Visualizing climate change impact with ubiquitous spatial technologies

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Prospective observational cohort study of the association between antiplatelet therapy, bleeding and thrombosis in patients with coronary stents undergoing noncardiac surgery

Background: The perioperative management of antiplatelet therapy in noncardiac surgery patients who have undergone previous percutaneous coronary intervention (PCI) remains a dilemma. Continuing dual antiplatelet therapy (DAPT) may carry a risk of bleeding, while stopping antiplatelet therapy may increase the risk of perioperative major adverse cardiovascular events (MACE). Methods: Occurrence of Bleeding and Thrombosis during Antiplatelet Therapy In Non-Cardiac Surgery (OBTAIN) was an international prospective multicentre cohort study of perioperative antiplatelet treatment, MACE, and serious bleeding in noncardiac surgery. The incidences of MACE and bleeding were compared in patients receiving DAPT, monotherapy, and no antiplatelet therapy before surgery. Unadjusted risk ratios were calculated taking monotherapy as the baseline. The adjusted risks of bleeding and MACE were compared in patients receiving monotherapy and DAPT using propensity score matching. Results: A total of 917 patients were recruited and 847 were eligible for inclusion. Ninety-six patients received no antiplatelet therapy, 526 received monotherapy with aspirin, and 225 received DAPT. Thirty-two patients suffered MACE and 22 had bleeding. The unadjusted risk ratio for MACE in patients receiving DAPT compared with monotherapy was 1.9 (0.93–3.88), P=0.08. There was no difference in MACE between no antiplatelet treatment and monotherapy 1.03 (0.31–3.46), P=0.96. Bleeding was more frequent with DAPT 6.55 (2.3–17.96) P=0.0002. In a propensity matched analysis of 177 patients who received DAPT and 177 monotherapy patients, the risk ratio for MACE with DAPT was 1.83 (0.69–4.85), P=0.32. The risk of bleeding was significantly greater in the DAPT group 4.00 (1.15–13.93), P=0.031. Conclusions: OBTAIN showed an increased risk of bleeding with DAPT and found no evidence for protective effects of DAPT from perioperative MACE in patients who have undergone previous PCI

Handwashing adherence by visitors is poor: Is there a simple solution?

Available evidence suggests that handwashing adherence by visitors to hospital clinics is poor. In this investigation, an audit of 180 people showed that handwashing adherence by visitors to a hospital clinic was 25%, which was very low. Our active method to encourage handwashing led to a marked improvement in adherence from 25% to 68%, increasing to 77% for longer term visitors to the clinic (significance, P < .0001)

Visualizing climate change impact with ubiquitous spatial technologies

This paper further articulates the role of ubiquitous spatial technologies (e.g. Google Earth) as tools for analyzing, visualizing, and developing policy responses to predicted climate change impacts. Specifically, the efficiency and effectiveness of using the tools in the production of visualizations for the local level is studied. A brief background to climate change response reveals limited data and visualizations at the local level: ubiquitous spatial technologies can potentially fill the void. Case study data including temperature, rainfall and land suitability information from southwest Victoria (Australia) are used to test the hypothesis. The research team produced thirty short visualizations using minimal time, resources and a moderate skill base. The effectiveness of the visualizations was tested on a diverse group of stakeholders. It was found that the visuals provided contextual information and understandings of overarching climate change trends, however, integration with other datasets and higher levels of detail are required if the platform is to be used as a stand alone policy development tool. Moreover, the need to further develop design guidelines to guard against, or at least inform users about visual sensationalism is required

Right motive, wrong action: Direct consequentialism and evaluative conflict

The original publication can be found at www.springerlink.comIn this paper I look at attempts to develop forms of consequentialism which do not have a feature considered problematic in Direct Consequentialist theories (that is, those consequentialist theories that apply the criterion of rightness directly in the evaluation of any set of options). The problematic feature in question (which I refer to as ‘evaluative conflict’) is the possibility that, for example, a right motive might lead an agent to perform a wrong act. Theories aiming to avoid this phenomenon must argue that causal relationship entails motives and acts (for example) having the same moral status. I argue that attempts to ensure such ‘evaluative consistency’ are themselves deeply problematic, and that we must therefore accept evaluative conflict.Jennie Louis