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This book responds to growing calls to conceptualise and analyse internal migration as a trajectory that unfolds over the life course of individuals rather than a series of discrete events. It combines macro and micro modes of analysis into a cohort framework to explore how individuals transition from one migration to the next. The book presents new methodological developments in longitudinal analysis and applies them to internal migration in 27 European countries. It demonstrates that the traditional dichotomy between migrants and non-migrants conceals a wide range of migration behaviour and heterogeneity among repeat migrants. It also reveals a continuity of migration behaviour: being exposed to the challenges and benefits of migration early in life predisposes individuals toward migration in adulthood. By adopting a cohort approach to migration coupled with state-of-the-art methods and novel concepts, this book provides new insights into internal migration for graduate students, academics and policymakers interested in understanding migration behaviour in Europe and beyond.

Reoperation rates are high after surgery for hip fractures. We investigated the effect of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes. For this international, multicentre, allocation concealed randomised controlled trial, we enrolled patients aged 50 years or older with a low-energy hip fracture requiring fracture fixation from 81 clinical centres in eight countries. Patients were assigned by minimisation with a centralised computer system to receive a single large-diameter screw with a side-plate (sliding hip screw) or the present standard of care, multiple small-diameter cancellous screws. Surgeons and patients were not blinded but the data analyst, while doing the analyses, remained blinded to treatment groups. The primary outcome was hip reoperation within 24 months after initial surgery to promote fracture healing, relieve pain, treat infection, or improve function. Analyses followed the intention-to-treat principle. This study was registered with ClinicalTrials.gov, number NCT00761813. Between March 3, 2008, and March 31, 2014, we randomly assigned 1108 patients to receive a sliding hip screw (n=557) or cancellous screws (n=551). Reoperations within 24 months did not differ by type of surgical fixation in those included in the primary analysis: 107 (20%) of 542 patients in the sliding hip screw group versus 117 (22%) of 537 patients in the cancellous screws group (hazard ratio [HR] 0·83, 95% CI 0·63–1·09; p=0·18). Avascular necrosis was more common in the sliding hip screw group than in the cancellous screws group (50 patients [9%] vs 28 patients [5%]; HR 1·91, 1·06–3·44; p=0·0319). However, no significant difference was found between the number of medically related adverse events between groups (p=0·82; appendix); these events included pulmonary embolism (two patients [<1%] vs four [1%] patients; p=0·41) and sepsis (seven [1%] vs six [1%]; p=0·79). In terms of reoperation rates the sliding hip screw shows no advantage, but some groups of patients (smokers and those with displaced or base of neck fractures) might do better with a sliding hip screw than with cancellous screws. National Institutes of Health, Canadian Institutes of Health Research, Stichting NutsOhra, Netherlands Organisation for Health Research and Development, Physicians' Services Incorporated.

The East German Ministry for State Security stood for Stalinist oppression and all-encompassing surveillance. The \"shield and sword of the party,\" it secured the rule of the Communist Party for more than forty years, and by the 1980s it had become the largest secret-police apparatus in the world, per capita. Jens Gieseke tells the story of the Stasi, a feared secret-police force and a highly professional intelligence service. He inquires into the mechanisms of dictatorship and the day-to-day effects of surveillance and suspicion. Masterful and thorough at once, he takes the reader through this dark chapter of German postwar history, supplying key information on perpetrators, informers, and victims. In an assessment of post-communist memory politics, he critically discusses the consequences of opening the files and the outcomes of the Stasi debate in reunified Germany. A major guide for research on communist secret-police forces, this book is considered the standard reference work on the Stasi and has already been translated into a number of Eastern European languages.

Cervical artery dissection is a major cause of stroke in young people (aged <50 years). Historically, clinicians have preferred using oral anticoagulation with vitamin K antagonists for patients with cervical artery dissection, although some current guidelines—based on available evidence from mostly observational studies—suggest using aspirin. If proven to be non-inferior to vitamin K antagonists, aspirin might be preferable, due to its ease of use and lower cost. We aimed to test the non-inferiority of aspirin to vitamin K antagonists in patients with cervical artery dissection. We did a multicentre, randomised, open-label, non-inferiority trial in ten stroke centres across Switzerland, Germany, and Denmark. We randomly assigned (1:1) patients aged older than 18 years who had symptomatic, MRI-verified, cervical artery dissection within 2 weeks before enrolment, to receive either aspirin 300 mg once daily or a vitamin K antagonist (phenprocoumon, acenocoumarol, or warfarin; target international normalised ratio [INR] 2·0–3·0) for 90 days. Randomisation was computer-generated using an interactive web response system, with stratification according to participating site. Independent imaging core laboratory adjudicators were masked to treatment allocation, but investigators, patients, and clinical event adjudicators were aware of treatment allocation. The primary endpoint was a composite of clinical outcomes (stroke, major haemorrhage, or death) and MRI outcomes (new ischaemic or haemorrhagic brain lesions) in the per-protocol population, assessed at 14 days (clinical and MRI outcomes) and 90 days (clinical outcomes only) after commencing treatment. Non-inferiority of aspirin would be shown if the upper limit of the two-sided 95% CI of the absolute risk difference between groups was less than 12% (non-inferiority margin). This trial is registered with ClinicalTrials.gov, NCT02046460. Between Sept 11, 2013, and Dec 21, 2018, we enrolled 194 patients; 100 (52%) were assigned to the aspirin group and 94 (48%) were assigned to the vitamin K antagonist group. The per-protocol population included 173 patients; 91 (53%) in the aspirin group and 82 (47%) in the vitamin K antagonist group. The primary endpoint occurred in 21 (23%) of 91 patients in the aspirin group and in 12 (15%) of 82 patients in the vitamin K antagonist group (absolute difference 8% [95% CI −4 to 21], non-inferiority p=0·55). Thus, non-inferiority of aspirin was not shown. Seven patients (8%) in the aspirin group and none in the vitamin K antagonist group had ischaemic strokes. One patient (1%) in the vitamin K antagonist group and none in the aspirin group had major extracranial haemorrhage. There were no deaths. Subclinical MRI outcomes were recorded in 14 patients (15%) in the aspirin group and in 11 patients (13%) in the vitamin K antagonist group. There were 19 adverse events in the aspirin group, and 26 in the vitamin K antagonist group. Our findings did not show that aspirin was non-inferior to vitamin K antagonists in the treatment of cervical artery dissection. Swiss National Science Foundation, Swiss Heart Foundation, Stroke Funds Basel, University Hospital Basel, University of Basel, Academic Society Basel.

Background Managing femoral neck fractures (FNFs) in young adults remains a significant clinical dilemma. No single internal fixation method has demonstrated clear superiority. The aim of this study was to compare the clinical and radiographic outcomes of FNFs in young adults treated with femoral neck locking plate (FNLP) or conventional partially-threaded 6.5 mm multiple cannulated cancellous screws (MCCS). Methods A randomized controlled clinical trial (RCT) study was conducted on 74 patients to assess FNLP and MCCS in management of FNFs in young adults in Sohag university hospital between October 2022 and October 2024. The outcomes included Harris Hip Score (HHS), weight-bearing timelines, radiographic union times, and complication rates. Results FNLP demonstrated superior functional outcomes with significantly higher HHS scores compared to MCCS. Patients treated with FNLP achieved earlier partial and full weight-bearing ( p  <.001) and faster radiographic union times ( p  =.012), indicating better biomechanical stability. MCCS had a significantly shorter operative time at (49.3 ± 3.5 min) compared to the FNLP group at (62.3 ± 9.9 min), ( p  =.042). Complication rates, including femoral neck shortening, avascular necrosis, and infection, were comparable between the two groups. Conclusion FNLP is a more effective fixation method for young adults with FNFs, offering faster functional recovery and improved radiographic outcomes. MCCS demonstrated significant shorter operative time which is a potential advantage especially in resources-constrained settings. Complication rates were similar between FNLP and MCCS, making MCCS a viable option in selected cases based on fracture severity, surgical expertise, and resources availability. Level of evidence Level II therapeutic: prospective randomized controlled clinical trial. Trial registration The trial was retrospectively registered at 27 November, 2023 at www.clinicaltrials.gov (Trial Registration Number: NCT06162637).

Although increasingly used, the benefit of surgical treatment of displaced 2-part proximal humerus fractures has not been proven. This trial evaluates the clinical effectiveness of surgery with locking plate compared with non-operative treatment for these fractures. The NITEP group conducted a superiority, assessor-blinded, multicenter randomized trial in 6 hospitals in Finland, Estonia, Sweden, and Denmark. Eighty-eight patients aged 60 years or older with displaced (more than 1 cm or 45 degrees) 2-part surgical or anatomical neck proximal humerus fracture were randomly assigned in a 1:1 ratio to undergo either operative treatment with a locking plate or non-operative treatment. The mean age of patients was 72 years in the non-operative group and 73 years in the operative group, with a female sex distribution of 95% and 87%, respectively. Patients were recruited between February 2011 and April 2016. The primary outcome measure was Disabilities of Arm, Shoulder, and Hand (DASH) score at 2-year follow-up. Secondary outcomes included Constant-Murley score, the visual analogue scale for pain, the quality of life questionnaire 15D, EuroQol Group's 5-dimension self-reported questionnaire EQ-5D, the Oxford Shoulder Score, and complications. The mean DASH score (0 best, 100 worst) at 2 years was 18.5 points for the operative treatment group and 17.4 points for the non-operative group (mean difference 1.1 [95% CI -7.8 to 9.4], p = 0.81). At 2 years, there were no statistically or clinically significant between-group differences in any of the outcome measures. All 3 complications resulting in secondary surgery occurred in the operative group. The lack of blinding in patient-reported outcome assessment is a limitation of the study. Our assessor physiotherapists were, however, blinded. This trial found no significant difference in clinical outcomes at 2 years between surgery and non-operative treatment in patients 60 years of age or older with displaced 2-part fractures of the proximal humerus. These results suggest that the current practice of performing surgery on the majority of displaced proximal 2-part fractures of the humerus in older adults may not be beneficial. ClinicalTrials.gov NCT01246167.