Subsidiaries within a High-Tech MNC. A reappraisal of the Role of Functions

The recent management literature on multinational corporations (MNCs) has mainly focused on the new role played by subsidiaries within the international firms. Many scholars have underlined that MNCs tend to organise themselves along a differentiated network approach, where subsidiaries play a very different role according to their internal resources and the significance of the local environment. This strategic and organisational model dates back to the pioneering work of Bartlett and Goshal, who called this new international strategy “Transnational” so as to differentiate it from the classical Multidomestic and Global strategies. Along with the different roles played by the subsidiaries, this model is characterised by the simultaneous existence of cooperation and competition within the multinational corporations. The present work focuses on the role of the Italian subsidiary of AgilentTechnologies, a multinational firm with around 36,000 employees that is active in more than 40 countries in high-tech sectors such as electronics, telecommunications and life science. The case study brought new light to the usual distinction that is commonly made with regard to the role of a subsidiary. When we try to apply the Transnational model to Agilent we realise that neither this model nor the traditional typologies (Multidomestic, Global) apply to the case we have studied. The role of the subsidiary changes significantly according to the function being considered. Therefore, we conclude that the role of function should be re-evaluated when the strategy and the structure of an MNC is defined. Not only does the classification of subsidiaries change according to the function in question, but the strategic posture and the organisational structure of MNCs should also be re-evaluated in light of the function under consideration. Our study shows how activities such as R&D, where coopetition represents a strategic source of advantage, seem to follow the Transnational scheme, while others such as sales are mainly globally managed

Rescue Therapies for H. pylori Infection in Italy

Curing Helicobacter pylori infection remains challenging for clinicians, as no proposed first-line therapy achieves bacterial eradication in all treated patients so that several patients need two or more consecutive treatments. Bacterial culture with antibiotics susceptibility testing is largely unachievable in Italy, and empiric second-line and rescue therapies are generally used. This study aimed to identify what eradication regimens perform better in Italy, following first-line therapy failure. Methods: We performed a literature search on PubMed for studies on standard therapy regimens used as second-line or rescue treatments performed in adult patients. Studies including modified drug combinations were not considered. Both intention-to-treat and perprotocol analyses were computed for each therapy subgroup. Results: Data from 35 studies with a total of 4830 patients were eventually considered. As a second-line therapy, Pylera® (90.6%) and a sequential regimen (89.8%) achieved eradication rates significantly higher than other therapies. For third-line therapy, a levofloxacin-based regimen and Pylera® achieved comparable eradication rates (88.2% vs. 84.7%; p = 0.2). Among therapies used as fourth (or more) attempts, Pylera® and a rifabutin-based therapy achieved 77.4% and 66.4% cure rates, respectively (p = 0.013). A therapy sequence based on the type of first-line therapy used was proposed. Conclusions: Data obtained through our review indicate that standard therapies for H. pylori eradication can be used when following an appropriate sequence, allowing clinicians to improve the cure rate without resorting to bacterial culture

Metformin therapy effects on the expression of sodium-glucose cotransporter 2, leptin, and sirt6 levels in pericoronary fat excised from pre-diabetic patients with acute myocardial infarction

Background and purpose: pericoronary fat over-inflammation might lead to the development and destabilization of coronary plaque in patients with pre-diabetes (PDM). Notably, pericoronary fat could over-express the sodium-glucose cotransporter 2 (SGLT2) and leptin, along with decreased sirtuin 6 (SIRT6) expression in PDM vs. normoglycemic (NG) patients undergoing coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI). However, in the current study, we evaluated inflammatory markers, SGLT2, SIRT6, and leptin levels in pericoronary fat and, subsequently, 12-month prognosis comparing PDM to NG subjected to CABG for AMI. In addition, we evaluated in PDM patients the effects of metformin therapy on SIRT6 expression, leptin, and SGLT2 levels, and assessed its beneficial effect on nitrotyrosine and inflammatory cytokine levels. Methods: we studied AMI patients referred for CABG, divided into PDM and NG-patients. PDM patients were divided into never-metformin users and metformin users. Finally, we evaluated major adverse cardiac events (MACE) at a 12-month follow-up. Results: the MACE was 9.1% in all PDM and 3% in NG patients (p < 0.05). Metformin users presented a significantly lower MACE rate in PDM than never-metformin users (p < 0.05). PDM showed higher inflammatory cytokines, 3-nitrotyrosine levels, SGLT2, and leptin content, and decreased SIRT6 protein levels in pericoronary fat compared to NG-patients (p < 0.05). PDM never-metformin-users showed higher SGLT2 and leptin levels in pericoronary fat than current-metformin-users (p < 0.05). Conclusions: metformin therapy might ameliorate cardiovascular outcomes by reducing inflammatory parameters, SGLT2, and leptin levels, and finally improving SIRT6 levels in AMI-PDM patients treated with CABG

Civiltà della Campania. Anno III, n. 4 (gennaio-marzo 1976)

A. III, n. 4 (gennaio-marzo 1976): Ricordo di Alfonso, P. 3 ; A. Gatto, Un sodalizio d’arte sotto lo stesso cielo, P. 4 ; R. Causa, Itinerari nell’arte catalana, P. 12 ; B. Gatta, Un altro inglese che ama Garibaldi, P. 18 ; A. Garzya, Napoli e Bisanzio, P. 26 ; S. Ferraretti, Il grande Archivio Napoletano, P. 32 ; B.G., L’Abate Galiani tra Napoli e Parigi, P. 34 ; M. Stefanile, Campania a tavola, P. 36 ; D. Rea, Pulcinella: il mistero di una maschera, P. 44 ; L. Compagnone, Il piccolo teatro di Raffaele Petra, P. 56 ; V. Ricciuti, Quando il cinema si chiamava Napoli, P. 58 ; R. Cantarella, C’era una volta una piccola città, P. 62 ; E. Mallardo, La cattedrale di Avellino, P. 66 ; V. Gramignazzi-Serrone, S. Guglielmo al Goleto, P. 70 ; F. de Ciuceis, I fasti del San Carlo, P. 78 ; L. Orsini, Faito una selva nel cielo, P. 82 ; S. Ferraro, Archeologia a Sorrento, P. 86 ; G. Blasi, Un parco negli Alburni, P. 88 ; D. Lanzara, Il convento di Ischia, P. 92 ; Notiziario, P. 93

Civiltà della Campania. Anno II, n. 2 (febbraio-marzo 1975)

A. II, n. 2 (febbraio-marzo 1975): M. Parrilli, All’Unesco Ravello e Castellabate, P. 3 ; L’anno santo in Campania, P. 7; B. Gatta, Videre Petrum, P. 8; B. Lucrezi, Gli itinerari sacri, P. 12 ; Il Duomo di Salerno: novecento anni di fede e storia », P. 24 ; R. Causa, Santuari nel Nocerino, P. 26 ; G. Giordano, Pacem in maribus, P. 32 ; R. Virtuoso, L’ambiente e il ruolo del turismo, P. 40 ; S. Pavia, I centri storici, P. 32 ; R. Di Stefano, Villa Campolieto, P. 48 ; R. De Simone, Feste popolari, P. 56 ; E. Corsi, II riassetto di Ischia, P. 60 ; C. Nazzaro, Rosmarino col pomodoro, P. 65 ; G. Doria, Il napoletano che cammina, P. 66 ; M. Stefanile, Raffaele Viviani, P. 68 ; A. Fratta, Amedeo Maiuri: una vita per l’archeologia, P. 80 ; E. Fiore, Gli Incontri del Cinema, P. 86 ; G. Blasi, Petrosino l’antipadrino, P. 90 ; I. Santoro, Il mistero di Velia di, P. 93 ; R. Senatore, La rinascita del Borgo Scacciaventi di, P. 97 ; P. Andria, Salerno: S. Pietro a Corte, P. 100 ; U. Abundo, Amalfi sempre di, P. 102 ; V. Gramignazzi Serrone, S. Agata dei Goti, P. 106 ; Attività congressuali in Campania, P. 108 ; Notiziario, P. 10

SARS-CoV-2 vaccination modelling for safe surgery to save lives : data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.Peer reviewe

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

L'Italia come modello per l'Europa e per il mondo nelle politiche sanitarie per il trattamento dell'epatite cronica da HCV

The World Health Organization foresees the elimination of HCV infection by 2030. In light of this and the curre nt, nearly worldwide, restriction in direct-acting agents (DAA) accessibility due to their high price, we aimed to evaluate the cost-effectiveness of two alternative DAA treatment policies: Policy 1 (universal): treat all patients, regardless of the fibrosis stage; Policy 2 (prioritized): treat only priori tized patients and delay treatment of the remaining patients until reaching stage F3. T he model was based on patient’s data from the PITER cohort. We demonstrated that extending HC V treatment of patients in any fibrosis stage improves health outcomes and is cost-effective

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries