Matching Outreach and Financial Sustainability An Assessed Accounting Framework in Evaluating Performance of Microfinance Project

The theoretical framework, consisting of thetraditional literature on performance is contextualized accordingto the specific rationale that characterizes the microfinanceoperation. Performance evaluation, moreover, is not a newsubject matter in microfinance. On the international level,different models of evaluation have been developed over thecourse of the last years. This work proposes an alternativeperformance measure for microfinance. The innovative force isinspired with respect to three specific requirements: the first isthe strict derivation of the classical doctrine on performanceanalysis – that assures the rigorousness and reliability; itsadaptability to formal institutions, including non-profitorganizations that are less formal and complex; the need to find acorrect balance between the two dichotomous objectives thatcharacterize microfinance, that is the financial sustainability andoutreach

Is it really useful the harmonic scalpel in axillary dissection for locally advanced breast cancer? A case series

Background. The seroma is one of the most common complications in the axillary lymph nodal dissection (different surgical approaches have been tried to reduce the seroma incidence). In our study we evaluate the outcome of patients using or not the ultrasonic scalpel (Harmonic scalpel) according to a standardized surgical technique. Patients and Methods. From January 2011 to December 2015 120 patients underwent axillary dissection for breast cancer. Patients were divided in two groups: patients belonging to the first group underwent Harmonic scalpel dissection and patients belonging to the second group underwent classical dissection. Each group consisted of 60 patients. Quadrantectomy (QUAD) was performed in 54 patients, 66 women underwent mastectomy. In all patients axillary dissection included the I, II and III level. We compared two groups in terms of: time of surgery, hematoma, drainage volume, days of sealing drainage, seroma formation, number of post-seroma aspirations, upper limb lymphedema, wound infections, post-operative pain. Results. Statistically significant results were obtained in terms of the total volume of the breast and axillary drainage in the two techniques. There were no significant differences in the two samples in terms of operative time incidence of seroma, post-operative hematoma, wound infection, and lymphedema of the upper limb. Conclusion. The small number of cases did not allow us to reach definitive conclusions. The use of Harmonic scalpel seems to show smaller incidence of seroma and reduction of the amount of both breast and axillary drainages. Further studies are needed to define the real advantage in terms of cost benefit of using these devices in the axillary surgery

Mercato secondario degli Npl, intermediari, servicer e banche: verso quali equilibri di sistema?

Il mercato dei crediti deteriorati richiede nuove e specifiche analisi ed approfondimenti. Occorre guardare di più ai problemi strategici, gestionali ed operativi degli intermediari finanziari che operano anche come servicer. Lo richiedono il recente, forte sviluppo del mercato secondario, finora non indagato a sufficienza, le complessità di gestione degli stessi intermediari, le difficoltà che si vanno manifestando in termini di riduzione dei tassi di recupero e di allungamento dei tempi di rientro. Ne possono scaturire contraccolpi negativi sul mercato primario e sull’effettiva possibilità delle banche di continuare a cedere Npl. La recente indagine conoscitiva avviata dalla Banca d’Italia potrà gettare luce su specifici aspetti organizzativi e operativi dei servicer

Anti-Biofilm Activity of a Long-Chain Fatty Aldehyde from Antarctic Pseudoalteromonas haloplanktis TAC125 against Staphylococcus epidermidis Biofilm

Staphylococcus epidermidis is a harmless human skin colonizer responsible for ~20% of orthopedic device-related infections due to its capability to form biofilm. Nowadays there is an interest in the development of anti-biofilm molecules. Marine bacteria represent a still underexploited source of biodiversity able to synthesize a broad range of bioactive compounds, including anti-biofilm molecules. Previous results have demonstrated that the culture supernatant of Antarctic marine bacterium Pseudoalteromonas haloplanktis TAC125 impairs the formation of S. epidermidis biofilm. Further, evidence supports the hydrophobic nature of the active molecule, which has been suggested to act as a signal molecule. In this paper we describe an efficient activity-guided purification protocol which allowed us to purify this anti-biofilm molecule and structurally characterize it by NMR and mass spectrometry analyses. Our results demonstrate that the anti-biofilm molecule is pentadecanal, a long-chain fatty aldehyde, whose anti-S. epidermidis biofilm activity has been assessed using both static and dynamic biofilm assays. The specificity of its action on S. epidermidis biofilm has been demonstrated by testing chemical analogs of pentadecanal differing either in the length of the aliphatic chain or in their functional group properties. Further, indications of the mode of action of pentadecanal have been collected by studying the bioluminescence of a Vibrio harveyi reporter strain for the detection of autoinducer AI-2 like activities. The data collected suggest that pentadecanal acts as an AI-2 signal. Moreover, the aldehyde metabolic role and synthesis in the Antarctic source strain has been investigated. To the best of our knowledge, this is the first report on the identification of an anti-biofilm molecule form from cold-adapted bacteria and on the action of a long-chain fatty aldehyde acting as an anti-biofilm molecule against S. epidermidis

THE SOCIAL AUDIT AND SOCIAL ACCOUNTABILITY AMBIGUITIES IN THE CONTEXT OF THE PARTICIPATORY BUDGETING ADOPTION

An interesting initiative introduced in the public sector in recent years is participatory budgeting (PB), which has gained popularity, particularly with the advent of the New Public Governance (Touchton et al., 2023; Wampler & Touchton, 2019). PB aims to develop democratic strategies that allow communities to exercise popular control over decision-making processes (Mattei et al., 2022). While the preparatory side of PB has been extensively investigated in the literature, the user side remains largely unknown (Bartocci et al., 2022). In this light, it is possible to hypothesize that involving citizens in the evaluation and monitoring phases could improve the alignment between policy-making and citizens‘ expectations (Mattei et al., 2022). From this perspective, it becomes interesting to focus on social audit, which is a crucial process for an organization‘s social accountability. It is characterized by openness, transparency, and accountability, involving all stakeholders (Sathiabama, 2018). It serves as a managerial control mechanism that measures intangible and qualitative issues (Cotton, 2000). The purpose of a social audit is to enable organizations to evaluate and demonstrate their social, ethical, economic, and environmental benefits, as well as aspects related to health, working conditions, human rights, ethical rights, social protection, and transparency (Cotton, 2000; Humphrey & Owen, 2000; Sathiabama, 2018). It provides an assessment of an organization‘s performance and non-financial objectives by showcasing the achievement of its social goals and monitoring stakeholders‘ opinions (Sathiabama, 2018). However, the literature on this topic is still underdeveloped, and uncertainties persist, particularly regarding the terms used (e.g., ―social audit‖, ―social accountability‖, ―voice and accountability‖, or ―social control‖ used as synonyms) and the implied concepts (e.g., social auditing sometimes seen as equivalent to social accountability, while other times seen as a tool for it) (Baltazar & Sepúlveda, 2015). Therefore, considering the significance of participatory budgeting and the ambiguities surrounding social audit (or accountability), the aim is to understand how previous studies have analyzed the relationships between ―social audit‖ or ―social accountability‖ and ―participatory budgeting‖ to clarify the existing relations between these terms, given the aforementioned ambiguities about social audit and social accountability. To achieve this aim, a structured review of the literature (Massaro et al., 2016) has been carried out. In light of the purpose of the study, the keywords ‗participatory budget*‘ and ‗social audit*‘ and ‗social account*‘ were chosen in the string TITLE-ABS-KEY (―participatory budget*‖ and (―social audit*‖ or ―social account*‖)). This string was searched on Scopus because it is the most widely used and most available database for multidisciplinary scientific literature (De Moya-Anegón et al., 2007). The search was done in title, abstract and keywords because these are considered the sections‘ articles that typically contain keywords (Dal Mas et al., 2019; Natalicchio et al., 2017; Paoloni et al., 2020). The available papers were twelve. Then, the search was restricted to papers written in English to avoid translation problems (Mauro et al., 2017). Finally, two contributions were removed: a book that was a duplicate and a paper that was out of topic. Therefore, the eligible sample includes ten contributions. This analysis highlights the path of social auditing and its implications in the participatory process, like PB. The ten manuscripts have different natures; in detail: five are articles, and five are book chapters. Longitudinal analysis shows that the first publication dates to 2010 and that, thereafter, scientific production on this topic is very patchy. In fact, some years (2017, 2018 and 2021) present a couple of publications per year. In other years (2011, 2013, 2014, 2015, 2016 and 2020), no articles are published. Looking at the geographical content considered by the authors of the eligible manuscripts, following the categorisation used by (Broadbent & Guthrie, 2008; Paoloni et al., 2020), it is possible to highlight that two documents have not considered a particular case because are literature review or conceptual paper. Then, four documents analysed the Asia context, followed by three manuscripts from Central and South America and only one document from Africa and the Middle East. The eligible studies are carried out with various methodologies; in detail: 7 used qualitative methods, only one author used a quantitative method, one used a conceptual, and one used a literature review. Finally, analysing the papers‘ content, it is possible to highlight how, over time, the social audit has become a means used not only by private companies to reconcile economic and social objectives (Evans et al., 1998) but also in the public sector, as the participatory budgeting, a participatory governance tool, even if they do it differently. Based on the literature review, social audit and participatory budgeting are considered tools within the broader concept of social accountability. Some authors (Chowdhury & Panday, 2018) see them as interconnected, while others view participatory budgeting as a means to enhance social accountability without explicitly mentioning social audit (Touchton et al., 2023). Future research could try to clarify these grey areas that have been highlighted. Further evidence emerges regarding the need to produce contextualised studies in Europe as well as a lack of quantitative studies analysing the above-mentioned phenomena. This study aims to emphasize the significance of social auditing, despite the persisting ambiguities surrounding the use of terms like social audit or social accountability in the context of PB. Additionally, it contributes by analyzing the present state of social auditing and social accountability in PB, highlighting the public sector reforms implemented during the analyzed period

Antarctic Marine Bacteria as a Source of Anti-Biofilm Molecules to Combat ESKAPE Pathogens

: The ESKAPE pathogens, including bacteria such as Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species, pose a global health threat due to their ability to resist antimicrobial drugs and evade the immune system. These pathogens are responsible for hospital-acquired infections, especially in intensive care units, and contribute to the growing problem of multi-drug resistance. In this study, researchers focused on exploring the potential of Antarctic marine bacteria as a source of anti-biofilm molecules to combat ESKAPE pathogens. Four Antarctic bacterial strains were selected, and their cell-free supernatants were tested against 60 clinical ESKAPE isolates. The results showed that the supernatants did not exhibit antimicrobial activity but effectively prevented biofilm formation and dispersed mature biofilms. This research highlights the promising potential of Antarctic bacteria in producing compounds that can counteract biofilms formed by clinically significant bacterial species. These findings contribute to the development of new strategies for preventing and controlling infections caused by ESKAPE pathogens

A Stepwise Proposal for Low-Grade Hemorrhoidal Disease: Injection Sclerotherapy as a First-Line Treatment and Rubber Band Ligation for Persistent Relapses

Outpatient treatments are actually the techniques of choice in the management of low-grade hemorrhoidal disease. Among these, rubber band ligation (RBL) and injection sclerotherapy (IS) are the most frequently performed. Both techniques are used, without one having been determined to be superior over the other. We analyzed the studies that compare these two techniques in terms of efficacy and safety in order to offer a proposal for treatment choice. RBL seems to be most efficient in terms of symptom resolution for second-degree hemorrhoidal disease and equal or superior for treatment of third-degree disease. However, IS offers lower rates of severe post-operative pain and minor complications. Since outpatient treatments are offered to patients as painless options that allow a prompt recovery, we propose a stepwise protocol using 3% polidocanol or aluminum potassium sulfate and tannic acid IS as the first treatment option, as it has less complications, followed by RBL in cases of relapse

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

FISSIT (Fistula Surgery in Italy) study: A retrospective survey on the surgical management of anal fistulas in Italy over the last 15 years

Background: Surgical treatment of anal fistulas is still a challenge. The aims of this study were to evaluate the adoption and healing rates for the different surgical techniques used in Italy over the past 15 years. Methods: This was a multicenter retrospective observational study of patients affected by simple and complex anal fistulas of cryptoglandular origin who were surgically treated in the period 2003-2017. Surgical techniques were grouped as sphincter-cutting or sphincter-sparing and as technology-assisted or techno-free. All patients included in the study were followed for at least 12 months. Results: A total of 9,536 patients (5,520 simple; 4,016 complex fistulas) entered the study. For simple fistulas, fistulotomy was the most frequently used procedure, although its adoption significantly decreased over the years (P &lt; .0005), with an increase in sphincter-sparing approaches; the overall healing rate in simple fistulas was 81.1%, with a significant difference between sphincter-cutting (91.9%) and sphincter-sparing (65.1%) techniques (P = .001). For complex fistulas, the adoption of sphincter-cutting approaches decreased, while sphincter-sparing techniques were mildly preferred (P &lt; .0005). Moreover, there was a significant trend toward the use of technology-assisted procedures. The overall healing rate for complex fistulas was 69.0%, with a measurable difference between sphincter-cutting (81.1%) and sphincter-sparing (61.4%; P = .001) techniques and between techno-free and technology-assisted techniques (72.5% and 55.0%, respectively; P = .001). Conclusion: Surgical treatment of anal fistulas has changed, with a trend toward the use of sphincter-sparing techniques. The overall cure rate has remained stable, even if the most innovative procedures have achieved a lower success rate

Timing and morbidity of loop ileostomy closure after rectal cancer resection: a prospective observational multicentre snapshot study from Multidisciplinary Italian Study group for STOmas (MISSTO)

Purpose: Time to closure and morbidity are significant issues associated with ileostomy reversal after rectal cancer resection. This study aimed to investigate the rate, time, and morbidity associated with ileostomy closure procedure. Methods: Between February and December 2022, patients who underwent protective ileostomy after rectal cancer surgery across 45 Italian surgical centres were prospectively included. Data on ileostomy closure times, surgical methods, and complications were collected and analyzed. Both univariate and multivariate statistical tests were employed to assess stoma closure rates and the occurrence of post-operative complications. Results: A total of 287 patients participated in the study. Ileostomy closure was achieved in 241 patients, yielding overall and 6-month closure rates of 84% and 62%, respectively. The median time for ileostomy closure was 146&nbsp;days. Direct sutures were used to close approximately 70% of skin defects, while purse-string sutures were applied in around 20%. The overall morbidity rate was 17%, with complications including skin suture dehiscence (7%), small bowel obstruction (6%), and anastomotic leakage (2%). Multivariate analysis revealed that an American Society of Anesthesiologists (ASA) score &gt; 2 (p = 0.028), advanced age (p = 0.048), and previous stoma complications (p = 0.048) were independently linked to failure of stoma closure; hypertension (p = 0.036) was found to be a significant independent risk factor for post-operative complications. Conclusion: This study demonstrated that a delay and a significant no-closure rate exist in ileostomy reversal after rectal cancer surgery. Post-operative complications remain high but can be prevented with adequate pre-operative assessment and post-operative care