Immigrant entrepreneurship

The interplay of migration and entrepreneurship has been shifted to a significant research area by the continuous increase of immigrants as a share in the population of countries, that are considered to be having a high attractiveness towards migrants. The United Kingdom has been pronounced as one of the countries receiving the biggest flows of immigrants. It has led to increasing immigrant self-employment, particularly in the areas with a high immigrant concentration. Considerable numbers of Lithuanian immigrants have established themselves in rural areas in the East of England region, and some of them eventually got engaged in entrepreneurial activities. Despite the country's business-friendly environment, immigrant entrepreneurs still encounter challenges that significantly constraint their business, both establishment and performance. Challenges and constraints that immigrant entrepreneurs face in a host country are caused by the interplay of various contexts such as social, economic, cultural, institutional, etc. that immigrant entrepreneurs are embedded in. Furthermore, entrepreneurship in a rural context is respectively associated with even more obstacles. There are less developed and available local services and infrastructure compared to urban areas, long distances, which eventually lead to limited access to essential resources and capital, necessary for a viable business. In this thesis, I analyse Lithuanian immigrant entrepreneurship in the UK and contexts mentioned above, which impact immigrant business performance and can be perceived as push and pull factors. Through semi-structured interviews with Lithuanian immigrant entrepreneurs, I explore the perceptions of Lithuanian immigrants' experience in their entrepreneurial activities based in the East of England region through the lens of mixed embeddedness concept. More specifically, I investigate different social, economic, and institutional contexts that Lithuanian immigrants are embedded in. In order to illustrate the mixed embeddedness concept, which aims to incorporate co‐ethnic social networks and links between immigrant entrepreneurs and the economic and institutional context in the host society, I present a case study of Lithuanian immigrant entrepreneurs in rural East of England. The research study was conducted during the pre- Brexit period when immigration to the UK was seen as one of the central factors in the Brexit debate

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001). Interpretation Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication. Funding DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant

Factors affecting weight regain after Roux-en-Y gastric bypass operation in obese patients

The aim of the study was to evaluate the factors that influence weight regain after Roux-en-Y gastric bypass operation in obese patients. The study included 25 patients who underwent Roux-en-Y gastric bypass operation in 2005-2007 at the Hospital of Lithuanian University of Health Sciences Kaunas Clinics. Patients were evaluated for anthropometric measurements, dietary habits were assessed by 24-hour Dietary Recall and Food Frequency Questionnaires, anxiety and depression disorders were evaluated using Hospital Anxiety and Depression Scale and for physical activity WHO Global Physical Activity Questionnaire was completed by patients. Computed tomography and upper GI endoscopy were utilized to evaluate anatomical factors. A total of 25 patients, aged 49.72 ± 11.03 years, were evaluated. Average time since surgery was 11.80 ± 2.78 years, and the vast majority of study participants were women (88%). Patients in the control group lost maximum 94.77 ± 17.51% EWL and experienced 16.03 ± 12.51% EWL weight regain. The weight regain group reached a maximum of 78.83 ± 24.52% EWL and regained 38.73 ± 18.55% EWL. There was no difference in physical activity between the groups except the time spent sitting: 187.50 ± 130.03 min. in control group and in WR group 338.89 ± 129.47 min. (p = 0.03). All subjects were consuming an insufficient daily amount of protein: 0.69 ± 0.31 g / kg in the control group, 0.51 ± 0.167 g / kg WR group. The WR group consumes more fatty products (58.91 ± 43.72 g) than control group (50.57 ± 24.37 g). There is no difference in dietary habits between groups. In the CT scan, gastric pouch volume was determined: control group average of 17.25 ± 7.86 ml, WR group average of 29.00 ± 17.20 ml, p = 0.076. In the Upper GI endoscopy, the stomach length was determined to be 1.92 ± 0.20 cm in control group and 2.70 ± 1.25 cm in the WR group, p = 0.082. Psychiatric and eating disorders among the groups were distributed without statistically significant difference. A statistically significant factor among the groups was the time spent sitting alone. No differences in nutrition and anatomical factors among groups were found. The incidence of psychiatric and eating disorders among the study groups also did not differ

Tarpžinybinis bendradarbiavimas vietos savivaldoje: jaunimo politikos įgyvendinimas

ISSN 2351-6909 (Online)Jaunimo aktualijos – viena svarbiausių veiklos sričių ne tik politikoje, bet ir visuomenėje. Todėl svarbu išskirti tarpžinybinio bendradarbiavimo institucijas vietos savivaldoje, kurios yra atsakingos už jaunimo politikos įgyvendinimąVytauto Didžiojo universitetasŽemės ūkio akademij

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe