Framing and shaping migration governance: the case of EU-Tunisian migration relations

Migration governance is an organisational process, which means it centres on how organisations make sense of and respond to signals from their environment. This thesis contributes to the study of migration governance by developing comparative insight into how organisationally bound and ‘situated’ migration governance processes in Tunisia and at European Union (EU) level relate to each other and, through their actions and inactions, define the challenges that they face. An abundance of literature is available on the ‘EU’s external migration governance’. However, much of this literature focuses on the policy outputs produced, or the policy outcomes determined, often reaching assumptions on processes of migration governance based on these analyses. As the EU has been the main driver of this policy production, the literature developed is largely Eurocentric, and often fails to give adequate and equal consideration to non-EU state dynamics. To address these issues, the thesis develops an actor-centred analysis of the organisational processes through which migration is conceptualised in the EU and in Tunisia, building from theories that value the importance of framing and sensemaking. Based on forty three interviews with migration governance actors across the two cases and extensive use of the primary and secondary literature, it analyses the dual meaning of migration governance, as actors first need to make sense of migration diagnosing its causes and consequences; and then prognosing a line of work that follows such diagnoses. The thesis finds that migration governance systems play a key role in defining migration and its challenges, rather than being simply externally impacted by them. By understanding the importance of cognitive biases and dissonance in shaping individual understandings and thus actions, it shows that contrary to what much of the available literature assumes, the EU is failing to externalise its priorities and associated meanings of migration, and EU-Tunisian migration relations remain a field of profound contestation. Firstly, the EU is not as strong as expected in this ‘profusion’ of its ideas because the thesis shows that these are contested in the EU itself. This notwithstanding, the thesis shows that the EU is driven by a framing of migration related to crisis, which urges action. Tunisia actively resists the profusion of migration frames and policies of migration from the EU preferring inaction, which aligns with a rights-based approach that emerged after the 2011 revolution and which included the right to mobility, and a view of Tunisian migration as an opportunity for the country. As such, a clash characterizes these relations, between the products of EU framings of migration, such as return and readmission, and Tunisian ones, such as increasing mobility for its citizens

An EU-Africa partnership scheme for human capital formation and skill mobility. CEPS Project Report. June 2019

Proper management of migration across the Mediterranean Sea requires close cooperation between the EU and African countries. Cooperation is difficult because core interests diverge. EU countries are focused on curbing irregular migration; African countries are primarily interested in economic development, with migration as one of the opportunities. At the moment, the EU lacks a credible long-term programme to engage African countries on migration issues. We propose an ambitious EU-Africa partnership scheme for human capital formation and skill mobility that can be embedded into the current framework for EU-Africa dialogue. The scheme comprises three elements: First, extensive vocational training programmes would be set up in African countries, funded by the EU or individual member states, to train participants according to labour market needs in both the EU and African countries. Second, EU member states would issue a substantial number of work permits, offering programme graduates a good chance of employment in the EU while allowing member states to manage the inflow of workers according to their needs. Third, the private sector would be actively involved in planning and implementing vocational training programmes to ensure that graduates are employable in the EU and to facilitate job search and hiring across the Mediterranean. The scheme fits in the current legal framework for labour migration into the EU, and should be seen as one element in building a comprehensive forward-looking partnership with Africa for the benefit of all stakeholders involved in both origin and destination countries

New actors and new understandings in European Union external migration governance? : the case of EU-Tunisian migration relations

This chapter analyses the expanding nature of the EU’s external migration governance network, focusing on the case of EU-Tunisia migration relations. It develops an actor-centred perspective on migration governance, analysing how the ‘intersection’ of policy universes that followed the so called European migration crisis has led to the inclusion of new actors with new understandings to this governance system. As such, it shows how the EU does not act as a monolithic actor when ‘going abroad’ with its policies and instruments. Instead different policies and relations are developed by actors that often have different understandings of migration and of the challenges it poses, thereby developing their actions based on different priorities. Recognizing two main frames on the basis of which such actors develop their actions -a securitized frame based on the perception of the threat of a migrant invasion, and a migrant centred frame largely focused on the migrant’s experience- the chapter shows the extent to which this system of migration governance plays a key role in defining the challenges with which it is confronted, driving like this relations on migration between the EU and Tunisia

Different impact of sex on baseline characteristics and major periprocedural outcomes of transcatheter and surgical aortic valve interventions: results of the multicenter Italian OBSERVANT Registry

Background: Despite the widespread use of transcatheter aortic valve implantation (TAVI), the role of sex on outcome after TAVI or surgical aortic valve replacement (AVR) has been poorly investigated. We investigated the impact of sex on outcome after TAVI or AVR. Methods: There were 2108 patients undergoing TAVI or AVR who were enrolled in the Italian Observational Multicenter Registry (OBSERVANT). Thirty-day mortality, major periprocedural morbidity, and transprosthetic gradients were stratified by sex according to interventions. Results: Female AVR patients showed a worse risk profile compared with male AVR patients, given the higher mean age, prevalence of frailty score of 2 or higher, New York Heart Association class of 3 or higher, lower body weight, and preoperative hemoglobin level (P ≤.02). Similarly, female TAVI patients had a different risk profile than male TAVI patients, given a higher age and a lower body weight and preoperative hemoglobin level (P ≤.005), but with a similar New York Heart Association class, frailty score, EuroSCORE (P = NS), a better left ventricular ejection fraction and a lower prevalence of left ventricular ejection fraction less than 30%, porcelain aorta, renal dysfunction, chronic obstructive pulmonary disease, arteriopathy, and previous cardiovascular surgery or percutaneous coronary intervention (P ≤.01). Women showed a smaller aortic annulus than men in both populations (P <.001). Female sex was an independent predictor in the AVR population for risk-Adjusted 30-day mortality (odds ratio [OR], 2.34; P =.043) and transfusions (OR, 1.47; P =.003), but not for risk-Adjusted acute myocardial infarction, stroke, vascular complications, permanent atrioventricular block (P = NS). Female sex was an independent predictor in the TAVI population for risk-Adjusted major vascular complications (OR, 2.92; P =.018) and transfusions (OR, 1.93; P =.003), but proved protective against moderate to severe postprocedural aortic insufficiency (P =.018). Conclusions: Female sex is a risk factor for mortality after aortic valve replacement, for major vascular complications after TAVI, and for transfusions after both approaches. Copyright © 2014 by The American Association for Thoracic Surgery

1-Year Outcomes After Transfemoral Transcatheter or Surgical Aortic Valve Replacement: Results From the Italian OBSERVANT Study.

Tamburino C, Barbanti M, D'Errigo P, Ranucci M, Onorati F, Covello RD, Santini F, Rosato S, Santoro G, Fusco D, Grossi C, Seccareccia F; OBSERVANT Research Group. Collaborators (209) Marra S, Marra S, D'Amico M, Gaita F, Moretti C, De Benedictis M, Aranzulla T, Pistis G, Reale M, Bedogni F, Brambilla N, Ferrario M, Ferrero L, Vicinelli P, Colombo A, Chieffo A, Ferrari A, Inglese L, Casilli F, Ettori F, Frontini M, Antona C, Piccaluga E, Klugmann S, De Marco F, Tespili M, Saino A, Leonzi O, Rizzi A, Grisolia E, Franceschini Grisolia E, Isabella G, Fraccaro C, Bernardi G, Bisceglia T, Armellini I, Vischi M, Parodi E, Vignali L, Ardissimo D, Marzocchi A, Marrozzini C, Cremonesi A, Colombo F, Giannini C, Pierli C, Iadanza A, Santoro G, Meucci F, Berti S, Mariani M, Tomai F, Ghini A, Violini R, Confessore P, Crea F, Giubilato S, Sardella G, Mancone M, Ribichini F, Vassanelli C, Dandale R, Giudice P, Vigorito F, Liso A, Specchia L, Indolfi C, Spaccarotella C, Stabile A, Gandolfo C, Tamburino C, Ussia G, Comoglio C, Dyrda O, Rinaldi M, Salizzoni S, Micalizzi E, Grossi C, Di Gregorio O, Scoti P, Costa R, Casabona R, Del Ponte S, Panisi P, Spira G, Troise G, Messina A, Viganò M, Aiello M, Alfieri O, Denti P, Menicanti L, Agnelli B, Donatelli F, Muneretto C, Frontini M, Rambaldini M, Frontini M, Gamba A, Tasca G, Ferrazzi P, Terzi A, Antona C, Gelpi G, Martinelli L, Bruschi G, Graffigna AC, Mazzucco A, Pappalardo A, Gatti G, Livi U, Pompei E, Coppola R, Gucciardo M, Parodi E, Albertini A, Caprili L, Ghidoni I, Gabbieri D, La Marra M, Aquino T, Gherli T, Policlinico S, Di Bartolomeo R, Savini C, Popoff G, Innocenti D, Bortolotti U, Pratali S, Stefano P, Blanzola C, Glauber M, Cerillo A, Chiaramonti F, Pardini A, Fioriello F, Torracca L, Rescigno G, De Paulis R, Nardella S, Musumeci F, Luzi G, Possati G, Bonalumi G, Covino E, Pollari F, Sinatra R, Roscitano A, Chiariello L, Nardi P, Lonobile T, Baldascino F, Di Benedetto G, Mastrogiovanni G, Piazza L, Marmo J, Vosa C, De Amicis V, Speziale G, Visicchio G, Spirito R, Gregorini R, Specchia L, Villani M, Pano MA, Bortone A, De Luca Tupputi Schinosa L, De Cillis E, Gaeta R, Di Natale M, Cassese M, Antonazzo A, Argano V, Santaniello E, Patanè L, Gentile M, Tribastone S, Follis F, Montalbano G, Pilato M, Stringi V, Patanè F, Salamone G, Ruvolo G, Pisano C, Mignosa C, Bivona A, Cirio EM, Lixi G, Seccareccia F, D'Errigo P, Rosato S, Maraschini A, Badoni G, Tamburino C, Santoro G, Santini F, Grossi C, Ranucci M, Covello RD, Fusco D, Onorato F, De Palma R, Scandotto S, Orlando A, Copello F, Borgia P, Marchetta F, Porcu R. BACKGROUND: There is a paucity of prospective and controlled data on the comparative effectiveness of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in a real-world setting. OBJECTIVES: This analysis aims to describe 1-year clinical outcomes of a large series of propensity-matched patients who underwent SAVR and transfemoral TAVR. METHODS: The OBSERVANT (Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment) trial is an observational prospective multicenter cohort study that enrolled patients with aortic stenosis (AS) who underwent SAVR or TAVR. The propensity score method was applied to select 2 groups with similar baseline characteristics. All outcomes were adjudicated through a linkage with administrative databases. The primary endpoints of this analysis were death from any cause and major adverse cardiac and cerebrovascular events (MACCE) at 1 year. RESULTS: The unadjusted enrolled population (N = 7,618) included 5,707 SAVR patients and 1,911 TAVR patients. The matched population had a total of 1,300 patients (650 per group). The propensity score method generated a low-intermediate risk population (mean logistic EuroSCORE 1: 10.2 ± 9.2% vs. 9.5 ± 7.1%, SAVR vs. transfemoral TAVR; p = 0.104). At 1 year, the rate of death from any cause was 13.6% in the surgical group and 13.8% in the transcatheter group (hazard ratio [HR]: 0.99; 95% confidence interval [CI]: 0.72 to 1.35; p = 0.936). Similarly, there were no significant differences in the rates of MACCE, which were 17.6% in the surgical group and 18.2% in the transcatheter group (HR: 1.03; 95% CI: 0.78 to 1.36; p = 0.831). The cumulative incidence of cerebrovascular events, and rehospitalization due to cardiac reasons and acute heart failure was similar in both groups at 1 year. CONCLUSIONS: The results suggest that SAVR and transfemoral TAVR have comparable mortality, MACCE, and rates of rehospitalization due to cardiac reasons at 1 year. These data need to be confirmed in longer term and dedicated ongoing randomized trial

