The Multidimensional Depth of the Image: Body-Environment-Artefact (A philosophical reflection for graphic design)

Full version unavailable due to 3rd party copyright restrictions.The Multidimensional Depth of the Image: Body-Environment-Artefact Current discourses within cultural studies are re-iterating the limitations of language to adequately describe the affective domains of corporeality and materiality in the study of cultural artefacts. Within the discourse of graphic design, however, there remains an enduring focus placed upon models of language and communication to understand the meaning of designed materials. Rather than upholding a focus upon language, this thesis undertakes a theoretical investigation to extend the literature available to the discourse of graphic design to better understand how visual materials ‘come to mean’ within the experience of an embodied subject coupled to an affective environment. This thesis proposes an ontology of images that is emergent as a part of what, within the phenomenology of Merleau-Ponty, is describes as a mind-body-world system through which the ‘meaning’ of visual materials should be grounded. This thesis asks not ‘what’ visual materials mean but rather ‘how’ visual materials come to mean in terms of a complex relationship involving the embodied perceptual experience of the maker and the viewer that is immersed within an affective environment, what the thesis terms the multidimensional depth of the image. A phenomenological theory of art is extended to include a range of materials of popular visual culture to frame a study of how form and style come to mean qua the gestures of an embodied experience as coupled to an environment — a meaning that reciprocally emerges through the embodied experience of the work by the viewer. The environmental processes of which an embodied subject’s movements are coupled are brought into focus through enactive conceptions of mind within the cognitive sciences, describing how mind and meaning are emergent within an autopoietic organism-environment system. This provides a framework in which the affective dimensions of matter can be more fully understood as having a cognitive efficacy. Within this context, Material Engagement Theory (an approach within cognitive archaeology) is utilized to include a more focussed discussion of the affective domains of materials, objects, and artefacts and their role in the emergence of mind and meaning.HER

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Parental decisional satisfaction after hypospadias repair in the United Kingdom

Background: in hypospadias, the aim of surgical treatment is to achieve both desirable functional and cosmetic outcomes; however, complications following surgery are common and 18% of boys require re-operation. In mild degrees of hypospadias, repair may be offered entirely to improve cosmesis, meaning parents should be fully informed of this and the potential for complications, during the consent process. Parents’ decision-making may be aided by making them aware of how others in a similar position have felt about the decision that they made for their child. One method of measuring parental satisfaction is decisional regret (DR). Objectives: to assess parental satisfaction following hypospadias surgery in the United Kingdom by assessing DR and to determine the feasibility of obtaining meaningful data via a mobile phone survey. Study design: the National Outcomes Audit in Hypospadias database was commissioned by the British Association of Paediatric Surgeons to capture clinical information from hypospadias repairs. Following ethical approval (16/NW/0819), a text message was sent to mobile numbers in the database inviting participation in a questionnaire incorporating the validated DR scale (DRS). The primary outcome measure was mean DRS score, which was correlated with clinical information, a score of zero indicated no regret and 100 indicated maximum regret. Results: there were 340 (37%) responses. The median age at the primary procedure was 16 (interquartile range 13–20) months. No DR (score = 0) was detected in 186 (55% [95%CI 49–60]) respondents; however, moderate-to-severe DR (score = 26–100) was seen in 21 (6.2% [95%CI 3.6–8.7]) respondents. On multivariate analysis, a distal meatus, a small glans and developing complications requiring repeat surgery were all associated with increased levels of regret (Table). There was no association between DR and cases performed per surgeon. Discussion: around half of respondents demonstrated no DR and postoperative complications requiring surgery were associated with the highest levels of DR, which is similar to a Canadian study. Lorenzo et al. however found that DR was associated with circumcision, which was undertaken in all boys; however, in this UK study, around a third of boys were circumcised and regret levels between those circumcised and those not circumcised were similar. The limitations of this work include the following: surgeons submitting their own data on complications and there is potential of selection bias between respondents and non-respondents as with any survey. Conclusions: data from this study can be used to improve pre-operative counselling during the consent process. Smart mobile phone technology can be used successfully to distribute and collect parent-reported outcomes. [Table presented]</p