Primary Versus Staged Reconstruction and Risk of Surgical Failure in Patients With Ulcerative Colitis: a Nation-wide Cohort Study

Background Restorative surgery after colectomy due to ulcerative colitis (UC) may be performed simultaneously with colectomy (primary) or as a staged procedure. Risk factors for failure after restorative surgery are not fully explored. This study aimed to compare the risk of failure after primary and staged reconstruction. Methods This is a national register-based cohort study of all patients 15 to 69 years old in Sweden treated with colectomy due to UC and who received an ileorectal anastomosis (IRA) or ileal pouch-anal anastomosis (IPAA) between 1997 and 2017. Failure was defined as a reoperation with new ileostomy after restorative surgery or a remaining defunctioning ileostomy after 2 years. Risk of failure was calculated using the Kaplan-Meier method and Cox regression adjusted for sex, age, calendar period, primary sclerosing cholangitis, and duration of UC. Results Of 2172 included patients, 843 (38.8%) underwent primary reconstruction, and 1329 (61.2%) staged reconstruction. Staged reconstruction was associated with a decreased risk of failure compared with primary reconstruction (hazard ratio, 0.73; 95% CI, 0.58–0.91). The 10-year cumulative risk of failure was 15% vs 20% after staged and primary reconstruction, respectively. In all, 1141 patients (52.5%) received an IPAA and 1031 (47.5%) an IRA. In stratified multivariable models, staged reconstruction was more successful than primary reconstruction in both IRA (hazard ratio, 0.75; 95% CI, 0.54–1.04) and IPAA (hazard ratio, 0.73; 95% CI, 0.52–1.01), although risk estimates failed to attain statistical significance. Conclusions In UC patients undergoing colectomy, postponing restorative surgery may decrease the risk of failure.

Good times and bad: Client and vendor insights on ITO relationship quality

<p>The success of Information Technology Outsourcing (ITO) today is intrinsically linked to the quality of the relationship formed between client and vendor. The academic literature has already defined the key characteristics of a quality relationship - one which will weather the test of time. Researchers have also portrayed how an ITO relationship should mature and that the focus should move over time from cost and transactional drivers to an outcomes-based alliance. While these studies answer the questions of why relationships are central to ITO success, what form they take, and when they evolve, they do not answer the question of how to create a quality relationship. This research complements this existing body of research by tapping in to the best practices client and vendor practitioners use every day to make their ITO relationships successful. For those seeking to establish a new relationship, invigorate an existing one or mitigate the risk of failure this report provides a valuable resource of validated and prioritised best practices along with descriptions and recommendations on how and when to apply them.</p>

Good times and bad: Client and vendor insights on ITO relationship quality

<p>The success of Information Technology Outsourcing (ITO) today is intrinsically linked to the quality of the relationship formed between client and vendor. The academic literature has already defined the key characteristics of a quality relationship - one which will weather the test of time. Researchers have also portrayed how an ITO relationship should mature and that the focus should move over time from cost and transactional drivers to an outcomes-based alliance. While these studies answer the questions of why relationships are central to ITO success, what form they take, and when they evolve, they do not answer the question of how to create a quality relationship. This research complements this existing body of research by tapping in to the best practices client and vendor practitioners use every day to make their ITO relationships successful. For those seeking to establish a new relationship, invigorate an existing one or mitigate the risk of failure this report provides a valuable resource of validated and prioritised best practices along with descriptions and recommendations on how and when to apply them.</p>

Plotting the coloniality of conservation

Contemporary and market-based conservation policies, constructed as rational, neutral and apolitical, are being pursued around the world in the aim of staving off multiple, unfolding and overlapping environmental crises. However, the substantial body of research that examines the dominance of neoliberal environmental policies has paid relatively little attention to how colonial legacies interact with these contemporary and market-based conservation policies enacted in the Global South. It is only recently that critical scholars have begun to demonstrate how colonial legacies interact with market-based conservation policies in ways that increase their risk of failure, deepen on-the-ground inequalities and cement global injustices. In this article, we take further this emerging body of work by showing how contemporary,market-based conservation initiatives extend the temporalities and geographies of colonialism, undergird long-standing hegemonies and perpetuate exploitative power relations in the governing of nature-society relations, particularly in the Global South. Reflecting on ethnographic insights from six different field sites across countries of the Global South, we argue that decolonization is an important and necessary step in confronting some of the major weaknesses of contemporary conservation and the wider socio-ecological crisis itself. We conclude by briefly outlining what decolonizing conservation might entail.

Hungarian Government on the Whitening of the Economy Measures to Stabilize the Budget

The Hungarian government developed a package of tools for improving legal control and compliance for Hungarian companies and entered into force between 2012 and 2021. Part of this complex package of measures sought to broaden the tax base without raising taxes, while others sought to reduce the size of the black economy by reducing the amount of illegally available benefits. The level of compliance may increase, as inspections are continuous, the risk of failure is high, and compliance with legal actions does not require a large intellectual or financial expense from the taxpayer. Part of this package was the obligation to use online cash registers, the introduction of reverse charge VAT, the targeted reduction of VAT rates, the introduction of an electronic goods tracking and verification system, and the introduction of online invoicing.

The Radiographic “Air Sign” in Neonatal Mandibular Distraction Osteogenesis

Timing of extubation on post-mandibular distraction osteogenesis (MDO) surgery is critical, given that at baseline these infants have difficult airways and failed extubation requires either re-intubation of an already complex airway with a fragile, recently osteotomized mandible, or adjunctive airway measures such as CPAP that may apply unwanted pressure to the surgical site. Thus, the goal is to plan extubation when the risk of failure is minimal. Currently, there is a void in the literature addressing the timing of extubation post-MDO and no objective sign of extubation readiness has been elucidated. This study describes a simple clinical pearl to assist in the evaluation of extubation readiness in these patients. Postoperatively, we obtain weekly radiographs to assess distractor stability and advancement, and to assess for the “Air Sign”. The Air Sign describes a radiolucent space (air) visualized in the oropharynx on lateral radiographs, likely indicating that the tongue based airway obstruction has been relieved by mandibular advancement.

Securing Transplanted Meniscal Allografts Using Bone Plugs Results in Lower Risks of Graft Failure and Reoperations: A Meta-analysis

Background: Meniscal allograft transplant (MAT) is an important treatment option for young patients with deficient menisci; however, there is a lack of consensus on the optimal method of allograft fixation. Hypothesis: The various methods of MAT fixation have measurable and significant differences in outcomes. Study Design: Meta-analysis; Level of evidence, 4. Methods: A single-arm meta-analysis of studies reporting graft failure, reoperations, and other clinical outcomes after MAT was performed. Studies were stratified by suture-only, bone plug, and bone bridge fixation methods. Proportionate rates of failure and reoperation for each fixation technique were pooled with a mixed-effects model, after which reconstruction of relative risks with confidence intervals was performed using the Katz logarithmic method. Results: A total of 2604 patients underwent MAT. Weighted mean follow-up was 4.3 years (95% CI, 3.2-5.6 years). During this follow-up period, graft failure rates were 6.2% (95% CI, 3.2%-11.6%) for bone plug fixation, 6.9% (95% CI, 4.5%-10.3%) for suture-only fixation, and 9.3% (95% CI, 6.2%-13.9%) for bone bridge fixation. Transplanted menisci secured using bone plugs displayed a lower risk of failure compared with menisci secured via bone bridges (RR = 0.97; 95% CI, 0.94-0.99; P = .02). Risks of failure were not significantly different when comparing suture fixation to bone bridge (RR = 1.02; 95% CI, 0.99-1.06; P = .12) and bone plugs (RR = 0.99; 95% CI, 0.96-1.02; P = .64). Allografts secured using bone plugs were at a lower risk of requiring reoperations compared with those secured using sutures (RR = 0.91; 95% CI, 0.87-0.95; P < .001), whereas allografts secured using bone bridges had a higher risk of reoperation when compared with those secured using either sutures (RR = 1.28; 95% CI, 1.19-1.38; P < .001) or bone plugs (RR = 1.41; 95% CI, 1.32-1.51; P < .001). Improvements in Lysholm and International Knee Documentation Committee scores were comparable among the different groups. Conclusion: This meta-analysis demonstrates that bone plug fixation of transplanted meniscal allografts carries a lower risk of failure than the bone bridge method and has a lower risk of requiring subsequent operations than both suture-only and bone bridge methods of fixation. This suggests that the technique used in the fixation of a transplanted meniscal allograft is an important factor in the clinical outcomes of patients receiving MATs.

Is Penicillin Allergy a Risk Factor for Early Dental Implant Failure? A Systematic Review

The prescription of preventive antibiotics in dental implant treatments reduces the incidence of early failures. This study has focused mainly on the influence of amoxicillin, which is contraindicated in penicillin-allergic patients. The present systematic review aimed to determine whether penicillin-allergic patients have a higher risk of implant failure compared to non-allergic patients. An electronic search was performed on Medline and Web of Science using the following MeSH terms: (penicillin allergy OR clindamycin OR erythromycin OR azithromycin OR metronidazole) AND (dental implant OR dental implant failure OR dental implant complications). The criteria employed were those described in the PRISMA® Declaration. Only five articles were included that analyzed the failure rates of implants placed in penicillin-allergic patients who were prescribed clindamycin compared to non-allergic patients who were prescribed amoxicillin. With the limitations of this study, it is not possible to state that penicillin allergy per se constitutes a risk factor for early dental implant failure as most of the studies included self-reported allergic patients. Clindamycin has been associated with a significantly elevated risk of failure and an up to six times increased risk of infection. Immediate implants also have a 5.7 to 10 times higher risk of failure.

E-Government, Governance and Corruption in Asian countries

In developing countries, the implementation of e-government is at greater risk of failure when the corruption is still high. This paper examines the effect of e-government on the level of corruption in 47 developing countries in Asia using E-Government Development Index which is divided into components of online service, human capital, telecommunication infrastructure and e-participation. This paper also places the role of governance in government to moderate the relationship between e-government and perceptions of corruption. The result shows that implementation of e-government and governance has increased the perception of corruption with telecommunications infrastructure has the most significant effect.