Pleural tuberculosis: medical thoracoscopy greatly increases the diagnostic accuracy

Our objective was to evaluate the efficacy of a standardised work-up in the diagnosis of pleural tuberculosis (TB) that included fibreoptic bronchoscopy and medical thoracoscopy. A consecutive series of 52 pleural TB patients observed during the period 2001-2015 was evaluated retrospectively. 20 females, mean (range) age 39.7 (18-74) years, and 32 males, mean (range) age 45.75 (21-83) years, were included (28 non-EU citizens (53.8%)). The diagnosis of TB infections was established by identification (using stains, culture or molecular tests) of Mycobacterium tuberculosis in the pleura, sputum and/or bronchial specimens, or by evidence of caseous granulomas on pleural biopsies. Patients with and without lung lesions were considered separately. The diagnostic yield of the microbiological tests on pleural fluid was 17.3% (nine out of 52 patients). Among the 18 patients with lung lesions, bronchial samples (washing, lavage or biopsy) were positive in 50% of cases (nine patients). Cultures of pleural biopsies were positive in 63% of cases (29 out of 46 patients); pleural histology was relevant in all patients. Without pleural biopsy, a diagnosis would have been reached in 15 out of 52 patients (28.6%) and in four of them only following culture at 30-40 days. An integrated diagnostic work-up that includes all the diagnostic methods of interventional pulmonology is required for a diagnosis of pleural TB. In the majority of patients, a diagnosis can be reached only with pleural biopsy

L'economia politica e l'evoluzione del capitalismo negli ultimi quarant'anni

Convegno in onore di Giorgio Lunghini

Modelling human choices: MADeM and decision‑making

Research supported by FAPESP 2015/50122-0 and DFG-GRTK 1740/2. RP and AR are also part of the Research, Innovation and Dissemination Center for Neuromathematics FAPESP grant (2013/07699-0). RP is supported by a FAPESP scholarship (2013/25667-8). ACR is partially supported by a CNPq fellowship (grant 306251/2014-0)

Conflict between communities, citizen ownership and the production of public goods

The paper investigates the conditions under which consumer ownership should be preferred to investor ownership in economies with externalities. On making their choices investor-owners take into account producer surplus only, while consumer-owners take into account both producer and consumer surplus, whereby consumer-owned firms' objectives are naturally aligned with those of society. Nonetheless, we find that pursuing consumers' objectives may be socially less beneficial than pursuing investors', when external effects of consumption are at work. For the dominance of investor ownership there is needed a conflict, in a sense that is made precise in the paper, between the community of consumers and external communities of citizens affected by the externality. This, however, is not by itself sufficient and there is also needed the existence of a s common interest between investors and the external community of citizens

Customer Ownership and Quality Provision in Public Services under Asymmetric Information

The implementation of projects producing external effects is often a source of disagreement and conflict between hosting and nonhosting communities. The article focuses on the impact of participatory ownership on conflict resolution and social welfare in the presence of asymmetric information and imperfect quality monitoring. We show that in such situations the participatory solution may help solve deadlocks that money transfers to a for-profit operator cannot solve. The analysis highlights three main factors behind this fact. First, a customer-owned cooperative internalizes, at least partially, the external effects generated by the project. Second, the alignment of cooperative members' preferences with those of the social planner reduces (in some cases eliminates) the distortions caused by information asymmetries. Third, cooperatives require less costly monitoring than their for-profit counterparts. We also show that cooperatives' productive inefficiency with respect to for-profits may emerge endogenously as a consequence of a lower pressure to compete on costs for the market