LUNA: Nuclear Astrophysics Deep Underground

Nuclear astrophysics strives for a comprehensive picture of the nuclear reactions responsible for synthesizing the chemical elements and for powering the stellar evolution engine. Deep underground in the Gran Sasso laboratory the cross sections of the key reactions of the proton-proton chain and of the Carbon-Nitrogen-Oxygen (CNO) cycle have been measured right down to the energies of astrophysical interest. The salient features of underground nuclear astrophysics are summarized here. The main results obtained by LUNA in the last twenty years are reviewed, and their influence on the comprehension of the properties of the neutrino, of the Sun and of the Universe itself are discussed. Future directions of underground nuclear astrophysics towards the study of helium and carbon burning and of stellar neutron sources in stars are pointed out.Comment: Invited review, submitted to Annu. Rev. Nucl. Part. Scienc

Co-production in healthcare services: What we know, how we can evaluate it

Background In times of increasing population aging, higher incidence of chronic diseases and higher expectations regarding public service provision, healthcare services are under increasing strain to cut costs while keeping quality. In this context, debates on the importance of promoting systems of co-produced health between stakeholders have gained considerable traction both in the literature and in policy debates of the public sector (Dunston et al., 2009, Voorberg et al. 2015; European Commission 2010). Co-production occurs \u201cwhen public service organizations partner with external entities, including other public organizations, third sector, or service user, to jointly produce services that they previously produced on their own\u201d (Thomas, 2013, p. 788). In this perspective, co-production is not only a patient involvement tool, but mainly a managerial tool, where partner in the production process could influence the methods used to organise and manage the service delivery (Sorrentino et al., 2015; Brandsen and Honingh, 2015; Gilardi et al., 2016). Despite this widespread acceptance, minimal consensus exists on the mechanisms for evaluating the actual impacts of the co-production in healthcare sector. More specifically, little has been produced on how the results of these changing structures, practices and goals in healthcare management and provision can be monitored and evaluated (Hardyman et al., 2015; Gilardi et al., 2016; Palumbo, 2016). Objectives The study aims at filling this gap by developing a conceptual framework for assessing co-production in healthcare. Specifically, drawing on existing literature on co-production in healthcare, we develop an original analytical evaluation framework with respect to: i) the multidimensional perspectives to be taken into consideration; ii) the dimensions to be analysed; iii) the methods that allow implementing our framework in practice. Methodolody First of all, a quantitative bibliometric analysis, using Bibliometrix software (Aria and Cuccurullo, 2017), is carried out. The reference database chosen is WoS and the inclusion criterion is \u201cco-production AND heath* OR coproduction AND health*\u201d in topic. Moreover, the search is refined by language, i.e. English, and type of publication, i.e. journal academic article. No time limitation is selected. After deleting non-inherent papers, our final sample was made up of 213 papers. As second stage, a qualitative content analysis based on PRISMA protocol is developed, focusing on those papers targeting evaluation issues. Finally, a preliminary co-production evaluation model proposal is proposed and discussed. Main results The study shows an increasing attention on the co-production topic, as highlighted by an annual percentage growth rate of about 26% and the big increase in the last 5 years in number of publications. The countries with a highest number of publications and collaborations are UK (mainly England), Netherlands, Australia and USA. As expected, the most repeated keyword is co-production, however, it is interesting to underline the presence of \u201cmental health\u201d and \u201cpublic health\u201d, that can be assumed as the main topic of studies analyzed. Nonetheless, only few studies focus on the evaluation of outcomes. Among them, the content analysis has revealed a predominantly mono-dimensional and mono-stakeholder approach. Specifically, clinical, economic or psychological-social - mainly in terms of patient satisfaction \u2013 impacts (i.e. Lwembe et al., 2016; Harvey et al., 2017) are assessed. The analysis reveals that one of the main challenges of assessing co-production lies in its multi-dimensional nature; thus a multiple perspectives framework has to be adopted. To contribute filling this gap, we developed a preliminary multidimensional (i.e. performance indicators) and multi-stakeholder (i.e. different actors involved) evaluation model (Figure 1). Specifically, the framework takes into account the three main outcome domains \u2013 i) economic, ii) managerial/organisational and iii) clinical \u2013 and three main stakeholders involved \u2013 i) hospital, ii) healthcare professionals, iii) patients and their families. The economic and efficiency measures concerning direct and indirect cost for hospital and patients/family, should be integrated with clinical and managerial measures for each stakeholder: 1. Hospital: administrative efficiency, activating capacity, inclusiveness of decision making, stability/flexibility of rules, conflict resolution and collaboration climate, frequency of interaction. 2 Patient (and caregiver or family): objective (i.e. compliance) and subjective (i.e. quality of life, quality of care perception, patient satisfaction) indicators. 3. Healthcare professional and staff: objective (e.g. turnover rate, absences, injuries and work-related ill health) and subjective (e.g. burnout, satisfaction, healthcare professional engagement, occupational health, risk perception) indicators

