The Strategic Role of Sales Management for Market Access in the Pharmaceutical Sector

In this paper we analyze the evolution of the role of the sales manager and of the sales force in a relational perspective of value creation in businessto- business contexts, included in the sale of prescription drugs, in Italy. The empirical research and the strategic implications are to highlight the importance of the customer-supplier relationship in business to business context and the role of the sales force in managing long-lasting relationships with customers. The work ends with the study of a task force model for easier market access by pharmaceutical companies and an expected value proposition through the sharing of knowledge and the creation of partnerships

The Strategic Role of Sales Management for Market Access in the Pharmaceutical Sector

In this paper we analyze the evolution of the role of the sales manager and of the sales force in a relational perspective of value creation in business-to-business contexts, included in the sale of prescription drugs, in Italy. The empirical research and the strategic implications are to highlight the importance of the customer-supplier relationship in business to business context and the role of the sales force in managing long-lasting relationships with customers. The work ends with the study of a task force model for easier market access by pharmaceutical companies and an expected value proposition through the sharing of knowledge and the creation of partnerships

Implementation of Non-Reflecting Boundary Conditions in a Finite Volume Unstructured Solver for the Study of Turbine Cascades

The analysis of component interaction in the turbomachinery field is nowadays of growing importance. This leads to the combination of different approaches, such as Large Eddy Simulation for combustors and Unsteady Reynolds-Averaged Navier-Stokes equations for turbines, and is responsible for the increase of both computational effort and required accuracy of the numerical tools. To guarantee accurate results and efficient convergence rates, numerical schemes must handle the spurious reflecting waves coming from the boundaries of truncated domains. This can be achieved by means of Non-Reflecting Boundary Conditions. The research activity described in the present paper is aimed at implementing the method of Non-Reflecting Boundary Conditions for the Linearized Euler Equations proposed by Giles in an in-house finite volume implicit time-marching solver. The methodology is validated using the available experimental data obtained at the von Karman Institute for Fluid Dynamics on the LS89 High-Pressure Turbine vane for both subsonic and transonic working condition. The implemented approach demonstrates its importance for the correct evaluation of the pressure distribution both on the vane surface and in the pitchwise direction when the computational domain is truncated at the experimental probe's position

Unintetional tracheal extubation during prone position: what is the best rescue airway device?

