Civil Society and Conflict Transformation in Abkhazia, Israel/Palestine, Nagorno-Karabakh, Transnistria and Western Sahara

The paper describes and analyses the role of civil society in five conflict cases – Abkhazia, Nagorno-Karabakh, Transnistria, Western Sahara and Israel/ Palestine. It evaluates the relative effectiveness of civil society organisations (CSOs) and assesses the potential and limits of CSO involvement in conflicts. In particular it concentrates on civil society activities in the fields of peace training and education, including formal and non-formal education, as well as research and media work. The research also identifies the obstacles that local third sector is faced with, examining experiences and lessons learned. The study then presents critical assessments of local CSO contributions to conflict transformation and concludes with a set of suggestions for local and mid-level civil society actors involved in these five conflict cases and beyond. This paper is an overview study, to provide ideas and documentation to the more detailed empirical research carried out in the context of the MICROCON Work Package ‘Conflict in the European Neighbourhood’.Civil society, European Union, European Neighbourhood, Abkhazia, Nagorno-Karabakh, Transnistria, Western Sahara, Israel/Palestine, violent conflict, conflict transformation

European Union comprehensive approach : what's in a name?

O artigo parte da ideia de que o conceito de abordagem abrangente passou a ser adotado como uma característica distintiva da União Europeia no que respeita à gestão de crises. O novo enquadramento institucional dado pelo Tratado de Lisboa e o crescente número e complexidade dos desafios globais com os quais a União procura lidar, em muito contribuiu para a sua operacionalização. Ao nível conceptual, o âmbito e objeto da abordagem abrangente da União foi parcialmente definida por um Comunicado Conjunto adotado em 2013 e pela Estratégia Global da União a ser apresentada pela Alta Representante em junho de 2016. Contudo importantes divergências entre Estados-membros, bem como entre as clivagens existentes entre instituições europeias e os obstáculos operacionais ainda impedem a sua efetiva implementação. Este artigo tem por objeto analisar a génese, evolução e perspetivas atuais sobre a abordagem abrangente da União com o propósito de incentivar o debate em curso nas instituições europeias e entre as comunidades de peritos. A primeira parte oferece uma perspetiva sobre o desenvolvimento do conceito desde a adoção da Estratégia Europeia de Segurança até à entrada em vigor do Tratado de Lisboa e à adoção pela Comissão Europeia e Alta Representante do Comunicado Conjunto. A segunda parte avalia os esforços e lacunas relativas à sua operacionalização, considerando em particular a questão do desenvolvimento de capacidades na área da segurança, desenvolvimento, programas conjuntos na cooperação para o desenvolvimento e migrações. Conclui com uma perspetiva sobre o futuro da abordagem abrangente da União considerando a adoção da Estratégia Global da União Europeia.info:eu-repo/semantics/publishedVersio

Towards Multiple, Sustained, and Indirect Actions

The EU is increasingly concerned with the diffusion and uncertainty of risks and threats in the neighbourhood, and resilience appears as a useful and pragmatic policy framework to address risks in areas of limited statehood and contested orders. The working paper draws from extensive report analysis and semi-structured interviews with EU officials to examine the diplomatic, economic, and military instruments that the EU mobilizes in a resilience-informed external action. The main contribution is that these instruments are increasingly facilitating resilience through multiple, long-term, and indirect actions. First, instruments have expanded and diversified to undertake as many different actions as possible. Second, they are sustained over long periods of time, even when there are no risks or threats or after peace and stability have been reached. Third, since resilience emerges “from below”, building on societies’ own resources and tools, EU instruments facilitate resilience indirectly, through constant engagement in the neighbourhood

EU civilian crisis management : what role after the war on Ukraine?

info:eu-repo/semantics/publishedVersio

A new paradigm for managing crises after Covid-19

Complexidade, Entropia, Incerteza, Intermitência, Exponencialidade. Eis alguns conceitos que têm sido utilizados para caracterizar a crise que vivemos. Neste IDN Brief quisemos perceber em que medida esta situação desafia o atual paradigma da Gestão de Crises a nível internacional, europeu e nacional. Reunimos perspetivas variadas sobre o papel e desempenho dos sistemas de planeamento civil e de emergência e de proteção civil, a coordenação entre atores, o lugar dos cidadãos e da sociedade civil, os ajustamentos necessários para desenvolver resiliência e as lições que se vislumbram para o futuro.info:eu-repo/semantics/publishedVersio

Bowel preparation for elective colorectal resection: multi-treatment machine learning analysis on 6241 cases from a prospective Italian cohort

background current evidence concerning bowel preparation before elective colorectal surgery is still controversial. this study aimed to compare the incidence of anastomotic leakage (AL), surgical site infections (SSIs), and overall morbidity (any adverse event, OM) after elective colorectal surgery using four different types of bowel preparation. methods a prospective database gathered among 78 Italian surgical centers in two prospective studies, including 6241 patients who underwent elective colorectal resection with anastomosis for malignant or benign disease, was re-analyzed through a multi-treatment machine-learning model considering no bowel preparation (NBP; No. = 3742; 60.0%) as the reference treatment arm, compared to oral antibiotics alone (oA; No. = 406; 6.5%), mechanical bowel preparation alone (MBP; No. = 1486; 23.8%), or in combination with oAB (MoABP; No. = 607; 9.7%). twenty covariates related to biometric data, surgical procedures, perioperative management, and hospital/center data potentially affecting outcomes were included and balanced into the model. the primary endpoints were AL, SSIs, and OM. all the results were reported as odds ratio (OR) with 95% confidence intervals (95% CI). results compared to NBP, MBP showed significantly higher AL risk (OR 1.82; 95% CI 1.23-2.71; p = .003) and OM risk (OR 1.38; 95% CI 1.10-1.72; p = .005), no significant differences for all the endpoints were recorded in the oA group, whereas MoABP showed a significantly reduced SSI risk (OR 0.45; 95% CI 0.25-0.79; p = .008). conclusions MoABP significantly reduced the SSI risk after elective colorectal surgery, therefore representing a valid alternative to NBP

Abdominal drainage after elective colorectal surgery: propensity score-matched retrospective analysis of an Italian cohort

background: In italy, surgeons continue to drain the abdominal cavity in more than 50 per cent of patients after colorectal resection. the aim of this study was to evaluate the impact of abdominal drain placement on early adverse events in patients undergoing elective colorectal surgery. methods: a database was retrospectively analysed through a 1:1 propensity score-matching model including 21 covariates. the primary endpoint was the postoperative duration of stay, and the secondary endpoints were surgical site infections, infectious morbidity rate defined as surgical site infections plus pulmonary infections plus urinary infections, anastomotic leakage, overall morbidity rate, major morbidity rate, reoperation and mortality rates. the results of multiple logistic regression analyses were presented as odds ratios (OR) and 95 per cent c.i. results: a total of 6157 patients were analysed to produce two well-balanced groups of 1802 patients: group (A), no abdominal drain(s) and group (B), abdominal drain(s). group a versus group B showed a significantly lower risk of postoperative duration of stay >6 days (OR 0.60; 95 per cent c.i. 0.51-0.70; P < 0.001). a mean postoperative duration of stay difference of 0.86 days was detected between groups. no difference was recorded between the two groups for all the other endpoints. conclusion: this study confirms that placement of abdominal drain(s) after elective colorectal surgery is associated with a non-clinically significant longer (0.86 days) postoperative duration of stay but has no impact on any other secondary outcomes, confirming that abdominal drains should not be used routinely in colorectal surgery

Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps' vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries