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Background In response to the imperative need for standardized support for adolescent Gender Dysphoria (GD), the Italian Academy of Pediatrics, in collaboration with the Italian Society of Pediatrics, the Italian Society for Pediatric Endocrinology and Diabetes, Italian Society of Adolescent Medicine and Italian Society of Child and Adolescent Neuropsychiatry is drafting a position paper. The purpose of this paper is to convey the author's opinion on the topic, offering foundational information on potential aspects of gender-affirming care and emphasizing the care and protection of children and adolescents with GD.Main body Recognizing that adolescents may choose interventions based on their unique needs and goals and understanding that every individual within this group has a distinct trajectory, it is crucial to ensure that each one is welcomed and supported. The approach to managing individuals with GD is a multi-stage process involving a multidisciplinary team throughout all phases. Decisions regarding treatment should be reached collaboratively by healthcare professionals and the family, while considering the unique needs and circumstances of the individual and be guided by scientific evidence rather than biases or ideologies. Politicians and high court judges should address discrimination based on gender identity in legislation and support service development that aligns with the needs of young people. It is essential to establish accredited multidisciplinary centers equipped with the requisite skills and experience to effectively manage adolescents with GD, thereby ensuring the delivery of high-quality care.Conclusion Maintaining an evidence-based approach is essential to safeguard the well-being of transgender and gender diverse adolescents.

Objective To describe the clinical and ultrasound characteristics of recurrent granulosa cell and Sertoli-Leydig cell tumors. Methods This was a retrospective observational study performed at Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Rome (Gemelli center). Patients with a histological diagnosis of recurrent granulosa cell tumor or Sertoli-Leydig cell tumor were identified from the database of the Department of Gynecological Oncology. Those who had undergone a preoperative ultrasound examination at the Gemelli center between 2012 and 2020 were included, and the data retrieved from the original ultrasound reports. In all of these reports, the recurrent tumors were described using International Ovarian Tumor Analysis (IOTA) terminology. If a patient had more than one episode of relapse, information from all episodes was collected. If there was more than one recurrent tumor at the same ultrasound examination, all tumors were included. One expert sonographer also reviewed all available ultrasound images to identify typical ultrasound patterns using pattern recognition. Results We identified 30 patients with a histological diagnosis of recurrent granulosa cell tumor (25 patients, 55 tumors) or Sertoli-Leydig cell tumor (five patients, seven tumors). All 30 had undergone at least one preoperative ultrasound examination at the Gemelli center and were included. These women had a total of 66 episodes of relapse, of which a preoperative ultrasound examination had been performed at the Gemelli center in 34, revealing 62 recurrent lesions: one in 22/34 (64.7%) episodes of relapse, two in 4/34 (11.8%) episodes and three or more in 8/34 (23.5%) episodes. Most recurrent granulosa cell tumors (38/55, 69.1%) and recurrent Sertoli-Leydig tumors (6/7, 85.7%) were classified as solid or multilocular-solid tumors, while 8/55 (14.5%) recurrent granulosa cell tumors and 1/7 (14.3%) recurrent Sertoli-Leydig cell tumors were

In recent years, corporate social responsibility has become the most outstanding challenges for firms and circular economy has emerged as an innovative business model able to transform corporate social responsibility into actions. Even if by adopting such a strategic model firms could enhance their performance, results continue to be mixed and unclear. The aim of the paper is twofold. First, the study investigates the effect of three circular economy practices (waste treatment, reduction and recycling), on brand reputation and financial performance. Second, the study tests the role of brand reputation in mediating the relationship between circular economy practices and financial performance. The findings highlight the crucial role of 3Rs practices and of brand reputation in enhancing firm performance. This paper contributes to a better understanding on the relationship between circular economy practices, as sustainable strategic and managerial practices, and firm performance, in both marketing and financial terms. Moreover, it sheds light on circular economy implementation and its effect at the firm level, by analyzing managers perceptions on how firms and policy makers have to incorporate the circular economy concept in their sustainability agenda.

Objective Retrospective series have shown minimally invasive secondary cytoreductive surgery is a feasible approach in selected cases of recurrent ovarian cancer. However, no predictors of minimally invasive secondary cytoreductive surgery feasibility are currently available. This study aims to identify predictive factors of minimally invasive secondary cytoreductive surgery feasibility and to compare perioperative and survival outcomes in a matched series of recurrent ovarian cancer patients who underwent secondary cytoreduction via an open or minimally invasive surgical approach. Methods We retrospectively identified all platinum-sensitive recurrent epithelial ovarian cancer patients who underwent minimally invasive or laparotomic secondary cytoreductive surgery between January 2013 and July 2020. Each patient underwent a preoperative positron emission tomography (PET) computerized tomography (CT) scan and diagnostic laparoscopy before secondary cytoreductive surgery. A 1:2 propensity score-matched analysis was performed to balance predictive factors of minimally invasive secondary cytoreductive surgery. Results Overall, 276 patients were identified (62 minimally invasive and 214 open), and a complete gross resection was achieved in 262 (94.9%) patients. At multivariate analysis, predictive factors for minimally invasive secondary cytoreductive surgery were neoadjuvant chemotherapy at first diagnosis (p=0.007), site of recurrence (p=0.031), and number of lesions (p=0.001). In the 1:2 propensity-matched population (39 minimally invasive and 78 open), complete gross resection was similar for both groups (p=0.082). Early post-operative complications were significantly higher in the laparotomy (33.3%) than in the minimally invasive surgery (10.3%) group (p=0.004). Only one (2.6%) patient experienced a grade >3 early post-operative complication in the minimally invasive surgery group compared with 13 (16.7%) patients in the open cohort (p<0.001). The median follo