Unintentional tracheal extubation during surgery is a dramatic situation and may be a life-threatening event if it is not followed by a rapid reintubation. This is particularly true in patients with difficult airways or in patients whose airways are difficult to access such as patients undergoing facial surgery or in prone position. The patient prone is a problem for the anesthesiologist because accidental tracheal extubation in this setting could be a catastrophic event often treated by turning the patient supine for ventilation and tracheal re intubation. However, patient's rotation in supine position is not always achievable and requires time, the support of personnel not necessarily immediately available, and it may contaminate the sterile surgical field with serious postoperative complications.[1] In the last years, several reports have been published to describe the anesthesiological management after unexpected intraoperative tracheal extubation particularly focusing on devices more often used.[2,3] The laryngeal mask airway (LMA) has become the most used device in the catastrophic situation \u201ccannot intubate, cannot ventilate\u201d and in literature, it has been described its insertion as rescue airway management in patients with unintentional tracheal extubation during general anesthesia in prone position.[4] In 1993, McCaughey and Bhanumurthy have inserted for the 1st time a supraglottic airway device (SAD) following the induction in prone position and from that time several studies have been performed to valuate the facility and the security of insertion in this position. In fact, it has been shown that prone insertion may be easy as in the supine because the tongue falls anteriorly and creates an open space for the placement of LMA device (LMAD), whose seal is improved by the cephalic displacement of the larynx. Moreover, the risk of aspiration is reduced because regurgitant fluid for the gravity will be drained from the airway.[5] In the issue of \u201cJournal of Emergencies, Trauma, and Shock\u201d Gupta et al. describe an observational study that they conducted to test the feasibility of SAD insertion for ensure airway ventilation in prone position and fixed head as in neurosurgical patients during accidental extubation.[6] Forty partecipanting anesthesia residents were asked to place to airway trainer (Laerdal) manikin in the prone position three SADs; i-gel, LMA Proseal\u2122 (PLMA), and LMA Classic\u2122 (CLMA). The authors found that despite all three SADs were successful as rescue devices during accidental extubation in prone position, however, the ease of insertion was maximum with i-gel followed by CLMA and PLMA, in fact, i-gel was characterized by fewer time taken for insertion, least resistance in insertion, no maneuvers required for optimal positioning and bronchoscopic view and insertion score was significantly higher with i-gel as compared to CLMA and PLMA. Therefore, the authors compared three different SADs of which CLMA belongs to the first generation of LMA, whereas PLMA and i-gel to second generation of LMA. Second generation LMA was born to reduce the problems associated to the first generation LMA such as the difficult in positioning, the relatively low airway pressures with the risk of aspiration, and dislodgment. The second generation LMADs like proseal have a gastric channel allowing the passage of a tube for gastric decompression. i-gel is a more recent SAD with a non-inflatable cuff made of a thermoplastic elastomer, able to provide a seal by conforming to differently shaped throats. Several studies have compared the i-gel with various types of LMADs regarding to efficacy and ease of insertion. In a systematic review and meta-analysis performed by de Montblanc et al., i-gel was superior regarding first generation LMAD in terms of time of insertion and leak pressure despite this superiority was not for i-gel compared to the second generation LMADs. The main clinical advantage of the i-gel was the less frequent sore throat.[7] Furthermore, in the study of Gupta et al. i-gel seems to have better quality of insertion. The novelty of this manuscript is that the authors' aim was to compare the insertion of different SADs in prone position during emergency situations such as accidental extubation and nowadays the evidence is lacking regarding the feasibility of SADs insertion in prone position in emergency situations because all the data were derived from elective setting or observational studies and case reports and translation of experience of elective cases into emergent situations could be misleading. It is not ethic to conduct randomized clinical trials to test the best rescue airway device for emergency airway management. Therefore, the authors have tried to get around this limit by performing a manikins study. In recent years, it became very difficult to conduct clinical research and obtain ethical approval. Therefore, it was born a research based on manikin studies. For these studies, the approval ethic committee is usually easily obtained, there are no adverse effects, and the studies can be fastly completed. However, manikins are not like real patients for their hard plastic and lack of secretions so the results cannot be simply extrapolated and extended to humans. Howes et al. have evaluated the insertion of LMA supreme first in a manikin and then in patients. All partecipants have inserted successfully the device at the first attempt in the manikin phase of the study. In the patient phase of the study, insertion was successful in only 86% of cases on the first attempt.[8] Rai and Popat have attributed this difference to population diversity that could not be simulated and that is clinically challenging.[9] The studies evaluating the feasibility of insertion of SADs in elective prone position after induction of anesthesia have stressed that the anesthesiologist should have considerable experience with the use of supraglottic airways in the prone position and that for these techniques low-risk patients should be selected. Moreover, the frequent endpoints of the studies regarding positioning of SADs in prone position evaluate the simplicity of insertion, the reduction of complications, and the insertion speed but probably the most important issue in this situation is the most appropriate SAD in terms of successful of insertion, adequate ventilation, utility for intubation through laryngeal mask, and the best position of the operator to insert the device. In fact, for the insertion in prone position different techniques have been described. Some authors describe the insertion of the SAD by the anesthesiologist while an assistant opens the patient's mouth by extending the tip of the patient's chin while in the Stevens and Mehta technique the assistant extends and turns the patient's head to the side.[10,11] However, the condition of insertion of SAD is quite different in an emergency situation, and the expertise of the operator is very important to position the LMA. The insertion of SAD is not elective, and the head cannot be turned. The evenience of an unaspected extubation during surgery in the operating room is not paragonable with the scenario described by authors. Therefore, it is not possible to extrapolate the experiences from the elective to the emergent situation since the insertion of SADs in prone position and emergency situations is not like the insertion in elective series where preoxygenation is often performed and a second bed is positioned alongside the operating table. Furthermore, the assistance of another operating room nurse or anesthesia assistant is often required to open the patient's mouth during the SAD insertion.[10] In conclusion, more prospective randomized studies are needed to investigate the best management for airway management in patient in prone position. Many questions exist regarding to the best device to be used for the feasibility of insertion and the patient's security and currently, the first recommendation for the anesthesiologists involved in surgical procedures with the patient in prone position is to firmly anchor the endotracheal tube to avoid an accidental extubation because the question regarding which SAD is the best choice is still unresolved

Serum resistin is causally related to mortality risk in patients with type 2 diabetes: Preliminary evidences from genetic data

