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Patterns of Disease Progression and Outcomes of Inferior ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: The Multicenter INSTINCT Registry
No full text: Background: Cardiogenic shock (CS) is a frequent presentation of anterior ST-elevation myocardial infarction (STEMI); however, data regarding disease progression and outcomes in inferior STEMI complicated by CS are scarce. The present study aims to analyze the prevalence, patterns of disease progression, and outcomes of inferior STEMI-CS. Methods: The INSTINCT (Inferior ST-elevation myocardial Infarction complicated by Cardiogenic shock) Registry retrospectively included consecutive patients who developed CS following inferior STEMI treated at three centers in Italy from 2015 to 2023. Data regarding CS stage according to the Society of Cardiovascular Angiography and Interventions (SCAI) upon diagnosis of shock and during disease progression and in-hospital outcomes were collected. Patients were defined "worsening" (WPs) if the SCAI stage increased. Results: A total of 130 patients developed CS after inferior STEMI and were included in the analysis, the mean age was 69.8 ± 12.4 years, and 31.5% were female. The rate of in-hospital mortality was 22.3%; predictors of in-hospital mortality were cardiopulmonary resuscitation (CPR) > 20 min or refractory cardiac arrest (CA) (OR [CI]: 9.67 [3.17-29.51]), persistently low systolic blood pressure (SBP) (OR [CI]: 12.91 [2.47-68.82]), and increase in lactates (OR [CI]: 3.53 [1.42-7.87]) during medical management. Twenty (15.4%) patients experienced worsening CS; WPs had a significantly higher rate of in-hospital mortality (13 [65%] vs. 15 [13.6%], p < 0.001), major bleeding (4 [20%] vs. 7 [6.4%], p = 0.044), and mechanical circulatory support weaning failure (7 [35%] vs. 3 [2.7%], p = 0.032). Conclusions: The in-hospital mortality rate of inferior STEMI complicated by CS was 22.3%. Predictors of in-hospital mortality included prolonged CPR, persistently low SBP, and elevated lactates. Progression through SCAI stages was rare but associated with significantly higher mortality and complication rates
Relationship Between Vertical Facial Patterns and Palatal Morphology in Class I and Class II Malocclusion
Full text linkAbstract: (1) The purpose of this study is to relate the bidimensional and tridimensional
measures of the palate to the vertical facial pattern defined by the angle “SN-MP” between
the mandibular plane and the anterior cranial base (Sella–Nasion/mandibular plane angle)
in skeletal Class II untreated patients. Furthermore, the same palatal measures were
used to compare Class II with Class I subjects. (2) A sample of 197 Class II Caucasian
subjects (112 females and 85 males) with untreated skeletal Class II was collected retrospectively
(from a private dental clinic specialized in orthodontics) and divided into two
main groups according to the ANB angle: 74 Class I patients (0° ≤ ANB ≤ 4°) and 123 Class
II patients (ANB > 4°). Class II subjects were furthermore divided into three groups depending
on the angle SN-MP. Lateral cephalograms and digital 3D maxillary dental scans
were available. Bidimensional and tridimensional measures were taken on each maxillary
dental scan. The differences among the groups were analyzed for significance using a variance
analysis. (3) A decrease in the posterior palatal height and an increase in the palatal
surface area in Class I subjects were reported. The results showed a change in upper arch
form, with a greater intermolar width in patients with a low SN-MP angle and a smaller
one in high-angle patients. The more a Class II subject tended towards high-angle divergence,
the narrower the palate was. (4) A greater posterior palatal height was found in
Class II malocclusion, while greater surface area was noted in Class I malocclusion. In
addition to this result, another statistical significance was detected in Class II malocclusion:
the intermolar distance was greater in hypodivergent than in hyperdivergent patients.
Similar volume values were noted across different malocclusions and vertical divergence
groups. Palatal width seemed to be related to vertical facial pattern, while palatal
height and area seemed to be related to sagittal malocclusions. These findings underscore
the importance of considering palatal morphology variations in designing individualized
orthodontic treatments, thereby improving patient-specific outcomes and broadening
our understanding of skeletal Class II malocclusion
Per una chiesa in Uscita: il caso dei «Promessi sposi»
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Il saggio esplora il concetto di "chiesa in uscita" nei "Promessi Sposi" di Manzoni, analizzando come l'autore incarni i principi cristiani attraverso i personaggi e la struttura narrativa. Figure come Padre Cristoforo e il Cardinale Borromeo rappresentano diversi approcci missionari. Manzoni "disloca il sacro", trasferendo elementi religiosi in contesti narrativi, come il sacrificio di Cristo riflesso nella vicenda di Lucia. Il romanzo, quindi, non si limita a descrivere la religione, ma ne mette in atto i valori essenziali
The Hidden Preparation of the Great War: The Commitment of the Italian Army to Horse Selection, 1861–1914
No full textBefore the military motorization, it was essential for armies to have a reserve of animals to be requisitioned in the event of war mobilization, both for food and as means of transport. Even in peacetime, military authorities were interested in animals normally used for civil purposes, looking at the size of the stock and taking care of their quality. In the case of horses, the State arranged for the purchase of part of the breeders, taking into account military authorities’ requirements. On the other hand, the use of horses in agriculture and other sectors intensified. In facts, farmers developed a real “hunger for energy”, looking for animals more specialized in work, by means of a more careful feeding and breeding. Therefore, farmers and their associations looked for other breeds, different from the heavy horses traditionally imported from Central and Northern Europe, or the elegant breeds liked by the nobility and the military word. Their criteria did not correspond at all to rural needs and exacerbated the confusion among the selection of breeds. Due to the "horse issue", an intense debate and several initiatives at different level arose. Consequently, a private and cooperative industry of breeding horses controlled by farmers emerged, while the State abandoned direct control over animal reproduction. Our contribution will analyze this divergence of interests and criteria about horse breeding between the military and farmers at different levels, from the management of State stallions to national discussions on horse policy (Departments of Agriculture and War, National zoo-technical Council, Parliament)
Sustainable Finance in the New Geo-Political Era: A Difficult Balancing Act
No full textThe aim of this work is to assess how geopolitical tensions and risks can affect sustainable investment strategies and the approach to the transition that is dependent on a growing supply of critical raw materials. In particular, we analyze the effect that tensions in the US-China relation have on the US investment in renewables. Using the Electricity Installed Capacity Index, we show that an increase in tensions in the bilateral trade relations and, more generally, an increase in the uncertainty of the geopolitical context, can act as a stimulus for the renewable energy sector. Given the prudent strategy of the US financial institutions in funding green energy, this correlation is not much connected to better green investment yields but to the US governments attempts to decouple from China. It also shows that US trade policy will be used to help the development of US green technologies
Prefazione
No full textLa Prefazione in oggetto motiva l'attualità culturale del chiarimento, operato da Eugen Wiesnet, circa la non fondabilità biblica di concezioni retributive della giustizia e individua in tale teologo un precursore del concetto di "restorative justice
Predicting Tail-Risks for the Italian Economy
Full text linkThis paper investigates the empirical performance of various econometric methods to predict tail risks for the Italian economy. It provides an overview of recent econometric methods for assessing tail risks, including Bayesian VARs with stochastic volatility (BVAR-SV), Bayesian additive regression trees (BART) and Gaussian processes (GP). In an out-of-sample forecasting exercise for the Italian economy, the paper assesses the point, density, and tail predictive performance for GDP growth, inflation, debt-to-GDP, and deficit-to-GDP ratios. It turns out that BVAR-SV performs particularly well for Italy, in particular for the tails. It is then used to also predict expected shortfalls and longrises for the variables of interest, and the probability of specific interesting events, such as negative growth, inflation above the 2% target, an increase in the debt-to-GDP ratio, or a deficit-to-GDP ratio above 3%
Introducing Rondine, the Citadel of Peace: The Place to Live Restoratively
No full textThe article presents the experience of "Rondine - The Citadel of Pace" (Arezzo, Italy) and in particular its World House, where university students from warring countries live together while studying. The article discusses the place of Rondine in restorative justice and restorative diplomacy
Why do companies reincorporate abroad? Evidence from Europe
No full textWe take advantage of the institutional, fiscal, and regulatory differences across European countries to investigate why firms decide to reincorporate. Reincorporations within Europe have become increasingly common over the last decade, with Italy experiencing the largest outflow of firms and the Netherlands being the preferred destination. We investigate the expansion, tax saving, and regulatory arbitrage explanations. The evidence does not support the expansion and tax saving motivations as we observe no significant changes in firms’ investments and effective tax rates. On the other hand, we find that firms reincorporate in countries with a permissive legislative approach towards the adoption of control-enhancing mechanisms, as predicted by the regulatory arbitrage explanation. This is especially the case of Italian firms reincorporating in the Netherlands as they implement a degree of separation between ownership and control that goes beyond what their country of origin would allow. We discuss the governance implications of such decision
Mitigating exposure bias in large language model distillation: an imitation learning approach
Full text link Knowledge distillation is recognized as a valuable model compression strategy that alleviates the computational
burden of large language models while preserving performance. This strategy involves training a smaller model
utilizing both real data and predictions from a more cumbersome model. Traditional distillation methods,
however, are often compromised by exposure bias, which results from reliance on next-step prediction training
loss. This bias emerges when models are tested in free-running mode, differing from their training regime and
leading to a progressive drift in input distributions between testing and training phases. An analogous issue,
known as ‘distributional shift’, has been effectively addressed in imitation learning through various methodologies.
Therefore, this paper specifically tailors an imitation learning-based solution to a traditional knowledge
distillation framework which inherently considers both real data and the teacher’s predictions as dual sources of
expert demonstrations. The effectiveness of this approach is demonstrated over five different test datasets, where
it outperforms traditional benchmarks across all evaluation metrics. Specifically, it achieves superior results in
perplexity, multi-token generation, and G-Eval score, indicating improvements in both predictive accuracy and
alignment with human judgment in text quality. These results underscore the potential of this approach to
effectively address exposure bias in large language model distillation