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As part of their ordinary enforcement activities, tax authorities around the world use letters and other forms of personalised communications to elicit tax compliance at a low cost. The literature shows that the impact of a threat-of-audit letter (TAL) depends critically on the credibility of the letter which, in turn, depends on the information disclosed to the taxpayer. We study a TAL that is credible because it also uses third-party information to target a form of cost manipulation but, at the same time, incentivises alternative forms of cost manipulation by not targeting them. We find that the direct impact on the targeted cost manipulation is stronger than the strategic increase in other costs, and therefore the overall effect of the TAL on taxable income is positive. Our approach can be applied to any letter or enforcement action that reveals information to taxpayers and thus prompts their strategic responses. By observing the taxpayers’ responses along all relevant dimensions, the tax authority can evaluate the impact of the strategy and also obtain valuable information to target future enforcement activities.

Significant paravalvular leak regurgitation (PVLR) after transcatheter aortic valve replacement (TAVR) is a well-known complication associated with disabling symptoms related to heart failure and hemolysis or both, with poor prognostic implications. Although challenging and technically demanding, percutaneous closure is an effective treatment option for high-risk patients with symptomatic PVLR. Here, we present two cases of transcatheter PVLR closure after replacement of third-generation (one self-expandable and one balloon-expandable) transcatheter aortic valves, each with peculiar challenges, and the strategies adopted to increase the success rate of percutaneous closure.

We use a large administrative tax-returns panel dataset merged with a tax audit database to estimate the effect of real-world operational tax audits on subsequent tax behavior of a large sample of Italian self-employed taxpayers. Results from operational audits do not suffer from the fact that taxpayers are aware that they have been randomly selected for research purposes and, then, such audits are viewed as more of a signal about true audit rates by the taxpayer. Our empirical approach relies on fixed-effects difference-in-difference comparisons with an ex-ante matched sample of non-audited taxpayers. To address concerns about the endogenous selection into audit, we provide evidence for the common trends assumption. We find a positive and lasting effect of audits on subsequent reported income. However, in line with theoretical predictions, taxpayers do not increase tax compliance when the tax authority does not assess a positive additional income. Our results are robust to a variety of specifications and samples.

In 2016, an update of the 2009 recommendations for the evaluation of left ventricular (LV) diastolic function (DF) was released by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. The aims of this study were to assess the concordance between the 2016 and 2009 recommendations and to test the impact of the consideration of "myocardial disease" recommended in the 2016 update on the evaluation of diastolic dysfunction (DD) and LV filling pressures in patients with normal and reduced LV ejection fractions referred to a general echocardiography laboratory.A total of 1,508 outpatients referred to an echocardiography laboratory during a predefined 5-month period were prospectively enrolled. All patients underwent targeted clinical history and Doppler echocardiographic examination. DD and LV filling pressures were assessed according to 2009 and 2016 recommendations. Concordance was calculated using the κ coefficient and overall proportion of agreement.Overall proportion of agreement between the two recommendations was 64.7% (κ = 0.43). Comparing the 2009 and 2016 recommendations, 47.5% and 36.1% patients, respectively, had DD (P .0001), and 22.7% and 12.6% had elevated LV filling pressures (P .0001). This difference remained significant in the setting of patients with normal LV ejection fractions (21.6% vs 10.7%, P .0001). In the application of the 2016 recommendations, whether or not the presence of "myocardial disease" was considered, the prevalence of indeterminate diastolic function was, respectively, 7.3% versus 13.7%, while patients in whom the DD grade could not be determined were 8.1% versus 14.4% (P .0001 for all).Considering the presence of myocardial disease when applying the 2016 recommendations resulted in a lower prevalence of inconclusive diagnosis.

Tax evasion by small businesses can be tackled using different approaches. A traditional one recommends to increase the probability of an audit that is perceived by small businesses. Clearly, this entails high administrative and compliance costs. Another possibility is to reduce the room for accounting manipulation by applying more stringent accounting standards. This article uses a panel of administrative data concerning 71,000 Italian small businesses observed in tax years 2005 to 2008. The aim of this article is to evaluate the impact of a reform implemented in 2006. Until 2005, small businesses adopting more stringent accounting standards were granted a special audit regime such that the probability to be audited was particularly low. This regime was repealed in 2006. It is shown that the reform increased profits and turnover, as reported by the subset of businesses that were more likely to perceive the reform as an increase in the probability of an audit.

We use confidential data on value‐added tax payments at the sector level, in two large Italian cities, to estimate the effect of audit publicity on the tax compliance of local sellers. By employing a difference‐in‐differences identification strategy, we find that such publicity has a positive effect on fiscal declarations made shortly thereafter. The results suggest that increasing awareness on future audits via the media can be an important instrument in the hands of tax authorities.

We study the impact on tax compliance of a letter sent by the Italian Revenue Agency in 2009 to taxpayers suspected to have overreported some costs in order to decrease their taxable income without increasing the probability to be audited. We find strong and robust evidence that the letter did reduce manipulation of targeted costs, but that the impact on taxable income was much smaller. This difference is likely due to a strategic response by the taxpayers who increased other costs that they perceived were not targeted by the Revenue Agency and were able to do so without increasing the probability to be audited. This shows that strategic responses are likely to appear also in an institutionally complex environment.

We use a large administrative tax-returns panel dataset merged with tax audit database to estimate the effect of real-world operational tax audits on subsequent tax behavior. Our identification strategy and the institutional setting that we consider enable us to address potential endogeneity related to non-random selection of taxpayers to be audited. We find a positive and lasting effect of audits on subsequent reported income. However, in line with theoretical predictions, taxpayers do not increase tax compliance when the tax authority does not assess a positive additional income. Our results are robust to a variety of specifications and samples.

Purpose To investigate determinants of right ventricular (RV) function in competitive athletes by a combined assessment of speckle tracking (STE) and real time 3D echocardiography (RT3DE). Methods Right ventricular function of 40 top-level rowers was compared to 43 sedentary normal controls by standard Doppler echocardiography, RT3DE, and STE. RV diameters and wall thickness, tricuspid annular plane systolic excursion (TAPSE), tricuspid E/A ratio, and pulsed tissue Doppler of lateral tricuspid annulus were analyzed. RV volumes, ejection fraction (EF), and stroke volume (SV) were determined. RV global longitudinal strain (GLS) (average of 6 regions), septal strain (average of 3 septal regions, septal longitudinal strain [SLS]), and lateral strain (average of 3 lateral regions, lateral longitudinal strain [LLS]) were estimated by STE. Results The 2 groups were comparable for age, body mass index, and blood pressure, but heart rate was lower in rowers. RV diameters were larger and TAPSE, tricuspid E/A ratio, and tissue Doppler-derived s′ and e′ velocities were higher in rowers. By RT3DE, RV end-diastolic volume (EDV) and end-systolic volume were greater in rowers (both P

In a 61-year-old woman with well controlled arterial hypertension, hypercholesterolemia, and smoke and suffering from recurrent angina pectoris despite angiographically normal epicardial coronary vessels and maximal therapy, the replacement of nitrates with novel antiangina drug ranolazine, after 6-month therapy, induced a complete relief of angina and a relevant rising of the transthoracic Doppler-derived coronary flow reserve (CFR). The present clinical case underlines therefore how in patients with chronic ischemic heart disease without epicardial coronary stenosis ranolazine can induce an improvement till the complete solution of the angina symptoms and a substantial increase of CFR as expression of the enhancement of the microvascular coronary function. The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug. Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion. The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade.

Aims The present study aimed to test the capability of real-time three-dimensional echocardiography (RT3DE) in characterizing early abnormalities of left ventricular (LV) structure and function in native, untreated hypertensive patients. Methods and results Thirty-eight newly diagnosed, never-treated hypertensives (H) and 38 healthy controls (C) underwent both standard echo-Doppler and RT3DE assessment. LV volumes and ejection fraction (EF), sphericity index, LV mass index (LVMi), global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS) were calculated by RT3DE. The two groups were comparable for age and heart rate. Body mass index and blood pressure (BP) were significantly higher in H. LV volumes, EF, and sphericity index calculated by RT3DE did not differ significantly between the two groups, while LVMi was higher in H than in C ( P < 0.0001). GAS (−29.1 ± 2.5% in H vs. −33.6 ± 3.4% in C), GLS, and GRS (all P < 0.0001) were lower in H, but GCS was not significantly different between the two groups. Among the different 3D strain components, GAS showed the best independent associations with mean BP ( β = −0.502, P < 0.0001) and LVMi ( β = −0.385, P < 0.001; cumulative R 2 = 0.55, P < 0.0001) in the pooled population. Conclusion RT3DE identifies early functional LV changes in native hypertensive patients. GAS is precociously reduced, and longitudinal and radial strain impaired, while circumferential strain is still preserved, supporting a normal LV chamber systolic function. Reduction of GAS is independently associated with both pressure overload and magnitude of the LV mass.

Aims The relative role of multiple determinants of left atrial volume index (LAVi) in athletes and non-athletes is not fully defined. Thus, we decided to prospectively assess the determinants of LAVi in healthy individuals and competitive athletes over a wide age range. Methods and results Four hundred and eighteen healthy individuals (mean age 41.7 ± 15.6 years, range 16–84, 65% males, 38% competitive athletes) underwent Doppler echocardiography including assessment of LAVi by the biplane area-length method and of left ventricular (LV) diastolic function including the ratio of early diastolic peak LV inflow velocity to peak myocardial early diastolic velocity ( E / e ′). Mean LAVi was 32.2 ± 9.0 mL/m2 in the pooled population. LAVi was larger in athletes than in non-athletes (38.9 ± 9.6 mL/m2 vs. 28.4 ± 5.8 mL/m2, P < 0.0001). In the pooled population a stepwise multiple linear regression analysis identified LV end-diastolic volume index (LVEDVi) ( β = 0.378, P < 0.0001), LV mass index (LVMi) ( β = 0.260, P < 0.0001), competitive sport activity ( β = 0.258, P < 0.0001), and age ( β = 0.222, P < 0.0001) as independent determinants of LAVi (model R 2 = 0.54, P < 0.0001). By separate analyses, although LVEDVi, age, and LVMi were predictors of LAVi in both groups, body mass index and the E / e ′ ratio were additional predictors of LAVi only in non-athletes. Conclusions In healthy individuals LV size, competitive sport, age, and LV mass are independent determinants of LAVi. Body mass index and the E / e ′ ratio affect LAVi only in non-athletes. These findings may have practical implications when assessing normalcy of LA size in the clinical setting.

Traditionally, the literature has seen stratification as linked closely to within-group inequality. More recently, some papers have focused on measuring the impact of stratification on between-group inequality. In this paper, we show that when two groups are involved, such an impact can be measured by a simple comparison of the two cumulative distribution functions. This approach allows an interpretation of stratification in terms of probabilities and paves the way for a neat and simple graphical illustration. We apply it to the analysis of between-continent inequality.

Italy adopted in 1998 a peculiar audit scheme (Studi di Settore), for small and medium enterprises and the self-employed. This scheme is based on a particular interaction between the tax agency and taxpayers, where the agency unveils only part of the information used to develop its audit rule. The authors study this scheme by means of a simple theoretical model and they test it using a sample of 23,000 firms in manufacturing sectors in the 2005 tax year. A number of theoretically relevant relations are confirmed. In particular, reports made by taxpayers seem to be positively associated to the firm's size. When taxpayers know that the probability to be audited decreases, they tend to report less. Other factors that are expected to influence the behavior of taxpayers have no or an ambiguous impact on reporting behavior. © The Author(s) 2011.

The aim of this study was to compare speckle-tracking echocardiography-derived left ventricular (LV) systolic mechanics and their relationships with LV diastolic properties in young patients with hypertension and in young competitive athletes in relation to their respective alterations of LV structure.Nineteen sedentary controls, 22 top-level rowers, and 18 young newly diagnosed, never-treated patients with hypertension, all male, underwent Doppler echocardiography including pulsed tissue Doppler of the mitral annulus and speckle-tracking echocardiography. Peak longitudinal strain was calculated in apical long-axis, four-chamber, and two-chamber views, and values of the three views were averaged (global longitudinal strain [GLS]). Regional circumferential and radial strain were calculated at the LV basal, middle, and apical levels, and values were averaged (global circumferential strain and global radial strain). LV torsion was determined as the net difference in the mean rotation between the apical and basal levels.The three groups were comparable for age, whereas body mass index and blood pressure were higher in patients with hypertension, and heart rate was lower in rowers. LV mass index was higher in rowers and in patients with hypertension than in controls, without differences in relative wall thickness, ejection fraction, and midwall shortening. Left atrial volume index was greater in rowers than in controls and patients with hypertension. Annular systolic velocity (s') (P.001) and early diastolic velocity (e') (P.0001) were lower and the E/e' ratio was higher (P.0001) in patients with hypertension. GLS was lower in patients with hypertension (-17.5 ± 2.8%) than in rowers (-22.2 ± 2.7%) and in controls (-21.1 ± 2.0%) (P.0001). Global circumferential strain, global radial strain, and torsion were similar among the three groups. In the pooled population, GLS was an independent contributor to E/e' ratio (P.0001) after adjusting for age, heart rate, meridional end-systolic stress, LV mass index and left atrial volume index. By receiver operating characteristic curve analyses, both GLS and E/e' ratio appeared to be accurate in discriminating patients with hypertension from healthy controls, with the E/e' ratio being more sensitive (77.8%) and GLS more specific (89.5%).The hearts of young patients with hypertension are characterized by reduced GLS, whereas global circumferential strain, global radial strain, and torsion are similar to those of athletes' hearts. The extent of GLS is strongly associated with LV diastolic function, independently of afterload changes and the degree of LV hypertrophy.

The present clinical case shows that assessment of longitudinal strain in the coronary care unit using speckle tracking echocardiography can help to quantify myocardial damage in the context of acute coronary syndromes and detect changes otherwise not visible with semi-quantitative evaluation of wall motion.

This Note belongs to the recent literature emphasizing that the residual in the traditional Gini index decomposition reveals more than what is commonly believed. We show that the residual reveals the so far unexplored contribution of stratification to between-group inequality, and this suggests that the between-group inequality measure should be modified accordingly. We propose a measure of between-group inequality which is a function of stratification. This is our first result. Moreover, we show that this measure is numerically equivalent to the one suggested by Yitzhaki and Lerman (1991), yet, contrary to the latter, we are able to define precisely its range of variation. This is our second result. Both results are illustrated by analysing between-group inequality and stratification among Italian households.

This paper uses a panel of administrative data concerning 71,000 Italian small businesses observed in tax years 2005-2008. The aim of the paper is to evaluate the impact of a reform of audit rules implemented in 2006. The reform repealed a special audit exemption previously granted to businesses which adopted a stringent accounting standard. It is shown that the reform increased the level of economic activity, as measured by the value of inventory, for the generality of businesses involved. However, an increase in profits and turnover was reported only by the subset of businesses which were more likely to perceive it as an increase in the probability of an audit. This result is in line with the predictions of the Allingham-Sandmo model and it casts some doubts on the possibility to reduce evasion by limiting the opportunities of manipulating accounting books.

Income tax evasion by small firms has been seldom investigated mostly because of lack of data. In this paper we use a large data set produced by the Italian Revenue Agency for this project to analyse a recent policy to contrast business income tax evasion. Since 1998 Italy has adopted a method to audit small businesses (Studi di Settore), which defines the probability of a tax audit based on presumptive and reported levels of sales. In 2007 a letter campaign was implemented by the Italian Revenue Agency aimed at reducing manipulation of reports by threatening that if the "anomaly" was repeated with the 2008 tax declaration, the probability of a thorough tax audit would have drastically increased. By using difference in difference with matching methods on a sample of about 50,000 treated firms and 95,000 controls, we find that the letter campaign had a positive and statistically significant average effect on treated firms. A cost-benefit analysis of the policy suggests that the letter campaign generated a net increase of revenues of about 140 million euros.

Unilateral absence of pulmonary artery (UAPA) is a rare congenital anomaly which can seldom be isolated (1:200,000) and incidentally discovered in adulthood. We describe the case of a 54-year-old male patient who was found to have isolated UAPA (IUAPA) during the clinical and radiological investigation of a single episode of hemoptysis. Although abnormal, chest X-ray findings differed considerably from those previously reported and the diagnosis was only achieved by multidetector-row computed tomography angiography and later confirmed by bed-side echocardiography. Further clinical and instrumental investigation revealed systemic hypertension (158/95 mmHg) and bilateral mild hydronephrosis which both remitted after transurethral prostatic adenomyomectomy. (C) 2012 Elsevier Inc. All rights reserved.

When applying echo-Doppler imaging for either clinical or research purposes it is very important to select the most adequate modality/technology and choose the most reliable and reproducible measurements. Quality control is a mainstay to reduce variability among institutions and operators and must be obtained by using appropriate procedures for data acquisition, storage and interpretation of echo-Doppler data. This goal can be achieved by employing an echo core laboratory (ECL), with the responsibility for standardizing image acquisition processes (performed at the peripheral echo-labs) and analysis (by monitoring and optimizing the internal intra- and inter-reader variability of measurements). Accordingly, the Working Group of Echocardiography of the Italian Society of Cardiology decided to design standardized procedures for imaging acquisition in peripheral laboratories and reading procedures and to propose a methodological approach to assess the reproducibility of echo-Doppler parameters of cardiac structure and function by using both standard and advanced technologies. A number of cardiologists experienced in cardiac ultrasound was involved to set up an ECL available for future studies involving complex imaging or including echo-Doppler measures as primary or secondary efficacy or safety end-points. The present manuscript describes the methodology of the procedures (imaging acquisition and measurement reading) and provides the documentation of the work done so far to test the reproducibility of the different echo-Doppler modalities (standard and advanced). These procedures can be suggested for utilization also in non referall echocardiographic laboratories as an "inside" quality check, with the aim at optimizing clinical consistency of echo-Doppler data.

Traditionally, the literature has seen stratification as linked closely to within-group inequality. More recently, some papers have focused on measuring the impact of stratification on between-group inequality. In this paper, we show that when two groups are involved, such an impact can be measured by a simple comparison of the two cumulative distribution functions. This approach allows an interpretation of stratification in terms of probabilities and paves the way for a neat and simple graphical illustration. We apply it to the analysis of between-continent inequality.

Existing methods of between-groups income inequality measurement are rather uninformative if applied to genders since they are not sensitive to discrimination. We introduce a Gini-based measure of between-genders inequality which explicitly depends upon discrimination and we apply it to measure the impact of a gender-based tax reform in Italy.

Following Ahmad and Stern (1984) a number of papers have been devoted to the analysis and the application of revenue-neutral and welfare-enhancing marginal commodity tax reforms. A recent stream of literature has investigated poverty-reducing commodity tax reforms using specific poverty measures. Here we derive the conditions under which a revenue-neutral marginal commodity tax reform increases the mean income of the poor and generates Lorenz-dominance of post-tax with respect to pre-tax distribution of equivalent income among the poor. These conditions are easy to interpret and not particularly difficult to apply. © 2007 Elsevier Ltd. All rights reserved.

As noted 30 years ago by Martin Feldstein, optimal taxes may be useless for practical purposes and emphasis should instead be placed on the possibility of enhancing welfare by reforming existing tax rates. In this perspective, marginal commodity tax reforms are gaining increasing attention due to political and economic constraints on large reforms of direct (or indirect) taxation. In this paper, we summarize the main features and results of the literature on marginal commodity tax reforms pioneered by Ahmad and Stern, further developed by Yitzhaki and Thirsk and recently reinterpreted by Makdissi and Wodon. We establish new links to other fields of research, namely the literature on the use of equivalence scales and on poverty measurement. We also critically examine some issues associated with the implementation of marginal tax reforms with special reference to the calculation of welfare weights and revenue effects. Finally, we suggest directions for future research on poverty-reducing commodity tax reforms.

A Tobin tax (TT) is studied by means of a portfolio model defined over the means and variances of two rates of return (domestic and foreign). When the correlation is negative, the TT is likely to decrease the speculative component of the share of portfolio invested abroad and to increase the hedging component. For a TT to decrease both the components of the share, one needs not only a small expected gain from speculation, but also either a high positive correlation between the two rates of return or a sufficiently large value of the coefficient of variation of the foreign rate.

Miniaturization has evolved in the creation of a pocket-size imaging device which can be utilized as an ultrasound stethoscope. This study assessed the additional diagnostic power of pocket size device by both experts operators and trainees in comparison with physical examination and its appropriateness of use in comparison with standard echo machine in a non-cardiologic population. Three hundred four consecutive non cardiologic outpatients underwent a sequential assessment including physical examination, pocket size imaging device and standard Doppler-echo exam. Pocket size device was used by both expert operators and trainees (who received specific training before the beginning of the study). All the operators were requested to give only visual, qualitative insights on specific issues. All standard Doppler-echo exams were performed by expert operators. One hundred two pocket size device exams were performed by experts and two hundred two by trainees. The time duration of the pocket size device exam was 304 ± 117 sec. Diagnosis of cardiac abnormalities was made in 38.2% of cases by physical examination and in 69.7% of cases by physical examination + pocket size device (additional diagnostic power = 31.5%, p < 0.0001). The overall K between pocket size device and standard Doppler-echo was 0.67 in the pooled population (0.84 by experts and 0.58 by trainees). K was suboptimal for trainees in the eyeball evaluation of ejection fraction, left atrial dilation and right ventricular dilation. Overall sensitivity was 91% and specificity 76%. Sensitivity and specificity were lower in trainees than in experts. In conclusion, pocket size device showed a relevant additional diagnostic value in comparison with physical examination. Sensitivity and specificity were good in experts and suboptimal in trainees. Specificity was particularly influenced by the level of experience. Training programs are needed for pocket size device users.