Efficacy of spa-therapy, mud-pack therapy, balneotherapy and mud-bath therapy in the management of knee osteoarthritis. A systematic review

Background: Osteoarthritis (OA) is the most common musculoskeletal disease in the world. OA is the result of an inflammatory and degenerative process affecting the entire joint. Osteoarthritis, especially involving the knee, has a relevant socio-economic impact in terms of drugs, hospital admissions, work absences and temporary or permanent invalidity. Therapy of knee osteoarthritis is based on pharmacological and non-pharmacological measures. Methods: We conducted a systematic review of the studies published between 2002 and 2017 on spa-therapy, mud-pack therapy, balneotherapy and mud-bath therapy in the treatment of knee osteoarthritis in order to investigate the evidence of the efficacy of such treatment on pain, functional limitation, drug use and quality of life. Overall, 35 studies were examined among which 12 were selected and included in the review if trial comparative. Each report was reviewed to identify the criteria used for study enrolment and for assignment to experimental vs control groups, sample size, type and characteristics of treatment, features of mineral water, control intervention, assessment point, endpoints, outcome measures, tests used for statistical analysis of the results. We have been able to illustrate the main results obtained in the individual studies and to elaborate these results in order to allow as much a unitary presentation as possible, and hence an overall judgment. Results: Because the studies we reviewed differed markedly from one another in terms of the methods used, we were unable to conduct a quantitative analysis (meta-analysis) of pooled data from the 12 studies. For the purposes of the present review, we re-evaluated the results of the different studies using the same statistical method, the Student’s t test, which is used to compare the means of two frequency distributions. Among all the studies, the most relevant indexes used to measure effectiveness of spa therapy were improved including VAS, Lequesne’s and WOMAC Score. Conclusions: The mud-pack therapy, balneotherapy, mud-bath therapy and spa therapy has proved to be effective in the treatment and in the secondary prevention of knee osteoarthritis, by reducing pain, non-steroidal antiinflammatory drug consumption, functional limitation and improving quality of life of affected patients. Is a noninvasive, complication-free, and cost-effective alternative modality for the conservative treatment of knee osteoarthritis

Uno studio sulla “dissenting opinion” con particolare riguardo all’esperienza del diritto inglese

The essay explores the many means through which judicial dissent has traditionally made its way into the English legal system in order to be finally accepted as an ineliminable instrument that the minority has availed itself of to air its differing opinion, mostly in matters of general, public importance. So, the research is in the first place directed towards the identification of the different types of dissent and of the forms (even concurring) in which it may be shaped. Furthermore, the study involves the attempt to find out what reasons may underlie the expression of dissent and whether they may conceal some kind of idyiosincratic state of mind on the part of the dissenters. A view is also taken of a number of famous, even for their strong tones, dissenting opinions in the courts of last instance. The general, and reassuring, impression is that such dissents not only reflect issues and values which reasonably may split the public opinion as well as the courts. They are also expressed with the clear perspective of contributing, although adopting a different point of view, to a better development of the domestic legal system. And not infrequently dissents have over an adequate span of time converted themselves into majority views once their intrinsic force has come to be accepted. Which brings us to conclude that dissent in itself does not constitute a menace to the coherence and credibility of a legal system, is well embedded in the English legal tradition and is not likely to be abandoned in the foreseeable future. Conversely, it gives rise to a positive example that could be fruitfully followed, without any fear, by continental systems, such as the Italian, so sweeping away the unjustified diffidence and suspicion that dissent might shake its stability

Empirical applications of the interacted panel VAR model

2016 - 2017The Vector Autoregressive (VAR) Models can be considered as a dynamic multivariate extension of the univariate autoregressive models. This family of models has become very popular in macroeconomics analysis after the work of Sims(1980) and they are widely used in time series literature thanks to their flexibility. As a matter of fact, by setting appropriately a VAR model, we can describe efficiently the dynamics of the economy and provide quite accurate forecasts. During recent years, researchers developed different VAR models with the purpose to represent better the data generating process. Among these, the nonlinear VAR models have gained a central role in macroeconometric analysis in testing the theory, due to their capacity to capture a richer set of dynamics regarding current macroeconomic phenomenons. Depending on the specific model, they can allow, for example, different states (regimes) of the world, to allow the coefficients of the model to vary over time in each time unit, allowing for interactions between variables potentially revealing important information. The first paper included in this thesis is a survey which have the purpose to examine linear and nonlinear VAR models. The second and third papers present two empirical applications of the Interacted Panel VAR Model, which is a new nonlinear methodology we illustrated over the first paper. Specifically, we analyze in both papers the behavior of government spending multiplier when the interest rate is at the Zero Lower Bound (ZLB). This is a highly topical question since the outbreak of Great Recession, given that many policy makers have wondered whether fiscal stimulus would be able to help the economy to recover from recession. In particular, there exist two different and opposite theoretical predictions. New Keynesian DSGE models show that, when the interest rate is at the ZLB, a raise in government spending has a strong and positive impact on the economy. On the other side, theoretical prediction indicate very low multipliers, showing that an increase in government spending does not stimulate private activity. Although there exist many theoretical predictions about the size of government spending multiplier at the ZLB, very few empirical evidences are provided. These two paper aim to shed light on the size of the government spending multiplier at the ZLB. Among the nonlinear VAR models, we choose the Interacted (Panel) VAR Model because it offers an important advantage compared to others nonlinear approaches. Thanks to the interaction term, we are able to investigate among the entire sample. This can be done also within a time varying framework, but it implies a larger number of estimates which requires informative priors. In order to be as more agnostic as possible, we also use a Bayesian approach for inference but with uninformative priors. In the first paper we develop an Interacted VAR Model and conduct our analysis on the United States sample. In order to identify government spending shocks we use the sign restrictions approach, furthermore we use the forecast series of government spending to account for the potential effects of anticipation that can pose serious problems for the identification of government spending shocks. We find that the government spending multiplier ranges between 3.4 and 3.7 at the ZLB, while it ranges from 1.5 to 2.7 away from the ZLB. Then, we develop a Factor-Augmented IVAR (FAIVAR) model with the purpose to address another limited information problem. It confirms our results from a qualitatively point of view. As a matter of fact, the government spending multiplier ranges between 2.0 and 2.1 at the ZLB and between 1.5 and 1.8 away from the ZLB. These results are also in line with some recent studies which predict higher multipliers at the ZLB than in normal times... [edited by author]XVI n.s

Measurements with the ELI-NP cavity Beam Position Monitor Read-out Electronics at FLASH

The Extreme Light Infrastructure - Nuclear Physics Gamma Beam System (ELI-NP GBS) will be installed and commissioned starting within the next year in Magurele, Romania. It will generate gamma beam through Compton back-scattering of a recirculated laser and a multi-bunch electron beam, produced by a 720 MeV LINAC. In order to obtain bunch by bunch position measurements, four cavity beam position monitors (cBPM) near the two interaction points are foreseen. Extensive tests on the cBPM readout electronics, recently developed by Instrumentation Technologies and acquired for ELI-NP GBS, were performed in laboratory at INFN-LNF and at FLASH in DESY, during the user operation. In the latter case, three cBPMs installed along the LINAC, with similar features as the ones of ELI-NP GBS, were used as measuring devices and signal sources for the read-out electronics under test. We present here the measurements collected and the related analysis, with a particular focus on the beam position measurement resolution