Antitrust policy and price collusion : public agencies vs delegation

This paper investigates the effectiveness of antitrust policy in fighting horizontal collusion under different regimes of policy implementation. We consider two regimes : a public agency regime, where an antitrust authority is in charge of competition policy, and a "delegation" regime, where the policy is chosen by consumers. In both regimes the policy is implemented under discretion. The analysis shows that delegation dominates, both in case of complete and imperfect information about production costs, the public agency regime because consumers credibly start off an higher level of investigation activity than the public agency. This resuit implies that the public agency will fight the cases involving "relevant" anti-competitive activities, while consumers will act also against "minor" violations. The combination of the two regimes yields an higher welfare than having only a public agency in charge of competition policy, because consumers can partially relax the agency's limited resources constraint.Antitrust policy, Horizontal collusion, Delegation, Policy regimes

A Methodological Approach to Evaluate Seismic Vulnerability of Masonry Cathedrals

The seismic analysis of historical and monumental masonry buildings, especially churches and cathedrals, is challenging and expensive. These difficulties are mainly related to complex geometry and the mechanical modelling of historic masonry structures. This paper aims to show the methodological approach to evaluate the seismic vulnerability of Masonry Cathedrals by modelling seismic analysis. The numerical finite element model, modelled with solid elements, was optimised based on identifying the primary dynamic properties performed in ambient and seismic excitations recorded by a continuous dynamic monitoring system in operation since 2015. We carried out linear dynamic analyses for the optimised model of the entire structure. We also carried out non-linear dynamic analyses for the vaults, where damage concentrations were detected after various seismic events. The linear dynamic analysis of the optimised entire structural model aimed to estimate the time histories of acceleration at the connection areas between the vaults to the vertical structures. The numerical analysis results were consistent with the damage maps identified for the actual structure. Furthermore, the numerical model and the analysis procedure showed an excellent ability to reproduce the accurate structural response

BRCA in Gastrointestinal Cancers: Current Treatments and Future Perspectives

: A strong association between pancreatic cancer and BRCA1 and BRCA2 mutations is documented. Based on promising results of breast and ovarian cancers, several clinical trials with poly (ADP-ribose) polymerase inhibitors (PARPi) are ongoing for gastrointestinal (GI) malignancies, especially for pancreatic cancer. Indeed, the POLO trial results provide promising and awaited changes for the pancreatic cancer therapeutic landscape. Contrariwise, for other gastrointestinal tumors, the rationale is currently only alleged. The role of BRCA mutation in gastrointestinal cancers is the subject of this review. In particular, we aim to provide the latest updates about novel therapeutic strategies that, exploiting DNA repair defects, promise to shape the future therapeutic scenario of GI cancers

Effectiveness of 1-year treatment with long-acting formulation of aripiprazole, haloperidol, or paliperidone in patients with schizophrenia: retrospective study in a real-world clinical setting

Background: Schizophrenia is a chronic mental illness that requires lifelong antipsychotic treatment. Therapy discontinuation, often due to poor adherence, increases the risk of relapses after both first and subsequent psychotic episodes. Long-acting injectable (LAI) antipsychotic drugs (APDs) have been introduced to increase therapeutic adherence, reducing blood-level variability compared to corresponding oral preparations. Purpose: To compare the effectiveness of three LAI-APDs: aripiprazole (Apr) prolonged release once monthly (OM) haloperidol decanoate (Hal-D) and paliperidone palmitate (PP-OM). Methods: We retrospectively collected data for all patients with schizophrenia or other psychoses (n=217) treated with the three LAI-APDs for the first time from January 1, 2012 to October 31, 2016: n=48 with Apr-OM, n=55 with Hal-D, and n=114 with PP-OM. After 6 and 12 months of LAI treatments, we assessed clinical and functioning improvement, urgent consultations, psychiatric hospitalizations, adverse effects, and dropout. We compared urgent consultations and psychiatric hospitalizations required by the same patient 6 and 12 months before and after LAI implementation. Data were statistically analyzed. Results: The three LAI groups differed significantly only for “need for economic support from social service” (more frequent in the Hal-D group) and “schizoaffective disorder” (prevalent in the Apr-OM group). Apr-OM was prescribed at the maximum dose required by the official guidelines, whereas the other two LAIs were prescribed at lower doses. After 6 and 12 months’ treatment with the three LAI-APDs, we registered similar and significant reductions in both urgent consultations and psychiatric hospitalizations (P,0.001) and overlapping clinical and functioning improvement-scale scores (P,0.001), and 14.28% of patients dropped out, with no difference among the three LAI-APDs. Different kinds of adverse effects, though similar for number and severity, were reported in the three LAI groups. Conclusion: Our results suggest that both first- and second-generation LAI-APDs represent important therapeutic options, useful for improving schizophrenia’s clinical course and its economic burden. Our study, which offers a wide and comprehensive observation of real-world clinical settings, combined an effectiveness evaluation through mirror analysis performed for each individual patient to a subsequent comparison among the three LAI-APDs, allowing us a more complete evaluation of clinical efficacy

Comparison between Areas of Bone Visualization Using Radiolucent Hybrid Fixator Frames and Graphically Simulated Metallic Frames: An Ex Vivo Study

The objective of this study is to evaluate the difference between the amount of bone visible with the superimposition of a radiolucent hybrid external fixator and a graphically simulated metallic frame. Eighteen frames were applied to eighteen bone specimens. The fracture area (FA), the radiolucent area (RLA) and the radiopaque area (ROA) inside the FA were calculated for each construct on both postoperative views. The ratio between the RLA and FA and between the ROA and FA was used to evaluate the amount of bone visible in the FA with a radiolucent and a radiopaque fixator, respectively. Finally, the areas of RLA and ROA were compared using the Wilcoxon test and Friedman test to evaluate the effect of the radiolucent material on the amount of bone visible. Differences were considered significant if p < 0.5. In every specimen p was <0.5. The amount of bone visible was significantly higher with the radiolucent frame compared to the radiopaque frame. Based on the results of this study, the use of radiolucent materials can be a valuable option for external fixation, in order to decrease the radiographic interference of the frame, allowing better assessment of fracture reduction and bone healing on postoperative radiographs

Attitude towards drug therapy in a Community Mental Health Center evaluated by the Drug Attitude Inventory

Introduction: Negative attitude towards drug therapy can foster limited adherence to treatment, which remains one of the biggest obstacles for implementing effective treatments, especially long term. Purposes: The purposes of the study were 1) to evaluate the attitude towards drug therapy among a representative sample of patients treated in a community psychiatric service using 30-item Drug Attitude Inventory (DAI-30); 2) to evaluate the DAI-30 dimensions, applying factorial analysis; and 3) to highlight the socio-demographic and clinical variables correlated to DAI-30 score and factors. Methods: The DAI was administered, over a 7-month period, to all patients treated in our psychiatric outpatient services who agreed to participate in this study and provided their informed consent. Data were statistically analyzed. Results: With a response rate of 63.3%, 164 females and 136 males completed the DAI-30 with an average score of 14.24 (±10.46 SD), indicating moderately positive attitude towards drug therapy. The analysis of DAI-30 internal consistency confirmed its reliability (Cronbach’s alpha=0.84). Our factorial analysis highlighted three factors: Factor 1 (Cronbach’s alpha=0.81), composed of 7 items which indicate positive, trustful attitude; Factor 2 (Cronbach’s alpha=0.78), composed of 5 items indicating negative attitude of suspiciousness; and Factor 3 (Cronbach’s alpha=0.66), composed of 4 items suggesting defensive and control attitude towards drug therapy. Discussion: Among the selected variables, “monotherapy” and “total number of hospitalizations” were negatively correlated to the final score of DAI-30, whereas being “married” was positively correlated to it, in a statistically significant way, using the multiple linear regression model. These correlations suggest that positive attitude towards drug therapy could be reinforced by the condition of being married and reduced by relapses with hospitalization, as literature highlighted, and, paradoxically, by a monotherapy, which could suggest a sort of psychological dependence on therapy and, indirectly, on psychiatric service, potentially correlated to the long-term treatments of our patients

Sulfur content in foods consumed in an Italian population and impact of diet quality on sulfur intake

Sulfur is an essential nutrient but data about its intake are scarce. We aimed to measure sulfur content in food samples and assess its habitual intake in relation to adherence to healthy dietary patterns in 719 Italian adults. Using a food frequency questionnaire, we estimated overall sulfur intake, and its relation with adherence to healthy dietary patterns. The highest sulfur content was found in preserved/canned fish (3.0 g/kg), seafood (2.8 g/kg), white meat (2.8 g/kg) and dairy products, particularly aged cheeses (2.1 g/kg) and lowest in fresh fruit (87 mg/kg), oils and fats (157 mg/kg), and beverages (141 mg/kg), with the exception of onion and garlic (1.3 g/kg). The mean sulfur intake in the study population was 1.1 g/day, slightly higher in men than women. The foods contributing most to sulfur intake were meat (29%) and cereals (19%), with also substantial contribution (&gt;10%) from beverages and dairy products. Adherence to dietary patterns had little influence on sulfur intake, except for adherence to MIND diet positively and linearly associated with sulfur intake. Our study provides an updated overview of sulfur content in foods composing the Italian diet, as well as of sulfur intake in an Italian community of Northern Italy

ADHD Follow-Up in Adulthood among Subjects Treated for the Disorder in a Child and Adolescent Mental Health Service from 1995 to 2015

Background and Objectives: ADHD is a neurodevelopmental disorder characterized by inattention and hyperactivity/impulsivity and can persist in adulthood. The aim of this study is to deepen knowledge about adult ADHD follow-up. Materials and Methods: This observational study consists of one retrospective part aimed at collecting records of children and adolescents treated for ADHD in the Children and Adolescent Mental Health Service (CAMHS) from 1995 to 2015 and, successively, at identifying their adult follow-up in Adult Mental Health Service (AMHS); the second part consists of ADHD scale administration, Diagnostic Interview for ADHD in Adults (DIVA 2-0) and Adult Self Rating Scale (ASRSv1.1), for the subjects currently being treated at AMHS who agreed to participate in the study. Results: We observed that among the 55 patients treated at CAMHS between 1995 and 2015 for ADHD and subsequently at the AMHS, none presented a diagnosis of ADHD; instead, they were treated for Intellectual Dysfunction (33%), Borderline Personality Disorder (15%) and Anxiety Disorders (9%), and two individuals were also diagnosed with comorbid substance/alcohol abuse (4%). Of the 55 patients, only 25 (45%) were treated at AMHS during the study period. Though we asked for their informed consent to administer the questionnaires, we were able to test only seven patients. The ASRS-V1.1 score showed that 43% of patients reported symptoms of ADHD persistence in adulthood. For DIVA 2.0, 57% of individuals reported scores indicating the persistence of the ADHD inattention component, and 43% the persistence of both ADHD dimensions. Conclusions: ADHD cannot be considered a disorder confined to childhood/adolescence but instead is a chronic and complex condition that can persist into adulthood. The very small size of our final sample may account for both the high ADHD dropout rate over the long follow-up period and the difficult transition from child to adult health care in ADHD treatment. Our investigation suggests the need for specific training in the diagnosis and treatment of adult ADHD and the implementation of transition protocols between minor and adult services to improve long-term treatments