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Race with the machine: can Artificial Intelligence help managers fight their limits?
No full textIntelligence, whether biological or artificial, is fundamentally constrained by energy. This paper explores the parallel energy taxes paid by human evolution and modern Artificial Intelligence (AI), arguing that both systems are shaped by the thermodynamic need to optimize information processing within strict metabolic limits. While the human brain solved this constraint by evolving energy-saving heuristics, manifesting today as cognitive biases, AI is currently overcoming its energy bottlenecks through massive scaling and architectural efficiency.
Managerial decision making is persistently vulnerable to cognitive bias, yet many debiasing interventions remain modest in impact because they target surface-level judgment errors rather than the structural constraints that make heuristics metabolically and organizationally attractive. This conceptual paper reframes cognitive bias as a constraint-induced default emerging from (i) evolutionary canalization of survival-oriented responses and (ii) the efficiency topology of neural networks that favors low-cost, fast, “good-enough” inference over globally optimal computation. In parallel, contemporary artificial intelligence systems face their own energy and scaling constraints, but they also offer a new design opportunity: AI can function as a metacognitive scaffold that externalizes and stress-tests managerial assumptions through structured dialogue. Building on discourse-oriented strategy research, we argue that AI is most valuable not as an oracle that replaces judgment, but as a dialogical partner that systematically generates counter-arguments, alternative stakeholder perspectives, and probabilistic scenario distributions to induce reflective “System 2” pauses in high-stakes workflows. Because AI can also introduce automation bias, hallucinations, and training-data bias, effective debiasing must be treated as a socio-technical design problem involving transparency, contestability, and governance. We conclude by outlining managerial design principles and a research agenda for testing when and how AI-supported dialogue improves decision quality under uncertainty
Italian SIGENP (Italian Society of gastroenterology, hepatology and pediatric nutrition) registry of pediatric home artificial nutrition: First report
No full textBackground: Home Artificial Nutrition (HAN), including Home Enteral Nutrition (HEN) and Home Parenteral Nutrition (HPN), is essential for managing pediatric patients with complex nutritional needs. This article presents the first report from the Italian Pediatric HAN registry, promoted and endorsed by the Italian Society for Pediatric Gastroenterology, Hepatology, and Nutrition (SIGENP) in order to document HAN practices and clinical outcomes. Aims: The registry aims to analyze data from the Italian network of pediatric HAN to provide insights into its epidemiology, efficacy and safety. Methods: Established in 2020, the registry is an online platform accessible via the SIGENP website (www.nad-sigenp.org/site/home) for recording data on pediatric patients aged 0–19 years who currently or previously required HAN. Registered SIGENP network centers enter data on patient demographics, nutritional support details, clinical outcomes and complications. Results: As of December 31, 2022, the registry included 3525 home artificial nutrition programs (2402 HEN, 917 oral nutritional supplements [ONS]and 206 HPN) provided by 13 centers across 9 regions. The prevalence of pediatric HAN in Italy reached 365 programs per million inhabitants aged 0–19 years (249 HEN, 57 ONS, and 21 HPN), showing a clear increase compared to previous national surveys conducted by the Italian Society of Artificial Nutrition and Metabolism (SINPE) [12]. Mean age at initiation was 1.8 years for HEN and 0.9 years for HPN. Median duration of HEN was 1.4 years, predominantly prescribed for neurological patients, showing significant correlation between early HEN initiation and improved nutritional outcomes. Major complication rate for HEN was 2.3 % (n = 55; e.g. gastrocolic fistula, aspiration pneumonia, significant bleeding). Among HPN patients, intestinal failure-associated liver disease (IFALD) was detected in 8.3 % based on gamma-glutamyl transferase (GGT) ≥2 × normal, 3.9 % based on bilirubin >1 mg/dL, and 11.6 % based on alanine aminotransferase (ALT) ≥2 × normal each persisting for more than three months. Hepatic steatosis and biliary sludge occurred in 23.3 % and 16.0 % of patients, respectively. Complications rate and prevalence align with international trends, confirming the importance and safety of home care in children with chronic diseases. Conclusions: The registry provides a comprehensive overview of pediatric HAN practices in Italy, highlighting a significantly growing need for specialized nutritional care. The predominance of HEN, especially among neurological patients, underscores its critical role in long-term nutritional management. The observed correlation between early initiation of HEN and improved nutritional outcomes reinforces the importance of timely nutritional interventions. HPN remains less common, as it is mainly indicated for patients with primary intestinal failure. The registry's data provide valuable insights into epidemiological trends and clinical practices, which contribute to future policy development for pediatric HAN
