9 research outputs found
Effects of land degradation induced migration in Africa : providing evidence on the role of climate and environmental change as drivers of migration
No full textClimate change and migration are closely interconnected in many parts of the world. Migration is a key way by which households cope with and adapt to rapid and slow environmental changes. Under extreme conditions of drought, economic hardship, and political instability, migration is used as a last-resort survival mechanism. Although these cases continue to happen, they are a less common form of climate-induced migration. Most migration associated with environmental and climate change does not occur under conditions of absolute distress, but of diversification, as households search for opportunities to generate new income sources and to reduce their exposure to environmental and climate related risks and hazards. This type of migration tends to be ignored and raises almost no interest in the media. However, to fully understand the dynamics of migration in less developed countries, it is essential to consider climate change and environmental degradation and increase understanding on the role they play in driving the decision to migrate.
In this thesis, the author tried to address this complex subject by adopting a mix of different approaches that take in consideration the challenges and gaps in knowledge. In particular, the aim of this thesis is to provide new evidence on relationship between climatic and environmental changes and migration by: (i) adopting an inter-disciplinary approach and comparing concepts and paradigms from different academic and policy fields; (ii) elaborating a conceptual framework that shifts from the dominant focus on climate change and addresses migration as a response to gradual environmental changes, such as land degradation and natural resource depletion; (iii) producing new empirical data through a survey conducted on migrants from sub-Saharan Africa.
This thesis consists of a collection of articles and is structured in three chapters, each of which contains one articles/paper. The first two articles have been co-authored, peer-reviewed and published, while the third one has been done in collaboration with the Institute for Scientific Research of the Rabat University that administered the questionnaire in Morocco under the supervision of the author.
The first article is a chapter published in the book “Migration, Risk Management and Climate Change: Evidence and Policy Responses” published by Springer under the series Global Migration Issues in 2016. The title of the chapter is “Remittances for adaptation: an ‘alternative source’ of international climate finance?”. Bringing together literature on climate finance and remittances, the article analyze whether remittances could be considered as an ‘alternative’ source of adaptation finance in international climate negotiations. The second article is a on “Vulnerability and resilience in West Africa: understanding human mobility in the context of land degradation” reviews the evidence on land degradation induced migration in West Africa and explores the circumstances under which migration can actually increase the resilience of households in the face of climate and environmental change. The third article, titled “Environmental change and migration: the role of climatic and environmental conditions in the migration decision”, aims at discussing the nexus between climate/environmental change and migration by focusing on perception of the hazards and motivations for migration from an individual’s perspective. The result of the survey confirmed that, in general, climate and environmental change are important determinants of the decision to migrate, even though concurring with other major motivations. In particular, they turned out to be the most important reasons to migrate for a non-negligible number of migrants
Orthodontic extraction: the riskless extraction of the impacted lower third molar close to the man
No full textSummary: The study aims was to describe an orthodontic approach to move the third molar's root, which are radiographically close to the mandibular canal, away from the neuro-vascular unit in order to perform riskless extractions.
Materials and methods: SEventy impacted lower third molars were extruded (patient's age between 18 and 50 years).
The procedure consists of various phases:
Phase 1: Creation of orthodontic anchorage
Phase 2: Surgical exposure of the third molar crown
Phase 3: Orthodontic extrusion of the third molar
Phase 4: Radiographic assessment of the extrusion level
Phase 5: Third molar extraction
Results. Sixty eight lower third molars were orthodontically extruded until the roots were moved out of the mandibular canal. Two patients stopped the extrusion and had temporary paresthesia after the extraction.
The treatment time was 3 to 6 months in vertically impacted teeth and 6 to 10 months in horizontally impacted teeth.
Conclusion: The orthodontic-surgical approach to the impacted lower third molar is a simple technique for the dentist and minimally traumatizing for the patient.
This technique makes the extraction easier and quicker, without risk of paresthesia or mandibular fracture, with less post-operative discomfort and with advantages on a periodontal level
Orthodontic Extraction: Riskless Extraction of Impacted Lower Third Molars Close to the Mandibular Canal
No full textPurpose
The study purpose was to describe an orthodontic approach to move the
third molar’s roots, which are radiografically demonstrated to be close to
the mandibular canal, away from the neuro-vascular unit in order to
perform riskless extractions.
