The Impact of Exogenous Shocks on Business Models and Business Relationships: An Empirical Analysis of the Italian Music Industry

Purpose: Scholars have been increasingly interested in understanding business models. However, little attention has been paid to how business models change in reaction to exogenous circumstances and how business relationships alter be-cause of business model changes. This paper investigates how the business model paradigm of the Italian music industry altered in response to two major exogenous influences that impacted the sector: the digital revolution and the COVID-19 pandemic. Design/methodology/approach: As the purpose of this study is to investigate phenomena in a real-world setting, qualitative research methodology has been selected as the most appropriate one. It was decided to conduct sixteen semi-structured interviews with professionals active in the Italian music business, selected through a combination of snowball and convenience sampling. Findings: The empirical findings indicate that the digital revolution and COVID-19 pushed Italian music companies to revise their business models by either reducing or adding the number of linkages to the existing ones. This was done in order for the companies to remain competitive in an environment that is constantly changing and to outcompete rivals. Originality/value: Few studies have evaluated how business relationships alter in response to the many business models emerging in the music industry due to external causes. This research is one of the first to examine music companies’ reactions to exogenous events such as crises or disruptive advances that affect the competitive landscap

Local and transboundary transmission of methicillin-resistant Staphylococcus aureus sequence type 398 through pig trading

Livestock-associated methicillin-resistant Staphylococcus aureus sequence type (ST) 398 (LA-MRSA ST398) is a genetic lineage for which pigs are regarded as the main reservoir. An increasing prevalence of LA-MRSA ST398 has been reported in areas with high livestock density throughout Europe. In this study, we have investigated the drivers contributing to the introduction and spread of LA-MRSA ST398 along the pig farming system in Southern Italy. Whole-genome sequencing (WGS) of LA-MRSA ST398 isolates collected in 2018 from pigs (n=53) and employees (n=14) from 10 farms in the Calabria region were comparatively analysed with previously published WGS data from Italian ST398 isolates (n=45), an international ST398 reference collection (n=89) and isolates from Danish pigs farms (n=283), which are the main suppliers of pigs imported to Italy. Single-nucleotide polymorphisms (SNP) were used to infer isolates relatedness and, together with data from animal trading, factors contributing to LA-MRSA ST398 dissemination were identified. The analyses support the existence of two concurrent pathways for the spread of LA-MRSA ST398 in Southern Italy: i) multiple introductions of LA-MRSA ST398 through the import of colonized pigs from other European countries including Denmark and France and; ii) the spread of distinct clones dependent on local trading of pigs between farms. Phylogenetically related Italian and Danish LA-MRSA ST398 isolates shared extensive similarities including carriage of antimicrobial resistance genes. Our findings highlight the potential risk of transboundary transmission of antimicrobial-resistant bacterial clones with a high zoonotic potential when importing pigs from countries with high LA-MRSA prevalence

Burden of disease, healthcare pathways and costs of cardiovascular high-risk patients with type 2 diabetes: a real world analysis:

Objective: To estimate the burden of disease and to describe healthcare pathways and costs of type-2diabetes (DMT2) patients at high cardiovascular risk (HRCV). Methods: A real-world analysis was performed by using a subset of the AR-CO database, containing administrative health data of >4.3 million of inhabitants. A cohort of adult patients with DMT2 and HRCV was selected in 2013, and followed for 1 year. Through this period, information on antidiabetic and cardiovascular therapies, other co-treatments, hospitalisations, and outpatient services, was collected and analysed. The costs associated with each variable were assessed to estimate the integrated health care expenditure. Results: Overall, 7,167 patients with DMT2 and HRCV were identified, corresponding to 3.1% of all diabetic patients and 0.2% of adult population. During the 1-year follow-up, 90.1% of the cohort received at least a prescription of an antidiabetic drug, 98.0% of a cardiovascular medication and 95.9% used at least an outpatient service. 44.5% had an admission during the follow-up period, especially for cardiovascular events. The integrated cost analysis showed that the overall average cost for each subject was € 13,567. Hospitalisations generated 86.8% of this expenditure, followed by drugs (7.7%) and by outpatient services (5.5%). Conclusions: Although patients with DMT2 and HRCV represent a small percentage of the overall population with diabetes, they generate very high costs for National Healthcare System. These costs are mainly due to the hospitalisations, especially for cardiovascular events. New therapeutic strategies involving these patients should allow reduction of hospital admission, resulting in savings for National Healthcare System

The relationship between intracellular calcium and contraction in calcium-overloaded ferret papillary muscles.

The photoprotein aequorin was microinjected into cells on the surface of ferret papillary muscles. Tension and aequorin light, a function of intracellular Ca concentration ([Ca2+]i), were monitored. The preparations were exposed to increased concentrations of extracellular Ca ([Ca2+]o). Small increases in [Ca2+]o led to the usual increase in both the systolic light signal and the developed tension. However, high [Ca2+]o led to a fall in developed tension known as Ca overload. This fall of tension was seen at lower [Ca2+]o if the experiment was performed in the presence of strophanthidin. In conditions of Ca overload, the systolic light signal was either similar in amplitude or larger than the systolic light observed under conditions which did not lead to Ca overload. Oscillations of diastolic light were invariably present under conditions of Ca overload. These oscillations were accompanied by after-contractions which were small in relation to the magnitude of the aequorin light oscillations. During Ca overload, the variance of the amplitude of the systolic light signal was greater than could be accounted for by the random nature of the arrival of photons. Small systolic light signals occurred when there had been an oscillation of light in the diastolic period immediately preceding the systolic light signal. Large systolic light signals occurred when the preceding period (approximately 1 s) was free of oscillations of light. These observations suggest that if the sarcoplasmic reticulum (s.r.) has spontaneously released its contents of Ca as shown by a diastolic [Ca2+]i oscillation, then a stimulated systolic Ca signal occurring within about the next second is smaller, possibly because it takes longer than this period for the s.r. to reload with Ca. If this process occurs randomly in the various cells of the preparation, developed tension will be reduced because those cells which have a small Ca release will act as a compliance in series with cells which have a large Ca release

The presence of crystals of sodium polystyrene sulfonate in the colonic wall: innocent bystander or pathogenic factor?

Hyperkalemia is a frequent electrolyte disturbance in patients on dialysis or non-dialysis CKD patients, including those using renin-angiotensin system inhibitor drugs. Sodium polystyrene sulfonate (SPS; Kayexalate) is a resin widely used for hyperkalemia treatment. Unfortunately, its use entails some serious unwanted gastrointestinal side effects. We report the case of a 64-year-old male diabetic patient, suffering from ESRD on hemodialysis, who was treated with 30 g of Kayexalate twice a week (long interdialytic interval). This is a quite common case in the clinical practice. The patient experienced an episode of rectal bleeding followed by the diagnosis of non-specific colitis through colonoscopy. Histological examination, showed the presence of crystals of Kayexalate in the colonic mucosa leading to the suspect of iatrogenic intestinal damage caused by Kayexalate administration. Treatment with SPS was stopped. Nevertheless crystals remain evident in the intestinal mucosa in a colonoscopy performed 14 months later due to a new episode of rectal bleeding. Two years after the first episode the patient died because of intestinal infarction. The review of the literature highlights the risk of serious side effects such as necrotizing colitis with perforation both for the drug in sodium phase and in calcium phase. New intestinal potassium-binger agents, apparently without intestinal severe side effects, are under clinical evaluation. This case does not assess if the crystals deposited in the colonic mucosa are inert or have contributed to the final event, but it shows that Kayexalate is a drug with potential harmful effect even when used orally, at very low dosage and without sorbitol. In our opinion, the SPS should be prescribed carefully, especially as chronic administration, and the prescription should be limited to real and pressing requirements

Hypophyseal pathology in AIDS

One hundred and eleven pituitary glands of patients (93 males, 18 females; mean age 32 years, 5 months) who died of fully developed AIDS or ARC were examined under light microscopy with the aid of immunohistochemistry. On post mortem (p.m.) examination a wide series of multiorgan alterations was noticed. Microscopically vanous lesions in both adeno- and neurohypophysis were seen. These ranged from vessel damage to secondaries to systemic infections, neoplasms and functional derangements. Necrotic lumps due to recent infarction could appear in both parts of the gland, while old fibrous scars sustained a previously overcome necrosis. Different pathogens (mainly fungi) could be seen either within the gland or arising from its meningeal surroundings. Examples of tumour pathology were provided by microadenomas, gliosis/gliomas; the frequency of adenomas (11.7%) was similar to that typical of senility. The functional impairment was mainly connected with ACTH cell hyperplasia, which seems in keeping with corticoadrenal or ACTH-receptor damage