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Summary We consider the estimation of the relative median poverty gap (RMPG) at the level of Italian provinces by using data from the European Union Survey on Income and Living Conditions. The overall sample size does not allow reliable estimation of income-distribution-related parameters at the provincial level; therefore, small area estimation techniques must be used. The specific challenge in estimating the RMPG is that, as it summarizes the income distribution of the poor, samples for estimating it for small subpopulations are even smaller than those available in other parameters. We propose a Bayesian strategy where various parameters summarizing the distribution of income at the provincial level are modelled by means of a multivariate small area model. To estimate the RMPG, we relate these parameters to a distribution describing income, namely the generalized beta distribution of the second kind. Posterior draws from the multivariate model are then used to generate draws for the distribution's area-specific parameters and then of the RMPG defined as their functional.

This paper aims to verify the presence of the learning-by-exporting effect on total factor productivity growth. The study starts, as is typical in this context, by addressing the pre-entry selection bias at firm level but differs from the literature by focusing on the distribution of the outcome and considering the presence of the different influences of macroeconomic factors on exporters and non-exporters. Additionally, the paper addresses the panel attrition, a current source of estimation bias in longitudinal studies. The analysis is based on a panel of Italian manufacturing firms in the 1998–2007 period. We design an experiment by aligning and pooling cohorts of firms that allows us to obtain a sufficiently large group of firms entering the international market. Our results show that internationalisation affects firms’ productivity and that the effect is heterogeneous over total factor productivity distribution and larger for the firms at the bottom section of the distribution itself. Furthermore, we observe that the learning-by-exporting effect may be confounded without i) considering that domestic and exporter firms may afford heterogeneous demand cycles and ii) managing the dropout of some firms from the panel.

Background Low reliability of Revised Cardiac Risk Index (RCRI) in predicting major cardiac events (MACE) among Vascular Surgery patients emerged in recent literature, suggesting procedure-specific risk evaluation - particularly in major surgery. Methods-results Comorbidities, perioperative variables, RCRI and MACE were retrospectively analyzed in a consecutive series of 899 elective open abdominal aortic aneurysm (AAA) repairs performed at our Institution. Possible MACE predictors were studied through univariate/multivariable analysis (logistic regression, MVRE) and stepwise-backward elimination/odds ratio (MVR-SBE/OR). Patients were divided by clampsite in 2 subgroups: 1. infrarenal (690 cases); 2. pararenal (209 cases). RCRI resulted predictive for MACE in the whole dataset but its performance resulted lower for pararenal aneurysms (p = 0.11) than for infrarenal ones (p ≤ 0.00). Among RCRI covariates of the whole cohort, dilated cardiomyopathy (p ≤ 0.001), ischemic cardiopathy (p ≤ 0.01) and cerebrovascular disease (p ≤ 0.02) resulted predictive. Peripheral arteriopathy also related to MACE (p ≤ 0.03). At MVR-SBE/OR analysis, the following resulted to be MACE predictors: dilated cardiomyopathy (p ≤ 0.001), cerebrovascular disease (p ≤ 0.02), and surgical access (p = 0.04) in subgroup 1; previous myocardial infarction (p ≤ 0.01), congestive failure (p ≤ 0.03) and chronic pneumopathy (p = 0.04) in subgroup 2. Conclusions Predictability of RCRI in elective AAA surgery is influenced by clampsite and resulted to be lower in aneurysms requiring suprarenal clamping. Variables included in the RCRI show to have different weights when patients are stratified by clampsite. Some variables not included in the RCRI model significantly affect the onset of MACE. RCRI should be revised to elaborate a specific score for AAAs including further MACE predictors, to improve risk assessment and to support proper surgical strategy.

Summary In business surveys, estimates of means and totals for subnational regions, industries and business classes can be too imprecise because of the small sample sizes that are available for subpopulations. We propose a small area technique for the estimation of totals for skewed target variables, which are typical of business data. We adopt a Bayesian approach to inference. We specify a prior distribution for the random effects based on the idea of local shrinkage, which is suitable when auxiliary variables with strong predictive power are available: another feature that is often displayed by business survey data. This flexible modelling of random effects leads to predictions in agreement with those based on global shrinkage for most of the areas, but enables us to obtain less shrunken and thereby less biased estimates for areas characterized by large model residuals. We discuss an application based on data from the Italian survey on small and medium enterprises. By means of a simulation exercise, we explore the frequentist properties of the estimators proposed. They are good, and differently from methods based on global shrinkage remain so also for areas characterized by large model residuals.

Summary Small domain business statistics are becoming important for better planning business policies. We focus on the estimation of the averages of value added and labour cost in small domains. To take into account the positive skewness in the distribution of outcomes and the correlation between them, we propose a bivariate skew normal small area model. Estimates are obtained from real survey data. The performance of the estimator proposed is evaluated on the basis of both survey data and a synthetic firm population. Results show that the model proposed increases the estimates’ reliability and that the estimates obtained make it possible to perform detailed regional economic studies.

Background This study aims to develop and validate a new classification system that better predicts combined risk of neurological and neurovascular complications following CBT surgery, crucial for treatment decision-making. Methods Multinational retrospective cohort study with 199 consecutive cases. A cohort of 132 CBT cases was used to develop the new classification. To undertake external validation, assessment was made between the actual complication rate and predicted risk by the model on an independent cohort (n = 67). Results Univariate analyses showed statistically significant associations between developing a complication and the following factors: craniocaudal dimension, volume, Shamblin classification, and Mehanna types. In the multivariate prognostic model, only Mehanna type remained as a significant risk predictor. The risk of developing complications increases with increasing Mehanna type. Conclusions We have developed and then validated a new classification and risk stratification system for CBTs, which demonstrated better prognostic power for the risk of developing neurovascular complications after surgery.

BACKGROUND: The aim of this study is to report our results with carotid body tumor (CBT) surgical management. METHODS: Between 2010 and 2018, 100 CBTs (mean age: 48.0 years, range 21-80 years old) were treated in our center. The patients were classified in 3 groups according to the size: group I (5 cm). RESULTS: Surgical resection was performed in 88 patients and conservative treatment in 2 cases. Nine patients were treated for bilateral involvement and one of them was also treated again for a relapse. Postoperatively, cranial nerve injury (CNI) was significantly higher in group II [3 (8.3%) vs. 16 (31.4%) vs. 2 (15.4%); P=0.030] with no statistical differences between the CN involved. At univariate analysis for CNI, CBT group (P=0.030), maximum diameter (P=0.046), patients presenting with dysphonia (P=0.035) and dysphagia (P=0.007) and patients suffering from any intraoperative complication (P=0.047) were statistically significant. At multivariate analysis the only significant variable was CBT group II (P=0.016). For blood loss, CBT group III (P

In this mini review, we discuss the main results obtained so far by us and other authors on the matter of bias correction for entropy inequality measures in small samples.

Based on a unique dataset concerning small firms operating in the machinery and equipment industry in Emilia Romagna (Italy), we estimate the separate effects of social capital and local market size on the probability to either fully or partially outsource parts of the production process. We are able to distinguish 29 different phases of the production cycle, from design, to early processing to post-production. Our estimates show that: (1) social capital influences the full outsourcing of core assembly and post-assembly activities, while local market size affects the full outsourcing of early processing activities; (2) neither social capital nor local market size have a statistically significant effect on the probability of partially outsourcing any step of the production process. Robustness tests confirm our results vis-A -vis the endogeneity of the local market size and social capital, and the potential Modifiable Area Unit Problem relating to local market size.

Open repair of thoracoabdominal aortic aneurysms (TAAAs) is an extraordinary challenge for both vascular surgeons and patients. Consistent outcome data have been reported by high-volume centers with 30-day mortality rates lower than 10% and improved long-term survivals [1]. The development of devices and techniques have allowed total endovascular treatment of TAAA with fenestrated (FEVAR) or branched (BEVAR) endografts [2–6]. Early results are encouraging; a recent meta-analysis has reported a 30-day mortality rate of 8.6%, spinal cord ischemia in 17.3% of cases with permanent consequences in 4.9%, and renal failure in 25.4%. However, anatomic feasibility of BEVAR/FEVAR is still limited, manufacturing times for custom devices are lengthy, and open repair remains the only viable strategy in a number of specific conditions, such as emergency cases, infections, and patients affected by connective tissue disorders.

BACKGROUND: Carotid plaque has emerged as a marker of coronary heart disease (CHD) risk. Comparison of carotid plaque burden between different race/ethnic groups may provide a relative estimate of their future CHD risk. METHODS: We conducted a population-based study among apparently healthy middle-aged men aged 40–49 years (ERA JUMP study (n=924)) and recruited 310 Whites in Pittsburgh, US, 313 Japanese in Otsu, Japan, and 301 Koreans in Ansan, South Korea. Number of carotid plaque and CHD risk factors was assessed using a standardized protocol across all centers. The burden of carotid plaque was compared between race/ethnic groups after adjustment for age and BMI, and after multivariable adjustment for other CHD risk factors using marginalized zero-inflated Poisson regression models. Cross-sectional associations of risk factors with plaque were examined. RESULTS: Whites (22.8%) had more than four-fold higher prevalence (p

This article addresses on an aspect of firms internationalization so far little explored, the choice of the number of export destinations and a proxy of the complexity of the export activity. As the outcome variable is a count with an excess of zeros, we use a hurdle regression model for count data that also allow disentangling the aspect of heterogeneity related to the decision to export from those measuring the number of markets served. Some differences arise by the comparison between the estimates regarding the propensity to export model and those of the model describing the number of export destinations. Regarding the propensity to export, the estimated models support the familiar evidences already presented in literature: exporters are larger, more productive, more innovative and invest more. With reference to the number of export destinations, it seems that not only the larger the number of markets served the more productive, large and willing to invest is the firm but also firms engaged in multiple markets seem to be older, financially stable, and willing to support organizational and managerial innovations.

Purpose To correlate the degree of plaque vulnerability as determined by contrast-enhanced ultrasound (CEUS) with histological findings. Secondary objectives were to optimize the CEUS acquisition technique and image evaluation methods. Materials and methods Fifty consecutive patients, either symptomatic and asymptomatic referring to our department in order to perform carotid endarterectomy (TEA), were enrolled. Each patient provided informed consent before undergoing CEUS. Ultrasound examination was performed using high-frequency (8–14 MHz) linear probe and a non-linear pulse inversion technique (mechanical index: 0.09–1.3). A double contrast media injection (Sonovue, 2 mL and 4 mL; Bracco, Italy) was performed. Two videotapes were recorded for every injection: early “dynamic” phase and late “flash” phase, performed with 6 high mechanical index impulses. Movies were quantitatively and qualitatively evaluated. Qualitative and quantitative evaluation were statistically compared to immunohistological diagnosis of vulnerable plaque, considered as gold standard. Results Qualitative CEUS evaluation obtained high statistical results when compared to immunohistological results, with values of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 94%, 68%, 87%, 85% and 86%, respectively, which became higher if considering only asymptomatic patient, with a NPV of 91%. Nevertheless, quantitative software evaluation proved less effective and could not reach similar results. Conclusion Carotid plaque enhancement assessed with CEUS well correlates with histological assessment of plaque instability. CEUS may provide valuable information for plaque risk stratification and may play a role in the indication to treatment of patients with carotid stenoses, particularly in asymptomatic population.

Background: In the era of rising endovascular treatment of thoracoabdominal aortic aneurysms (TAAAs), the analysis of visceral vessel (VV) patency after open surgical repair is crucial to provide a future benchmark between these different approaches. This study reports the late outcomes of a single-center experience with open TAAA repair, focusing on the results of different techniques adopted for renal and splanchnic revascularization. Methods: Data were analyzed for 382 consecutive open TAAA repairs performed between January 2009 and July 2015 (284 men; mean age, 66 ± 10 years). Follow-up of surviving patients was carried out by computed tomography angiography and office checkups at 3 and 12 months and yearly afterward. Kaplan-Meier analysis was performed for overall survival, patency of reconstructed VVs (celiac trunk, superior mesenteric artery, right renal artery, left renal artery), and reinterventions on visceral arteries. Furthermore, VV long-term patency was analyzed in subgroups of patients according to the revascularization strategy (patch inclusion of all vessels, group 1; one-vessel separate reattachment and patch inclusion of the remaining vessels, group 2; separate reattachment of all VVs, group 3). Results: In-hospital mortality and paraparesis/paraplegia occurred in 7.6% and 8.1% of patients, respectively. Among the 353 survivors, 338 complied with the follow-up protocol, and adequate computed tomography angiography images were available in 247 patients (952 VVs were analyzed). Overall follow-up survival was 94%, 91%, and 70% at 1 year, 2 years, and 5 years, respectively. At the same time points, VV patency was 99%, 98%, and 98% for celiac trunk; 100%, 100%, and 100% for superior mesenteric artery; 100%, 96%, and 96% for right renal artery; and 91%, 87%, and 82% for left renal artery (log-rank test, P < .0001). Estimates for reinterventions on VVs were 1.2%, 6.3%, and 17% at the same time points. Freedom from occlusion of any VV at 1 year and 3 years was 95% and 87% for group 1, 89% and 79% for group 2, and 92% and 92% for group 3, respectively (log-rank test, P = .13). Conclusions: Long-term patency of VVs after open TAAA repair performed in high-volume centers is high, regardless of the technique employed for revascularization. The left renal artery appears to be most prone to occlusion over time.

Inflammation is a part of the initial process leading to atherosclerosis and cholesterol crystals (CC), found in atherosclerotic plaques, which are known to induce complement activation. The pentraxins C-reactive protein (CRP), long pentraxin 3 (PTX3), and serum amyloid P component (SAP) are serum proteins associated with increased risk of cardiovascular events and these proteins have been shown to interact with the complement system. Whether the pentraxins binds to CC and mediate downstream complement-dependent inflammatory processes remains unknown. Binding of CRP, PTX3, and SAP to CC was investigated in vitro by flow cytometry and fluorescence microscopy. CRP, PTX3, and SAP bound to CC in a concentration-dependent manner. CRP and PTX3 interacted with the complement pattern recognition molecule C1q on CC by increasing the binding of both purified C1q and C1q in plasma. However, CRP was the strongest mediator of C1q binding and also the pentraxin that most potently elevated C1q-mediated complement activation. In a phagocytic assay using whole blood, we confirmed that phagocytosis of CC is complement dependent and initiated by C1q-mediated activation. The pathophysiological relevance of the in vitro observations was examined in vivo in human atherosclerotic plaques. CRP, PTX3, and SAP were all found in atherosclerotic plaques and were located mainly in the cholesterol-rich necrotic core, but co-localization with the terminal C5b-9 complement complex was only found for CRP. In conclusion, this study identifies CRP as a strong C1q recruiter and complement facilitator on CC, which may be highly relevant for the development of atherosclerosis.

Using an original dataset of small, machine-tool firms located in Emilia Romagna, Italy, we estimate the effect of social capital on the propensity to fully or partially outsource production activities. In particular, we investigate whether social capital favours outsourcing in contexts characterized by a relatively high infrastructure endowment. We show that the likelihood to fully outsource production activities increases with the local level of social capital. We also find that this effect is higher in regions where the density of transport infrastructures is higher. On the other hand, we do not find any significant effect of social capital on the propensity to partially outsource production activities. We argue that social capital is more effective in reducing the scope for opportunistic behaviour when monitoring costs are higher and where mobility is easier.

Inflammatory mechanisms may be involved in atherosclerotic plaque rupture. By using a novel histology-based method to quantify plaque instability here, we assess whether lectin pathway (LP) of complement activation, a major inflammation arm, could represent an index of plaque instability. Plaques from 42 consecutive patients undergoing carotid endarterectomy were stained with hematoxylin-eosin and the lipid core, cholesterol clefts, hemorrhagic content, thickness of tunica media, and intima, including or not infiltration of cellular debris and cholesterol, were determined. The presence of ficolin-1, -2, and -3 and mannose-binding lectin (MBL), LP initiators, was assessed in the plaques by immunofluorescence and in plasma by ELISA. LP activation was assessed in plasma by functional in vitro assays. Patients presenting low stenosis (≤75%) had higher hemorrhagic content than those with high stenosis (>75%), indicating increased erosion. Increased hemorrhagic content and tunica media thickness, as well as decreased lipid core and infiltrated content were associated with vulnerable plaques and therefore used to establish a plaque vulnerability score that allowed to classify patients according to plaque vulnerability. Ficolins and MBL were found both in plaques' necrotic core and tunica media. Patients with vulnerable plaques showed decreased plasma levels and intraplaque deposition of ficolin-2. Symptomatic patients experiencing a transient ischemic attack had lower plasma levels of ficolin-1. We show that the LP initiators are present within the plaques and their circulating levels change in atherosclerotic patients. In particular, we show that decreased ficolin-2 levels are associated with rupture-prone vulnerable plaques, indicating its potential use as marker for cardiovascular risk assessment in atherosclerotic patients.

The empirical literature on international trade predicts that internationally involved firms experience a productivity premium when compared to domestic firms. This finding is supported by comparing the unconditional productivity averages or distributions, or regressing the productivity on the international status dummy, controlled for the relevant covariates. In the present paper, we disentangle the distribution of the gross productivity premium from the component that is created by the different structural compositions of the two groups of firms; we can thereby measure the distribution of the net premium that is attributable to internationalisation. To this purpose, we use the quantile decomposition methodology (Melly, 2005). The main results highlight that (i) the net premium is substantially lower than the gross premium and (ii) while the difference in the gross premium is uniform along the entire distribution, the net premium is significant only for the less productive firms. These results are confirmed even if different internationalisation modes are considered (i.e. exports, agreements and commercial penetration) using the domestic firms as baseline. One exception is the net premium for firms enrolled in foreign direct investment and/or offshoring; this premium does not decrease for firms at the top of the productivity distribution.

Relying on a new firm–level dataset, this paper focuses on the factors underlying both the decision, and the relative intensity, to either fully or partially source production activities by small firms operating in the indus- trial machinery and equipment sector of Emilia Romagna (Italy). Particular attention is devoted to spatial agglomeration variables, as capturing poten- tial proximity effects that may reduce transaction costs and favour vertical disintegration. We estimate a Hurdle Negative Binomial model where the de- pendent variable is the number of product transformation stages contracted out, and the covariates include firm size, age, labour cost per employee, the stages operated by the firm, and three spatial agglomeration variables, mea- suring specialisation vs. diversification economies at the level of local labour system. Our estimates show that, once controlled for endogeneity and for the composition of the product transformation process, the number of fully out- sourced activities is positively related to the share of skilled personnel, the engagement in foreign markets and the density of neighbouring employment in related three-digit industry. Differently, concurrent sourcing decisions are affected by firm size, age, and unit labour cost, whereas no effect seem to emerge with respect to spatial agglomeration variables. The insensitivity of concurrent outsourcing to the spatial concentration of an industry reflects the lower costs of transaction compared to full outsourcing of activities.

To analyze the clinical features, surgical management and oncologic results of a series of six patients undergoing seven operations for resection of uterine leiomyoma extending into the right cardiac chambers.A retrospective review of patients operated on for surgical resection of a pelvic leiomyomatous mass originating from the uterus and extending into the right cardiac chambers was performed. The most common symptoms at presentation were syncope and dyspnea; two patients were asymptomatic. Four patients had been misdiagnosed as having intracardiac thrombus or primary cardiac tumor. The intracardiac and upper intracaval portion was removed under circulatory arrest in moderate hypothermia; the remaining portion was removed by caval incision. In one patient with cardiogenic shock, the sole intracardiac portion of the mass was removed at primary surgery. A mean of 2.8 +/- 1.5 years of follow-up was available, consisting of clinical and radiological tests (computed tomography scan, echocardiography).There were no cases of operative mortality in the present series. No recurrence was observed at the end of the follow-up in all cases of complete resection of the mass from its intracardiac to its pelvic end. Conversely, in the only case in which partial resection was performed due to the patient's clinical condition, recurrence of the intracardiac involvement was observed 6 months after primary surgery.Radical resection is curative for uterine leiomyomatosis extending into the right cardiac chambers. Surgery can be afforded with acceptable risks. A high level of suspicion for intracardiac extension of pelvic leiomyomatosis should be retained in the presence of a floating mass within the right cardiac chambers. Such a finding should prompt radiographic evaluation of the abdomen and the pelvis.

We report a case of acute necrotizing pancreatitis after extraperitoneal repair of an abdominal aortic aneurysm (AAA). Acute pancreatitis (AP) is an uncommon complication of vascular surgery; however, managing its local and general consequences, including the eventual pancreatic abscess and the risk of prosthetic infection, presents formidable challenges.

Objective This study presents a retrospective analysis of long-term outcomes and factors influencing early and late results of a 20-year experience with open repair of atherosclerotic pararenal abdominal aortic aneurysms (PAAAs). Methods Records of consecutive patients who underwent open repair of PAAA between 1990 and 2010 at a tertiary referral care center were analyzed for demographics, comorbidities, operative variables, complications, and 30-day mortality. Long-term results were also assessed through a local electronic medical database and direct follow-up. Variables influencing early and late results were evaluated by univariate and multivariate logistic regression analyses, stepwise backward elimination, and Cox proportional hazard regression. Results The study included 200 patients (94% men; mean age, 69.5 years) who were monitored for a mean of 107.3 months. The aneurysm was juxtarenal in 78% of patients, suprarenal in 19.5%, and type IV thoracoabdominal in 2.5%. Mortality at 30 days was 2.5%. At least one major complication occurred in 51.5%. Postoperative acute renal failure (pARF) occurred in 11% of the patients, 3% had temporary hemodialysis, but only 0.5% required chronic hemodialysis. pARF was significantly related to preoperative renal function ( P = .009), visceral ischemia >30 minutes ( P = .05), and supraceliac or supramesenteric clamp site ( P = .005). Respiratory complications (13.8%) were associated with an increasing stage of chronic obstructive pulmonary disease ( P = .020), proximal clamp site ( P = .047), and intraoperatively infused crystalloids ( P = .014). Cardiac complications (12.8%) were related to previous myocardial infarction ( P = .031) and proximal clamp site ( P = .003). Late deaths were observed in 21.5%. Mean survival was 50 months, with Kaplan-Meier survival estimates of 78% at 5 years and 60.5% at 10 years. Variables influencing long-term survival included age (hazard ratio [HR], 2.67; P = .01), chronic obstructive pulmonary disease stage 2 (HR, 5.14; P = .01) and stage 3 (HR, 4.54; P = .03), postoperative cardiac complication (HR, 3.93; P ≤ .00), previous myocardial infarction (HR, 1.47; P = .02), peripheral artery disease (HR, 1.97; P = .03), and smoking (HR, 1.17; P = .02). Survival and late-onset renal insufficiency were unaffected by preoperative renal function. Late renal failure was observed in 6.2% of the patients but did not predict mortality. Conclusions Conventional surgical repair of PAAAs can be performed with acceptable short-term and long-term mortality. Although pARF is frequent, chronic hemodialysis at discharge is rare. Cardiac and respiratory complications are also common and associated with worse survival. Our data represent a potentially useful benchmark for complex endovascular repairs of this type of aneurysm.

This paper investigates the dynamics of productivity experienced by firms that start to exporting. The effect of entering into international markets is disentangled by the self-selection component and its empirical distribution is evaluated. Results show that the impact on productivity of moving from the status of non-exporter to the status of exporter is different at different sections of the productivity distribution.

Over the last few years many studies have been carried out in Italy to identify reliable small area labour force indicators. Considering the rotated sample design of the Italian Labour Force Survey, the aim of this work is to derive a small area estimator which “borrows strength” from individual temporal correlation, as well as from related areas. Two small area estimators are derived as extensions of an estimation strategies proposed by Fuller (1990) for partial overlap samples. A simulation study is carried out to evaluate the gain in efficiency provided by our solutions. Results obtained for different levels of autocorrelation between repeated measurements on the same outcome and different population settings show that these estimators are always more reliable than the traditional composite one, and in some circumstances they are extremely advantageous.

Background and Objectives: The clinical characteristics and patient outcome of a group of patients treated for differentiated thyroid carcinoma (DTC) were analyzed in order to assess the relative influence of different prognostic factors. Materials and Methods: We retrospectively reviewed data about sex, age, size and histologic behavior of the tumor, extrathyroid extension of the tumor, lymph node status, distant metastasis at diagnosis, surgical procedures, and overall survival from 234 patients treated for DTC. Data were submitted to a statistical analysis. Results: Using a univariate analysis, we found that survival rates were significantly influenced by age (P = 0.0001), size (P = 0.018), extra-thyroidal extension (P = 0.000001), lymph node involvement (P = 0.03), and distant metastases (P = 0.049). Age and size were independent prognostic factors at multivariate analysis (t = 2.694 and t = 2.443, respectively). Conclusions: On the basis of our results and of a review of the literature, we conclude that total thyroidectomy is the treatment of choice in DTC, except for small (

Relying on a unique dataset of small, machine-tool firms located in Emilia Romagna, Italy, we estimate the separate effects of industrial relatedness and social capital on the propensity to fully or partially outsource production activities. We focus on a series of 29 production phases, for which we have information on whether they are accomplished in-house or outside the firm. After controlling for endogeneity, we find that: (i) full outsourcing is positively related to social capital, but this effect vanishes as industrial proximity with neighbouring firms increases; and (ii) firms engage in concurrent sourcing only when industrial relatedness with neighbouring firms is high. Also phase estimates show that: (iii) while social capital matters for full outsourcing of core activities, for full outsourcing of peripheral activities it is industrial relatedness that is relevant; and (iv) there is no significant effect of either industrial relatedness or social capital on the concurrent sourcing of core and peripheral activities.

We analyze the anti-poverty effect of social cash transfers using a micro-econometric approach. Aggregate analyses, based on comparing average poverty indicators before and after public transfers, fail to address who receives the transfers and how the transfers are distributed among the poor. We consider three dichotomous outcome variables: (i) poverty status before the receipt of transfers; (ii) the receipt of transfers; and (iii) poverty status after the receipt of transfers. We use a trivariate probit model with sample selection, connecting the outcome variables to the characteristics of the household and its head. Our empirical results highlight that the Italian social transfers system overprotects certain household typologies at the expense of others, as social transfers are primarily awarded to employees with permanent positions and the elderly, while the system is not generous enough to large households with dependant children, the self-employed, temporary contract workers, and the unemployed.

Most of the literature on the relationship between firm’s participation in international markets and firm heterogeneity focuses on export and foreign direct investment. This paper considers a wider range of forms of internationalisation that firms could combine into different patterns. With the purpose of analysing the selection of heterogeneous firms into different internationalisation patterns, we jointly model the decisions on the forms of internationalisation through a multivariate probit. This model allows us to avoid any a priori assumption about the firm’s behaviour. In this context we study the complementarity/substitutability relationships between forms of internationalisation. The results obtained show that: (i) neglecting some forms could lead to an incomplete representation about the firm’s internationalisation strategy, (ii) different firm’s characteristics influence the choice of internationalisation pattern, i.e. some types of firm are more prone to choosing one type of process over another, (iii) complementarity between forms of internationalisation seems to be preferred over substitution, but some heterogeneity also arises in this context.

Retrospective review of aorto-iliac infections in a single vascular surgery center.From a retrospective review of their experience in the last 20 years, the Authors analyze a series of 12 cases of aorto-iliac infection. Prognostic factors, surgical options and results are discussed and compared with the literature.Infections of the aorta eventually associated with aneurysmal degeneration are uncommon (less than 3% of all aortic aneurysms) but still a life-threatening condition with high hospital mortality (25%). No statistical evaluation can be drawn from small series; however, early results are apparently influenced by emergency surgery and comorbidities affecting the immune response; in-situ reconstruction is associated with better long-term results (patency 100%, recurrent infection 0%).In our experience, in situ aortic grafting reconstruction associated with proper antibiotic therapy obtained satisfactory results in terms of mortality and long-term survival Endovascular treatment can be adopted in critical patients with prohibitive surgical risk.

A model-based small area method for calculating estimates of poverty rates based on different thresholds for subsets of the Italian population is proposed. The subsets are obtained by cross-classifying by household type and administrative region. The suggested estimators satisfy the following coherence properties: (i) within a given area, rates associated with increasing thresholds are monotonically increasing; (ii) interval estimators have lower and upper bounds within the interval (0, 1); (iii) when a large domain-specific sample is available the small area estimate is close to the one obtained using standard design-based methods; (iv) estimates of poverty rates should also be produced for domains for which there is no sample or when no poor households are included in the sample. A hierarchical Bayesian approach to estimation is adopted. Posterior distributions are approximated by means of MCMC computation methods. Empirical analysis is based on data from the 2005 wave of the EU-SILC survey.

By exploiting a new rich fi rm-level dataset, this paper investigates the decision to subcontract production activities (outsourcing) with respect to vertically integrate them. In particular, we aim at identifying the main factors underlying the decision to either fully or partially decentralise production activities by mechanical firms located in Emilia Romagna (Italy). In so doing, we fir st account for firm characteristics, such as size, age and the skill composition of the labour force, then we focus on labour costs per employee, product diversity and the presence of the fi rm on international markets. Finally, and differently from previous research, we include in the analysis both the qualitative composition of the production process, as given by the stages of production potentially developed by the fi rm, and the industrial composition of the local market. On this last purpose, we estimate the relationship between the propensity and the intensity of concurrent and total sourcing and the main sources of agglomeration economies identified in the literature: specialisation economies, variety and urbanisation economies. Our estimates show a particularly strong and positive relation between the intensity of 'pure' outsourcing and our measure of variety, workforce skill intensity and the internal composition of production, while a negative relation emerges with respect to firm size, age and labour cost. Results concerning concurrent sourcing, instead, appear weaker, but, differently from the case of full outsourcing, we nd a positive relationship with rm size and product diversity.

Thrombolytic drugs may be an alternative therapy for acute limb ischemia in patients who are not surgically treatable. Two cases of acute limb ischemia managed successfully with a sequential intraarterial infusion of urokinase and recombinant-type tissue plasminogen activator (rt-TPA) are reported. The positive results suggest the two drugs have a synergistic action. Further studies are needed to demonstrate the interactions between these thrombolytic agents

The present paper proposes a statistical strategy for the analysis of regional disparities in income poverty. For the EU countries, information on individual income has been collected until now by the European Community Household Panel survey, which only yields reliable estimates for very large regions within countries. In order to obtain reliable estimates for some of the poverty indicators suggested by the Laeken Council at the sub-national level, we suggest the adoption of a multivariate small area estimation approach which enables us to reduce estimate variability. We concentrate on Italy, the country with the lowest degree of regional cohesion within the EU. Results show that disparity cannot be reduced to the so-called “North–South divide,” with the “poor” South separated from the “affluent” North, as both these macro-regions display large internal differences in terms of both poverty level and income inequality. The strategy we propose could also be adopted in order to measure poverty in other European regions, using information produced by the new EU Survey on Income and Living Conditions, which is replacing the European Community Household Panel.

In this paper, we explore the internationalization pattern of firms and its relationship with firms’ heterogeneity. Besides the more traditional exports and Foreign Direct Investments (FDI), we consider various forms of non-equity internationalization. The use of a Multivariate Probit Model allows us to assess the associations among the choices driving the firms’ internationalization strategy as a whole and, at the same time, to avoid a priori assumptions on the internationalization patterns. From the empirical evidence, two main results emerge. At first, we observe that Italian firms jointly adopt various internalization forms, others than exports and FDI, conditionally to characteristics of the firms. The hypothesis reported in literature of a complementary or subsidiary relationship between exports and FDI is then confirmed also for non-equity internationalization forms. Secondly, we find that the heterogeneity of firms, measured by a large range of variables, has an important role in defining the choice of firms on the patterns of internalization. Thus in this context, we endorse the emerging opinion asserting that various dimensions other than productivity are relevant, Statistica; Vol 68, No 1 (2008); 31-55

Acute ischemia of the upper limb is a complication of intravenous drug abuse due to accidental puncture of the arterial tree. The authors report a suc cessfully treated case of hand ischemia in a heroin addict. Anticoagulant and fibrinolytic therapy appeared to be effective treatment of this type of arterial thrombosis.

