Search

The aim of this study is to assess the effectiveness of the Italian State Credit Guarantee Scheme (Central Guarantee Fund). The paper analyzes the impact of the program on SMEs’ profitability considering the firm size and sector. The analysis is performed using propensity-score matching estimators and the Difference in Differences regressions on a proprietary sample of about 38,000 SMEs in the period 2007–2009. Overall, the Central Guarantee Fund generated an increase in the profitability of guaranteed firms during the period of economic downturn. However, significant differences emerged across firms by size and sector. The effect is positive and robust only for micro- and small-sized firms, and the most relevant improvement in the profitability is recorded for firms operating in the manufacturing sector. This implies that more customized programs are necessary to reach a higher value for money in entrepreneurial policies

Identify a subset of early-stage HL children (GR1) curable with limited chemotherapy+/-radiotherapy; improve outcome of intermediate (GR2) and high-risk (GR3) patients; establish impact of response to chemotherapy evaluated with conventional imaging (CI). One hundred and sixty GR1-patients received 3ABVD + involved-field (IF) low-dose (LD) (20 Gy) irradiation if mediastinal mass or partial response (PR) after chemotherapy. Eighty-five GR2- and 315 GR3-patients received 4 and 6 COPP/ABV + IFRT, respectively. The 63 GR1 patients spared from radiotherapy had 15-year survival and EFS of 100 and 84.5%, respectively. The GR2 and GR3 15-year FFP were 84.7 and 78.6%, respectively. No different prognosis for patients in CR or PR evaluated during and after chemotherapy was observed. In conclusion, low-risk patients in CR may be successfully treated with radiation-free, low-intensity chemotherapy. Good, but less satisfactory, results were registered in GR2 and GR3. Response evaluated with CI is not a prognostic factor, but permits identification of low-risk patients who can avoid radiotherapy.

The research tryes to investigate the unexplored yet complex and diffused problem of rural shrinkage as a political landscape. By analysing an Italian rural municipality, which has been took as representative European rural area, it proposes a general spatial design strategy that, by relying on local resources and local actors, is able to become site specific. As consequence of such still unexplored and uncommon design topic, the work has been a valuable opportunity also to tackle the role of the architect and the one of architecture. In a moment of transition and crisis like the contemporary one, both, the architectural profession and discipline are experiencing a radical shift towards a more open, horizontal and participated design approach. This is particularly true and effective when dealing with public spaces., Architecture and The Built Environment, Architecture

When globalization affects jobs and economies, policy makers strive to plan, design and implement actions to support their communities and businesses (Ansell and Gash 2007). Furthermore, local development policies are at the core of international cooperation programs or more in general represent a challenge for emerging countries. They could refer to infrastructure, entrepreneurship innovation or urban renewal. However, more frequently than not, development policies, which involve different institutional levels and public and private players, fail due to poor implementation management. This research book presents a managerial approach (the so called Managerial Flow) that could help the closure of gaps that hamper an efficient and effective policy execution. The managerial flow model observes the phenomenon of policy implementation for economic development through managerial lens. In the book, the research team has empirically identified five gaps in practice whereupon public policy implementation falls down. As a response Managerial Flow model outlines sets of managerial actions that can be adopted to facilitate a clear ‘flow’ from policy development through to implementation. This book expands on the Managerial Flow model, and acts as both a practical guide to stimulate evidence based policy implementation in governments and as theoretical contribution to policy and strategy execution. Written for researchers and academics, this book begins by outlining the theoretical foundations of Managerial Flow and moves to unpack application and cases, based in different sectors and countries, in order to discuss and show how the Managerial Flow approach can concretely support managers in the implementation of economic development policies. It reviews and discusses how the managerial flow could be relevant in the implementation of a set of sectorial policies and uses the managerial flow concept to analyse cases of economic development and establish lessons for broader managem

In the search of better policy tools, governments have begun to promote the development of public-private partnerships (PPPs) involving firms, financial institutions and public managers to provide a better financial support for SMEs growth. This chapter uses the Managerial Flow framework to analyse the role of strategy, coordination, selection, governance and knowledge management in the context of SMEs financing in Italy. The study focuses on the role of the Italian Central Guarantee Fund (CGF) and its partnering role in developing italian SMEs. We focus on the CGF's guarantee role in the process of bank lending for SMEs using the Managerial Flow framework of Vecchi and Brusoni (2012), we identify the gaps in the design and execution of the Italian CGF policy.

Due to the importance played by SMEs in the european economy, national authorities and govenrments have made recourse to measures to help SMEs in access to credit, in particular by using loan guarantee programs, grants, or subsidized loans. In this chapter we test whether bank-lending constraints increase firm's demand for government aid. We use a sample of euro area SME derived form ECB/EC survey on access to finance for small and medium enterprise (SAFE) for the years 2009-2014 across 11 euro area countries. First we test what type of firms is accessing financial aid and then we verify the relevance of financial constraints. In doing so, we focus the attention on government measures put into practice since 2011. We divide countries that implemented or expanded only guarantee schemes from those that supported firms also with grants and loans.

This book expands on the Managerial Flow model, and acts as both a practical guide to stimulate evidence based policy implementation in governments and as theoretical contribution to policy and strategy execution.

When globalization affects jobs and economies, policy makers strive to plan, design and implement actions to support their communities and businesses (Ansell and Gash 2007). Furthermore, local development policies are at the core of international cooperation programs or more in general represent a challenge for emerging countries. They could refer to infrastructure, entrepreneurship innovation or urban renewal. However, more frequently than not, development policies, which involve different institutional levels and public and private players, fail due to poor implementation management. This research book presents a managerial approach (the so called Managerial Flow) that could help the closure of gaps that hamper an efficient and effective policy execution. The managerial flow model observes the phenomenon of policy implementation for economic development through managerial lens. In the book, the research team has empirically identified five gaps in practice whereupon public policy implementation falls down. As a response Managerial Flow model outlines sets of managerial actions that can be adopted to facilitate a clear ‘flow’ from policy development through to implementation. This book expands on the Managerial Flow model, and acts as both a practical guide to stimulate evidence based policy implementation in governments and as theoretical contribution to policy and strategy execution. Written for researchers and academics, this book begins by outlining the theoretical foundations of Managerial Flow and moves to unpack application and cases, based in different sectors and countries, in order to discuss and show how the Managerial Flow approach can concretely support managers in the implementation of economic development policies. It reviews and discusses how the managerial flow could be relevant in the implementation of a set of sectorial policies and uses the managerial flow concept to analyse cases of economic development and establish lessons for broader managem

OBJECTIVES: Venovenous extracorporeal gas exchange is increasingly used in awake, spontaneously breathing patients as a bridge to lung transplantation. Limited data are available on a similar use of extracorporeal gas exchange in patients with acute respiratory distress syndrome. The aim of this study was to investigate the use of extracorporeal gas exchange in awake, spontaneously breathing sheep with healthy lungs and with acute respiratory distress syndrome and describe the interactions between the native lung (healthy and diseased) and the artificial lung (extracorporeal gas exchange) in this setting. DESIGN: Laboratory investigation. SETTING: Animal ICU of a governmental laboratory. SUBJECTS: Eleven awake, spontaneously breathing sheep on extracorporeal gas exchange. INTERVENTIONS: Sheep were studied before (healthy lungs) and after the induction of acute respiratory distress syndrome via IV injection of oleic acid. Six gas flow settings (1-10 L/min), resulting in different amounts of extracorporeal CO2 removal (20-100% of total CO2 production), were tested in each animal before and after the injury. MEASUREMENTS AND MAIN RESULTS: Respiratory variables and gas exchange were measured for every gas flow setting. Both healthy and injured sheep reduced minute ventilation according to the amount of extracorporeal CO2 removal, up to complete apnea. However, compared with healthy sheep, sheep with acute respiratory distress syndrome presented significantly increased esophageal pressure variations (25 ± 9 vs 6 ± 3 cm H2O; p < 0.001), which could be reduced only with very high amounts of CO2 removal (> 80% of total CO2 production). CONCLUSIONS: Spontaneous ventilation of both healthy sheep and sheep with acute respiratory distress syndrome can be controlled via extracorporeal gas exchange. If this holds true in humans, extracorporeal gas exchange could be used in awake, spontaneously breathing patients with acute respiratory distress syndrome to support gas exchan

Chest computed tomography (CT) is a fundamental tool for the characterization of acute respiratory distress syndrome (ARDS). Its frequent use is, however, hindered by the associated radiation exposure. The aim of the present study was to evaluate, in patients with ARDS, the accuracy of quantitative and visual anatomical lung analysis performed on low-dose CT. We hypothesized that low-dose CT would provide accurate quantitative and visual anatomical results. Chest CT was performed in 45 ARDS patients in static conditions at set airway pressures of 45 and 15 or 45 and 5 cmH(2)O. During each pause, two consecutive scans were obtained at two different tube current-time products (mAs). In 24 patients 110 mAs was coupled with 60 mAs; in 21 patients 110 was coupled with 30 mAs. All other CT parameters were kept unaltered. Quantitative and visual anatomical results obtained at different mAs were compared via Bland-Altman analysis. Good agreements were observed between 110 and 60 mAs and between 110 and 30 mAs both for quantitative and visual anatomical results (all biases below 1.5 %). Estimated mean effective dose at 110, 60, and 30 mAs corresponded to 5.3 +/- A 1.6, 2.8 +/- A 0.8, and 1.4 +/- A 0.3 mSv, respectively. In patients with ARDS a reduction of mAs up to 30 (70 % effective dose reduction) can be achieved without significant effect on quantitative and visual anatomical results. Low-dose chest CT, with related quantitative and visual anatomical analysis, could be a valuable tool to characterize and potentially monitor lung disease in patients with ARDS

Introduction: The clinical use of serial quantitative computed tomography (CT) to characterize lung disease and guide the optimization of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) is limited by the risk of cumulative radiation exposure and by the difficulties and risks related to transferring patients to the CT room. We evaluated the effects of tube current-time product (mAs) variations on quantitative results in healthy lungs and in experimental ARDS in order to support the use of low-dose CT for quantitative analysis. Methods: In 14 sheep chest CT was performed at baseline and after the induction of ARDS via intravenous oleic acid injection. For each CT session, two consecutive scans were obtained applying two different mAs: 60 mAs was paired with 140, 15 or 7.5 mAs. All other CT parameters were kept unaltered (tube voltage 120 kVp, collimation 32x0.5 mm, pitch 0.85, matrix 512x512, pixel size 0.625x0.625 mm ). Quantitative results obtained at different mAs were compared via Bland-Altman analysis. Results: Good agreement was observed between 60 mAs and 140 mAs and between 60 mAs and 15 mAs (all biases less than 1%). A further reduction of mAs to 7.5 mAs caused an increase in the bias of poorly and non aerated tissue (-2.9 and 2.4%, respectively) and determined a significant widening of the limits of agreement for the same compartments (-10.5 - 4.8 % for poorly aerated and -5.9 - 10.8% for non aerated tissue). Estimated mean effective dose at 140, 60, 15 and 7.5 mAs corresponded to 17.8, 7.4, 2.0 and 0.9 millisievert, respectively. Image noise of scans performed at 140, 60, 15 and 7.5 mAs corresponded to 10, 16, 38 and 74 Hounsfield Units, respectively. Conclusions: A reduction of effective dose up to 70% has been achieved with minimal effects on lung quantitative results. Low-dose computed tomography provides accurate quantitative results and could be used to characterize lung compartment distribution and possibly monitor t

PURPOSE: Bicaval dual-lumen catheters allow for single-site cannulation venovenous extracorporeal gas exchange and facilitate early mobilization of patients. Using these catheters blood is drained from the superior and inferior venae cavae, pumped through a respiratory membrane, and returned into the right atrium. The insertion of these catheters is challenging as their correct positioning is fundamental to reduce recirculation and avoid severe complications. We describe here a new technique for the positioning of bicaval dual-lumen catheters. MATERIALS AND METHODS: The right internal jugular vein was percutaneously cannulated in nine sheep. The distance between skin and tricuspid valve was measured from the point of pressure change in the waveform of a Swan-Ganz catheter being retracted from the right ventricle into the right atrium. The atrium-tricuspid valve-ventricle axis was determined by observing the fluctuations of the tip of the Swan-Ganz entering the ventricle during fluoroscopy. A bicaval dual-lumen catheter was placed on the basis of these evaluations and connected to an extracorporeal respiratory support system. RESULTS: The position of the catheter was verified at necropsy approximately 18 h after insertion. In all cases the catheter was correctly placed, with the central port situated in front of the tricuspid valve. CONCLUSIONS: The described technique may help to position bicaval dual-lumen catheters for venovenous extracorporeal gas exchange without the use of transesophageal echocardiography or contrast media during fluoroscopy

This study describes up-to-date cancer incidence and survival in Italian paediatric and adolescent patients, based on data collected by the network of Italian cancer registries (AIRTUM). It updates the monograph published on the same topic in 2008. The main objective of this monograph is to present the statistics according to standard rigorous epidemiological methods and disseminate them to a wide range of readers, including the lay public. Given the deep impact of the 2008 monograph on the general public, in this update we complement descriptive statistics with additional data and commentaries on issues of importance for public health, in order to provide unambiguous criteria on how to interpret the statistics. The study is the result of the collaboration between AIRTUM and AIEOP (Italian Association of Paediatric Haematology and Oncology) with contributions from interested parties, including representatives of parent associations. The monograph is divided into three parts. The first part presents incidence rates, survival probabilities, and time trends, by sex, age, geographical area, and cancer site or type, by means of tables and graphs as in the previous monograph, to facilitate direct comparisons. Four articles summarize and comment the results. The second part uses data from AIRTUM and AIEOP to outline patient management and health care issues; it includes estimates of the number of new cases in the next decade and of young adults living after a paediatric cancer diagnosis. Health organizational aspects of treatment services for paediatric patients, based on the AIEOP database, are also discussed, along with long-term complications in cured patients. The third section describes the changes in mortality trends due to improving therapies and healthcare services, and discusses risk factors and prevention of childhood cancer, late adverse events in cured patients, and other related issues.

Background: Major Depression (MD) and treatment-resistant depression (TRD) are worldwide leading causes of disability and therapeutic strategies for these impairing and prevalent conditions include pharmacological augmentation strategies and brain stimulation techniques. In this perspective, repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain stimulation technique with a favorable profile of tolerability which, despite being recently approved by the Food and Drug Administration (FDA) for the treatment of patients with medication-refractory unipolar depression, still raises some doubts about most effective parameters of stimulation. Methods: A literature search was performed using PubMed for the years 2001 through February 2011 in order to review meta-analytic studies assessing efficacy and safety issues for rTMS in depressive disorders. Fifteen meta-analyses were identified and critically discussed in order to provide an updated and comprehensive overview of the topic with specific emphasis on potentially optimal parameters of stimulation. Results: First meta-analyses on the efficacy of rTMS for the treatment of MD and TRD have shown mixed results. On the other hand, more recent meta-analytic studies seem to support the antidepressant efficacy of the technique to a greater extent, also in light of longer periods of stimulation (e.g. > 2 weeks). Conclusion: rTMS seems to be an effective and safe brain stimulation technique for the treatment of medication refractory depression. Nevertheless, further studies are needed to better define specific stimulation-related issues, such as duration of treatment as well as durability of effects and predictors of response. © Dell'Osso et al.

Il contributo presenta un modello di riferimento economico-aziendale per il coordinamento degli obiettivi di finanza pubblica tra governo centrale ed amministrazioni locali. Dopo aver delineato le logiche generali di programmazione e controllo nella prospettiva inter-istituzionale il saggio propone alcuni meccanismi operativi per la revisione del patto di stabilità interno.