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This paper presents a novel framework for the thorough analysis of fake news and disinformation campaigns, which have the potential to result in both offline and online criminal activities. Its primary focus relies on the spread analysis of disinformation across social media and online platforms, aiming to uncover the underlying dynamics and mechanisms driving the dissemination of false information. The framework integrates state-of-the-art Natural Language Processing (NLP) techniques for sentiment analysis, Deep Learning (DL) algorithms for prediction of criminal activties related to the disiformation spread and graph analysis to identify key actors and propagation pathways. To address the emerging challenges of disinformation that transcend the online realm and have tangible real-world consequences, the framework extends its analysis to potential offline actions incited by disinformation, such as acts of violence and public unrest or the disruption of public health efforts especially in case of pandemics. By exploring the complex interconnections between disinformation and crimes, our research aims to contribute to a deeper understanding of the societal implications of false information and provide actionable insights for policymakers, security practitioners and the broader public.

Purpose This paper analyzes the effect of circular economy practices on firm performance for a circular supply chain and explores the moderating role that big-data-driven supply chain plays within these relationships. Design/methodology/approach This study uses data collected through an online survey distributed to managers of 378 Italian firms that have adopted circular economy principles. The data are processed using multiple regression analysis. Findings The results indicate that the three categories of circular economy practices investigated – namely circular economy supply chain management design, circular economy supply chain relationship management and circular economy HR management – play a crucial role in enhancing firm performance from a circular economy perspective. A big-data-driven supply chain acts as a moderator of the relationship between circular economy HR management and firm performance for a circular economy supply chain. Originality/value This study makes a number of original contributions to research on circular economy practices in a big-data-driven supply chain and provides useful insights for practitioners. First, it answers the call to capture digital transformation trends and to extend research on sustainability in supply chain management. Second, it enhances the literature by investigating the relationships between three different kinds of circular economy supply chain practices and firm performance. Finally, it clarifies the moderating role of big data in making decisions and implementing circular supply chain solutions to achieve better environmental, social and economic benefits.

OBJECTIVES: Lung metastases from gynaecological tract cancers are rare, and prognostic factors are still undefined. The goal of this study was to analyse prognostic factors for survival in this group of patients. METHODS: Data of patients with lung metastases from gynaecological tract cancers who underwent surgical resections from 1 January 2005 to 31 May 2019 were reviewed retrospectively. All patients were treated surgically if the primitive tumour was under control and the lung was the only organ involved. Clinical and pathological data associated with metastatic patterns and previous treatment types were correlated with overall survival (OS) and disease-free survival using Kaplan-Meier curves, whereas the log-rank test was used to assess differences between subgroups. RESULTS: The analysis was conducted on 55 patients. OS was 65% at 5 years. With univariable analysis, age >45 years (P = 0.022) and the absence of pleural infiltration (P = 0.001) were determined to be favourable prognostic factors. The 5-year OS was 69.9% versus 53.3% in patients with pleural involvement. Multivariable analysis confirmed the absence of pleural infiltration as a favourable independent prognostic factor; the hazard ratio was 0.06; the 95% confidence interval was 0.00-0.23 (P = 0.011).At univariable analysis, the absence of pleural infiltration was determined to be a favourable prognostic factor (P = 0.034) for disease-free survival. The numbers and dimensions of the metastases did not influence survival in these patients.In uterine cancers of endometrial or cervical origin, the presence of pleural infiltration (P = 0.001), lymph node involvement (P = 0.001) and young age (P = 0.044) were considered unfavourable prognostic factors for OS. CONCLUSIONS: Surgical treatment in technically resectable gynaecological tract metastases may represent an important option. Pleural infiltration and lymph node metastases seem to be adverse prognostic factors.

Introduction: Psoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed. Methods: In September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced. Results: There was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy. Conclusions: Targeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis

Background: Surgical exploration remains the gold standard for evaluating the extension of disease and predicting resectability. A laparoscopy-based scoring model was developed by Fagotti and colleagues in 2006 and updated in 2015, based on the intraoperative presence or absence of some specific cancer features. The model proved an overall accuracy rate of 77% to 100% and is considered the reference test for assessing resectability in our institution. Objective: The primary aim of the study was to analyze the agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intraabdominal disease using 6 parameters described by Fagotti's score. Study Design: This was a prospective single-center observational study. Between January 2019 and June 2020, consecutive patients with clinical or radiological suspicion of ovarian or peritoneal cancer were assessed with preoperative ultrasound examination and assigned a score based on the 6 Fagotti score parameters (great omentum, liver surface, lesser omentum/stomach/spleen, parietal peritoneum, diaphragms, bowel disease). Presence of mesenteral retraction of the small bowel and miliary carcinomatosis on the serosa were also evaluated. Each parameter was correlated with laparoscopic findings. Concordance was calculated between ultrasound and laparoscopic parameters using Cohen's kappa. Results: Cohen's kappa ranged from 0.70 to 0.90 for carcinomatosis on the small or large bowel, supracolic omentum, liver surface, and diaphragms. Cohen's kappa test was lower for carcinomatosis on the parietal peritoneum (k=0.63) and on the lesser omentum or lesser curvature of the stomach or spleen (k=0.54). The agreement between ultrasound and surgical predictive index value (score) was k=0.74. For the evaluation of mesenteral retraction and miliary carcinomatosis, the agreement was low (k=0.57 and k=0.36, respectively). Conclusion: The results of ultrasound and laparoscopy in the assessment of in

BRCA 1/2 genes mutation status can already determine the therapeutic algorithm of high grade serous ovarian cancer patients. Nevertheless, its assessment is not sufficient to identify all patients with genomic instability, since BRCA 1/2 mutations are only the most well-known mechanisms of homologous recombination deficiency (HR-d) pathway, and patients displaying HR-d behave similarly to BRCA mutated patients. HRd assessment can be challenging and is progressively overcoming BRCA testing not only for prognostic information but more importantly for drugs prescriptions. However, HR testing is not already integrated in clinical practice, it is quite expensive and it is not refundable in many countries. Selecting patients who are more likely to benefit from this assessment (BRCA 1/2 WT patients) at an early stage of the diagnostic process, would allow an optimization of genomic profiling resources. In this study, we sought to explore whether somatic BRCA1/2 genes status can be predicted using computational pathology from standard hematoxylin and eosin histology. In detail, we adopted a publicly available, deep-learning-based weakly supervised method that uses attention-based learning to automatically identify sub regions of high diagnostic value to accurately classify the whole slide (CLAM). The same model was also tested for progression free survival (PFS) prediction. The model was tested on a cohort of 664 (training set: n = 464, testing set: n = 132) ovarian cancer patients, of whom 233 (35.1%) had a somatic BRCA 1/2 mutation. An area under the curve of 0.7 and 0.55 was achieved in the training and testing set respectively. The model was then further refined by manually identifying areas of interest in half of the cases. 198 images were used for training (126/72) and 87 images for validation (55/32). The model reached a zero classification error on the training set, but the performance was 0.59 in terms of validation ROC AUC, with a 0.57 validation accuracy. Finally

Objective: The aims of the present study were to assess the oncological outcomes of platinum-sensitive recurrent ovarian cancer patients undergoing secondary cytoreduction (SCS) after treatment with neoadjuvant chemotherapy (NACT) and interval debulking surgery (IDS) at diagnosis and to compare the performance of different selection models in these patients. Methods: Retrospective, observational, single-center cohort study including patients with platinum-sensitive recurrent epithelial ovarian cancer with abdominal/inguinal/cardiophrenic disease between November 2012 and November 2020. Patients were selected as surgical candidates with PET/CT-scan and with diagnostic laparoscopy. Results: 272 patients were included in the study. Of these, 165 (60.7%) patients were treated with PDS at diagnosis and 107 (39.3%) with IDS. SCS was performed in 178 (65.4%) cases, with complete gross resection achieved in 155/178 (87.1%). No progression-free survival (PFS) difference was demonstrated when patients treated with PDS were compared with those treated with NACT+IDS at first diagnosis (median 21 versus 21 months; p = 0.684); no post-recurrence survival (PRS) difference was evident between the two groups (median 81 versus 77 months, respectively; p = 0.574). Current selection models to candidate patients to SCS adequately performed in patients treated with IDS at diagnosis, as well as in the PDS group, with combination of PET/CT-scan and laparoscopy being an accurate tool in prediction of no gross residual disease at SCS in this pre-selected population. Conclusions: Patients with platinum-sensitive recurrent epithelial ovarian cancer treated with NACT/IDS as primary treatment have similar post-recurrence survival outcomes of those treated with PDS. Current models to select patients for SCS can be safely applied to IDS patients.

Introduction: The role of a molecular pattern predictive of hyperthermic intraperitoneal chemotherapy (HIPEC) efficacy in advanced ovarian cancer (AOC) patients has been poorly investigated. We aimed to assess the effect of HIPEC after primary debulking surgery (PDS) in AOC according to patient's Breast Cancer Gene (BRCA) mutational status. Methods: This is a retrospective, single center, case-control study. Data on AOC patients receiving HIPEC at the end of PDS as previously enrolled in a phase II monocentric trial (HIPEC group), were retrieved and matched for clinical and surgical characteristics with a group of cases who underwent PDS without receiving HIPEC between 01/2010 and 01/2015 (No HIPEC group). Patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥IIIB disease, aged between 18 and 70 years, with a laparoscopic Predictive Index value (PIV) ≤8 and residual disease ≤2.5 mm were included. Results: 70 patients were included. With the except of age (p = 0.012), the populations were balanced for the main characteristics. At a median follow-up of 48 months, no differences in Progression Free Survival (PFS) (p = 0.968) and Overall Survival (OS) (p = 0.789) were recorded. Survival analysis according to HIPEC administration and BRCA mutational status showed an improved PFS (p = 0.011) and OS (p = 0.003) in BRCA mutated compared to wild-type patients when HIPEC was not administered, whilst they were superimposable in case of HIPEC administration (p = 0.857 vs p = 0.372; respectively). No differences in terms of neither intra-operative (p = 1.0) nor early post-operative complications (p = 0.920) were detected. Conclusions: Our results show that HIPEC in AOC may be a promising treatment in BRCA wild-type patients, as it seems to balance their decreased chemosensitivity compared to mutation carriers.

Nowadays organizations are increasingly engaged in talent management, because it allows firms to grow rapidly by leveraging on human capital. Most antecedent studies focused on expectations and motivations of talents living in developed countries. Though, a little is known about career expectations of talents in emerging economies, and whether they diverge from those of developed countries or not. However, this information might be of use for several motives. First, emerging countries have a high growth rate. Second, these talents may be effectively harnessed from domestic and non-domestic firms, depending on whether their expectations are met or not. Consistently, this study aims at exploring the career expectations of individuals in emerging countries, by capturing the heterogeneity of expectations between emerging and developed countries due to cultural, politic, economic, and religious differences. As a matter of fact, emerging countries are frequently characterized by low levels of both income and employment, differently from many developed countries. For such motives and because of the absence of valid employment alternatives, talents might be more willing to engage in entrepreneurial initiatives rather than attempting to be employed in an organization. Thus, the primary intent of this explorative study is to understand what are the factors that affect career expectations of talents in emerging countries. Consistently, a cross-sectional principal component analysis (PCA) was used for hypotheses testing. The sample refers to a set of African countries, based on data availability for 2019. Data used for the analysis are drawn from the Global Entrepreneurship Monitor (GEM) and they refer to individual entrepreneurial behaviours and attitudes. Notably, findings show that career expectations of talents are driven by motivation and opportunity, especially in the male groups. However, the study also originally shows that the need for achievement and the willingness t

Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration. The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.

Despite the considerable increase in studies on international joint ventures (IJVs) and family business, the two research streams have yet to be systemically integrated. Family firms have unique characteristics that affect their involvement in IJVs differently from their non-family counterparts. Indeed, family firms face a paradox entailing a lower willingness to form IJVs, but a higher ability to govern them. Drawing on three distinct components of strategic agility (i.e., strategic sensitivity, leadership unity, and resource fluidity), we develop a theoretical framework that unravels this paradox. Specifically, we argue that strong emotional attachment reduces family firms' strategic sensitivity, creating a motivational gap with respect to forming IJVs. On the other hand, when family firms overcome this gap by making full use of their board of directors, they have higher levels of leadership unity and resource fluidity. These dimensions lead to a greater ability to govern the complexities of the relationship, hence reducing opportunistic hazards, and significantly increasing the odds of the long-term success of IJVs. We develop propositions for empirical studies, and offer implications and directions for future research.

Despite the considerable increase in studies on international joint ventures (IJVs) and family business, the two research streams have yet to be systemically integrated. Family firms have unique characteristics that affect their involvement in IJVs differently from their non-family counterparts. Indeed, family firms face a paradox entailing a lower willingness to form IJVs, but a higher ability to govern them. Drawing on three distinct components of strategic agility (i.e., strategic sensitivity, leadership unity, and resource fluidity), we develop a theoretical framework that unravels this paradox. Specifically, we argue that strong emotional attachment reduces family firms' strategic sensitivity, creating a motivational gap with respect to forming IJVs. On the other hand, when family firms overcome this gap by making full use of their board of directors, they have higher levels of leadership unity and resource fluidity. These dimensions lead to a greater ability to govern the complexities of the relationship, hence reducing opportunistic hazards, and significantly increasing the odds of the long-term success of IJVs. We develop propositions for empirical studies, and offer implications and directions for future research.

The cross-border transfer of technological and managerial knowledge, including marketing strategies, is often focused on the recipients' absorptive capacity or the country's institutional environment. However, factors such as the recipient's learning intent, the attractiveness of the knowledge source, and the relationship quality between the recipient and the source, and their influence on the effective and efficient transfer of knowledge in emerging markets have remained under-researched. In high-technology sectors, the nature of the intra-organizational knowledge being transferred (especially tacit knowledge) is critical for the organization to achieve a competitive advantage. This study addresses these issues and empirically tests these relationships using data from Pakistan's cellular network sector. A total of 180 completed survey responses from all cellular network providers operating in the country were analyzed. Using multiple regression analysis, we find support for our hypotheses and highlight how the highly educated workforce and the motivation to learn impact the effective cross-border sharing of technological and marketing knowledge.

This study explores the challenges experienced by managers in adopting competency modeling (CM) and recommends an approach to overcome these challenges in promoting competency based intellectual capital in organizations. Using in-depth interviews with organizational practitioners in India, this study identifies the challenges of competency modeling in emerging market economies. This study identified nine contextual and eight non-contextual challenges in implementing CM practices in organization. The framework addresses the CM challenges using direction setting, negotiation and selling, and monitoring and control dimension of implementation with behavioral, operational, and change alignment aspects of CM. The framework proposes a checklist for stakeholders to help them diagnose and analyze the gaps in effective CM implementation. This article contributes in the concept of competency based intellectual capital and adoption of competency modeling practices. This framework will assist the change management practitioners, HR leaders, Organizational Development consultants and practitioners as a toolkit to address the challenges in the people management intervention. The framework suggests a checklist for stakeholders to help diagnose and analyze the gaps in effective Competency Modeling adoption.

The cross-border transfer of technological and managerial knowledge, including marketing strategies, is often focused on the recipients' absorptive capacity or the country's institutional environment. However, factors such as the recipient's learning intent, the attractiveness of the knowledge source, and the relationship quality between the recipient and the source, and their influence on the effective and efficient transfer of knowledge in emerging markets have remained under-researched. In high-technology sectors, the nature of the intra-organizational knowledge being transferred (especially tacit knowledge) is critical for the organization to achieve a competitive advantage. This study addresses these issues and empirically tests these relationships using data from Pakistan's cellular network sector. A total of 180 completed survey responses from all cellular network providers operating in the country were analyzed. Using multiple regression analysis, we find support for our hypotheses and highlight how the highly educated workforce and the motivation to learn impact the effective cross-border sharing of technological and marketing knowledge.

This study explores the challenges experienced by managers in adopting competency modeling (CM) and recommends an approach to overcome these challenges in promoting competency based intellectual capital in organizations. Using in-depth interviews with organizational practitioners in India, this study identifies the challenges of competency modeling in emerging market economies. This study identified nine contextual and eight non-contextual challenges in implementing CM practices in organization. The framework addresses the CM challenges using direction setting, negotiation and selling, and monitoring and control dimension of implementation with behavioral, operational, and change alignment aspects of CM. The framework proposes a checklist for stakeholders to help them diagnose and analyze the gaps in effective CM implementation. This article contributes in the concept of competency based intellectual capital and adoption of competency modeling practices. This framework will assist the change management practitioners, HR leaders, Organizational Development consultants and practitioners as a toolkit to address the challenges in the people management intervention. The framework suggests a checklist for stakeholders to help diagnose and analyze the gaps in effective Competency Modeling adoption.

We offer a microfoundational perspective to challenge the consensual view of ambidextrous search as a superior approach to addressing performance problems. We characterize the nature of search as both ostensive and agentic, and suggest that search performance is idiosyncratic across individuals and highly dependent on decision makers' cognitive frameworks and social contexts. To test our theory, we develop a mathematical simulation model that formalizes the mechanisms regulating the search behaviors of senior leaders in both family and non-family firms. Our results suggest that a search approach that is conducive to superior performance in non-family firms may yield inferior performance in family firms depending on the senior leader's family membership and her/his positional history in the firm (i.e., non-family, founder, later-generation). Moreover, we reveal that while ambidexterity constitutes a superior search approach for family firms with founder CEOs, those with non-family or later-generation CEOs would seem to benefit from specialization.

Purpose The study aims to investigate whether and how digital transformation, in terms of digital collaboration, joint efforts with internal/external partners to achieve common goals and the adoption of digital tools supporting this practice, affect social innovation capital in the context of small innovative enterprises (SIEs). Design/methodology/approach The research hypotheses derived from the analysis of the literature, evaluating how sharing resources, sharing intensity and digital patterns affect the collective capacity of SIEs to innovate, were investigated by applying multiple regression analysis. Data were retrieved from a sample of Italian SIEs through an online survey. Findings The main findings suggest that the propensity to spread resources and the sharing intensity positively affect the collective capacity of SIEs to innovate. Also, the effect of resources sharing on collective innovation increases as more digital patterns are used as tools. The connection is weaker for the intensity of resources sharing. Research limitations/implications The study is conducted on Italian SIEs, a particular cluster of small and medium enterprises (SMEs). It would be interesting to compare and contrast the results of an analysis of a large sample of international companies, of different sizes and belonging to digital and non-digital sectors. Originality/value The results enrich the existing literature on social innovation capital, by clarifying its competitive benefits on the characteristic context of the SIEs and underlining the mediating role of the digital patterns.

We offer a microfoundational perspective to challenge the consensual view of ambidextrous search as a superior approach to addressing performance problems. We characterize the nature of search as both ostensive and agentic, and suggest that search performance is idiosyncratic across individuals and highly dependent on decision makers' cognitive frameworks and social contexts. To test our theory, we develop a mathematical simulation model that formalizes the mechanisms regulating the search behaviors of senior leaders in both family and non-family firms. Our results suggest that a search approach that is conducive to superior performance in non-family firms may yield inferior performance in family firms depending on the senior leader's family membership and her/his positional history in the firm (i.e., non-family, founder, later-generation). Moreover, we reveal that while ambidexterity constitutes a superior search approach for family firms with founder CEOs, those with non-family or later-generation CEOs would seem to benefit from specialization.

The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic. Only, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted worldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high intensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with frailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic disorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular treatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity. However, any age, including infancy, could be affected by the pandemic. Based on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a Consensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the management of children and adolescents with allergic or immunologic diseases.

Drawing upon the resource-based view and the ability-motivation-opportunity theory, we examined how green human resource management interplays on to the linkages amongst green transformational leadership, green innovation and environmental performance. Using a survey questionnaire, we collected triadic data from 309 manufacturing sector small and medium-sized enterprises (SMEs). We used covariance-based structural equation modeling (SEM) to examine hypotheses in this study. Results of the study suggest that green HRM practices mediates the influence of green transformational leadership on green innovation. We also found that green HRM indirectly through green innovation influences firm's environmental performance. Overall, the findings of our study support all hypotheses of direct and indirect effects and have several theoretical and practical implications. Finally, our study significantly advances theory and suggests that HRM-performance relationship neither depends upon the additive effect of green transformational leadership and green innovation as antecedent and mediator, respectively, nor on their interactive effect but a mix of both combinational forms (ie., additive and interactive) to affect firm environmental performance. Overall, our study contributes and advances the previous studies wherein in leadership plays critical role to influence the HRM practices and that in turn to predict green innovation in the organization.

Background: A radical surgical approach represents the mainstay treatment for gynecological malignancy, and preoperative staging of ovarian cancer is crucial. Ultrasound evaluation is widely recognized as the gold standard technique for the characterization of ovarian masses due to a high sensitivity for malignancy. In addition, its accuracy in defining intra-abdominal ovarian cancer spread has been previously proposed. Primary objective: To analyze the agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intra-abdominal disease using six parameters as described by Fagotti's score. Study hypothesis: When performed by expert examiners, ultrasound can be an accurate technique to assess tumor spread in ovarian cancer and therefore to predict surgical resectability. Trial design: This is a single-center prospective observational study. Patients with clinical and/or radiological suspicion of advanced ovarian or peritoneal cancer will be assessed with preoperative ultrasound and assigned a score based on the six Fagotti's laparoscopic score parameters. Each parameter will then be correlated with laparoscopic findings. Major inclusion/exclusion criteria: Eligible patients include women 18-75 years of age with clinical and/or imaging suggestive of advanced ovarian or peritoneal cancer, and an ECOG performance status 0-3. Primary endpoints: Sensitivity and specificity of ultrasound in detecting carcinomatosis, using the parameters of Fagotti's score as a reference standard. Agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intra-abdominal disease as described in Fagotti's score. Sample size: 240 patients. Estimate dates for completing accrual and presenting results: The accrual started in January 2019. Enrollment should be completed approximately by October 2020 and the results will be analyzed by December 2020. Trial registration: The study received the Ethic