Smart Retailing: a model to assess the economic sustainability of smart shelf-enabled dynamic pricing

Smart Retailing, a new approach to retail management that leverages digital technologies, is gaining much attention, as it enables innovation and improvements in consumers’ quality of life. However, the potentialities stemming from the application of such technologies are still not fully explored. Investment analyses addressing specific technologies could be useful to fill the academic gaps and guide retailers in their digital transition. This paper aims thus at evaluating the economic sustainability of investment in smart shelves, which are employed to perform dynamic pricing in presence of perishable goods. A model simulating the pricing variation in different scenarios was built and economic and financial analyses were performed to evaluate the sustainability of the investment. Data to feed the model were collected through semi-structured interviews with a smart shelf technology provider and three grocery retailers. The results show that the employment of smart shelves allows retailers to increase their profits. First, they are always able to assign to the product the price which most accurately reflects the customers’ willingness to pay. Second, the costs related to misplacement issues are reduced. This study contributes to the knowledge in this unexplored field by providing a model that simulates the dynamic pricing policy after the introduction of smart shelf technology and evaluates its economical sustainability. It also provides retailers who want to join the digital transformation of the stores with a useful tool to guide their investments

Impact of a multistrain probiotic formulation with high bifidobacterial content on the fecal bacterial community and short-chain fatty acid levels of healthy adults

The consumption of probiotic products is continually increasing, supported by growing scientific evidence of their efficacy. Considering that probiotics may primarily affect health (either positively or negatively) through gut microbiota modulation, the first aspect that should be evaluated is their impact on the intestinal microbial ecosystem. In this study, we longitudinally analyzed the bacterial taxonomic composition and organic acid levels in four fecal samples collected over the course of four weeks from 19 healthy adults who ingested one capsule a day for two weeks of a formulation containing at least 70 billion colony-forming units, consisting of 25% lactobacilli and 75% Bifidobacterium animalis subsp. lactis. We found that 16S rRNA gene profiling showed that probiotic intake only induced an increase in a single operational taxonomic unit ascribed to B. animalis, plausibly corresponding to the ingested bifidobacterial strain. Furthermore, liquid chromatography/mass spectrometry revealed a significant increase in the lactate and acetate/butyrate ratio and a trend toward a decrease in succinate following probiotic administration. The presented results indicate that the investigated probiotic formulation did not alter the intestinal bacterial ecosystem of healthy adults and suggest its potential ability to promote colonization resistance in the gut through a transient increase in fecal bifidobacteria, lactic acid, and the acetate/butyrate ratio

'First, do no harm': the role of negative emotions and moral disengagement in understanding the relationship between workplace aggression and misbehavior

