Semplificazione strutturale e razionalizzazione della regolazione

2014 - 2015This research wants to focalize its attention on the finance world, especially on the financial markets supervision in order to obtain their simplification and rationalisation. After the computer revolution, the world began a “global village” and most part of the economy has suffered a financialisation process; the decrese and the speed up of the economic exchanges in the space and time found its best expression in the speeding up of the financial exchanges. The current interexchanges have made the financial world more complex and in few years it took over politics. Particularly the categories, by which one used to study politics and States life, have no value anymore: the triad territory – state – nation has to be substituted by a sort of local, national, overnational and international interconnected networks. The crisis of the State moved the balance from the executive to the administrative and the legal certanty with the State monopoly has left the place to an interexchangeable sets of rules network. From here the independent authorities are born and they were succesful even thanks tothe process of liberalization-privatization of the economy. Above all in Italy these Authorities were born in a chaotic and no organic way, with a series of overlaps of competences that don’t let understand “who does what”: so it needs simplification and rationalisation. In the financial world, especially all after the crisis in 2007/2008, we understood that the world, as de Larosière report says, was in front of two ways: or to do chacun pour soi or to take again the destiny in its hands, i.e. to try to take back finance under the direction of politics. the UE chose the second hypothesis leaving Lamfalussy care (soft law) and moving to de Larosière care (hard law), as a doctor does towards ills people: he tries to prevent instead of caring. The European regulations in 2010 and the international institutions like G20, FSB, Basel Committee, IOSCO, IFAC, IASB and IAIS, by their standards, tried to put order again in the financial world and to prevent the socalled “systemic risks” (macroprudential supervision), including the microprudential supervision in the most important sectors of finance (banking, insurance, securities) too. So it is necessary to study and know better the international supervision sistems (coordinated inter se) especially the EU Authorities (EBA, ESMA, EIOPA). The UE needed to rationalise the sistem and imposed it by regulations on every member State; in other words the Bank of Italy, CONSOB, IVASS and COVIP (financial indipendent Authorities) began the longa manus of the European Authorities by introducing into the italian system some rules coming directly from Europe, without “passing” through government or parliament way. Considering that the other member States have more less adeguated their “organogram” of Authorities following the UE model, Italy is still late, no because it didn’t adopte the European binding rules, but because it persevered to retain a “set” of inadeguated Authorities for the financial markets challenge. There are a lot of overlaps – interferences of competences between CONSOB and the Bank of Italy, the Bank of Italy and AGCM, whithout considering the “financialisation” of the insurance sector; Germany faced questions like Bankassurance and Allfinanz by BaFin reform, Italy instead persists in a “mixed” model of supervision in which coexists the “pourpose” model (fixed by TUF) and the “sectorial” model (there are specific supervision Authorities in every sector). In the italian system, as Kant says, it is necessery a new criterion of truth that combines empiricism of the American approach (SEC and CFTC) with the organic system and the predictability of the European model. So it is strongly necessary a simplification – reduction of Authorities to two: one in the field of micropudential supervision (Bank of Italy – CONSOB) and one Authority for macroprudential supervision (like UE model); in this way we’ll have a regulation, with overnational legal standards, based on prefixed, general, abstract defined criterions that are possibly “waterproof” for private interests of strong big groups. [edited by Author]XIV n.s

Clinical Outcomes and Joint Stability after Lateralized Reverse Total Shoulder Arthroplasty with and without Subscapularis Repair: A Meta-Analysis

Introduction: Subscapularis tendon repair in reverse total shoulder arthroplasty represents a potentially modifiable risk factor for dislocation, and its role continues to be debated. The purpose of the present meta-analysis was to compare the outcomes of the primary lateralized RSAs with and without subscapularis repair in terms of range of motion, clinical outcomes, dislocations, and complications rate. Materials and Methods: A systematic literature search in MEDLINE (Pubmed), Embase, and the Cochrane Central Register of Controlled Trials database was carried up to December 2020. A data extraction form was developed to collect select data from the included studies. The methodological quality was assessed using a Methodological Index for Nonrandomized Studies (MINORS) score. Statistical analysis was performed with Review Manager (Version 5.4, The Cochrane Collaboration). Results: A total of four comparative studies involving 978 patients were included. In the pooled analysis, the reinsertion of the subscapularis yielded better functional outcomes in terms of the constant (P < 0.00001) and ASES (P = 0.002) scores. The forward elevation, external rotation at 0°, internal rotation, and dislocation rates were comparable between the two groups (P = n.s.), while statistically increased abduction was observed in those patients who did not have their subscapularis repaired (P < 0.00001). Conclusion: The results of the present findings suggest that it seems reasonable to reinsert the subscapularis whenever it is present, in good tissue conditions, and with no evidence of fatty degeneration of its muscle belly. Level of evidence: Level III meta-analysi

Screening high school students in Italy for sudden cardiac death prevention by using a telecardiology device. a retrospective observational study

BACKGROUND: In 2010, an Italian project was launched aimed at using a telecardiology device in order to perform early diagnosis of young students at risk of sudden cardiac death. METHODS: Our retrospective observational study was conducted on a population of 13,016 students, aged between 16 and 19 years, in different Italian regions. It consisted of analysis of data recorded during a telecardiology pilot study. The recorded data were electrocardiograms and data concerning lifestyle habits and family history of cardiovascular diseases. In total, 14 alterations in the electrocardiogram signal have been considered in this study. Some of these alterations are as follows: ventricular ectopic beats, atrioventricular block, Brugada-like electrocardiogram pattern, left anterior/posterior fascicular block, left/right ventricular hypertrophy, long/short QT interval, left atrial enlargement, right atrial enlargement, short PQ interval, and ventricular pre-excitation Wolff-Parkinson-White syndrome. On the basis of the collected data, we implemented this retrospective observational study. RESULTS: The analysed data showed that 13.60% of students had a family history for cardiovascular diseases, 22.43% reported smoking habits, 26.23% reported alcohol consumption, and 7.24% reported abuse of drugs. A total of 24% of students had at least one of the 14 electrocardiogram pathological alterations considered in our study and 32% had electrocardiogram values within the normal range. CONCLUSIONS: This retrospective observational study analysed data registered during our telecardiology activity. This activity permitted to maximise data collection and minimise the costs for collecting such data. This activity of screening is being continued and in the next few years it will allow us to have a greater mass of data

Hypertensive Disorders of Pregnancy and Fetal Growth Restriction: Clinical Characteristics and Placental Lesions and Possible Preventive Nutritional Targets

Background: The purpose of this study was to describe the placental lesions in pregnancies complicated by hypertensive disorders (HDP) and/or fetal growth restriction (FGR) and in uneventful control pregnancies. Methods: This is a case control study that included singleton pregnancies with HDP and normally grown fetus (HDP-AGA fetus), with HDP and FGR, early FGR, late FGR, and uneventful pregnancies. Feto-placental Doppler velocimetry and sFlt-1/PlGF ratio were performed. Placental histology was evaluated blinded according to the Amsterdam Consensus criteria. Results: Placental lesions with maternal vascular malperfusion (MVM) were significantly more frequent in HDP-FGR and early FGR (92% and 83%). MVM were significantly associated with abnormal feto-placental Doppler parameters, especially in early FGR. Delayed villous maturation (DVM) was associated with late FGR (83%). HDP-AGA fetus cases presented a heterogeneous pattern of placental lesions, including 60% of cases with MVM, but were not associated with abnormal Doppler feto-placental velocimetry. Conclusions: We found a prevalence of placental maternal vascular malperfusion in HDP-FGR and early FGR groups. These lesions were also associated with abnormal, anti-, and angiogenic markers. Conversely HDP-AGA fetus and late FGR presented more heterogeneous placental lesions not severe enough to cause feto-placental Doppler anomalies. These conditions are likely associated with different etiologies, such as maternal pre-pregnancy risk factors for metabolic syndrome. These findings suggest a possible preventive nutritional approach in addition to low-dose aspirin in pregnant women with predisposing factors for HDP-AGA fetuses and late FGR

Consob e sistema di vigilanza

La presente ricerca vuole focalizzare la sua attenzione sul mondo finanziario e in particolare sulla vigilanza dei mercati finanziari per proporne una semplificazione e razionalizzazione. Dopo la rivoluzione informatica il mondo è divenuto un “villaggio globale” e gran parte dell’economia ha subito un processo di finanziarizzazione; la riduzione e la velocizzazione degli scambi economici a livello spazio – temporale hanno trovato la loro più incisiva espressione nella velocizzazione degli scambi finanziari. I continui interscambi hanno complessizzato il mondo della finanza che da alcuni anni ha preso il sopravvento sulla politica. Significativamente le categorie con cui si studiava la politica e la vita degli Stati oggi non hanno più valore: alla triade territorio – stato – nazione si deve sostituire una sorta di interconnessione di reti locali, nazionali, sovranazionali e internazionali. La crisi dello Stato ha fatto spostare la bilancia dall’esecutivo all’amministrativo e la stessa certezza del diritto con il monopolio statale ha lasciato il posto ad una rete di ordinamenti tra loro interscambiabili. Da qui la nascita delle Autorità indipendenti che devono il loro “successo” anche al processo di liberalizzazione – privatizzazione dell’economia. Soprattutto in Italia queste Autorità sono nate in modo farraginoso e, a dir poco, per niente organico, con una serie di sovrapposizioni di competenze che non lasciano comprendere “chi fa che cosa”: da qui l’esigenza di una semplificazione e razionalizzazione. Nel mondo della finanza, soprattutto dopo la crisi del 2007/2008, si è compreso che il mondo, come dice il rapporto de Larosière, era di fronte a due strade: o fare chacun pour soi oppure riprendere il destino fra le proprie mani, cioè tentare di riportare la finanza sotto la direzione della politica. L’UE ha scelto la seconda ipotesi abbandonando la cura Lamfalussy (soft law) per passare alla cura de Larosière (hard law) comportandosi come un medico di fronte ad un malato che cerca di prevenire piuttosto che curare. I regolamenti europei del 2010 e le istituzioni internazionali quali G20, FSB, Comitato di Basilea, IOSCO, IFAC, IASB e IAIS con i loro standards hanno cercato di riportare ordine nella finanza e di prevenire i cosiddetti “rischi sistemici” (vigilanza macropudenziale) aggiungendo a questo la vigilanza microprudenziale nei settori principali della finanza (bancario, assicurativo, valori mobiliari). Da qui l’esigenza di studiare e conoscere più approfonditamente i sistemi di vigilanza internazionali (coordinati tra di loro) e, più in particolare, quelli comunitari (EBA, ESMA, EIOPA). La razionalizzazione del sistema è sentita come un’esigenza dalla stessa UE ed è stata imposta per regolamento ad ogni Stato membro; in altri termini la Banca d’Italia, la CONSOB, l’IVASS e la COVIP (le Autorità indipendenti “finanziarie”) sono diventate la longa manus delle Autorità europee arrivando a introdurre nell’ordinamento italiano norme provenienti direttamente dall’Europa senza “passare” per la via governativa o parlamentare. Se gli altri Stati membri, bene o male, hanno adeguato l’”organigramma” delle loro Authorities al modello UE, l’Italia è ancora in ritardo, non nel senso di non aver recepito le vincolanti normative comunitarie ma nel senso di continuare a mantenere un “organico” di Autorità poco adeguato alla sfida dei mercati finanziari. Esistono ancora troppe sovrapposizioni – interferenze di competenze tra CONSOB e Banca d’Italia, Banca d’Italia e AGCM, senza tener conto della “finanziarizzazione” del settore assicurativo; i tedeschi hanno dato la loro risposta ai fenomeni della Bankassurance e Allfinanz con la riforma della BaFin, l’Italia invece continua a persistere in un modello di vigilanza “misto” che fa coesistere il modello per finalità (sancito dal TUF) con quello per settori (avere singole Autorità di vigilanza per ogni settore). Nel nostro sistema occorre, kantianamente parlando, un nuovo criterio di verità, che metta insieme l’empiricità dell’approccio statunitense (SEC e CFTC) con l’organicità e la prevedibilità del modello europeo. Da qui l’esigenza abbastanza forte di una semplificazione – riduzione delle Autorità a due dal punto di vista microprudenziale (Banca d’Italia – CONSOB) e un’Autorità per la vigilanza macroprudenziale (sul modello europeo) per avere una regolazione, in corrispondenza ai legal standards sovranazionali, che sia incentrata su criteri predeterminati, generali, astrattamente definiti, il più possibile impermeabili a quella parte di privato esclusiva espressione della forza condizionante dei gruppi di parte

TNM-like classification: A new proposed method for heart failure staging

Heart Failure (HF) is an acute or chronic syndrome, that causes a lot of damaging effects to every system. The involvement of different systems is variably related to age and others comorbidities. The severity of organ damage is often proportional to the duration of heart failure. The typology of HF and the duration determine which organs will be affected and vice versa the severity of organ damage supplies precious information about prognosis and outcome of patients with heart failure. Moreover, a classification based not only on symptomatic and syndromic typical features of heart failure, but also on functional data of each system, could allow us to apply the most appropriate therapies, to obtain a more accurate prognosis, and to employ necessary and not redundant human and financial resources. With an eye on the TNM staging used in oncology, we drawn up a classification that will consider the different involvement of organs such as lungs, kidneys, and liver in addition to psychological pattern and quality of life in HF patients. For all these reasons, it is our intention to propose a valid and more specific classification available for the clinical staging of HF that takes into account pathophysiological and structural changes that can remark prognosis and management of HF

Cost-effectiveness of Levosimendan in Patients With Acute Heart Failure

Heart failure is a major public health problem because of its high prevalence and impact on mortality, morbidity, quality of life, and social costs. The aim of this analysis was to estimate the effects of the novel inodilator levosimendan versus standard inotropic therapy (ST) of dobutamine in acute heart failure. A study population of 292 patients with acute heart failure was derived from an observational registry of patients referred to our department. Of these, 147 patients received iv levosimendan (0.05-0.1 mu g.kg(-1).min(-1) for 24 hours), and 145 patients were treated with ST. Duration of hospitalization, survival at 1 month, and the rehospitalization rate during the year after the index hospitalization were evaluated. Cost-effectiveness analysis was performed. The mean length of hospitalization was 12.08 and 13.57 days in the levosimendan and ST groups, respectively (P, 0.05). Rehospitalization rates were lower in the levosimendan group at 6 months (1.44% vs. 2.3%; P < 0.05) and 12 months (7.6% vs. 14.3%; P < 0.05). Mortality rate at 1 month was 2.1% versus 6.9% in the levosimendan and ST groups, respectively (P < 0.05). The percapita cost of treatment with levosimendan was (sic)78.86 higher than that with ST during the first hospitalization but (sis)280.22 lower when the rehospitalization rate was considered