Objective As an increasing number of patients with advanced/relapsed ovarian cancer need extensive cytoreductive procedures, there is an increasing number of complex cases collected in accredited tertiary cancer centers. With nosocomial infections and bacterial colonizations being a significant challenge in these patient cohorts, we aimed to evaluate the risk such infections pose to surgical outcome. Methods Prospective assessment of pathological bacterial colonization (vaginal, umbilical/groin, intraperitoneal, urine, oral/nose cavity) in patients who underwent open cytoreductive surgery for advanced/relapsed ovarian cancer in two large European tertiary referral centers for gynecologic malignancies. We recruited patients at initial diagnosis with International Federation of Gynecology and Obstetrics (FIGO) stage III and IV ovarian cancer and patients undergoing surgery for relapse. Swabs or cultures were taken from the following sites: vagina, groin and/or umbilicus, urine, intraperitoneal, mouth and/or nose. Only evidence of pathogenic bacteria was considered positive for bacterial colonization. Results A total of 172 primary advanced (70.9%) or relapsed (29.1%) ovarian cancer patients were included; 63.4% of them had received chemotherapy±additional targeted agents (16.3%) by the time of cytoreduction. 39.5% of the patients had a long-term vascular access line in situ. A bowel resection was performed in 44.8% and a splenectomy in 16.3% of the patients. Predefined surgical morbidity and mortality were 22.3% and 0%, respectively. Forty-one patients (23.8%) screened positive for pathogenic bacterial colonization with the presence of long-term intravenous access as the only independent risk factor identified (OR 2.34; 95% CI 1.05 to 5.34; p=0.04). Type of systemic treatments, previous bowel resections, previous hospitalizations, and patient demographics did not appear to significantly impact the risk of bacterial colonization. Furthermore, pathogenic bacterial colon

BJECTIVE: This study is aimed to analyze the clinical outcome of recurrent ovarian cancer patients bearing isolated lymph-node recurrence (ILNR) who underwent salvage lymphadenectomy (SL). The prognostic role of clinicopathological variables and the mutational status of BRCA1/2 have also been investigated. METHODS: This retrospective, single-institutional study included women with platinum-sensitive lymph node recurrence underwent to SL between June 2008 and June 2018. Univariate and multivariate analysis was performed to evaluate the impact of clinical parameters, and BRCA1/2 mutational status on post salvage lymphadenectomy progression-free survival (PSL-PFS). RESULTS: As of June 2019, the median follow-up after SL was 30 months, and the relapse has been documented in 48 (56.5%) patients. In the whole series, the median PSL-PFS was 21 months, and the 3-year PSL-PFS was 36.7%. The median PSL-PFS, according to patients with ILNR (N = 71) versus patients with lymph-nodes and other sites of disease (N = 14), was 27 months versus 12 months, respectively. Univariate analysis of variables conditioning PSL-PFS showed that platinum-free interval (PFI) ≥12 months, normal Ca125 serum levels, and number of metastatic lymph-nodes ≤3 played a statistically significant favorable role. In multivariate analysis, PFI duration ≥12 months and the number of metastatic lymph nodes ≤3 were shown to keep their favorable, independent prognostic value on PSL-PFS. CONCLUSIONS: In the context of SL, the patients with long PFI and low metastatic lymph node numbers at ILNR diagnosis have the best outcome. The BRCA mutational status seems not associated with clinical variables and PSL-PFS, differently from other sites of disease in ROC patients.

Mucopolysaccharidosis II (MPS II) is a lysosomal storage disorder (LSD), caused by iduronate 2-sulphatase (IDS) enzyme dysfunction. The neuropathology of the disease is not well understood, although the neural symptoms are currently incurable. MPS II-patient derived iPSC lines were established and differentiated to neuronal lineage. The disease phenotype was confirmed by IDS enzyme and glycosaminoglycan assay. MPS II neuronal precursor cells (NPCs) showed significantly decreased self-renewal capacity, while their cortical neuronal differentiation potential was not affected. Major structural alterations in the ER and Golgi complex, accumulation of storage vacuoles, and increased apoptosis were observed both at protein expression and ultrastructural level in the MPS II neuronal cells, which was more pronounced in GFAP + astrocytes, with increased LAMP2 expression but unchanged in their RAB7 compartment. Based on these finding we hypothesize that lysosomal membrane protein (LMP) carrier vesicles have an initiating role in the formation of storage vacuoles leading to impaired lysosomal function. In conclusion, a novel human MPS II disease model was established for the first time which recapitulates the in vitro neuropathology of the disorder, providing novel information on the disease mechanism which allows better understanding of further lysosomal storage disorders and facilitates drug testing and gene therapy approaches.

Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration. The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.

Several studies highlighted the relevance of extrinsic noise in shaping cell decision making and differentiation in molecular networks. Bimodal distributions of gene expression levels provide experimental evidence of phenotypic differentiation, where the modes of the distribution often correspond to different physiological states of the system. We theoretically address the presence of bimodal phenotypes in the context of microRNA (miRNA)-mediated regulation. MiRNAs are small noncoding RNA molecules that downregulate the expression of their target mRNAs. The nature of this interaction is titrative and induces a threshold effect: below a given target transcription rate almost no mRNAs are free and available for translation. We investigate the effect of extrinsic noise on the system by introducing a fluctuating miRNA-transcription rate. We find that the presence of extrinsic noise favours the presence of bimodal target distributions which can be observed for a wider range of parameters compared to the case with intrinsic noise only and for lower miRNA-target interaction strength. Our results suggest that combining threshold-inducing interactions with extrinsic noise provides a simple and robust mechanism for obtaining bimodal populations without requiring fine tuning. Furthermore, we characterise the protein distribution’s dependence on protein half-life., QC 20180530

