraction, as the biodegradability of the solid fraction remained constant after the pretreatment. Mass balances showed that 34% of the VS were released to the liquid fraction, generating nearly 50% of the total methane produced, with much faster kinetics compared to the solid fraction. These results support the hypothesis of a separate liquid-solid digestion of thermally pretreated sludge, which would result in decreasing the digestion volume to half while duplicating the methane productivity per kilogram of sludge fed to digestion