Heteromatic Robots on Mars: Ethics of going Outer Space

The exploration of space has gained pace. It is urgent to face this emerging and deeply transforming technological process with research that deals with societal, political, technical, legal, and ethical dimensions of the trans-planetary developments. This is part of a broader research program that draws attention to the manifold human and ethical implications of these endeavors, particularly those related to the exploration of Mars. The specific goal, in this case, is to open a space of critical discussion that shows the need of such research program: the relevance and opportunity to investigate the features of responsibility and their links to the governance of the space race. This program asks about the ethical implications of going and being in outer space, and lifts the question towards a broader transdisciplinary discussion. Challenging the fundamental notion of automatism as an essential feature of the outer-space technology, this research shows that multiple interstices of responsibility open as critical spaces that require ethical and political questioning. The concepts of heteromation -as a challenge to automation- and of heterogeneity -as a challenge to homogeneity- serve this critical purpose and shed light to a chain of processes usually blinded to critical enquiry. This is done here with three (and half) specific Martian missions that serve as examples: 1) NASA’s helicopter drone Ingenuity, 2) SpaceX Starship program and 3) the former Mars One mission, or 4) the Tianwen China National Space Administration (CNSA) mission. These cases illustrate the potential of this approach and suggest further research possibilities. These cases help trace and draw together sets of connections that allow the identification of specific ethical issues, the investigation of the values and norms upon which the current actions and future plans, the aims, motifs and goals of these initiatives are built and reproduce. This paper ends by suggesting an interdisciplinary research approach that combines a technoscientific Actor-Network Theory (ANT) and a fluid Grounded Theory. Such frames suggest a mix of quantitative, qualitative digital and network methods of research, that expand from the collection and analysis of online and social media activity, to expert interviews, content and document analysis. These tools serve to follow and connect the manifold of actors, systems, and processes that make up a heterogeneous heteromatic network of engineering, managerial and organizational activities that involve the multiple ethical implications of going outer space. This decade and the decades ahead will see many new challenges and changes regarding all things space; and the gaze of this project critically enquiries about their ethical awareness

Medienperformanz als didaktisches Prinzip medienpädagogischer Praxis

Die medienpädagogische Diskussion wird stark vom Konzept der Medienkompetenz dominiert. Der Ansatz der Medienperformanz als Manifestation der kognitiven Dispositionen im konkreten auf Medien bezogenen Handeln ist demgegenüber unterbelichtet. In diesem Aufsatz wird diskutiert, wie die beiden Konzepte in medienpädagogischer Praxis aufeinander bezogen werden können. Dabei wird Medienperformanz als didaktische Grundhaltung konzipiert, welche mit den Prinzipien einer handlungs- bzw. alltagsorientierten Medienpädagogik korrespondiert. Am Beispiel des medienpädagogischen Projekts "Schaut her! Ich zeig's euch digital!" wird das didaktische Potenzial des Medienperformanz-Ansatzes dargelegt

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research