Creating the Gorizia-Goriska euroregion: an European cross-border administrative model for integrated socio-economic development in the upper adriatic. Crossborder co-operation as a tool for trans-national integration and conflict resolution

Contribució al Seminari: "Les Euroregions: Experiències i aprenatges per a l’Euroregió Pirineus-Mediterrània", 15-16 de desembre de 2005

Cross-border co-operation in Europe

Contribució al Seminari: "Les Euroregions: Experiències i aprenatges per a l’Euroregió Pirineus-Mediterrània", 15-16 de desembre de 2005

Treatment of congenital aortic valve stenosis: impact of the Ross operation.

GOAL: To evaluate the impact of the Ross operation, recently (1997) introduced in our unit, for the treatment of patients with congenital aortic valve stenosis. METHODS: The period from January 1997 to December 2000 was compared with the previous 5 years (1992-96). Thirty-seven children (< 16 yrs) and 49 young adults (16-50 yrs) with congenital aortic valve stenosis underwent one of these treatments: percutaneous balloon dilatation (PBD), aortic valve commissurotomy, aortic valve replacement and the Ross operation. The Ross operation was performed in 16 patients, mean age 24.5 yrs (range 9-46 yrs) with a bicuspid stenotic aortic valve, 7/10 adults with calcifications, 2/10 adults with previous aortic valve commissurotomy, 4/6 children with aortic regurgitation following PBD, and 1/6 children who had had a previous aortic valve replacement with a prosthetic valve and aortic root enlargement. RESULTS: PBD was followed by death in two neonates (fibroelastosis); all other children survived PBD. Although there were no deaths, PBD in adults was recently abandoned, owing to unfavourable results. Aortic valve commissurotomy showed good results in children (no deaths). Aortic valve replacement, although associated with good results (no deaths), has been recently abandoned in children in favour of the Ross operation. Over a mean follow-up of 16 months (2-40 months) all patients are asymptomatic following Ross operation, with no echocardiographic evidence of aortic valve regurgitation in 10/16 patients and with trivial regurgitation in 6/16 patients. CONCLUSIONS: The approach now for children and young adults with congenital aortic valve stenosis should be as follows: (1) PBD is the first choice in neonates and infants; (2) Aortic valve commissurotomy is the first choice for children, neonates and infants after failed PBD; (3) The Ross operation is increasingly used in children after failed PBD and in young adults, even with a calcified aortic valve.

Review of the Operation of the Mental Health Act 2001

The Mental Health Act 2001 replaces the Mental Treatment Acts 1945-61 which provided the statutory framework for the detention of people with mental illness and the administration of psychiatric services for over 50 years.The 2001 Act was introduced on a phased basis to allow for the necessary preparatory work to be undertaken. In March 2002 sections 1 to 5, 7, and 31 to 55 were commenced with effect from the 5 April 2002 (Establishment Day). This allowed for the establishment of the Mental Health Commission and the Inspector of Mental Health Services to replace the Inspector of Mental Hospitals. The Mental Health Act 2001 replaces the Mental Treatment Acts 1945-61 which provided the statutory framework for the detention of people with mental illness and the administration of psychiatric services for over 50 years. The 2001 Act was introduced on a phased basis to allow for the necessary preparatory work to be undertaken. In March 2002 sections 1 to 5, 7, and 31 to 55 were commenced with effect from the 5 April 2002 (Establishment Day). This allowed for the establishment of the Mental Health Commission and the Inspector of Mental Health Services to replace the Inspector of Mental Hospitals. Click here to download PDF 202kb

Cohesion, competition and contradiction: INTERREG and Franco-British Cross border co-operation

Aquest article resumeix el desenvolupament del programa INTERREG i la cooperació a la frontera franc-britànica en els últims vint anys. Això és seguit per una anàlisi de la forma transfronterera cooperació pot entendre recorrent a les discussions conceptuals de canviar la governança europea i les relacions de poder entre els diferents nivells de govern. Aquestes idees conceptuals proporcionen un context per a un examen en profunditat de la iniciativa INTERREG IIIA, a la frontera franc-britànica que es destaquen alguns dels principals problemes i les contradiccions de la cooperació transfronterera.

Operation Restore Trust of Iowa Fact Sheet,

A document produced by Department of Elder of Affairs about resoruces for elderly people.

Optable : The operation table serious game

Aquest treball consisteix en la realització d'un estudi al voltant dels anomenats serious games, jocs destinats a l'aprenentatge. Concretament, el projecte es centra en els serious games d'àmbit sanitari. A més d'un estudi de l'art, el treball consta del desenvolupament d'un serious game anomenat Optable per a la pràctica de la preparació del material quirúrgic d'una taula d'operacions. Aquesta aplicació ha estat desenvolupada sota llicència GNU GPL.

Präoperative Azidose und Entwicklung von Säuglingen nach Operation angeborener Herzfehler Preoperative acidosis and infant development following surgery for congenital heart disease.

OBJECTIVE: Prenatal diagnosis has been shown to decrease pre-operative acidosis and might prevent the occurrence of disturbed developmental outcome. The aim of this study is to evaluate parameters for acidosis and their predictive value on developmental outcome in newborns with congenital heart disease. METHODS: A total of 117 patients requiring surgery for structural heart disease in the first 31 days of life were included. Diagnosis was established either pre- or postnatally. Preoperative values of lactate, pH and base excess levels were compared to the occurrence of disturbed developmental outcome, i.e. an underperformance of more than 10% on the P90 of a standardized Dutch developmental scale. Patients were divided into groups according to blood levels of acidosis parameters, using receiver operating characteristics curves to determine cut-off values for pH, base excess and lactate. RESULTS: No significant difference in developmental outcome was found using values for pH or base excess as a cut-off level. Preoperative lactate values exceeding 6.1 mmol/l resulted in a significant increase in impaired development compared to infants with a pre-operative lactate lower than 6.1 mmol/l: 40.9% vs 15.1% in (p=0.03). CONCLUSIONS: Pre-operative lactate values might have a prognostic value on developmental outcome in newborns with congenital heart disease. The limited prognostic value of pH can be explained by the fact that pH can be easily corrected, while lactate better reflects the total oxygen debt experienced by these patients.

Long diagnostic delay in Crohn's disease is associated with complicated disease course and increased operation rate

Background: We have recently shown that the median diagnostic delay to establish Crohn's disease (CD) diagnosis (i.e. the period from first symptom onset to diagnosis) in the Swiss IBD Cohort (SIBDC) was 9 months. Seventy five percent of all CD patients were diagnosed within 24 months. The clinical impact of a long diagnostic delay on the natural history of CD is unknown. Aim: To compare the frequency and type of CD-related complications in the patient groups with long diagnostic delay (>24 months) vs. the ones diagnosed within 24 months. Methods: Retrospective analysis of data from the SIBDCS, comprising a large sample of CD patients followed in hospitals and private practices across Switzerland. The proportions of the following outcomes were compared between groups of patients diagnosed 1, 2-5, 6-10, 11-15, and ≥ 16 years ago and stratified according to the length of diagnostic delay: bowel stenoses, internal fistulas, perianal fistulas, CD-related surgical interventions, and extraintestinal manifestations. Results: Two hundred CD patients (121 female, mean age 44.9 ± 15.0 years, 38% smokers, 71% ever treated with immunomodulators and 35% with anti-TNF) with long diagnostic delay were compared to 697 CD patients (358 female, mean age 39.1 ± 14.9 years, 33% smokers, 74% ever treated with immunomodulators and 33% with anti-TNF) diagnosed within 24 months. No differences in the outcomes were observed between the two patient groups within year one after CD diagnosis. Among those diagnosed 2-5 years ago, CD patients with long diagnostic delay (n = 45) presented more frequently with internal fistulas (11.1% vs. 3.1%, p = 0.03) and bowel stenoses (28.9% vs. 15.7%, p = 0.05), and they more frequently underwent CD-related operations (15.6% vs. 5.0%, p = 0.02) compared to the patients diagnosed within 24 months (n = 159). Among those diagnosed 6-10 years ago, CD patients with long diagnostic delay (n = 48) presented more frequently with extraintestinal manifestations (60.4% vs. 34.6%, p = 0.001) than those diagnosed within 24 months (n = 182). For the patients diagnosed 11-15 years ago, no differences in outcomes were found between the long diagnostic delay group (n = 106) and the one diagnosed within 24 months (n = 32). Among those diagnosed ≥ 16 years ago, the group with long diagnostic delay (n = 71) more frequently underwent CD-related operations (63.4% vs. 46.5%, p = 0.01) compared to the group diagnosed with CD within 24 months (n = 241). Conclusions: A long diagnostic delay in CD patients is associated with a more complicated disease course and higher number of CD-related operations in the years following the diagnosis. Our results indicate that efforts should be undertaken to shorten the diagnostic delay in CD patients in order to reduce the risk for progression towards a complicated disease phenotype.