Selective Policy Research Articles

EP.TH.109Full cycle audit reviewing the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests required: an aid to rational resource utilisation of finite resources during the COVID-19 pandemic

AimsOpen hernia repairs are common elective and emergency surgical procedures; the majority are performed without complication. A primary audit indicated pre-operative group and save could be disregarded without compromising safety. A selective group and save policy was introduced, and safety of this approach examined with a 2nd cycle audit.MethodsRetrospective review of electronic patient records between October 2019 to September 2020. Cross referencing of operative and blood transfusion records performed compared to the primary audit cycle of April 2018 to March 2019.ResultsA total of 225 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed during the 2nd cycle compared to 410 in the 1st cycle. Patients were ASA 1-5 including emergencies.The post-operative blood transfusion rate was reduced from 1.46% to 0% following implementation of the selective policy. The number of pre-operative group and saves obtained reduced to 117; saving £6,840.19.ConclusionsThis single centre full cycle audit indicates pre-operative group and save tests are unnecessary in open hernia repair. A selective group and save policy introduced for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction reduced the post-operative blood transfusion rate to 0%.Discontinuing mandatory pre-operative group and save is a safe approach synchronously reducing clinical and financial burden. COVID-19 has stretched already limited resources, resulting in reduced surgical services and diminished case numbers during the 2nd cycle. Therefore, rational resource utilisation with a selective group and save policy maintains patient safety during the pandemic.

The “War on Terror” and Public Diplomacy during the Cold War: Israeli–Turkish Relations and the 1980 Military Coup

What influence does the digital diplomacy of the post 9/11 world have on our understanding of counter-terrorism (CT) diplomacy during the Cold War? This article explores this question and the intersection between intelligence, counterterrorism diplomacy and the digital transformation long overlooked by scholars of Israeli–Turkish relations, Cold War history and terrorism studies. Diplomacy in crisis situations usually operates in an uncertain reality triggered by conflict. Turkey’s domestic crises, specifically its energy crisis between 1978 and 1980, served to shift the country’s foreign policy toward the more anti-Israeli stance of the Arab nations and their demands that Turkey boycott Israel in return for supplying Turkey’s energy needs. This came in the context of a regional wave of contentious politics in the Middle East after the 1979 Iranian revolution, when Israel had just lost three decades of massive investment in Iran under the Shah. I argue that knowing the Turkish military junta’s primary goals centered on the fight against the far left and right political violence at home and on Armenian terror attacks against Turkish diplomats abroad, Israeli diplomats employed a very selective CT policy focusing on the cooperation between Armenian Secret Army for the Liberation of Armenia and the Palestine Liberation Organization. Public diplomacy was key to conveying this message, and attempts to plant information about the Armenian-Palestinian cooperation in Turkish news outlets and national television were made. Israel’s goal was to influence Turkey’s public emotions and convey to Turkey’s military junta that Jerusalem was a true ally, working to confront the mutual regional threat of Armenian-Palestinian terrorists arising from Lebanese training camps. This case study highlights the paradox that Ministries of Foreign Affairs and diplomats enjoyed an unparalleled monopoly of power during the Cold War over the use of means of public diplomacy, while at the time having very limited capacity, and a frequent need for third party mediators to engage with foreign public audiences. It is thus unlikely that the conveyed messages would have been as visible and disseminated as easily as they could be in the post 9/11 via means of digital diplomacy.

Transfusion Preparedness in the Labor and Delivery Unit: An Initiative to Improve Safety and Cost.

