Envelope wages, hidden production and labor productivity

We evaluate the relative importance of aggregate labor productivity versus income taxes and social contributions for tax compliance in an economy with a large degree of informality. Empirical evidence points out that tax evasion in Europe happens through partially concealing wages and profits in formally registered enterprises. To this end, we build a model in which employer-employee pairs of heterogeneous productive capacities make joint decisions on the degree of tax evasion. The quantitative model is used to analyze the case of Bulgaria which has the largest informal economy in Europe and underwent a number of important tax reforms over the period 2000–2014, including the introduction of a flat income tax in 2008. The estimation strategy relies on matching the empirical series for the size of the informal economy and other aggregate outcomes for 2000–2014. Our counterfactual experiments show that the most important factor for the changing size of the informal economy is labor productivity, which accounts for more than 75% of the change. The variation in corporate income tax accounts for the rest. We find that the 2008 flat tax reform did not play any visible role in coping with informality

Envelope Wages, Hidden Production and Labor Productivity

We evaluate the relative importance of aggregate labor productivity versus income taxes and social contributions for tax compliance in an economy with a large degree of informality. Empirical evidence points out that tax evasion in Europe happens through partially concealing wages and profits in formally registered enterprises. To this end, we build a model in which employer-employee pairs of heterogeneous productive capacities make joint decisions on the degree of tax evasion. The quantitative model is used to analyze the case of Bulgaria which has the largest informal economy in Europe and underwent a number of important tax reforms over the period 2000-2014, including the introduction of a flat income tax in 2008. The estimation strategy relies on matching the empirical series for the size of the informal economy and other aggregate outcomes for 2000-2014. Our counterfactual experiments show that the most important factor for the changing size of the informal economy is labor productivity, which accounts for more than 75% of the change. The variation in corporate income tax accounts for the rest. We find that the 2008 flat tax reform did not play any visible role in coping with informality

Colorectal resections - clinical and immunological results

INTRODUCTION: Surgery induces a generalized state of postoperative immunosuppression responsible for a lot of complications in postoperative period. Magnitude and type of the intraoperative injury depend on the extent and duration of postoperative immune suppression. This study compared clinical outcomes and immune changes after minimally invasive and open colorectal resections in patients with colorectal cancer (CRC).MATERIAL AND METHODS: Study included 40 patients with CRC who underwent colorectal resections in our clinic last year. Twenty one of them underwent minimally invasive surgery, with a mean age of 64.8 years (49-86). The rest 19 patients underwent conventional surgery, with a mean age of 66.2 years (56-84). Blood tests were performed 24 hours prior to surgery, 24 hours and 7 days after surgery. Analysis included full blood count, total protein, albumin and markers of inflammation (CRP, ESR, fibrinogen). T- (CD3+), B- (CD19+) and NK-cell lymphocyte populations were studied by means of flow cytometry, as well as activation of leucocytes, according to the expression of HLA-DR, CD38, CD279, CD163 and some clinical parameters. All data were analyzed using SPSS version 21.RESULTS: There was no significant difference in preoperative results between minimally invasive group and conventional group. At 24 hours after surgery there were significant decrease in lymphocyte percentages and increased leucocyte count, granulocyte percentages and CRP levels in conventional group. This ratio maintained at 7 days after surgery. Activated monocyte (CD 163+), total protein and albumin, eosinophiles, percentage of monocytes, lymphocytes and NKT-cells (CD3+ CD16/CD56+) were significant decrease in conventional group compared with minimally invasive group at first postoperative day.CONCLUSIONS: Minimally invasive colorectal cancer resection is a technically feasible option, with comparable results in terms of oncologic clearance, lesser degrees of tissue injury, surgical metabolic stress, and immunosuppressive response to conventional open surgery. Patients undergoing minimally invasive resections demonstrated improved clinical recovery and shorter hospital stay than patients undergoing open surgery. 

Cystic Echinococcosis of the Breast - Diagnostic Dilemma or just a Rare Primary Localization

Introduction: Although the liver and lung are the most frequently affected organs in cystic echinococcosis, the cysts may develop in any viscera and tissues. Breast is a rare primary localization with few cases described in the literature. We present an updated and systematic review and discuss the possible mechanisms of spreading, diagnostic and treatment options.Materials and methods: We performed a literature search in PUBMED using the key words ‘hydatid disease’, ‘cystic echinococcosis’ and ‘breast echinococcosis’ without time limitation. Only studies reporting breast cystic echinococcosis were included.Results: Overall, 121 cases with cystic echinococcosis and 2 with alveolar echinococcosis were reported. A total of 52 cases were included in the analysis. The mean size of cysts was 5.5 cm (range 1.7-12). The most common clinical presentation was painless lump presented from 4 months to 19 years before the final diagnosis. Most cases had isolated breast CE, few cases had synchronous localizations – femoral, thigh and lung, and previous liver CE. Most were active CL and CE1-2 cysts (72%). Ultrasound was used in 83%, followed by mammography (35%). Fine needle aspiration was reported in 27 cases with positive finding in 59%.Conclusions: In cases with cystic breast lesions from endemic regions we recommend the US as a gold standard. CT and MRT are more accurate but expensive tools without the potential to change the surgical tactic. In contrast to the other localizations of CE, complete excision of the cysts is the best diagnostic and treatment approach

Laparoscopic Treatment Of High Sigmoidovaginal Fistula. Case Report

Rectovaginal and/or colovaginal fistulas are difficult-to-treat conditions that can cause vaginitis, abnormal flatulence through the vagina, skin excoriations, and more. Depending on the type of fistula, they can be rectovaginal, anovaginal, colovaginal, enterovaginal, vesicovaginal, ureterovaginal, urethrovaginal, with the most common being vesicovaginal and rectovaginal. In most cases, these conditions present a challenge and require a comprehensive diagnostic approach and treatment. We present a clinical case of a 73-year-old patient manifesting with flatulence through the vagina. During hospitalization, a high sigmoidovaginal fistula was diagnosed. The patient has a history of hysterectomy 17 years ago, due to myomatous uterus. Subsequently, she had three operations for postoperative hernia, two of which involved the placement of synthetic mesh. During the diagnostic plan, diverticulosis of the colon was also detected. This was observed as probable etiological cause for the formation of the fistula. The patient had comorbidities: arterial hypertension and severe obesity (Grade III). A laparoscopic disconnection of the fistula was performed, followed by laparoscopic suturing of the vagina and sigmoid colon, with subsequent omentoplasty. After an uncomplicated postoperative period, the patient was discharged on the 5th postoperative day, fully mobilized, with restored gas and feculent passage. There are few cases of high sigmoidoaginal fistulas described in the medical literature. The treatment in such patients is still unclear and subject to discussion. With the advancement of minimally invasive techniques in medicine, the laparoscopic surgical approach is a suitable option for treatment, but long-term follow-up and in-depth analyses are necessary

Late Diagnosis of Urinary Peritonitis Due to a Lesion of the Left Ureter During Laparoscopic Anterior Resection of the Rectum—Laparoscopic Solution. Clinical Case and Literature Review

Ureteral lesions are a rare complication of colorectal surgery. This type of surgical procedure is the second most common cause of such complications, second only to gynecological operations, which account for around 50%. According to the localization of the lesion, they аre grouped into three types: injury to the proximal, middle, and distal part of the ureter, with the latter being the most common—around 80–90%. Most of the lesions are not recognized intraoperatively and sometimes the diagnosis can be delayed significantly. The time of diagnosis and the localization of the injury are crucial to the choice of treatment. We present a case of a patient, with a late diagnosis of lesion of the left ureter after the laparoscopic anterior resection of the rectum, which was treated with a laparoscopic uretero-ureteral anastomosis with simultaneous double-J catheterization. We also present a short literature review on the subject

Effects of Psychopathy on Neurocognitive Domains of Impulsivity in Abstinent Opiate and Stimulant Users

Background: Psychopathy and substance use disorders (SUDs) are both characterized by neurocognitive impairments reflecting higher levels of impulsivity such as reward-driven decision-making and deficient inhibitory control. Previous studies suggest that psychopathy may exacerbate decision-making deficits, but it may be unrelated to other neurocognitive impairments among substance dependent individuals (SDIs). The aim of the present study was to examine the role of psychopathy and its interpersonal-affective and impulsive-antisocial dimensions in moderating the relationships between dependence on different classes of drugs and neurocognitive domains of impulsivity.Method: We tested 693 participants (112 heroin mono-dependent individuals, 71 heroin polysubstance dependent individuals, 115 amphetamine mono-dependent individuals, 76 amphetamine polysubstance dependent individuals, and 319 non-substance dependent control individuals). Participants were administered the Psychopathy Checklist: Screening Version (PCL:SV) and seven neurocognitive tasks measuring impulsive choice/decision-making (Iowa Gambling Task; Cambridge Gambling Task; Kirby Delay Discounting Task; Balloon Analog Risk Task), and impulsive action/response inhibition (Go/No-Go Task, Immediate Memory Task, and Stop Signal Task).Results: A series of hierarchical multiple regressions revealed that the interpersonal-affective dimension of psychopathy moderated the association between decision-making, response inhibition and both amphetamine and heroin dependence, albeit differently. For amphetamine users, low levels of interpersonal-affective traits predicted poor decision-making on the Iowa Gambling Task and better response inhibition on the Stop Signal task. In contrast, in heroin users high interpersonal-affective psychopathy traits predicted lower risk taking on the Cambridge Gambling Task and better response inhibition on the Go/No-Go task. The impulsive-antisocial dimension of psychopathy predicted poor response inhibition in both amphetamine and heroin users.Conclusions: Our findings reveal that psychopathy and its dimensions had both common and unique effects on neurocognitive function in heroin and amphetamine dependent individuals. Our results suggest that the specific interactions between psychopathy dimensions and dependence on different classes of drugs may lead to either deficient or superior decision-making and response inhibition performance in SDIs, suggesting that psychopathy may paradoxically play a protective role for some neurocognitive functions in specific subtypes of substance users

Validation of the Substance Use Risk Profile Scale (SURPS) With Bulgarian Substance Dependent Individuals

Background: The Substance Use Risk Profile Scale (SURPS) is a 23-item self-report questionnaire that assesses four well-validated personality risk factors for substance misuse (Impulsivity, Sensation Seeking, Anxiety Sensitivity, and Hopelessness). While the SURPS has been used extensively with adolescents at risk for substance dependence, its properties with adult substance-dependent populations have been understudied. Further, the validity of the Bulgarian version of the SURPS has not been evaluated. The aims of the present study were to examine the factor structure of the Bulgarian version of the SURPS, its psychometric properties, and its ability to distinguish individuals with substance dependence from healthy controls.Methods: Participants included 238 individuals ages 18 to 50 (45% female): 36 “pure” (i.e., mono-substance dependent) heroin users, 34 “pure” amphetamine users, 32 polysubstance users, 64 controls with no history of substance dependence, 43 unaffected siblings of heroin users, and 29 unaffected siblings of amphetamine users. We explored the factor structure of the Bulgarian version of the SURPS with confirmatory factor analyses, examined its reliability and validity, and tested for group differences between substance dependent and non-dependent groups.Results: Confirmatory factor analyses (CFA) replicated the original four-factor model of the SURPS. The four subscales of the SURPS demonstrated good internal consistency (Cronbach's alphas ranged from 0.71 to 0.85) and adequate concurrent validity. Significant group differences were found on the Impulsivity and Sensation Seeking subscales, with the three substance dependent groups scoring higher than controls.Conclusions: The SURPS is a valid instrument for measuring personality risk for substance use disorders in the Bulgarian population. The Bulgarian version of the SURPS demonstrates adequate to good reliability, concurrent validity, and predictive validity. Its ability to distinguish between groups with and without a history of substance dependence was specific to externalizing traits such as Impulsivity and Sensation Seeking, on which opiate, stimulant, and polysubstance dependent individuals scored higher than non-dependent controls

Global Study of Nuclear Structure Functions

We present the results of a phenomenological study of unpolarized nuclear structure functions for a wide kinematical region of x and Q^2. As a basis of our phenomenology we develop a model which takes into account a number of different nuclear effects including nuclear shadowing, Fermi motion and binding, nuclear pion excess and off-shell correction to bound nucleon structure functions. Within this approach we perform a statistical analysis of available data on the ratio of the nuclear structure functions F_2 for different nuclei in the range from the deuteron to the lead. We express the off-shell effect and the effective scattering amplitude describing nuclear shadowing in terms of few parameters which are common to all nuclei and have a clear physical interpretation. The parameters are then extracted from statistical analysis of data. As a result, we obtain an excellent overall agreement between our calculations and data in the entire kinematical region of x and Q^2. We discuss a number of applications of our model which include the calculation of the deuteron structure functions, nuclear valence and sea quark distributions and nuclear structure functions for neutrino charged-current scattering.Comment: 67 pages, 18 figures (v3: updated text and references, a new section with discussion about relation between off-shell effect and modification of the nucleon size in nuclei, accepted for publication in Nucl. Phys. A

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation