11 research outputs found
Predicting opioid consumption after surgical discharge: a multinational derivation and validation study using a foundation model.
No full textOpioids are frequently overprescribed after surgery.We applied a tabular foundationmodel to predict the risk of post-discharge opioid consumption. The model was trained and internally validated on an 80:20 training/test split of the ‘Opioid PrEscRiptions and usage After Surgery’ (ACTRN12621001451897p) study cohort, including adult patients undergoing general, orthopaedic, gynaecological and urological operations (n = 4267), with external validation in a distinct cohort of patients discharged after general surgical procedures (n = 826). The area under the receiver operator curve was 0.84 (95%confidence interval [CI] 0.81–0.88) at internal testing and 0.77 (95% CI 0.74–0.80) at external validation. Brier scores were 0.13 (95% CI 0.12–0.14) and 0.19 (95%CI 0.17–0.2). Patients with a <50% predicted risk of opioid consumption consumed a median of 0 oralmorphine equivalents in the firstweek after surgery. Applying this model would reduce opioid prescriptions by 4.5%globally, and counterfactual modelling suggests without increasing time in severe pain (−4.3%, 95% CI −17.7 to 8.6).Chris Varghese, Luke Peters, Lorane Gaborit, William Xu, Kaviya Kalyanasundaram, Aya Basam, Melissa Park, Cameron Wells, Kenneth A. McLean, Gabriel Schamberg, Greg O'Grady, Deborah Wright, Jennifer Martin, Ewen Harrison, Peter Pockney, TASMAN Collaborativ
Technical and value obstacles faced by Building with Nature flood defence solutions: A case study on technical feasibility in relation to value conflict in Building with Nature flood defence solutions for the Houtribdijk reinforcement project
No full textBuilding with Nature (BwN) is a relatively novel way of thinking for flood protection. Unlike traditional flood protection solutions that are poised to bring forces of nature to a halt, the BwN’s philosophy is to use natural dynamic processes for engineering advantage as a protection against natural disasters and events. Yet, the BwN design philosophy faces obstacles in terms of technical efficacy and evaluating added benefits when compared to traditional flood defence solutions.This research sets out to understand how these obstacles faced by the BwN design philosophy play a role in the consideration of a BwN flood defence solution during project development. This is done by relating the assessment of the added benefits to five discussion fields, namely Costs, Function, Policy, Responsibility and Support. In doing so it can be determined which discussion fields play an important part in embracing a BwN design based on its added benefits while considering its technical uncertainties. This research limits itself to a case study of the Houtribdijk reinforcement project where both traditional and BwN flood defence solutions were employed. Furthermore, this research limits itself to the project phase where flood defence options are still considered.This research found that although BwN flood defence project face technical uncertainties and discussions on efficacy, there is willingness to embrace a BwN solution when involved parties can agree on shared responsibilities. The curators of a flood defence project were found to be least willing to accept a technically uncertain design as they are accountable should it fail. The curators’ concern regarding their responsibilities can be mitigated and they can be more open to alternative solution if they are ensured of proper research and shared accountability when other values are destroyed in favour of flood protection. It was also found that the effect on stakeholders in financing and taking share of the responsibilities also have a positive effect on embracement of a BwN solution when the discussions on efficacy have not yet been settled
Predicting opioid consumption after surgical discharge: a multinational derivation and validation study using a foundation model
No full textOpioids are frequently overprescribed after surgery. We applied a tabular foundation model to predict the risk of post-discharge opioid consumption. The model was trained and internally validated on an 80:20 training/test split of the ‘Opioid PrEscRiptions and usage After Surgery’ (ACTRN12621001451897p) study cohort, including adult patients undergoing general, orthopaedic, gynaecological and urological operations (n = 4267), with external validation in a distinct cohort of patients discharged after general surgical procedures (n = 826). The area under the receiver operator curve was 0.84 (95% confidence interval [CI] 0.81–0.88) at internal testing and 0.77 (95% CI 0.74–0.80) at external validation. Brier scores were 0.13 (95% CI 0.12–0.14) and 0.19 (95% CI 0.17–0.2). Patients with a <50% predicted risk of opioid consumption consumed a median of 0 oral morphine equivalents in the first week after surgery. Applying this model would reduce opioid prescriptions by 4.5% globally, and counterfactual modelling suggests without increasing time in severe pain (?4.3%, 95% CI ?17.7 to 8.6). © 2025 Elsevier B.V., All rights reserved
Photographing photographs
No full textIf photography is to be understood as a representation of reality, what kind of reality would that be and how should it be represented? Philosophers have grappled with similar questions for hundreds of years but in this thesis, I engage with a particular way of looking at these questions of representation. I focus on the practice of rendering reality that concerns itself with the photographing of photographs themselves. This meta-practice could be explained as a rejection of a given firstsource reality - a kind of refusal to depict the World as seen through human eyes and their technological extensions. Conversely, it can also be understood as advocating a form of fictionality, positioning the photograph as a world parallel to the World. The historic medium of photography and the role of the photographer as a type of author is undergoing radical re-evaluations in light of machinic and computational transformations. Machine vision and machine learning are decentering the human within the chain of photographic production. Could it be then that what is left for the photographer – as constituted by the historical legacy of photography - is a photography of the photograph itself? Beyond dramatic interpretations of this question, the thesis at hand attempts to unpick this practice of Photo-Photographing and how it constitutes a particular trajectory. It does this through a series of open-ended conversations with texts, thinkers, and artists that point toward the theoretical grounding, the values and the exigency of this specific photographic phenomenon. This venture should be considered an early first attempt at mapping and articulating a practice that has already existed in various forms since the invention of modern photography. Why do we take photographs of photographs and what does this practice tell us about the world we live in
PREVALENCE AND POTENTIAL RISK FACTORS OF HEPATITIS B VIRUS IN A SAMPLE OF CHILDREN IN TWO SELECTED AREAS IN YEMEN
No full textObjective: The global epidemic of hepatitis B is a significant public health problem. The endemicity of HBV infection used to be believed high in Yemen. Data for the prevalence of HBsAg among children in rural and urban areas in Yemen is scarce and incompetent. The study was made to determine prevalence of HB surface antigen among children in 2 selected areas in Yemen.
Methods: Eight hundred forty and 212 children were randomly chosen from Sana'a city and Shabowah governorate, respectively. Sera were tested for HBs antigen by ELISA technique, and HB genome was tested for positive HB surface antigen specimens to confirm positivity using polymerase chain reaction (PCR)-based test. Each data collected in a pre-designed questionnaire including sex, age, and risk factors of HBV and prior vaccine of HBV.
Results: The prevalence of HB surface antigen among children in Sana'a city was only 1.8%, and in Shabowah governorate was 3.8%. There was a significant association of non-vaccinated children, birth by cesarean, and with a history of parental exposure with contracting HBV infection.Conclusion: Evidence from these studies in Yemen suggests that there is a steady increase in exposure to HBV over a lifetime. Hospital-acquired HBV infection is common in Yemen, and high vaccination coverage rate should be achieved, particularly in rural areas, in parallel with health education.
Peer Review History:
Received 3 April 2019; Revised 8 May; Accepted 29 June; Available online 15 July 2019
Academic Editor: Dr. Amany Mohamed Alboghdadly, Princess Nourah bint abdulrahman university, Riyadh, [email protected]
Reviewer(s) detail:
Aya Mohammed Mohammed Essawy, MTI University- Mokattam, Egypt, [email protected]
Dr. Dalia Kamal Zaffar Ali, Modern University for technology and information, Egypt, [email protected]
In search for the hero: A study of the possible causes that make or break the hero in children's literature
No full textThis study investigates the possible causes that make or break the hero character in children’s literature. It looks into if these causes could be seen as universal, or if they change due to variations of outer influence. To achieve this, the study will examine these causes from three different perspectives; the hero's effect, the child reader's choice and the influence of the author. Out of these, the prime influence and main causes are found in connection with the hero’s effect, and therefore this study will have its main focus on the hero. To demonstrate all the effect the hero has, I have first shortly redefined the structure of the core of the hero, and then shown how the hero character manifests as three specific hero-types that underline all existing hero characters, these I have named: the 'Traditional Hero', the 'True Hero' and the 'Ultimate Hero'. These hero-types are then further examined in connection to change, rules regarding right and wrong and possible impairments to determine their inner models of behaviour, which manifest in their respective social realities. These models define those specific causes that contribute to the making or breaking the hero. The secondary focus is divided between the child reader and the author out of which the study will first investigate the child reader’s affect on the hero. This is accomplished through determining what affects the child reader’s perceptions and preferences regarding the hero as well as demonstrating how the child reader' s choice