Psychological Underpinnings of Brands.

Research in psychology has shown that even routinely experienced everyday objects such as brands can trigger cognitively engaging, emotional, and socially meaningful experiences. In this article, we review three key areas where current advances reside: brands as passive objects with utilitarian and symbolic meanings, brands as relationship partners and regulators of personal relationships, and brands as creators of social identity with social group linking value. Research in these areas is grounded in a number of fundamental perspectives within cognitive, emotional, motivational, personality, interpersonal, and group psychology. We conclude by addressing emerging areas for research.

Using marginal structural joint models to estimate the effect of a time-varying treatment on recurrent events and survival: An application on arrhythmogenic cardiomyopathy.

In many clinical applications to evaluate the effect of a treatment, randomized control trials are difficult to carry out. On the other hand, clinical observational registries are often available and they contain longitudinal data regarding clinical parameters, drug therapies, and outcomes. In the past, much research has addressed causal methods to estimate treatment effects from observational studies. In the context of time-varying treatments, marginal structural models are often used. However, most analyses have focused on binary outcomes or time-to-the-first event analyses. The novelty of our approach is to combine the marginal structural methodology with the case where correlated recurrent events and survival are the outcomes of interest. Our work focuses on solving the nontrivial problem of defining the measures of effect, specifying the model for the time-dependent weights and the model to estimate the outcome, implementing them, and finally estimating the final treatment effects in this life-history setting. Our approach provides a strategy that allows obtaining treatment effect estimates both on the recurrent events and the survival with a clear causal and clinical interpretation. At the same time, the strategy we propose is based on flexible modeling choices such as the use of joint models to capture the correlation within events from the same subject and the specification of time-dependent treatment effects. The clinical problem which motivated our work is the evaluation of the treatment effect of beta-blockers in arrhythmogenic right ventricular cardiomyopathy (ARVC/D), and the dataset comes from the Trieste Heart Muscle Disease Registry.

Introducing the Front-Of-Pack Acceptance Model: the role of usefulness and ease of use in European consumers' acceptance of Front-Of-Pack Labels.

In recent years, increasing attention to the utilisation of Front-Of-Pack Labels (FOPLs) as a tool to prompt individuals towards healthier food choices has been observed both in regulatory bodies and academic research. However, few theoretical models have been used to understand their role in consumer decision-making, as well as the antecedents that induce individuals to accept the information provided by the label, and to benchmark FOPL performance in different markets.Through a sequence of two studies conducted in Italy, France and the UK on 2812 primary grocery shoppers, we developed a new theoretical framework, the Front-Of-Pack Acceptance Model, applicable both in contexts in which FOPL are present, and in which they should be introduced. Our findings suggest a structural link between the usefulness and ease of use of the labels and the way consumers form their attitudes and intentions towards buying healthier products.

Interpretability of time-series deep learning models: A study in cardiovascular patients admitted to Intensive care unit.

Interpretability is fundamental in healthcare problems and the lack of it in deep learning models is currently the major barrier in the usage of such powerful algorithms in the field. The study describes the implementation of an attention layer for Long Short-Term Memory (LSTM) neural network that provides a useful picture on the influence of the several input variables included in the model. A cohort of 10,616 patients with cardiovascular diseases is selected from the MIMIC III dataset, an openly available database of electronic health records (EHRs) including all patients admitted to an ICU at Boston's Medical Centre. For each patient, we consider a 10-length sequence of 1-hour windows in which 48 clinical parameters are extracted to predict the occurrence of death in the next 7 days. Inspired from the recent developments in the field of attention mechanisms for sequential data, we implement a recurrent neural network with LSTM cells incorporating an attention mechanism to identify features driving model's decisions over time. The performance of the LSTM model, measured in terms of AUC, is 0.790 (SD = 0.015). Regard our primary objective, i.e. model interpretability, we investigate the role of attention weights. We find good correspondence with driving predictors of a transparent model (r = 0.611, 95% CI [0.395, 0.763]). Moreover, most influential features identified at the cohort-level emerge as known risk factors in the clinical context. Despite the limitations of study dataset, this work brings further evidence of the potential of attention mechanisms in making deep learning model more interpretable and suggests the application of this strategy for the sequential analysis of EHRs.

Exercise Dynamic of Patients with Chronic Heart Failure and Reduced Ejection Fraction.

PURPOSE OF REVIEW: Exercise causes various dynamic changes in all body parts either in healthy subject or in heart failure (HF) patients. The present review of current knowledge about HF patients with reduced ejection fraction focuses on dynamic changes along a "metabo-hemodynamic" perspective. RECENT FINDINGS: Studies on the dynamic changes occurring during exercise span many years. Thanks to the availability of advanced methods, it is nowadays possible to properly characterize respiratory, hemodynamic, and muscular function adjustments and their mismatch with the pulmonary and systemic circulations. Exercise is a dynamic event that involves several body functions. In HF patients, it is important to know at what level the limitation takes place in order to better manage these patients and to optimize therapeutic strategies.

Comparison between PtCO2 and PaCO2 and Derived Parameters in Heart Failure Patients during Exercise: A Preliminary Study.

Evaluation of arterial carbon dioxide pressure (PaCO2) and dead space to tidal volume ratio (VD/VT) during exercise is important for the identification of exercise limitation causes in heart failure (HF). However, repeated sampling of arterial or arterialized ear lobe capillary blood may be clumsy. The aim of our study was to estimate PaCO2 by means of a non-invasive technique, transcutaneous PCO2 (PtCO2), and to verify the correlation between PtCO2 and PaCO2 and between their derived parameters, such as VD/VT, during exercise in HF patients. 29 cardiopulmonary exercise tests (CPET) performed on a bike with a ramp protocol aimed at achieving maximal effort in ≈10 min were analyzed. PaCO2 and PtCO2 values were collected at rest and every 2 min during active pedaling. The uncertainty of PCO2 and VD/VT measurements were determined by analyzing the error between the two methods. The accuracy of PtCO2 measurements vs. PaCO2 decreases towards the end of exercise. Therefore, a correction to PtCO2 that keeps into account the time of the measurement was implemented with a multiple regression model. PtCO2 and VD/VT changes at 6, 8 and 10 min vs. 2 min data were evaluated before and after PtCO2 correction. PtCO2 overestimates PaCO2 for high timestamps (median error 2.45, IQR -0.635-5.405, at 10 min vs. 2 min, p-value = 0.011), while the error is negligible after correction (median error 0.50, IQR = -2.21-3.19, p-value > 0.05). The correction allows removing differences also in PCO2 and VD/VT changes. In HF patients PtCO2 is a reliable PaCO2 estimation at rest and at low exercise intensity. At high exercise intensity the overall response appears delayed but reproducible and the error can be overcome by mathematical modeling allowing an accurate estimation by PtCO2 of PaCO2 and VD/VT.

Effects on consumers' subjective understanding of a new front-of-pack nutritional label: a study on Italian consumers.

Front-of-pack nutritional label (FOPL) systems have been developed worldwide to amplify and simplify nutritional information and induce healthier choices. This study explores consumers' internal reactions - in terms of subjective understanding and liking - to a new FOPL: the NutrInform Battery. The investigation aims to assess the clear comprehension by consumers of the information provided by the NutrInform Battery FOPL scheme, based on a sample of 200 Italian respondents, in a real-life setting, with products representative of the most widely consumed food categories, using a between-subject design. Participants were randomly assigned to one of the two conditions: products marked with NutrInform Battery or Nutri-Score labels. The results provided evidence of the effectiveness of NutrInform Battery in being perceived by consumers as an informative FOPL scheme. Specifically, consumers found NutrInform Battery more informative and helpful than Nutri-Score in terms of their understanding of the product composition.

A cross-country experimental study on consumers' subjective understanding and liking on front-of-pack nutrition labels.

Different Front-of-Pack (FOP) nutritional labels have been implemented in order to increase consumers' awareness of food nutritional quality and encourage healthier choices. However, few studies have analysed the effects of FOPLs on consumers' subjective understanding and liking across different socio-cultural contexts. This study tests the effect that the new enriched informative label NutrInform Battery and the summary label Nutri-Score have on subjective comprehension and liking across 2776 respondents of seven European countries (France, Germany, Greece, Italy, Portugal, Romania and Spain). Main effects regarding socio-demographic differences are also explored according to extant literature and highlighting significant effects of education and income. This study therefore extends the current research on subjective understanding and liking with a cross-country analysis. Findings suggest that NutrInform Battery can help consumers in understanding information in a relevant way, obtaining the highest performance across countries and showing limited impact of socio-cultural differences.

Focus on arrhythmogenic right ventricular cardiomyopathy.

Arrhythmogenic right ventricular cardiomyopathy is a myocardial disease generally caused by desmosomal mutations and characterized by progressive replacement of cardiomyocites with fibro-adipose tissue. In the classic form of the disease right ventricle is predominantly affected. However, biventricular and left-dominant variants have been recently recognized, leading to the new nosological definition of arrhythmogenic cardiomyopathy. The condition affects mostly young adults and athletes and is clinically characterized by ventricular arrhythmias, heart failure and sudden cardiac death. The diagnosis is based on clinical-instrumental criteria, including family history, morpho-functional and electrocardiographic abnormalities, ventricular arrhythmias and genetic defects (Task Force Criteria, 2010). The main goal in the management of patients is the prevention of sudden cardiac death, where implantable cardioverter-defibrillator is the only effective therapeutic strategy. Many arrhythmic risk factors have been described. Recently, an on-line calculator has been proposed, but it needs further validation.

Domestic food practices: A study of food management behaviors and the role of food preparation planning in reducing waste.

Recent research has started to show the key role of daily food provision practices in affecting household food waste. Building on and extending these previous contributions, the objective of this paper is to investigate how individuals' everyday practices regarding food (e.g., shopping, cooking, eating, etc.) lead to food waste, and how policy makers and the food industry can implement effective strategies to influence such practices and ultimately help consumers reduce food waste. The research performs three Studies; a critical incident qualitative study (Study 1; N = 514) and a quantitative, survey-based study (Study 2; N = 456) to identify and examine relevant food management behaviors associated with domestic waste. Lastly, findings from a field experiment (Study 3; N = 210) suggest that a specific educational intervention, directed at increasing consumers' perceived skills related to food preparation planning behaviors, reduces domestic food waste. Implications of the research for policy makers and the food industry are discussed.

Influence of Storage Temperature on Radiochemical Purity of 99mTc-Radiopharmaceuticals.

The influence of effective room temperature on the radiochemical purity of 99mTc-radiopharmaceuticals was reported. This study was born from the observation that in the isolators used for the preparation of the 99mTc-radiopharmaceuticals the temperatures can be higher than those reported in the commercial illustrative leaflets of the kits. This is due, in particular, to the small size of the work area, the presence of instruments for heating, the continuous activation of air filtration, in addition to the fact that the environment of the isolator used for the 99mTc-radiopharmaceuticals preparation and storage is completely isolated and not conditioned. A total of 244 99mTc-radiopharmaceutical preparations (seven different types) have been tested and the radiochemical purity was checked at the end of preparation and until the expiry time. Moreover, we found that the mean temperature into the isolator was significantly higher than 25 °C, the temperature, in general, required for the preparation and storage of 99mTc-radiopharmaceuticals. Results confirmed the radiochemical stability of radiopharmaceutical products. However, as required in the field of quality assurance, the impact that different conditions than those required by the manufacturer on the radiopharmaceuticals quality have to be verified before human administration.

Improving the understanding of key nutritional elements to support healthier and more informed food choices: The effect of front-of-pack label bundles.

OBJECTIVES: In the current open debate at the European level on what would be the best Front-of-Pack Label (FOPL) to support customers' healthier and more informed food choices, little effort has been dedicated to analyzing the potential effects of bundling existing FOPLs. This study aims to compare the effects of consumers' subjective understanding and liking of different types of FOPL bundles. METHODS: We performed an experimental design by manipulating the FOPLs' scheme, where different types of FOPL bundles were designed according to the "directiveness" of the FOPLs' scheme. A "mixed" bundle was composed of a non-directive label (i.e., NutrInform Battery) and a directive label (i.e., Keyhole), and a "double-directive" bundle was composed of two directive labels (i.e., Nutri-Score and Keyhole). This study was conducted among a sample of 327 Swedish individuals responsible for purchases recruited through international web panel providers. RESULTS: The results showed that a mixed bundle has been more effective than the double-directive bundle and the single-directive label (i.e., the existing FOPL in the investigated market) in allowing consumers to improve their subjective understanding (in terms of comprehensibility, help-to-shop, and complexity reduction) and liking towards the labels. CONCLUSIONS: This study extends the current research on bundling in general and on FOPL bundles in particular by providing evidence regarding consumers' subjective understanding and liking of the labels. Additionally, the research provided findings that might be relevant for policymakers by suggesting to investigate bundle of FOPLs to help the consumers' understanding in their process toward healthier and more informed food choices.

