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The Internet of Things (IoT) can trigger innovation processes across all sectors of the economy. However, this potential is not available to all regions. As with other enabling technologies, the competences required to develop IoT solutions are numerous and var-ied, ranging from hardware to software and related services, and are often provided by different companies. To map the application potential of these technologies across Eu-ropean regions, we use textual analysis applied to the description of companies’ activi-ties, which in turn allows us to identify the NACE codes associated with five main IoT domains. We identify clusters of regions characterised by different mixes of compe-tences in IoT technologies, and we discern three groups of regions – regions with spe-cialised IoT competences in software, data processing and telecommunications, regions with specialised IoT competences in hardware manufacturing, and regions with cross-layer IoT competences. Regions with cross layer IoT competences are highly concen-trated in the North-West of Europe and have a significant presence in either urban re-gions, often centred in the capital cities and their metropolitan areas, or in very-high income manufacturing regions. Regions specialised in hardware manufacturing coin-cide with the more established manufacturing regions in Germany, Italy and France. Regions specialised in software, data processing and telecommunications tend to be urban, medium-high income regions in North-West Europe. We discuss the policy im-plications of our findings at both European and regional levels.

Multiple sclerosis (MS) is a progressive neurologic disorder that can profoundly influence mobility, independence and quality of life. Gait dysfunction in MS is common, resulting in an increased risk of losing walking ability. Robotic exoskeletons have been developed to offer a new form of locomotor training. The aim of our study was to investigate the effectiveness of the powered exoskeleton (Ekso) in improving gait and balance in patients affected by MS. Twenty patients with MS (mean ± SD: age = 43.7 ± 10.3 years; 66.7% male) were enrolled in this retrospective study. They were divided into two groups, matched for demographic data (age and sex) and medical characteristics (disease duration and Expanded Disability Status Scale), but differing for the type of rehabilitation training performed. Group 1 [experimental group (EG)] received gait training with the Ekso device, whereas group 2 (control group) performed traditional gait training. Although both trainings led to a significant improvement in the ability to walk and balance, only in the EG a significant improvement in walking speed (10 Meter Walk test; P = 0.002), in person's mobility (Timed Up and Go test; P = 0.002), and in the perception of mental well-being (MSQoL-M; P = 0.004), with a good usability and acceptance of the device, was found. Powered exoskeletons could be considered a valuable tool to improve functional outcomes and get the therapeutic goal in patients with MS.

The automotive industry is undergoing a radical transformation. New social, technological, environmental and geopolitical challenges are redefining the characteristics of a saturated market, opening new scenarios while offering opportunities for the entry of new players. These challenges are bound to trigger reorganization of the global value chain between old and new suppliers and car makers and their suppliers, affecting the distribution of employ-ment, the regionalization of production and the dynamic evolution of the comparative ad-vantage of nations. In this paper we address the issue of the reorganization of global value chains in the face of these challenges. The analysis will compare the relative position of core and peripheries in the North-American and European macro-regions, focusing on Mexico, which represents a significant case study for analysis of the impact of the digital transformation on the domestic value chain in an “integrated periphery”, and of trade agreements on the location policies of big multinationals. The dependency of the Mexican automotive industry on the strategic decisions of global players is considered a factor of great vulnerability, especially in a context of rapid change in the patterns of consumption, technologies and international trade agreements. For Mexico, as for European producers in the integrated and semi-peripheries, the main challenge in the near future will be posed by the radical transformation the industry is going through in electrical and autonomous-driving vehicles, which sees regions and players outside the traditional automotive clusters in the lead. The transformations taking place are bound to change the global structure of automotive production. The rise of new competitors from the emerging economies and would-be entrants from other sectors, competing in mastering the new digital and software technologies, threatens the established structure of the industry. The pandemic has led to a spectacular acceleration in the process of change, while heightening uncertainty about future developments. This is why the governments of leading countries are joining in the race, wielding carrots and sticks in support of their industries and in the endeavor to encourage risk-taking and investment in research and innovation, step up e-vehicle production while providing for the necessary infrastructures, and guarantee their companies a place in the new industry.

Background. Multiple sclerosis (MS) is an autoimmune and demyelination disease of the central nervous system that causes progressive accumulation of disability over time. Recent studies have highlighted the correlation between metabolic disorders and cognitive dysfunctions. The present study aims to evaluate the correlation between components of the lipid profile and cognitive dysfunctions in patients affected by MS.Methods. 90 MS inpatients were included in this study. We divided the sample into three subgroups to evaluate the influence of the presence of dyslipidemia: G1 (patients with dyslipidemia), G2 (patients without dyslipidemia), G3 (patients with a higher than normal lipid value). Patients underwent rehabilitation treatment which included conventional physiotherapy, speech therapy, psychological support, cognitive rehabilitation, nutritional therapy, robotic rehabilitation, cognitive rehabilitation, and virtual reality.Results. The results showed that the three subgroups had a significant improvement in global cognitive functioning (MOCA p

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is a rare and heterogeneous acquired sensory-motor polyneuropathy with autoimmune pathogenesis. Intravenous immunoglobulins (IVIG) are a well-established therapy for CIDP: it is well known that at least two-thirds of these patients need these infusions for several years. More recently, Subcutaneous Immunoglobulins (SCIg) have been proved to be effective: this finding has been confirmed either in isolated cases or in few randomized trials. However, it appeared that the longest SCIg treatment follow up lasted no longer than 48 months. We report herein the results of a long-term SCIg treatment with a follow up period up to 7 years (84 months), considering safety, tolerability and patients’ perception of SCIg treatment in a CIDP population. We studied 17 patients (10 M; 7 F) with a diagnosis of CIDP, defined according to the EFNS/PNS criteria, successfully treated with IVIG every 4/6 weeks before being switched to SCIg treatment. Clinical follow-up included, apart from a routinely clinical assessment, the administration of Medical Research Council (MRC) sum-score, the Overall Neuropathy Limitation Scale (ONLS) and the Life Quality Index questionnaire (LQI). The results showed that, in the majority of this pre-selected group of CIDP patients (16/17), SCIg were well tolerated and were preferred over IVIG. Strength and motor functions remained stable or even improved during the long term follow-up (up to 84 months) with benefits on walking capability and resistance, manual activity performances and fatigue reduction.

Introduction: The approval of 9-δ-tetrahydocannabinol (THC)+cannabidiol (CBD) oromucosal spray (Sativex®) in Italy as an add-on medication for the management of moderate to severe spasticity in multiple sclerosis (MS) has provided a new opportunity for MS patients with drug-resistant spasticity. We aimed to investigate the improvement of MS spasticity-related symptoms in a large cohort of patients with moderate to severe spasticity in daily clinical practice. Materials and methods: MS patients with drug-resistant spasticity were recruited from 30 Italian MS centers. All patients were eligible for THC:CBD treatment according to the approved label: ≥ 18 years of age, at least moderate spasticity (MS spasticity numerical rating scale [NRS] score ≥ 4) and not responding to the common antispastic drugs. Patients were evaluated at baseline (T0) and after 4 weeks of treatment (T1) with the spasticity NRS scale and were also asked about meaningful improvements in 6 key spasticity-related symptoms. Results: Out of 1615 enrolled patients, 1432 reached the end of the first month trial period (T1). Of these, 1010 patients (70.5%) reached a ≥ 20% NRS score reduction compared with baseline (initial responders; IR). We found that 627 (43.8% of 1432) patients showed an improvement in at least one spasticity-related symptom (SRSr group), 543 (86.6%) of them belonging to the IR group and 84 (13.4%) to the spasticity NRS non-responders group. Conclusion: Our study confirmed that the therapeutic benefit of cannabinoids may extend beyond spasticity, improving spasticity-related symptoms even in non-NRS responder patients. © 2020, Fondazione Società Italiana di Neurologia.

In several countries, governments have assigned to public innovation intermediaries (PIIs) the mandate to support the digital transition, by facilitating the development and adoption of new digital technologies on the part of firms and other organisations. This new mandate requires PIIs to upgrade their business models, moving beyond their traditional involvement in firms’ technology upgrading and university-industry knowledge transfer, toward supporting the creation of new innovation systems around the emerging digital technologies. To understand how PIIs are reconfiguring their business models to support the digital transition, we study four cases of PIIs operating in the United Kingdom and France, whose mandates include providing support for firms and other organisations in the implementation of new digital technologies, focusing in particular on the Internet of Things (IoT). We show that, despite their differences, all four PIIs have substantially reconfigured their business models in similar ways in order to fulfil these mandates. Both the formal legitimacy arising from their policy mandate, and the knowledge resources and informal legitimacy they have developed, have played a decisive role in their ability to orchestrate the development of innovation systems around IoT.

In 2018, after 25 years of the North America Trade Agreement (NAFTA), the United States requested new rules which, among other requirements, increased the regional con-tent in the production of automotive components and parts traded between the three part-ner countries, United States, Canada and Mexico. Signed by all three countries, the new trade agreement, USMCA, is to go into force in 2022. Nonetheless, after the 2020 Presi-dential election, the new treaty's future is under discussion, and its impact on the automo-tive industry is not entirely defined. Another significant shift in this industry – the acceler-ated rise of electric vehicles – also occurred in 2020: while the COVID-19 pandemic largely halted most plants in the automotive value chain all over the world, at the reopen-ing, the tide is now running against internal combustion engine vehicles, at least in the an-nouncements and in some large investments planned in Europe, Asia and the US. The definition of the pre-pandemic situation is a very helpful starting point for the analysis of the possible repercussions of the technological and geo-political transition, which has been accelerated by the epidemic, on geographical clusters and sectorial special-isations of the main regions and countries. This paper analyses the trade networks emerg-ing in the past 25 years in a new analytical framework. In the economic literature on inter-national trade, the study of the automotive global value chains has been addressed by us-ing network analysis, focusing on the centrality of geographical regions and countries while largely overlooking the contribution of countries' bilateral trading in components and parts as structuring forces of the subnetwork of countries and their specific position in the overall trade network. The paper focuses on such subnetworks as meso-level structures emerging in trade network over the last 25 years. Using the Infomap multilayer clustering algorithm, we are able to identify clusters of countries and their specific trades in the automotive internation-al trade network and to highlight the relative importance of each cluster, the interconnec-tions between them, and the contribution of countries and of components and parts in the clusters. We draw the data from the UN Comtrade database of directed export and import flows of 30 automotive components and parts among 42 countries (accounting for 98% of world trade flows of those items). The paper highlights the changes that occurred over 25 years in the geography of the trade relations, with particular with regard to denser and more hierarchical network gener-ated by Germany’s trade relations within EU countries and by the US preferential trade agreements with Canada and Mexico, and the upsurge of China. With a similar overall va-riety of traded components and parts within the main clusters (dominated respectively by Germany, US and Japan-China), the Infomap multilayer analysis singles out which com-ponents and parts determined the relative positions of countries in the various clusters and the changes over time in the relative positions of countries and their specialisations in mul-tilateral trades. Connections between clusters increase over time, while the relative im-portance of the main clusters and of some individual countries change significantly. The focus on US and Mexico and on Germany and Central Eastern European countries (Czech Republic, Hungary, Poland, Slovakia) will drive the comparative analysis.

largest world producer of automotive vehicles. The Mexican experience is part of the more general case of the “integrated peripheries.” The development of these cannot be accounted for separately from the developments occurring in its core country. Unlike the core-periphery literature, however, our analysis emphasizes that the various clusters of cores and integrated peripheries are not alike. In the case under study, the core has been systematically lagging behind the main transformations pioneered by its competitors. The paper traces the evolution of the Mexican automotive industry, emphasizing the difficulties faced by a late-comer country in developing an independent industry, and the importance of policy choices as well as the macroeconomic context in affecting its development. NAFTA represents the culmination of an integration process that has profoundly transformed the structure of the Mexican automotive industry, deepening its dependence on the US market. While there is no doubt that it has contributed to the spectacular growth of the Mexican auto industry, whether it also increased its resilience or, rather, its dependence is still an open question. This issue is particularly relevant in view of the transformations that are taking place in the automotive sector and in the geopolitical scenario. These include the end of NAFTA and the advent of USMCA, the entry of powerful competitors into the global market, and the transition to electric and autonomous vehicles, which all entail risks and opportunities. The lens of the centre-periphery relationship can help to understand the present integration of North America and its future direction.

Multiple Sclerosis (MS) is an inflammatory degenerative disease of the central nervous system. Cognitive impairment is a frequent feature of MS at both the earlier and later stages of the disease, and it tends to worsen over time. Cognitive rehabilitation (CR) is becoming a standard component of neurorehabilitation in patients with MS. The aim of this study is to evaluate the effect of computerized CR, by using the Italian software ERICA, on cognitive and daily life performance in MS patients with mild to moderate cognitive impairment. We studied 40 individuals affected by MS, randomized into either traditional CR group (TCRG: n = 20), which performed a conventional cognitive training, or the computer-assisted CR group (CCRG: n = 20), which performed PC-based CR. The cognitive dysfunctions were investigated through a complete neuropsychological battery, administered before (T0) and after (T1) each different training. Both the trainings were well-tolerated and led to improvement in cognitive function. Notably, the CCRG had a significant effect in improving memory, attention, and processing speed, as compared to TCRG. ERICA training could be a valuable tool for the CR in patients affected by MS. Further studied are needed to confirm these promising results and evaluate the long-term effects.

