Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Players agents in German professional football

In der folgenden Arbeit soll die Entstehung und Entwicklung des Berufsbildes des Spielervermittler -/ Beraters in Bezug auf den deutschen Profifußball dargestellt und erläutert werden und durch eine Expertenbefragung belegt werden. Aus diesem Grund behandelt diese Arbeit, folgende Fragstellungen: Wie hat sich diese Berufsbranche entwickelt? Inwiefern wurde diese Branche durch das Fußballbusiness beeinflusst? Wie hoch ist deren Einfluss in dieser Branche und in wie weit ist dieser Beruf nötig? Fragestellungen einer Branche die sehr umstritten ist

Righting Sexual Wrongs: Personhood, Sex and Intent in a Former South African Bantustan

Righting Sexual Wrongs examines how survivors of sexual violence seek assistance under a racialized system of legal pluralism in the town of Thohoyandou in northeastern South Africa. Over 22 months of ethnographic fieldwork, I charted itineraries of justice through a variety of sites: a criminal court, trauma clinics, family gatherings, the homes of “traditional healers,” churches, social media and others. I also participated in the daily rhythms of a beauty salon where conversations about sex, love and crime were common. This dissertation argues that sexual harm inhabits survivors in numerous ways, a multiplicity that cannot be reduced to the criminal definition of rape. Survivors did not necessarily talk about injury in terms of force, coercion or consent – ways of reckoning sexual harm invested in liberal ideals of autonomy and freedom-as-separation. Instead, the harm of sexual wrongdoing was spoken of in terms of economic precarity, infidelity, pathological exposure, and the disembodied violence of witchcraft. These understandings of sexual harm were shaped by practices of remedy and restitution, but in ways that challenge spatialized theories of legal pluralism. The larger context of this study is a post-apartheid South Africa simultaneously grappling with a “rape crisis” and the legal legacy of settler colonialism. Under British indirect rule and then apartheid, ethnic bantustans (“homelands”) held captive Africans subject to a reified form of “customary law.” The policing and prosecution of rape was only ever partial for non-white populations. Today, human rights advocates and policymakers worry that the legacy of this history is popular misrecognition of the problem of sexual violence. This misrecognition is understood to happen at the institutional level, where complaints go unregistered by service providers, but also at the level of individuals, who understand sex as an entitlement owed to men. The result has been a turn to criminal justice materialized in legal, psycho-social, and medical procedures that unevenly affect survivors, accused persons and their respective loved ones. Complicating these efforts at criminalization is the post-apartheid persistence of legal pluralism, as new forms of insecurity have given way to privatized policing and parliamentarians work to legislatively reinstitute the judicial authority of chiefs and kings. Righting Sexual Wrongs contributes to pressing debates about justice and inequality, debates with a global scope. Ours is a moment when disparate political movements are coalescing around punitive legal reforms in the name of women’s rights. At the same time, demands for criminal justice reform and even prison abolition have become increasingly urgent. Sexual offences are uniquely resistant to such reforms, in part because of how rape is universalized as “a fate worse than death.” The programmatic insistence on the crime of rape as the only way to experience sexual harm justifies state violence that manifests in policing, prosecution and punishment, but also in medical care and counseling for victims. This state violence strikes along existing lines of inequality. In South Africa, it targets ethnic subjects, HIV-positive black men, and poor and working class people. By highlighting the multiple forms sexual wrongdoing takes, this dissertation endorses a structural framing of gender-based violence. In so doing, it rejects a path to justice through personal accountability and punishment, proposing a course to a world without sexual violence through shared responsibility, mutuality and obligation.PHDAnthropologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/162841/1/srupcic_1.pd

Founding Speech: Aristotle's Rhetoric as Political Philosophy

There is notoriously little agreement in the literature on Aristotle’s Rhetoric. While disputes about most every aspect of Aristotle’s argument abound, most scholars tend to agree on one general point. That is, most read the work as an attempt at discovering and describing the nature of rhetorical persuasion. The present study takes a different view: it maintains that the Rhetoric is better understood as an attempt at replacing the existing teaching and practice of rhetoric with one that is better suited for use within the deliberative institutions of political society. The Rhetoric, on this reading, is a work with a political project. This dissertation contributes to the literature in three distinct ways. First, it attempts to show that there is a significant rhetorical component to some of Aristotle’s most prominent arguments. It argues, among other things, that the first chapter of the work and the taxonomy of rhetoric presented in chapters two and three should not be taken at face value. Second, this study illustrates the extent to which concerns about legislation figure into Aristotle’s attempts at articulating an art of speech. Most readings conceptualize the problem of rhetoric as consisting in the relationship between rhetoric and collective judgment, taking the view that Aristotle’s solution lies in liberating judgment from a rhetorical practice that enmeshes it in some incongruous or inappropriate way. This study suggests that preserving the rule of law, protecting a state’s legislative institutions, and cultivating civic virtue, are among Aristotle’s chief concerns. Third, the present work also locates, what it considers to be, Aristotle’s non-rhetorical teaching about the nature of rhetorical persuasion.Ph.D

Techno-Religion and Cyberspace Spirituality in Dystopian Video Games

Once a niche part of the cyber community, video games today represent one of the major industries and “the combination of technology and spiritualist narratives”. In the cyberspace dedicated to video game trivia, we can find intimate reports of players who claim that video games impacted them spiritually or that they felt unity with the spirit of the universe. By analyzing three video games (Everybody’s Gone to the Rapture, Cyberpunk 2077, and Death Stranding), the author aims to explore how spirituality and cyberspace interact in narratives that follow the mentioned games and the interface that pulls the player deeper into the storyline. These games vary in styles and approaches and do not tend to support a view of one true God or any mainstream religion. Therefore, an intricate relationship between cyberspace, algorithmic patterns, and spirituality make these games different and exciting for examination. The author demonstrates the unique perception of spirituality and ideas that influenced the creation of these new spiritual cyberspaces within video games, especially New Age concepts of technopagans such as singularitarians and transhumanists

Reduction of Sidelobes by Nonuniform Elements Spacing of a Spherical Antenna Array

This paper presents a significant sidelobe reduction if nonuniform elevational spacing of antenna elements on the sphere is used. Antenna elements are progressively phased with a uniform amplitude excitation. The calculation of the required element position is presented. The achieved sidelobe level reduction with unequally spaced arrays could reach even more than 20dB difference with regard to the first significant sidelobe level of equally spaced arrays. By this method, arrays have the ability to produce the desired radiation pattern and could satisfy requirements for many applications

Fabrication Errors Influence on the Sperical Array Radiation Pattern

The paper studies fabrication errors influence on the radiation pattern of a spherical antennas array. The developed Moment Method (MoM) program analyzes a particular influence of an azimuth and elevation position and local angle errors of antenna elements as well as model dimension errors on the radiation pattern. The spectral domain approach to the analysis of the spherical antenna arrays is applied here. Finally, results obtained from the theoretical investigation are verified by comparison with measured results