The Influence of Foreign States on the Activities of Extremist Organisations in the South of Russia

Introduction. The problem of the spread of extremist organizations’ activities in the South of Russia is intensified due to the increasing role of international actors and the influence of neighboring States. Extremist groups are included in the sphere of interests of countries with high level of institutional instability that have unresolved territorial administrative problems and also major terrorist organizations such as the ‘Islamic State’ (ISIL) prohibited on the territory of the Russian Federation. Methods. The author applies an institutional method to determine the role of international influence on the development of extremist organizations in the South of Russia. Analysis. Despite the decline in its activity, the ISIL continues to be among the priority threats to international security. The Russian Federation has successfully conducted anti-terrorist operation in Syria, while the ISIL operates in Iraq and other regions of the world. Its area of interest includes Russia, since the ISIL units exist on the territory of the Caucasus region and the Crimean Peninsula. At the same time, the territory of the Rostov region and the Republic of Crimea are subjected to the influence of the Ukrainian geo-strategic interests. The Ukrainian authorities act with territorial claims to the Russian Federation on a number of border regions as well as organize sabotage operations and support marginal movements. The so-called ‘Circassian question’ continues to be significant for the South of Russia. In the context of the present research, the author poses the problem of considering the interaction of neighboring countries and extremist organizations in the Russian border regions. The institutional research approaches allow determining the main “point of tension” in the southern border area, and to identify the main actors influencing the extremist organization. Results. The results of the work give conclusions about the main directions of foreign States’ influence on the regions of the South of Russia and counteraction to them by the security authorities

Military Service of the Cossacks in the Security System of the South of Russia (On the Example of Rostov Region)

Introduction. Modern Russian Cossacks, having undergone the process of revival and institutionalization, are now incorporated into the system of state and other services of the Russian Federation. Given the pre-revolutionary status of the Cossacks as a military class of the Russian Empire, Ministry of Defense of the Russian Federation, beginning from the 1990s, has a particular interest in attracting the descendants of the Cossacks and members of Cossack societies to military service. Methods. Through the institutional analysis, the study assesses the role of the Cossacks in military service and security in the South of Russia. Analysis. In order to incorporate the Cossacks into the system of military service in the Russian Federation, a number of normative legal acts have been adopted that allow the Cossacks to serve in Cossack units with traditional Cossack names, to use Cossack insignia on military uniforms. As part of the implementation of the Strategy of the state policy of the Russian Federation in relation to the Russian Cossacks until 2020, regional plans for its implementation, Cossack societies are actively involved in the preparation of pre-conscription youth, interact with military commissariats. Recently, pilot projects have been launched to create specialized Cossack territorial defense companies. At a high level, the participation of the Cossacks in ensuring public order during important international events has been evaluated: the XXII Winter Olympic Games in Sochi, the World Cup 2018. Results. The need to expand the participation of the Cossacks in the military service of the Russian Federation by increasing the number of territorial defense companies, opening Cossack cadet corps, forming the role of the Cossacks as a guarantor of stabilization of interethnic relations of the South of Russia

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)