The rise of social ereading : interactive ebook platforms and the development of online reading communities : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in English at Massey University, Manawatū, New Zealand

Ebooks have caused a revolution in how people read fiction. Ereading devices and apps now integrate interactive features which have led to the development of digital reading communities populated by millions of readers from around the world, with a resurgence of social reading practices in new forms. Two of the biggest social reading communities in existence today are hosted by Amazon’s Kindle and Wattpad. This thesis offers an analysis of how these platforms’ readers are using the interactive technology within the pages of their ebooks to participate in these online reading communities. Original research into popular texts on Wattpad reveals that while only a small percentage of users are actively engaging with the ebooks and other readers during the process of reading, all active and passive interactions have a significant influence on the reading experience. Thus, the infrastructure of such communities ‘rewards’ serialised books which encourage higher levels of reader interactivity with greater recognition within the community, but this reward is short-lived. The application of Genette’s paratextual theory to the interactive features of these ereading platforms reveals new processes of authorisation and readers-as-writers. New paths for the evolution of digital paratextual theory see paratexts developing from ‘thresholds’ into ‘vectors’. The statistical notations of reader interactions are now informational paratexts attached to each ebook, and these online reading communities may be considered paratexts themselves, operating through the new paratextual phenomenon of digital marginalia. Furthermore, the existence of these reading communities on free platforms such as Wattpad is supported by commercial paratexts found within the ebook pages. These new paratexts are iii having a significant impact on social ereading and reading communities - such as how they operate and judge the ‘value’ of ebooks - but historical precedents suggest these paratexts will be readily accepted by most readers, leading to an increase in the incidence and influence of such digital paratexts. These new interactive technologies and paratexts will potentially lead to significant changes in how fiction is read. Exactly how these technologies may develop, and how public, industrial, and academic stakeholders might take advantage of these opportunities, requires further research

Postoperative continuous positive airway pressure to prevent pneumonia, re-intubation, and death after major abdominal surgery (PRISM): a multicentre, open-label, randomised, phase 3 trial

Background: Respiratory complications are an important cause of postoperative morbidity. We aimed to investigate whether continuous positive airway pressure (CPAP) administered immediately after major abdominal surgery could prevent postoperative morbidity. Methods: PRISM was an open-label, randomised, phase 3 trial done at 70 hospitals across six countries. Patients aged 50 years or older who were undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive CPAP within 4 h of the end of surgery or usual postoperative care. Patients were randomly assigned using a computer-generated minimisation algorithm with inbuilt concealment. The primary outcome was a composite of pneumonia, endotracheal re-intubation, or death within 30 days after randomisation, assessed in the intention-to-treat population. Safety was assessed in all patients who received CPAP. The trial is registered with the ISRCTN registry, ISRCTN56012545. Findings: Between Feb 8, 2016, and Nov 11, 2019, 4806 patients were randomly assigned (2405 to the CPAP group and 2401 to the usual care group), of whom 4793 were included in the primary analysis (2396 in the CPAP group and 2397 in the usual care group). 195 (8\ub71%) of 2396 patients in the CPAP group and 197 (8\ub72%) of 2397 patients in the usual care group met the composite primary outcome (adjusted odds ratio 1\ub701 [95% CI 0\ub781-1\ub724]; p=0\ub795). 200 (8\ub79%) of 2241 patients in the CPAP group had adverse events. The most common adverse events were claustrophobia (78 [3\ub75%] of 2241 patients), oronasal dryness (43 [1\ub79%]), excessive air leak (36 [1\ub76%]), vomiting (26 [1\ub72%]), and pain (24 [1\ub71%]). There were two serious adverse events: one patient had significant hearing loss and one patient had obstruction of their venous catheter caused by a CPAP hood, which resulted in transient haemodynamic instability. Interpretation: In this large clinical effectiveness trial, CPAP did not reduce the incidence of pneumonia, endotracheal re-intubation, or death after major abdominal surgery. Although CPAP has an important role in the treatment of respiratory failure after surgery, routine use of prophylactic post-operative CPAP is not recommended