Operatividad política de la táctica terrorista

La táctica terrorista como variante de violencia política, a modo de forma propagandística extrema, ha ganado creciente protagonismo en la política internacional de los últimos 60 años, constituyendo hoy razón y excusa de acciones gubernamentales, tanto interiores como exteriores, de las principales potencias mundiales. La intención de este ensayo reside en analizar el alcance político de la táctica terrorista y su operatividad, en el marco de un propósito político trascendente. La operatividad política esta determinada por la capacidad del actor político, que opta por este tipo de violencia, para reflotar un cleavage anterior –contienda histórica entre socivs et hostis–, enmarcado en un proyecto político –de trasfondo– que lo contiene y explica. No todos los sistemas políticos actuales canalizan eficien los sistemas políticos actuales canalizan eficientemente las demandas; pudiendo dejar insatisfechos a ciertos actores minoritarios.Instituto de Relaciones Internacionales (IRI

Opciones estratégicas de asociación entre política y religión: modelos de legitimación confesional en la política del Medio Oriente

Este ensayo indaga sobre las posibles opciones estratégicas de asociación entre Política y Religión. Tomando casos de Medio Oriente, se presentan distintos modelos de vinculación entre posturas ofensivas o defensivas y sus combinaciones con posturas religiosas o seculares. Dichas combinaciones entre política y religión serán contrastadas contra ejemplos históricos. La intención última del trabajo reside en, formular modelos de relación Política-Religión como versátiles recursos estratégicos.Mesa: Identidad y procesos políticosInstituto de Relaciones Internacionales (IRI

Opciones estratégicas de asociación entre política y religión: modelos de legitimación confesional en la política del Medio Oriente

Este ensayo indaga sobre las posibles opciones estratégicas de asociación entre Política y Religión. Tomando casos de Medio Oriente, se presentan distintos modelos de vinculación entre posturas ofensivas o defensivas y sus combinaciones con posturas religiosas o seculares. Dichas combinaciones entre política y religión serán contrastadas contra ejemplos históricos. La intención última del trabajo reside en, formular modelos de relación Política-Religión como versátiles recursos estratégicos.Mesa: Identidad y procesos políticosInstituto de Relaciones Internacionales (IRI

Operatividad política de la táctica terrorista

La táctica terrorista como variante de violencia política, a modo de forma propagandística extrema, ha ganado creciente protagonismo en la política internacional de los últimos 60 años, constituyendo hoy razón y excusa de acciones gubernamentales, tanto interiores como exteriores, de las principales potencias mundiales. La intención de este ensayo reside en analizar el alcance político de la táctica terrorista y su operatividad, en el marco de un propósito político trascendente. La operatividad política esta determinada por la capacidad del actor político, que opta por este tipo de violencia, para reflotar un cleavage anterior –contienda histórica entre socivs et hostis–, enmarcado en un proyecto político –de trasfondo– que lo contiene y explica. No todos los sistemas políticos actuales canalizan eficien los sistemas políticos actuales canalizan eficientemente las demandas; pudiendo dejar insatisfechos a ciertos actores minoritarios.Instituto de Relaciones Internacionales (IRI

Opciones estratégicas de asociación entre política y religión: modelos de legitimación confesional en la política del Medio Oriente

Este ensayo indaga sobre las posibles opciones estratégicas de asociación entre Política y Religión. Tomando casos de Medio Oriente, se presentan distintos modelos de vinculación entre posturas ofensivas o defensivas y sus combinaciones con posturas religiosas o seculares. Dichas combinaciones entre política y religión serán contrastadas contra ejemplos históricos. La intención última del trabajo reside en, formular modelos de relación Política-Religión como versátiles recursos estratégicos.Mesa: Identidad y procesos políticosInstituto de Relaciones Internacionales (IRI

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

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

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

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients