Does the crossed-limb deficit affect the uncrossed portions of limbs?

When locating touch we remap its location from skin-based to external coordinates as a function of body posture. While remapping is thought to occur whenever there is tactile input, research has focused on a special case, the crossed-hands deficit, where tactile localization is impaired when the limbs are crossed, as compared to uncrossed. To date, these studies have always stimulated portions of the limbs that are crossed, such as a finger of each hand. It is therefore unknown whether the deficit induced by arm crossing is specific to the crossed portion of the limb or affects the limb as a whole. In Experiments 1 and 2, we stimulated the shoulders and elbows and found that tactile localization, measured with temporal order judgments, was unaffected by crossing the forearms. In Experiment 3, a crossed-limbs deficit was observed for touches on a single skin location when that location was distal – but not proximal – to the crossing point of the arms. In Experiment 4, we found a similar crossed-limbs deficit irrespective of how far distally to the crossing point touch was applied. Together, these results demonstrate that crossing the limbs affects tactile perception only distal to the point of crossing. The process of remapping tactile events does not take into account the endpoint location of the limb, but an extremely precise metric description of the touch relative to the configuration of both arms

State of the art. Overview of concepts, indicators and methodologies used for analyzing the social OMC.

This paper is a detailed analysis about the literature on the Social OMC from 2006-2010, focusing on how OMC research has been carried out. It specifically points to which theoretical framework/concepts are used, and how change is conceptualised and measured. It is organised in five sections. The first concerns visibility and awareness about the OMC; the second analyses research on the EU level coordination process; the third scrutinizes how features of the OMC have been analysed. The fourth and fifth sections, addressing how national integration of the OMC has been researched, respectively address substantive policy change as well as national policy-making. Strikingly, virtually all OMC research adopts theoretical frameworks derived from literature on Europeanisation and/or institutionalisation. Also, as the OMC is voluntary and sanction-free, it depends heavily on how and the the extent to which actors use it (agenda-setting, conflict resolution, maintaining focus on a policy issue, developing a policy dialogue, etc). OMC research has become nuanced and does highlight how, for which purpose and with which outcome actors engage with the OMC. Another finding is that there is data on policy issues addressed through the OMC, learning does take place and there is knowledge about domestic policy problems. However, the linkage between knowledge of an issue and direct use of the OMC for policy change in social policy is weak, but that may change with EU2020, where social policy has received a higher profile. Most research covers the EU-15, much more research needs to be undertaken in newer EU member states

Adults with congenital heart diseases: our experience with diagnosis and surgical treatment

Introduction: The population of adults with congenital heart disease (CHD) (commonly called grown-ups with congenital heart disease or GUCH) is increasing steadily, due to the remarkable improvement in survival of patients with CHD. In addition, some defects (e.g. ASD, CoA, Ebstein`s anomaly, and ccTGA) may be diagnosed for the first time in adult life. In Europe (727 million inhabitants), the GUCH population is estimated between 1.2 and 2.7 million patients with prevalence of about 2800 adults per 1 million. In Bulgaria, there isn`t confirmed statistical analysis, but the data from different health centers suggest of about 20 000 cases. Methods: We made an overview of echocardiographic and surgical approach to GUCH patients operated on at the Department of Cardiac Surgery in St.Marina University Hospital, presenting examples of the most interesting abnormalities observed. The surgical approach classifies them in 2 groups: (1) survival into adulthood of patients with known congenital heart disease and previous surgical procedures (2) patients with conditions not diagnosed or not considered severe enough to require surgery in childhood. The echocardiographic approach divides them in several categories: (1) stenotic lesions (2) regurgitant lesions (3) intracardiac shunts (4) abnormal connections (5) combinations or complex congenital diseases.Aim: Our aim is to compare the prevalence of adult congenital heart disease in our department with European data.Results and conclusion: No significant difference was found in the rate and approach between our practice and reported European sources. Key words: adult congenital heart diseases, prevalence, diagnosis, echocardiography, surgical treatmen

Drainless robot-assisted minimally invasive oesophagectomy—randomized controlled trial (RESPECT)

Abstract Background The purpose of this randomized trial is to evaluate the early removal of postoperative drains after robot-assisted minimally invasive oesophagectomy (RAMIE). Evidence is lacking about feasibility, associated pain, recovery, and morbidity. Methods/design This is a randomized controlled multicentric trial involving 72 patients undergoing RAMIE. Patients will be allocated into two groups. The “intervention” group consists of 36 patients. In this group, abdominal and chest drains are removed 3 h after the end of surgery in the absence of contraindications. The control group consists of 36 patients with conventional chest drain management. These drains are removed during the further postoperative course according to a standard algorithm. The primary objective is to investigate whether postoperative pain measured by NRS on the second postoperative day can be significantly reduced in the intervention group. Secondary endpoints are the intensity of pain during the first week, analgesic use, number of postoperative chest X-ray and CT scans, interventions, postoperative mobilization (steps per day as measured with an activity tracker), postoperative morbidity and mortality. Discussion Until now, there have been no trials investigating different intraoperative chest drain strategies in patients undergoing RAMIE for oesophageal cancer with regard to perioperative complications until discharge. Minimally invasive approaches combined with enhanced recovery after surgery (ERAS) protocols lower morbidity but still include the insertion of chest drains. Reduction and early removal have been proposed after pulmonary surgery but not after RAMIE. The study concept is based on our own experience and the promising current results of the RAMIE procedure. Therefore, the presented randomized controlled trial will provide statistical evidence of the effectiveness and feasibility of the “drainless” RAMIE. Trial registration ClinicalTrials.gov NCT05553795. Registered on 23 September 2022

The OMC - an Opaque Method of Consideration or Deliberative Governance in Action?

Abstract the open method of coordination (omc) is a new mode of european union (eu) governance which, according to political rhetoric, aims to install (elements of) deliberative governance at the level. The article provides an empirical assessment of whether and how deliberative processes are actually induced in the practical implementation of the method. It presents results of a series of interviews conducted with members of the employment committee of the eu. The collected empirical material suggests that, in spite of initial expectations, the omc (so far) falls short in establishing a novel deliberative basis of legitimacy for eu governance