4 research outputs found

    Between Text and Talk: Expertise, Normativity, and Scales of Belonging in the Montreal Tamil Diasporas.

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    In the global city-region of Montreal, Tamil-speaking residents are orienting themselves to multiple homelands, nations, and diasporas of different spatial and temporal scales. These scales of belonging are constituted by regimenting linguistic forms, practices, and speakers into a series of hierarchical relationships that are recursively modeled on the ideological distinctions between “text” and “talk”. Various language ideologies contribute to this politics of regimentation, including the globally dominant ethnolinguistic language ideology, the locally-specific language ideology of sociolinguistic compartmentalization, and the regionally-specific diglossia language ideology. Out of these mutually reinforcing ideologies and institutions have emerged two morally incommensurable Tamil sociolinguistic personas. In the Indian Tamil diaspora, the cultivation of talk-like expertise in Tamil is celebrated as an index of speakers’ globalizing and modernist moral sensibilities. In the Sri Lankan Tamil diaspora, the cultivation of text-like expertise in Tamil is celebrated as an index of speakers’ purist and primordialist moral sensibilities. There is a complementarity to this division of language labor, with Indian Tamils entrusted to modernize the prestige of the mother tongue and Sri Lankan Tamils entrusted to preserve the purity of the literary standard. The expansion of the Sri Lankan Tamil diaspora, with its heritage language institutions and textual facades, and the increase in Indian Tamil linguistic entrepreneurs testifies to the profitability of this arrangement for both Montreal Tamil groups. Each Tamil diaspora also socializes its youth to endorse mutually-opposed ethnonational Tamil personas while cultivating similar linguistic repertoires. Thus, even though 2nd generation Indian Tamils are socialized to speak English and colloquial Tamil and Sri Lankan Tamils are socialized to speak French and literary-stylized Tamil, incentives to habitually code-switch between Tamil, English, and/or French have caused these linguistic repertoires to converge. Sometimes, such acts of code-switching/code-mixing are intended to shift the normative scale of the communicative encounter or the discursive frame. For Sri Lankan Tamil nationalists, the political uncertainties of the refugee experience will precipitate a shift in the inter-discursive frame between diaspora and homeland. For other Montreal Tamils, the racialization of “tamouls” as permanent “étrangers” will prompt attempts to shift the scales of communicative encounters between majority and minority interlocutors.Ph.D.AnthropologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/61571/1/sndas_1.pd

    Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

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    Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

    The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

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    © 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

    Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

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    This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London
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