Covert brand recognition engages emotion-specific brain networks.

Consumer goods' brands have become a major driver of consumers' choice: they have got symbolic, relational and even social properties that add substantial cultural and affective value to goods and services. Therefore, measuring the role of brands in consumers' cognitive and affective processes would be very helpful to better understand economic decision making. This work aimed at finding the neural correlates of automatic, spontaneous emotional response to brands, showing how deeply integrated are consumption symbols within the cognitive and affective processes of individuals. Functional magnetic resonance imaging (fMRI) was measured during a visual oddball paradigm consisting in the presentation of scrambled pictures as frequent stimuli, colored squares as targets, and brands and emotional pictures (selected from the International Affective Picture System [IAPS]) as emotionally-salient distractors. Affective rating of brands was assessed individually after scanning by a validated questionnaire. Results showed that, similarly to IAPS pictures, brands activated a well-defined emotional network, including amygdala and dorsolateral prefrontal cortex, highly specific of affective valence. In conclusion, this work identified the neural correlates of brands within cognitive and affective processes of consumers.

Exercise oxygen pulse kinetics in patients with hypertrophic cardiomyopathy.

OBJECTIVES: Reduced cardiac output (CO) has been considered crucial in symptoms' genesis in hypertrophic cardiomyopathy (HCM). Absolute value and temporal behaviour of O2-pulse (oxygen uptake/heart rate (VO2/HR)), and the VO2/work relationship during exercise reflect closely stroke volume (SV) and CO changes, respectively. We hypothesise that adding O2-pulse absolute value and kinetics, and VO2/work relationship to standard cardiopulmonary exercise testing (CPET) could help identify more exercise-limited patients with HCM. METHODS: CPETs were performed in 3 HCM dedicated clinical units. We retrospectively enrolled non-end-stage consecutive patients with HCM, grouped according to left ventricle outflow tract obstruction (LVOTO) at rest or during Valsalva manoeuvre (72% of patients with LVOTO <30; 10% between 30 and 49 and 18% ≥50 mm Hg). We evaluated the CPET response in HCM focusing on parameters strongly associated with SV and CO, such as O2-pulse and VO2, respectively, considering their absolute values and temporal behaviour during exercise. RESULTS: We included 312 patients (70% males, age 49±18 years). Peak VO2 (percentage of predicted), O2-pulse and ventilation to carbon dioxide production (VE/VCO2) slope did not change across LVOTO groups. Ninety-six (31%) patients with HCM presented an abnormal O2-pulse temporal behaviour, irrespective of LVOTO values. These patients showed lower peak systolic pressure, workload (106±45 vs 130±49 W), VO2 (21.3±6.6 vs 24.1±7.7 mL/min/kg; 74%±17% vs 80%±20%) and O2-pulse (12 (9-14) vs 14 (11-17) mL/beat), with higher VE/VCO2 slope (28 (25-31) vs 27 (24-31)) (p<0.005 for all). Only 2 patients had an abnormal VO2/work slope. CONCLUSION: None of the frequently used CPET parameters, either as absolute values or dynamic relationships, were associated with LVOTO. Differently, an abnormal temporal behaviour of O2-pulse during exercise, which is strongly related to inadequate SV increase, correlates with reduced functional capacity (peak and anaerobic threshold VO2 and workload) and increased VE/VCO2 slope, identifying more advanced disease irrespectively of LVOTO.

[Hyperkalemia in heart failure: etiology, epidemiology and prognosis]. / L'iperpotassiemia nello scompenso cardiaco: eziologia, epidemiologia e prognosi.

Hyperkalemia (HK) is a common condition among heart failure (HF) patients, either due to their comorbidities, such as chronic renal failure, or due to the administration of therapies capable of promoting an increase in serum potassium (K+), such as renin-angiotensin-aldosterone system inhibitors (RAASi). RAASi are among the most important treatments for HF, especially in patients with reduced ejection fraction. This class of drugs, acting on the neurohormonal mechanisms, that lead to the worsening of hemodynamic compensation, has shown to improve the prognosis of HF patients, both in terms of mortality and HF hospitalizations. HK is a major cause of dose reduction, or even discontinuation, of RAASi, thus, indirectly worsening HF patient's prognosis. Pharmacological strategies for HK treatment in outpatients have long been based solely on therapies of dubious efficacy, such as sodium polystyrene sulfonate, which are difficult to administer in an extended period of time. Reasonably, the use of the new K+ binders (patiromer and sodium zirconium cyclosilicate) in clinical practice, allowing to reduce serum K+ levels without discontinuing RAASi therapy, will improve the prognosis of patients with HK and HF.

Antiarrhythmic therapy and risk of cumulative ventricular arrhythmias in arrhythmogenic right ventricle cardiomyopathy.

OBJECTIVES: The aim of our study was to investigate the benefit of antiarrhythmic drugs (AAD) - beta-blockers, sotalol or amiodarone - in a cohort of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) patients with long-term longitudinal follow up. BACKGROUND: AAD are prescribed in ARVC to prevent ventricular arrhythmias and control symptoms. However, there are no controlled clinical trials and knowledges regarding the efficacy of AAD in ARVC are limited. METHODS: The study population included 123 patients with definite diagnosis of ARVC and ≥ 2 clinical evaluations. The primary outcome was a composite of sudden cardiac death (SCD)/recurrent major ventricular arrythmias (MVA): sudden cardiac arrest, sustained ventricular tachycardia (VT) and appropriate implantable cardioverter defibrillator interventions, including recurrent events in patients with >1 MVA. Time to first event (SCD or MVA) was considered as secondary composite endpoint. RESULTS: Sixteen patients were taking AAD at baseline and 75 started at least one AAD during a median follow-up of 132 months [61-255]. A total of 37 patients experienced ≥1 MVA with a total count of 83 recurrent MVA. After adoption of a propensity score analysis, no AAD were associated with lower risk of recurrent MVA. However, if dosage of AAD was considered, beta-blockers at >50% target dose were associated with a significant reduction in the risk of MVA compared to patients not taking beta-blockers (HR 0.10, 95% CI 0.02-0.46, p = 0.004). CONCLUSIONS: In a large cohort of ARVC patients with a long-term follow-up, only beta-blockers administrated at >50% target dose were associated with lower risk of SCD/recurrent MVA.

Comparison of different prediction models for the indication of implanted cardioverter defibrillator in patients with arrhythmogenic right ventricular cardiomyopathy.

AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a high risk of sudden cardiac death. Three different prediction models for the indication of implanted cardioverter defibrillator (ICD) are now available: the 5 year ARVC risk score, the International Task Force Consensus (ITFC) criteria, and the Heart Rhythm Society (HRS) criteria. We compared these three prediction models in a validation cohort of patients with definite ARVC. METHODS AND RESULTS: In a cohort of 140 patients with definite ARVC, the 5 year ARVC risk score and the ITFC and HRS criteria were compared for the prediction of a major combined endpoint of sudden cardiac death, appropriate ICD intervention, resuscitated cardiac arrest, and sustained ventricular tachycardia. During the follow-up, 65 major events occurred. The 5 year ARVC risk score with a threshold >10%, derived from the maximally selected rank statistic, predicted 62 (95%) events [odds ratio (OR) 9.1, 95% confidence interval (CI) 2.6-32, P = 0.0006], the ITFC criteria 53 (81%, OR 4.8, 95% CI 2.2-10.3, P = 0.0001), and the HRS criteria 29 (45%, OR 4.2, 95% CI 1.9-9.3, P = 0.0003). At the analysis of decision curve for ICD implantation, a 5 year ARVC risk score >10% showed a greater net benefit than the ITFC and HRS criteria over a wide range of threshold probability of events. Finally, at multivariate analysis, the 5 year ARVC risk score >10% was the only independent predictor of major events. CONCLUSIONS: The 5 year score with a threshold of >10% was more effective for predicting events than the ITFC and HRS criteria.

[Hyperkalemia in heart failure: new solutions for an old problem]. / Iperpotassiemia nello scompenso cardiaco: nuove soluzioni per un vecchio problema.

Potassium is the main intracellular ion and its homeostasis is finely regulated by the renal and gastrointestinal tract. Renal failure and hyperkalemia are conditions commonly found in patients with heart failure, the result of a complex interaction between heart and kidney (e.g. cardio-renal syndrome) and the side effects of drugs commonly used for treating heart disease (e.g. renin-angiotensin-aldosterone system inhibitors). Although hyperkalemia increases the risk of heart conduction disorders and life-threatening arrhythmias, its prognostic significance in heart failure is uncertain. Hyperkalemia and progression of renal damage are the main limitations to the introduction and titration of heart failure therapies. New drugs for the prevention and chronic treatment of hyperkalemia allow the introduction and modulation of anti-neurohormonal therapies in patients with heart failure otherwise excluded from these treatments due to excessively high serum potassium levels.This review illustrates the pathophysiological, epidemiological and prognostic aspects of hyperkalemia and analyses the possible treatments for this condition in heart failure patients.

Current diagnostic strategies for dilated cardiomyopathy: a comparison of imaging techniques.

INTRODUCTION: Dilated cardiomyopathy (DCM) is generally thought as a final common pathway of several conditions leading to the same clinical phenotype. Multiple imaging modalities play a fundamental role in recognizing the underlying pathological substrate in DCM. Areas covered: Echocardiography represents the first reliable and easily accessible diagnostic tool, allowing the identification of associated cardiac abnormalities, such as valve disease and highlighting features associated with an adverse prognosis. Recent advances in technology such as strain analysis and 3D-echocardiography have improved the diagnostic and prognostic capabilities of this technique. Cardiac magnetic resonance (CMR) is considered the gold standard for an accurate and reproducible assessment of ventricular volumes and ejection fraction. In addition, CMR allows us to perform tissue characterization that, through new sophisticated sequences, could be obtained even without gadolinium. Nuclear images could be useful to identify specific causes of left ventricular dysfunction, such as cardiac sarcoidosis and amyloidosis. Finally, endomyocardial biopsy is generally performed if acute myocarditis is suspected in high-risk patients. Expert commentary: Strengths and limitations are different for every method, but multiparametric evaluation of patients and family members could progressively improve current understanding of the disease. This is fundamental to specifically target therapy, allowing us to improve patients' prognosis.

Automated Synthesis of 68Ga-DOTA-TOC with a Cationic Purification System: Evaluation of Methodological and Technical Aspects in Routine Preparations.

BACKGROUND AND OBJECTIVE: Gallium-68 is a PET isotope available in each nuclear medicine departments, even those not equipped with a cyclotron, since it is easily obtained by eluting compact and transportable generator system. The preparation of Ga-68 DOTA-labeled compounds is performed by remotely controlled automated systems developed in order to ensure production efficiency, reproducibility of the results, fast reaction time, to facilitate the synthesis and minimize the radiation exposure. Many automatic synthesis systems are available on the radiopharmaceutical market, however, they requires some technical adaptations for routine use. We reported the [68Ga]Ga-DOTA-TOC production by automated cassette-based theranostic synthesizer system used in combination with a disposable GMP grade cassette system for cationic purification. METHODS: The synthesizer is integrated with the 68Ge/68Ga generator systems and it allows to perform elution, eluate purification and radiolabeling in about 38 minutes. We have performed in 2 year (January 2016 - January 2018) over 100 [68Ga]Ga-DOTA-TOC preparations. RESULTS: The average synthesis yield of radiopharmaceutical production was 54.4 ± 2.3 % and the radiochemical purity average was found 96.94 ± 0.74 %. Only three [68Ga]Ga-DOTA-TOC preparations have failed. CONCLUSION: The methodology and the adopted technical solutions allowed to obtain a high quality radiopharmaceutical product as required by the European Pharmacopoeia.