Pain and Frailty in Hospitalized Older Adults

Introduction: Pain and frailty are prevalent conditions in the older population. Many chronic diseases are likely involved in their origin, and both have a negative impact on quality of life. However, few studies have analysed their association. Methods: In light of this knowledge gap, 3577 acutely hospitalized patients 65 years or older enrolled in the REPOSI register, an Italian network of internal medicine and geriatric hospital wards, were assessed to calculate the frailty index (FI). The impact of pain and some of its characteristics on the degree of frailty was evaluated using an ordinal logistic regression model after adjusting for age and gender. Results: The prevalence of pain was 24.7%, and among patients with pain, 42.9% was regarded as chronic pain. Chronic pain was associated with severe frailty (OR = 1.69, 95% CI 1.38–2.07). Somatic pain (OR = 1.59, 95% CI 1.23–2.07) and widespread pain (OR = 1.60, 95% CI 0.93–2.78) were associated with frailty. Osteoarthritis was the most common cause of chronic pain, diagnosed in 157 patients (33.5%). Polymyalgia, rheumatoid arthritis and other musculoskeletal diseases causing chronic pain were associated with a lower degree of frailty than osteoarthritis (OR = 0.49, 95%CI 0.28–0.85). Conclusions: Chronic and somatic pain negatively affect the degree of frailty. The duration and type of pain, as well as the underlying diseases associated with chronic pain, should be evaluated to improve the hospital management of frail older people

The multifaceted spectrum of liver cirrhosis in older hospitalised patients: Analysis of the REPOSI registry

Background: Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. Objectives: To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. Methods: A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. Results: LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. Conclusions: LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features

Does natural language perform better than formal systems? Results from a fuzzy agent-based model

The objective of the paper is to present the use of the March model on exploration and exploitation in organisational learning (1991) as a virtual laboratory of organisational design. The virtual laboratory, named CLOD (Computational Laboratory of Organisational Design), will be devoted to exploring the behaviour of organisational learning and evaluation systems under different external and internal conditions. The contribution of the paper would be twofold: firstly, the cellular automata model of March is transposed in an agent-based environment and then extended to be used as a virtual lab supporting organisational design; secondly, a fuzzy version of the model is proposed in order to analyse, through generative experiments, the differences between crisp and fuzzy organisational learning approaches to environmental complexity

Responsible research and innovation in innovation value chains: focus on the catalytic role of non-governmental organizations

This study explores the role of NGOs in Innovation Value Chains (IVCs) and Responsible Research and Innovation (RRI). It investigates how NGOs' presence influences RRI adoption in ecosystems and whether their strong RRI focus enhances its diffusion. Agent-Based Modelling and Simulation are employed for analysis. Findings reveal that NGOs promote RRI when adopting intermediate RRI values for consortium evaluation, whereas strict criteria hinder RRI diffusion. Highly RRI-oriented NGOs foster knowledge dissemination and network diversity, despite limited IVC involvement. These insights offer guidance for Research Funding Organizations to promote RRI and assist Research Performing Organizations in managing dynamic innovative networks

The effectiveness of ambiguity in the management of complexity

This paper is aimed at exploring the role of natural language in organizational learning performances, particularly under conditions of high complexity of external environment. To address this issue, the stylized representation of organizational learning proposed in the seminal paper of March of 1991 “Exploration and exploitation in organizational learning” is used as a reference model to build up an agent-based computational laboratory. Through this lab simulative experiments have been settled and performed to verify in which environmental conditions a cognitive system capable of managing vague descriptions of reality is more effective than a formal system which instead provides precise descriptions. Experimental results show that in stable environments the language-based management of organizations does not offer significant advantages with respect to traditional approaches. In turbulent environments, instead, the benefits of natural language are related to the ability of the fuzzy organization to cope effectively with environmental complexity (modelled as turbulence) in the long run

The evolution of student entrepreneurship: State of the art and emerging research direction

In the knowledge society, universities are asked to contribute to regional development and economic growth through the direct exploitation of research products and, indirectly, through enhancing entrepreneurial awareness in students. Student entrepreneurship (SE) gained increasing relevance among scholars that suggest more research is needed and identify student entrepreneurship as an emerging and growing phenomenon. In this paper, we present the results of a systematization of the current literature to define the state of the art and identify possible new research directions, analyzing 288 published articles in the main International Entrepreneurship and Management Journals and the main journals in Education and Management Business Accounting subject area. The results are presented in two macro sections. The first one is related to the corpus overview and bibliometrics which explores articles by evolution on time, author, citation analysis, and journals. The second section will involve a content analysis that highlights the main issues that emerge from the analysis of the papers, such as the most frequently used theories, data gathering methodologies and methods and mechanisms adopted by universities to support and promote SE. We are confident that these topic areas will significantly help any researcher approaching the study of SE by offering an overview of the different sub-fields in this area. Our work offers suggestions to management educators and business schools administrators to identify new ways to support student entrepreneurs by enhancing their entrepreneurial activities, and institutional leader to rethink policies that encourage entrepreneurship among students

Technological innovation-enabling industry 4.0 paradigm: A systematic literature review

Technological innovation and the Industry 4.0 paradigm have gained increasing attention from both the scientific community and practitioners, with the two themes being considered topical research avenues of great interest. Adopting a systematic literature review approach, this paper aimed to provide an overview of the existing scientific literature that focuses on the interplay between these two aspects. The analysis carried out offers an in-depth overview of the selected sources and a bibliometric analysis that highlights various aspects of the evolution of the scientific literature and the identification of five clusters: theories; technologies; methodologies and countries; research areas and sectors; and current and future impacts, from which the scientific debate has developed. On the basis of the clusters that emerged, a content analysis was performed to highlight the focus of the literature in the field of technological innovation under the Industry 4.0 paradigm. The paper also offers a research agenda in order to identify unexplored and promising research paths that can be of inspiration for those who intend to address these issues in the future and in relation to Industry 5.0

Interorganizational collaboration in innovation networks: An agent based model for responsible research and innovation in additive manufacturing

The significant progress in scientific research and innovation has led to the need for a new paradigm to legitimise the innovation process in society and politics. The European Union, with the Horizon 2020 framework program and Horizon Europe, institutionalises this change by defining the concept of responsible research and innovation (RRI), aiming at greater inclusiveness and sustainability in the research and innovation processes. This paper aimed to present an agent-based model (ABM) to simulate the dynamics between the different actors that cooperate within networks during the innovation process, taking the inclinations toward RRI practices into account. The different types of agent, their characteristics, and the different strategies that they follow have been formulated within the Horizon 2020 project I AM RRI-Webs of Innovation Value Chains (IVCs) of Additive Manufacturing (AM) under consideration of RRI. Besides, some experiments are reported to validate the model, ensuring its rigor and making our model a useful tool for policymakers, assisting them in defining strategic guidelines for disseminating and encouraging RRI best practices and defining the critical factors of the innovative cooperative process

The ambiguity of natural language as resource for organizational design: A computational analysis

This paper intends to contribute, theoretically and methodologically, to the debate in organizational design's research on the need of new approaches and tools able to cope with the increasing complexity of the organizations and of the environments in which they operate. The article presents a set of simulative experiments carried out through an agent-based computational laboratory (Computational Laboratory of Organizational Design-CLOD), to explore the eventual benefits on organizational performances obtained through informal coordination mechanisms based on natural language. Main results of the research show that internal coordination mechanisms based on informal systems, like the natural language, allow organizations to achieve better performances under different external and internal conditions. Particularly, in turbulent environments the coordination through natural language provides the organizations with additional capabilities to adapt to changing external requirements

The ambiguity of natural language as resource for organizational design: A computational analysis

This paper intends to contribute, theoretically and methodologically, to the debate in organizational design's research on the need of new approaches and tools able to cope with the increasing complexity of the organizations and of the environments in which they operate. The article presents a set of simulative experiments carried out through an agent-based computational laboratory (Computational Laboratory of Organizational Design-CLOD), to explore the eventual benefits on organizational performances obtained through informal coordination mechanisms based on natural language. Main results of the research show that internal coordination mechanisms based on informal systems, like the natural language, allow organizations to achieve better performances under different external and internal conditions. Particularly, in turbulent environments the coordination through natural language provides the organizations with additional capabilities to adapt to changing external requirements