Search

Il saggio intende indagare la libertà di concorrenza in prospettiva costituzionale. Dapprima le sue radici, così come intese dall’Assemblea costituente, poi l’evoluzione dovuta all’ordinamento europeo, con l’istituzione di autorità nazionali indipendenti, di cui si discuterà la legittimità costituzionale, nonché le complesse relazioni tra pubblici poteri ed ex-monopolisti. / 𝑇ℎ𝑒 𝑒𝑠𝑠𝑎𝑦 𝑎𝑖𝑚𝑠 𝑡𝑜 𝑎𝑛𝑎𝑙𝑦𝑧𝑒 𝑓𝑟𝑒𝑒𝑑𝑜𝑚 𝑜𝑓 𝑐𝑜𝑚𝑝𝑒𝑡𝑖𝑡𝑖𝑜𝑛 𝑏𝑦 𝑎 𝑐𝑜𝑛𝑠𝑡𝑖𝑡𝑢𝑡𝑖𝑜𝑛𝑎𝑙 𝑝𝑜𝑖𝑛𝑡 𝑜𝑓 𝑣𝑖𝑒𝑤. 𝐹𝑖𝑟𝑠𝑡𝑙𝑦, 𝑖𝑡𝑠 𝑜𝑟𝑖𝑔𝑖𝑛 𝑖𝑛 𝑡ℎ𝑒 𝐶𝑜𝑛𝑠𝑡𝑖𝑡𝑢𝑡𝑖𝑜𝑛 𝑜𝑓 1948 𝑤𝑖𝑙𝑙 𝑏𝑒 𝑎𝑛𝑎𝑙𝑦𝑧𝑒𝑑. 𝑆𝑒𝑐𝑜𝑛𝑑𝑙𝑦, 𝑖𝑡𝑠 𝑒𝑣𝑜𝑙𝑢𝑡𝑖𝑜𝑛, 𝑚𝑎𝑖𝑛𝑙𝑦 𝑑𝑢𝑒 𝑡𝑜 𝑡ℎ𝑒 𝐸𝑢𝑟𝑜𝑝𝑒𝑎𝑛 𝑙𝑎𝑤, 𝑤𝑖𝑙𝑙 𝑏𝑒 𝑐ℎ𝑟𝑜𝑛𝑖𝑐𝑙𝑒𝑑. 𝑇ℎ𝑖𝑟𝑑𝑙𝑦, 𝑡ℎ𝑒 𝑙𝑒𝑔𝑎𝑙 𝑖𝑚𝑝𝑙𝑖𝑐𝑎𝑡𝑖𝑜𝑛𝑠 𝑜𝑓 𝑡ℎ𝑒 𝑒𝑠𝑡𝑎𝑏𝑙𝑖𝑠ℎ𝑚𝑒𝑛𝑡 𝑜𝑓 𝑖𝑛𝑑𝑒𝑝𝑒𝑛𝑑𝑒𝑛𝑡 𝑟𝑒𝑔𝑢𝑙𝑎𝑡𝑜𝑟𝑦 𝑎𝑢𝑡ℎ𝑜𝑟𝑖𝑡𝑖𝑒𝑠 𝑤𝑖𝑙𝑙 𝑏𝑒 𝑒𝑣𝑎𝑙𝑢𝑎𝑡𝑒𝑑. 𝐶𝑜𝑛𝑠𝑡𝑖𝑡𝑢𝑡𝑖𝑜𝑛𝑎𝑙 𝑙𝑒𝑔𝑖𝑡𝑖𝑚𝑎𝑐𝑦 𝑜𝑓 𝑡ℎ𝑒𝑠𝑒 𝑎𝑢𝑡ℎ𝑜𝑟𝑖𝑡𝑖𝑒𝑠 𝑎𝑛𝑑 𝑡ℎ𝑒 𝑐𝑜𝑚𝑝𝑙𝑒𝑥 𝑟𝑒𝑙𝑎𝑡𝑖𝑜𝑛𝑠ℎ𝑖𝑝𝑠 𝑏𝑒𝑡𝑤𝑒𝑒𝑛 𝑝𝑢𝑏𝑙𝑖𝑐 𝑖𝑛𝑠𝑡𝑖𝑡𝑢𝑡𝑖𝑜𝑛𝑠 𝑎𝑛𝑑 𝑖𝑛𝑐𝑢𝑚𝑏𝑒𝑛𝑡𝑠 𝑖𝑛 𝑟𝑒𝑔𝑢𝑙𝑎𝑡𝑒𝑑 𝑠𝑒𝑐𝑡𝑜𝑟𝑠 𝑤𝑖𝑙𝑙 𝑎𝑙𝑠𝑜 𝑏𝑒 ℎ𝑖𝑔ℎ𝑙𝑖𝑔ℎ𝑡𝑒𝑑.