In the future of European Union (EU) Cohesion Policy, a critical feature is how to capitalize on the current Research and Innovation Strategy for Smart Specialisation (RIS3), introduced in the 2014���20 programming period as an ex-ante conditionality for accessing European Structural Investment Funds. As a contribution to the current debate, this paper frames the socioeconomic comparative analysis of EU regions, considering subnational structural similarities, and referring to population, labour market and the sectoral composition of the economy. Principal component analysis and cluster analysis are performed on 31 input variables, returning 19 different types of EU regions. With an application to the EU macro-regions, the paper supports policy planning in macro-regions as a meso-level of interventions for the future Cohesion Policy.

Endometriosis can take one of three forms depending on its clinical presentation and management: endometriotic ovarian cyst (ovarian endometrioma), superficial or peritoneal endometriosis and deep infiltrating endometriosis (DIE).1Among them, DIE is considered the most aggressive, and the patient is often affected by more than one type together. The therapeutic methodology should not be influenced by a combination of different types of endometriotic lesion. According to the clinical context and the patient's needs, the treatment of this pathology can be medical or surgical. Although medical therapy could improve endometriosis-associated symptoms, it never offers a definite treatment for symptomatic patients, who often require surgical treatment. The rationale behind endometriosis surgical treatment is to achieve the complete removal of all lesions through a one-step surgical procedure; to obtain promising long-term results for pelvic pain, recurrence rate, and fertility; and to protect the functionality of the involved organs. Achieving these results depends on the total removal of the pathology from the pelvis, in an attempt to preserve, as much as possible, the healthy tissues surrounding the site of the disease. The choice of a surgical approach rather than medical therapy is subject to the patient's expectations, such as pregnancy desire, the effectiveness of treatment compared to possible complications, the type of pain and its intensity, and the location and severity of the disease. In this context, surgical management using a multidisciplinary endometriosis team is an important factor for achieving good outcomes.

Objective: To identify baseline factors associated with disease activity in patients with relapsing–remitting multiple sclerosis (RRMS) under teriflunomide treatment. Methods: This was an independent, multi-centre, retrospective post-marketing study. We analysed data of 1,507 patients who started teriflunomide since October 2014 and were regularly followed in 28 Centres in Italy. We reported the proportions of patients who discontinued treatment (after excluding 32 lost to follow-up) and who experienced clinical disease activity, i.e., relapse(s) and/or confirmed disability worsening, as assessed by the Expanded Disability Status Scale (EDSS). Decision tree-based analysis was performed to identify baseline factors associated with clinical disease activity during teriflunomide treatment. Results: At database lock (September 2020), approximately 29% of patients (430 out of 1,475) discontinued teriflunomide because of disease activity (~ 46%), adverse events (~ 37%), poor tolerability (~ 15%), pregnancy planning (~ 2%). Approximately 28% of patients experienced disease activity over a median follow-up of 2.75years: ~ 9% had relapses but not disability worsening; ~ 13% had isolated disability worsening; ~ 6% had both relapses and disability worsening. The most important baseline factor associated with disease activity(especially disability worsening) was an EDSS > 4.0 (p < 0.001). In patients with moderate disability level (EDSS 2.0–4.0), disease activity occurred more frequently in case of ≥ 1 pre-treatment relapses (p = 0.025). In patients with milder disability level (EDSS < 2.0), disease activity occurred more frequently after previous exposure to ≥ 2 disease-modifying treatments (p = 0.007). Conclusions: Our study suggests a place-in-therapy for teriflunomide in naïve patients with mild disability level or in those who switched their initial treatment for poor tolerability. Adverse events related with teriflunomide were consistent with literature data, without any new safety concern.

In the past decade many papers have discussed innovation policies in terms of their design, assessment and impact. Drawing on those contributions, the EC OECD STIP Compass suggests a detailed taxonomy of innovation policies with regard to their themes, target groups of beneficiaries and instruments. Implemented with a web platform, that taxonomy has promoted an extensive collection of information on innovation policy initiatives across OECD member countries. Using the STIP dataset, in this paper we employ that taxonomy to identify the innovation policy mixes by referring to all the dimensions encompassed in each policy initiative, i.e., themes, targets, instruments. The evidence-based multidimensional analyses yield a typology and set of topics of innovation policy mixes that we use to conduct a cross-country analysis of innovation policy portfolios. Although the results of the cross-country analysis are statistically significant, caution is necessary when using them because of three main fragilities of the current version of STIP Compass: the absence of information on innovation policies at subnational level; the classification of the largest group of target beneficiaries, i.e. innovation intermediaries; the quality of some information essential for enhancing the analysis. The proposed navigation of the STIP Compass data is freely accessible online.

