first admissions for psychoses in eastern piedmont italy

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Custos de Agência e Escassez de Recursos: Influências no Franchising Brasileiro

This paper revisits a traditional issue in literature on franchising: the contractual mix (i.e., the proportion between franchised and company- owned stores). We analyze 270 Brazilian chains to better understand the Brazilian scenario. We stress the dynamics of this proportion over time considering the perspective of monitoring costs and the difficulty of access to resources as possible explanations. Considering the moment of the Brazilian economy, it is pertinent and opportune to investigate the behavior of the chains in times of turbulence. Panel data covering the 2011-2016 period was analyzed through econometric tools. The results corroborate aspects related to monitoring and incentives advocated by the agency theory, that is: costs of monitoring in elevation due to the geographic dispersion induce a greater proportion of franchised stores. In addition, the concept of dispersion is extended to capture socioeconomic aspects of the different regions occupied by the chains. Effects related to restriction to scarce resources are also noted, but in a less unambiguous way.Este artigo revisita uma tradicional questa?o na literatura em franchising: o mix contratual, ou seja, a proporc?a?o entre franquias e lojas pro?prias. Analisam-se 270 redes brasileiras para entender melhor o cena?rio nacional. Ressalta-se a dina?mica dessa proporc?a?o ao longo do tempo considerando como possi?veis explicac?o?es o problema dos custos de monitoramento e da dificuldade das redes em acessar recursos vitais para o sucesso da operac?a?o. Considerando o momento da economia brasileira, considera- se pertinente e oportuno investigar o comportamento das redes em tempos de turbule?ncia. Um painel de dados cobrindo o peri?odo 2011- 2016 foi analisado por meio de ferramentas econome?tricas. Os resultados corroboram aspectos relacionados a problemas de age?ncia, ou seja: custos de monitoramento em elevac?a?o devido a? dispersa?o geogra?fica induzem uma maior proporc?a?o de lojas franqueadas. Ale?m disso, o conceito de dispersa?o e? estendido para capturar aspectos socioecono?micos das diferentes regio?es ocupadas pelas cadeias. Efeitos relacionados a? restric?a?o a recursos escassos tambe?m sa?o notados, mas de maneira menos ambi?gua

Franchise Chains Governance in Emerging Markets: Studying the Presence of Multi-Unit Franchisees in Brazilian Chains

Na discussão em torno de governança de redes de franquias, a proporção de lojas próprias e franqueadas (mix contratual) é um tema recorrente. No caso do presente estudo, uma terceira possibilidade em termos deste mix é abordada: o franqueado multi-unidades (franqueados que operam duas ou mais unidades de uma mesma rede). A literatura no tema tem, de forma quase unânime, indicado benefícios decorrentes da presença de MUFs (multi-unit franchisees). O estudo desenvolve e testa um modelo teórico relacionando custos horizontais de agência e ativos intangíveis (locais de sistêmicos) à opção de franqueadores pelo uso mais intenso de franquias multi-unidades em comparação a franquias tradicionais (single-unit franchisees) ou lojas próprias. São aplicados procedimentos econométricos sobre uma amostra com 202 redes referente ao ano de 2018. Os resultados indicam que a concentração de lojas em mercados contíguos, a uniformidade e a importância da manutenção da proposta de valor da rede estão associadas a uma maior proporção de lojas MUF. Espera-se contribuir para a literatura de governança e controle de redes de franquias ao abordar um fenômeno que não é tão novo, mas ainda é muito pouco conhecido em termos de estruturação destas redes.The proportion of owned and franchised stores (contractual mix) is a recurring theme in the discussion around the governance of franchise chains. In the present study, a third possibility in terms of this contractual mix is ​​addressed: the multi-unit franchisee or MUF (franchisees that operate two or more units of the same network). The literature on the subject has, almost unanimously, indicated benefits arising from the presence of MUFs. Our study develops and tests a theoretical model relating horizontal agency costs and intangible assets (systems locations) to franchisors' option for more intensive use of multi-unit franchises in comparison to traditional franchises (single-unit franchisees or SUFs) or owned stores. Econometric procedures are applied to a sample of 202 chains for the year 2018. The results indicate that the concentration of stores in contiguous markets, uniformity issues, and the importance of maintaining the chain's value proposition are associated with a higher proportion of MUF stores. It is expected to contribute to the literature on governance and control of franchise chains by approaching a phenomenon that is not so new, but is still very little known in terms of structuring these networks

Evaluation of Two-Month Antibody Levels after Heterologous ChAdOx1-S/BNT162b2 Vaccination Compared to Homologous ChAdOx1-S or BNT162b2 Vaccination

none11noWe evaluated the post-vaccination humoral response of three real-world cohorts. Vaccinated subjects primed with ChAdOx1-S and boosted with BNT162b2 mRNA vaccine were compared to homologous dosing (BNT162b2/BNT162b2 and ChAdOx1-S/ChAdOx1-S). Serum samples were collected two months after vaccination from a total of 1248 subjects. The results showed that the heterologous vaccine schedule induced a significantly higher humoral response followed by homologous BNT162b2/BNT162b2 and ChAdOx1-S/ChAdOx1-S vaccines (p < 0.0001). Moreover, analyzing factors (i.e., vaccine schedule, sex, age, BMI, smoking, diabetes, cardiovascular diseases, respiratory tract diseases, COVID-19 diagnosis, vaccine side effects) influencing the IgG anti-S response, we found that only the type of vaccine affected the antibody titer (p < 0.0001). Only mild vaccine reactions resolved within few days (40% of subjects) and no severe side effects for either homologous groups or the heterologous group were reported. Our data support the use of heterologous vaccination as an effective and safe alternative to increase humoral immunity against COVID-19.openBarocci, Simone; Orlandi, Chiara; Diotallevi, Aurora; Buffi, Gloria; Ceccarelli, Marcello; Vandini, Daniela; Carlotti, Eugenio; Galluzzi, Luca; Rocchi, Marco Bruno Luigi; Magnani, Mauro; Casabianca, AnnaBarocci, Simone; Orlandi, Chiara; Diotallevi, Aurora; Buffi, Gloria; Ceccarelli, Marcello; Vandini, Daniela; Carlotti, Eugenio; Galluzzi, Luca; Rocchi, Marco Bruno Luigi; Magnani, Mauro; Casabianca, Ann

Abiotic Parameters and Pedogenesis as Controlling Factors for Soil C and N Cycling Along an Elevational Gradient in a Subalpine Larch Forest (NW Italy)

Mountain regions are vulnerable to climate change but information about the climate sensitivity of seasonally snow-covered, subalpine ecosystems is still lacking. We investigated the impact of climatic conditions and pedogenesis on the C and N cycling along an elevation gradient under a Larch forest in the northwest (NW) Italian Alps. The environmental gradient that occurs over short distances makes elevation a good proxy for understanding the response of forest soils and nutrient cycling to different climatic conditions. Subalpine forests are located in a sensitive elevation range&mdash;the prospected changes in winter precipitation (i.e., shift of snowfalls to higher altitude, reduction of snow cover duration, etc.) could determine strong effects on soil nitrogen and carbon cycling. The work was performed in the western Italian Alps (Long-Term Ecological Research- LTER site Mont Mars, Fontainemore, Aosta Valley Region). Three sites, characterized by similar bedrock lithology and predominance of Larix decidua Mill., were selected along an elevation gradient (1550&ndash;1900 m above sea level-a.s.l.). To investigate the effects on soil properties and soil solution C and N forms of changing abiotic factors (e.g., snow cover duration, number of soil freeze/thaw cycles, intensity and duration of soil freezing, etc.) along the elevation gradient, soil profiles were opened in each site and topsoils and soil solutions were periodically collected from 2015 to 2016. The results indicated that the coldest and highest soil (well-developed Podzol) showed the highest content of extractable C and N forms (N-NH4+, DON, DOC, Cmicr) compared to lower-elevation Cambisols. The soil solution C and N forms (except N-NO3&minus;) did not show significant differences among the sites. Independently from elevation, the duration of soil freezing, soil volumetric water content, and snow cover duration (in order of importance) were the main abiotic factors driving soil C and N forms, revealing how little changes in these parameters could considerably influence C and N cycling under this subalpine forest stand

