A neural network based technique for short-term forecasting of anomalous load periods

The paper illustrates a part of the research activity conducted by authors in the field of electric Short Term Load Forecasting (STLF) based on Artificial Neural Network (ANN) architectures. Previous experiences with basic ANN architectures have shown that, even though these architectures provide results comparable with those obtained by human operators for most normal days, they evidence some accuracy deficiencies when applied to ''anomalous'' load conditions occurring during holidays and long weekends. For these periods a specific procedure based upon a combined (unsupervised/supervised) approach has been proposed. The unsupervised stage provides a preventive classification of the historical load data by means of a Kohonen's Self Organizing Map (SOM) The supervised stage, performing the proper forecasting activity, is obtained by using a multi-layer perceptron with a backpropagation learning algorithm similar to the ones above mentioned. The unconventional use of information deriving from the classification stage permits the proposed procedure to obtain a relevant enhancement of the forecast accuracy for anomalous load situations

Tako-tsubo Syndrome as First Manifestation in a Case of Pheochromocytoma Developed From a Non-functional Adrenal Incidentaloma

Abstract Background: Pheochromocytoma is a catecholamine secreting tumor that, in extremely rare cases, may develop over time from a non-functional adrenal adenoma. Catecholamine excess can lead to a kind of cardiomyopathy similar to that seen in tako-tsubo syndrome (TTS). Case report: A 69 years old female with a history of type 2 diabetes, hypertension, and a non-functional right adrenal adenoma diagnosed 3 years earlier was referred to our center for further investigations. During the evaluation, she had a hypertensive crisis with chest pain, tachycardia, and diaphoresis. Suspecting an acute coronary syndrome, she underwent coronary angiography, which showed the typical features of TTS. The high 24 h-urinary metanephrines excretion and abdominal MRI findings were suggestive of pheochromocytoma. Right laparoscopic adrenalectomy was performed, with the resolution of all symptoms. Pathology findings confirmed the diagnosis of pheochromocytoma. After 12 months, the patient was still asymptomatic, with the echocardiography displaying a complete recovery of the left-ventricular function. Conclusions: The development of a pheochromocytoma from an adrenal non functional adenoma is an extremely rare event, but potentially life-threating because of the catecholamine-associated cardiovascular toxicity. In particular, TTS is a form of cardiomyopathy that has been increasingly described as associated with catecholamine-secreting tumors. The exclusion of pheochromocytoma in a patient with TTS has important therapeutic implications, since the administration of β-blockers may be extremely harmful in patients with catecholamine surge in the absence of adequate α-blockage. Keywords: adrenal incidentaloma; catecholamine; infarction; pheochromocytoma; tako-tsubo syndrome; ventricular dysfunction

Novel psychoactive substances: the pharmacology of stimulants and hallucinogens

There are increasing levels of concern relating to the rapidly evolving novel psychoactive substances/NPS and web markets' scenarios. The paper aims at providing an overview of the clinical pharmacological issues related to some of the most popular NPS categories, e.g. stimulants and hallucinogens. NPS intake is typically associated with the imbalance of a complex range of neurotransmitter pathways/receptors, namely: dopamine; cannabinoid/CB1; and 5-HT2A. The intake is almost invariably undetectable with standard screening tests. Hence, it may frequently occur that the acute management of NPS misusers will need to focus on decreasing levels of both self/outward-directed aggression and agitation. Benzodiazepines may be considered as first line treatment. Alternatively, propofol and/or antipsychotics can be administered. Focus will be as well on treatment of possible rhabdomyolysis and hyperthermia. Indeed, future studies should inform better tailored management/treatment strategies

Observed anomalous atmospheric patterns in summers of unusual Arctic sea ice melt

The Arctic sea ice retreat has accelerated over the last decade. The negative trend is largest in summer, but substantial interannual variability still remains. Here we explore observed atmospheric conditions and feedback mechanisms during summer months of anomalous sea ice melt in the Arctic. Compositing months of anomalous low and high sea ice melt over 1979–2013, we find distinct patterns in atmospheric circulation, precipitation, radiation, and temperature. Compared to summer months of anomalous low sea ice melt, high melt months are characterized by anomalous high sea level pressure in the Arctic (up to 7 hPa), with a corresponding tendency of storms to track on a more zonal path. As a result, the Arctic receives less precipitation overall and 39% less snowfall. This lowers the albedo of the region and reduces the negative feedback the snowfall provides for the sea ice. With an anticyclonic tendency, 12 W/m2 more incoming shortwave radiation reaches the surface in the start of the season. The melting sea ice in turn promotes cloud development in the marginal ice zones and enhances downwelling longwave radiation at the surface toward the end of the season. A positive cloud feedback emerges. In midlatitudes, the more zonally tracking cyclones give stormier, cloudier, wetter, and cooler summers in most of northern Europe and around the Sea of Okhotsk. Farther south, the region from the Mediterranean Sea to East Asia experiences significant surface warming (up to 2.4◦C), possibly linked to changes in the jet stream

The FDA “black box” warning on antidepressant suicide risk in young adults: More harm than benefits?

The decision made in the year 2004 by the U.S. Food and Drug Administration (FDA) to require a boxed warning on antidepressants regarding the risk of suicidality in young adults still represents a matter of controversy. The FDA warning was grounded on industry-sponsored trials carried one decade ago or earlier. However, within the past decade, an increasing number of reports have questioned the actual validity of the FDA warning, especially considering a decline in the prescription of the antidepressant drugs associated with an increase in the rate of suicidal events among people with severe depression. The present report provides an overview of the FDA black box warning, also documenting two Major Depressive Disorder patients whose refusal to undergo a pharmacological antidepressant treatment possibly led to an increased risk for suicidal behaviors. The concerns raised by the FDA black box warning need to be considered in real-world clinical practice, stating the associated clinical and public health implications

Why golimumab in the treatment of psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis?

Golimumab is an anti-TNF monoclonal antibody administred subcutaneously once a month and produced with an innovative technology that minimizes immunogenicity. This paper reviews and updates the main studies on the efficacy, safety and pharmacoeconomic aspects of treatment with golimumab of psoriatic arthritis, ankylosing spondylitis and rheumatoid arthritis

Different fracture risk profile in patients treated with anti-osteoporotic drugs in real-life

In this retrospective study, we intended to investigate the baseline fracture risk profile in patients who started treatment with different anti-osteoporotic medications. We analyzed retrospectively the fracture risk calculated with DeFRA, a validated FRAX derived tool, in women who started an anti-osteoporotic treatment from 2010 to 2017. We analyzed baseline data of 12,024 post-menopausal women aged over 50 years. Teriparatide initiators had a baseline 10-year risk of major osteoporotic fracture of 82.1% with a Standard Deviation (SD) of 66.5%. Denosumab initiators and zoledronic acid initiators had a greater 10-year baseline risk of fracture (54.3%, SD 46.5% and 47.0%, SD 42.0 respectively) than patients initiated on alendronate (24.9%, SD 34.6%) and patients initiated on risedronate (23.9%, SD 24.1%). Using DeFRA, a FRAX™ derived tool, we showed significantly different fracture risk profiles in women who were started on various therapeutic agents for the treatment of osteoporosis in routine clinical practice

Novel Psychoactive Substances: : the pharmacology of stimulants and hallucinogens

This is an Accepted Manuscript of an article published by Taylor & Francis in Expert Review of Clinical Pharmacology, on March 2016, available online at doi: : http://www.tandfonline.com/doi/full/10.1586/17512433.2016.1167597.There are increasing levels of concern relating to the rapidly evolving novel psychoactive substances/NPS and web markets’ scenarios. The paper aims at providing an overview of the clinical pharmacological issues related to some of the most popular NPS categories, e.g. stimulants and hallucinogens. NPS intake is typically associated with the imbalance of a complex range of neurotransmitter pathways/receptors, namely: dopamine; cannabinoid/CB1; and 5-HT2A. The intake is almost invariably undetectable with standard screening tests. Hence, it may frequently occur that the acute management of NPS misusers will need to focus on decreasing levels of both self/outward-directed aggression and agitation. Benzodiazepines may be considered as first line treatment. Alternatively, propofol and/or antipsychotics can be administered. Focus will be as well on treatment of possible rhabdomyolysis and hyperthermia. Indeed, future studies should inform better tailored management/treatment strategies.Peer reviewedFinal Accepted Versio