Some thoughts on compassion inspired by Sir Thomas Legge

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Medicine and the McNamara fallacy

The ‘McNamara fallacy’ (also known as quantitative fallacy) is named after the US Secretary of Defense during the Vietnam War. The fallacy consists of over-reliance on metrics, and may be summarised as: ‘if it cannot be measured, it is not important’. This paper describes the McNamara fallacy as it applies to medicine and healthcare, taking as examples hospital mortality data, NHS targets and quality assurance

Doctors’ practice and attitudes towards red blood cell transfusion at Mthatha Regional Hospital, Eastern Cape, South Africa: A mixed methods study

Background: Unnecessary blood transfusion exposes recipients to potential harms. Aim: The aim of this study was to describe blood transfusion practice and explore doctors’ attitudes towards transfusion. Setting: A hospital providing level 1 and 2 services. Methods: A mixed-methods study design was used. In the cross-sectional descriptive component, a sample was taken from patients transfused over a 2-month period. Blood use was categorised as for medical anaemia or haemorrhage, and appropriate or not. The qualitative component comprised a purposeful sample for focus group and individual semi-structured interviews. Results: Of 239 patients sampled, 62% were transfused for medical anaemia and 38% for haemorrhage. In the medical anaemia group, compliance with age-appropriate transfusion thresholds was 69%. In medical anaemia and haemorrhage, 114 (77%) and 85 (93.4%) of recipients had orders for ≥ 2 red blood cell (RBC) units, respectively. In adults ≥ 18 years old with medical anaemia, 47.1% of orders would have resulted in a haemoglobin (Hb) < 8 g/dL. Six doctors participated in focus group and eleven in individual interviews. There was a lack of awareness of institutional transfusion guidelines, disagreement on appropriate RBC transfusion thresholds and comments that more than one RBC unit should always be transfused. Factors informing decisions to transfuse included advice from senior colleagues, relieving symptoms of anaemia and high product costs. Conclusion: Most orders were for two or more units. In medical anaemia, doctors’ compliance with RBC transfusion thresholds was reasonable; however, almost half of the orders would have resulted in overtransfusion. The attitudes of doctors sampled suggest that their transfusion practice is influenced more by institutional values than formal guidelines

Isolation and Characterization of toxin A-negative, toxin B-positive Clostridium difficile in Dublin, Ireland

Clostridium difficile is a major cause of infectious diarrhoea in hospitalised patients. Most pathogenic C. difficile strains produce two toxins, A and B; however, clinically relevant toxin A-negative, toxin Bpositive (A– B+ ) strains of C. difficile that cause diarrhoea and colitis in humans have been isolated worldwide. The aims of this study were to isolate and characterise A– B+ strains from two university hospitals in Dublin, Ireland. Samples positive for C. difficile were identified daily by review of ELISA results and were cultured on selective media. Following culture, toxin-specific immunoassays, IMR-90 cytotoxicity assays and PCR were used to analyse consecutive C. difficile isolates from 93 patients. Using a toxin A-specific ELISA, 52 samples produced detectable toxin. All isolates were positive using a toxin A ⁄ B ELISA. Similarly, all isolates were positive with the cytoxicity assay, although variant cytopathic effects were observed in 41 cases. PCR amplification of the toxin A and toxin B genes revealed that 41 of the previous A– B+ strains had a c. 1.7-kb deletion in the 3¢-end of the tcdA gene. Restriction enzyme analysis of these amplicons revealed the loss of polymorphic restriction sites. These 41 A– B+ isolates were designated toxinotype VIII by comparison with C. difficile strain 1470. PCR ribotyping revealed that all A– B+ isolates belonged to PCR-ribotype 017. A– B+ C. difficile isolates accounted for 44% of the isolates examined in this study, and appeared to be isolated more frequently in Dublin, Ireland, than reported rates for other countries

Coopetition of software firms in Open source software ecosystems

Software firms participate in an ecosystem as a part of their innovation strategy to extend value creation beyond the firms boundary. Participation in an open and independent environment also implies the competition among firms with similar business models and targeted markets. Hence, firms need to consider potential opportunities and challenges upfront. This study explores how software firms interact with others in OSS ecosystems from a coopetition perspective. We performed a quantitative and qualitative analysis of three OSS projects. Finding shows that software firms emphasize the co-creation of common value and partly react to the potential competitiveness on OSS ecosystems. Six themes about coopetition were identified, including spanning gatekeepers, securing communication, open-core sourcing and filtering shared code. Our work contributes to software engineering research with a rich description of coopetition in OSS ecosystems. Moreover, we also come up with several implications for software firms in pursing a harmony participation in OSS ecosystems.Comment: This is the author's version of the work. Copyright owner's version can be accessed at https://link.springer.com/chapter/10.1007/978-3-319-69191-6_10, Coopetition of software firms in Open source software ecosystems, 8th ICSOB 2017, Essen, Germany (2017

Multi-Granular Optical Cross-Connect: Design, Analysis, and Demonstration

A fundamental issue in all-optical switching is to offer efficient and cost-effective transport services for a wide range of bandwidth granularities. This paper presents multi-granular optical cross-connect (MG-OXC) architectures that combine slow (ms regime) and fast (ns regime) switch elements, in order to support optical circuit switching (OCS), optical burst switching (OBS), and even optical packet switching (OPS). The MG-OXC architectures are designed to provide a cost-effective approach, while offering the flexibility and reconfigurability to deal with dynamic requirements of different applications. All proposed MG-OXC designs are analyzed and compared in terms of dimensionality, flexibility/reconfigurability, and scalability. Furthermore, node level simulations are conducted to evaluate the performance of MG-OXCs under different traffic regimes. Finally, the feasibility of the proposed architectures is demonstrated on an application-aware, multi-bit-rate (10 and 40 Gbps), end-to-end OBS testbed

Iatrogenic encephalocele: a rare complication of vacuum extraction delivery

Vacuum extraction is a frequently used form of assisted vaginal delivery. Here we describe a child who was born by vacuum extraction delivery. Days after the birth, a frontal swelling, which was thought to be a caput succedaneum, enlarged. Imaging revealed an iatrogenic encephalocele with a large subcutaneous CSF collection. Surgical reconstruction was performed. A parasagittal dura defect was closed. There was no involvement of the superior sagittal sinus. To our knowledge, encephalocele is an infrequent complication of vacuum extraction delivery, rarely described in literature. The child had a good recovery after the operation, without neurologic deficits