I NUOVI ASSETTI DELLA RAGIONERIA GENERALE DELLO STATO NELLA RIFORMA DE STEFANI-DE BELLIS QUALE PRESUPPOSTO ECONOMICO-ORGANIZZATIVO DELLO STATO INTERVENTISTA

reform and the progressive consolidation of a season of substantial public intervention in all sectors of Italian economic and social life over the years 20s-70s. This expansive season, with particular reference to the welfare sector, marks in Italy the progressive transition from the liberal State (so-called “night watchman”) to the interventionist State. The basic hypothesis from which the work originates is that the expansion process of the public role in the socio-economic sphere as rapid and intense as that which characterized Italy at the time, even if conveyed by more general historical and political reasons, could hardly have been realized in the absence of a preventive work of unification of the economic and administrative organization of the State and strengthening of the powers of control by central administration on the expenditure processes. In these terms, it is possible to assume that the General Accounting Office of the State, whose transformation in a modern sense begins under the Ministry of Alberto De Stefani and the direction of Vitantonio De Bellis, laid the technical and administrative premises of the interventionist State. The study was conducted according to the diachronic comparison method typical of the History of Accounting, having as its historical reference period the 20s and 30s years. In this framework, the historical and political scope of the De Stefani-De Bellis reform is investigated, with particular reference to the economic significance of the role played by the General Accounting Office of the State, as an institution at the same time preparatory to the managerial season and as guarantee for financial sustainability of the new public investments in the socio-economic sphere. The research underlying the paper makes it possible to verify the formulated hypothesis, identifying the General Accounting Office of the State as the main institution at the basis for an orderly development of the new public interventionism. In particular, it is demonstrated how the 20s and 30s years are characterized by the contemporary presence of two opposing trends which, on the whole, have guaranteed a certain equilibrium to the development process of the Country: on the one hand, a strongly “centrifugal” push, which was resulted in the increase of public assistance bodies for workers and the poorest sectors of the population; on the other, as a response to the multiplication of spending centres (which presented the risk of being confused and risky in terms of financial sustainability), a strongly “centripetal” push in terms of the management and control of public finance processes. Therefore, it can be argued that the reform of the economic and accounting organization of the State (the 1920s) led to the establishment of the fundamental technical infrastructure for the development of the interventionist State throughout the following fifty years (from 30 to 70s). This assumption allows the History of Accounting studies to take a step forward in terms of evaluating the economic and institutional role played by the General Accounting Office of the State and the reform of public accounting in the development process of Italy until the 1970s, it revealing as a key-driver in a much broader context than that which characterized its setting-up

The effectiveness of intellectual capital disclosure in market assessments of corporate value creation

According to literature on the value relevance of intellectual capital (IC), a gap between the market and book value of a company larger than one indicates the contribution of IC resources (mostly off-balance sheet) to the value creation potential of a firm as perceived by investors. In Italy, with the introduction of Legislative Decree no. 32/2007 (by which the EU Directive No. 2003/51/CE was partially implemented into Italian law), companies are encouraged (for the first time in Italy) to disclose in the management commentary for the fiscal year-end of 2008 and for subsequent years non-financial information about employee matters. The purpose of this study is to investigate whether a more virtuous corporate disclosure behaviour on nonfinancial IC information relating to the human capital significantly contributes to better explain (more than other IC components) the market-to-book value gap. In addition, this paper aims to investigate the effectiveness of IC disclosure in improving the accuracy of market valuation process. The results demonstrate that both human capital performance and the related (human capital) non-financial disclosure tend to significantly explain the market-to-book value gap, playing a unique role in the market valuation process of high-tech companies. Moreover, a greater disclosure on IC appears to be determinant in improving the accuracy of market assessment of high-tech companies characterised by higher IC performance

Awake Nonresectional Lung Volume Reduction Surgery

OBJECTIVE: To assess the feasibility, safety, and early results of awake lung volume reduction surgery (LVRS) performed under thoracic epidural anesthesia by a new nonresectional technique. SUMMARY BACKGROUND DATA: So far, resectional LVRS under general anesthesia and one-lung ventilation is the more frequently used technique, but procedure-related morbidity has been considerable. METHODS: The study cohort included 12 patients undergoing unilateral awake LVRS. Evaluated parameters included technical feasibility and anesthesia satisfaction scored into 4 grades (from 1 = poor to 4 = excellent), global operating room time, and arterial carbon dioxide tension (PaCO(2)). In addition, 6-month changes in outcome measures, including forced expiratory volume in 1 second (FEV1), residual volume (RV), 6-minute walking test (SMWT), and dyspnea index were recorded. Perioperative and 6-month results were comparable with those of a control group undergoing unilateral resectional LVRS. RESULTS: Technical feasibility was excellent to satisfactory in 11 patients. One patient required conversion to one-lung ventilation. Differences between the awake and control group included global operating room time (90 ± 17 minutes versus 145 ± 19 minutes, P < 0.00001); PaCO(2) 24 hours after surgery (45 ± 6 mm Hg versus 49 ± 6 mm Hg, P = 0.02); and hospital stay (7.8 ± 5 days versus 11.7 ± 4 days, P = 0.02). Significant (P < 0.002) improvements occurred at 6 months in FEV1 (0.31 ± 0.17 L), RV (−1.41 ± 0.7 L), SMWT (73 ± 25 m), and dyspnea index (−1.3 ± 0.5) and were comparable with those of the control group. CONCLUSIONS: In this study, awake nonresectional LVRS proved feasible and safe. This new modality was associated with a faster recovery and satisfactory 6-month outcome, which did not differ from that of resectional LVRS

Adjuvant pneumomediastinum in thoracoscopic thymectomy for myasthenia gravis

To facilitate initial visualization and subsequent mobilization of the thymus, adjuvant pneumomediastinum was preoperatively induced in 4 patients who underwent video-assisted thoracoscopic thymectomy. Neither mortality nor technique-related morbidity was observed. This experience shows video-assisted thoracoscopic thymectomy to be a safe and reliable procedure. In addition, we believe that adjuvant pneumomediastinum seems to facilitate the dissection maneuvers and could shorten operative time

Ultrasound-guided removal of foreign bodies: personal experience.

Foreign bodies (FBs) retained in the soft tissues are a common reason for medical consultation, and usually consist of wooden or metal splinters or glass shards. Failure to remove foreign bodies is likely to give rise to acute or late complications, such as allergies, inflammation or infection, that may be severe. The surgical removal of an FB is invasive, costly and technically challenging. The procedure may fail in some cases and carries the risk of complications. Our study describes a technique for the ultrasound-guided removal of an FB, devised from our experience, and demonstrates its advantages over the standard surgical procedure. Sixty-two patients (43 males and 19 females aged from 9 to 65 years, median age 31 years) presented at our institution between October 2005 and June 2008 with suspected foreign bodies retained in the soft tissues of various body districts. Radiographic and/or ultrasound diagnosis was established by a radiologist expert in musculoskeletal sonography. The same radiologist helped by a nurse subsequently undertook the ultrasound-guided removal in the outpatient's clinic according to the technique described in the paper. ATL 5000 and PHILIPS iu22 ultrasound systems were used with high-frequency linear-array probes, sterile material, local anaesthetic (lidocaine 2%), scapels and surgical forceps. Antibiotic prophylaxis with amoxicillin and clavulanic acid were prescribed to all patients for 7 days after the procedure. Ninety-five FBs (39 glass, 35 metal, 17 vegetable, 2 plastic, 2 stone) were successfully removed under ultrasound guidance in all patients and the procedure took between 15 and 30 min. No complications arose either during or after the procedure. Seventy-five skin incisions were made and the wounds closed with Steri-Strips in 73/75 cases, whereas skin sutures were used in 2/75 cases. No complications arose either during or after the procedure. Ultrasound-guided removal of an FB retained in the soft tissues is a good alternative to surgery as is its relatively straightforward, inexpensive, repeatable and carries a low risk of complications. In addition, failure to remove an FB does not preclude traditional surgical removal. The advantages of this real-time procedure and the use of small instruments minimize bleeding time and avoid injury to surrounding structures. Patient compliance is enhanced by the fact that the procedure has little or no aesthetic impact. These encouraging results suggest ultrasound-guided removal as a first-choice procedure for the extraction of foreign bodies

Is early detection of late-onset Pompe disease a pneumologist’s affair? A lesson from an Italian screening study

Abstract Background Late-onset Pompe disease (LOPD) is a recessive disease caused by α-glucosidase (GAA) deficiency, leading to progressive muscle weakness and/or respiratory failure in children and adults. Respiratory derangement can be the first indication of LOPD, but the diagnosis may be difficult for pneumologists. We hypothesize that assessing the GAA activity in suspected patients by a dried blood spot (DBS) may help the diagnosis of LOPD in the pneumological setting. Population and methods We performed a multicenter DBS survey of patients with suspected LOPD according to a predefined clinical algorithm. From February 2015 to December 2017, 140 patients (57 ± 16 yrs., 80 males) were recruited in 19 Italian pneumological units. The DBS test was performed by a drop of blood collected on absorbent paper. Patients with GAA activity < 2.6 μmol/L/h were considered positive. A second DBS test was performed in the patients positive to the first assay. Patients testing positive at the re-test underwent a skeletal muscle biopsy to determine the GAA enzymatic activity. Results 75 recruited subjects had outpatient access, 65 subjects were admitted for an acute respiratory failure episode. Two patients tested positive in both the first and second DBS test (1.4% prevalence), and the LOPD diagnosis was confirmed through histology, with patients demonstrating a deficient GAA muscle activity (3.6 and 9.1 pmol/min/mg). A further five subjects were positive in the first DBS test but were not confirmed at re-test. The two positive cases were both diagnosed after hospitalization for acute respiratory failure and need of noninvasive ventilation. Most of the recruited patients had reduced maximal respiratory pressures (MIP 50 ± 27% and MEP 55 ± 27% predicted), restrictive pattern (FEV1/FVC 81.3 ± 13.6) and hypoxaemia (PaO2 70.9 ± 14.5 mmHg). Respiratory symptoms were present in all the patients, but only 48.6% of them showed muscle weakness in the pelvic girdle and/or in the scapular girdle (35.7%). Conclusions DBS GAA activity test may be a powerful screening tool among pneumologists, particularly in the acute setting. A simple clinical algorithm may aid in the selection of patients on which to administer the DBS test