Fighting HER2 in Gastric Cancer: Current Approaches and Future Landscapes
No full textGastric cancer (GC) remains a major cause of cancer-related mortality worldwide, with human epidermal growth factor receptor 2 (HER2)-positive disease representing a clinically relevant subset. Trastuzumab combined with chemotherapy is the standard first-line treatment in advanced settings, following the landmark ToGA trial. However, resistance to trastuzumab has emerged as a significant limitation, prompting the need for more effective second-line therapies. Trastuzumab deruxtecan, a novel antibody–drug conjugate (ADC) composed of trastuzumab linked to a cytotoxic payload, has demonstrated promising efficacy in trastuzumab-refractory, HER2-positive GC, including cases with heterogeneous HER2 expression. Other HER2-targeted ADCs are also under investigation as potential alternatives. In addition, strategies to overcome resistance include HER2-specific immune-based therapies, such as peptide vaccines and chimeric antigen receptor T cell therapies, as well as antibodies targeting distinct HER2 domains or downstream signaling pathways like PI3K/AKT. These emerging approaches aim to improve efficacy in both HER2-high and HER2-low GC. As HER2-targeted treatments evolve, addressing resistance mechanisms and optimizing therapy for broader patient populations is critical. This review discusses current and emerging HER2-directed strategies in GC, focusing on trastuzumab deruxtecan and beyond, and outlines future directions to improve outcomes for patients with HER2-positive GC across all clinical settings
Adding invasive alien plant-derived biochar and stinging nettle powder in Populus nigra phytoremediation of arsenic- and lead-contaminated Technosol alters microbial community assembly and network stability
No full textThis study examined the effects of biochar and nettle Urtica dioica amendments on microbial diversity and community assembly in a historically contaminated Technosol collected from a former silver‐lead mine in Pontgibaud (Puy-de-Dôme, France). We investigated how two types of biochar obtained from the biomass pyrolysis of two invasive alien plant species (Ailanthus altissima and Solidago gigantea) at different doses (2 % vs 5 %), alone and in combination with stinging nettle (Urtica dioica) powder inputs that influence the soil's microbial community structure under controlled phytoremediation conditions using Populus nigra. We integrated niche theory and network analysis to examine how these amendments alter community-level cohesion and resilience under heavy metal stress, with implications for phytoremediation. We found that a 5 % biochar dose imposed stronger environmental pressure compared to a 2 % dose, resulting in a significant increase in soil alkalinity and electrical conductivity (EC). In amended soils, bacterial community assembly was primarily driven by stochastic processes, mainly due to dispersal. Fungal communities, in contrast, exhibited reduced stochasticity, particularly under the 5 % biochar–Solidago treatments. Furthermore, bacteria expanded their niche width, whereas fungi shifted toward specialist-dominated, narrower niches with greater overlap. The biochar co-application with stinging nettle increased network complexity for both microbial groups; however, the bacterial network responded with higher modularity and more negative links, while the fungal networks were non-modular and exhibited increased positive feedback loops. Network robustness analysis revealed that bacterial networks remained more stable under perturbation across all treatments, whereas fungal networks were more sensitive to hub node loss. Our findings suggest that both the concentration and type of biochar, as well as the presence of Urtica dioica amendment, distinctly affect microbial communities and should be carefully considered in designing optimal application regimes and strategies for soil remediation
Per una didattica della storia contemporanea del Medio Oriente
No full textLa didattica della storia contemporanea è quanto mai di attualità giacché nel caso
di questo insegnamento è urgente oltrepassare la prospettiva eurocentrica a partire dalla denominazione stessa della regione: dalla
denominazione di Medio Oriente e Nord Africa (MENA) sarebbe
opportuno passare a quella di South West Asia and North Africa
(SWANA). Inoltre, per raccontare gli eventi salienti del Novecento,
lo sguardo degli accademici, degli scrittori e dei registi mediorientali è ormai indispensabile, anche per avere piena coscienza delle
conseguenze della storia sull’attualità
Association of intraoperative end-tidal CO2 levels with postoperative outcomes: a patient-level analysis of two randomised clinical trials
No full textBackground: The relationship between intraoperative end-tidal CO2 (etCO2) levels and postoperative outcomes remains unclear. We conducted a post hoc analysis of two randomised trials in adults undergoing major surgery under general anaesthesia. Methods: We re-analysed individual participant data comparing high or low positive end-expiratory pressure with low tidal volume intraoperative ventilation using a merged database derived from two randomised trials in non-obese (PROVHILO: ISRCTN70332574) and obese (PROBESE: NCT02148692) patients. The exposure of interest was low etCO2 (<4.7 kPa) vs normal-high etCO2 (≥4.7 kPa). The primary outcome was postoperative pulmonary complications within 5 days. A time-weighted etCO2 analysis and propensity score matching were also performed to adjust for confounding. Results: Of 2793 participants, 891 (29.4%; 52% female) had low etCO2, compared with 1972/2793 (70.6%; 65% female) participants with normal-high etCO2. Compared with participants with normal-high etCO2, higher minute volumes (normalised to body weight) were delivered in participants with low etCO2. Postoperative pulmonary complications developed in 278/821 (34%) participants with low etCO2, compared with 462/1972 (23%) participants who had normal-high etCO2 (adjusted hazard ratio, 1.3; 95% confidence interval, 1.1–1.6; P<0.001). The time-weighted analysis showed an inverse linear relationship between the mean etCO2 and postoperative pulmonary complications, which was also confirmed by propensity matching. Conclusions: Low etCO2 occurs often during intraoperative ventilation and is associated with a higher rate of PPCs. The etCO2 level has an inverse dose-dependent relationship with postoperative pulmonary complications. Clinical trial registration: NCT05550181
The development of climate change litigation and its financing in a comparative perspective: contingency fee agreements, crowdfunding, and third-party funding
No full textToll-like receptor 4 deficiency ameliorates experimental ileitis and enteric neuropathy: involvement of nitrergic and 5-hydroxytryptaminergic neurotransmission
Get PDFBackground and Purpose: Inflammatory bowel disease (IBD) patients display genetic polymorphisms in toll-like receptor 4 (TLR4) genes, contributing to dysregulate enteric nervous system (ENS) circuits with increased levels of 5-HT and alteration of the neuroimmune crosstalk. In this study, we investigated the impact of TLR4 signalling on mouse ENS dysfunction caused by dextran sulphate sodium (DSS)-induced ileitis. Experimental Approach: Male C57BL/6J (wild-type [WT]) and TLR4−/− mice (10 ± 2 weeks old) received 2% DSS in drinking water for 5 days and then were switched to 3-day regular drinking water. Histological analysis and proinflammatory cytokine mRNA levels were assessed in ileal samples. Gut motility was evaluated by changes in transit of a fluorescent-labelled marker and isometric neuromuscular responses of ileal full-thickness segments to receptor and non-receptor-mediated stimuli. Alterations in ENS architecture were assessed by confocal immunohistochemistry in longitudinal muscle–myenteric plexus whole-mount preparations. Key Results: In WT mice, DSS treatment caused delayed gastrointestinal transit, ileal myenteric neurodegeneration, reactive gliosis and release of proinflammatory cytokines. Enhanced cholinergic and tachykinergic excitatory tone, increased inducible nitric oxide synthase (iNOS)-mediated relaxation, and changes in 5-HT2A and 5-HT3 receptor-mediated responses were observed during ileitis in WT mice. TLR4 deficiency reversed most of the functional and morphological abnormalities. Conclusion and Implications: Our results demonstrate that TLR4 activity influences the severity of ileitis, neuroglial plasticity, gut motility, and nitrergic and 5-HTergic neurotransmissions. The neuroimmune interaction between TLR4 and 5-HT observed in our study appears to be a potential pharmacological target to treat ENS dysfunction implicated in IBD onset/progression
Ongoing post-pandemic peak of Mycoplasma pneumoniae cases in July 2024: A single-center experience in north-west Italy
No full text: We report an increase of Mycoplasma pneumoniae (Mp) respiratory infections during 2023-2024. The positive rate in 2024 is higher at 68 per 1668 (5%) compared with 2023 at nine per 1264 (0.7%), highlighting the Mp increased circulation in north-west Italy. The increase in Mp cases showed an outbreak in July 2024