From Incremental to Comprehensive: Towards Island-Friendly European Union Policymaking

The sustainability challenges faced by islands in the European Union (EU) are not well reflected in EU policy, where the approach to island issues has been incremental and fragmented. This paper identifies EU islands and their main sustainability issues, and argues for a stronger awareness of island issues in EU policy processes. It notes in particular the current restrictive definition of islands, which excludes island states, and the fact that the issues of peripherality and insularity do not fit into any of the categories provided in the EU’s impact assessment guidelines. Moreover, since European islands are found at various administrative scales, there is a lack of harmonized statistical data on fundamental factors necessary for monitoring their sustainable development

A framework for participatory impact assessment : involving stakeholders in European policy making, a case study of land use change in Malta

A Framework for Participatory Impact Assessment is presented for use within European land use policy impact assessment. The context and rationale for the development of the Framework are outlined, both in the context of European policy making and within a project called "Sustainability Impact Assessment: Tools for Environmental, Social and Economic Effects of Multifunctional Land Use in European Regions". A detailed description of the sequence of methods that make up the Framework is provided, followed by illustrations and details of the practical application and results from a case study in Malta, where the Framework was used to carry out an impact assessment of biodiversity policies. After reporting on the reflections of the research team and valuable feedback provided by Maltese stakeholders, the Framework’s ability to enhance the quality, credibility and legitimacy of European policy impact assessment is discussed.peer-reviewe

Visibility actions and training on the implementation of the Aarhus Convention in Malta

With the purpose of strengthening environmental democracy and improving the implementation of the public’s environmental rights, the Malta Environment & Planning Authority (MEPA) and the Austrian Environment Agency (Umweltbundesamt) have compiled tailored guidelines on the rights and obligations related to the Aarhus Convention. These guidelines offer practical and tailored advice for civil servants, for industry and for the public to ensure that public authorities are accountable for environmental decisions. The guidelines for civil servants and for the general public were presented during visibility actions organised for civil servants (24.-25.03.2009) and for NGOs, local councils and the public (26.03.2009) in Malta. The initially foreseen training and awareness-raising seminars have been enhanced to the extent of visibility actions, in order to address as many civil servants and members of the general pubic as possible, in compliance with the core contents of the Aarhus Convention. Nominated civil servants from public agencies and institutions, the general pubic and its representatives (11 NGOs, the Association of the Local Councils and all 68 Local Councils in Malta) were invited. Of these, 18 civil servants, 1 NGO, 18 Local Councils and 3 members of the general public confirmed their attendance. The visibility actions were attended by respectively 18 civil servants, 2 representatives of the NGOs, 8 representatives of the Local Councils and 3 members of the general public.peer-reviewe

Key sustainability issues and the spatial classification of sensitive regions in Europe

Cross-cutting environmental, social and economic changes may have harsh impacts on sensitive regions. To address sustainability issues by governmental policy measures properly, the geographical delineation of sensitive regions is essential. With reference to the European impact assessment guidelines from 2005, sensitive regions were identified by using environmental, social and economic data and by applying cluster analysis, United Nation Environmental Policy priorities and expert knowledge. On a regionalised ‘Nomenclature of Territorial Units for Statistics’ (NUTS) level and for pre-defined sensitive region types (post-industrial zones, mountains, coasts and islands) 31 % of the European area was identified as sensitive. However, the delineation mainly referred to social and economic issues since the regional data bases on environmental indicators are limited and do not allow the separation of medium-term vital classes of sensitive regions. Overall, the sensitive regions showed indicator values differing from the EU- 25 average.peer-reviewe

Final report in connection with MED-ERMIS (Mediterranean Environmental Reporting Monitoring and Information System) MALTA

This report outlines the work that has been carried so far as part of the MED-ERMIS (Malta) project between November 2000 and November 2002. The Sustainability Indicators – Malta Observatory (SI-MO) was established in November 2000 to meet the requirements of the MED-ERMIS (Malta) project. The Observatory’s main remit was to conduct research and development work, and to disseminate information on Sustainability Indicators for Malta. SI-MO engaged research assistants, consultants and secretarial staff in order to assist in the execution of this project.peer-reviewe

Guidelines on enhanced recovery after cardiac surgery under cardiopulmonary bypass or off-pump

International audienceObjective: To provide recommendations for enhanced recovery after cardiac surgery (ERACS) based on a multimodal perioperative medicine approach in adult cardiac surgery patients with the aim of improving patient satisfaction, reducing postoperative mortality and morbidity, and reducing the length of hospital stay. Design: A consensus committee of 20 experts from the French Society of Anaesthesia and Intensive Care Medicine (Societe francaise d'anesthesie et de reanimation, SFAR) and the French Society of Thoracic and Cardiovascular Surgery (Societe francaise de chirurgie thoracique et cardio-vasculaire, SFCTCV) was convened. A formal conflict-of-interest policy was developed at the onset of the process and enforced throughout. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. Methods: Six fields were defined: (1) selection of the patient pathway and its information; (2) preoperative management and rehabilitation; (3) anaesthesia and analgesia for cardiac surgery; (4) surgical strategy for cardiac surgery and bypass management; (5) patient blood management; and (6) postoperative enhanced recovery. For each field, the objective of the recommendations was to answer questions formulated according to the PICO model (Population, Intervention, Comparison, Outcome). Based on these questions, an extensive bibliographic search was carried out and analyses were performed using the GRADE approach. The recommendations were formulated according to the GRADE methodology and then voted on by all the experts according to the GRADE grid method. Results: The SFAR/SFCTCV guideline panel provided 33 recommendations on the management of patients undergoing cardiac surgery under cardiopulmonary bypass or off-pump. After three rounds of voting and several amendments, a strong agreement was reached for the 33 recommendations. Of these recommendations, 10 have a high level of evidence (7 GRADE 1+ and 3 GRADE 1-); 19 have a moderate level of evidence (15 GRADE 2+ and 4 GRADE 2-); and 4 are expert opinions. Finally, no recommendations were provided for 3 questions. Conclusions: Strong agreement existed among the experts to provide recommendations to optimise the complete perioperative management of patients undergoing cardiac surgery. (C) 2022 The Authors. Published by Elsevier Masson SAS on behalf of Societe francaise d'anesthesie et de reanimation (Sfar)

Book of abstracts, international conference, impact assessment of land use change

Cross-cutting environmental, social and economic changes may have harsh impacts on sensitive regions. To address sustainability issues by governmental policy measures properly, the geographical delineation of sensitive regions is essential. With reference to the European impact assessment guidelines from 2005, sensitive regions were identified by using environmental, social and economic data and by applying cluster analysis, United Nation Environmental Policy priorities and expert knowledge. On a regionalised ‘Nomenclature of Territorial Units for Statistics’ (NUTS) level and for pre-defined sensitive region types (post-industrial zones, mountains, coasts and islands) 31 % of the European area was identified as sensitive. However, the delineation mainly referred to social and economic issues since the regional data bases on environmental indicators are limited and do not allow the separation of medium-term vital classes of sensitive regions. Overall, the sensitive regions showed indicator values differing from the EU-25 average.peer-reviewe

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)