Different Factors Affecting Human ANP Amyloid Aggregation and Their Implications in Congestive Heart Failure

Atrial Natriuretic Peptide (ANP)-containing amyloid is frequently found in the elderly heart. No data exist regarding ANP aggregation process and its link to pathologies. Our aims were: i) to experimentally prove the presumptive association of Congestive Heart Failure (CHF) and Isolated Atrial Amyloidosis (IAA); ii) to characterize ANP aggregation, thereby elucidating IAA implication in the CHF pathogenesis.A significant prevalence (85\%) of IAA was immunohistochemically proven ex vivo in biopsies from CHF patients. We investigated in vitro (using Congo Red, Thioflavin T, SDS-PAGE, transmission electron microscopy, infrared spectroscopy) ANP fibrillogenesis, starting from α-ANP as well as the ability of dimeric β-ANP to promote amyloid formation. Different conditions were adopted, including those reproducing β-ANP prevalence in CHF. Our results defined the uncommon rapidity of α-ANP self-assembly at acidic pH supporting the hypothesis that such aggregates constitute the onset of a fibrillization process subsequently proceeding at physiological pH. Interestingly, CHF-like conditions induced the production of the most stable and time-resistant ANP fibrils suggesting that CHF affected people may be prone to develop IAA.We established a link between IAA and CHF by ex vivo examination and assessed that β-ANP is, in vitro, the seed of ANP fibrils. Our results indicate that β-ANP plays a crucial role in ANP amyloid deposition under physiopathological CHF conditions. Overall, our findings indicate that early IAA-related ANP deposition may occur in CHF and suggest that these latter patients should be monitored for the development of cardiac amyloidosis

Cerium Oxide Nanoparticles Protect Cardiac Progenitor Cells from Oxidative Stress

Cardiac progenitor cells (CPCs) are a promising autologous source of cells for cardiac regenerative medicine. However, CPC culture in vitro requires the presence of microenvironmental conditions (a complex array of bioactive substance concentration, mechanostructural factors, and physicochemical factors) closely mimicking the natural cell surrounding in vivo, including the capability to uphold reactive oxygen species (ROS) within physiological levels in vitro. Cerium oxide nanoparticles (nanoceria) are redox-active and could represent a potent tool to control the oxidative stress in isolated CPCs. Here, we report that 24 h exposure to 5, 10, and 50 !g/mL of nanoceria did not a!ect cell growth and function in cardiac progenitor cells, while being able to protect CPCs from H2O2-induced cytotoxicity for at least 7 days, indicating that nanoceria in an e!ective antioxidant. Therefore, these "ndings con"rm the great potential of nanoceria for controlling ROS-induced cell damage

Off-label long acting injectable antipsychotics in real-world clinical practice: a cross-sectional analysis of prescriptive patterns from the STAR Network DEPOT study

Introduction Information on the off-label use of Long-Acting Injectable (LAI) antipsychotics in the real world is lacking. In this study, we aimed to identify the sociodemographic and clinical features of patients treated with on- vs off-label LAIs and predictors of off-label First- or Second-Generation Antipsychotic (FGA vs. SGA) LAI choice in everyday clinical practice. Method In a naturalistic national cohort of 449 patients who initiated LAI treatment in the STAR Network Depot Study, two groups were identified based on off- or on-label prescriptions. A multivariate logistic regression analysis was used to test several clinically relevant variables and identify those associated with the choice of FGA vs SGA prescription in the off-label group. Results SGA LAIs were more commonly prescribed in everyday practice, without significant differences in their on- and off-label use. Approximately 1 in 4 patients received an off-label prescription. In the off-label group, the most frequent diagnoses were bipolar disorder (67.5%) or any personality disorder (23.7%). FGA vs SGA LAI choice was significantly associated with BPRS thought disorder (OR = 1.22, CI95% 1.04 to 1.43, p = 0.015) and hostility/suspiciousness (OR = 0.83, CI95% 0.71 to 0.97, p = 0.017) dimensions. The likelihood of receiving an SGA LAI grew steadily with the increase of the BPRS thought disturbance score. Conversely, a preference towards prescribing an FGA was observed with higher scores at the BPRS hostility/suspiciousness subscale. Conclusion Our study is the first to identify predictors of FGA vs SGA choice in patients treated with off-label LAI antipsychotics. Demographic characteristics, i.e. age, sex, and substance/alcohol use co-morbidities did not appear to influence the choice towards FGAs or SGAs. Despite a lack of evidence, clinicians tend to favour FGA over SGA LAIs in bipolar or personality disorder patients with relevant hostility. Further research is needed to evaluate treatment adherence and clinical effectiveness of these prescriptive patterns

The Role of Attitudes Toward Medication and Treatment Adherence in the Clinical Response to LAIs: Findings From the STAR Network Depot Study

Background: Long-acting injectable (LAI) antipsychotics are efficacious in managing psychotic symptoms in people affected by severe mental disorders, such as schizophrenia and bipolar disorder. The present study aimed to investigate whether attitude toward treatment and treatment adherence represent predictors of symptoms changes over time. Methods: The STAR Network \u201cDepot Study\u201d was a naturalistic, multicenter, observational, prospective study that enrolled people initiating a LAI without restrictions on diagnosis, clinical severity or setting. Participants from 32 Italian centers were assessed at three time points: baseline, 6-month, and 12-month follow-up. Psychopathological symptoms, attitude toward medication and treatment adherence were measured using the Brief Psychiatric Rating Scale (BPRS), the Drug Attitude Inventory (DAI-10) and the Kemp's 7-point scale, respectively. Linear mixed-effects models were used to evaluate whether attitude toward medication and treatment adherence independently predicted symptoms changes over time. Analyses were conducted on the overall sample and then stratified according to the baseline severity (BPRS &lt; 41 or BPRS 65 41). Results: We included 461 participants of which 276 were males. The majority of participants had received a primary diagnosis of a schizophrenia spectrum disorder (71.80%) and initiated a treatment with a second-generation LAI (69.63%). BPRS, DAI-10, and Kemp's scale scores improved over time. Six linear regressions\u2014conducted considering the outcome and predictors at baseline, 6-month, and 12-month follow-up independently\u2014showed that both DAI-10 and Kemp's scale negatively associated with BPRS scores at the three considered time points. Linear mixed-effects models conducted on the overall sample did not show any significant association between attitude toward medication or treatment adherence and changes in psychiatric symptoms over time. However, after stratification according to baseline severity, we found that both DAI-10 and Kemp's scale negatively predicted changes in BPRS scores at 12-month follow-up regardless of baseline severity. The association at 6-month follow-up was confirmed only in the group with moderate or severe symptoms at baseline. Conclusion: Our findings corroborate the importance of improving the quality of relationship between clinicians and patients. Shared decision making and thorough discussions about benefits and side effects may improve the outcome in patients with severe mental disorders

Atrial fibrillation genetic risk differentiates cardioembolic stroke from other stroke subtypes

AbstractObjectiveWe sought to assess whether genetic risk factors for atrial fibrillation can explain cardioembolic stroke risk.MethodsWe evaluated genetic correlations between a prior genetic study of AF and AF in the presence of cardioembolic stroke using genome-wide genotypes from the Stroke Genetics Network (N = 3,190 AF cases, 3,000 cardioembolic stroke cases, and 28,026 referents). We tested whether a previously-validated AF polygenic risk score (PRS) associated with cardioembolic and other stroke subtypes after accounting for AF clinical risk factors.ResultsWe observed strong correlation between previously reported genetic risk for AF, AF in the presence of stroke, and cardioembolic stroke (Pearson’s r=0.77 and 0.76, respectively, across SNPs with p &lt; 4.4 × 10−4 in the prior AF meta-analysis). An AF PRS, adjusted for clinical AF risk factors, was associated with cardioembolic stroke (odds ratio (OR) per standard deviation (sd) = 1.40, p = 1.45×10−48), explaining ∼20% of the heritable component of cardioembolic stroke risk. The AF PRS was also associated with stroke of undetermined cause (OR per sd = 1.07, p = 0.004), but no other primary stroke subtypes (all p &gt; 0.1).ConclusionsGenetic risk for AF is associated with cardioembolic stroke, independent of clinical risk factors. Studies are warranted to determine whether AF genetic risk can serve as a biomarker for strokes caused by AF.</jats:sec