781 research outputs found
Towards a common migration policy : potential impact on the EU economy
No full text"There is no simple answer to the question of the potential impact of migration on the EU economy. EU migration policy is expected to meet the requirements of economic and social policy, in particular of the Lisbon Agenda, as well as national cultural, political, strategic and security imperatives. The problem is complicated by different national traditions in social organisation, which are deeply rooted in history and which have resulted in different migration models within the EU. Moreover, what is an issue in its own right is immigration as a tool to counter the negative impact of population ageing on economic growth and the pressure on public funds. Another aspect of migration concerns the internationalisation of production and its contribution to the diversification of the productive structure of the EU and its member states. Further, migration may also contribute to the growth of the informal economy, an aspect of concern in member states with large shares of the informal sector in GDP. Yet another question to be resolved is the role of migration in the flow of trade in goods and services within an enlarged Europe and between the EU (25) and the rest of the world. The distinction between migration and trade in services (mode 4) is important for judging the impact on the labour market, as the regulatory mechanisms differ. The paper addresses all the above issues. As with employment, education and social policies, a common understanding about the impact of various possible routes of migration policies on the societies of the member states has to be obtained before entering a process of policy coordination towards eventual convergence. The paper focuses on ways in which different policies on various categories of migration - labour migration, family reunification, refugee and asylum-seeker intake - and the free movement of service providers can differentially impact the EU economy, calling for a complex mix of policy interventions to address the various socio-economic challenges emanating from them." (Author's abstract, IAB-Doku) ((en))Wanderungspolitik, Einwanderungspolitik, europäische Integration, Wirtschaftsentwicklung, Wirtschaftspolitik, Sozialpolitik, demografischer Wandel, Altersstruktur, Bevölkerungsstruktur, Produktion - Internationalisierung, EU-Binnenmarkt, Gütermarkt, Liberalisierung, Außenhandel, Dienstleistungen, Schattenwirtschaft, Arbeitsmigration, Familiennachzug, Asylpolitik, Flüchtlinge, EU-Osterweiterung, Arbeitsmarkt, Integrationspolitik, Europäische Union
The open abdomen, indications, management and definitive closure
No full textThe indications for Open Abdomen (OA) are generally all those situations in which is ongoing the development an intra-abdominal hypertension condition (IAH), in order to prevent the development of abdominal compartmental syndrome (ACS). In fact all those involved in care of a critically ill patient should in the first instance think how to prevent IAH and ACS. In case of ACS goal directed therapy to achieve early opening and early closure is the key: paradigm of closure shifts to combination of therapies including negative pressure wound therapy and dynamic closure, in order to reduce complications and avoid incisional hernia. There have been huge studies and progress in survival of critically ill trauma and septic surgical patients: this in part has been through the great work of pioneers, scientific societies and their guidelines; however future studies and continued innovation are needed to better understand optimal treatment strategies and to define more clearly the indications, because OA by itself is still a morbid procedure
Blunt traumatic occlusion of the internal carotid and vertebral arteries Clinical article
No full textObject The stroke rate, management, and outcome after blunt cerebrovascular occlusion (Biffl Grade IV injury) is not well defined, given the rarity of the disease. Both hemodynamic failure and embolic mechanisms have been implicated in the pathophysiology of subsequent stroke after blunt cerebrovascular occlusion. In this study, the authors evaluated their center's experience with Biffl Grade IV injuries, focusing on elucidating the mechanisms of stroke and their optimal management. Methods A retrospective review identified all internal carotid artery (ICA) or vertebral artery (VA) Biffl Grade IV injuries over a 7-year period at a single institution. Results Fifty-nine Biffl Grade IV injuries were diagnosed affecting 11 ICAs, 44 unilateral VAs, and 2 bilateral VAs. The stroke rates were 64%, 9%, and 50%, respectively. Of the 11 Biffl Grade IV ICA injuries, 5 presented with stroke while 2 developed delayed stroke. An ipsilateral posterior communicating artery greater than 1 mm on CT angiography was protective against stroke due to hemodynamic failure (p = 0.015). All patients with Biffl Grade IV injuries affecting the ICA who had at least 8 emboli per hour on transcranial Doppler (TCD) ultrasonography developed an embolic pattern of stroke (p = 0.006). Treatment with aspirin versus dual antiplatelet therapy had a similar effect on stroke rate in the ICA group (p = 0.5) and all patients who suffered stroke either died (n = 3) or required a decompressive hemicraniectomy with subsequent poor outcome (n = 4). All 10 strokes associated with Biffl Grade IV VA injuries were embolic and clinically asymptomatic. In VA Biffl Grade IV injury, neither the presence of emboli nor treatment with antiplatelet agents affected stroke rates. Conclusions At the authors' institution, traumatic ICA occlusion is rare but associated with a high stroke rate. Robust collateral circulation may mitigate its severity. Embolic monitoring with TCD ultrasonography and prophylactic antiplatelet therapy should be used in all ICA Biffl Grade IV injuries. Unilateral VA Biffl Grade IV injury is the most common type of traumatic occlusion and is associated with significantly less morbidity. Embolic monitoring using TCD and prophylactic antiplatelet therapy do not appear to be beneficial in patients with traumatic VA occlusion
Oesophageal injuries: Position paper, WSES, 2013
No full textThe oesophagus is a difficult challenge for the surgeon because of its lack of serosal covering, the tenuous, segmental blood supply and the common delay in the diagnosis of injury. Early diagnosis is the key to successful management. Recent introduction of newer, minimally invasive techniques have provided management alternatives for both the normal and the diseased organ that is injured with both early and delayed diagnosis. © 2014 Ivatury et al.; licensee BioMed Central Ltd
A Runtime Safety Enforcement Approach by Monitoring and Adaptation
No full textThe use of models and formal analysis techniques at runtime is fundamental to address safety assurance during the system operational stage, when all relevant uncertainties and unknowns can be resolved. This paper presents a novel approach to runtime safety enforcement of software systems based on the MAPE-K control loop architecture for system monitoring and control, and on the Abstract State Machine as runtime model representing the enforcement strategy aimed at preserving or eventually restoring safety. The enforcer software is designed as an autonomic manager that wraps around the software system to monitor and manage unsafe system changes using probing and effecting interfaces provided by the system, so realising grey-box safety enforcement. The proposed approach is supported by a component framework that is here illustrated by means of a case study in the health-care domain
Correction: Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES) (World Journal of Emergency Surgery, (2023), 18, 1, (5), 10.1186/s13017-022-00468-2)
No full textFollowing publication of the original article [1], in this article the author name Gregory W. J. Hawryluk was incorrectly written as Gregory W. J. Hawrylux. The original article has been corrected
COVID-19 infection is a significant risk factor for death in patients presenting with acute cholecystitis: a secondary analysis of the ChoCO-W cohort study
No full textBackground: During the coronavirus disease (COVID-19) pandemic, there has been a surge in cases of acute cholecystitis. The ChoCO-W global prospective study reported a higher incidence of gangrenous cholecystitis and adverse outcomes in COVID-19 patients. Through this secondary analysis of the ChoCO-W study data, we aim to identify significant risk factors for mortality in patients with acute cholecystitis during the COVID-19 pandemic, emphasizing the role of COVID-19 infection in patient outcomes and treatment efficacy." Methods: The ChoCO-W global prospective study reported data from 2546 patients collected at 218 centers from 42 countries admitted with acute cholecystitis during the COVID-19 pandemic, from October 1, 2020, to October 31, 2021. Sixty-four of them died. Nonparametric statistical univariate analysis was performed to compare patients who died and patients who survived. Significant factors were then entered into a logistic regression model to define factors predicting mortality. Results: The significant independent factors that predicted death in the logistic regression model with were COVID-19 infection (p < 0.001), postoperative complications (p < 0.001), and type (open/laparoscopic) of surgical intervention (p = 0.003). The odds of death increased 5 times with the COVID-19 infection, 6 times in the presence of complications, and it was reduced by 86% with adequate source control. Survivors predominantly underwent urgent laparoscopic cholecystectomy (52.3% vs. 23.4%). Conclusions: COVID-19 was an independent risk factor for death in patients with acute cholecystitis. Early laparoscopic cholecystectomy has emerged as the cornerstone of treatment for hemodynamically stable patients
Emergency surgery during the COVID-19 pandemic: What you need to know for practice
No full textINTRODUCTION Several articles have been published about the reorganisation of surgical activity during the COVID-19 pandemic but few, if any, have focused on the impact that this has had on emergency and trauma surgery. Our aim was to review the most current data on COVID-19 to provide essential suggestions on how to manage the acute abdomen during the pandemic. METHODS A systematic review was conducted of the most relevant English language articles on COVID-19 and surgery published between 15 December 2019 and 30 March 2020. FINDINGS Access to the operating theatre is almost exclusively restricted to emergencies and oncological procedures. The use of laparoscopy in COVID-19 positive patients should be cautiously considered. The main risk lies in the presence of the virus in the pneumoperitoneum: the aerosol released in the operating theatre could contaminate both staff and the environment. CONCLUSIONS During the COVID-19 pandemic, all efforts should be deployed in order to evaluate the feasibility of postponing surgery until the patient is no longer considered potentially infectious or at risk of perioperative complications. If surgery is deemed necessary, the emergency surgeon must minimise the risk of exposure to the virus by involving a minimal number of healthcare staff and shortening the occupation of the operating theatre. In case of a lack of security measures to enable safe laparoscopy, open surgery should be considered
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What’s the cool thing to do here? : navigating uncertainty by engaging social media professionals
No full textThis study investigates uncertainty through an exploration of social media professionals and their perceptions, choices, and motivations. Through an analysis of interviews with 31 social media professionals, findings suggest that the organizations that social media professionals provide services for, as well as the professionals themselves, experience consistent uncertainty. As a result, these individuals and organizations engage in a combination of strategies to reduce uncertainty; the simultaneous employment of these multiple strategies in the complex space of social media work creates tensions that social media managers and organizations must work to resolve. Finally, findings indicate that social media professionals must also communicate legitimacy to their organizations or client organizations and to the public. This study expands on theory related to isomorphism, innovation-diffusion, and legitimacy by delving into organizational social media use, and uncovering how social media professionals navigate their own uncertainty, their clients’ uncertainty, as well as tension caused by varying approaches to managing this uncertainty. I argue that social media professionals engage in behaviors that reflect fad-following (Rogers, 1962, 1983), fashion-following (Hirsch, 1972), and the use of efficient-choice (Abrahamson, 1991; Grandori, 1987) to reduce uncertainty and to display legitimacy.Communication Studie
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