Workplace aggression is a critical phenomenon particularly in the healthcare sector, where nurses are especially at risk of bullying and third-party aggression. While workplace aggression has been frequently examined in relation to health problems, less is known about the possible negative impact such aggression may have on the (un)ethical behavior of victims. Our research aims to fill this gap. Drawing on literature on counterproductive work behavior (CWB) and the social-cognitive literature on aggression we investigated in two independent studies (NStudy1 = 439; NStudy2 = 416), the role of negative emotions - in particular anger, fear, and sadness, - and of moral disengagement (MD) in the paths between workplace aggression, CWB and health symptoms. The focus on these relationships is rooted in two reasons. First, misbehavior at work is a pervasive phenomenon worldwide and second, little research has been conducted in the healthcare sector on this type of behavior despite the potential importance of the issue in this context. We empirically tested our hypotheses considering a specific form of workplace aggression in each study: workplace bullying or third-party aggression. Results from the two empirical studies confirm the hypotheses that being target of workplace aggression (bullying or third-party aggression) is not only associated with health symptoms but also with misbehavior. In addition, the results of structural equation modeling attest the importance of examining specific discrete negative emotions and MD for better understanding misbehavior at work. In particular, this research shows for the first time that anger, fear, and sadness, generally aggregated into a single dimension, are indeed differently associated with MD, misbehavior and health symptoms. Specifically, in line with the literature on discrete emotions, while sadness is only associated with health symptoms, anger and fear are related to both health and misbehavior

Migraine and cluster headache show impaired neurosteroids patterns

Background: Perturbation of neuronal excitability contributes to migraine. Neurosteroids modulate the activity of γ-aminobutyric acid A and N-methyl-d-aspartate receptors, and might be involved in the pathogenesis of migraine. Here, we measured plasma levels of four neurosteroids, i.e., allopregnanolone, epiallopregnanolone, dehydroepiandrosterone and deydroepiandrosterone sulfate, in patients affected by episodic migraine, chronic migraine, or cluster headache. Methods: Nineteen female patients affected by episodic migraine, 51 female patients affected by chronic migraine, and 18 male patients affected by cluster headache were recruited to the study. Sex- and age-matched healthy control subjects (31 females and 16 males) were also recruited. Patients were clinically characterized by using validated questionnaires. Plasma neurosteroid levels were measured by liquid chromatography-tandem mass spectrometry. Results: We found disease-specific changes in neurosteroid levels in our study groups. For example, allopregnanolone levels were significantly increased in episodic migraine and chronic migraine patients than in control subjects, whereas they were reduced in patients affected by cluster headache. Dehydroepiandrosterone and dehydroepiandrosterone sulfate levels were reduced in patients affected by chronic migraine, but did not change in patients affected by cluster headache. Conclusion: We have shown for the first time that large and disease-specific changes in circulating neurosteroid levels are associated with chronic headache disorders, raising the interesting possibility that fluctuations of neurosteroids at their site of action might shape the natural course of migraine and cluster headache. Whether the observed changes in neurosteroids are genetically determined or rather result from exposure to environmental or intrinsic stressors is unknown. This might also be matter for further investigation because stress is a known triggering factor for headache attacks in both migraineurs and cluster headache patients

Patient Verbal Aggression and Emotion Work among Nurses: The Buffering Role of Job and Personal Resources : A Moderated Mediation Model

Background. Client aggression is considered a growing stressor in several workplaces. This study aims to analyse how and why these experiences may trigger burnout. Focusing on healthcare workers, we tested a moderated mediation model of the relationship between exposure to patient verbal aggression and burnout with the goal of assessing the mediation effects of emotion work and the moderating effects of personal resources (i.e. perceived self-efficacy in communication with patients) and job resources (job control, role clarity, social support by colleagues and by supervisors) on this relationship. Methods A purposive sample of 356 nurses was recruited from four hospitals in northern Italy. A structured, self-report questionnaire was used to collect data. Mediated and moderated mediation regression models with PROCESS were used to test the hypotheses. Results: Emotion work mediates the relationship between patient verbal aggression and nurses\u2019 burnout. Role clarity and social support were found to reduce the harmful effects of emotion work triggered by patient aggression. The perceived self-efficacy in communication with patients does not have a buffering effect in the tested model. Conclusion. These results offer a novel approach to design preventive actions aimed at cultivating resources against the impact of perceived exposure to client aggression on well-being

Healthcare Co-production and the Indirect Government Paradigm: addressing the managerial challenges

This qualitative study focuses on the relevant organizational challenges of co-production for the public healthcare system at the micro-level, that of the providers: the hospitals, trust, local health communities, etc. To build this complex picture the authors use a framework developed in the field of policy studies. An analysis and discussion of the scientific literature on the implications of the co-production options highlights the implementation gaps and the as-yet unsolved organizational puzzles and how they are managed in actual practice. The study considers co-production as an indirect tool of government and maps a research agenda of the knowledge gaps and open issues in extant literature

Healthcare services and the co-production challenge : insights for engaging unwilling patterns

The need to reconcile effectiveness with shrinking budgets is pushing contemporary health services to develop co-production practices. But the patient is often an unwilling client and patient engagement with both their therapy and the relative organizational system remains largely unexplored. The article analyzes an Italian hospital\u2019s co-production initiative and uses the results to reflect on what key factors impact the efficacy and the efficiency of healthcare co-production. The empirical evidence indicates that a) the socio-organizational conditions of both the patients and the relevant actors must be taken into account to achieve the truly meaningful engagement of the patient, as opposed to merely symbolic acceptance in co-production practices, as opposed to just their symbolic acceptance; b) no divide exists between organizational production and client co-production, rather, it is a relationship of interdependence that in turn raises critical issues; and c) to take a significant step forward in our understanding of co-production and its managerial challenges we must perforce combine the use of public management studies and health psychology studie

Far fronte all’aggressività dei clienti in servizi in cambiamento: i Management Standards proteggono il benessere degli operatori?

Questo contributo analizza le relazioni tra aggressivit\ue0 dei clienti, risorse lavorative e benessere degli operatori in servizi pubblici che affrontano riconfigurazioni della loro missione. Basandosi sul modello Job Demands-Resources, lo studio ha esplorato: a) se il grado di esposizione percepita all'aggressivit\ue0 verbale influisse su esaurimento emotivo e soddisfazione al lavoro; b) se risorse del contesto lavorativo (controllo, chiarezza di ruolo, supporto dei colleghi, supporto dei superiori, modalit\ue0 di gestione del cambiamento) attenuassero gli esiti negativi; c) se tali risorse sostenessero maggiormente la soddisfazione lavorativa in condizioni di alta aggressivit\ue0. I dati, raccolti attraverso un questionario inviato a 279 lavoratori di biblioteche pubbliche italiane (154 rispondenti), sono stati analizzati mediante una serie di regressioni gerarchiche moderate. I risultati confermano che all\u2019aumentare dell\u2019aggressivit\ue0 dei clienti, percepita dagli operatori, cresce l\u2019esaurimento emotivo e decresce la soddisfazione lavorativa. Solo due risorse tra quelle considerate (modalit\ue0 di gestione del cambiamento organizzativo e supporto dei colleghi) hanno mostrato effetti protettivi sull\u2019esaurimento emotivo, mentre il legame tra risorse lavorative e soddisfazione lavorativa non \ue8 risultato modificarsi al variare dell\u2019intensit\ue0 di esposizione all\u2019aggressivit\ue0.This paper analyses the relations among perceived customers aggression, job resources and employees wellbeing in public services that are dealing with a changes in their mission towards customers. Based on the Job Demands \u2013 Resources model, the research explored a) if the level of exposure to verbal aggression by customers is related to employees\u2019 emotional exhaustion and job satisfaction; b) if a set of resources (control, clarity in role, support from colleagues and supervisors, change) contributes to buffering the negative impact of verbal aggression on burnout; c) if such resources are most beneficial in boosting job satisfaction under conditions of high aggressiveness. Data, gathered through a self-report questionnaire administered to 279 librarians in Italian public libraries (154 respondents), were analysed with a set of moderated hierarchical regression analyses. The results showed that increasing levels of perceived customer aggression are related to higher emotional exhaustion and lower job satisfactions. Only two of the organizational resources taken into consideration (change and support from colleagues) showed protective effects on emotional exhaustion, while the boosting effect was not confirmed