BackgroundDespite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR.MethodsOne-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients’ clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.ResultsAllergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p < 0.001), while GPs’ caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67.5%) suffered from moderate/severe AR (discomfort score: 7.7 ± 1.3) and 917 (32.4%) from mild AR (5.7 ± 1.9). About one-third of mild patients had a discomfort score ≥ 7. Main prescription drivers were “effective on all symptoms” (54.3% patients) and “quick symptom relief” (47.8%), whereas minor drivers were “affordable price” (13.4%) and “refundable” (8.7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59.6%). HCPs’ believe that the majority of the patients was adherent to treatment (88% with score > 7).ConclusionsThis survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients’ adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.

Abstract Background: Despite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR. Methods: One-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients’ clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi-square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.Results: Allergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p&lt;0.001), while GPs’ caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67,5%) suffered from moderate/severe AR (discomfort score: 7,7±1,3) and 917 (32,4%) from mild AR (5.7±1.9). About one-third of mild patients had a discomfort score &gt;=7. Main prescription drivers were “effective on all symptoms” (54,3% patients) and “quick symptom relief” (47,8%), whereas minor drivers were “affordable price” (13,4%) and “refundable” (8,7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59,6%). HCPs’ believe that the majority of the patients was adherent to treatment (88% with score&gt;7).Conclusions: This survey describes the therapeutic approach adopted by Italian physicians to cope with AR and shows that HCPs underestimated AR severity and had a non-realistic perception of patients’ adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.

Abstract Background: Despite availability of clinical guidelines, underdiagnosis, undertreatment, and poor adherence are still significant concerns in allergic rhinitis (AR) therapeutic management. We investigated clinical practice patterns and prescribing behavior of Italian healthcare professionals (HCPs) specialized in AR management. Methods: One-hundred allergologists, 100 ear, nose and throat (ENT) specialists, and 150 general practitioners (GPs) were recruited. The survey assessed: socio-demographic, work experience, monthly caseload, prescription drivers. Next, HCPs were invited to retrospectively recover patients’ clinical data to investigate: AR clinical characteristics, therapy management, prescription patterns, patient adherence. Descriptive statistics, Chi-square, One-Way analysis of variance, and Two-Way Analysis of Variance were performed.Results: Allergologists visited more AR patients (31% of monthly caseload) than ENTs (21%, p&lt;0.001), while GPs’ caseload was the lowest (6%). Clinical information of 2823 patients were retrieved of whom 1906 (67,5%) suffered from moderate/severe AR (discomfort score: 7,7±1,3) and 917 (32,4%) from mild AR (5.7±1.9). About one-third of mild patients had a discomfort score &gt;=7. Main prescription drivers were “effective on all symptoms” (54,3% patients) and “quick symptom relief” (47,8%), whereas minor drivers were “affordable price” (13,4%) and “refundable” (8,7%). The most prescribed drugs were antihistamines and intranasal corticosteroids (79% and 55% prescriptions), followed by fixed-dose-combination of intranasal azelastine/fluticasone (19%). Polytherapy was the most common treatment strategy (59,6%). HCPs’ believe that the majority of the patients was adherent to treatment (88% with score&gt;7).Conclusions: This survey describes AR pharmacological management by Italian physicians. HCPs underestimated AR severity and had a non-realistic perception of patients’ adherence. These findings suggest that further efforts are required to improve AR clinical management in Italy.

The overwhelming increase of parcel transports has prompted the need for effective and scalable intelligent logistics systems. In parallel, with the advent of Industry 4.0, a tight integration of Internet of Things technologies and Big Data analytics solution has become necessary to effectively manage industrial processes and to early predict product faults or service disruptions. In the context of good transports, the development of smart monitoring tools is particularly useful for couriers to ensure effective and efficient parcel deliveries. However, the existing predictive maintenance frameworks are not tailored to parcel delivery services. We present REDTag Service, an integrated framework to track and monitor the shipped packages. It relies on a network of IoT-enabled devices, called REDTags, allowing courier employees to easily collect the status of the package at each delivery step. The framework provides back-end functionalities for smart data transmission, management, storage, and analytics. A machine-learning process is included to promptly analyze the features describing event-related data to predict potential breaks of the goods in the packages. The framework provides also a dynamic view on the integrated data tailored to the different stakeholders, as well as on the prediction outcomes, enabling immediate feedback and model improvements. We analyze a real-world dataset including event-related data about parcel transports. To validate the hypothesis that the acquired data contains information relevant to predict the package status (i.e., broken or safe), we empirically analyze the performance of different, scalable classifiers. The experimental results confirm, in good approximation, the predictive power of the models extracted from the event-related features. To the best of the authors' knowledge, this work is the first attempt to address predictive maintenance in smart good transport logistics to predict package breaks from real-world data.

General skincare measures such as the use of moisturisers and products containing adequate photoprotection are important components of acne patients' management to complement the pharmacological regimen. Acne RA-1,2 is a novel dermato-cosmetic product which contains selective photofilters and active ingredients against the multifactorial pathophysiology of acne. To evaluate the tolerability of Acne RA-1,2 and its effect on the clinical signs of acne. This double-blind, placebo-controlled study randomized 40 adult patients with 10-25 comedones per half face to once-daily application of Acne RA-1,2 or placebo for 8weeks. Evaluations after 4 and 8weeks included the number of comedones, transepidermal water loss (TEWL), sebum production, and tolerability. In the Acne RA-1,2 group, there was a significant 35% decrease in the mean number of comedones from 26 at baseline to 17 at Week 8 (P<.001), a 7% significant reduction in TEWL (9.32 to 8.66g/h/m2 ; P<.001), and a 24% significant reduction in sebum production (154.8 to 117.6μg/cm2 ; P<.001). The reductions in TEWL and sebum production were significantly greater than those in the placebo group at Weeks 4 and 8 (P<0.05). There were no adverse events. Acne RA-1,2 was well tolerated and effective at reducing comedones and sebum production and improving epidermal barrier function. These results suggest that Acne RA-1,2 is useful against acne-prone facial skin, particularly as it targets sebum production, which topical pharmacological acne therapies do not address.

To provide evidence-based recommendations for the management of exocrine pancreatic insufficiency (EPI) after pancreatic surgery. EPI is a common complication after pancreatic surgery but there is certain confusion about its frequency, optimal methods of diagnosis, and when and how to treat these patients. Eighteen multidisciplinary reviewers performed a systematic review on 10 predefined questions following the GRADE methodology. Six external expert referees reviewed the retrieved information. Members from Spanish Association of Pancreatology were invited to suggest modifications and voted for the quantification of agreement. These guidelines analyze the definition of EPI after pancreatic surgery, (one question), its frequency after specific techniques and underlying disease (four questions), its clinical consequences (one question), diagnosis (one question), when and how to treat postsurgical EPI (two questions) and its impact on the quality of life (one question). Eleven statements answering those 10 questions were provided: one (9.1%) was rated as a strong recommendation according to GRADE, three (27.3%) as moderate and seven (63.6%) as weak. All statements had strong agreement. EPI is a frequent but under-recognized complication of pancreatic surgery. These guidelines provide evidence-based recommendations for the definition, diagnosis, and management of EPI after pancreatic surgery.

Thymus involution, associated with aging or pathological insults, results in diminished output of mature T-cells. Restoring the function of a failing thymus is crucial to maintain effective T cell-mediated acquired immune response against invading pathogens. However, thymus regeneration and revitalization proved to be challenging, largely due to the difficulties of reproducing the unique 3D microenvironment of the thymic stroma that is critical for the survival and function of thymic epithelial cells (TECs). We developed a novel hydrogel system to promote the formation of TEC aggregates, based on the self-assembling property of the amphiphilic EAK16-II oligopeptides and its histidinylated analogue EAKIIH6. TECs were enriched from isolated thymic cells with density-gradient, sorted with fluorescence-activated cell sorting (FACS), and labeled with anti-epithelial cell adhesion molecule (EpCAM) antibodies that were anchored, together with anti-His IgGs, on the protein A/G adaptor complexes. Formation of cell aggregates was promoted by incubating TECs with EAKIIH6 and EAK16-II oligopeptides, and then by increasing the ionic concentration of the medium to initiate gelation. TEC aggregates embedded in EAK hydrogel can effectively promote the development of functional T cells in vivo when transplanted into the athymic nude mice.

Thymus involution, associated with aging or pathological insults, results in diminished output of mature T-cells. Restoring the function of a failing thymus is crucial to maintain effective T cell-mediated acquired immune response against invading pathogens. However, thymus regeneration and revitalization proved to be challenging, largely due to the difficulties of reproducing the unique 3D microenvironment of the thymic stroma that is critical for the survival and function of thymic epithelial cells (TECs). We developed a novel hydrogel system to promote the formation of TEC aggregates, based on the self-assembling property of the amphiphilic EAK16-II oligopeptides and its histidinylated analogue EAKIIH6. TECs were enriched from isolated thymic cells with density-gradient, sorted with fluorescence-activated cell sorting (FACS), and labeled with anti-epithelial cell adhesion molecule (EpCAM) antibodies that were anchored, together with anti-His IgGs, on the protein A/G adaptor complexes. Formation of cell aggregates was promoted by incubating TECs with EAKIIH6 and EAK16-II oligopeptides, and then by increasing the ionic concentration of the medium to initiate gelation. TEC aggregates embedded in EAK hydrogel can effectively promote the development of functional T cells in vivo when transplanted into the athymic nude mice.

An innovative community residency program that provides training in the clinical and administrative aspects of specialty pharmacy practice is described. An ongoing rapid rise in U.S. approvals of specialty therapies for chronic diseases and conditions (e.g., Crohn's disease, cystic fibrosis, infertility, hepatitis C infection, multiple sclerosis) is fueling demand for pharmacists trained to meet the complex needs of patients receiving those therapies, which are typically subject to risk evaluation and mitigation strategy (REMS) requirements and limited distribution arrangements. In 2011, Duquesne University Mylan School of Pharmacy partnered with Walgreens Specialty Pharmacy to launch a one-year community residency program designed to (1) provide enhanced education on diseases and conditions targeted by specialty therapies, (2) develop well-rounded clinicians who are fully knowledgeable of the medications used to treat those disorders, and (3) prepare trainees for the operational and business-related challenges of specialty pharmacy practice. The first half of the residency year emphasizes direct patient care experiences, with team-based rotations focusing on specific disease states and health conditions; the second half of the residency program emphasizes operational-administrative training in areas such as clinical program development, resource utilization review, REMS compliance, contracting, and navigating manufacturer-sponsored patient assistance programs. Other program components include a one-month external rotation at a managed care organization, research projects, and teaching experiences. A unique community residency program jointly developed by Duquesne University and Walgreens Specialty Pharmacy prepares trainees for careers in diverse clinical, managed care, community-based, and academic practice settings.