Materials and Methods
The authors described the different phases of this approach:
Phase 0: Assessment of surgical risks. A topographic diagnosis is made
first through a panoramic radiograph and then, if there is a suspected
contact between root and mandibular canal, through a CT scan. If the
proximity is confirmed, the orthodontic extraction will be started by:
Phase 1: Creation of the orthodontic anchorage.
Phase 2: Surgical exposure of the third molar crown and bracket bonding
to the occlusal surface.
Phase 3: Orthodontic extrusion of the third molar. A cantilever is anchored
to the first molar to produce the extrusive forces.
Phase 4: Radiographic assessment of the extrusion level. A new
radiological check is requested to confirm the tooth movement.
Phase 5: Third molar extraction.
Results
This therapeutic approach makes extraction of impacted lower third molar
easier and quicker, with less post-operative discomfort, without risk of
paresthesia or mandibular fracture and with periodontal advantages. This
technique allows extraction of lower third molars otherwise impossible for
the high risk of complications.
Conclusion
The orthodontic-surgical approach to the high-risk extraction of impacted
lower third molar has proved to be a technique quite simple for the doctor
and minimally traumatizing for the patient. It is a prudent, safe and
biologically more conservative therapeutic choice
Orthodontic extraction: the extraction of the third molars in close proximity to the mandibular canal by an orthodontic-surgical approach
No full textAn orthodontic-surgical approach to performing riskles extractions of those third molars with contiguity between the roots and the mandibular canal. Different phases: first the surgical risks have to be assessed. A first topographic diagnosis is made using a panoramic radiograph and then, if there is a suspected contact between root and mandibular canal, a CT scan is done. When the proximity is confirmed, "the orthodontic extraction procedure" will start with the creation of an orthodontic anchorage. This phase is followed by a surgical exposure of the third molar crown in order to bond a bracket to the occlusal surface. A stainless steel sectional wire is anchored from the first molar to the third molar to produce the extrusive forces. After a positive clinical assessment of the extrusion level, a new radiological check is requested to evaluate the tooth movement. When trhe tooth is out of the mandibular canal, the surgeon can perform a safe and easy third molar extraction
Aiming at a curative strategy for follicular lymphoma
No full textAbstract
Follicular lymphoma is often managed as an incurable disease. However, a substantial and growing fraction of patients are achieving long-term disease-free survival from aggressive treatment approaches. The application of novel therapeutic tools, including monoclonal antibodies, radioimmunotherapy, and vaccines, as well as new and more active chemotherapeutic agents, is producing complete responses in the majority of treated patients, with a 2-fold increase in disease- and progression-free survival in randomized trials. For some of these treatment approaches, follow up has not yet been long enough to determine a median response duration, but it certainly exceeds the "2 to 3 years" that is routinely stated as dogma to patients with this illness. Furthermore, some patients remain in complete remission beyond a decade from their initial treatment, implying that the assumption of inevitable relapse also must be challenged. One clear fact is that no patients will ever be cured by adopting a palliative treatment approach. The assumption that patients with follicular lymphoma are incurable is certain to be a self-fulfilling prophecy. Here the author summarizes the large and growing body of knowledge that suggests an expectant approach to management is not appropriate for all patients
Red blood cell transfusion and mortality after transcatheter aortic valve implantation via transapical approach : A propensity-matched comparison from the TRITAVI registry
No full textObjective: Bleeding is frequent during transcatheter aortic valve implantation (TAVI), especially when performed through a transapical approach (TA), and is associated with a worse prognosis. The present study aims to test the implication of red blood cell (RBC) transfusion and the optimal transfusion strategy in this context. Methods: Among 11,265 participants in the multicenter TRITAVI (Transfusion Requirements in Transcatheter Aortic Valve Implantation) registry, 548 patients (4.9%) who received TA-TAVI at 19 European centers were included. One-to-one propensity score matching was performed to reduce treatment selection bias and potential confounding among transfused versus non-transfused patients. The primary endpoint of the study was the 30-day occurrence of all-cause mortality. Results: 209 patients (38 %) received RBC transfusions. The primary endpoint occurred in 47 (8.6 %) patients. Propensity score matching identified 188 pairs of patients with and without RBC transfusion. In the propensity score-matched analysis, RBC transfusion was associated with increased 30-day mortality (HR 3.35, 95 % CI 1.51 – 7.39; p = 0.002). At multivariable cox regression analysis, RBC transfusion was an independent predictor of 30-day mortality (HR 3.07, 95 % CI 1.01–9.41, p = 0.048), as well as baseline ejection fraction (HR 0.96, 95 % CI 0.92–0.99, p = 0.043), and acute kidney injury (HR 3.95, 95 % CI 1.11–14.05, p = 0.034). Conclusions: RBC transfusion is an independent predictor of short-term mortality in patients undergoing TA-TAVI, regardless of major bleeding. Clinical trial registration: https://www.clinicaltrials.gov Unique identifier: NCT03740425.Peer reviewe
Risk Score for Prediction of Dialysis After Transcatheter Aortic Valve Replacement
No full textBackground Dialysis is a rare but serious complication after transcatheter aortic valve replacement. We analyzed the large multicenter TRITAVI (transfusion requirements in transcatheter aortic valve implantation) registry in order to develop and validate a clinical score assessing this risk. Methods and Results A total of 10 071 consecutive patients were enrolled in 19 European centers. Patients were randomly assigned (2:1) to a derivation and validation cohort. Two scores were developed, 1 including only preprocedural variables (TRITAVIpre) and 1 also including procedural variables (TRITAVIpost). In the 6714 patients of the derivation cohort (age 82±6 years, 48% men), preprocedural factors independently associated with dialysis and included in the TRITAVIpre score were male sex, diabetes, prior coronary artery bypass graft, anemia, nonfemoral access, and creatinine clearance <30 mL/min per m2. Additional independent predictors among procedural features were volume of contrast, need for transfusion, and major vascular complications. Both scores showed a good discrimination power for identifying risk for dialysis with C‐statistic 0.78 for TRITAVIpre and C‐statistic 0.88 for TRITAVIpost score. Need for dialysis increased from the lowest to the highest of 3 risk score groups (from 0.3% to 3.9% for TRITAVIpre score and from 0.1% to 6.2% for TRITAVIpost score). Analysis of the 3357 patients of the validation cohort (age 82±7 years, 48% men) confirmed the good discrimination power of both scores (C‐statistic 0.80 for TRITAVIpre and 0.81 for TRITAVIpost score). Need for dialysis was associated with a significant increase in 1‐year mortality (from 6.9% to 54.4%; P=0.0001). Conclusions A simple preprocedural clinical score can help predict the risk of dialysis after transcatheter aortic valve replacement
Randomized Trial of Fludarabine Versus Fludarabine and Idarubicin as Frontline Treatment in Patients With Indolent or Mantle-Cell Lymphoma
No full text PURPOSE: A first comparative trial of fludarabine (FLU) alone versus FLU plus idarubicin (FLU-ID) for indolent or mantle-cell lymphomas. PATIENTS AND METHODS: From September 1995 to July 1998, 199 patients aged 25 to 65 years (median, 54 years) with newly diagnosed stages II to IV indolent or mantle-cell lymphomas (standard risk according to the International Prognostic Index) were enrolled onto a multicenter, 1:1 randomized study. Of the 199 patients who were able to be assessed, 101 were assigned to the FLU group (six monthly cycles of FLU 25 mg/m2/d on days 1 through 5) and 98 to the FLU-ID group (six monthly cycles of FLU 25 mg/m2/d on days 1 through 3 and idarubicin 12 mg/m2 on day 1). RESULTS: In the FLU group, complete response (CR) and partial response rates were 47% and 37%, respectively, whereas in the FLU-ID group, they were 39% and 42%, respectively. In-depth analysis of the CR rate with respect to histologic type showed that FLU seemed to be superior to FLU-ID in treating follicular lymphomas (60% v 40%, respectively), whereas FLU-ID seemed to be more effective than FLU in treating nonfollicular lymphomas (small lymphocytic, 43% v 29%, respectively; immunocytoma, 38% v 23%, respectively; P = not significant), excluding the mantle-cell subset (in which there was no difference between the two groups). No striking differences were observed between the two protocols in terms of overall response or toxicity, which was generally mild. However, with a median follow-up of 19 months, only 29 patients (62%) who received FLU alone have maintained their initial CR, compared with 32 (84%) of those who received FLU-ID therapy (P = .021). CONCLUSION: Although the FLU-ID regimen may not significantly improve the induction of CR in most indolent-lymphoma patients, our preliminary data do suggest that, with respect to FLU alone, it may be capable of conferring a longer-lasting CR and that it might be superior in terms of CR rate in small lymphocytic and immunocytoma subtypes. </jats:p
