ECONOMIC REGIONAL IMPACT OF THE NATIONAL RECOVERY AND RESILIENCE PLAN: THE CASE OF SICILY

La Sicilia, in questi ultimi cinque anni, è stata caratterizzata da una drammatica crisi economica e sociale che ha fatto precipitare la regione in una continua recessione sempre più profonda in cui le disuguaglianze economiche, sociali e territoriali permangono non solo all’interno delle aree urbane ma anche in confronto all’eterogeneità tra le regioni del nostro paese e quelle europee. Il quadro macroeconomico siciliano è penalizzato principalmente da due eventi straordinari che ne evidenziano sempre di più la fragilità del tessuto regionale, la cui manifestazione, a distanza così ravvicinata, rappresenta comunque una circostanza inconsueta: la crisi economico-sanitaria dovuta alla pandemia da Covid-19 e le difficoltà originate dallo scenario internazionale, in particolare quelle causate dal conflitto russoucraino. Alla luce delle dinamiche di questo contesto, la Regione Siciliana, in linea con gli indirizzi di programmazione economica della Commissione Europea, ha pianificato un pacchetto di misure di politica economica rivolte a stimolare la fase di ripresa per le quali si prevedono opportunità di sviluppo, investimenti e riforme, cercando di riparare i danni economici causati dalla diffusione della pandemia. L’obiettivo di questo lavoro è di analizzare gli effetti della manovra del piano regionale di ripresa e resilienza della Sicilia, programmata dal governo regionale per stimolare la ripresa economica, a seguito degli effetti del lockdown e valutare gli impatti delle diverse proposte sull’economia siciliana. La presentazione del contesto socio-economico della regione siciliana ha richiesto la predisposizione di un set di informazioni dettagliate e adeguate a livello locale. L’utilizzo di queste informazioni da parte dell’amministrazione regionale permetterebbe di programmare le manovre di politica economica orientate alla ricerca di quelle variabili di policy, che sia nel breve periodo (stabilizzazione) che nel lungo periodo (sviluppo) sarebbero in grado di elaborare gli interventi indirizzati alla realizzazione degli obiettivi fissati e di valutarne ex-ante ed ex-post l’impatto sulle principali variabili macroeconomiche. A questo fine, è stata costruita appositamente una base dati specifica per la Regione Sicilia, Social Accounting Matrix (SAM), in grado di presentare e valutare, attraverso l’analisi multisettoriale, gli effetti diretti, indiretti e indotti sulle principali variabili macroeconomiche, in termini aggregati e disaggregati, delle politiche pubbliche. Disporre di questo tipo di schema contabile significa rappresentare in modo articolato la situazione economica e sociale della regione. Sulla base dei dati forniti dalla matrice di contabilità sociale è stato costruito un modello computazionale di equilibrio economico generale (CGE) specifico per la Sicilia, in grado di valutare l’impatto delle politiche economiche regionali sul territorio della regione. Il modello proposto è un modello computazionale di equilibrio economico generale statico e disaggregato, modellato tenendo conto delle funzioni comportamentali e dei vincoli di bilancio per quanti sono i settori istituzionali inclusi nella SAM, con l'obiettivo di quantificare gli effetti diretti, indiretti e indotti delle politiche fiscali adottate. Nel primo capitolo si presenta il sistema economico regionale siciliano descrivendone le caratteristiche economiche, strutturali e territoriali, in un contesto normativo definito e regolato da un’autonomia speciale regionale e di delicato stadio di transizione per una prospettiva migliore di sviluppo. Si è proceduto, in base alle informazioni disponibili e alle indagini effettuate, all’esplorazione, descrizione e sintesi dei dati di ricerca economica della Regione Sicilia per una accurata comprensione e conoscenza del tessuto territoriale regionale, individuandone punti di forza e di debolezza. Il lavoro offre un punto di partenza per la conoscenza e l’analisi dei principali problemi dell’economia siciliana. Il secondo capitolo delinea la proposta dell’Amministrazione regionale ai fini della realizzazione di una quota di interventi del Piano Nazionale di Ripresa e Resilienza (PNRR), nonché le difficoltà di progettualità, ai fini dell’allocazione delle risorse e dell’ammissibilità dei progetti. Per la realizzazione di tali interventi è necessario avere a disposizione strumenti interpretativi per il policy maker che permettano di pianificare politiche di implementazione mirate alla realizzazione dei risultati attesi. In questo ambito, lo strumento scelto ai fini dell’analisi dell’impatto delle politiche economiche regionali sul tessuto economico territoriale è il modello computazionale di equilibrio economico generale (CGE). Si è proceduto pertanto alla costruzione del modello computazionale attraverso un inquadramento teorico, definendone le caratteristiche e le peculiarità. Il terzo capitolo presenta l’analisi dei risultati della proposta regionale di ripresa e resilienza approvata dal governo regionale per superare la crisi dovuta all’emergenza da pandemia. L’analisi dei diversi scenari individua le peculiarità dell’economia regionale, caratterizzata da interazioni esistenti tra processi produttivi, generazione di valore aggiunto e settori istituzionali. Il modello CGE regionale siciliano, permettendo di confrontare una situazione di equilibrio iniziale con una controfattuale dovuta alla realizzazione della manovra di politica economica, consente di definire l’importanza e la fondatezza degli impatti di tale manovra sulle grandezze macroeconomiche regionali, fornendo utili indicazioni di policy. In questo lavoro le simulazioni presentate in base a un apprezzabile livello di disaggregazione del processo produttivo individuano le strutture di intervento di policy sulla produzione, sulla domanda finale e sul reddito disponibile effettuate dai settori istituzionali. Gli interventi della politica di implementazione regionale, stimolando i consumi della pubblica amministrazione e gli incentivi agli investimenti, agevolando la crescita produttiva attraverso trasferimenti e contributi alle imprese, generano un effetto moltiplicatore positivo sul Pil regionale per tutto l’arco temporale considerato. I risultati ottenuti dalle diverse simulazioni, seguendo le fasi del flusso circolare del reddito, dimostrano come gli interventi di policy della manovra regionale siano uno stimolo per la crescita economica dell’economia regionale, registrando un significativo incremento del prodotto interno lordo reale e in generale di tutte le sue component

The role of healthcare professionals in encouraging parents to see and hold their stillborn baby: a meta-synthesis of qualitative studies.

Background: Globally, during 2013 there were three million recorded stillbirths. Where clinical guidelines exist some recommend that professionals do not encourage parental contact. The guidance is based on quantitative evidence that seeing and holding the baby is not beneficial for everyone, but has been challenged by bereaved parents' organisations. We aim to inform future guideline development through a synthesis of qualitative studies reporting data relevant to the research question; how does the approach of healthcare professionals to seeing and holding the baby following stillbirth impact parents views and experiences? Methods/Findings: Using a predetermined search strategy of PubMed and PsychINFO we identified robust qualitative studies reporting bereaved parental views and/or experiences relating to seeing and holding their stillborn baby (final search 24 February, 2014). Eligible studies were English language, reporting parental views, with gestational loss >20weeks. Quality was independently assessed by three authors using a validated tool. We used meta-ethnographic techniques to identify key themes and a line of argument synthesis. We included 12 papers, representing the views of 333 parents (156 mothers, 150 fathers, and 27 couples) from six countries. The final themes were: "[Still]birth: Nature of care is paramount", "Real babies: Perfect beauties, monsters and spectres", and "Opportunity of a lifetime lost." Our line-of-argument synthesis highlights the contrast between all parents need to know their baby, with the time around birth being the only time memories can be made, and the variable ability that parents have to articulate their preferences at that time. Thus, we hypothesised that how health professionals approach contact between parents and their stillborn baby demands a degree of active management. An important limitation of this paper is all included studies originated from high income, westernised countries raising questions about the findings transferability to other cultural contexts. We do not offer new evidence to answer the question "Should parents see and hold their stillborn baby?", instead our findings advance understanding of how professionals can support parents to make appropriate decisions in a novel, highly charged and dynamic situation. Conclusions: Guidelines could be more specific in their recommendations regarding parental contact. The role of healthcare professionals in encouraging parents to see and hold their stillborn baby is paramount. Parental choice not to see their baby, apprehension, or uncertainty should be continuously revisited in the hours after birth as the opportunity for contact is fleeting and final

KODAMA: an R package for knowledge discovery and data mining

Summary: KODAMA, a novel learning algorithm for unsuper-vised feature extraction, is specifically designed for analysing noisy and high-dimensional data sets. Here we present an R package of the algorithm with additional functions that allow improved interpretation of high-dimensional data. The pack-age requires no additional software and runs on all major plat-forms. Availability and Implementation: KODAMA is freely available from the R archive CRAN (http://cran.r-project.org). The soft-ware is distributed under the GNU General Public License (ver-sion 3 or later)

Long-term effects of functional appliances in treated versus untreated patients with Class II malocclusion: A systematic review and meta-analysis

Objective To assess the cephalometric skeletal and soft-tissue of functional appliances in treated versus untreated Class II subjects in the long-term (primarily at the end of growth, secondarily at least 3 years after retention). Search methods Unrestricted electronic search of 24 databases and additional manual searches up to March 2018. Selection criteria Randomised and non-randomised controlled trials reporting on cephalometric skeletal and soft-tissue measurements of Class II patients (aged 16 years or under) treated with functional appliances, worn alone or in combination with multi-bracket therapy, compared to untreated Class II subjects. Data collection and analysis Mean differences (MDs) and 95% confidence intervals (95% CIs) were calculated with the random-effects model. Data were analysed at 2 primary time points (above 18 years of age, at the end of growth according to the Cervical Vertebral Maturation method) and a secondary time point (at least 3 years after retention). The risk of bias and quality of evidence were assessed according to the ROBINS tool and GRADE system, respectively. Results Eight non-randomised studies published in 12 papers were included. Functional appliances produced a significant improvement of the maxillo-mandibular relationship, at almost all time points (Wits appraisal at the end of growth, MD -3.52 mm, 95% CI -5.11 to -1.93, P < 0.0001). The greatest increase in mandibular length was recorded in patients aged 18 years and above (Co-Gn, MD 3.20 mm, 95% CI 1.32 to 5.08, P = 0.0009), although the improvement of the mandibular projection was negligible or not significant. The quality of evidence was \u2018very low\u2019 for most of the outcomes at both primary time points. Conclusions Functional appliances may be effective in correcting skeletal Class II malocclusion in the long-term, however the quality of the evidence was very low and the clinical significance was limited

Early diagnosed impacted maxillary canines and the morphology of the maxilla: a three-dimensional study

BACKGROUND: The aetiology of the canine displacement still remains controversial. Some authors implicated a deficiency in maxillary width as a local mechanical cause for impacted canines. The aim of the study was to examine whether there is a relationship between impacted maxillary canines, early diagnosed by using panoramic radiographs, and the morphology of the maxilla on 3D model casts. METHODS: The displaced maxillary canines (DMC) group consisted of 24 patients (mean age, 9.1\u2009\ub1\u20091.1 years), while the control group consisted of 25 subjects (mean age, 8.7\u2009\ub1\u20090.9 years). Seven measurements were calculated on the digital casts of each subject: intermolar width (IMW), arch length (AL), depth of the palatal vault (PVD), available arch space (AAS), the sum of the anterior segments (SAS), the right/affected (R-Af) and left/unaffected (L-Un) available spaces. RESULTS: Both IMW and AL in the DMC group were significantly decreased relative to the control group (P\u2009<\u20090.01), indicating that patients with displaced canines presented a shorter and narrower palate than subjects without eruption problems. Moreover, the values of the SAS and AAS were significantly decreased (P\u2009<\u20090.01) in the DMC group relative to the controls. CONCLUSIONS: The shape of the maxillary arch was narrower and shorter in the displaced maxillary canines group compared with the control group

BILATERAL RENAL ARTERY STENOSIS IN A HYPERTENSIVE LUPUS PATIENT WITHOUT RENAL DYSFUNCTION: A CASE REPORT

Systemic lupus erythematosus (SLE) is associated with a high prevalence of atherosclero-sis and an enhanced cardiovascular mortality. In adult subjects, several studies have shown the coexistence of SLE and renal artery stenosis, most of them with unilateral in-volvement or with renal dysfunction. We observed a 62-year-old man with SLE and a 10-year history of moderate-to-severe hy-pertension who was admitted to our hospital because of uncontrolled blood pressure val-ues (152/95 mmHg), despite drug therapy. No signs of renal impairment were evident. After an initial physical examination, which presented a periumbilical bruit, a renal ultra-sound was performed with evidence of bilateral renal artery stenosis. An angio-MR study also confirmed the diagnosis and showed a double renal artery on the right side. Many different factors can contribute to the bilateral renal artery stenosis in this patient. Chronic inflammatory state associated to SLE, metabolic alterations with dyslipidemia and steroid therapy may all be involved in the development of the renal atherosclerotic le-sions

Telerehabilitation for Lee Silverman Voice Treatment (Tele-LSVT)-Loud on voice intensity and voice use in daily living in people with multiple sclerosis: A protocol for a feasibility and pilot randomized controlled study

Objective: Alterations in voice intensity and quality may constitute a social life limitation in people with multiple sclerosis (MS), but only 2% of cases receive speech therapy. Especially the Lee Silverman Voice Treatment (LSVT)-Loud is a highly effective intensive method for voice intensity, requiring subjects’ repeated attendance at the clinic. Telerehabilitation may represent a feasible solution to bypass potential barriers related to speech therapy attendance, scaling up the beneficial effects of the treatment to a broader population. The proposed protocol aims to test the feasibility and the pilot efficacy of the LSVT-Loud delivered in telerehabilitation (Tele-LSVT-Loud), compared to the same treatment delivered in the clinic (LSVT-Loud). Methods: A single-blinded, parallel, two-arm, pilot randomized (1:1 ratio) controlled trial will be performed involving 20 people with MS. Patients will be allocated to 4 weeks of Tele-LSVT-Loud by accessing a telerehabilitation platform at home or LSVT-Loud conventionally delivered in the clinic. Feasibility and pilot effectiveness will be evaluated three times: before (T0), after the treatment (T1), and 3-month follow-up (T2). Feasibility measures will include adherence, adverse events, user experience, motivation, engagement, and acceptability. Vocal intensity during a 1-minute monologue will be the primary outcome measure. Secondary outcome measures will be the vocal quality during a 1-minute monologue, sustained /a/ voice intensity, quality and stability, voice use in daily life, voice subjective perception in daily life, and quality of life. Results: Expected results will be (1) high feasibility of Tele-LSVT-Loud and (2) a non-inferiority effect of Tele-LSVT-Loud compared with face-to-face treatment delivery on voice intensity and quality outcomes. Conclusions: Tele-LSVT-Loud may be a feasible intervention for MS alteration in voice intensity and quality with a non-inferior effect compared to LSVT-Loud

Switch to restoration therapy in a testosterone treated central hypogonadism with erythrocytosis

We describe a case of severe erythrocytosis caused by testosterone replacement therapy in a 66-year-old man affected with hypogonadotropic hypogonadism (HH) determining osteoporosis, resolved by switching to restoration therapy with clomiphene citrate. The patient complained fatigue, loss of libido and defective erections and a spontaneous vertebral fracture despite bisphosphonate therapy and vitamin D supplementation. The examinations proved isolated HH and he was therefore treated with testosterone gel with regression of specific manifestations but elevated hemoglobin and hematocrit values. Therefore, it was decided to switch to a restoration therapy with clomiphene citrate 25\u2009mg/die, which resulted in the resolution of symptoms without evident side effects. In a couple of months, the patient showed normalization of testosterone levels and increment of testicular volume. Since secondary hypogonadism is the consequence of an insufficient stimulation of the gonads by hypothalamic-pituitary axis, therapeutic approaches aimed to restore endogenous testosterone production should be considered in alternative to testosterone replacement, particularly if side effects intervene. Among these strategies, clomiphene citrate seems to have a high efficacy and safety profile also in the elderly with isolated HH and no evident pituitary lesion

Pathology of autoimmune hepatitis

Autoimmune hepatitis (AIH) is a relatively rare non-resolving chronic liver disease, which mainly affects women. It is characterized by hypergammaglobulinemia, circulating autoantibodies, interface hepatitis on liver histology and a favourable response to immunosuppression. The putative mechanism for the development of autoimmune hepatitis is thought to be the interaction between genetic predisposition, environmental triggers and failure of the native immune system. AIH still remains a major diagnostic and therapeutic challenge, mainly because it is a very heterogeneous disease. Prompt and timely diagnosis is crucial since, if left untreated, AIH has a high mortality rate. Histological demonstration of hepatitis is required for the diagnosis of AIH and, therefore, liver biopsy is mandatory in the initial diagnostic work-up, before treatment. In this review, we summarize the histological features of AIH with the main aim of highlighting the most important clinical-pathological hallmarks useful in the routine diagnostic practice