In the last decade, the Internet of Things (IoT) has affected the approach of organizations to innovation and how they create and capture value in everyday business activities. This is compounded in the so-called Smart Cities, where the objective of the IoT is to exploit information and communication technologies (ICTs) to support added-value services for citizens, giving companies more opportunities to innovate through the use of the latest technologies. In this context, multinational enterprises (MNEs) are building alliances, starting several projects with public and private city stakeholders aimed at exploring new technologies for cities but also at exploiting new IoT-based devices and services in order to profit from them. This implies that companies need to manage and integrate different types of knowledge to efficiently and effectively support the simultaneous pressure of exploration and exploitation, at a project portfolio level. Using structural equations modeling with data collected from 43 IoT smart city project alliances in Italy, this paper tests and finds evidence that MNEs need to develop knowledge management (KM) capabilities combined with ICT capabilities if they want to obtain greater ambidexterity performance at the project portfolio level. More specifically, we highlight that KM capabilities enhance alliance ambidexterity indirectly through firms’ ICT capabilities, suggesting that MNE managers should design KM tools and develop new ICT skills. Implications for academics, managers and future lines of research are proposed. © 2017 Elsevier Inc.

Item does not contain fulltext, This article discusses 3 ways in which adaptive developmental mechanisms may produce maladaptive outcomes. First, natural selection may favor risky strategies that enhance fitness on average but which have detrimental consequences for a subset of individuals. Second, mismatch may result when organisms experience environmental change during ontogeny, for instance, because they move from one environment to another. Third, organisms may learn about their environment in order to develop an appropriate phenotype; when cues indicate the environmental state probabilistically, as opposed to deterministically, sampling processes may produce mismatch. For each source of maladaptation, we present a selection of the relevant empirical research and illustrate how models from evolutionary biology can be used to make predictions about maladaptation. We also discuss what data can be collected to test these models in humans. Our goal is to show that evolutionary approaches not only yield insights into adaptive outcomes but can also illuminate the conditions leading to maladaptation. This perspective provides additional nuance to the dialectic between the developmental psychopathology model and evolutionary developmental psychology.

Item does not contain fulltext, This article discusses 3 ways in which adaptive developmental mechanisms may produce maladaptive outcomes. First, natural selection may favor risky strategies that enhance fitness on average but which have detrimental consequences for a subset of individuals. Second, mismatch may result when organisms experience environmental change during ontogeny, for instance, because they move from one environment to another. Third, organisms may learn about their environment in order to develop an appropriate phenotype; when cues indicate the environmental state probabilistically, as opposed to deterministically, sampling processes may produce mismatch. For each source of maladaptation, we present a selection of the relevant empirical research and illustrate how models from evolutionary biology can be used to make predictions about maladaptation. We also discuss what data can be collected to test these models in humans. Our goal is to show that evolutionary approaches not only yield insights into adaptive outcomes but can also illuminate the conditions leading to maladaptation. This perspective provides additional nuance to the dialectic between the developmental psychopathology model and evolutionary developmental psychology.

Item does not contain fulltext, This article discusses 3 ways in which adaptive developmental mechanisms may produce maladaptive outcomes. First, natural selection may favor risky strategies that enhance fitness on average but which have detrimental consequences for a subset of individuals. Second, mismatch may result when organisms experience environmental change during ontogeny, for instance, because they move from one environment to another. Third, organisms may learn about their environment in order to develop an appropriate phenotype; when cues indicate the environmental state probabilistically, as opposed to deterministically, sampling processes may produce mismatch. For each source of maladaptation, we present a selection of the relevant empirical research and illustrate how models from evolutionary biology can be used to make predictions about maladaptation. We also discuss what data can be collected to test these models in humans. Our goal is to show that evolutionary approaches not only yield insights into adaptive outcomes but can also illuminate the conditions leading to maladaptation. This perspective provides additional nuance to the dialectic between the developmental psychopathology model and evolutionary developmental psychology.

Item does not contain fulltext, This article discusses 3 ways in which adaptive developmental mechanisms may produce maladaptive outcomes. First, natural selection may favor risky strategies that enhance fitness on average but which have detrimental consequences for a subset of individuals. Second, mismatch may result when organisms experience environmental change during ontogeny, for instance, because they move from one environment to another. Third, organisms may learn about their environment in order to develop an appropriate phenotype; when cues indicate the environmental state probabilistically, as opposed to deterministically, sampling processes may produce mismatch. For each source of maladaptation, we present a selection of the relevant empirical research and illustrate how models from evolutionary biology can be used to make predictions about maladaptation. We also discuss what data can be collected to test these models in humans. Our goal is to show that evolutionary approaches not only yield insights into adaptive outcomes but can also illuminate the conditions leading to maladaptation. This perspective provides additional nuance to the dialectic between the developmental psychopathology model and evolutionary developmental psychology.

Item does not contain fulltext, This article discusses 3 ways in which adaptive developmental mechanisms may produce maladaptive outcomes. First, natural selection may favor risky strategies that enhance fitness on average but which have detrimental consequences for a subset of individuals. Second, mismatch may result when organisms experience environmental change during ontogeny, for instance, because they move from one environment to another. Third, organisms may learn about their environment in order to develop an appropriate phenotype; when cues indicate the environmental state probabilistically, as opposed to deterministically, sampling processes may produce mismatch. For each source of maladaptation, we present a selection of the relevant empirical research and illustrate how models from evolutionary biology can be used to make predictions about maladaptation. We also discuss what data can be collected to test these models in humans. Our goal is to show that evolutionary approaches not only yield insights into adaptive outcomes but can also illuminate the conditions leading to maladaptation. This perspective provides additional nuance to the dialectic between the developmental psychopathology model and evolutionary developmental psychology.