of hero is a process consisting of individual factors such as rejection, choice and abandonment. These factors determine whether or not the hero is accepted or remains as, a hero, and thus contribute to those possible causes that can make or break the hero's character. Finally, this study will examine the author’s influence on the hero by mainly how the author's covert and overt choices affect the hero's character. This will demonstrate that the author's main contribution to the hero's character is connected to the inert choice of the hero-type, which in turn contributes to the hero's failure or success. This point is further demonstrated through a children’s book I wrote in which I purposefully attempted to write a hero which would be chosen by the child reader. My failure to do so concurred with my findings
El Nord-est de Jorge Amado en català : la traducció de Tocaia Grande i de Gabriela, cravo e canela
No full textDescripció del recurs: el 27-10-2011El principal objectiu d'aquesta tesi és la descripció i l'anàlisi de les solucions de traducció adoptades per als referents culturals d'obres literàries brasileres, concretament de les novel·les Tocaia Grande i Gabriela, cravo e canela de Jorge Amado i les seves versions catalanes. Per arribar a aquest objectiu general definim els objectius específics següents: a) Elaborar una bibliografia de les traduccions catalanes d'obres literàries brasileres. b) Fer un breu repàs de la recepció de la literatura brasilera als Països Catalans a partir de la bibliografia elaborada. c) Fer una síntesi dels estudis traductològics més rellevants que se centren en els referents culturals i en els possibles àmbits de classificació d'aquests referents. d) Establir una tipologia d'àmbits de classificació dels referents culturals que resulti operativa en l'anàlisi de la traducció de textos literaris en general i, concretament, de les novel·les objecte d'estudi. e) Identificar els referents culturals presents a Tocaia Grande i Gabriela, cravo e canela i en les seves traduccions catalanes i classificar-los en funció de la tipologia establerta. f) Sintetitzar les últimes aportacions més significatives relacionades amb les tècniques de traducció dels referents culturals. g) Establir la tipologia de tècniques de traducció que feim servir en l'anàlisi que duim a terme. h) Identificar i classificar les solucions que s'adopten en els textos d'arribada en funció de les tècniques de traducció aplicades. Pel que fa a la metodologia aplicada en la descripció i l'anàlisi de les solucions adoptades per als referents culturals de Tocaia Grande i de Gabriela en les traduccions al català, l'estudi comença amb el buidatge del corpus de treball, que consisteix a identificar els referents culturals, primer en els originals brasilers i després en les versions catalanes. En segon lloc, definim una tipologia d'àmbits de classificació que ens permeti agrupar en diverses categories els referents culturals identificats durant el procés de buidatge. A més, consideram la conveniència d'establir una llista de tècniques de traducció que s'adapti als objectius plantejats, per la qual cosa ens basam en la proposta de Josep Marco (2004), en què defineix una llista de tècniques de traducció adequada al tractament dels referents culturals. Aquests dos instruments, els àmbits de classificació dels referents culturals i les tècniques de traducció, constitueixen, doncs, la base metodològica que ens serveix per a analitzar les obres que estudiam. La tesi que presentam està constituïda per una part central en què, en primer lloc, elaboram una bibliografia de traduccions catalanes d'obres brasileres, repassam l'estat de la qüestió de la recepció de la literatura brasilera i ens apropam a la figura de Jorge Amado i a les traduccions catalanes de les novel·les d'aquest autor. En segon lloc, sintetitzam algunes propostes teòriques que contemplen el vincle entre cultura i llenguatge i cultura i traducció, i recollim les aportacions teòriques principals que contemplen la importància dels elements culturals en l'àmbit de la traductologia i les tècniques de traducció. Aquesta síntesi constitueix el marc teòric sobre el qual definim la nostra proposta amb relació als dos instruments metodològics en què basam l'anàlisi que duim a terme. Per acabar, analitzam i descrivim les solucions de traducció adoptades en els textos que constitueixen el corpus del nostre estudi. Al final d'aquesta part central incloem un capítol de conclusions en què presentam els resultats més rellevants relacionats amb les línies de recerca de la tesi. Tancam el capítol de les conclusions amb unes reflexions sobre les possibles línies de recerca que l'elaboració de la tesi ens ha suggerit.The main objective of this thesis is the description and analysis of the solutions adopted in the translation of cultural references in Brazilian literary works, specifically novels Tocaia Grande and Gabriela, cravo e canela by Jorge Amado and their Catalan versions. The specific objectives of the study are as follows: a) Bibliography gathering of Brazilian/Catalan translations of literary works. b) Brief review of the reception of Brazilian literature in the Catalan speaking territories. c) Literature review of relevant translation studies that focus on cultural references and possible areas of classification of these references. d) Establish a typology of cultural references that may be operative in the analysis of the translation of literary texts in general and, specifically, the novels under study. e) Identify the cultural references present in Tocaia Grande and Gabriela, cravo e canela and its Catalan translations and classify them according to the typology established. f) Synthesize the most significant recent contributions related to the technical translation of cultural references. g) Establish the type of translation techniques used in the analysis. h) Identify and classify the solutions adopted in the meta texts depending on the translation techniques applied. Regarding the methodology used in the description and analysis of the solutions adopted for cultural references in Tocaia Grande and Gabriela in translations into Catalan, the study begins with the gathering of corpus that identifies the cultural references, first in the Brazilian texts and then in the Catalan versions. Secondly, a typology of levels of classification is defined. It allows for grouping into several categories cultural references identified during the process of gathering data. We also consider the desirability of establishing a list of translation techniques that suit the PhD objectives, based on Josep Marco (2004) proposal -which defines a list of translation techniques appropriate to treatment of cultural references. These two instruments, the areas of classification of cultural references and translation techniques, are therefore the basic methodology used to analyze the works under study. The PhD is formed by a central part with a bibliography of Catalan translations Brazilian literature, and also the state of the art in reception of Brazilian literature. Special focus is played to the figure of Jorge Amado and Catalan translations of novels by this author. Secondly, some theoretical posits are proposed which contemplate the link between culture and language/culture and translation, and collect the major theoretical contributions that look into the importance of cultural elements in the field of translation and translation techniques. This synthesis is the framework on which we define our proposal in relation to two methodological tools in which the analysis is based. Finally, an analysis and description of possible solutions adopted in translating the texts that constitute the corpus of the study. The PhD ends with central conclusions put forward the results related to the research of the thesis. The chapter concludes with some reflections on possible lines of research raised while studying and writing the PhD
El nord-est de Jorge Amado en català. La traducció dels referents culturals de Tocaia Grande i de Gabriela, cravo e canela
No full textEl principal objectiu d’aquesta tesi és la descripció i l’anàlisi de les solucions de
traducció adoptades per als referents culturals d’obres literàries brasileres, concretament
de les novel·les Tocaia Grande i Gabriela, cravo e canela de Jorge Amado i les seves
versions catalanes. Per arribar a aquest objectiu general definim els objectius específics
següents:
a) Elaborar una bibliografia de les traduccions catalanes d’obres literàries
brasileres.
b) Fer un breu repàs de la recepció de la literatura brasilera als Països
Catalans a partir de la bibliografia elaborada.
c) Fer una síntesi dels estudis traductològics més rellevants que se centren en
els referents culturals i en els possibles àmbits de classificació d’aquests
referents.
d) Establir una tipologia d’àmbits de classificació dels referents culturals que
resulti operativa en l’anàlisi de la traducció de textos literaris en general i,
concretament, de les novel·les objecte d’estudi.
e) Identificar els referents culturals presents a Tocaia Grande i Gabriela,
cravo e canela i en les seves traduccions catalanes i classificar-los en
funció de la tipologia establerta.
f) Sintetitzar les últimes aportacions més significatives relacionades amb les
tècniques de traducció dels referents culturals.
g) Establir la tipologia de tècniques de traducció que feim servir en l’anàlisi
que duim a terme.
h) Identificar i classificar les solucions que s’adopten en els textos d’arribada
en funció de les tècniques de traducció aplicades.
Pel que fa a la metodologia aplicada en la descripció i l’anàlisi de les solucions
adoptades per als referents culturals de Tocaia Grande i de Gabriela en les traduccions
al català, l’estudi comença amb el buidatge del corpus de treball, que consisteix a
identificar els referents culturals, primer en els originals brasilers i després en les
versions catalanes. En segon lloc, definim una tipologia d’àmbits de classificació que
ens permeti agrupar en diverses categories els referents culturals identificats durant el
procés de buidatge. A més, consideram la conveniència d’establir una llista de tècniques
de traducció que s’adapti als objectius plantejats, per la qual cosa ens basam en la
proposta de Josep Marco (2004), en què defineix una llista de tècniques de traducció adequada al tractament dels referents culturals. Aquests dos instruments, els àmbits de
classificació dels referents culturals i les tècniques de traducció, constitueixen, doncs, la
base metodològica que ens serveix per a analitzar les obres que estudiam.
La tesi que presentam està constituïda per una part central en què, en primer lloc,
elaboram una bibliografia de traduccions catalanes d’obres brasileres, repassam l’estat
de la qüestió de la recepció de la literatura brasilera i ens apropam a la figura de Jorge
Amado i a les traduccions catalanes de les novel·les d’aquest autor. En segon lloc,
sintetitzam algunes propostes teòriques que contemplen el vincle entre cultura i
llenguatge i cultura i traducció, i recollim les aportacions teòriques principals que
contemplen la importància dels elements culturals en l’àmbit de la traductologia i les
tècniques de traducció. Aquesta síntesi constitueix el marc teòric sobre el qual definim
la nostra proposta amb relació als dos instruments metodològics en què basam l’anàlisi
que duim a terme. Per acabar, analitzam i descrivim les solucions de traducció
adoptades en els textos que constitueixen el corpus del nostre estudi. Al final d’aquesta
part central incloem un capítol de conclusions en què presentam els resultats més
rellevants relacionats amb les línies de recerca de la tesi. Tancam el capítol de les
conclusions amb unes reflexions sobre les possibles línies de recerca que l’elaboració de
la tesi ens ha suggerit.The main objective of this thesis is the description and analysis of the solutions
adopted in the translation of cultural references in Brazilian literary works, specifically
novels Tocaia Grande and Gabriela, cravo e canela by Jorge Amado and their Catalan
versions. The specific objectives of the study are as follows:
a) Bibliography gathering of Brazilian/Catalan translations of literary works.
b) Brief review of the reception of Brazilian literature in the Catalan speaking
territories.
c) Literature review of relevant translation studies that focus on cultural
references and possible areas of classification of these references.
d) Establish a typology of cultural references that may be operative in the
analysis of the translation of literary texts in general and, specifically, the
novels under study.
e) Identify the cultural references present in Tocaia Grande and Gabriela,
cravo e canela and its Catalan translations and classify them according to
the typology established.
f) Synthesize the most significant recent contributions related to the technical
translation of cultural references.
g) Establish the type of translation techniques used in the analysis.
h) Identify and classify the solutions adopted in the meta texts depending on
the translation techniques applied.
Regarding the methodology used in the description and analysis of the solutions
adopted for cultural references in Tocaia Grande and Gabriela in translations into
Catalan, the study begins with the gathering of corpus that identifies the cultural
references, first in the Brazilian texts and then in the Catalan versions. Secondly, a
typology of levels of classification is defined. It allows for grouping into several
categories cultural references identified during the process of gathering data. We also
consider the desirability of establishing a list of translation techniques that suit the PhD
objectives, based on Josep Marco (2004) proposal –which defines a list of translation
techniques appropriate to treatment of cultural references. These two instruments, the
areas of classification of cultural references and translation techniques, are therefore the
basic methodology used to analyze the works under study.
The PhD is formed by a central part with a bibliography of Catalan translations
Brazilian literature, and also the state of the art in reception of Brazilian literature. Special focus is played to the figure of Jorge Amado and Catalan translations of novels
by this author. Secondly, some theoretical posits are proposed which contemplate the
link between culture and language/culture and translation, and collect the major
theoretical contributions that look into the importance of cultural elements in the field of
translation and translation techniques. This synthesis is the framework on which we
define our proposal in relation to two methodological tools in which the analysis is
based. Finally, an analysis and description of possible solutions adopted in translating
the texts that constitute the corpus of the study. The PhD ends with central conclusions
put forward the results related to the research of the thesis. The chapter concludes with
some reflections on possible lines of research raised while studying and writing the
PhD
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
No full textBackground: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1–30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80–100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. −1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not. Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.
A correction has been published: British Journal of Surgery, Volume 111, Issue 6, June 2024, znae152, https://doi.org/10.1093/bjs/znae15
Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries
No full textBackground: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures. Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge. Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to sideeffects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and lowand middle-income countries, patient-reported outcomes did not. Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely
