Knotless PEEK and double-loaded biodegradable suture anchors ensure comparable clinical outcomes in the arthroscopic treatment of traumatic anterior shoulder instability: a prospective randomized study

Purpose: To compare the clinical outcome of arthroscopic capsulolabral repair for traumatic anterior shoulder instability with PEEK knotless and knotted biodegradable suture anchors. Methods: Arthroscopic stabilization was performed in 78 patients with recurrent traumatic anterior shoulder instability. They were divided into 2 groups of 39 patients each, according to suture anchors used: knotless PEEK anchors in group 1, and biodegradable anchors in group 2. Exclusion criteria were: instability without dislocation, posterior or multidirectional instability, glenoid bone loss > 20%, off-track lesions, concomitant rotator cuff tears and previous surgery. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) self-administered questionnaire. Secondary outcomes were: Work-DASH, Sport-DASH, Rowe score, recurrent instability and subsequent surgery. The following independent variables were considered: age, gender, dominance, generalized ligamentous hyperlaxity, duration of symptoms, age at first dislocation, number of dislocations, type of work, type of sport, sports activity level, capsule-labral injury pattern, SLAP lesion and number of anchors. Differences between groups for numerical variables were analyzed by use of the Student’s t-test or Mann–Whitney U-test. Fisher’s exact test was used for analysis of categorical variables. Significance was set at p < 0.05. Results: Seven patients (9%) were lost at follow-up, 5 from group 1 and 2 from group 2. Follow-up ranged from 36 to 60 months (median: 44; IQR: 13). Comparison between groups did not show significant differences for each independent variable considered. No differences could be found either for DASH (n.s.) or Rowe (p = n.s.) scores between the two groups. Overall recurrence rate was 7%. Three re-dislocations were reported in group 1 and two in group 2 (n.s.). Only one patient in each group underwent re-operation. Conclusions: The study showed no significant differences in clinical outcomes after arthroscopic treatment of traumatic anterior shoulder instability using PEEK knotless or biodegradable knotted anchors at mid-term follow-up. Level of evidence: I

Electromechanical coupling of the Kv1.1 voltage-gated K+ channel is fine-tuned by the simplest amino acid residue in the S4-S5 linker

Investigating the Shaker-related K+ channel Kv1.1, the dysfunction of which is responsible for episodic ataxia 1 (EA1), at the functional and molecular level provides valuable understandings on normal channel dynamics, structural correlates underlying voltage-gating, and disease-causing mechanisms. Most studies focused on apparently functional amino acid residues composing voltage-gated K+ channels, neglecting the simplest ones. Glycine at position 311 of Kv1.1 is highly conserved both evolutionarily and within the Kv channel superfamily, is located in a region functionally relevant (the S4-S5 linker), and results in overt disease when mutated (p.G311D). By mutating the G311 residue to aspartate, we show here that the channel voltage-gating, activation, deactivation, inactivation, and window currents are markedly affected. In silico, modeling shows this glycine residue is strategically placed at one end of the linker helix which must be free to both bend and move past other portions of the protein during the channel’s opening and closing. This is befitting of a glycine residue as its small neutral side chain allows for movement unhindered by interaction with any other amino acid. Results presented reveal the crucial importance of a distinct glycine residue, within the S4-S5 linker, in the voltage-dependent electromechanical coupling that control channel gating

Unraveling the impact of upfront chemotherapy and proton beam therapy on treatment outcome and follow-up in central nervous system germ cell tumors: a single center experience

Background: Germ cell tumors (GCT) account for a minority of central nervous system (CNS) malignancies, highly prevalent in adolescents and young adults. Despite their aggressive biological behavior, prognosis is excellent in most cases with risk stratified treatment, consisting in a combination of chemotherapy and radiotherapy. Whole ventricular irradiation (WVI) and craniospinal irradiation, the treatment of choice for localized and metastatic disease, pose significant risk of collateral effects, therefore proton beam radiation (PBT) has been recently proposed for its steep dose fallout. Materials and methods: We report our experience in a consecutive series of 17 patients treated for CNS GCT at our Institution from 2015 to 2021. Results: Most frequent lesion location were sellar/suprasellar (35%) and bifocal germinoma (35%), followed by pineal (18%) and thalamic (12%). Two patients (12%), had evidence of disseminated disease at the time of diagnosis. At the latest follow-up all but one patient showed complete response to treatment. The only relapse was successfully rescued by additional chemotherapy and PBT. PBT was well tolerated in all cases. No visual, neurological or endocrinological worsening was documented during and after treatment. Neuropsychological evaluation demonstrated preservation of cognitive performance after PBT treatment. Conclusions: Our data, albeit preliminary, strongly support the favourable therapeutic profile of PBT for the treatment of CNS germ cell tumors

Smart cash point in a B2B market to enable service innovation: toward transparency and shared intentions. A case study.

Purpose – This work tries to detect the factors that can impact service innovation in the retail sector according to a service ecosystem (SES) perspective. This paper aims to understand whether it is possible to study innovation focusing on the impact of technology on resource integration practices in SESs and to rank different patterns of innovation by evaluating their effects in terms of value co-creation. Design/methodology/approach – To show up the perception of actors, a case study has been carried out through semi-structured interviews. The aggregates of practices and the service innovation archetypes, drawn from the theoretical background, have been used as categories of analysis. Findings – Service innovation is reconceptualised as the result of the application of new technology to resource integration practices in the retail SES, and it is possible to rank its patterns and outcomes by deepening its effects on the emergence of value co-creation phenomena. Shared intentions have been identified as drivers of service innovation, but greater transparency in systems used to embolden a higher willingness to use could be necessary. Originality/value – Service innovation has been studied by focusing on value co-creation; for this reason, the willingness to use technology emerged as a determinant of service innovation. This result implies the need for a multilevel reinterpretation of contemporary SES, both regarding the technical features of digital solutions and their adherence to users’ skills and the effects of willingness or unwillingness to use on value cocreation

CONDIZIONI DI VITALITÀ E DRIVER PER L’INNOVAZIONE NEL RETAIL

Il presente lavoro mira ad indagare una possibile interdipendenza tra il concetto di innovazione ed il concetto di vitalità, osservati nell’ambito del retail. Il lavoro è finalizzato all’identificazione di un potenziale legame funzionale tra i due concetti e per fare ciò risulta necessario il preventivo approfondimento teorico di entrambi

Transparency in AI Systems for Value Co-creation in Healthcare

This conceptual chapter aims to understand the role of artificial intelligence (AI) in value co-creation phenomena in a healthcare service ecosystem, through a literature review and the definition of a conceptual framework. AI, as an operant resource, can stimulate a completely patient-centered, adaptive and resilient healthcare system, and governance models in healthcare based on data-driven decision-making (DDDM), ensuring faster choices, more timely diagnosis and more personalized treatment paths. However, the full implementation of AI in healthcare is inhibited by some frictions, mainly related to the risk that the AI black box may generate an inadequate automatic decision, also due to the quality of data used, often partial and unstructured given the reluctance to share them by patients concerned by privacy threats. The co-design (multi-part and multi-level) of a predictive decision model based on the functional transparency of the AI algorithm would allow for augmented decision as result of an effective human–machine interaction. Healthcare actors could thus make decisions using the information detected by the software (based on clear cause-andeffect correlations and modifiable variables in case of mistakes), integrated with their professional knowledge. This would also help to strengthen the patient’s perception of the decision’s reliability and accuracy and the safety of the tool (factors that can affect his/her trust). AI may be considered as a driver for value co-creation in healthcare, thanks to transparency. It would allow the promotion of collaborative behaviors involving actors by generating new institutions and new resource integration practices among them

Smart small villages conceptualization based on the capabilities co- elevation for smart citizens

Smart Cities represent a new paradigm, a new smart and sustainable urban model that is empowered by increasingly sophisticated technologies applied in various sectors of city ecosystem to enable actors to co-create value. The main actors to be engaged in this transformation process are the citizens who in turn can represent multiple actors simultaneously within the urban environment and are actively involved in economic, social and political life. For this reason, this conceptual paper aims to point out the effective smart city patterns enabling factors. This topic can be very issued in small towns where there are numerous structural, cultural and demographical barriers that inhibit their use from every day-life to urban settings of an increasingly digitized Public Administration. After framing cities as smart service systems and given the issues regarding the citizens' predisposition and ability to use technologies, with effects in terms of value co-creation, smart citizens and capabilities co-elevation have been outlined as drivers. An illustrative case involving a smart tourism app (PayTourist) in a small town in Southern Italy (Castellabate) is proposed to outline the factors that influence the technology acceptance by citizens and the ways to foster a capabilities coelevation path. It would be appropriate for scholars and practitioners to adopt the service innovation roadmap to design and map the development of smart cities through the capabilities upskilling of actors involved

Le dinamiche relazionali e i processi decisionali nell’Agricoltura di precisione secondo la prospettiva degli eco-sistemi di servizio