To evaluate patient safety, resource utilization, and transfusion-related cost after a policy change from universal type and screen to selective type and screen on admission to labor and delivery. Between October 2017 and September 2019, we performed a single-center implementation study focusing on risk-based type and screen instead of universal type and screen. Implementation of our policy was October 2018 and compared 1 year preimplementation with 1 year postimplementation. Patients were risk-stratified in alignment with California Maternal Quality Care Collaborative recommendations. Under the new policy, the blood bank holds a blood sample for processing (hold clot) on patients at low- and medium-risk of hemorrhage. Type and screen and crossmatch are obtained on high-risk patients or with a prior positive antibody screen. We collected patient outcomes, safety and cost data, and compliance and resource utilization metrics. Cost included direct costs of transfusion-related testing in the labor and delivery unit during the study period, from a health system perspective. In 1 year postimplementation, there were no differences in emergency-release transfusion events (4 vs 3, P>.99). There were fewer emergency-release red blood cell (RBC) units transfused (9 vs 24, P=.002) and O-negative RBC units transfused (8 vs 18, P=.016) postimplementation compared with preimplementation. Hysterectomies (0.05% vs 0.1%, P=.44) and intensive care unit admissions (0.45% vs 0.51%, P=.43) were not different postimplementation compared with preimplementation. Postimplementation, mean monthly type and screen-related costs (ABO typing, antibody screen, and antibody workup costs) were lower, $9,753 compared with $20,676 in the preimplementation year, P<.001. Implementation of selective type and screen policy in the labor and delivery unit was associated with projected annual savings of $181,000 in an institution with 4,000 deliveries per year, without evidence of increased maternal morbidity.

Time interval between rectal cancer resection and reintervention for anastomotic leakage and the impact of a defunctioning stoma: A Dutch population‐based study

In the Netherlands, a selective policy of faecal diversion after rectal cancer surgery is generally applied. This study aimed to evaluate the timing, type, and short-term outcomes of reoperation for anastomotic leakage after primary rectal cancer resection stratified for a defunctioning stoma. Data of all patients who underwent primary rectal cancer surgery with primary anastomosis from 2013-2019 were extracted from the Dutch ColoRectal Audit. Primary outcomes were new stoma construction, mortality, ICU admission, prolonged hospital stay, and readmission. In total, 10,772 rectal cancer patients who underwent surgery with primary anastomosis were included, of whom 46.6% received a primary defunctioning stoma. The reintervention rate for anastomotic leakage was 8.2% and 11.6% for patients with and without a defunctioning stoma (p<0.001). Reintervention consisted of reoperation in 44.0% and 85.3% (p<0.001), with a median time interval from primary resection to reoperation of sevendays (IQR 4-14) vs. fivedays (IQR 3-13), respectively. In the presence of a defunctioning stoma, early reoperation (<5days; n=47) was associated with significantly more end-colostomy construction (51% vs. 33%) and ICU admission (66% vs. 38%) than late reoperation (≥5days; n=127). Without defunctioning stoma, early reoperation (n=252) was associated with significantly higher mortality (4% vs. 1%), and more ICU admissions (52% vs.34%) than late reoperation (n=302). Early reoperations after rectal cancer resection are associated with worse outcomes reflected by a more frequent ICU admission in general, more colostomy construction, and higher mortality in patients with primary defunctioned and nondefunctioned anastomosis.

Optimum Location-Based Relay Selection in Wireless Networks

This paper studies the performance and key structural properties of the optimum location-based relay selection policy for wireless networks consisting of homogeneous Poisson distributed relays. The distribution of the channel quality indicator at the optimum relay location is obtained. A threshold-based distributed selective feedback policy is proposed for the discovery of the optimum relay location with finite average feedback load. It is established that the total number of relays feeding back obeys a Poisson distribution and an analytical expression for the average feedback load is derived. The analytical expressions for the average rate and outage probability with and without selective feedback are obtained for general path-loss models. It is shown that the optimum location-based relay selection policy outperforms other common relay selection strategies notably. It is also shown that utilizing location information from five relays on average is enough to achieve almost the same performance with the infinite feedback load case. As generalizations, isotropic Poisson point processes and heterogeneous source-to-relay and relay-to-destination links are also studied.

Impact of Environmental Subsidies on Environmental Technology Innovation of Polluting Enterprises

Environmental technology innovation plays an important role in solving pollution control problems. Under the background of the green development of the polluting industry, environmental subsidies have become an important financial instrument to make up for the lack of capital market. To explore the motivation of environmental technology innovation supported by environmental subsidies, using the data of listed polluting enterprises in China from 2013 to 2019, the impact of environmental subsidies on environmental technology patents of polluting enterprises was discussed from the perspective of selective industrial policies. Results show that environmental subsidies stimulate the total number of environmental technology patents and non-invention patents to increase significantly, showing the behavior characteristics of enterprises pursuing innovation quantity while ignoring quality. When enterprises expected to get more environmental subsidies, they make environmental technology patents to seek support. The above phenomenon is only significant in the state-owned enterprise group and senior executives group with a technical background in the group analysis results. The number of environmental technology invention patents of private enterprises increased significantly. The selective environmental subsidies policy stimulates the strategic innovation of enterprises, while the environmental technology invention patents representing substantive innovation and high-quality innovation are not improved significantly. The managerial implication of the conclusions is that the government should not only consider increasing environmental subsidies to polluting enterprises in the future but also should support better regulatory policies to improve the level of pollution prevention and control through environmental technology innovation.

State Populism in Rural Hungary*

AbstractOur concern in this contribution is to ask what the special features of populism in Hungary are, where government and the largest opposition party can be considered populist. The study aims at analyzing motivations, interests, benefits, and profits of populism in fragile Hungarian regions. The main part examines three peculiar features of state populism: the rural support for stabile political and social structures; early‐born conservative social policy, which freezes and preserves social inequalities and pacificates social conflicts; and selective social policy that has made a strong difference between “worthy” and “unworthy” poor, thus, contributing to ethnic‐based conflicts and emerging prejudice. The Hungarian case shows that poverty and social inequalities, disintegration, hierarchical local power structure with dominance of economic–political oligarchy, weak participation, monopolization of local and non‐local media, and racialization of poverty are enabling factors of populism.

From Retrenchment to Selective Social Policy Expansion: The Politics of Federal Cash Benefits in Canada

AbstractWhile much has been written about the politics of retrenchment, in a number of advanced industrial societies social policy expansion does occur today, which raises issues about how to study it in a post-retrenchment era. The present article explores the new politics of social policy expansion in Canada. Drawing on the work of Paul Pierson, we use an integrated framework that highlights the interaction of five factors: the availability of fiscal resources; the emergence of new social risks; the intensity and nature of partisan competition; the policy preferences of the main political parties; and the role of political institutions, especially federalism. Empirically, the article studies the politics of federal social policy expansion during the Harper (2006–2015) and Justin Trudeau (2015–) years, with a focus on three policy areas: child benefits (Universal Child Care Benefit and Canada Child Benefit), pensions (Old Age Security and Canada/Quebec Pension Plan) and Employment Insurance.

Migración venezolana reciente en Argentina: una política migratoria selectiva en el contexto del giro migratorio restrictivo

The purposeof this articleis to describe instruments and actions that constitutethe selective public policy towards Venezuelan migrants in Argentina between 2017-2019, in the context of the restrictive turn of the immigration policy underPresident Macri’s administration(2015-2019). Through thechange of normative instruments and public policy actions, complemented by a qualitative approach, we aimto verify the existence of a selective immigrationpolicy, discover the selection criteria applied,and indicatethe tensions between general and selective immigrationpolicy.

Does public money drive out private? Evidence from government regulations of industrial overcapacity governance in urban China

Governments are required to be fair in regulating market players, but their behaviors are often distorted by political connections with firms. In this study, we use the natural experiment of overcapacity reduction in China's industrial firms to examine to what extent their ownership matters in regulatory stringency. State-owned enterprises (SOEs) were significantly less likely than private firms to reduce their overcapacity. Furthermore, SOEs with more personnel redundancy and less degree of diversification in more competitive industries were less likely to meet central mandates. These results suggest that selective policy implementation helps to meet policy purposes albeit with unintended consequences.

Technology adoption and human capital: exploring the gender and cross-country impact 1870–2010

ABSTRACT Technology adoption and human capital are crucial determinants of economic growth. Here we use a fixed-effect panel model to measure the link between technology adoption and human capital for a sample of 104 countries since 1870–2010 using (HCCTA) and long-run enrolment ratios and educational attainment datasets. Unobserved heterogeneity factors (institutional, tradition, culture, economy type, educational system, migration, innovation, patents) account for the observed difference across countries/regions. Gender difference plays a role in the technology diffusion–human capital relationship, not a vital one. Advanced economies rode on the first three industrial revolutions, with Eastern Europe catching up on the third and fourth industrial waves. The economies of the East used the fourth industrial revolution to converge and surpass other regions. The results show that technology is necessary but not a sufficient determinant of human capital growth. Selective technology adoption policy, accompanied by supporting educational policy (entrepreneurial and research universities) stimulates technology, diffusion, and knowledge spillover. Our results are robust for including population and growth as significant technology adoption and human capital determinants (conditioning variables). Technology, diffusion, and a human capital link is a two-way street with many constraints.

The quantity–quality trade-off related to investment in healthy human capital: New evidence from the implementation of the “selective two-child policy” in China

Using data from China Family Panel Studies (CFPS), and employing the “selective two-child policy” as a quasi-natural experiment, this study provides empirical evidence of Becker’s quantity-quality tradeoff theory. We find that the selective two-child policy reduced households’ investment in health insurance for their first-child. The proportion of participated families and the amount invested in health insurance declined significantly among families in which one spouse was an only child. The reduction in investment in health insurance was more substantial when the first-child was a girl and when the first-child was younger. One likely mechanism was the wage penalty for motherhood. The relaxed birth policy led to a significant reduction in women’s income. As a result, households’ financial resources became more limited, and their budgets became tighter, leading to reductions in investments in the health of first-child.

IMMIGRATION EXAMINATION IN IMMIGRATION CHECKPOINT AS AN IMPROVEMENT OF INDONESIAN'S SOCIETY WELFARE

The traffic of people in and out of the country's territory is something that cannot be stopped by any countries in the world, include Indonesia. Various factors such as economic, cultural, and social become stimulants of traffic, which then called immigration. The principle of selective policy is the principle applied in the implementation of immigration in Indonesia, which it’s implementation is carried by Directorate General of Immigration, under the Ministry of Law and Human Rights of the Republic of Indonesia. The selective policy is the basis of the implementation of immigration examination that carried out in immigration checkpoints located at airports, seaports, land border, and other immigration checkpoints, which only people who are useful and do not endanger the unity of the nation can be allowed to enter the territory of the Unitary State of Republic of Indonesia. Immigration checks are also carried out strictly on Indonesian citizens to minimize the possibility of becoming non-procedural labor which can lead to the criminal act of human trafficking. In order to increase security for achieving the welfare of the Indonesian people, the Directorate General of Immigration needs to improving the quality of its human resources which leads to advances in policy and regulation making, systems and technology, and also the technicality of immigration services.

The impact of the selective two-child policy on residents’ fertility intentions in China

ABSTRACT The research uses CGSS, a family survey data, to study the impact of the second phase of the selective two-child policy (STCP II) on residents’ fertility intentions in China. It finds that the policy does improve residents’ two-child fertility intentions, which is more significant in the younger groups. The research results suggest that relaxing the family planning policies does increase the residents’ willingness to have more children in the short term.

IMMIGRATION SUPERVISION ON SEA TRANSPORTATION IN THE IMMIGRATION EXAMINATION PLACE OF TANJUNG PERAK SEA PORT

For the sake of realizing the upholding of state sovereignty and security, Indonesia must prioritize the duties and functions of Immigration in filtering people who want to enter or leave the territory of Indonesia by upholding the principle of Immigration, namely selective policy, especially for immigration officers at immigration checkpoints at airports, ports, and even at cross-border posts that must always prioritize this principle, that is, only foreigners who benefit and benefit the Indonesian state can enter Indonesian territory. Increased supervision of sea transportation means at the Tanjung Perak Seaport TPI must start from reforming the rules in carrying out immigration duties and functions by prioritizing immigration landing SOPs, regulation and availability of adequate budget preparation human resources as well as an increase in the welfare of officers in carrying out their duties both regarding the availability of equipment. transportation and accommodation outside the area. Permenkumham Number 44 of 2015 has not been implemented optimally, the old habits that have traditionally been in the landing task are still running. This mindset is clearly no longer appropriate to the current situation with rapid technological advances and is not in line with the Kemenkumhan Values, namely "PASTI".

ANALYSIS OF THE IMPLEMENTATION OF SELECTIVE POLICY IN STRENGTHENING OF BORDER CONTROLS AT IMMIGRATION CHECKPOINT

The problem of illegal immigrants has threatened the security and sovereignty of the Indonesian state. Even in 2013, the trend of illegal immigrants entering Indonesia increased by 12%. Most of them come from conflict-affected countries. Therefore, to prevent the increasing number of illegal immigrants from entering Indonesian territory, Indonesian immigration needs to strengthen border controls at the immigration checkpoints by continuing to implement immigration policy, namely selective policy. This policy only allows foreigners who provide benefits and does not endanger security and public order to be allowed to enter and reside in Indonesian territory. This policy supports the implementation of the immigration function, namely law enforcement and state security, particularly in preventing illegal immigrants who intend to enter Indonesian territory. The research method used is qualitative normative legal research with data analysis sourced from books, writings, scientific papers, and laws and regulations that are related to research.

ANALYSIS OF IMMIGRATION MANAGEMENT INFORMATION SYSTEM (SIMKIM) VERSION 2.0 FOR THE ISSUANCE OF A RESIDENCE PERMIT WITH THE COBIT 5 METHOD AT THE CLASS I IMMIGRATION OFFICE TPI MAKASSAR

Along with the advancement of information technology, the Directorate General of Immigration has integrated all immigration functions through SIMKIM since 2007. Immigration Management Information ‘System (SIMKIM) is a system used to collect, process and convey information to support operations, management, and policy making. Simkim implementation in the Immigration Technical Implementation Unit is one of them by ope rating the system in the process of issuing residence permits to Foreigners. The arrival of Foreigners through immigration checkpoints by remembering selective policy strategies, only foreigners who can benefit and do not interfere with the security or order of the public can enter and live in the Territory of Indonesia. The purpose of this study is to analyze the implementation of simkim version 2.0 use at TPI Makassar Class I Immigration Office. This research uses qualitative descriptive methods with the COBIT 5 (Control Objective for Information and Related Technology) model, while the data source is used namely primary and secondary data obtained by interview, document study and observation. The theoretical&#x0D; foundations used are information technology theory, management information systems, public service and information technology governance. Based on the analysis of data conducted, it was concluded that in terms of the process of issuing residence permits using SIMKIM Version 2.0 there are still various obstacles both from the system and in terms of facilities and implementation of information technology governance by measuring maturity level maturity level.

An Italian survey on the use of T-tube in liver transplantation: old habits die hard!

There is enough clinical evidence that a T-tube use in biliary reconstruction at adult liver transplantation (LT) does not significantly modify the risk of biliary stricture/leak, and it may even sustain infective and metabolic complications. Thus, the policy on T-tube use has been globally changing, with progressive application of more restrictive selection criteria. However, there are no currently standardized indications in such change, and many LT Centers rely only on own experience and routine. A nation-wide survey was conducted among all the 20 Italian adult LT Centers to investigate the current policy on T-tube use. It was found that 20% of Centers completely discontinued the T-tube use, while 25% Centers used it routinely in all LT cases. The remaining 55% of Centers applied a selective policy, based on criteria of technical complexity of biliary reconstruction (72.7%), followed by low-quality graft (63.6%) and high-risk recipient (36.4%). A T-tube use > 50% of annual caseload was not associated with high-volume Center status (> 70 LT per year), an active pediatric or living-donor transplant program, or use of DCD grafts. Only 10/20 (50%) Centers identified T-tube as a potential risk factor for complications other than biliary stricture/leak. In these cases, the suspected pathogenic mechanism comprised bacterial colonization (70%), malabsorption (70%), interruption of the entero-hepatic bile-acid cycle (50%), biliary inflammation due to an indwelling catheter (40%) and gut microbiota changes (40%). In conclusion, the prevalence of T-tube use among the Italian LT Centers is still relatively high, compared to the European trend (33%), and the potential detrimental effect of T-tube, beyond biliary stricture/leak, seems to be somehow underestimated.

Management of poor grade sub-arachnoid haemorrhage – clinical judgement v/s a formal model

Objective The poor grade subarachnoid haemorrhage patients represent a unique cohort with lack of clear treatment protocol. Most neurosurgical units in the UK will manage them at local hospital until they make a significant recovery, this period can put them at higher risk of rebleed while with aggressive treatment a significant subset can achieve a favourable outcome. Identification of this subset is difficult and decision to treat them is associated with significant commitment of neurosurgical and ITU resources. Recent paper by Szklener has come up with a scale for prognostication in this subgroup of patients. We wanted to check the validity of this scale in our patient population and see if this scale can be used to guide early patient transfer and aggressive management at the Neurosurgical unit. Methods We retrospectively reviewed our referral database for all poor grade subarachnoid patients referred over 2 years. Demographic information, Fisher and WFNS scores, admitting leucocyte count and outcome information as per MRS were obtained. These were scored as per the scale suggested by Szklener. Results A total of 115 poor grade subarachnoid patients were referred over the study time frame. 47 of them were accepted for admission . 18/47 patients achieved a favourable outcome (GOS4-5). Only 1 patient managed in peripheral hospital had a good outcome. There was a significant association between Szklener’s score and achieving a favourable outcome p = 0.002. Conclusion A selective admission policy could work specially with current economic climate, achieving outcomes comparable to admit-all. However, to optimise outcomes for all patients an aggressive standardised management at peripheral hospitals and a uniform admission policy assisted by Szklener score may be adopted. Szklener’s model predicts the outcome better than WFNS and age but more validation is needed.

Safety of transition from a routine to a selective intensive care admission pathway after elective open aneurysm repair

BackgroundThere is a growing trend to implement intermediate care units to avoid unnecessary costs associated with intensive care unit (ICU) admission and associated resources. We sought to evaluate the safety of transitioning from a routine to a selective policy of postoperative transfer to the ICU for elective open abdominal aortic aneurysm (AAA) repair.MethodsThis retrospective study included consecutive open elective AAA repair procedures performed at a single centre from Aug. 8, 2010, to Dec. 1, 2014. Patients were identified through a prospectively maintained database, and electronic charts were reviewed. Patients with interventions before Mar. 13, 2012, were routinely sent to the ICU after operation (group A). Patients treated after this date were sent directly to an intermediate care unit (group B) unless preoperative or intraoperative factors deemed them suitable for ICU admission. The primary outcome was in-hospital death; secondary outcomes were perioperative complications and length of stay. We used logistic and linear regression to determine the association between the use of an intermediate care unit and the primary and secondary outcomes after adjusting for confounders and clinically relevant covariates.ResultsThe cohort comprised 310 patients (266 men, 44 women) with a mean age of 69.7 (standard deviation 10.1) years and a mean AAA diameter of 61.2 mm (SD 9.6 mm). Groups A and B included 118 and 192 patients, respectively. Admission to the ICU was spared in 149 patients (77.6%) in group B. Only 2 patients (1.3%) in group B were subsequently admitted to the ICU. There was no statistically significant difference in in-hospital mortality or perioperative complications between the 2 groups on multivariable logistic regression. There was a nonsignificant trend toward slightly shorter length of stay in group B.ConclusionIn this single-centre experience with the majority of patients sent directly to an intermediate care unit, there was no statistically significant difference in mortality or morbidity between routine and selective ICU admission. Our results confirm the safety of a selective ICU admission pathway.