This update on treatment of asthma exacerbations in children is the result of an Italian Pediatric Society Task-force, made up of a panel of experts working in 2007-2008. The aim is to give clear indications on the use of the drugs most employed in children, grading the quality of evidence and the strength of recommendations. Suggestions on their limits due to unlicensed and off-label use are reported. The level of evidence and the strength of recommendations for different therapeutic approaches demonstrate that frequently the use of drugs in children is extrapolated from the experience in adults and that more studies are required to endorse the correct use of different drugs in asthmatic children.

Contains fulltext : 71235.pdf (publisher's version ) (Open Access), BACKGROUND: Duplications and deletions in the human genome can cause disease or predispose persons to disease. Advances in technologies to detect these changes allow for the routine identification of submicroscopic imbalances in large numbers of patients. METHODS: We tested for the presence of microdeletions and microduplications at a specific region of chromosome 1q21.1 in two groups of patients with unexplained mental retardation, autism, or congenital anomalies and in unaffected persons. RESULTS: We identified 25 persons with a recurrent 1.35-Mb deletion within 1q21.1 from screening 5218 patients. The microdeletions had arisen de novo in eight patients, were inherited from a mildly affected parent in three patients, were inherited from an apparently unaffected parent in six patients, and were of unknown inheritance in eight patients. The deletion was absent in a series of 4737 control persons (P=1.1x10(-7)). We found considerable variability in the level of phenotypic expression of the microdeletion; phenotypes included mild-to-moderate mental retardation, microcephaly, cardiac abnormalities, and cataracts. The reciprocal duplication was enriched in nine children with mental retardation or autism spectrum disorder and other variable features (P=0.02). We identified three deletions and three duplications of the 1q21.1 region in an independent sample of 788 patients with mental retardation and congenital anomalies. CONCLUSIONS: We have identified recurrent molecular lesions that elude syndromic classification and whose disease manifestations must be considered in a broader context of development as opposed to being assigned to a specific disease. Clinical diagnosis in patients with these lesions may be most readily achieved on the basis of genotype rather than phenotype.

Contains fulltext : 71235.pdf (publisher's version ) (Open Access), BACKGROUND: Duplications and deletions in the human genome can cause disease or predispose persons to disease. Advances in technologies to detect these changes allow for the routine identification of submicroscopic imbalances in large numbers of patients. METHODS: We tested for the presence of microdeletions and microduplications at a specific region of chromosome 1q21.1 in two groups of patients with unexplained mental retardation, autism, or congenital anomalies and in unaffected persons. RESULTS: We identified 25 persons with a recurrent 1.35-Mb deletion within 1q21.1 from screening 5218 patients. The microdeletions had arisen de novo in eight patients, were inherited from a mildly affected parent in three patients, were inherited from an apparently unaffected parent in six patients, and were of unknown inheritance in eight patients. The deletion was absent in a series of 4737 control persons (P=1.1x10(-7)). We found considerable variability in the level of phenotypic expression of the microdeletion; phenotypes included mild-to-moderate mental retardation, microcephaly, cardiac abnormalities, and cataracts. The reciprocal duplication was enriched in nine children with mental retardation or autism spectrum disorder and other variable features (P=0.02). We identified three deletions and three duplications of the 1q21.1 region in an independent sample of 788 patients with mental retardation and congenital anomalies. CONCLUSIONS: We have identified recurrent molecular lesions that elude syndromic classification and whose disease manifestations must be considered in a broader context of development as opposed to being assigned to a specific disease. Clinical diagnosis in patients with these lesions may be most readily achieved on the basis of genotype rather than phenotype.

Contains fulltext : 71235.pdf (publisher's version ) (Open Access), BACKGROUND: Duplications and deletions in the human genome can cause disease or predispose persons to disease. Advances in technologies to detect these changes allow for the routine identification of submicroscopic imbalances in large numbers of patients. METHODS: We tested for the presence of microdeletions and microduplications at a specific region of chromosome 1q21.1 in two groups of patients with unexplained mental retardation, autism, or congenital anomalies and in unaffected persons. RESULTS: We identified 25 persons with a recurrent 1.35-Mb deletion within 1q21.1 from screening 5218 patients. The microdeletions had arisen de novo in eight patients, were inherited from a mildly affected parent in three patients, were inherited from an apparently unaffected parent in six patients, and were of unknown inheritance in eight patients. The deletion was absent in a series of 4737 control persons (P=1.1x10(-7)). We found considerable variability in the level of phenotypic expression of the microdeletion; phenotypes included mild-to-moderate mental retardation, microcephaly, cardiac abnormalities, and cataracts. The reciprocal duplication was enriched in nine children with mental retardation or autism spectrum disorder and other variable features (P=0.02). We identified three deletions and three duplications of the 1q21.1 region in an independent sample of 788 patients with mental retardation and congenital anomalies. CONCLUSIONS: We have identified recurrent molecular lesions that elude syndromic classification and whose disease manifestations must be considered in a broader context of development as opposed to being assigned to a specific disease. Clinical diagnosis in patients with these lesions may be most readily achieved on the basis of genotype rather than phenotype.

We show by the combined means of high-resolution photoemission measurements at low temperatures on uranium and cerium compounds (including heavy fermions) and systematic resonant data on a series of uranium narrow-band compounds, that the "two-peaked" f-electron spectrum commonly found in cerium compounds is also found in uranium compounds. The 5f spectra consist of a superposition of features consistent with the band structure ground state plus a 5f satellite due to poorly-screened final state effects. © 1987.

We show by the combined means of high-resolution photoemission measurements at low temperatures on uranium and cerium compounds (including heavy fermions) and systematic resonant data on a series of uranium narrow-band compounds, that the "two-peaked" f-electron spectrum commonly found in cerium compounds is also found in uranium compounds. The 5f spectra consist of a superposition of features consistent with the band structure ground state plus a 5f satellite due to poorly-screened final state effects. © 1987.