1-Year Outcomes After Transfemoral Transcatheter or Surgical Aortic Valve Replacement: Results From the Italian OBSERVANT Study.

BACKGROUND: There is a paucity of prospective and controlled data on the comparative effectiveness of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in a real-world setting. OBJECTIVES: This analysis aims to describe 1-year clinical outcomes of a large series of propensity-matched patients who underwent SAVR and transfemoral TAVR. METHODS: The OBSERVANT (Observational Study of Effectiveness of SAVR-TAVI Procedures for Severe Aortic Stenosis Treatment) trial is an observational prospective multicenter cohort study that enrolled patients with aortic stenosis (AS) who underwent SAVR or TAVR. The propensity score method was applied to select 2 groups with similar baseline characteristics. All outcomes were adjudicated through a linkage with administrative databases. The primary endpoints of this analysis were death from any cause and major adverse cardiac and cerebrovascular events (MACCE) at 1 year. RESULTS: The unadjusted enrolled population (N = 7,618) included 5,707 SAVR patients and 1,911 TAVR patients. The matched population had a total of 1,300 patients (650 per group). The propensity score method generated a low-intermediate risk population (mean logistic EuroSCORE 1: 10.2 ± 9.2% vs. 9.5 ± 7.1%, SAVR vs. transfemoral TAVR; p = 0.104). At 1 year, the rate of death from any cause was 13.6% in the surgical group and 13.8% in the transcatheter group (hazard ratio [HR]: 0.99; 95% confidence interval [CI]: 0.72 to 1.35; p = 0.936). Similarly, there were no significant differences in the rates of MACCE, which were 17.6% in the surgical group and 18.2% in the transcatheter group (HR: 1.03; 95% CI: 0.78 to 1.36; p = 0.831). The cumulative incidence of cerebrovascular events, and rehospitalization due to cardiac reasons and acute heart failure was similar in both groups at 1 year. CONCLUSIONS: The results suggest that SAVR and transfemoral TAVR have comparable mortality, MACCE, and rates of rehospitalization due to cardiac reasons at 1 year. These data need to be confirmed in longer term and dedicated ongoing randomized trials