Track Approach Research Articles

Incidence of acute and persistent postoperative pain in cardiac surgery after sternotomy and lateral thoracotomy using a fast track protocol

Introduction The aim of the study was to compare the incidence of acute and persistent postoperative pain following cardiac surgery performed through sternotomy (group S) or lateral thoracotomy (group T) at discharge from hospital, 3 and 6 months after surgery, using a fast track protocol. Methods Patients scheduled for elective cardiac surgery and postoperative fast track approach were prospectively included in the study. All patients were trained how to use the numerical rating scale (NRS (0 = no pain, 10 = worst pain)) to estimate the level of postoperative pain. Induction and maintenance of anaesthesia were performed according to our standard protocol. All patients were transferred to the post anaesthetic care unit with continuous perfusion of Propofol and Remifentanil, where they received a bolus of Piritramid 0.1 mg/Kg and Metamizol 1mg. Postoperative pain management was performed due to our standard multimodal analgesic protocol to achieve NRS Results 202 patients (96 in group S / 106 in group T) were included. There was no loss of patients during follow-up. Demographics of two groups were similar. The type of surgery performed in group S and T were: CABG (60.4% vs 16.6%), isolated valve (20.8% vs 52.8%) and CABG + single valve (0% vs 47.2%). The surgery was longer in group S (219.3±8.7 S vs 175.7±5.7min T (p There was no statistically significant difference in the incidence of pain at hospital discharge, 3 and 6 postoperative months between the two groups (table1). Discussion Our study showed no difference in the incidence of acute and persistent postoperative pain at 3 and 6 months in patients undergoing cardiac surgery with sternotomy or lateral thoracotomy using a fast track protocol.

Періопераційне харчування як важлива ланка імплементації принципів Fast Track хірургії

ABSTRACT. Relevance. Fast Track surgery concept provides for a significant reduction of patient’s stress response to surgical intervention. The main task is a quick rehabilitation, quick return to a normal quality of life and significant reduction for an in-patient stay, thereby reducing medical costs. Objective: To assess the efficacy of the lack of pre- and postoperative fasting in accelerating postoperative recovery of patients and the reduction of patient’s stress response to operative injury. Materials and methods. We performed 564 surgical interventions under Fast Track approach. In particular, we used adapted, high-caloric sipping (drinking as small sips through a straw) feed manufactured at a medical enterprise and does not include dietary fibre — Nutricomp Drink Plus (BBraun). Results. Early oral feeding within the first hours after surgery accelerates recovery of productive intestinal motility. In 73.5 % of patients, the passage of flatus (spontaneous) is reported to the end of the first postoperative day that is about 8-fold higher than in patients who were not on such diet. General weakness, hunger and thirst reduced 2.5, 3 and 2.5-fold, respectively, in patients on Fast Track approach compared with the conventional perioperative management. Conclusion. The lack of pre- and postoperative fasting is one of the cornerstones of this program that proved the efficacy in terms of reduced stress response to surgical injury. Key Words: Fast Track approach, surgical intervention, pre- and postoperative nutrition.

Post Kampala

Abstract Since the Kampala Amendments filled the placeholder in the Statute of the International Criminal Court (ICC) with a comprehensive definition of the crime of aggression, States Parties have felt encouraged to implement the so-called ‘crime of crimes’ into domestic law. This article gives an overview of how these early implementers defined the crime of aggression and designed provisions on domestic jurisdiction. The fast track approach to domestic implementation would have been to copy the definition contained in Article 8bis of the ICC Statute and extend the existing jurisdictional regime applicable to other international crimes. Instead, states often opted for a (slightly) modified definition and occasionally decided to deviate from the jurisdictional provisions applicable to other core crimes.

Dedicated versus mainstreaming approaches in local climate plans in Europe

Cities are gaining prominence committing to respond to the threat of climate change, e.g., by developing local climate plans or strategies. However, little is known regarding the approaches and processes of plan development and implementation, or the success and effectiveness of proposed measures. Mainstreaming is regarded as one approach associated with (implementation) success, but the extent of integration of local climate policies and plans in ongoing sectoral and/or development planning is unclear. This paper analyses 885 cities across the 28 European countries to create a first reference baseline on the degree of climate mainstreaming in local climate plans. This will help to compare the benefits of mainstreaming versus dedicated climate plans, looking at policy effectiveness and ultimately delivery of much needed climate change efforts at the city level. All core cities of the European Urban Audit sample were analyzed, and their local climate plans classified as dedicated or mainstreamed in other local policy initiatives. It was found that the degree of mainstreaming is low for mitigation (9% of reviewed cities; 12% of the identified plans) and somewhat higher for adaptation (10% of cities; 29% of plans). In particular horizontal mainstreaming is a major effort for local authorities; an effort that does not necessarily pay off in terms of success of action implementation. This study concludes that climate change issues in local municipalities are best tackled by either, developing a dedicated local climate plan in parallel to a mainstreamed plan or by subsequently developing first the dedicated and later a mainstreaming plan (joint or subsequent “dual track approach”). Cities that currently provide dedicated local climate plans (66% of cities for mitigation; 26% of cities for adaptation) may follow-up with a mainstreaming approach. This promises effective implementation of tangible climate actions as well as subsequent diffusion of climate issues into other local sector policies. The development of only broad sustainability or resilience strategies is seen as critical.

Fast Track Integration of Computational Methods with Experiments in Small Wind Turbine Development

In general, standard aerodynamic design is divided into two paths—numerical analysis and empirical tests. It is crucial to efficiently combine both approaches in order to entirely fulfill the requirements of the design process as well as the final product. An effective use of computational analysis is a challenge, however it can significantly improve understanding, exploring and confining the search for optimal product solutions. The article focuses on a rapid prototyping and testing procedure proposed and employed at the Institute of Turbomachinery, Lodz University of Technology (IMP TUL). This so called Fast Track approach combines preparation of numerical models of a wind turbine rotor, manufacturing of its geometry by means of a 3D printing method and testing it in an in-house wind tunnel. The idea is to perform the entire procedure in 24 h. The proposed process allows one to determine the most auspicious sets of rotor blades within a short time. Owing to this, it significantly reduces the amount of individual subsequent examinations. Having fixed the initial procedure, it is possible to expand research on the singled-out geometries. The abovementioned observations and the presented overview of the literature on uses of 3D printing in aerodynamic testing prove rapid prototyping as an innovative and widely-applicable method, significantly changing our approach to experimental aerodynamics.

Repo Rate, Inflation and Growth: The Way Forward

Inflation targeting was synonymous with repo rate determinations, till Alan Greenspan tried to co-opt growth with credit control as the dual objective of Federal Reserve Bank's Policy in the USA. India has also pursued this track approach till 2016 when the RBI Act was amended to bring in both inflation control and growth as conjoint objectives. AMonetary Policy Committee (MPC) has also been put in place with representation from think tanks in statistics, economics and finance to provide a more realistic architecture to repo rate determination. This paper tries to analyse the relationship between three variables viz. repo rate, gross domestic product (GDP) and growth andinflation. It applies the Taylor Rule to repo rate determination. The paper brings out some of the disquieting trends in repo rate revision, which does not jell with the notion of a glide path of 4±2 per cent in inflation. By insisting on mediumterm 4per cent inflation as a non-negotiable target, credit growth is likely to be affected further; along with a high level of Non-Performing Asset (NPA). It suggestedadopting a more reasonable repo rate, based on the Taylor Rule, factors both the potential and actual growth and inflation trends. The monetary policy must help in the acceleration of growth and investment in India.

ECOWAS Single Currency and the Political Constrains

Economic Community of West African States (ECOWAS), a regional institution comprising of fifteen nations. It emerged on May 28 1975 in Lagos Nigeria. One of the reasons behind the establishment is to ensure the existence of a single currency in the region. The desire to integrate the region into one economic bloc that will lead to the circulation of a single currency has been in the agenda of various regional heads of states conferences, but it was discovered that colonial loyalty and the long existing monetary cooperation of Francophone nations with France was a strong impediment towards the proposal of such target likewise member states have not been able to meet the set of convergence criteria which led to delays and shift of dates in establishing a common currency. In addition, there is lack of political will and fear of domination among ECOWAS member states. To solve this problem, it was agreed in April 2000 in Accra Ghana, a two-fast track approach strategy should be adopted for the realization of single currency. For the first track, the non-West African Economic and Monetary Union (WAEMU) were to form a second monetary union called the West African Monetary Zone (WAMZ) by July 2005, which comprises mainly of Anglophone nations, with the second track being the subsequent merging of WAEMU and WAMZ to form a single currency union in the region. This work examined the political constrain behind the constant shifting of dates for ECOWAS single currency integration, those obstacles and other unforeseen circumstances that had contributed to the delay from the target dates shifting from 2003 to 2005, 2009, 2015 and 2020 at present. The research is qualitative in nature as such document analysis was adopted. The finding will suggest way for accelerating the plan action and ensure the newly target will not lapse as before.

Electoral Gender Quotas and Women's Rights

Electoral gender quotas, which aim to increase either the proportion of women candidates or political representatives, are currently used in over 100 countries around the world. In most cases quota measures have been adopted over the past two decades. This chapter shows that the 1995 Beijing Declaration and Platform for Action fundamentally changed the international discourse on the diagnosis of women’s under-representation in politics and thus the solutions to it. As opposed to waiting for women to incrementally ‘catch up’ with men, quotas represent a fast track approach to increasing women’s representation in politics. Significantly, the use of electoral gender quotas means that the Global South has now overtaken the Global North as world leaders in women’s parliamentary representation. This is a rapid turnaround on the situation just 20 years ago where the Scandinavian countries and the Netherlands were at the top of the world rankings for women’s representation. Despite there being resistance to their adoption and implementation in most contexts, this chapter argues that electoral gender quotas have significantly advanced women’s access to parliamentary politics at a global level. The use of proportional representation (PR) continues to advance women’s representation to a much greater extent than plurality/majoritarian systems and PR systems are generally more facilitating of quota implementation. Voluntary party quotas can be as effective as legal quotas if the right institutional and ideological factors are present. When properly implemented, quotas obstruct highly male-dominated recruitment patterns by encouraging or requiring parties to select increased numbers of women candidates or representatives.

COMPARISON OF GLOBAL REGULATORY GUIDELINES FOR AVAILABILITY OF DIFFERENT BIOWAIVER PROVISIONS AND APPLICATION REQUIREMENTS OF BIOPHARMACEUTICS CLASSIFICATION SYSTEM (BCS) BASED BIOWAIVER.

To waive a complete and systemic Bioequivalence (BE) study, Biowaiver or Request for a Biowaiver is a fast track approach to boost the drug development process. Over the past three-four years the Biowaiver market shows greater number of Biowaiver submissions and the wider use of In-vitro permeability study. Biowaiver is a beneficial approach for getting approval of Abbreviated New Drug Application (ANDA) while, BCS based Biowaiver is the novel approach to gain approval for New Drug Application (NDA) as well as ANDA. A Biopharmaceutics Classification System (BCS) based Biowaiver is an exemption from conducting human bioequivalence studies when active ingredient and dosage form meet criteria of solubility, permeability and dissolution. The Paper covers different kind of Biowaiver approaches and the criteria for the applicability of BCS based Biowaivers in the different geographic scopes with regard to global development strategy. There is a comparison of global guidelines on provisions availability for different types of Biowaiver approaches as well as for requirements of Biowaiver based on BCS. From comparison of different global guidelines it is reviewed that most of the guidance resembles to the USFDA, EU and WHO guidelines because most of the regulatory authorities are following the BCS based Biowaiver concept as one of the three main guidance documents (USFDA, EMA, WHO) or a combination of specific requirements.

The effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care

Purpose: The objective of this study was to investigate the effect of a local promotional campaign on preconceptional lifestyle changes and the use of preconception care (PCC). Material and methods: This quasi-comparative study was carried out between February 2015 and February 2016 at a community midwifery practice in the Netherlands. The intervention consisted of a dual track approach (i) a promotional campaign for couples who wish to conceive and (ii) a PCC pathway for health care providers. Questionnaires were collected from a sample of women who received antenatal care during the pre-intervention (n = 283) and post-intervention (n = 257) period. Main outcome measures were preconceptional lifestyle changes and PCC use (defined as searching for information and/or consulting a health care provider). Results: Women who were exposed to the intervention were significantly more likely to make at least one lifestyle change during the preconception period [adjusted OR 1.56 (95% CI 1.02–2.39)]. Women were especially more likely to preconceptionally reduce or quit [adjusted OR 1.72 (95% CI 1.05–2.83)] their alcohol consumption after exposure to the intervention. Although non-significant, it appeared that women who were exposed to the intervention more often prepared themselves for pregnancy by means of independently searching for preconception health information [adjusted OR 1.13 (95% CI 0.77–1.65)] or consulting a health care provider regarding their wish to conceive [adjusted OR 1.24 (95% CI 0.81–1.92)]. Conclusions: Exposure to a local promotional campaign targeted at preconceptional health was associated with improved preconceptional lifestyle behaviours, especially with regard to alcohol consumption, and has the potential to improve the use of PCC.

FAST TRACK rehabilitation in patients after laparoscopic repair of hiatal hernia

To assess an effectiveness of FAST TRACK rehabilitation in patients after laparoscopic repair of hiatal hernia. There were 87 patients with hiatal hernia who underwent laparoscopic Nissen-Rossetti procedure with wrapping only anterior wall of the stomach. FAST TRACK approach was applied in 49 patients, standard protocol - in 38 cases. Effectiveness of FAST TRACK rehabilitation was assessed in this report considering early postoperative morbidity, length of hospital-stay, time of postoperative intestinal paresis, complaints by GSRS questionnaire. FAST TRACK rehabilitation is followed by reduced early postoperative morbidity, length of hospital-stay and number of postoperative complaints.

NATO’s ‘Out of Area’ Operations: A Two- Track Approach. The Normative Side of a Military Alliance

AbstractEven though many would have bet on NATO’s demise after the Cold War and consider it now to be an archaic, antiquated alliance - as the reality that led to its formation no longer exists to justify its purpose - the need for collective defence in an increasingly complicated security environment stands as grounds for its ever-growing importance and its need to adapt to a spectrum of challenges that is becoming more diversified. NATO has long surpassed its military defensive role and has adapted to new challenges and new threats, while it has broadened its security agenda accordingly. The ‘out of area’ missions that dragged the Alliance out of its borders brought more meaning to the community of shared values, whilst allowing it to become both a security exporter, and a values and norms exporter. The International Security Assistance Force (ISAF) mission in Afghanistan comprises NATO’s transformation and adaptation to the new security challenges and its diffusion of norms in the ‘near abroad’.

The Reconstruction Strategy “Internet+” from the Perspective of Education

The rapid development of the to broaden the platform for the development of all walks of life, but also to the traditional mode of impact, Internet plus education has become a hot issue in current educational research. In the Internet + from the perspective of humanistic quality has the fusion of open and personalized feature. Humanistic quality should make full use of technology, to take the online and offline parallel track approach, on the one hand to build online platform, on the other hand, deepen the reform of the line of human education. In this paper, we explore the factors that influence the teaching strategies, and reveal the reasons and methods of teaching and learning. The main factors that affect the teaching strategies are: teaching objectives, learner characteristics, teaching content, teaching environment, etc.

Biowaivers-An updated Review

PURPOSE : A Biowaiver has been regarded as an official approval of the waiver for conducting a bioequivalence study in the context of an application for drug approval process. Bioequivalence is an important parameter in the process of drug development that is needed to be performed when there is a change in the formulation of dosage form. Approach : The approach of biowaivers is necessary to waive a complete and systemic Bioequalence study, which as a fast track approach to boost the drug development process. Findings : This review mainly discusses about the criteria for Biowaivers, requirements for a BCS based biowaiver study, conditions to grant the BCS based biowaiver, Applications, limitations, supporting data for Biowaivers. Conclusion : BCS biowaiver studies in preparing a submission for worldwide filing to satisfy US, European, and emerging market regulators. It is hoped that the availability of BCS Class I and Class III biowaivers in multiple jurisdictions will encourage more sponsors to request waivers of in vivo bioavailability/bioequivalence testing using the BCS approach.

A Fast Track approach to deal with the temporal dimension of crop water footprint

Population growth, socio-economic development and climate changes are placing increasing pressure on water resources. Crop water footprint is a key indicator in the quantification of such pressure. It is determined by crop evapotranspiration and crop yield, which can be highly variable in space and time. While the spatial variability of crop water footprint has been the objective of several investigations, the temporal variability remains poorly studied. In particular, some studies approached this issue by associating the time variability of crop water footprint only to yield changes, while considering evapotranspiration patterns as marginal. Validation of this Fast Track approach has yet to be provided. In this Letter we demonstrate its feasibility through a comprehensive validation, an assessment of its uncertainty, and an example of application. Our results show that the water footprint changes are mainly driven by yield trends, while evapotranspiration plays a minor role. The error due to considering constant evapotranspiration is three times smaller than the uncertainty of the model used to compute the crop water footprint. These results confirm the suitability of the Fast Track approach and enable a simple, yet appropriate, evaluation of time-varying crop water footprint.

Global Health in the Anthropocene: Moving Beyond Resilience and Capitalism Comment on "Health Promotion in an Age of Normative Equity and Rampant Inequality".

There has been much reflection on the need for a new understanding of global health and the urgency of a paradigm shift to address global health issues. A crucial question is whether this is still possible in current modes of global governance based on capitalist values. Four reflections are provided. (1) Ecological –centered values must become central in any future global health framework. (2) The objectives of ‘sustainability’ and ‘economic growth’ present a profound contradiction. (3) The resilience discourse maintains a gridlock in the functioning of the global health system. (4) The legitimacy of multi-stakeholder governance arrangements in global health requires urgent attention. A dual track approach is suggested. It must be aimed to transform capitalism into something better for global health while in parallel there is an urgent need to imagine a future and pathways to a different world order rooted in the principles of social justice, protecting the commons and a central role for the preservation of ecology.

Impact of centralization of pancreaticoduodenectomy coupled with fast track recovery protocol: a comparative study from India

Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduodenectomy (PD) from an individual unit during transit from low to a high volume center. A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received conventional surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postoperative recovery, length of hospital stay and patient readmission requirement. The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9+/-83.8 vs 997.4+/-151.8 mL, P<0.001), blood transfused (a median of 0 vs 1 unit, P<0.001) and operative time taken (125 vs 245 minutes, P<0.001) were significantly lower in the fast track group. The frequency of pancreatic fistula (4.9% vs 13.0%) and delayed gastric emptying (7.0% vs 17.4%) was also significantly reduced with fast track treatment. Nevertheless, the readmission rate (11.3% vs 6.5%) was found relatively higher within the fast track group. However, increased readmission rates in this study seem to be independent of fast track protocol. This preliminary analysis suggests that the fast track approach might be beneficial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and significantly shortens their length of hospital stay.

SOUTH AFRICA’S TWO TRACK APPROACH TO SCIENCE DIPLOMACY

SOUTH AFRICA’S TWO TRACK APPROACH TO SCIENCE DIPLOMACY

SOUTH AFRICA’S TWO TRACK APPROACH TO SCIENCE DIPLOMACY

While debate continues around the usefulness of the concept of Science Diplomacy, in practice international scientific relations are already facilitating diplomatic engagement, and diplomatic relations are supporting international scientific engagement. This interaction takes place in the context of the current global knowledge structure where industrialised or developed states are the producers of knowledge, and developing states the consumers. With science, technology and innovation integral to addressing transnational challenges, this article considers the expanding body of literature, which is primarily from developed states, highlighting the shortfall in understanding the role of developing states in science diplomacy. The article then considers developments in South Africa's science diplomacy, arguing that Pretoria demonstrates a two-track approach; one that reflects the state's pursuit of international recognition as a producer and exporter of knowledge at the centre of the global knowledge structure; and the second, where a shortfall in capacity and resources has increasingly seen the state as a consumer or importer of knowledge in meeting domestic priorities.

SOUTH AFRICA’S TWO TRACK APPROACH TO SCIENCE DIPLOMACY

SOUTH AFRICA’S TWO TRACK APPROACH TO SCIENCE DIPLOMACY