IRIS Università degli Studi dell'Aquila
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Reaching international consensus on the definition of refractory migraine using the Delphi method
Full text linkAimDespite its frequency in tertiary headache centers, the International Classification of Headache Disorders, 3rd edition (ICHD-3) does not include refractory migraine. Multiple definitions have been proposed with a recent 2020 proposal for both refractory migraine and resistant migraine by the European Headache Federation (EHF). The aim is to reach an international consensus on the definition of refractory migraine.MethodsThis study is a Delphi consensus carried out by a group of international experts in headache medicine. Following a focus group, a panel of 20 experts and one facilitator reviewed the EHF proposed criteria to build upon their definitions. The Delphi consensus was conducted across five rounds. Questions with >70% consensus were deemed to have strong agreement, 60-70% consensus was deemed minor agreement, and <60% deemed no agreement. A final meeting was held to discuss any concerns and specific wording.ResultsThe Delphi consensus led to the development of four key categories: refractory migraine, probable refractory migraine, resistant migraine, and treatment-responsive migraine. Similar to the EHF 2020 definitions, refractory migraine requires treatment failure of all evidence-based classes, and resistant migraine requires failure of at least three classes. Probable refractory migraine criteria were designed to account for situations where treatment access barriers may prevent trials of certain medication classes (e.g. pediatrics, low to middle-income countries, lack of insurance coverage). Finally, treatment-responsive migraine criteria were developed to allow for standardization in research studies comparing refractory or resistant migraine to migraine that is treatment-responsive.ConclusionsThese four categories may aid in enrollment for studies on pathophysiology, biomarkers, and new treatment targets. Clinically, the criteria for refractory and resistant migraine will help with clinical decision-making by reinforcing the need to try evidence-based treatments and by providing guidance regarding when to try more aggressive treatment approaches. These criteria may also increase attention to this population's disease burden to help advocate for them as a specific migraine subgroup. Field testing in diverse clinical settings will be needed, but it is recommended that ICHD-3 considers inclusion of these four categories in their appendix
The Missing Link: Integrating Interventional Pain Management in the Era of Multimodal Oncology
Full text linkCancer-related pain (CrP) is one of the most frequent and debilitating issues that affect the quality of life of patients with cancer. Systemic analgesics, particularly opioids, have been the cornerstone of pain management. However, the following shortcomings of the mentioned therapies, such as side effects, tolerance, and inadequate relief in refractory cases, make implementing a more complete, multimodal treatment plan necessary. Interventional pain management (IPM) uses specific invasive procedures, with different degree of invasiveness, such as nerve blocks, neurolysis, neuromodulation, and intrathecal drug delivery systems to provide effective pain relief with reduced adverse effects compared with opioids. These approaches are frequently underutilized due to delayed referrals, insufficient awareness, and logistic inefficiencies, which delay access to pain management centers specializing in care for patients in pain. Recent technological advancements offer the potential to overcome these barriers, including artificial intelligence-driven decision support systems and automated referral pathways, enabling early intervention and individualized pain treatment plans. The future of CrP management should shift from the current reactive model to a proactive approach, enabling the earlier incorporation of interventional techniques into treatment plans. The integration of interdisciplinary collaboration and technological innovations will enhance cancer pain management and progress from current outdated approaches to provide more effective and timely pain relief for patients with chronic refractory cancer pain
Optimizing dismantling approaches for recycling of li-ion batteries: Strategies, challenges and economic analysis
Full text linkLithium-ion batteries (LIBs) are widely used in electric vehicles, consumer electronics, and energy storage systems due to their high energy density and long operational life. As demand for these batteries rises globally, their end-of-life management has become a growing concern due to environmental risks, material scarcity, and recycling inefficiencies. This review addresses the urgent need for safe, sustainable, and cost-effective dismantling practices, recognized as the most critical and preparatory step in LIB recycling, by evaluating current methods and proposing future directions. The review examines manual, mechanical and automated dismantling approaches, highlighting their respective advantages and limitations. Manual method offers straightforward material recovery but face safety, labour, and efficiency challenges. Emerging automated solutions using robotics, AI, and machine learning promise improvements in safety, scalability, and disassembly precision. In addition to dismantling strategies, the review discusses regulatory frameworks, environmental implications, and the importance of standardizing battery design for easier disassembly. It also provides future perspectives emphasizing automation, eco-friendly chemical processes, and public participation in battery collection. By organizing scattered knowledge and offering critical insights and recommendations, this review serves as a comprehensive resource for researchers, policymakers, and industry stakeholders. It aims to guide sustainable innovation and foster circular economy practices in LIB end-of-life management
Assistive Technologies for Individuals with a Disability from a Neurological Condition: A Narrative Review on the Multimodal Integration
Full text linkA Humean Williams and a Williamsian Hume
No full textIf one browses through Bernard Williams’s work, one might conclude that David Hume does not represent a predominant source of inspiration for him. This chapter tries to show that this is not the case; there are many elements in Williams’s theoretical approach, from his early papers to his late reflection on genealogy, that can be interpreted in a Humean light, revealing more than just a superficial resemblance. In turn, Hume proves to be less of a straightforward optimist than Williams believed when seen in relation to Williams’s philosophical concerns. Thus, the connection between the two will be reconstructed with the aim of illuminating how Williams, although not a declared Humean, was much closer to the great Scot than may appear at first sight
EFFETTI NEL TEMPO DELLA DICHIARAZIONE DI INCOSTITUZIONALITÀ E RUOLO DEL GIUDICE COSTITUZIONALE
Full text linkL'articolo esamina molte delle questioni che ruotano attorno alla problematica concernente l’efficacia nel tempo della dichiarazione di incostituzionalità. Tali questioni sono da sempre oggetto di attenzione da parte della dottrina1 e della giurisprudenza per gli inevitabili riflessi sulla disciplina da applicare nei singoli casi e, più in generale, sulle conseguenze in tema di tutela - immediata o differita - dei diritti lesi da norme incostituzionali
Creating the vision of rapid, repeatable, reactive data workflows for policy on biodiversity
Full text linkEffective biodiversity management and policymaking requires timely access to accurate and reliable scientific data on biodiversity status, trends and threats. However, current biodiversity monitoring processes are often time-consuming, complex and irreproducible. Moreover, the quality and types of biodiversity data are diverse, which challenges their integration and impedes effective monitoring. A major step to overcome such challenges would be the availability of standardized species occurrence data. However, challenges arise in aggregating and integrating these heterogeneous data with environmental and landscape data. By creating standardized biodiversity data cubes and automated workflows for post-processing, we envision that (1) information from complex datasets will be available in a known format to efficiently communicate biodiversity variables to policymakers; (2) the adoption of repeatable Open Data workflows will make biodiversity data more accessible, efficient and cost-effective; and (3) cloud computing will make it easier to analyse large datasets, benefit from a broader range of models, share resources and work together on biodiversity projects. This revolution in biodiversity monitoring will rely on community collaboration. By bridging the gap between policymakers' needs, bioinformation specialists' skills and data collectors' motivations, biodiversity monitoring can become a more inclusive and community-driven effort. As such, we advocate for the development of tools and workflows in close consultation with stakeholders to enhance the impact and use of biodiversity information. Practical implication. The proposed approach faces challenges in maintaining software, data standards and addressing biodiversity data complexity. However, leveraging existing infrastructures like GBIF and Copernicus, and building on the knowledge from GEO and GEO BON offers a feasible path