Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

The role of educational technologies in linking Saudi male and female campuses

This empirical study examines the role of educational technologies in connecting male and female university campuses in Saudi Arabia. In order to do so, it addresses the research question: What are the outcomes, ramifications and implications of the ways in which educational technologies have been employed to reconfigure social relations between male and female campuses in Saudi Arabia? This question is answered by a naturalistic study of a state university in the Eastern Province of Saudi Arabia, based on analysis of interviews, observations and documents. From an analysis of the data following the guidelines of the grounded theory technique, two themes emerged: (a) the influence of social relations on the way educational technologies are developed and used, so as to sustain certain aspects of the social structure; (b) the reciprocal influence of the technologies so developed and used on other aspects of the social structure. Considering both themes leads to a theoretical proposition that educational technologies might be introduced to preserve particular components of the social configuration, although once introduced, these technologies might impinge in return upon other components of the social configuration

The methodology of door-knocking: Saudi household surveys on socioeconomics and learning technologies

Some academics endorse analysing societies’ symbolic forms. This article, therefore, inspects the symbol of door-knocking. It addresses the research question of what impacts data collection through door-knocking. This question was addressed as part of a household survey conducted in low-income Saudi neighbourhoods to study socioeconomics and learning technologies. This study involved recruiting 18 male and female Saudis to knock on 1300 doors. It showed positive and negative influences on data collection. Concerning negative influences, knockers and “knockees” were gendered—constrained by gender separation, societal and parental restrictions upon women and lack of gender confidence. Knockers were intimidated by doors’ assertive features, such as elaborate carvings, decorative cut-outs or colouring. They were frightened by doors’ defensive features, like thick doors with enormous frames, two front doors per house, high concrete walls and unnecessary stairs. They were uncomfortable—exhausted, emotionally distressed and concerned about hygiene and safety. Regarding positive influences, knockers and knockees were traditional, following Saudi negotiation, charity work, hospitality and generosity. Knockees were respectful, showing respect to knockers’ authority, rank and class. They were profit-oriented, appreciating financial and non-financial incentives. Saudi households were distinguishable through food smells, shoes, cars, stickers and plants. These influences constitute methodological grounds for future door-knocking

The role of educational technologies in linking Saudi male and female campuses

This empirical study examines the role of educational technologies in connecting male and female university campuses in Saudi Arabia. In order to do so, it addresses the research question: What are the outcomes, ramifications and implications of the ways in which educational technologies have been employed to reconfigure social relations between male and female campuses in Saudi Arabia? This question is answered by a naturalistic study of a state university in the Eastern Province of Saudi Arabia, based on analysis of interviews, observations and documents. From an analysis of the data following the guidelines of the grounded theory technique, two themes emerged: (a) the influence of social relations on the way educational technologies are developed and used, so as to sustain certain aspects of the social structure; (b) the reciprocal influence of the technologies so developed and used on other aspects of the social structure. Considering both themes leads to a theoretical proposition that educational technologies might be introduced to preserve particular components of the social configuration, although once introduced, these technologies might impinge in return upon other components of the social configuration. 12-- _ Learning and Ne" Technologies Research Group - Department ot"EduGltion - University of Oxford 12EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The role of educational technologies in linking Saudi male and female campuses

This empirical study examines the role of educational technologies in connecting male and female university campuses in Saudi Arabia. In order to do so, it addresses the research question: What are the outcomes, ramifications and implications of the ways in which educational technologies have been employed to reconfigure social relations between male and female campuses in Saudi Arabia? This question is answered by a naturalistic study of a state university in the Eastern Province of Saudi Arabia, based on analysis of interviews, observations and documents. From an analysis of the data following the guidelines of the grounded theory technique, two themes emerged: (a) the influence of social relations on the way educational technologies are developed and used, so as to sustain certain aspects of the social structure; (b) the reciprocal influence of the technologies so developed and used on other aspects of the social structure. Considering both themes leads to a theoretical proposition that educational technologies might be introduced to preserve particular components of the social configuration, although once introduced, these technologies might impinge in return upon other components of the social configuration.</p

Coronian Education: Perceptions of Educational Changes during the COVID-19 Pandemic in Arab Countries

This article tackles the question: To what domains did education go when it left school buildings due to the coronavirus pandemic? To answer this question, 1184 observations of online activity, 1132 observations of face-to-face activity, 118 focus groups and 1110 individual interviews were undertaken. In addition, 1290 witticisms were collected, utilising humour to inform research. Data analysis reveals the relocation of education to three domains: the domestic, digital and political. Its relocation to the domestic domain has meant increased familial responsibility, fuelling domestic tensions and conflicting with home-based distractions. Its relocation to the digital domain has involved reduced physical interaction, rituality, social merit, mobility and student health. Its relocation to the political domain has given rise to issues of participation and reshaped the power, institutional fabrication and societal support of education. The conclusion introduces the concept of &ldquo;coronian education&rdquo;&mdash;a hybrid of the domestic, digital and political domains. Whereas pre-coronian education was limited to a single domain, the school, coronian education is fragmented across three domains. Although coronian education research is feasible in the digital and political domains, it is challenging to conduct such research in the domestic domain, as an enquiry into domesticity entails invading the private spaces of homes

Can People Be Managed through Fear? An Enquiry into Arab Culture

This research scrutinises the fear-driven management of Arabs. It conceptualises fear as a structural component of Arab society through a sociological lens and, by drawing upon the reflections of 28 Arab experts, philosophises on the potential of fear to develop into a well-configured managerial system (&lsquo;feararchy&rsquo;) that regulates public and private lives. This research finds this system to rest upon a foundation of three forms of fear: ontological (the normalisation of fear), epistemological (the utilisation of fear to shape knowledge) and axiological (the influence of fear on acceptability). This article makes five contributions. First, it shows how, through turning fear into a collective status, Arab managers exploit fear for social control. Second, it demonstrates the institutional nature of Arabs&rsquo; fear, making it worthy of attention from the field of management. Third, it investigates fear as an individually internalised, socially constructed feeling that is psychologically manipulative. Fourth, it presents fear as not merely a natural psychological sensation but a managerially distorted contextual frame within which current (and future) members think and operate. Fifth and finally, it exposes the contextuality of fear: sources of fear in one context may not be sources of fear in another

Social informatics in education

This article lies at the crossroads of education, technology, and culture, examining the assumption that societal cultures can exert influence on educational technologies. It is informed by a hypothesis that educational technology is not merely a matter of education and technology alone but is also about the societal culture wherein that educational technology is implemented. The study explores those societally and culturally informed factors that promote the rejection of educational technologies. It answers the research question: To what extent do societal cultures challenge educational technologies? This question is addressed by carrying out a quantitative enquiry into Israel and Saudi Arabia. Having analyzed the collected data using an exploratory factor analysis, societally and culturally directed factors were revealed that flew in the face of educational technologies. The theoretical proposition that could be drawn from this is that educational technologies can be rejected not based on educational or technological interests alone but rather based on societally and culturally promoted anxieties. The recommendation for research policy is thus that, when researching an educational technology, there should be constant consideration of how societally and culturally compatible it is with the wider societal culture wherein it will be or already is situated

ChatGPT and the rise of semi-humans

Abstract This article explores the research question: ‘What are ChatGPT’s human-like traits as perceived by society?’ Thematic analyses of insights from 452 individuals worldwide yielded two categories of traits. Category 1 entails social traits, where ChatGPT embodies the social roles of ‘author’ (imitating human phrasing and paraphrasing practices) and ‘interactor’ (simulating human collaboration and emotion). Category 2 encompasses political traits, with ChatGPT assuming the political roles of ‘agent’ (emulating human cognition and identity) and ‘influencer’ (mimicking human diplomacy and consultation). When asked, ChatGPT confirmed the possession of these human-like traits (except for one trait). Thus, ChatGPT displays human-like qualities, humanising itself through the ‘game of algorithms’. It transcends its inherent technical essence and machine-based origins to manifest as a ‘semi-human’ living actor within human society, showcasing the emergence of semi-humans. Therefore, researchers should redirect their attention towards the ‘sociology of semi-humans’ (studying their socio-political traits) beyond the ‘biology of semi-humans’ (examining their technical traits). While medieval society was captivated by mythical semi-human beings (e.g. mermaids), modern society finds itself increasingly captivated by computational semi-human beings like ChatGPT. Ethical concerns arise as semi-humans impersonate human traits without consent or genuine human existence, blurring the boundaries between what is authentically and artificially ‘human’