Migrant Workers Access to Justice at Home: Indonesia

Each year, around half a million Indonesians travel abroad to work, half of those to the Middle East. Many are women who suffer abuse and exploitation when they work abroad but have virtually no access to recourse within their host country's legal system. The vulnerability of migrant workers abroad makes it crucial for them to be able to seek redress in their own countries.Migrant Workers' Access to Justice at Home: Indonesia is the first comprehensive study of migrant workers' access to justice in their country of origin. A collaborative effort by the Open Society International Migration Initiative, the Tifa Foundation, and the Migrant Worker Access to Justice Project, the report analyzes how migrant workers may access justice in Indonesia, and identifies the systemic barriers that prevent them from receiving redress for harms they suffer before, during, and after their work abroad.The report also provides recommendations for improving access to justice and private sector accountability in 11 key areas, addressed to government, parliament, civil society, donors, and others.Migrant Workers' Access to Justice at Home: Indonesia is an important contribution to advancing the rights of migrant workers and will serve as a valuable guide for civil society groups in Indonesia and elsewhere to better understand, use, and test existing justice mechanisms to enforce migrant workers' rights

Migrant Workers’ Access to Justice at Home: Indonesia

Each year, around half a million Indonesians travel abroad to work, half of those to the Middle East. They are typically women from small cities or villages with primary education and limited work experience, hired to perform domestic work. Many suffer abuse and exploitation but have virtually no access to recourse within their host country’s legal system. The vulnerability of migrant workers abroad makes it crucial for them to be able to seek redress in their own countries. Access to justice at home also allows for redress when home governments and private recruitment businesses breach their legal responsibilities to migrant workers. \u27Migrant Workers’ Access to Justice at Home: Indonesia\u27 is the first comprehensive study of migrant workers’ access to justice in their country of origin. The report analyses the mechanisms through which migrant workers may access justice in Indonesia, and the systemic barriers that prevent most workers from receiving full redress for harms that they suffer before, during, and after their work abroad. The report also outlines the laws, policies, and procedures that govern the operation of each redress mechanism, and contains recommendations for improving access to justice and private sector accountability in 11 key areas, addressed to government, parliament, civil society, donors, and others. \u27Migrant Workers’ Access to Justice at Home: Indonesia\u27 provides a strong evidence-based foundation for advocacy and law reform within Indonesia and globally. It can also function as a guide for civil society groups in Indonesia to better understand, use, and test existing justice mechanisms to enforce migrant workers’ rights

Migrant Workers Access to Justice at Home: Nepal - Executive Summary

Much attention has been directed to the exploitation of low-wage migrant workers in the Middle East, where harms are commonplace and severe, and access to justice is limited. But the story of labor migration begins and ends at home.Migrant Workers' Access to Justice at Home: Nepal is the first comprehensive analysis of how laws and institutions in Nepal succeed or fail in protecting migrant workers from harms suffered during recruitment or while working in the Middle East. The study finds that despite Nepal's efforts to protect migrant workers, it often falls short in holding private recruitment companies and individual agents accountable.The report presents detailed short- and long-term recommendations for government and civil society advocates that address the failures of Nepal's migrant worker policies by treating workers as holders of defined, enforceable rights

Migrant Workers\u27 Access to Justice at Home: Nepal

Nepal’s citizens engage in foreign employment at the highest per capita rate of any other country in Asia, and their remittances account for 25 percent of the country’s GDP. The Middle East is now the most popular destination for Nepalis--nearly 700,000 were working in the Middle East in 2011 on temporary labor contracts. For some Nepalis, working abroad provides much-needed household wealth. For others, their contributions to Nepal come at great personal cost. Migrant workers in the Gulf, for example, routinely report wage theft, lack of time off and unsafe and unhealthy working conditions. Some migrant workers report psychological and physical abuse, and other forms of labor exploitation that may rise to the level of forced labor, debt bondage or other forms of trafficking. Women engaged in domestic work are often isolated in the home, where they may also endure emotional, physical and sexual abuse. The story of labor migration begins and ends at home. The conditions that give rise to labor trafficking are often set pre-departure in the recruitment phase itself. Between 2012 and 2014, researchers from Nepal, Australia and the United States conducted a study on migrant workers’ access to justice in Nepal, including for exploitation and trafficking. Justice was defined to comprise both compensation for losses, and the holding of perpetrators accountable, for example through fines, licensing sanctions, or even imprisonment. The study found that overall access to justice in Nepal was extremely low, especially for migrant workers who have been survivors of labor trafficking. However, clear routes exist to improvement. The full results of the study, and related recommendations, are contained in the report Migrant Workers Access to Justice at Home: Nepal. This is the second study in a series providing a comprehensive analysis of migrant workers’ access to justice at home; the first study, Migrant Workers Access to Justice at Home: Indonesia, was published October 2013

Applying Enquiry and Problem Based earning to Mission-oriented Innovation Policy: From Policy to Pedagogy to Teaching and Learning Practice

Mission-oriented Innovation Policy (MIP) has risen to prominence around the world. Within the European Union’s Horizon Europe FP9 programme it forms Pillar2, addressing sustainability ‘missions’ around climate, energy, mobility, food, natural resources and the environment. And yet there has been limited academic research to-date on the question of how to translate MIP into the knowledge and skills needed by multi-stakeholder practitioners to effectively work within a mission-oriented policy framework. Our paper addresses this question through the prism of Enquiry and Problem-Based Learning (EPBL). An iterative research study was undertaken comprising four elements. The first involved a literature review mapping the synergies between MIP and EPBL; the second piloted the use of EPBL for undergraduate modules related to sustainability challenges; the third involved external stakeholders in the co-creation of a postgraduate programme that brought together innovation and sustainability, with EPBL fundamental to the design and development; the fourth curated and comparatively analysed international cases of EPBL in the context of MIP, and sustainability challenges highlighting the versatility of EPBL and the importance of creativity in EPBL design and implementation. The paper makes both a scientific and practical contribution. In pedagogic scientific terms we show how EPBL can underpin the design of programmes to provide learners with the knowledge and skills to support organisations working effectively within a mission-orientated innovation policy addressing sustainability challenges. For practitioners we provide recommendations for educators seeking to embed EPBL within their curriculum. We conclude by calling for external stakeholders to proactively engage with educators to co-create programmes with context specific outcomes

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

New genetic loci link adipose and insulin biology to body fat distribution.

Body fat distribution is a heritable trait and a well-established predictor of adverse metabolic outcomes, independent of overall adiposity. To increase our understanding of the genetic basis of body fat distribution and its molecular links to cardiometabolic traits, here we conduct genome-wide association meta-analyses of traits related to waist and hip circumferences in up to 224,459 individuals. We identify 49 loci (33 new) associated with waist-to-hip ratio adjusted for body mass index (BMI), and an additional 19 loci newly associated with related waist and hip circumference measures (P < 5 × 10(-8)). In total, 20 of the 49 waist-to-hip ratio adjusted for BMI loci show significant sexual dimorphism, 19 of which display a stronger effect in women. The identified loci were enriched for genes expressed in adipose tissue and for putative regulatory elements in adipocytes. Pathway analyses implicated adipogenesis, angiogenesis, transcriptional regulation and insulin resistance as processes affecting fat distribution, providing insight into potential pathophysiological mechanisms

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden