Successful scaling in social franchising: The case of Impact Hub

Social entrepreneurs increasingly use franchising to scale social value. Tracey and Jarvis (2007) described how social franchising is similar to commercial franchising, but also noted critical challenges arising from dual social and commercial goals. We investigate a social franchisor that overcame these challenges and describe how the social mission became the source of innovation for its business model. We show that the social mission fostered a shared identity that motivated and guided the search for adaptations to the franchise model. In particular, the shared mission-driven identity created pressure toward (1) decentralized decision-making, (2) shared governance, and (3) a new role for the franchisor as orchestrator of collaborative knowledge sharing among franchisees. Findings should help social franchisors avoid common pitfalls and suggest future research questions for social entrepreneurship and franchising scholars

A simple phenotypic method for screening of MCR-1-mediated colistin resistance

Objectives: To evaluate a novel method, the colistin-MAC test, for phenotypic screening of acquired colistin resistance mediated by transferable mcr-1 resistance determinants, based on colistin MIC reduction in the presence of dipicolinic acid (DPA). Methods: The colistin-MAC test consists in a broth microdilution method, in which colistin MIC is tested in the absence or presence of DPA (900 \u3bcg/mL). Overall, 74 colistin-resistant strains of Enterobacteriaceae (65 Escherichia coli and nine other species), including 61 strains carrying mcr-1-like genes and 13 strains negative for mcr genes, were evaluated with the colistin-MAC test. The presence of mcr-1-like and mcr-2-like genes was assessed by real-time PCR and end-point PCR. For 20 strains, whole-genome sequencing data were also available. Results: A 658-fold reduction of colistin MIC in the presence of DPA was observed with 59 mcr-1-positive strains, including 53 E. coli of clinical origin, three E. coli transconjugants carrying MCR-1-encoding plasmids, one Enterobacter cloacae complex and two Citrobacter spp. Colistin MICs were unchanged, increased or at most reduced by twofold with the 13 mcr-negative colistin-resistant strains (nine E. coli and four Klebsiella pneumoniae), but also with two mcr-1-like-positive K. pneumoniae strains. Conclusions: The colistin-MAC test could be a simple phenotypic test for presumptive identification of mcr-1-positive strains among isolates of colistin-resistant E. coli, based on a 658-fold reduction of colistin MIC in the presence of DPA. Evaluation of the test with a larger number of strains, species and mcr-type resistance determinants would be of interest

Effect of Tofacitinib on One-Year Colectomy Risk in Anti-TNF Refractory Ulcerative Colitis: A Prospective Multicenter Italian Study

Background: Tofacitinib is an oral Janus kinase inhibitor recently approved to induce and maintain remission in ulcerative colitis (UC). Aims: Considering the number of anti-TNF non-responders, this study aims to assess the effectiveness and safety of tofacitinib in a cohort of multi-failure patients with moderate-to-severe UC at 52 weeks. Methods: From January 2021 to March 2023, we performed a prospective multicenter study observing adult patients with moderate-to-severe UC starting tofacitinib after an anti-TNF failure for a 52-week-long period. Effectiveness and safety were assessed in terms of colectomy rate, clinical remission and response, endoscopic remission, steroid-free clinical remission, and rate of adverse events. Results: We included 58 patients with UC with an age of 42 ± 14.4 years, 59% males, 96.6% left-sided or pancolitis, who were failure to a single (65.5%) or more than one anti-TNF (34.5%). Only 6 (10.3%) patients underwent colectomy. Colectomy was clinically associated with the necessity and the number of extra cycles of tofacitinib 10 mg bid at W8 (p = 0.023) and W24 (p = 0.004), and with a higher partial Mayo score at W8 (p = 0.025). At W52, clinical remission, clinical response, and steroid-free clinical remission were 53.4%, 43.1%, and 48.3%, respectively. Of 22 performed colonoscopies at W52, 11 (50%) showed endoscopic remission. Adverse events occurred in 14 (24.1%) patients, but only 2 (3.4%) led to tofacitinib discontinuation. Conclusions: In a real-life setting of patients with anti-TNF refractory UC, tofacitinib has proved to be effective in preventing colectomy and inducing clinical and endoscopic remission at 52 weeks with a good safety profile

Validation of a new optical diagnosis training module to improve dysplasia characterization in inflammatory bowel disease:a multicenter international study

Background and aims Inflammatory bowel disease (IBD) increases risk of dysplasia and colorectal cancer. Advanced endoscopic techniques allow for the detection and characterization of IBD dysplastic lesions, but specialized training is not widely available. We aim to develop and validate an online training platform to improve the detection and characterization of colonic lesions in IBD: OPTIC-IBD. Methods We designed a web-based learning module that includes surveillance principles, optical diagnostic methods, approach to characterization, classifications of colonic lesions, utilizing still images and videos. We invited gastroenterologists from Canada, Italy, and the UK, with a wide range of experience. Participants reviewed 24 educational videos of IBD colonic lesions, predicted histology, and rated their confidence. The primary endpoint was to improve accuracy in detecting dysplastic lesions following training on the platform. Furthermore, participants were randomized 1:1 to get additional training or not, with a final assessment occurring after 60 days. Diagnostic performance for dysplasia and rater confidence were measured. Results One hundred seventeen participants completed the study and were assessed for the primary endpoint. Diagnostic accuracy improved from 70.8% to 75.0% (p 0.002) following training, with the greatest improvements seen in less experienced endoscopists. Improvements in both accuracy and confidence were sustained after 2 months of assessment, although the group randomized to receive additional training did not improve further. Similarly, participants’ confidence in characterizing lesions significantly improved between pre- and post-course (

Mycosis fungoides with mixed cryoglobulinemia and pulmonary vasculitis. A case report

A 54 year old patient suffering from mycosis fungoides developed an immune complex disease with mixed cryoglobulinemia (type III) and pulmonary vasculitis, an association so far unreported. We believe that the pathogenesis could be ascribed to a T-cell imbalance (increase in OKT4+ cells with inversion of the OKT4/OKT8 ratio) and to a functional T-cell defect, as suggested by the reduced mitogenic responses to PHA and ConA we observed

Chemical composition of Chilean bottled waters: Anomalous values and possible effects on human health

The Chilean bottled water market has experienced continuous growth since 2000, surpassing 500 million liters sold in 2015. Generally, consumers tend to associate the consumption of bottled water with a healthy lifestyle, but current Chilean law does not require the product to be labelled with the chemical composition, thus preventing consumers from making informed choices. Our study focuses on determining the water quality of ten brands of bottled water available for sale in Santiago, Chile. All of the analyzed water was not carbonated and in plastic containers in the 1.5 L size when available and the closest size to this when not available. Thirty-two chemical elements were analyzed, including minor and trace elements, and the data have been evaluated with respect to the limits established by Chilean and international regulatory agencies. Our results indicate that the quality of the analyzed water generally complies with Chilean law for bottled water. However, 30% of the analyzed samples exceed the values of arsenic (As) permitted by Chilean drinking water regulations, the World Health Organization and the United States Environmental Protection Agency. In 40% of the samples, the NO3 content is higher than groundwater values suggesting that the source of the bottled water is superficial. The purified bottled water brands contain minimal amounts of dissolved elements but do not comply with all of the parameters (e.g., pH) established by Chilean drinking water regulations. Our study highlights that there is an inconsistency between the Chilean norms that regulate bottled water and those that regulate drinking water. Some of the analyzed bottled waters do not comply with the drinking water regulations and paradoxically these brands should not be consumed by humans. However, risk assessment calculations for As ingestion show that the consumption of 1 L/day of bottled water does not pose a risk for human health

Chronic Epstein-Barr virus infection

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