Migration: A Heideggerian analysis

The phenomenon of migration has been widely researched by the social sciences. Theories regarding the migrant have been developed in terms of the oppressive social context that is often encountered, proposing different alternatives to understand and overcome such oppression. Through the current project, an alternative view is presented that first, questions the accuracy of the social theories of migration and second, proposes an alternative understanding of this experience. Martin Heidegger’s phenomenology of Being offers a contextualized view of existence that nonetheless includes elements of our experience that are shared due to a common mode of being. I use Heidegger’s philosophy in order to broaden the understanding of the migrant’s experience analyzing those elements that he identifies as shared (for instance: human sociability, a desire for a home, the uncanny, etc.) and comparing them with common issues raised by migrants (identity, homesickness, belonging, etc.). In this way, I intend to present a more complete picture of the experience of migration that considers both empirical evidence of individual migrants and an existential analysis that incorporates the defining elements of our world and our existence as crucial means to understand any experience, including that of migration.

At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD ((sic)1,835.06 versus (sic)4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.