Background True venous aneurysms of the renal veins are very uncommon lesions. Diagnosis is incidental, and thrombosed aneurysms may simulate solid renal masses. Methods and Results A case of right renal vein aneurysm incidentally found in a patient with a ispilateral renal carcinoma and abdominal aortic aneurysm is reported. While CT examination suggested a high-flow arteriovenous (A-V) malformation, a selective angiographic study identified two separate and independent pathologic conditions (venous aneurysm and intratumoral, acquired A-V fistulae). Successful preoperative embolization of the renal tumor was obtained and surgical treatment (nephrectomy+aneurysmectomy) was uneventful. Conclusions Although uncommon, venous renal aneurysms require an accurate preoperative diagnosis; this case is interesting because the coexistence of renal tumor with acquired A-V fistulae raised the prospect of a large, high-flow A-V communication with secondary venous enlargement. The integrated imaging studies were basic to differentiate acquired, tumor-induced A-V fistulae found in the lower renal pole from the true venous aneurysm located in the upper pole. To our knowledge, this is the first report of such a condition.

Adrenal cysts are rare (0, 064%–0, 18% in autopsy series) and less than 500 cases have been reported in the western literature. Incidental diagnosis of adrenal cysts, however, is reported with increasing rates. We observed 12 patients with adrenal cyst. Each of them had a careful laboratory and instrumental evaluation; all the patients were operated. In our series about 67% of the patients were symptomatic (6 patients with abdominal pain, 1 with palpable mass, 1 with hemorrhagic shock). No biochemical alteration was observed. Conversely we observed an unusual subclinically hyperfunctioning cystic adenoma, potentially progressive to a clinically recognizable endocrine syndrome. US, CT and MRI had a sensitivity of 66, 7%, 80% and 100% respectively. Adrenalectomy was performed in all patients. The pathological findings were: 1 epithelial cyst (cystic adenoma), 2 endothelial cysts (vascular cystic ectasia with adenomatous adrenocortical hyperplasia and 1 vascular cyst) and 9 pseudocysts. On the basis of these results, we conclude that a careful hormonal, morpho-functional and instrumental evaluation is indicated in all adrenal cysts, even if the available diagnostic procedures, even when combined, cannot always define their nature. Surgical excision, when possible by laparoscopic approach, is indicated in presence of symptoms, endocrine abnormalities (even when subclinic), complications, suspicion of malignancy and/or large size (>5 cm). Adrenal gland must be excised en bloc, also because of the possible presence of other adrenal lesions.

Background. Recurrence of adrenal cortical carcinoma (ACC) after radical surgery is a common finding. Although successful reoperations have been reported with encouraging results, most published experiences are anecdotal and based on few cases. We report the results of surgical treatment for recurrent ACC in a multiinstitutional series. Methods. One hundred eighty-eight cases of ACC were collected in a national registry. A complete follow-up was obtained in 179 cases. At initial diagnosis 92 patients had local disease (stage I or II). One hundred seventy patients underwent surgical treatment, considered radical in 140; in this group, recurrent disease was observed in 52 cases (37%) after a mean disease-free interval of 21.7 months. Results. Adjuvant chemotherapy was ineffective in ameliorating the prognosis. The mean survival in 20 patients who underwent reoperation was significantly higher (15.85 ± 14.9 months) than in nonreoperated cases (3.2 ± 2.9 months). Five-year actuarial survival in reoperated patients is significantly better than in nonreoperated patients (49.7% versus 8.3%, respectively). Conclusions. Although the prognosis of this tumor is still poor, surgery is the only effective therapy; reoperation allows survival comparable to that observed in patients without recurrent disease. An aggressive strategy for recurrent ACC is advisable until prospective studies demonstrate a real effectiveness for chemotherapy.

Digestive and nutritional alterations are a common occurrence after pancreatic resections. The authors report the results of a multiparametric evaluation performed in a group of 26 patients submitted to total or cephalic pancreatectomy. Patients were divided into two groups according to the surgical procedure; group A (n = 13) included gastroresected patients and group B (n = 13) included those submitted to pylorus-sparing pancreatic resection. Subclinical digestive and absorptive impairment has been found in 61.5% of group A patients; the nutritional status was clinically poor in four cases from the same group. Digestive alterations have also been found in 69.2% of group B cases, but nutritional status was always satisfactory in the whole group. The more positive results obtained with the pylorus-sparing technique encourage wider adoption of this procedure.