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Metropolitan development is a complex phenomenon depending on the joint action of multiple socioeconomic and territorial factors, which are generally quantified through indicators interacting across spatial and temporal scales. A comprehensive understanding of metropolitan development requires a detailed examination of the dependence structure within the development trajectories of both urban and suburban areas. Multidimensionality, non-linearity, and evolutionary components at the base of metropolitan development should be jointly considered when investigating the socioeconomic mechanisms underlying the long-term expansion of cities and their surrounding regions. In this multidimensional perspective, the Functional Data Analysis approach enables the simultaneous investigation of the level and evolution over time of multiple socioeconomic processes through summary functional measures, such as the modified hypograph index and the weighted integrated first derivative. Starting from these tools, a functional distance-based approach is proposed to study the relationship between urban and suburban areas from a twofold perspective: focusing on the entire set of metropolitan development indicators, and considering each dimension individually. This approach contributes to overpass the limitations of standard econometric approaches offering a multivariate measure of change in local systems experiencing complex development trajectories. The proposal is illustrated via a simulation study and a real data set. • Multidimensional Understanding of Metropolitan Development (MD). • A functional distance-based approach is proposed to investigate MD levels and evolution over time. • Twofold Perspective of the relationship between urban and suburban areas. • Temporal Variability of MD indicators is taken under consideration. [ABSTRACT FROM AUTHOR]

Abstract Background and purpose Interactive guided imagery (IGI) and progressive muscle relaxation (PMR) are complementary therapies with a recognised positive effect on cancer pain relief. This multicentre randomised controlled trial was designed to assess the adjuvant effect of PMR−IGI in alleviating pain in a sample of hospice patients with terminal cancer. Materials and methods A total of 104 patients were randomised to two groups. Group A patients (n = 53) were administered the Revised Edmonton Symptom Assessment Scale (ESAS-r) and the numerical rating scale (NRS) for pain immediately prior to (T1) and 2 h following an individual PMR−IGI session (T3). Group B patients (n = 51) received usual care and were assessed using the same tools. Acute pain episodes and rescue analgesics over the following 24 h were recorded. Results The Pain Intensity Difference (NRS at T3-NRS at T1) was 1.83 in group A and 0.55 in group B and was significant in both groups (p < 0.0001). The mean Total Symptom Distress Score declined by 8.83 in group A and by 1.84 in group B.The average difference in the emotional symptoms ESAS-r subscore (anxiety and depression) was 2.93 in group A (p < 0.0001) and 0.07 in group B (p > 0.05). Conclusion The results of this trial suggest that PMR−IGI may be considered as an effective adjuvant in alleviating pain-related distress in terminal cancer patients. Further studies should be performed to assess the effectiveness of repeated interventions. [ABSTRACT FROM AUTHOR]

The increased availability of online information in recent years has aroused interest in the possibility of deriving indications for many kinds of phenomena. In the more specific economic and statistical context, numerous studies suggest the use of online search data to improve the forecasting and nowcasting of official economic indicators with a view to increasing the promptness of their circulation. The purpose of this work is to investigate if the use of big data can improve the forecasting of the youth unemployment rate – estimated in Italy on a monthly basis by the Italian National Institute of Statistics – by means of time series models. The time series used are those of the Google Trends query share for the keyword offerte di lavoro (job offers) and the official labour force survey data for the Italian youth unemployment rate since 2004. Two different models are estimated: an ARIMA model using only the official youth unemployment rate series and a VAR model combining the former series with the Google Trends query share. The results show that the use of Google Trends information leads to an average decrease in the forecast error. [ABSTRACT FROM AUTHOR]

Background: Postoperative secondary hyperalgesia arises from central sensitization due to pain pathways facilitation and/or acute opioid exposure. The latter is also known as opioid-induced hyperalgesia (OIH). Remifentanil, a potent μ-opioid agonist, reportedly induces postoperative hyperalgesia and increases postoperative pain scores and opioid consumption. The pathophysiology underlying secondary hyperalgesia involves N-methyl-D-aspartate (NMDA)-mediated pain pathways. In this study, we investigated whether perioperatively infusing low-dose buprenorphine, an opioid with anti-NMDA activity, in patients receiving remifentanil infusion prevents postoperative secondary hyperalgesia.Methods: Sixty-four patients, undergoing remifentanil infusion during general anaesthesia and major lung surgery, were randomly assigned to receive either buprenorphine i.v. infusion (25 μg h-1 for 24 h) or morphine (equianalgesic dose) perioperatively. The presence and extent of punctuate hyperalgesia were assessed one day postoperatively. Secondary outcome variables included postoperative pain scores, opioid consumption and postoperative neuropathic pain assessed one and three months postoperatively.Results: A distinct area of hyperalgesia or allodynia around the surgical incision was found in more patients in the control group than in the treated group. Mean time from extubation to first morphine rescue dose was twice as long in the buprenorphine-treated group than in the morphine-treated group: 18 vs 9 min (P=0.002). At 30 min postoperatively, patients receiving morphine had a higher hazard ratio for the first analgesic rescue dose than those treated with buprenorphine (P=0.009). At three months, no differences between groups were noted.Conclusions: Low-dose buprenorphine infusion prevents the development of secondary hyperalgesia around the surgical incision but shows no long-term efficacy at three months follow-up. [ABSTRACT FROM AUTHOR]

• Depopulation rate in Italy was analysed comparatively over three decades (1981–2011). • Depopulation is strictly associated with time-invariant territorial characteristics. • Spatial heterogeneity in depopulation rates increased over time. • Analysis of depopulation trends confirms the importance of cumulative demographic effects. • Results inform local development policies in areas exposed to depopulation risk. Population decline is a major issue impacting environmental sustainability, economic growth and social well-being. Although earlier studies evaluated demographic factors, social forces and economic aspects associated with population decline in Europe, the role of territorial factors was less considered when investigating the spatial linkages between rural depopulation and the local context. As demographic patterns are the result of past dynamics depending on place-specific factors, this study hypothesizes that (time-invariant) territorial characteristics (altitude, geographical area, proximity to the sea, and urban hierarchy) are important drivers of the spatial variability in depopulation rates on a local scale. To verify this assumption, changes over time (1981–2011) in resident populations of Italian municipalities were investigated and a regression model aimed at identifying the relevant factors shaping the population decline in Italy was run separately for three decades (1981–1991, 1991–2001, 2001–2011) with depopulation rate as the dependent variable. Model estimation was based on a system of simultaneous equations where the dependent variable at time t is an explanatory variable of the model at a subsequent time (t + 1). Results show that basic territorial factors – and especially altitude - impacted significantly on local-scale depopulation rates. North-south differences in population decline emerged more clearly in the last decade. Municipalities with a declining population at a given time were more likely to experience depopulation also in the subsequent decade. These findings highlight the relevant role of territorial factors in shaping depopulation across Italy and the importance of a spatially explicit analysis of demographic dynamics for local development research and policy. [ABSTRACT FROM AUTHOR]