Resistin has been firmly associated with all-cause mortality. We investigated, whether, in patients with type 2 diabetes (T2D), this association is sustained by a cause-effect relationship. A genotype risk score (GRS), created by summing the number of resistin increasing alleles of two genome-wide association studies (GWAS)-derived single nucleotide polymorphisms (SNPs), serum resistin measurements and allcause death records were obtained in 1,479 (403 events/12,454 person-years), patients with T2D from three cohorts, Gargano Heart Study-prospective design (n = 350), Gargano Mortality Study (n = 698) and Foggia Mortality Study (n = 431), from Italy. GRS was strongly associated with serum resistin in a non-linear fashion (overall p = 3.5 ∗ 10-7) with effect size modest for GRS = 1 and 2 and much higher for GRS >3, with respect to GRS = 0. A significant non-linear association was observed also between GRS and all-cause mortality (overall p = 3.3 ∗ 10-2), with a low effect size for GRS = 1 and 2, and nearly doubled for GRS ≥ 3, with respect to GRS = 0. Based on the above-reported associations, each genetic equivalent SD increase in log-resistin levels showed a causal hazard ratio of all-cause mortality equal to 2.17 (95%CI: 1.22-3.87), thus providing evidence for a causal role of resistin in shaping the risk of mortality in diabetic patients

Implementation of ROSA radio occultation data handling into EUMETSAT and GRAS SAF processing

Within this contribution, outcomes from a GRAS - SAF Visiting Scientist activity focused on the analysis of ROSA data quality for their use in operational weather forecasting will be described and main results will be shown. The ROSA Radio Occultation instrument has been developed by Thales-Alenia-Space, Italy and was funded by the Italian Space Agency (ASI). Such instrument is actually flying on-board three opportunity missions: the Indian OCEANSAT-2, the Argentinean SAC-D and the Indian-French MEGATROPIQUES. Focus of this Visiting Scientist activity has primarily been the analysis of ROSA data from OCEANSAT-2.This activity was divided into two parts. In the first one, performed at EUMETSAT, ROSA data processing was implemented into the EUMETSAT YAROS processor. The required updates into such processing package were implemented in order to make it able to properly manage also ROSA raw observations. It has to be noted that this processor is the baseline for the operational next generation EUMETSAT Radio Occultation ground segment: any changes performed in the framework of YAROS can easily be transferred to the operational ground segment. The YAROS - EUMETSAT processor was then updated and adapted to work with the ROSA raw data, tracking frequencies and instrument database. Adaptation to open loop data, navigation bits acquisition and potentially ionospheric measurement will be performed in the next future. NetCDF-4 YAROS output files are phases, amplitudes, bending angles over impact parameter, along with all other required data. Robust bias and standard deviation of bending angles to ECMWF collocated data were the statistical indicators generated to evaluate the quality of the ROSA observations. The second part of the activity was the adaptation of the GRAS-SAF ROPP (Radio Occultation Processing Package) processor for ROSA data processing. This second part was performed at Danish Meteorological Institute and has been focused on bending angles, refractivity and higher level product generation and validation against ECMWF and co-located occultation profiles. For the first time, one month of ROSA data have been deeply analyzed by a state-of-the-art Radio Occultation processing software and results will be described in the framework of this contributio

The role of attitude toward chatbots and privacy concern on the relationship between attitude toward mobile advertising and behavioral intent to use chatbots.

Abstract Chatbots are technological tools equipped with artificial intelligence that allow companies to interact with their consumers. Through their computers or mobile devices, consumers can use this technology to search for information, make purchases or request after-sales services. This study aims to identify the role of attitude toward chatbots and privacy concern in the relationship between attitude toward mobile advertising and behavioral intent to use chatbots. After reviewing the literature, the study proposes a moderated mediation model. Through a survey, the study shows that attitude toward mobile advertising does not have a direct effect on the behavioral intent to use chatbot, but is rather mediated by one’s attitude toward chatbots. In fact, the interactivity is unidirectional in the case of mobile advertising (from the company to the consumer), but bidirectional in the case of chatbots (in which consumers have an active role in communication). In line with these assumptions, the data analysis shows that internet privacy concerns only negatively moderate the relationship between attitude toward chatbots and behavioral intent to use this technology. These results can be useful for companies and researchers in terms of developing and testing new digital marketing strategies. The paper concludes with a discussion of the results’ theoretical and managerial implications

postoperative analgesia in thoracic surgery a comparison between continuous paravertebral nerve block and continuous incisional infusion with onq pain relief system

Objectives: Thoracotomy is one of the most painful surgical stimuli and inadequate management of postthoracotomy pain is often associated with pulmonary and cardiac complications. The aim of this prospective, randomized, double-blinded study was to compare continuous paravertebral block versus continuous incisional infusion with OnQ Pain Relief System. Methods: Forty eight patients, undergoing thoracotomy for elective lobectomy, were randomized to receive a continuous paravertebral infusion of bupivacaine 0.25% through an elastomeric pump which delivers 0.1 mL/Kg/h (group A) or a continuous incisional infusion of bupivacaine 0.25% at an infusion rate of 4 mL/h with OnQ Pain Relief System (group B). Both infusions were started before wound closure, and continued for 48 postoperative hours. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia (PCA). Visual analogue scale at rest (VASr) and when coughing (VASi), rescue patientcontrolled analgesia morphine consumption, hemodynamic, time to ambulation and side-effects were evaluated within 48 h. Results: The two groups were comparable regarding to patients' number and characteristics, type of surgery, time to ambulation and side-effects; postoperative hemodynamic profile was stable in all the patients. Absolute pain scores were low in both groups; patients in group A reported significant lower VASr and VASi values during the postoperative 48 hours compared with group B (p<0.001). Total morphine consumption and PCA requests number were significantly lower in group A than in group B (p= 0.05 and p< 0.01). Conclusions: Continuous incisional infusion of local anesthetic is not as effective as paravertebral analgesia after thoracotomy

Programa de Educação Tutorial (PET – Educação): contribuições para a formação docente dos alunos do CECITEC-UECE

The Tutorial Education Program (TEP) stands out for its dynamic character, based on the basic principles of teaching, research and extension. present work is to evaluate the contributions of the Tutorial Education Program (TEP-Education) to the teaching formation of the students of CECITEC – UECE. This study adopts a mixed approach (quanti-qualitative). The instrument of data collection of data used was an interview through a structured questionnaire made available by Google Forms. The participants comprised a sample of 26 students, consisting of current, former, volunteer and former volunteers of the program. of the program. We used an analysis based on descriptive statistics for the quantitative stage and content analysis for the qualitative stage. After the data and data analysis, it was highlighted that TEP-Education through it’s extracurricular activities involving teaching, research and extension had an important contribution to the professional and personal formation of students at CECITEC of CECITEC- UECE.El Programa de Educación Tutorial (PET) se destaca por su carácter dinámico, basado en los principios básicos de la docencia, la investigación y la extensión El objetivo del presente trabajo es evaluar los aportes del Programa de Educación Tutorial (PET-Educación) para la formación docente de los estudiantes de CECITEC - UECE. Este estudio adopta un enfoque de tipo mixto (cuanti-cualitativo). El instrumento de recogida de datos utilizado fue la entrevista a través de un cuestionario estructurado puesto a disposición a través de Google Forms. Los participantes constituyeron una muestra de 26 estudiantes, formada por becarios actuales, ex becarios, voluntarios y ex voluntarios del programa. Se utilizó un análisis basado en la estadística descriptiva para la etapa cuantitativa y el análisis de contenido para la etapa cualitativa. Tras la recopilación y el análisis de los datos, se puso de manifiesto que el PET-Educación, a través de sus actividades extracurriculares de docencia, investigación y extensión, tuvo una importante contribución en la formación profesional y personal de los alumnos de CECITEC-UECE.Le Tutorial Education Program (PET) se distingue par son caractère dynamique, basé sur les principes de base de l'enseignement, de la recherche et de la vulgarisation CECITEC – étudiants de l'UECE. Cette étude adopte une approche mixte (quanti-qualitative), avec une prédominance de lignes directrices de recherche qualitatives. L'instrument de collecte de données utilisé était un entretien via un questionnaire structuré mis à disposition via Google Forms. Les participants comprenaient un échantillon de 26 étudiants, formé par des boursiers actuels, des ex-boursiers, des bénévoles et des ex-bénévoles du programme. Une analyse basée sur des statistiques descriptives a été utilisée pour l'étape quantitative et une analyse de contenu pour l'étape qualitative. Après avoir collecté et analysé les données, il a été mis en évidence que PET-Education, à travers ses activités parascolaires impliquant l'enseignement, la recherche et la vulgarisation, avait une contribution importante à la formation professionnelle et personnelle des étudiants CECITEC-UECE.O Programa de Educação Tutorial (PET) destaca-se pelo seu caráter dinâmico, pautado nos princípios básicos de ensino, pesquisa e extensão O objetivo do presente trabalho é avaliar as contribuições do Programa de Educação Tutorial (PET-Educação) para a formação docente dos alunos do CECITEC – UECE. Este estudo adota uma abordagem do tipo mista (quanti-qualitativo). O instrumento de coleta de dados utilizado foi um questionário estruturado disponibilizado via Google Forms. Os participantes compuseram uma amostra de 26 alunos, formada por atuais bolsistas, ex-bolsistas, voluntários e ex-voluntários do programa. Utilizou-se uma análise baseada na estatística descritiva para a etapa quantitativa e análise de conteúdo para a etapa qualitativa. Após a coleta e análise dos dados, foi destacado que o PET-Educação por meio das suas atividades extracurriculares envolvendo ensino, pesquisa e extensão tiveram uma importante contribuição na formação profissional e pessoal dos discentes do CECITEC-UECE