Il Mezzogiorno alla ricerca di una strategia di sviluppo

Il contributo esamina, anche la luce degli esiti del referendum sulla revisione costituzionale, i principali indicatori del grave disagio economico-sociale in cui versa il Sud e le misure adottate sul piano degli interventi finanziari e delle misure di perequazione in attuazione delle politiche di coesione economico-sociale nazionali ed europee. In particolare, viene analizzata la questione dell\u2019inveramento del principio di addizionalit\ue1 dei fondi strutturali e del Fondo europeo per gli investimenti strategici (il c.d. \u201cPiano Juncker\u201d) rispetto al Masterplan per il Mezzogiorno ed ai \u201cPatti per il Sud\u201d ed alle misure di coesione adottate per la riduzione del divario economico-sociale e per la perequazione infrastrutturale

Indagine conoscitiva per l\u2019istruttoria legislativa sul disegno di legge n. 1577 in materia di riorganizzazione delle amministrazioni pubbliche

si tratta delle osservazioni sulla riforma della pubblica amministrazione rese nel corso della Indagine conoscitiva per l\u2019istruttoria legislativa sul disegno di legge n. 1577 in materia di riorganizzazione delle amministrazioni pubbliche condotta dalla I Commissione del Senato della Repubblic

LA REVISIONE DELLE RELAZIONI FINANZIARIE TRA REGIONE SICILIANA E STATO NELLA NUOVA STAGIONE DEL REGIONALISMO

Questo lavoro ha ad oggetto una riflessione sulle prospettive dell'autonomia finanziaria della Regioni speciali insulari ed in particolare della Sicilia nel contesto della nuova stagione del regionalismo italiano connessa all'attuazione della "clausola di asimmetria" stabilita dall?art. 116, terzo comma, Cost. L'Autonomia finanziaria e tributaria delle Regioni insulari si ricollega non solo agli statuti speciali ma anche alla giurisprudenza europea che ne rinviene il fondamento nell'esercizio di particolari forme di autonomia (costituzionalmente garantita, decisionale e finanziaria) al fine di introdurre forme di fiscalit\ue0 di sviluppo. E' ormai chiaro che l'esito della revisione costituzionale, lungi dal rappresentare un approdo stabile per il regionalismo italiano, impone, al fine di scongiurare che al fallito tentativo di accentramento subentrino spinte centrifughe ed indifferenti alle esigenze di coesione economico-sociale e territoriale che il dibattito sulla complessiva riforma dell'ordinamento regionale riprenda al pi\uf9 prestohis work has as its object a reflection on the prospects of the financial autonomy of the special and insular regions and in particular of Sicily in the context of the new season of Italian regionalism connected to the implementation of the "asymmetry clause" under art. 116, third paragraph, Cost. The financial and tax autonomy of the island regions is linked not only to the special statutes but also to the European jurisprudence which finds its foundation in the exercise of particular forms of autonomy (constitutionally guaranteed, decision-making and financial) in order to introduce forms of taxation of development. It is now clear that the outcome of the constitutional review, far from being a steady landing place for Italian regionalism, requires, in order to prevent the failed attempt at centralization to take over centrifugal thrusts and indifferent to the economic, social and territorial cohesion, needs that the debate on the overall reform of the regional system resume as soon as possibl

Autogoverno e autonomia. Baschi e siciliani a confronto

L'articolo si occupa delle origini del concetto di autonomia rintracciando nella giurisprudenza medievale le caratteristiche distinzioni con l'autogoverno

Regionalismo differenziato, Armao: Non dannegger\ue0 la Sicilia solo se si applicher\ue0 lo Statuto

l'articolo riguarda l\u2019intervento del vicepresidente della Regione Siciliana Gaetano Armao della seduta dell\u2019Ars del 20 febbraio dedicata al regionalismo differenziato

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic