Civil society and international governance: the role of non-state actors in the EU, Africa, Asia and Middle East

Structures and processes occurring within and between states are no longer the only – or even the most important - determinants of those political, economic and social developments and dynamics that shape the modern world. Many issues, including the environment, health, crime, drugs, migration and terrorism, can no longer be contained within national boundaries. As a result, it is not always possible to identify the loci for authority and legitimacy, and the role of governments has been called into question. \ud \ud Civil Society anf International Governance critically analyses the increasing impact of nongovernmental organisations and civil society on global and regional governance. Written from the standpoint of advocates of civil society and addressing the role of civil society in relation to the UN, the IMF, the G8 and the WTO, this volume assess the role of various non-state actors from three perspectives: theoretical aspects, civil society interaction with the European Union and civil society and regional governance outside Europe, specifically Africa, East Asia and the Middle East. It demonstrates that civil society’s role has been more complex than one defined in terms, essentially, of resistance and includes actual participation in governance as well as multi-facetted contributions to legitimising and democratising global and regional governance

The cost of trauma operating theatre inefficiency.

The National Health Service (NHS) is currently facing a financial crisis with a projected deficit of £2billion by the end of financial year 2015/16. As operating rooms (OR) are one of the costliest components in secondary care, improving theatre efficiency should be at the forefront of efforts to improve health service efficiency. The objectives of this study were to characterize the causes of trauma OR delays and to estimate the cost of this inefficiency. A 1-month prospective single-centre study in St. Marys Hospital. Turnaround time (TT) was used as the surrogate parameter to measure theatre efficiency. Factors including patient age, ASA score and presence of surgical and anaesthetic consultant were evaluated to identify positive or negative associations with theatre delays. Inefficiency cost was calculated by multiplying the time wasted with staff capacity costs and opportunity costs, found to be £24.77/minute. The commonest causes for increased TT were delays in sending for patients (50%) and problems with patient transport to the OR (31%). 461 min of delay was observed in 12 days, equivalent to loss of £951.58/theatre/day. Non-statistically significant trends were seen between length of delays and advancing patient age, ASA score and absence of either a senior clinician or an anaesthetic consultant. Interestingly, the trend was not as strong for absence of an anaesthetic consultant. This study found delays in operating TT to represent a sizable cost, with potential efficiency savings based on TT of £347,327/theatre/year. Further study of a larger sample is warranted to better evaluate the identified trends

On the design of custom packs: grouping of medical disposable items for surgeries

A custom pack combines medical disposable items into a single sterile package that is used for surgical procedures. Although custom packs are gaining importance in hospitals due to their potential benefits in reducing surgery setup times, little is known on methodologies to configure them, especially if the number of medical items, procedure types and surgeons is large. In this paper, we propose a mathematical programming approach to guide hospitals in developing or reconfiguring their custom packs. In particular, we are interested in minimising points of touch, which we define as a measure for physical contact between staff and medical materials. Starting from an integer non-linear programming model, we develop both an exact linear programming (LP) solution approach and an LP-based heuristic. Next, we also describe a simulated annealing approach to benchmark the mathematical programming methods. A computational experiment, based on real data of a medium-sized Belgian hospital, compares the optimised results with the performance of the hospital’s current configuration settings and indicates how to improve future usage. Next to this base case, we introduce scenarios in which we examine to what extent the results are sensitive for waste, i.e. adding more items to the custom pack than is technically required for some of the custom pack’s procedures, since this can increase its applicability towards other procedures. We point at some interesting insights that can be taken up by the hospital management to guide the configuration and accompanying negotiation processes

Laboratory diagnostics of Brachyspira species

Bacteria of the genus Brachyspira are intestinal spirochaetes that can cause diarrhoea and mortality in pigs. Laboratory diagnostics of Brachyspira species is essential for confirming clinical diagnosis, for providing data for optimal treatment and for surveillance of the bacteria in individual animals or herds. The aims of the present thesis were to evaluate presently used, and develop new, laboratory diagnostic techniques for Brachyspira species, to describe the pathogenic and epidemiological features and antimicrobial susceptibility of selected Brachyspira isolates, and to evaluate DNA-based epidemiological and phylogenetic tools. In study I, seeded samples were sent to laboratories in northern Europe to assess their ability to detect and identify Brachyspira species and test antimicrobial susceptibility. In study II, a PCR system was set up and compared with traditional culture and biochemical tests; and in study III, well-described Brachyspira isolates were analysed by five molecular typing methods. In the last two studies Brachyspira isolates from animals other than pigs were included. An atypical isolate detected in study II was further characterised together with identical or similar isolates (study IV) and a new genetic typing method for the entire genus of Brachyspira species was tested and evaluated (study V). Overall, the results indicated that laboratory diagnostics of Brachyspira species is difficult. Of the tested genetic typing methods, the nox gene and MLST sequence analyses showed the highest taxonomic resolutions, and randomly amplified polymorphic DNA showed the highest discriminatory power for the isolates studied. A high genetic variability was observed within the Brachyspira genus. This genetic variability could make it difficult to rely solely on DNA-based methods for detection and identification of brachyspiras. A new unique group of isolates pathogenic to pigs was detectable only by the combined use of culture, biochemical tests and PCR. The provisional name "B. suanatina" was suggested for this type of isolates, of which some were found in mallards. By MLST data analysed by e-BURST, a close evolutionary relationship was identified for "B. suanatina" and B. hyodysenteriae isolates recovered from pigs and mallards. In conclusion, these studies show that the most reliable method for laboratory diagnostics of Brachyspira species is culture and biochemical tests, used together with at least one DNA-based method