In Italia, il settore agroalimentare è tra i principali protagonisti dell’export nazionale, anche grazie alla crescente attenzione e preferenza per i prodotti Made in Italy. Qui, come negli altri Paesi sviluppati, l’agricoltura sta subendo una forte trasformazione digitale. Un numero sempre più elevato di aziende, infatti, si occupa oggi di Agritech (serre idroponiche, orti personalizzati bio, agricoltura di precisione, utilizzo di droni, etc.) e di Agricoltura verticale, con aumenti significativi degli investimenti nei processi innovativi. In tale rinnovato scenario, l’utilizzo delle nuove tecnologie comporta un’evoluzione del ruolo stesso dell’agricoltore, che oggi è più affine alla figura di un manager chiamato ad assumere decisioni in grado di sviluppare soluzioni nuove ed innovative. Diventa inoltre necessario definire nuove relazioni tra gli attori operanti nel contesto o nuove modalità di interazione tra di essi, in grado di definire nuove “regole di gioco” e nuove possibilità di crescita per ciascuno. Il presente lavoro si propone di interpretare le più recenti innovazioni nel campo dell’agricoltura di precisione in Italia secondo la prospettiva della Service-Dominant logic, allo scopo di fornire nuovi strumenti d’indagine e di analisi delle dinamiche relazionali e dei processi decisionali degli Attori e desumere nuove riflessioni manageriali e di gestione d’impresa. Vengono pertanto suggeriti nuovi spunti interpretativi delle dinamiche relazionali che intercorrono tra gli attori operanti nell’ambito dell’agricoltura di precisione, attraverso la lente interpretativa fornita dagli studi sui service eco-system. Dal punto di vista metodologico infatti, le moderne tecniche colturali sono analizzate sulla base degli avanzamenti scientifici sui service eco-system. Allo scopo di verificare le riflessioni e le considerazioni derivate da tale prospettiva, viene presentato un case study progettuale, relativo ad una iniziativa di R&amp;S (“POMOVINO”) relativa allo sviluppo e test di nuove tecnologie di telerilevamento nell’agricoltura di precisione, recentemente co-finanziata con fondi europei a valere su un Avviso Pubblico nazionale e svolta in Regione Campania. L’originalità del lavoro risiede nella nuova prospettiva utilizzata per l’osservazione dell’ecosistema di servizio dell’agricoltura di precisione, volta ad indagare le modalità di interazione tra le parti, in ambito agricolo, e la possibilità che le nuove tecnologie adottate, attraverso un impatto sulla resourceness di ciascuno, ne possano riqualificare la capacità di essere attrattivi

Innovation and viability in the retail service ecosystem: nudges from DITRON’s history and evolution

Purpose – This work analyses the retail sector in a service ecosystem perspective. Its purpose is to empirically investigate how the adoption of a new technology can contribute to generate conditions of value co-creation (Storbacka et al., 2016) and to improve the efficiency and effectiveness of the system considered as a whole, through new shared logics and rules, institutions, used by actors to coordinate actions (Lusch, Nambisan, 2015) to survive. The concept of innovation has been considered as the starting point to analyse how actors react in order to adapt to changes in their context and re-define their value proposition (Vargo et al., 2008). Design/Methodology/approach – This study proposes a re-reading of retailing, complex context with many heterogeneous interrelated and interconnected actors, as a service ecosystem, with some suggestions by the VSA literature. It has been carried out through a case-study analysis. Findings – This work highlights how the exchange of resources between actors, and the value cocreated by them, can define new rules to shape the market. Specifically, both the new technology introduced and the innovation, depending by it and defined by market interactions, provide new institutions, guided by value co-creation processes (Vargo et al., 2015). According to this approach, the innovation is possible thanks to the re-configuration or the new generation, from a structural point of view, of relationships, resources and roles, as well as, from a dynamic point of view, to new forms of resources integration. These new forms of resources integration allow new value co-creation processes (Mele et al., 2010) that stimulate the emergence of institutions influencing the survival of each actor. Research implications – These results have practical managerial implications in terms of service and decision make processes. To provide a service new specific skills, developed and trained by each actor, are needed and decisions depend on new resources to integrate. Originality/value – In literature retailing has been studied not enough through the service ecosystem perspective. This work clarifies the interconnection between innovation and viability deepening on the concept of institutions. Thanks to these findings, we can match the Service Ecosystem literature with Viable Systems Approach, in fact institutions may be considered as tools to be resonant with the context and value co-creation as a driver for the viability