Restrictive Procedures Research Articles

Preventing COVID-19 in assisted living facilities: An impossible task pending vaccination roll out.

Here, we aimed to describe the clinical outcomes of the residents of a long-term care facility during its closure to visitors and suppliers in response to the first COVID-19 pandemic from February 23 to June 22, 2020, and the results of the facility-wide SARS-CoV-2 testing of residents and staff in June 2020 before its partially reopening. Seventy-four residents and 53 members of staff were included in the present study. The staff underwent nasopharyngeal swab tests for SARS-CoV-2, and both the staff and residents underwent serological tests to detect IgG antibodies against SARS-CoV-2. The results of all of the tests were negative. Conversely, 94% of residents and 38% members of the staff were tested positive to the nasopharyngeal swab tests during the second COVID-19 pandemic wave (data collected from November 1 to November 30, 2020). Our experience suggests that, in the presence of a life-threatening pandemic such as SARS-CoV-2 infection, the prompt use of restrictive procedures can prevent the spread and progression of disease in assisted living facilities in the short term but may fail in the long term, especially when the prevalence of the COVID-19 greatly increased outside the facility enhancing the risk of import the disease from outside. SARS-CoV-2 vaccination of residents and staff members would contribute to control/limit the prevalence and the spread of the virus.

Practices concerning sleeve gastrectomy in Turkey: A survey of surgeons.

BACKGROUNDLaparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgical procedure. LSG is a restrictive procedure and in this operation stomach volume is greatly reduced. When the details of the procedure are examined, it is seen that there are many different methods surgery.AIMTo analyze approaches of surgeons performing LSG.METHODSA questionnaire consist of 44 questions was sent by e-mail to the surgeons performing bariatric surgery. Approaches of surgery about preoperative period, surgical techniques and postoperative period was questioned.RESULTSDifferent approaches about antibiotic prophylaxis, stapler line reinforcement utilization, application of intraoperative and postoperative leakage test, approach to the crus and hiatal hernia repair were detected. It was observed that a few partipicipants applied contrary to the guidelines of antibiotic prophlaxis and thromboembolism prophylaxis. Approaches about other subjects were generally similar.CONCLUSIONIn this study, approaches about LSG that most common bariatric surgical procedure in our country was learned. According to these results, knowing the approaches in our country will be beneficial in terms of determining the training programs in bariatric surgery, improving surgical results and reducing the complications.

Ground-level aircraft operations as a measure of sustainable airport efficiency: A weight-restricted DEA approach

Ground-level aircraft operations and landing and take-off cycle account for the vast majority of an airport’s total emission. Among other factors, planning skills are critical in minimizing the emissions produced and fuel burn through reducing taxi times during landing and take-off operations. This study examines the sustainable efficiencies of busiest European airports considering their success in reducing emissions during landing and take-off cycles and argues (i) emission per landing and take-off cycle is a good proxy for ground-level aircraft operation planning skills and provides more practical results than the total amount of annual emission, (ii) weight restriction procedure is necessary in Data Envelopment Analysis applications to ensure furnishing the impact of emission criteria on overall efficiency. A weight-restricted Data Envelopment Analysis model was constructed, and both physical and sustainable efficiencies of each airport were examined during nine years between 2010 and 2018. A combinative Analytic Hierarchy Process – Criteria Importance Through Intercriteria Correlation approach was used to define criteria weights, and a new modified approach was proposed and used to include these weights in Data Envelopment Analysis. Findings proved the necessity of weight restriction when one would examine the impact of emissions produced on sustainable airport efficiency. The Malmquist Productivity Index showed a great shift in physical output production; however, improvements to reduce landing and take-off cycle times have lagged behind the shift in physical output production.

