Cloaked websites: propaganda, cyber-racism and epistemology in the digital era

This article analyzes cloaked websites, which are sites published by individuals or groups who conceal authorship in order to disguise deliberately a hidden political agenda. Drawing on the insights of critical theory and the Frankfurt School, this article examines the way in which cloaked websites conceal a variety of political agendas from a range of perspectives. Of particular interest here are cloaked white supremacist sites that disguise cyber-racism. The use of cloaked websites to further political ends raises important questions about knowledge production and epistemology in the digital era. These cloaked sites emerge within a social and political context in which it is increasingly difficult to parse fact from propaganda, and this is a particularly pernicious feature when it comes to the cyber-racism of cloaked white supremacist sites. The article concludes by calling for the importance of critical, situated political thinking in the evaluation of cloaked websites

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The burden of invasive infections in critically ill indigenous children in Australia

10.5694/mja16.00595Medical Journal of Australia206278-84MJAU

The burden of invasive infections in critically ill Indigenous children in Australia

Objectives: To describe the incidence and mortality of invasive infections in Indigenous children admitted to paediatric and general intensive care units (ICUs) in Australia. Design: Retrospective multi-centre cohort study of Australian and New Zealand Paediatric Intensive Care Registry data. Participants: All children under 16 years of age admitted to an ICU in Australia, 1 January 2002 e 31 December 2013. Indigenous children were defined as those identified as Aboriginal and/or Torres Strait Islander in a mandatory admissions dataset. Main outcomes: Population-based ICU mortality and admission rates. Results: Invasive infections accounted for 23.0% of non-elective ICU admissions of Indigenous children (726 of 3150), resulting in an admission rate of 47.6 per 100 000 children per year. Staphylococcus aureus was the leading pathogen identified in children with sepsis/septic shock (incidence, 4.42 per 100 000 Indigenous children per year; 0.57 per 100 000 non-Indigenous children per year; incidence rate ratio 7.7; 95% CI, 5.8e10.1; P < 0.001). While crude and risk-adjusted ICU mortality related to invasive infections was not significantly different for Indigenous and non-Indigenous children (odds ratio, 0.75; 95% CI, 0.53e1.07; P ¼ 0.12), the estimated population-based age-standardised mortality rate for invasive infections was significantly higher for Indigenous children (2.67 per 100 000 per year v 1.04 per 100 000 per year; crude incidence rate ratio, 2.65; 95% CI, 1.88e3.64; P < 0.001). Conclusions: The ICU admission rate for severe infections was several times higher for Indigenous than for non-Indigenous children, particularly for S. aureus infections. While ICU case fatality rates were similar, the population-based mortality was more than twice as high for Indigenous children. Our study highlights an important area of inequality in health care for Indigenous children in a high income country that needs urgent attention.Justyna A Ostrowski, Graeme MacLaren, Janet Alexander, Penny Stewart, Sheena Gune, Joshua R Francis, Subodh Ganu, Marino Festa, Simon J Erickson, Lahn Straney, Luregn J Schlapbac

Gestational age and risk of mortality in term-born critically ill neonates admitted to PICUs in Australia and New Zealand

OBJECTIVES:Gestational age at birth is declining, probably because more deliveries are being induced. Gestational age is an important modifiable risk factor for neonatal mortality and morbidity. We aimed to investigate the association between gestational age and mortality in hospital for term-born neonates (≥ 37 wk') admitted to PICUs in Australia and New Zealand. DESIGN:Observational multicenter cohort study. SETTING:PICUs in Australia and New Zealand. PATIENTS:Term-born neonates (≥ 37 wk) admitted to PICUs. INTERVENTIONS:None MEASUREMENTS AND MAIN RESULTS:: We studied 5,073 infants born with a gestational age greater than or equal to 37 weeks and were less than 28 days old when admitted to a PICU in Australia or New Zealand between 2007 and 2016. The association between gestational age and mortality was estimated using a multivariable logistic regression model, adjusting for age, sex, indigenous status, Pediatric Index of Mortality version 2, and site. The median gestational age was 39.1 weeks (interquartile range, 38.2-40 wk) and mortality in hospital was 6.6%. Risk of mortality declined log-linearly with gestational age. The adjusted analysis showed a 20% (95% CI, 11-28%) relative reduction in mortality for each extra week of gestation beyond 37 weeks. The effect of gestation was stronger among those who received extracorporeal life support: each extra week of gestation was associated with a 44% (95% CI, 25-57%) relative reduction in mortality. Longer gestation was also associated with reduced length of stay in hospital: each week increase in gestation, the average length of stay decreased by 4% (95% CI, 2-6%). CONCLUSIONS:Among neonates born at "term" who are admitted to a PICU, increasing gestational age at birth is associated with a substantial reduction in the risk of dying in hospital. The maturational influence on outcome was more strongly noted in the sickest neonates, such as those requiring extracorporeal life support. This information is important in view of the increasing proportion of planned births in both high- and low-/middle-income countries.Siva P. Namachivayam, John B. Carlin, Johnny Millar, Janet Alexander, Sarah Edmunds, Anusha Ganeshalingham, Jamie Lew, Simon Erickson, Warwick Butt, Luregn J. Schlapbach, Subodh Ganu, Marino Festa, Jonathan R. Egan, Gary Williams, Janelle Young, on behalf of Australian and New Zealand Intensive Care Society Paediatric Study Group (ANZICS PSG) and Australian and New Zealand Paediatric Intensive Care Registry (ANZPICR