Este estudo introduz o conceito de ecossistemas contratuais para compreender quadros obrigacionais multifários que apresentam uma função social una e ampla. São um conjunto de atos e negócios jurídicos que excedem a definição de coligação contratual. O conceito nasce de uma busca pelo arcabouço jurídico daquilo que, em política e economia, especialmente na última década, tem-se correntemente chamado de “ecossistemas sociais”, em referência ao complexo de agentes e relações voltadas a alguma realização coletiva com efeitos difusos. Reflete a lógica abrangente de grandes quadros de relações jurídicas delineada no art. 170 da Constituição Federal. Como principal referencial, apoia-se na experiência do direito do consumidor, especialmente com a tutela extendida aos consumidores equiparados, considerados de forma individual, coletiva e difusa; e com a reponsabilização objetiva e solidária da cadeia produtiva. Apreende também do direito do consumidor a aplicação dos princípios da boa-fé e da função social dos contratos a amplos ambientes de negócios, que permite aos contratos serem pensados como relações em continuidade, coletivizadas, com resguardos sócioambientais.

This article seeks to analyse in an intersectional manner certain implications of racialised female identity in the texts of the Antología de mujeres poetas afrocolombianas. On the one hand, there is the evocation of the collective memory of the African diaspora and, on the other, the current experience of living in a nation dominated by precariousness and racism. At the same time, the poetic voices assert their feminine experience through their bodies, expressing their desire and their contrasting experiences of motherhood. Poetic writing becomes a laboratory of identity by giving free rein to reflexive research and to the interpellation of the potential reader, an exercise in identity for poetic voices that highlights their place in social space and in cultural archives.

Editorial for Formazione & insegnamento, 22(2). The editorial “Shaping Education: Innovation, Identity, and Inclusion” reflects on how education, inspired by the principles of Paulo Freire, can become a tool for social transformation. The issue explores three fundamental dimensions of contemporary education: innovation, identity, and inclusion. Innovation is seen not only as technological progress but also as a rethinking of educational practices. Identity emerges as the recognition and valorisation of cultural diversity within educational contexts. Inclusion is proposed as a guiding principle aimed at ensuring equal and universal access to learning. This issue of the journal offers insights and reflections on how these dimensions intertwine, building a more just, equitable, and inclusive educational system.

For several years, scientific literature in the field of education and training has highlighted the opportunity to include disciplinary elements within school projects. That is, in addition to knowledge transfer and the training of technical skills. That entails a holistic approach to the individual and to their human and relational development. Hence, the need arises to provide new educational stimuli and instruments, especially for fragile youths, which experience high dropout rates. This paper illustrates the “points-based licence” mechanism, which is an assessment tool devised by CIOFS FP FVG of Trieste—a VET provider. The “licence” system arises from the need to convey students a sense of responsibility for their own actions by monitoring whether they abide by the rules or not, yet without acting exclusively as an impersonal punishment tool. That is, it is effective inasmuch as it works in parallel with well-designed student careers and the push towards self-realization.

Le questioni metodologiche relative all’uso delle fonti visive nella storia sociale dell’educazione invitano a una rivalutazione dell’affermazione di Ariès riguardo al sentimento dell’infanzia nel tardo Medioevo e nella prima età moderna. L’analisi delle illustrazioni tedesche e francesi della fine del XV secolo rivela che i neonati erano accuditi con affetto, prestando attenzione sia ai loro bisogni sanitari che morali. Questo studio si interroga sull’estensione di tale sentimento: si limitava al contesto familiare o coinvolgeva l’intera società? Dopo aver riformulato la tesi di Ariès attraverso le fonti visive tratte da illustrazioni francesi e tedesche della prima età moderna, l’articolo risponde a questa domanda esaminando le pratiche di cura organizzata per gli infanti abbandonati nella Toscana del XV secolo, una regione caratterizzata da pionierismo nell’istituzionalizzazione dei bambini lasciati dalle loro famiglie. La dimensione collettiva di questa cura è esplorata attraverso i cambiamenti linguistici, la transizione dall’allattamento esternalizzato a quello residenziale e la continua lotta contro le scarse condizioni igienico-sanitarie. Infine, l’analisi visiva degli affreschi dell’ospedale di Santa Maria della Scala a Siena rivela importanti intuizioni: (i) la cura dei bambini abbandonati integrava preoccupazioni morali, spirituali e logistiche; (ii) erano presenti pratiche educative avanzate, inclusa l’alfabetizzazione; e (iii) divisioni di lavoro di genere e personale specializzato svolgevano un ruolo cruciale. Questi risultati suggeriscono che la cura istituzionalizzata dei bambini operava come un dispositivo foucaultiano, plasmato dall’urbanizzazione e dalla necessità di tenere registri, sfidando l’affermazione di alcuni interpreti di Ariès secondo cui la società medievale fosse indifferente all’infanzia.

Objective: The aim of this study was to evaluate the economic consequences of the introduction of roxadustat on the market as treatment for chronic kidney disease (CKD)-related anaemia in Italy. Method: A budget impact model was developed to assess the economic impact of the introduction of roxadustat for the management of patient with CKD-related anaemia. The analysis was conducted considering National Health Service (NHS) perspective and three years’ time horizon. Eligible population for the treatment with roxadustat was estimated through published literature and clinicians’ support. Direct healthcare costs included drug acquisition (list prices for base case) and administration costs, monitoring costs, cost per blood transfusion, costs related to the management of adverse events and dialysis costs. Results: The model estimated a three years expenditure associated with the management of patients with CKD-related incident anaemia in Italy of about € 260 and € 44.6 million for non-dialysis dependent (NDD) and dialysis-dependent (DD) patients respectively. The introduction of roxadustat on the market could generate a reduction in the expenditure related to the iron supplementation both for NDD and for DD patients (−€ 397,305 and −€ 50,135 over three years of the analysis, respectively) and a reduction in the pharmaceutical expenditure for NDD patients (−€ 2.3 million, −€ 7.5 million and −€ 13 million at first, second and third year of the analysis). Overall, the introduction of roxadustat could generate a saving for NHS approximately equal to € 2.3, € 7.5 and € 13 million at first, second and third year of the analysis. Conclusion: The introduction of roxadustat could generate a reduction in the expenditure for the management of patients with CKD anaemia. A scenario analysis which used tender prices for ESAs and hypothesis of confidential discount for roxadustat showed that the saving for NHS will be kept if roxadustat’s discount is greater than 60.3%.

The history of Christian democratic party (DC) in Emilia-Romagna is only partially investigated by historians. By considering a variety of sources, this article reconstructs the reaction of the regional DC leadership to the deaths in Modena on 9 January 1950; the aim is to draw the general biographies of the protagonists, to highlight the role of «L’Avvenire d’Italia» and the repercussions that the debate in Emilia-Romagna had on the national leadership, using as a center of gravity the problems of public order of that year and anti-communism, widespread in large layers of Italian society.

La intervención de las mujeres en la economía medieval despierta cada vez más el interés de la historiografía europea. El mundo del crédito en general no es ajeno a este fenómeno, pero se encuentran pocas reflexiones sobre la participación femenina en el crédito menor que, por ende, es el que ha dejado menos rastro pero que, al mismo tiempo, resulta extremadamente interesante por sus posibilidades mercantiles. Así pues, con este artículo proponemos, utilizando como observatorio la Valencia bajomedieval y la riqueza de sus fuentes judiciales, analizar la figura de las acreedoras y las deudoras en relación con sus homólogos varones y plantear la cuestión de la existencia o no de comportamientos diferenciales marcados por el género. De esta forma, interesan cuestiones básicas como las cantidades, las realidades socioeconómicas, los circuitos del microcrédito, los motivos de préstamo o de endeudamiento y la justicia como instrumento de resolución de conflictos económicos, incluso a pequeña escala.

Given the nature of the lending industry and its importance for global economic stability, financial institutions have always been keen on estimating the risk profile of their clients. For this reason, in the last few years several sophisticated techniques for modelling credit risk have been developed and implemented. After the financial crisis of 2007-2008, credit risk management has been further expanded and has acquired significant regulatory importance. Specifically, Basel II and III Accords have strengthened the conditions that banks must fulfil to develop their own internal models for estimating the regulatory capital and expected losses. After motivating the importance of credit risk modelling in the banking sector, in this contribution we perform a review of the traditional statistical methods used for credit risk management. Then we focus on more recent techniques based on Machine Learning techniques, and we critically compare tradition and innovation in credit risk modelling. Finally, we present a case study addressing the main steps to practically develop and validate a Probability of Default model for risk prediction via Machine Learning Techniques.

Il Kalevala, poema epico finlandese per eccellenza, ospita un repertorio singolare di episodi riferiti a una concezione ‘mitologica’ dell’infanzia. Ciò lo rende un proficuo ambito di applicazione per uno studio dell’educazione informale in connessione al patrimonio culturale. Dopo aver stabilito come quest’ultimo costituisca la chiave di volta per lo studio dei processi informali di apprendimento, il presente contributo adotta la prospettiva dell’Umanesimo Metropolita per l’Educazione [Greater Humanities for Education] allo scopo di condurre un’analisi tematica delle istanze del Kalevala riguardanti l’infanzia che tenga conto delle dimensioni empirica, storica, ermeneutica ed etico-morale del fenomeno letterario in questione. Lo studio di caso che ne deriva mostra un concetto poliedrico di infanzia, che alterna concezioni deficitarie a forme di eccezionalismo. Dalle articolazioni di tale concetto emerge una teoria folk della formazione che in questo contributo è ribattezzata fatalismo formativo. A conclusione dell’elaborato, si ricavano induttivamente i tre pilastri del fatalismo formativo del Kalevala: (i) il determinismo intergenerazionale (storia); (ii) il quasi-determinismo della tradizione; (iii) l’idiosincrasia formativa dei percorsi esistenziali individuali. Vista l’ampia patrimonializzazione del Kalevala e il suo ruolo nella formazione dell’identità collettiva finlandese, si conclude riflettendo su come tale fatalismo possa coniugarsi con gli aspetti più progressisti della società finlandese contemporanea.

L’anticipazione è un processo cognitivo che agisce in numerose consegne matematiche, incluso il trattamento di espressioni algebriche. Tuttavia, alcuni studenti mostrano difficoltà nello sviluppo di questo tipo di abilità che possono essere ricondotte ad ostacoli di diversa natura: ontogenetico, epistemologici e didattici. Attraverso la somministrazione di un questionario e dei successivi focus group, si mette in evidenza che, nello sviluppo dell’anticipazione per studenti di scuola secondaria, intervengono ostacoli di tutti e tre i tipi e si suggerisce che alcuni di questi (quelli didattici in particolare) potrebbero essere prevenuti o risolti con opportuni interventi didattici.

Background: CardioMEMS is a device suitable for telemedicine that is currently being evaluated by the Regional Health Technology Assessment (HTA) Committee of Tuscany. Two detailed HTA reports are available in the specialized literature, the results of which need to be transferred to our regional setting. These decisions in Tuscany are made by the so-called Centro Operativo HTA. Aim: To validate, with local cost-effectiveness data, the decision on CardioMEMS that will be made in the Tuscany region. Methods: Two detailed international HTA reports were rearranged and adapted to our regional setting to generate a simplified analysis that could form the basis of our decision. Two willingness-to-pay (WTP) thresholds of €20,000/quality-adjusted life year (QALY) and €50,000/QALY were considered. Results: Based on epidemiological and regulatory information, the target population in Tuscany for this device is 166 cases. The value-based price of CardioMEMS is estimated to be €4,332 and €16,662 at WTP thresholds of 20,000/QALY and 50,000/QALY, respectively. Its current price in Italy is €12,000. Conclusion: In our region, the introduction of CardioMEMS is likely to be gradual, around 50 patients/year (or €0.60 million/year at current price). This example highlights the need to adapt the information published in the international literature to the local context in which the approval decision is made. In this context, simplified analyses are easier to apply than complex Markov models.

Using spatial regression models, we detect determinants of farmland’s prices in a rural area located in the upper Treviso plain (Veneto region, Italy). Econometric analysis is based on a Spatial linear regression model able to account for spatial lags in the data. Estimates show which intrinsic and extrinsic characteristics have the greatest influence on price, and how buyers and sellers’ profiles also matter on the price determination. Our application fosters spatial regression models in rural real estate market analysis and appraisal, and highlights that in the area under study the farmland’s prices are significantly affected by factors that are rarely considered in the literature, such as sellers and buyers’ profiles, the land use in the context where the sold plot is located matters, the hydraulic risk of the area and the presence of large infrastructures.

The subject of this essay is the reconstruction of some formal aspects of the relationship be-tween memory and oblivion. The reference context is that of the interpretation of the sociological theory of collective memory into cultural memory. The essay is also concerned with outlining a further shift from cultural to political theory through reference to counterfactual memory. The thesis it expresses, however, is that with respect to the political hypertrophy of memory, which operates as a guarantee of the identity of collective subjectivities, the critical work of historiography must always be guaranteed, which allows equal access to arguments based on evidences.

El análisis de autoría forense se basa en que cada hablante tiene su propia versión de una lengua o idiolecto cuyos rasgos lingüísticos son recurrentes de manera relativamente estable (Coulthard et al., 2011). En lingüística, hay una gran disparidad entre el conocimiento del concepto del idiolecto y su estudio con datos empíricos (Barlow, 2013). En esta investigación multigenérica (cross-genre, en inglés) cubrimos parte de estas lagunas, con datos de corpus escritos y orales del español mexicano. A través de un análisis de n-gramas de palabra, identificamos cuatro áreas de estabilidad idiolectal en español: lenguaje evaluativo y expresiones de cantidad, de modalidad deóntica y de modalidad epistémica. Nuestros resultados muestran que las construcciones gramaticales son útiles en el análisis de autoría, considerando el contexto forense, con análisis motivados lingüísticamente combinados con herramientas cuantitativas. Asimismo, proporcionamos un análisis lingüístico fundamentado en la teoría de la gramática de construcciones basada en el uso, la cual da cuenta adecuadamente del uso recurrente y particular de las construcciones idiolectales.

Specialist facilities for children are still unavailable in some Sub-Saharan African contexts. It is the case of pediatric urology, whose recent advances are still largely unshared. Prenatal diagnosis of urinary abnormalities (CAKUT) is largely unknown. Early recognition and referral of Undescended testis (UDT), Hypospadia, bladder exstrophy epispadias complex, ambiguous genitalia, stone disease, and tumours are uncommon in rural areas. Missed diagnosis is not uncommon and delayed management is associated with poor outcomes. We present a cross-sectional, descriptive study about the epidemiology of Pediatric urological admissions to three sub-Saharan East African Hospitals. All the urological cases between 0-18 years referred to three distinct East African Hospitals over 124 weeks were considered. Prevalence of different groups of diseases, age, and mode of presentation were reported. We found 351 cases (M/F 127/24) out of 2543 surgical referrals (13%). Seventy percent of cases were Hypospadias and UDT. Fifty percent of UDT were beyond 6, and most Hypospadias were between 4 and 7 yrs. CAKUT had a very low prevalence (4.84%), and about 50% of Wilms Tumours came too late to be resectable. In many African contexts, urology is still a tiny portion of the pediatric surgical workload compared to the 25% of European and American reports. There are also differences in the epidemiology of genitourinary conditions. A hidden burden of diseases may be presumed, remaining undiagnosed due to the shortage of specialist facilities.

Presentación de la Sección Dossier "40° aniversario del “Informe Rattenbach”

Objective: This paper aims to investigate the duration of the pricing & reimbursement (P&R) procedures submitted in Italy by pharmaceutical marketing authorization holders (MAH) for drugs indicated for rare diseases. Methods: All the data used in this analysis were publicly available on different sources of the Italian Ministry of Health, the Italian Medicines Agency (AIFA) and other official websites. The information was systematically collected to investigate the timeline (days) needed to complete the P&R process. The process was divided into 6 simplified steps and the median and range of days needed for each phase were estimated based on data reported in official/published documents. The analysis was stratified considering every single step of the assessment phase and included segmentation of drugs into indications for rare diseases, Orphan designation, Innovation assessment and Managed entry agreements (MEAs). Results: Overall, 181 first indication procedures were submitted to AIFA in the period considered and, of these, 167 (92.3%) were completed and 129 procedures were considered for the final analysis and the median duration of the entire process (MAH submission to final Gazette publication) was 434 days (range 176.0-918.0). The duration of procedures for rare diseases (n = 53) was longer than those for non-rare-disease procedures (n = 76) (463.0 days vs 407.5 days respectively). Among rare disease procedures, orphan designation and MEAs represent predictors for time prolongation while innovation is associated with a shorter assessment time. Conclusion: The study describes the time spent in each phase of the assessment and the appraisal process and demonstrates that uncertainty represents the main driver for the increment in the overall time.

Gli autori di questo studio intendono condurre in futuro un’analisi bibliometrica incentrata sui recenti progressi della biblioteconomia e degli studi bibliografici italiani. Per raggiungere questo obiettivo, Wikidata è stato identificato come un potente strumento per la generazione, l’elaborazione e lo scrutinio dei dati, ma manca di informazioni riguardanti le riviste bibliotecarie italiane degli ultimi decenni. In questo caso, l’ingente volume di dati da caricare su Wikidata richiede notevoli risorse umane. Di conseguenza, questo articolo studia i metodi per snellire e gestire in modo efficiente il processo di caricamento dei dati. Inoltre, l’articolo analizza i metodi, gli strumenti e le tecniche esistenti per un’accurata identificazione degli autori all’interno del set di dati. In aggiunta, esso, esamina il potenziale per stabilire sinergie che promuovano la continuità del progetto e facilitino i progressi futuri. Oltre a ciò, la ricerca valuta le procedure volte a migliorare la qualità dei dati citazionali. Lo studio analizza anche la fattibilità dell’analisi dei dati bibliografici su un campione caricato su Wikidata rispetto ad altri strumenti bibliometrici, con particolare attenzione alla produzione in lingua italiana. Facendo luce su questi aspetti fondamentali, l’articolo fornisce indicazioni preziose per la conduzione di ricerche bibliometriche nel campo della biblioteconomia e degli studi bibliografici italiani. I risultati non solo contribuiscono all’avanzamento delle conoscenze in questo campo, ma aprono anche la strada a una ricerca bibliometrica più efficiente ed efficace.

The article provides a reflection on the origins and transformation of Forza Italia from 1994 up to the 1998 Milan congress. First, I will explore the founding myths and rhetoric, then the ideological and organizational paths, and finally the causes of the following changes. Forza Italia was born as a movement with decidedly original characteristics: a light party – as opposed to the “heavy” organizations that had dominated the so-called First Republic – and with strong references to liberal ideals that had remained substantially marginal in the public debate of previous decades. Already after its first year, in 1995, a rather radical phase of organizational transformation and ideological readjustment begins in Forza Italia. This transformative phase will also be accompanied by major changes in the leadership of the party.

One of the most enigmatic and inevitably most suggestive words that Hölderlin’s philosophical work delivers to us is the neologism introduced in the summer of 1799: aorgisch, aorgic. A principle that is both ontological and mimetic, the aorgic undoubtedly represents the presence of the sublime in Hölderlin, albeit concealed terminologically, but also a particular declination that makes it not always easy to assimilate to the theories of the eighteenth-century and romantic sublime. This paper attempts to probe the role played by the aorgic in the configuration of an aesthetics of the tragic by considering two precise moments: the writing, Grund zum Empedokles, which seeks to give speculative legitimacy to the unfinished tragedy on Empedocles, and the notes that accompanied the translations of Sophocles that Hölderlin published in 1804. Interpreted as the dimension of the formless, but also of the possible, the aorgic is necessarily thought by Hölderlin always next to its opposite pole, the organic, that is the dimension of the human in the broad sense (art, culture, history). The relationship between these two poles is not only dialectical, along the lines of Fichte’s Wechselwirkung, but also analogical, recovering that relationship between physis and techne that Aristotle had already indicated in the second book of Physics. The aorgic therefore represents the necessary alienation to which nature is subjected in order to become culture (or art), a passage that, from the point of view of traditional aesthetic categories, could be read as the transition from the (natural) unrepresentability of the sublime to the (cultural) configuration of the beautiful: from chaos to form.

Introduction: The present work aims to discuss the current scenario of procedures and regulations regarding budget impact analysis/models (BIA/BIM) at regional level in Italy and to provide a standardized approach and detailed recommendations for developing these analyses. Method: A systematic review of the literature was conducted in order to collect existing guidelines or specific regional procedures for budget impact analysis in Italy. All the records were analysed in qualitative terms according to a pre-specified analytical framework, based on the ISPOR BIA guidelines. At the end of the analysis, a consensus questionnaire was developed to establish agreed approaches and to provide possible solutions to any critical issues. A list of 39 statements was developed. The survey was distributed to 69 experts who rated their level of agreement with each statement on a 5-point Likert scale. Consensus was predefined as more than 66% of the panel agreeing/disagreeing with any given statement. Results: Sisty-nine experts answered the questionnaire; a total of 30/39 statements achieved consensus. There was agreement on most of the statements. Time horizon to consider and costs were the issues on which no agreement was found. The results allowed the working group to define a list of good practices. Conclusion: While the structure and development of BIM are now well-known and well-applied at national level, there remains a great diversity of management of BIM tools at regional level. Consensus was reached among participating experts, as to the main characteristics, determinants and features of regional BIA/BIM in the perspective of the Italian payer.

Primary closure techniques that have been updated and longterm follow-up for CBE (classic bladder exstrophy) may be out of reach for many patients living in resource-limited settings. Late referrals to medical care and primary closures that lack the necessary skills and facilities for comprehensive treatment are still common. Alternative and long-term surgical solutions may improve the lives of these unfortunate patients. During surgical outreach missions, patients with CBE, either non-operated or with a previous unsuccessful bladder closure, who were referred from vast under-resourced rural areas to three Eastern African hospitals, were studied. The following information is provided: mode of presentation, clinical history, diagnostic workout, management, and outcome. There were 25 cases (M/F ratio 17/8) ranging in age from two days to twenty years. Five of the seventeen patients who were not treated (35%) were under 120 days old and eligible for primary closure in a qualified tertiary center when one was available in the country. There were twelve late referred cases (ranging from 120 days to 20 years). Between the ages of ten months and twelve years, eight children arrived following a failed primary closure. In all of them, the bladder plate was too altered to allow closure. Following a preoperative diagnostic workout, a Mainz II continent internal diversion was proposed to fourteen patients with acceptable bowel control and postponed in the other three. Three cases were lost before treatment because parents refused the procedure. Twelve cases ranging in age from three to twenty years (mean seven years) were operated on. Eight people were followed for a total of 53.87 months (range: 36-120). Except for three people who complained of occasional night soiling, day and night continence were good. The average voiding frequency during the day was four and 1.3 at night. There was no evidence of a metabolic imbalance, urinary infection, or significant upper urinary tract dilatation. Two fatalities could not be linked to urinary diversion. Four patients were not followed up on. Due to the limited number of specialist surgical facilities, CBE late referral or failed closure is to be expected in a resource-limited context. In lieu of the primary closure, a continent internal diversion will be proposed and encouraged even at the level of a non-specialist hospital to improve the quality of life of these unfortunate patients. It is recommended that patients be warned about the procedure’s potential long-term risks, which will necessitate a limited but regular follow-up.