87 research outputs found

    Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

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    Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

    Gender and Climate Change

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    In this chapter, I focus on the negative consequences of climate change for women’s rights. This chapter is divided into two parts. In the first part, I point out that poorer women in developing countries are one of the social groups most exposed to the effects of climate change. In the second part, I show why climate change affects women’s lives and their rights

    Anticipating Sex Robots: A Critique of the Sociotechnical Vanguard Vision of Sex Robots as ‘Good Companions’

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    A number of companies have started to developed humanoid robots that (1) bear some physical resemblance to human beings, (2) have some ability to initiate movements (e.g. blinking; head-turning, gyration, etc.) and (3) possess some AI functionalities enabling quasi-intelligent environment-responsiveness and linguistic expression. The robots I am speaking of are sex robots. A promise frequently voiced by sex-robot developers (and some academics) is that sex robots will be “good companions” who can enrich and transform the romantic lives of human persons, particularly those who – for various reasons – have trouble entering into traditional love relationships with other humans. Curbing this technological enthusiasm, many philosophers have offered more critical anticipations of sex robots (sex-robot-anticipation hereafter) and the idea that they can, will, or should become good companions to human users. While these critical sex-robot-anticipations alert us to some of the potential harms that may follow from a proliferation of sex robots into society, the overarching aim of this chapter is to show that, by and large, these anticipations fall short. Specifically, they continue to frame the anticipation of sex robots around the question of their potential as good companions. In doing so, I argue that many sex-robot-anticipations at best marginalise key ethical questions pertaining to our potential future with sex robots. At their worst, these sex-robot-anticipations are inadvertently contributing to the potential realisation of a technology that they are precisely worried about. In the process of critically engaging with much of today’s philosophical sex-robot-anticipation, I will introduce two criteria I take to be of central importance for good sex-robot-anticipation; what I call ‘reflective anticipation’ and ‘technological groundedness.

    Gender Differences in Job Preferences and Educational Choices

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    In this contribution, I focus on gender differences in job preferences and educational choices. The contribution is divided in three parts. First, I examine the distinction between sex and gender. Second, I show why gender stereotypes affect women’s performance and choice. Third, I analyse the link between stereotypes and certain forms of epistemic injustice

    Being and Value in Technology

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    Breaking the Fourth Wall in Videogames

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    In this chapter, I investigate the imaginary boundary between the actual world and fictional gameworlds by focusing on videogame situations in which this fourth wall is foregrounded or broken. For this purpose, I first define the videogame experience as a self-involving, interactive fiction experience, based on Kendall Walton’s account of fiction (1990). I then describe how, in the current academic discourse on games, it is often claimed that the concept of fourth wall breaks cannot be applied to videogames due to their inherent interactivity. Within game studies, the consensus seems to be that the boundaries between the real and the fictional world are always already blurred in videogame experiences. This chapter instead shows how using interactive, digital technologies to represent fictional worlds does not necessarily complicate the conceptualization of the fourth wall, but rather reveals new ways in which it can be broken. More precisely, this chapter discusses how appreciators of videogames can not only actively participate in fourth wall breaks, but are also uniquely able to initiate these breaks themselves

    Recommendations for the measurement of thrombin generation:Communication from the ISTH SSC Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibodies

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    Thrombin generation (TG) assay is an overall assay to assess the functionality of the hemostatic system and may be a useful tool in diagnosing patients with hyper- and hypocoagulability. Lack of standardization in performing the assays contributes largely to poor correlation between assays and study results. The current lack of standardization remains a major issue in the setting of TG, as illustrated in a recent survey of the ISTH/SSC indicating differences in pre-, analytical, and post-analytical factors among users. These factors may considerably affect the between-laboratory reproducibility of results. Based on the results of the survey and a current review of the literature, along with insights and strong consensus of key investigators in the field, we present guidance for measurement of TG in a clinical setting. Recommendations on blood drawing, handling, processing, and sample storage; reagent concentration and source; analytical conditions on dilution of samples and temperature; calibration and replicate testing; calculation and interpretation of results; and reference values are addressed to help in reducing interlaboratory variation. These recommendations aim at harmonization between methods and laboratories to support the application of TG in patient diagnosis and management

    The Ship of Theseus Puzzle

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    Does the Ship of Theseus present a genuine puzzle about persistence due to conflicting intuitions based on “continuity of form” and “continuity of matter” pulling in opposite directions? Philosophers are divided. Some claim that it presents a genuine puzzle but disagree over whether there is a solution. Others claim that there is no puzzle at all since the case has an obvious solution. To assess these proposals, we conducted a cross-cultural study involving nearly 3,000 people across twenty-two countries, speaking eighteen different languages. Our results speak against the proposal that there is no puzzle at all and against the proposal that there is a puzzle but one that has no solution. Our results suggest that there are two criteria—“continuity of form” and “continuity of matter”— that constitute our concept of persistence and these two criteria receive different weightings in settling matters concerning persistence

    A New Test for the Detection of Direct Oral Anticoagulants (Rivaroxaban and Apixaban) in the Emergency Room Setting

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    Determining whether a patient has taken a direct oral anticoagulant (DOAC) is critical during the periprocedural and preoperative period in the emergency department. However, the inaccessibility of complete medical records, along with the generally inconsistent sensitivity of conventional coagulation tests to these drugs, complicates clinical decision making and puts patients at risk of uncontrollable bleeding. In this study, we evaluate the utility of inhibitor-II-X (i-II-X), a novel, microfluidics-based diagnostic assay for the detection and identification of Factor Xa inhibitors (FXa-Is) in an acute care setting. Design: First-in-human, 91-patient, single-center retrospective pilot study. Setting: Emergency room. Patients: Adult patients admitted into the emergency department, which received any clinician-ordered coagulation test requiring a 3.2% buffered sodium citrate blood collection tube. Interventions: None. Measurements and Main Results: Plasma samples from patients admitted to the emergency department were screened for the use of FXa-Is, including apixaban and rivaroxaban, within the past 24 hours using our new i-II-X microfluidic test. i-II-X results were then compared with results from conventional coagulation tests, including prothrombin time (PT) and international normalized ratio (INR), which were ordered by treating clinicians, and an anti-Xa assay for rivaroxaban. The i-II-X test detected DOACs in samples collected from the emergency department with 95.20% sensitivity and 100.00% specificity. Unlike PT and INR, i-II-X reliably identified patients who had prolonged clotting times secondary to the presence of a FXa-I. Conclusions: The i-II-X test overcomes the limitations of currently available coagulation tests and could be a useful tool by which to routinely screen patients for DOACs in emergency and critical care settings. Our new diagnostic approach is particularly relevant in clinical situations where medical records may be unavailable, or where precautions need to be taken prior to invasive interventions, such as specific reversal agent administration
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