This paper investigates the socioeconomic impact of two large earthquakes (1997 and 2016) that occurred in Central Italy on the agricultural sector, and in particular on animal husbandry. Through a questionnaire-based field survey, involving 55 farm holdings located in Umbria (Assisano district), this work points out: i) the farmers' perception of the damage suffered with regard to residential buildings, agricultural facilities and animal husbandry activities; ii) the interventions carried out in the emergency phases; and iii) the reconstruction phases, as experienced by the farming households. Major vulnerabilities of these agricultural holdings have emerged: small-scale family-based farming, increased householders average age, little on-farm and off-farm diversification, persisting economic marginalisation. Recall and perception of the impact of the earthquakes in the Assisano district - direct damage and reconstruction interventions - are compared with the perception in the nearby mountainous area of the Marche Region, largely affected by the 2016 earthquake. In both areas, the experienced earthquakes have not acted as triggers for agents' mobilisation and change. Rather, the situation calls for a drastic, farsighted change of development policies by national and regional governments and for a convinced prompting for holistic local “building back better” initiatives.

This paper applies multidimensional clustering of EU-28 regions with regard to their specialisation strategies and socioeconomic characteristics. It builds on an original dataset. Several academic studies discuss the relevant issues to be addressed by innovation and regional development policies, but so far no systematic analysis has linked the different aspects of EU regions research and innovation strategies (RIS3) and their socio-economic characteristics. This paper intends to fill this gap, with the aim to provide clues for more effective regional and innovation policies. In the data set analysed in this paper, the socioeconomic and demographic classification associates each region to one categorical variable (with 19 categories), while the classification of the RIS3 priorities clustering was performed separately on “descriptions” (21 Boolean categories) and “codes” (11 Boolean Categories) of regions’ RIS3. The cluster analysis, implemented on the results of the correspondence analysis on the three sets of categories, returns 9 groups of regions that are similar in terms of priorities and socioeconomic characteristics. Each group has different characteristics that revolve mainly around the concepts of selectivity (group’s ability to represent a category) and homogeneity (similarity in the group with respect to one category) with respect to the different classifications on which the analysis is based. Policy implications showed in this paper are discussed as a contribution to the current debate on post-2020 European Cohesion Policy, which aims at orienting public policies toward the reduction of regional disparities and to the enhance complementarities and synergies within macro-regions.

We analyse whether public subsidies supporting collaborative research and development (R&D) projects in small and medium-sized enterprises (SMEs) are able to encourage persistent R&D investment and interorganisational networking more than subsidies supporting individual R&D projects. Adopting a counterfactual approach to policy evaluation, we compare subsidies for collaborative R&D and for individual R&D implemented in the same Italian region in the same period. Our findings suggest that, once public support is no longer available, the two subsidies have different effects on different types of SMEs. If the policymakers’ objective is to increase the number of R&D-performing SMEs over time, they should provide subsidies for collaborative R&D to firms with modest R&D experience. If their objective is to increase the amount of spontaneous R&D investment over time, they should target SMEs with some prior R&D experience, using either subsidy. Finally, if their objective is to induce SMEs to network with external organisations, subsidies for collaborative R&D projects should be preferred to subsidies for individual R&D projects.

Policymakers worldwide increasingly rely on the funding of innovation intermediaries in order to remedy failures in their innovation systems, including firms’ lack of information about sources of external knowledge and opportunities, lack of adequate competences and skills, lack of productive connections and the lack of formal and informal institutions in the system. To induce intermediaries to satisfactorily address the system failures they are called to confront, policymakers often make their funding conditional on their performance. Building on a case study of publicly funded innovation intermediaries in Tuscany (Italy), we identify several challenges in setting up appropriate performance-based incentives for intermediaries. These involve (i) failure to clearly articulate policy objectives in terms of system failures; (ii) failure to measure the achievement of all policy objectives; and (iii) failure to clearly link performance indicators with policy objectives. Based on the lessons learned from this case, we derive some implications for policy design.

Motor impairment is the most common symptom in multiple sclerosis (MS). Thus, a variety of new rehabilitative strategies, including robotic gait training, have been implemented, showing their effectiveness. The aim of our study was to investigate whether an intensive robotic gait training, preceding a traditional rehabilitative treatment, could be useful in improving and potentiating motor performance in MS patients. Forty-five patients, who fulfilled the inclusion criteria, were enrolled in this study and randomized into either the control group (CG) or the experimental group (EG). A complete clinical evaluation, including the Expanded Disability Severity Scale, the Functional Independence Measure, the Hamilton Rating Scale for Depression, the time up and go test (TUG), and the Tinetti balance scale, was performed at baseline (T0), after 6 week (T1), at the end of rehabilitative training (T2), and 1 month later (T3). A significant improvement was observed in the EG for all the outcome measures, whereas the CG showed an improvement only in TUG. In contrast, from T1 to T2, only CG significantly improved in all outcomes, whereas the EG had an improvement only regarding TUG. From T2 to T3, no significant differences in Functional Independence Measure scores emerged for both the groups, but a significant worsening in Tinetti balance scale and TUG was observed for the CG and in TUG for the EG. Our study provides evidence that robotic rehabilitationn coupled with two-dimensional virtual reality may be a valuable tool in promoting functional recovery in patients with MS.

Studies on the prevalence of sexual dysfunction (SD) in multiple sclerosis (MS) have shown that 40% to 80% of women and 50% to 90% of men have had sexual complaints. Sexual function is often disregarded during consultation with healthcare professionals, and SD is frequently underdiagnosed. The aim of this study was to investigate the prevalence of SD and its relationship to sociodemographic and disease-related factors, with regard to disability state, in a hospital cohort of MS patients, by using a semistructured interview.Of 130 screened outpatients, 87 met the inclusion criteria and completed the study. The mean age of the participants was 39.3 ± 8.3 years, with a disease duration of 8.3 ± 5.4 years and a mean Expanded Disability Status Scale (EDSS) score of 2.04 ± 0.19. Sexual function was evaluated by means of a semistructured interview, investigating a patient's 3 main life areas: sociodemographic information, illness perception, and sexuality.Approximately 70% of the patients complained at least 1 SD (decreased libido, erectile dysfunction, premature or retarded ejaculation, painful penetration), and 22% of them reported the disorder as frequent. The disease duration was associated with lower satisfaction in sexual function, and lack of sexual interest was the most common problem having a negative correlation with EDSS.Healthcare professionals involved in MS, should assess patients for SD. Further studies should be fostered to better quantify SD etiology, the degree of sexual impairment, and its impact on patients' quality of life to "overcome" this problem.

Objectives To describe the effects of osteopathic manipulative treatment in patients affected by Multiple Sclerosis (MS). Design and setting This is a pilot study involving 20 MS patients attending the IRCCS Neurolesi “Bonino-Pulejo”, Messina, Italy. Intervention The clinical evaluation was performed before starting rehabilitation treatment (T0) and after 8 weeks of treatment (T1). The CG sample undergo a conventional rehabilitation training (CRT), 5 times/week for 60 min (for a total of 40 sessions), the EG performed the same CRT (but with a different frequency, i.e. 3 times/week, for a total of 24 sessions) and a specific OMT 2 times/week for 60 min (for a total of 16 sessions). Main outcome measures We analyzed the scores recorded in the following main scales: Expanded Disability Status Scale (EDSS), 10 m walking test (10mWT), Hamilton anxiety rating scale (HRS-A), and the Fatigue severity scale (FSS). Results Our data showed a reduction in the FSS score for the EG (40 ± 1,41 at T0 vs 37 ± 2,32 at T1; p = 0.04) but not in the CG (41 ± 2,41 at TO vs 39 ± 2,6 at T1) with an intergroup difference p Conclusions Our data raise idea that OMT might be useful in rehabilitative setting in MS patients, with particular regard to anxiety and fatigue.

Multiple sclerosis (MS) can adversely affect several domains of cognitive function, including attention, information processing, memory and learning, executive functions and visuospatial skills. In recent years, technological innovations have proven effective in improving motor and cognitive impairment in neurological patients, including those affected by MS.The study aims to evaluate cognitive outcomes after rehabilitation training with the Virtual Reality rehabilitation system (VRRS) in patients suffering from MS.All patients were randomized into either the control group (CG: 15 patients) receiving conventional cognitive rehab or the experimental group (EG) using virtual reality (VR) (15 patients). Both groups underwent the same amount of cognitive training, 3 times a week for 8 weeks. They were submitted to neuropsychological assessment before (T0) and after the rehabilitation treatment (T1).Our data showed that both conventional and VR cognitive rehabilitation approaches improved mood (p 0.001) and visuospatial skills. However, only in the EG a significant improvement in specific cognitive domains (p 0.001), including learning ability, short-term verbal memory, lexical access ability, as well as quality of life related to mental states, was found.The present study demonstrated that VR can be a motivational and effective tool for cognitive recovery in MS patients.

Several cerebellar functions related to upper limb motor control have been studied using non-invasive brain stimulation paradigms. We have recently shown that transcranial alternating current stimulation (tACS) may be a promising approach in shaping the plasticity of cerebellum-brain pathways in a safe and effective manner. This study aimed to assess whether cerebellar tACS at different frequencies may tune M1-leg excitability and modify gait control in healthy human subjects. To this end, we tested the effects of different cerebellar tACS frequencies over the right cerebellar hemisphere (at 10, 50, and 300 Hz, besides a sham-tACS) on M1-leg excitability, cerebellum-brain inhibition (CBI), and gait parameters in a sample of 25 healthy volunteers. Fifty and 300 Hz tACS differently modified M1-leg excitability and CBI from both lower limbs, without significant gait perturbations. We hypothesize that tACS aftereffect may depend on a selective entrainment of distinct cerebellar networks related to lower limb motor functions. Therefore, cerebellar tACS might represent a useful tool to modulate walking training in people with cerebellum-related gait impairment, given that tACS may potentially reset abnormal cerebellar circuitries.

Multiple sclerosis (MS) is a demyelinating disease of autoimmune originate. A large proportion of patient present with cognitive deficits that negatively affect their quality of life, thus, a proper cognitive rehabilitation is mandatory. The aim of this study is to evaluate the effect of semi-immersive virtual reality training (sVRT) on neuropsychological and motor recovery individuals suffering from MS. We enrolled 60 MS patients, randomized into either the control group (CG: 30) undergoing a conventional cognitive training, or the experimental group (EG: 30), which performed sVRT. Cognitive and motor outcomes were investigated through clinical and neuropsychological scales before (T0) and at the end (T1) of each different training. Only in the EG, we observed a significant improvement in cognitive parameters and motor scores. Our data demonstrate that VR cognitive training could potentiate MS patients' rehabilitation outcome, with positive results on both motor and cognitive performance.

For any given territory, disaster risk is a function of hazard, exposure and vulnerability. The conceptual frameworks for these dimensions are largely debated in the scientific studies, focusing on spatial and temporal references and on system perspective of risk assessment. Despite broad in their scope, the analytical frameworks proposed to analyse policy programmes to reduce risk generally miss that risk indicators should be grounded on geographical and spatial features of the neighbouring territories and not only on communities' behaviour, and their resilience, as the paradigmatic solution in front of system events in areas prone to natural multi-hazard. The definition of "community" and of "neighbourhood" that are relevant for risk assessment cannot be simply defined in terms of absolute size of population or economic activity of individual local units under analysis or of the formal aggregation provided by jurisdictional agreements on specific functions. The paper presents an empirical analysis on spatially-lagged data in Italy, which was massively hit by adverse natural events in the last decade. It suggests to focus on social and material vulnerability, by using the comprehensive indicator at municipality level elaborated by the Italian Institute of Statistics. At the municipality-level, the analysis shows a positive correlation between multi-hazards, on the one hand, and spatially-lagged exposure and vulnerability, on the other. Thus, conditions in neighbouring municipalities would matter in prioritizing policy interventions aiming at mitigating hazard impacts, reducing vulnerability and enhancing communities' resilience. The definition of significant neighbouring spaces opens to a conceptualization of vulnerability grounded on a relational perspective in the creation of collective goods. This could enhance more effective Disaster Risk Reduction programmes.

For many years the transfer, exchange and collaboration of knowledge and technology between academia and industry have been discussed as an important means of generating commercial value. The underlying rationale for such collaborations is that knowledge and technology from academia lead to firms’ competitive advantage. What has received less attention in the literature, so far, is a science-based collaborative approach for addressing societal challenges. In particular, we focus on collaborations among different actors - ranging from academics, businesses, policy makers, intermediaries and society - who devote shared resources, competences and capabilities in developing unique solutions to economic and societal challenges. The specific domain of a such process - that demands thinking beyond the knowledge transfer or creation expected to produce business value - is framed as “co-creation”. This paper outlines a conceptual framework by capturing the heterogeneity of science-based co-creation and its determinants. In the paper, the concept of co-creation is positioned in the various strands of innovation literature which refer to collaboration across different domains, highlighting the uniqueness of co-creation. We suggest focussing on a distinctive character of co-creation: the production of both business value and social values that emerges with different forms of innovation, reach and prominence. While business value has its own metric in a monetary scale, when society is considered, metrics should refer to the many different dimensions that have been impacted on, leading to many social values (in plural). The paper highlights research gaps to further our knowledge on co-creation and suggests policy implications to support effective mutual interactions across science, technology and society

Policymakers wishing to enhance innovation processes in small and medium-sized enterprises increasingly channel their interventions through innovation intermediaries. However, limited empirical research exists regarding the activities and performance of intermediaries, with most contributions taking a qualitative approach and focusing on the role of intermediaries as brokers. In this paper, we analyse the extent to which innovation intermediaries, through their engagement in different activities, support the creation of communities of other agents. We use multilayer network analysis techniques to simultaneously represent the many types of interactions promoted by intermediaries. Furthermore, by originally applying the Infomap algorithm to our multilayer network, we assess the contribution of the agents involved in different activities promoted by intermediaries, and we identify the emerging multilayer communities and the intercohesive agents that span across several communities. Our analysis highlights the potential and the critical features of multilayer analysis for policy design and evaluation.

Molecular profiling of a tumor allows the opportunity to design specific therapies which are able to interact only with cancer cells characterized by the accumulation of several genomic aberrations. This study investigates the usefulness of next-generation sequencing (NGS) and mutation-specific analysis methods for the detection of target genes for current therapies in non-small-cell lung cancer (NSCLC), metastatic colorectal cancer (mCRC), and melanoma patients. We focused our attention on EGFR, BRAF, KRAS, and BRAF genes for NSCLC, melanoma, and mCRC samples, respectively. Our study demonstrated that in about 2% of analyzed cases, the two techniques did not show the same or overlapping results. Two patients affected by mCRC resulted in wild-type (WT) for BRAF and two cases with NSCLC were WT for EGFR according to PGM analysis. In contrast, these samples were mutated for the evaluated genes using the therascreen test on Rotor-Gene Q. In conclusion, our experience suggests that it would be appropriate to confirm the WT status of the genes of interest with a more sensitive analysis method to avoid the presence of a small neoplastic clone and drive the clinician to correct patient monitoring.

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system, affecting ambulation even in people with only mild neurological signs. Patients with MS frequently experience spasticity, which contributes significantly to impair their motor functions, including ambulation, owing to muscle stiffness, spasms, and pain.To clarify the role of delta-9-tetrahydrocannabinol(THC):cannabidiol(CBD) oromucosal spray, coupled to robot-aided gait training (RAGT) using the Lokomat©Pro to improve functional ambulation in patients with MS.We compared 20 patients with MS, who were treated with THC:CBD oromucosal spray in add-on to the ongoing oral antispastic therapy (OAT) (group A), with 20 individuals with MS (matched for clinical-demographic characteristics) who were treated only with OAT (group B). Both the groups underwent RAGT using the Lokomat-Pro (three 45-minute sessions per week). Our primary outcome measures were the Functional Independence Measure (FIM) and the 10 meters walking test (10MWT). As secondary outcome measures we evaluated the brain cortical excitability by using Transcranial Magnetic Stimulation. Both parameters were taken before and after the end of the RAGT.FIM improved in group A more than in group B (p0.001). Moreover, 10MWT decreased in group A more than in group B (p0.001). These clinical findings were paralleled by a more evident reshape of intracortical excitability in both upper and lower limbs, as suggested by motor evoked potential amplitude increase (p0.001), intracortical inhibition strengthening (p0.001), and intracortical facilitation decrease (p=0.01) in group A as compared to group B.Our results suggest that the combined THC:CBD-RAGT approach could be useful in improving gait performance in patients with MS.

Die Bereitstellung offentlicher Mittel fur private Unternehmen zum Erwerb von Dienstleistungen, insbesondere wissensintensiven, hat in der Bewertungsliteratur bislang wenig Beachtung gefunden (Bakhshi et al., 2015; Bruhn et al., 2018 sind bemerkenswerte Ausnahmen). Diese Masnahmen richten sich haufig an kleine und mittlere Unternehmen (KMU) und stellen ihnen einen geringen Betrag an offentlichen Mitteln zur Verfugung, mit denen sie ihre Kosten fur den Einkauf von Dienstleistungen senken konnen (Storey, 2003). Die offentliche Finanzierung kann in Form eines direkten Zuschusses oder eines Gutscheins erfolgen, den Unternehmen fur den Kauf von Dienstleistungen von zugelassenen Dienstleistern oder manchmal von beliebigen Anbietern, die vom begunstigten Unternehmen frei gewahlt wurden, verwenden mussen (OECD, 2000; Storey, 2003; IEG, 2013). .