Why Do Communities Recover Differently after Socio-Natural Disasters? Pathways to Comprehensive Success of Recovery Projects Based on Bam’s (Iran) Neighborhoods’ Perspective

Although recent studies have provided explanations for the causes of success and failure in recovery projects following socio-natural disasters, there is a need for a concise understanding of how different combinations of factors may contribute to recovery failure or success. In this study, to examine the community recovery pathways after the 2003 Bam earthquake, we conducted a fuzzy-set qualitative comparative analysis of 11 neighborhoods in Bam city and Baravat (the neighborhoods represent the division of the areas damaged by the earthquake, as presented by local government). The success of socio-natural disaster recovery projects is presented in three pathways in which the absence or presence of public engagement had a significant influence on the results. The results indicate that a recovery project should respond to the needs of the project within the continuous lifecycle of the project. Additionally, on the one hand, public participation and prompt rescue operations have a significant effect on project success. On the other hand, neglecting the needs of people and the area’s climate in housing design have led to project failure. It is expected that the findings from this study can be used to develop strategies for empowering people in recovery projects and to develop housing guidelines that respect residents’ needs while focusing on on-time and sufficient rescue processes. However, care should be taken when applying the present findings in practice, because every socio-natural disaster is unique and requires careful consideration of complex sets of features.

ENHANCED RECOVERY PATHWAYS (ERAS) IMPLEMENTATION IN MINIMALLY INVASIVE ESOPHAGECTOMY; AN EARLY EXPERIENCE

Objective: To evaluate the impact of enhanced recovery pathways (ERAS) on hospital stay and postoperative outcomes in patients undergoing minimally invasive esophagectomy in comparison to conventional pathway. Study Design: Quasi experimental study. Place and Duration of Study: Thoracic Surgery Department, Combined Military Hospital Rawalpindi Pakistan, from Jul 2018 to Mar 2020. Methodology: A total of 80 patients who underwent minimally invasive esophagectomy were divided in two groups. Group A underwent ERAS pathway and group B underwent conventional pathway. Both groups were compared for demographic characteristics, mean ICU stay, length of hospital stay, commencement of oral intake, and time of chest drain removal, readmission rates, postoperative morbidity and mortality. Results: There was no significant difference in age, gender and diagnostic indication among both groups. ERAS group was found to have shorter mean ICU stay (1.18 ± 0.55 vs 2.06 ± 1.10 days p<0.012), shorter hospital stay (7.50 ± 1.23 vs 11.6 ± 3.65 days, p<.001), earlier commencement of oral feeding (4.30 ± 1.41 vs 9.10 ± 4.26 days, p<0.001) and early removal of chest drains (3.22 ± vs 4.11 ± 1.52 p<0.001); when compared to conventional group. Overall morbidity in ERAS group was 50 (40%) versus 65% (81.25%) in conventional group. Mortality was same in both groups (2.5%). There was no readmission in ERAS group. Conclusion: ERAS in minimally invasive esophagectomy is safe and has positive impact on postoperative outcomes with marked reduction in overall morbidity in comparison to conventional regime. Results can be enhanced by ensuring better compliance to its.......

The role of digital technologies to unleash a green recovery: pathways and pitfalls to achieve the European Green Deal

PurposeThe article aims to concern identification and development of pathways for a green recovery process post pandemic taking into account the role of digital technologies for unleashing the policies planned within the European Green Deal (EGD).Design/methodology/approachThe study is based on a systematic literature review (SLR). The electronic databases Scopus and Web of Science (WoS) were surveyed. The authors followed the SLR guidelines laid down by Tranfield et al. (2003) and the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) framework and 65 articles were found eligible after thorough reading and inclusion in the analysis.FindingsThe article presents an innovative framework containing the digital technologies and their roles in enabling the achievement of the EGD policies and the barriers to their adoption.Originality/valueThe proposed framework would guide organizations and policymakers' decisions to pursue a pathway in which a green recovery is possible, mainly after the consequences of the current pandemic, considering the pitfalls of the journey. The article is original as it provides an up-to-date guidance toward an emerging theme, which is a green recovery economy including a net-zero carbon worldwide target.

Pain and Opioid Consumption and Mobilization after Surgery: Post Hoc Analysis of Two Randomized Trials

Background Early mobilization is incorporated into many enhanced recovery pathways. Inadequate analgesia or excessive opioids may restrict postoperative mobilization. The authors tested the hypotheses that in adults recovering from abdominal surgery, postoperative pain and opioid consumption are inversely related to postoperative mobilization, and that postoperative mobilization is associated with fewer potentially related complications. Methods The authors conducted a subanalysis of two trials that enrolled adults recovering from abdominal surgery. Posture and movement were continuously monitored for 48 postoperative hours using noninvasive untethered monitors. Mobilization was defined as the fraction of monitored time spent sitting or standing. Results A total of 673 patients spent a median [interquartile range] of 7% [3 to 13%] of monitored time sitting or standing. Mobilization time was 1.9 [1.0 to 3.6] h/day for patients with average pain scores 3 or lower, but only 1.2 [0.5 to 2.6] h/day in those with average scores 6 or greater. Each unit increase in average pain score was associated with a decrease in mobilization time of 0.12 (97.5% CI, 0.02 to 0.24; P = 0.009) h/day. In contrast, there was no association between postoperative opioid consumption and mobilization time. The incidence of the composite of postoperative complications was 6.0% (10 of 168) in the lower mobilization quartile, 4.2% (7 of 168) in the second quartile, and 0% among 337 patients in the highest two quartiles (P = 0.009). Conclusions Patients recovering from abdominal surgery spent only 7% of their time mobilized, which is considerably less than recommended. Lower pain scores are associated with increased mobility, independently of opioid consumption. Complications were more common in patients who mobilized poorly. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New