Recent Modalities in Management of Early Complications of Sleeve Gastrectomy

Background: One of the most common operation for weight loss is the laparoscopic sleeve gastrectomy which are an effective and relatively safe. Laparoscopic sleeve gastrectomy is superior in comparison to other restrictive procedures due to the decrease of large parts of ghrelin producing stomach mass. Aim of the Work: to outline recent modalities in management of early complications of sleeve gastrectomy. This study was performed at Benha university hospitals and Kasr El Aini University Hospitals on 30 early complicated cases post sleeve gastrectomy at the period from 1/1/2018 to 30/6/2018. Patients and Methods: This study was performed at Benha university hospitals at the period from 1/1/2018 to 30/6/2018 on 30 early complicated cases post sleeve gastrectomy. Consent of the patients was taken and data were collected included: age, sex, BMI, and comorbid conditions at the time of admission. Results: According to the co morbidities, eight of the studied cases (26.7%) suffered from hypertension, and 22 others (73.3%) didn’t suffer from hypertension, also half of the studied cases (50.0%) suffered from diabetes. As regard the complications that the patients suffered after the operation in our study, 7 patients (23.3%) suffered of Tachycardia, 5 patients (16.7%) suffered of Vomiting, 4 patients (13.3%) suffered of Hemorrhage, Leakage and Hematemsis, 3 patients (10.0%) suffered of Wound infection, 2 patients (6.7%) suffered of Gastric stenosis, Conversion to open and Melena. On the other side, none of the patients suffered from DVT, Gastric volvulus, pulmonary embolism and Mortality. Conclusion: LSG is one of the most effective surgical procedures in weight loss and is considered safe if its complications are diagnosed and managed early and we recommended to do this study on largenumber of patients to support our results and to know more about the sleeve gastrectomy complications to manage them as early as possible to get benefit from sleeve gastrectomy and to be used on a wide range.

Effect of postbariatric maternal weight loss and surgery to conception interval on perinatal outcomes of nulliparous women.

Bariatric surgery is associated with an increased risk of delivering a small neonate. The role of maternal weight loss and surgery to conception interval is unclear. To investigate the effect of maternal weight loss, as a result of bariatric surgery, and surgery to conception interval on fetal growth and birthweight (BW). Inner London Teaching Hospital METHODS: We studied prospectively nulliparous women with previous bariatric surgery. Information on type, time, and presurgery weight was obtained. Surgery-to-conception interval was calculated as the time between surgery and conception, defined as the fourteenth day of the pregnancy dated by first trimester ultrasound scan. In the first trimester, maternal weight was measured. Assessment of maternal weight change between presurgery and first trimester of pregnancy was defined as total weight loss (TWL) (%). Fetal ultrasound scans were performed twice; 30-32 and 35-37 weeks' gestation and estimated fetal weight (EFW) was calculated. Fetal growth rate was calculated as the ratio of EFW increase (in grams) between 30-32 and 35-37 weeks divided by the time interval (in days) between the 2 examinations. BW was recorded. The study included 54 pregnant women, 26 with a restrictive procedure (gastric band or vertical sleeve gastrectomy) and 28 with a gastric bypass. Surgery to conception interval was not a significant predictor of the offspring's growth. Maternal TWL was a significant predictor of fetal growth rate (P = .04) and predictor of BW (P = .005), even after adjustment for confounders. Maternal weight loss, as a result of bariatric surgery, has an inverse correlation with fetal growth rate and BW.

Fundectomy with Greater Curvature Plication; New Modification for Patients with Morbid Obesity

Background: Obesity is a global epidemic. Laparoscopic greater curvature plication [LGCP] is a restrictive surgical procedure described for the first time on 1981 by Wilkinson. Fundectomy is a selective resection of the acid-producing segment of the stomach, with removal of peptide hormone-producing cells [the oxyntic mucosa] as a consequence of the fundectomy. Aim of the work: Our aim is to assess the feasibility and advantages of the novel modification for morbidly obese patients which include fundectomy with greater curvature plication. Patients and Methods: Ten patients were included in this study, which carried out at Al-Azhar University Hospital [New Damietta]. Results: Body mass index [BMI] ranged from 30 to 48 kg/m2 [the mean was 38.8 kg/m2]. Operative time ranged from 60 to 120 minutes [Mean time: 93.5 minutes]. The mean hospital stay time was 1.35 days. The mean estimated weight loss percentage [EWL%] was 29.1% at three months, 44.6% at six months, 60.4% at one year, and 72.4% at two years. EWL% was less than 50% for one patient which needs reoperation with Laparoscopic Sleeve Gastrectomy. Two patients [20%] developed heartburn due to gastroesophageal reflux disease [GERD]. Nine patients [90%] presented nausea, and vomiting was present in four patients [40%]. Conclusion: Fundectomy and Greater curvature plication is a feasible, safe, effective as a bariatric operation with avoidance of complications of other bariatric operations. As a new modification for bariatric surgery, this operation needs more investigations and longer periods for follow up.

Laparoscopic Roux-en-Y Gastric Bypass After Failed Vertical Banded Gastroplasty: 2-Year Follow-up of 102 Patients

Vertical banded gastroplasty (VBG) is now discarded from being a restrictive procedure for morbid obesity due to its many drawbacks, doubtful efficacy, and lots of post-operative complications. Roux-en-Y gastric bypass (RYGB) is the most commonly performed procedure for VBG revision. So we aimed at reporting our experience in conversional RYGB for a failed VBG. Analyzing follow-up records of 102 patients who underwent revisional RYGB after failed VBG in the period from April 2014 to January 2018. A total of 102 laparoscopic revisions of failed VBGs to RYGB were performed. The mean operating time was 161.9 min ±29.2 and the mean length of the hospital stay was 1.5 days ±1.2. Fourteen patients (13%) developed early post-operative complications (gastrojejunostomy leak 5; bleeding 9). Four patients (4.7%) developed late complications (Port site hernia 2; internal hernia 1; Stomal ulcer 1). The mean BMI pre-RYGB was 46.6 ± 5.9 kg/m2, and the mean %EBWL (percent excess body weight lost) of the patients at 12 and 24 months post-revision were 56.2% and 64.3%, respectively. Our patients had immediate post-revision resolution of VBG-related complications like dysphagia and vomiting. We also report improvement in all obesity-related health problems with (75.7%) complete remission rate and (24.3%) partial remission or improvement rate of diabetes mellitus. Conversion of VBG to RYGB is a feasible procedure and is associated with acceptable early morbidity rates and reduced lengths of hospitalization also it provides acceptable weight loss and improvement in obesity-related health problems. Graphical Abstract.

Quantifying steric hindrance and topological obstruction to protein structure superposition

BackgroundIn computational structural biology, structure comparison is fundamental for our understanding of proteins. Structure comparison is, e.g., algorithmically the starting point for computational studies of structural evolution and it guides our efforts to predict protein structures from their amino acid sequences. Most methods for structural alignment of protein structures optimize the distances between aligned and superimposed residue pairs, i.e., the distances traveled by the aligned and superimposed residues during linear interpolation. Considering such a linear interpolation, these methods do not differentiate if there is room for the interpolation, if it causes steric clashes, or more severely, if it changes the topology of the compared protein backbone curves.ResultsTo distinguish such cases, we analyze the linear interpolation between two aligned and superimposed backbones. We quantify the amount of steric clashes and find all self-intersections in a linear backbone interpolation. To determine if the self-intersections alter the protein’s backbone curve significantly or not, we present a path-finding algorithm that checks if there exists a self-avoiding path in a neighborhood of the linear interpolation. A new path is constructed by altering the linear interpolation using a novel interpretation of Reidemeister moves from knot theory working on three-dimensional curves rather than on knot diagrams. Either the algorithm finds a self-avoiding path or it returns a smallest set of essential self-intersections. Each of these indicates a significant difference between the folds of the aligned protein structures. As expected, we find at least one essential self-intersection separating most unknotted structures from a knotted structure, and we find even larger motions in proteins connected by obstruction free linear interpolations. We also find examples of homologous proteins that are differently threaded, and we find many distinct folds connected by longer but simple deformations. TM-align is one of the most restrictive alignment programs. With standard parameters, it only aligns residues superimposed within 5 Ångström distance. We find 42165 topological obstructions between aligned parts in 142068 TM-alignments. Thus, this restrictive alignment procedure still allows topological dissimilarity of the aligned parts.ConclusionsBased on the data we conclude that our program ProteinAlignmentObstruction provides significant additional information to alignment scores based solely on distances between aligned and superimposed residue pairs.

Roux-en-Y gastric bypass versus one anastomosis-mini gastric bypass as a rescue procedure following failed restrictive bariatric surgery. A systematic review of literature with metanalysis.

Although different procedures have been proposed as revisional surgery for patients who had previously undergone a failed primary restrictive procedure, the ideal revisional procedure is still a matter of debate. A systematic search was performed in all electronic databases to find studies comparing one anastomosis-mini gastric bypass (OAGB-MGB) or Roux-en-Y gastric bypass (RYGB) as revisional bariatric surgery for weight regain or intolerance/complications of a primary restrictive procedure. The data regarding sample size, patients' gender, age, primary surgery type, number of perioperative complications, operative time, pre- and post-revisional body mass index (BMI), and excess weight loss % (EWL%) at 1-year follow-up were extracted. Five studies were included in the analysis. The primary bariatric procedures were represented by vertical banded gastroplasty (VBG), laparoscopic adjustable gastric band (LAGB) and laparoscopic sleeve gastrectomy (LSG). About perioperative complications, both RYGB and OAGB-MGB showed a similar rate of leaks but OAGB-MGB had a lower rate of bleedings; considering the progression from pre- to post-revisional BMI, OAGB-MGB reveals a better outcome as well as a shorter operative time. Our meta-analysis has shown OAGB-MGB, used as revisional intervention after failed restrictive surgery, achieves outcomes comparable to RYGB in terms of perioperative complications providing a simpler and more effective technique.

Government termination in Europe: a sensitivity analysis

The aim of this article is to examine which factors robustly influence cabinet duration in Central and Eastern Europe (CEE). In this respect the article investigates the role political institutions (including vote of no-confidence procedures), parliamentary and cabinet attributes, and various contextual factors have on cabinet stability. By using a type of sensitivity analysis (i.e. Extreme Bounds Analysis) on a panel of about 180 cabinets in CEE, it is possible to examine which factors consistently predict the probability of government survival. It is found that only a few factors are robust to alternative model specifications, namely: government type, fragmentation in parliament, the level of unemployment, and restrictive no-confidence votes procedures which make it more difficult for the opposition to bring down a government. Thus, the results indicate that cabinet duration in CEE is not primarily affected by sui generis factors to the region, but by factors of more general relevance.

Bariatric Surgery-How Much Malabsorption Do We Need?-A Review of Various Limb Lengths in Different Gastric Bypass Procedures.

The number of obese individuals worldwide continues to increase every year, thus, the number of bariatric/metabolic operations performed is on a constant rise as well. Beside exclusively restrictive procedures, most of the bariatric operations have a more or less malabsorptive component. Several different bypass procedures exist alongside each other today and each type of bypass is performed using a distinct technique. Furthermore, the length of the bypassed intestine may differ as well. One might add that the operations are performed differently in different parts of the world and have been changing and evolving over time. This review evaluates the most frequently performed bariatric bypass procedures (and their variations) worldwide: Roux-en-Y Gastric Bypass, One-Anastomosis Gastric Bypass, Single-Anastomosis Duodeno-Ileal Bypass + Sleeve Gastrectomy, Biliopancreatic Diversion + Duodenal Switch and operations due to weight regain. The evaluation of the procedures and different limb lengths focusses on weight loss, remission of comorbidities and the risk of malnutrition and deficiencies. This narrative review does not aim at synthesizing quantitative data. Rather, it provides a summary of carefully selected, high-quality studies to serve as examples and to draw tentative conclusions on the effects of the bypass procedures mentioned above. In conclusion, it is important to carefully choose the procedure and small bowel length excluded from the food passage suited best to each individual patient. A balance has to be achieved between sufficient weight loss and remission of comorbidities, as well as a low risk of deficiencies and malnutrition. In any case, at least 300 cm of small bowel should always remain in the food stream to prevent the development of deficiencies and malnutrition.

Comparison of primer and revisional laparoscopic mini-gastric bypass (MGB) for failed restrictive procedures: 2-year results at a tertiary center

Comparison of primer and revisional laparoscopic mini-gastric bypass (MGB) for failed restrictive procedures: 2-year results at a tertiary center

Optical flow and pattern noise-based copy–paste detection in digital videos

Digital videos are an incredibly important source of information, and as evidence, they are highly inculpatory. Digital videos are also inherently prone to conscious semantic manipulations, such as copy–paste forgeries, which involve insertion or removal of objects into or from a set of frames. Such forgeries involve direct manipulation of the information presented by a video scene, thus having an immediate effect on the meaning conveyed by that scene. Given the highly influential nature of video data and the fact that they are easy to manipulate, it becomes important to devise measures that can help ascertain their integrity and authenticity, so that we can be certain of their ability to serve as reliable evidence. The challenge of detecting copy–paste forgeries in digital videos has been at the receiving end of much innovation over the last decade, and as a result, the available literature in this domain has grown to considerable proportions. However, thorough analysis of this literature appears to show that the task of detecting such forgeries necessitates the use of elaborate and operationally restrictive procedures, and somehow cannot be accomplished via a relatively simpler process, whose method of operation imposes little to no restrictions on its scope of applicability. With the aim of quashing this notion, in this paper, we present two simple forensic solutions that can enable an analyst to detect copy–paste forgeries quickly and effectively, without having to resort to any complicated analyses or relying on unrealistic presumptions. These solutions are based on optical flow inconsistency analysis and pattern noise abnormality analysis, and have been validated on a substantial set of realistically tampered test videos in a diverse experimental set-up, which is representative of a neutral testing platform and simulates a real-world heterogeneous forensic environment, where the analyst has no control over any of the variable parameters of the video creation or manipulation process. When tested in such an experimental set-up, the proposed solutions achieved an average accuracy rate of 98% and demonstrated attributes desired of an efficacious and practical forensic solution, all the while validating our initial hypothesis that not only can the task of copy–paste detection be accomplished in a fast and uncomplicated manner, but also that in an actual forgery scenario, the less onerous a forensic solution is, the more likely it is to succeed.

Late Gastropleural Fistula Following Bariatric Surgery: Case Report

Although bariatric surgery procedures represent well-established methods for sustained weight loss worldwide, an important number of postoperative complications can be expected in both restrictive and mixed procedures. Gastropleural fistulas (GPF) represent an extremely rare life-threatening complication following bariatric surgery. Defined as a pathological communication between the gastric tract and the pleural cavity, the establishment of an appropriate and timely diagnosis may be quite challenging for physicians. We report on a case of a 33-year-old woman, who underwent a bariatric sleeve procedure, who presented several episodes of pneumonia in different occasions postoperatively with undiagnosed causes. Three years postoperatively the patient was hospitalized for a more detailed investigation and underwent video segmentectomy unsuccessfully. GPF was diagnosed following the observation of nutritional supplement escaping through the chest drain. The patient was initially treated with different endoscopic techniques (argon glow plasma, and endoscopic balloon dilatation) for the closure of the GPF, but despite all attempts, she eventually progressed to total gastrectomy. Bariatric surgery patients suffering from recurrent episodes of pneumonia should raise the alert for the possibility of GPF.

The first modified Delphi consensus statement on sleeve gastrectomy.

Sleeve gastrectomy (SG) is the commonest bariatric procedure worldwide. Yet there is significant variation in practice concerning its various aspects. This paper report results from the first modified Delphi consensus-building exercise on SG. We established a committee of 54 globally recognized opinion makers in this field. The committee agreed to vote on several statements concerning SG. An agreement or disagreement amongst ≥ 70.0% experts was construed as a consensus. The committee achieved a consensus of agreement (n = 71) or disagreement (n = 7) for 78 out of 97 proposed statements after two rounds of voting. The committee agreed with 96.3% consensus that the characterization of SG as a purely restrictive procedure was inaccurate and there was 88.7% consensus that SG was not a suitable standalone, primary, surgical weight loss option for patients with Barrett's esophagus (BE) without dysplasia. There was an overwhelming consensus of 92.5% that the sleeve should be fashioned over an orogastric tube of 36-40 Fr and a 90.7% consensus that surgeons should stay at least 1cm away from the angle of His. Remarkably, the committee agreed with 81.1% consensus that SG patients should undergo a screening endoscopy every 5years after surgery to screen for BE. A multinational team of experts achieved consensus on several aspects of SG. The findings of this exercise should help improve the outcomes of SG, the commonest bariatric procedure worldwide, and guide future research on this topic.

Research of Malting Procedures for Winter Hard Wheat Varieties-Part II.

This paper examines the influence of malting process parameters on the wheat malt quality obtained from the assortment of winter red wheat. For this assortment, previous research established that strongly restrictive and strongly intensive malting processes are not suitable, that is, they do not significantly improve the quality of the obtained wheat malts, and in some segments, they even disturb it. Therefore, modifications were introduced to both procedures, and malting was performed with moderately intensive procedure D and moderately restrictive procedure E. Starting wheat, indicators of micromalting process success, and finished wheat malts were analyzed. The results showed that the moderately restrictive malting process (E) significantly improves not only the values for soluble N for almost all tested varieties, but also the values of cytolytic degradation success (wort viscosity, filtration time), and extract yield. The moderately intensive procedure did not improve the determined indicators; for many varieties, the modification even resulted in poorer values. Furthermore, the moderately restrictive procedure allows a strong individual response of a particular variety to the process conditions during malting, which is very important for the assessment of the malting potential for a particular variety. Namely, when assessing the actual malting quality of an individual variety, it is necessary to include amylolytic indicators and indicators of enzymatic strength. In this way, a group of varieties were established which had an increased initial share of total N (varieties no. 7, 8, 9, 10, 12, 13, and 16). These varieties, by this procedure, gave the best quality wheat malts in the entire examined assortment.

3D-printed surface applicators for brachytherapy: a phantom study.

PurposeBrachytherapy is a great alternative for restrictive surgical procedures in facial cancers. Moreover, dose distribution is more beneficial compared with teleradiotherapy during treatment of lesions located on anatomical curves. However, repetitiveness of application is the main issue associated with using commercial applicators. The risk of its displacement is very unfavorable due to large dose gradients in brachytherapy. The aim of this study was to develop a process of preparation of applicators using 3D printing technology.Material and methodsIn planning system, circular volumes near the nose, eye, and ear were determined on transverse layers of an anthropomorphic phantom. Next, boluses with a thickness of 5 mm and 10 mm were designed for each of the layers. Channels in the 10 mm bolus were designed in such a way to place the catheters into the layers. Prepared applicators were printed using polylactic acid (PLA) filament. Plans to irradiate the films for their calibration and plans for treatment prepared in the treatment planning system were conducted. A special phantom was created to calibrate the radiochromic films. Dose distribution around the designed applicators was measured in an anthropomorphic phantom using films within the layers of phantom. Comparison of doses was performed with two-dimensional gamma analysis using OmniPro I’mRT software.ResultsThe obtained results confirmed compliance of the planned and measured doses in 92%; the analysis of gamma parameter showed 1%/1 mm for acceptability level of 95%. Moreover, the initial dosimetric analysis for gamma criteria with 2%/2 mm showed compliance at 99%.ConclusionsThe results of the present study confirm potential clinical usefulness of the applicators obtained with the use of 3D printing for brachytherapy.

Research of Malting Procedures for Winter Hard Wheat Varieties-Part I.

This paper examines the influence of the malting process of red hard wheat varieties (which have many characteristics of soft wheat varieties and represent a transitional form between durum and soft wheat). According to the values of total and soluble proteins and viscosity of wort these wheat varieties belong to the second malting quality group. To establish the individual response of each variety and estimate how the chosen varieties respond in groups to different process conditions, sixteen varieties were selected and malted according to the standard procedure (A), restrictive procedure (B), and intense procedure (C). Starting wheat, indicators of micromalting process success, and finished malts were analyzed. It was found that the restrictive procedure (B) gives poor results for the values of proteolysis performance parameters (soluble N, free amino nitrogen (FAN)) with simultaneous disturbance and values of cytolytic degradation (viscosity and filtration time) and extract yield. At the same time, this procedure lacks a stronger individual response of an individual variety to the process conditions during malting (F/C difference and extract yield). The optimal malting process for the specified assortment would include the modification of processes B and C in a way to alleviate the restrictive conditions in process B, or in a way to reduce the intensity of the decomposition in process C.

Covid-19 pandemic effects on food safety - Multi-country survey study

This study provides an important insight into the response of food safety systems during the first months of the pandemic, elevating the perspective of preventing Covid-19 within conventional food safety management systems. A multi-country survey was conducted in 16 countries involving 825 food companies. Based on the results of the survey, it is obvious that the level of maturity of a food safety system in place is the main trigger in classifying companies and their responses to the pandemic challenge.Staff awareness and hygiene are the two most important attributes in combating Covid-19, opposed to temperature checking of workers in food establishment and health protocols from the World Health Organization, recognized as attributes with limited salience and importance. Companies confirmed implementation of more restrictive hygiene procedures during the pandemic and the need for purchasing more additional personal protective equipment. Retailers were identified as the food supply chain link mostly affected by the pandemic opposed to food storage facilities ranked as least affected. During this challenging period, all companies declared that food safety has not been compromised at any moment. It is important to note that less than a half of the food companies had documented any emergency plans associated with pandemics and health issues in place.

Understanding ICSID Article 54

Abstract To the surprise of many, questions have recently arisen over the scope of inquiry, if any, that a national court may, consistent with Article 54 of the ICSID Convention, make in connection with the enforcement of an ICSID award. It has long been assumed in many, if not most, quarters that a national court is privileged to condition enforcement of an ICSID Convention award on a single simple requirement, viz. that the award be certified by the Secretary-General of ICSID. Until recently, doubts over whether that is so have been raised in a very small number of jurisdictions. But the Commission of the European Union has taken the view that an ICSID Convention award may be denied enforcement if it is contrary to a principle of “autonomy” of EU law and, based on its judgment in Achmea case in connection with non-ICSID awards, the European Court of Justice most likely takes the same view. This suggests that the European Union regards violation of EU public policy, more generally, as a defense to enforcement of an ICSID award. Based on text, object and purpose, legislative history, and predominant state practice, this position appears to run seriously afoul of the ICSID Convention. At the same time, some meaning must be given to the language in Article 54 according to which an ICSID award must be enforced by a national court “as if it were a final judgment of a court” of the enforcing State. The author finds that the understanding of Article 54 that best reflects all pertinent considerations is that it imposes on courts the modest requirement that they subject the enforcement of ICSID awards to no more restrictive or onerous procedures than they impose on the enforecement of national judgments.