Journal articles on the topic 'Embassy (Liberia)'

O artigo que ofereço ao leitor tem por objetivo apresentar um conjunto documental bastante completo, complexo e denso, que foi produzido pela Sociedade dos Artistas Mecânicos e Liberais entre meados do século XIX e meados do século XX. Contudo, nesse texto, restringi minhas análises às fontes relativas ao período imperial – material que embasou minha tese de doutorado, defendida na Universidade Estadual de Campinas, em fevereiro 2009, sob o título “Andaimes, casacas, tijolos e livros: uma associação de artífices no Recife, 1836-1880”, e meu estágio pós-doutoral. Localizada na capital da província de Pernambuco, a referida entidade artística reuniu mestres de ofícios pretos e pardos, brasileiros, livres e libertos, que promoviam práticas de auxílio mútuo e aulas noturnas – inicialmente para os sócios e depois para o público em geral. Junto da análise e da descrição das referidas fontes, também indicarei meus caminhos na pesquisa empírica e minhas escolhas metodológicas.

Se reporta los resultados de un estudio de campo y gabinete para determinar el coeficiente de descarga ( ) de una “compuerta desgravadora” de sistema de almacenamiento y captación de agua de un proyecto hidroenergético. En la mayoría de los proyectos hidroenergéticos, el agua se capta desde una represa construida en el cauce de un río. Aguas abajo de la represa las condiciones de vida en el río se alteran. Para remediar esta situación, principalmente en épocas de estiaje, se libera agua desde la represa de manera controlada (caudal ecológico) operando, usualmente, la compuerta desgravadora. En ese contexto, el problema de los operadores del embalse está relacionado con la abertura de la compuerta que garantice el caudal ecológico para un determinado nivel de agua en el embalse. Para abordar esta problemática, se midieron el caudal aguas abajo de la compuerta para 3 aberturas relativas de ésta (5%, 10% y 15%) y diferentes niveles de agua en el embalse. Con estos datos se hallaron valores de . Los resultados muestran que Cd tiende a aumentar para aberturas menores de 15%. Esta tendencia podría estar influenciada por la geometría del labio inferior de la compuerta.

The article examines the monarchies of Qatar, Jordan, and Morocco to demonstrate how specific policies and ideologies do not necessarily correspond with the label of “moderate,” which instead primarily reflects a reputational strategy. Prior to 2011, Qatar had cultivated an image as a relatively “liberal” Gulf monarchy, but although few policy changes occurred, after 2011 the emirate was seen as sponsoring terrorism. The government of Morocco developed a reputation for promoting “moderate Islam,” yet religious intolerance persists, while the Jordanian regime has focused less on cultivating a moderate image than previously. Government efforts to develop a specific reputation reflect strategic maneuvering for both international religious soft power as well as consolidation of domestic control. Combining nine months of ethnographic fieldwork involving interviews with government officials, religious bureaucrats, and embassy personnel, the paper offers insights into how the strategic use of reputation has shifted in the post-2011 context.

SUMMARYPhenomenological and mechanistic models are widely used to assist resource planning for pandemics and emerging infections. We conducted a systematic review, to compare methods and outputs of published phenomenological and mechanistic modelling studies pertaining to the 2013–2016 Ebola virus disease (EVD) epidemics in four West African countries – Sierra Leone, Liberia, Guinea and Nigeria. We searched Pubmed, Embase and Scopus databases for relevant English language publications up to December 2015. Of the 874 articles identified, 41 met our inclusion criteria. We evaluated these selected studies based on: the sources of the case data used, and modelling approaches, compartments used, population mixing assumptions, model fitting and calibration approaches, sensitivity analysis used and data bias considerations. We synthesised results of the estimated epidemiological parameters: basic reproductive number (R0), serial interval, latent period, infectious period and case fatality rate, and examined their relationships. The median of the estimated meanR0values were between 1·30 and 1·84 in Sierra Leone, Liberia and Guinea. Much higherR0value of 9·01 was described for Nigeria. We investigated several issues with uncertainty around EVD modes of transmission, and unknown observation biases from early reported case data. We found that epidemic models offeredR0mean estimates which are country-specific, but these estimates are not associating with the use of several key disease parameters within the plausible ranges. We find simple models generally yielded similar estimates ofR0compared with more complex models. Models that accounted for data uncertainty issues have offered a higher case forecast compared with actual case observation. Simple model which offers transparency to public health policy makers could play a critical role for advising rapid policy decisions under an epidemic emergency.

Abstract Canada is and will for the foreseeable future be a peaceful and prosperous liberal democracy whose Constitution Act, 1867, now 150 years old as of 2017, has become a model for the modern world. The Constitution of Canada has exerted considerable influence on other countries, particularly since the coming into force of its Constitution Act, 1982, which included the celebrated Canadian Charter of Rights and Freedoms. Just as Canada drew from foreign and international experiences in drafting its Charter, the world has learned a great deal from Canada, not only as to rights protections but also as to the separation of powers, the judicial function, and the structure of government. In light of these impressive achievements, an international symposium on the Canadian Constitution was held in Pisa at the Scuola Sant’Anna under the auspices of the Sant’Anna Legal Studies project and with the support of the DIRPOLIS (Law, Politics and Development) Institute at the Scuola Sant’Anna, the Canadian Embassy in Italy, and the International Association of Constitutional Law. This special issue collects some of the papers presented on that occasion.

Background The optimal glycemic target during the perioperative period is still controversial. We aimed to explore the effects of tight glycemic control (TGC) on surgical mortality and morbidity. Methods PubMed, EMBASE and CENTRAL were searched from January 1, 1946 to February 28, 2018. Appropriate trails comparing the postoperative outcomes (mortality, hypoglycemic events, acute kidney injury, etc.) between different levels of TGC and liberal glycemic control were identified. Quality assessments were performed with the Jadad scale combined with the allocation concealment evaluation. Pooled relative risk (RR) and 95% CI were calculated using random effects models. Heterogeneity was detected by the I2 test. Results Twenty-six trials involving a total of 9315 patients were included in the final analysis. The overall mortality did not differ between tight and liberal glycemic control (RR, 0.92; 95% CI, 0.78–1.07; I 2 = 20.1%). Among subgroup analyses, obvious decreased risks of mortality were found in the short-term mortality, non-diabetic conditions, cardiac surgery conditions and compared to the very liberal glycemic target. Furthermore, TGC was associated with decreased risks for acute kidney injury, sepsis, surgical site infection, atrial fibrillation and increased risks of hypoglycemia and severe hypoglycemia. Conclusions Compared to liberal control, perioperative TGC (the upper level of glucose goal ≤150 mg/dL) was associated with significant reduction of short-term mortality, cardic surgery mortality, non-diabetic patients mortality and some postoperative complications. In spite of increased risks of hypoglycemic events, perioperative TGC will benefits patients when it is done carefully.

Background. The perioperative management of pancreaticoduodenectomy is complicated, and the significant morbidity and mortality may be influenced by the method of intraoperative fluid management. Whether intraoperative restrictive fluid therapy can affect the outcomes of pancreaticoduodenectomy or not is controversial. Methods. PubMed, EMBASE, Cochrane Library, and clinicaltrials.gov were searched for prospective and retrospective studies comparing restrictive and liberal intraoperative fluids in patients undergoing pancreaticoduodenectomy. Following study identification, a systematic review and meta-analysis were performed. Results. Fourteen studies, including six prospective trials and eight retrospective studies, involving 2,596 patients, were included. Intraoperative restrictive fluid regimens had no effect on the mortality compared to liberal fluid regimens in the overall cohort (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 0.82–2.35, p = 0.773 ). Liberal fluid regimens could increase the risk of pulmonary adverse events (OR: 1.66; 95% CI: 1.10–2.50, p = 0.131 ) and prolong the length of hospital stay (SMD -0.10; 95% CI -0.19– -0.01, p = 0.375 ). There were no significant differences in the incidence of pancreatic fistulas. Conclusions. Restrictive fluid regimens have a slight effect on the outcomes of pancreaticoduodenectomy. The clinical relevance of this finding needs to be interpreted. The existing evidence may not be adequate; therefore, further studies are warranted.

La contribución de los embalses tropicales a las emisiones de gases de efecto invernadero (GEI) ha sido objeto de estudio recientemente, debido a los procesos de degradación y transformación del material vegetal que son llevados a cabo en estos, los cuales liberan metano y dióxido de carbono, aportando al cambio climático. En el presente trabajo, se realizaron ensayos en discontinuo utilizando material vegetal de la zona de inundación del embalse Topocoro (Santander-Colombia), con el objetivo de determinar los flujos de CH4 y CO2 de dicho material, simulando condiciones de inundación aerobias y anaerobias previas al llenado. Las mediciones de gases se realizaron empleando cromatografía de gases-masas (GC-MS). Las tasas de emisión bajo condiciones anaerobias variaron entre 118,513 – 377,666 Kg CH4 ton-1.año-1 y 120,870 – 553,758 Kg CO2 ton-1.año-1, mientras que bajo condiciones aerobias las tasas de emisión fueron menores, con valores que oscilaron entre 0,73 y 8,83 Kg CO2 ton-1.año-1. Las emisiones producidas estuvieron determinadas principalmente por la cantidad de material vegetal inundado y por la presencia de organismos aerobios y anaerobios presentes en los sistemas en batch.

ObjectivesWe employed a comprehensive systematic review and meta-analysis to assess benefits and risks of a threshold of haemoglobin level below 7 g/dL versus liberal transfusion strategy among critically ill patients, and even patients with septic shock.DesignSystematic review and meta-analysis.Data sourcesWe performed systematical searches for relevant randomised controlled trials (RCTs) in the Cochrane Library, EMBASE and PubMed databases up to 1 September 2019.Eligibility criteriaRCTs among adult intensive care unit (ICU) patients comparing 7 g/dL as restrictive strategy with liberal transfusion were incorporated.Data extraction and synthesisThe clinical outcomes, including short-term mortality, length of hospital stay, length of ICU stay, myocardial infarction (MI) and ischaemic events, were screened and analysed after data collection. We applied odds ratios (ORs) to analyse dichotomous outcomes and standardised mean differences (SMDs) to analyse continuous outcomes with fixed or random effects models based on heterogeneity evaluation for each outcome.ResultsEight RCTs with 3415 patients were included. Compared with a more liberal threshold, a red blood cell (RBC) transfusion threshold <7 g/dL haemoglobin showed no significant difference in short-term mortality (OR: 0.90, 95% CI: 0.67 to 1.21, p=0.48, I2=53%), length of hospital stay (SMD: −0.11, 95% CI: −0.30 to 0.07, p=0.24, I2=71%), length of ICU stay (SMD: −0.03, 95% CI: −0.14 to 0.08, p=0.54, I2=0%) or ischaemic events (OR: 0.80, 95% CI: 0.43 to 1.48, p=0.48, I2=51%). However, we found that the incidence of MI (OR: 0.54, 95% CI: 0.30 to 0.98, p=0.04, I2=0%) was lower in the group with the threshold <7 g/dL than that with the more liberal threshold.ConclusionsAn RBC transfusion threshold <7 g/dL haemoglobin is incapable of decreasing short-term mortality in ICU patients according to currently published evidences, while it might have potential role in reducing MI incidence.

Amid ongoing political instability, sarimbavy — same-sex-desiring and/or gender-expansive male-bodied persons — are increasingly rendered opportune subjects ripe for intervention across Madagascar by HIV prevention industries, homonationalist LGBT rights projects backed by the United States Embassy, and many Christian institutions. This article diverges from these biomedical and moral panics by attending to the shifting temporal allegiances of sarimbavy spirit medium-activists. Interlocutors’ roles as mediums to spirits of former reigning monarchs (tromba) necessitated an onerous dedication to Malagasy history (tantara) and tradition (fombandrazana); simultaneously, many sarimbavy mediums were also men who have sex with men (MSM) activists, and thus deeply committed to moving beyond what they saw as the stigma-ridden past and present. These activist engagements and the sarimbavy counterpublics that they produced were uncannily facilitated by mediumship social networks. Through these practices of monarchic veneration, sarimbavy medium-activists implicitly challenged Western expectations that queer social movements must emerge through the subversion of social norms and secular, liberal, democratic reform. In surrendering to the seemingly antidemocratic weight of divine queen-kingship, sarimbavy mediums became “possessed” by political organizations irreducible to the modern nation-state and its colonial genealogies and, furthermore, produced human-spirit relationalities that thwarted Western juridicolegal visions of a bounded, rights-bearing subject.

Abstract Background Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies. Methods The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients. Data were independently extracted. Risk ratios were calculated for 30-day complications, defined as inadequate oxygen supply (myocardial, cerebral, renal, mesenteric, and peripheral ischemic injury; arrhythmia; and unstable angina), mortality, composite of both, and infections. Statistical combination followed a context-specific approach. Additional analyses explored transfusion protocol heterogeneity and cointerventions effects. Results Thirty-one trials were regrouped into five context-specific risk strata. In patients undergoing cardiac/vascular procedures, restrictive strategies seemed to increase the risk of events reflecting inadequate oxygen supply (risk ratio [RR], 1.09; 95% CI, 0.97 to 1.22), mortality (RR, 1.39; 95% CI, 0.95 to 2.04), and composite events (RR, 1.12; 95% CI, 1.01 to 1.24—3322, 3245, and 3322 patients, respectively). Similar results were found in elderly orthopedic patients (inadequate oxygen supply: RR, 1.41; 95% CI, 1.03 to 1.92; mortality: RR, 1.09; 95% CI, 0.80 to 1.49; composite outcome: RR, 1.24; 95% CI, 1.00 to 1.54—3465, 3546, and 3749 patients, respectively), but not in critically ill patients. No difference was found for infections, although a protective effect may exist. Risk estimates varied with successful/unsuccessful transfusion protocol implementation. Conclusions Restrictive transfusion strategies should be applied with caution in high-risk patients undergoing major surgery.

Background To assess the efficacy and safety of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight infants. Methods We searched MEDLINE, EMBASE, and Cochrane database without any language restrictions. The last search was conducted in August 15, 2020. All randomized controlled trials comparing the use of restrictive versus liberal red blood cell transfusion thresholds in very low birth weight (VLBW) infants were selected. Pooled risk ratio (RR) for dichotomous variable with 95% confidence intervals were assessed by a random-effects model. The primary outcome was all-cause mortality. Results Overall, this meta-analysis included 6 randomized controlled trials comprising 3,483 participants. Restrictive transfusion does not increase the risk of all-cause mortality (RR, 0.99; 95% CI, 0.84 to 1.17; I2 = 0%; high-quality evidence), and does not increase the composite outcome of death or neurodevelopmental impairment (RR, 1.01, 95% CI, 0.93–1.09; I2 = 7%; high-quality evidence) or other serious adverse events. Results were similar in subgroup analyses of all-cause mortality by weight of infants, gestational age, male infants, and transfusion volume. Conclusions In very low birth weight infants, a restrictive threshold for red blood cell transfusion was not associated with increased risk of all-cause mortality, in either short term or long term.

RESUMO O objetivo deste trabalho foi analisar a visão das três coligações mais votadas nas eleições presidenciais em 2014, buscando identificar aproximações e distanciamentos ao projeto da Reforma Sanitária Brasileira (RSB). Utiliza como fontes os programas registrados no Tribunal Superior Eleitoral (TSE) e suas atualizações disponibilizadas nas páginas eletrônicas das candidaturas e as propostas do movimento da RSB, sistematizadas no Relatório da VIII Conferência Nacional de Saúde, de 1986. Conclui-se que os programas das três coligações, com variações, aderem à perspectiva neodesenvolvimentista, distinta das perspectivas liberal, social-democrata e socialista. Consideram que o Estado deve intervir para garantir a expansão do consumo e a reprodução do capital, concepção diversa da RSB que defende o direito à saúde e o acesso universal aos serviços, com estatização progressiva do sistema de saúde, evidenciando-se o distanciamento entre os programas apresentados e os princípios, diretrizes e valores que embasam o processo de RSB.

A educação é direito constitucional no Brasil. Ao longo da história da educação, algumas implicações internacionais tiveram espaço na legislação brasileira, inclusive ao que se refere a educação dos sujeitos privados de liberdade. Durante a consolidação da democracia brasileira, o desenvolvimento do país se deu em premissas de cunho liberal, positivista e neoliberal, por formas até autoritária garantindo direitos para a burguesia nacional e excluindo as classes econômicas desfavorecidas. Foi neste contexto que nasceu a constituição e outras normativas brasileiras, inclusive em relação ao sistema educacional do país. Entendendo a marginalização como resultado deste processo, nos propusemos em analisar a legislação que envolve a educação no contexto prisional pautada na Pedagogia Social, para verificar as possibilidades e limites da realização da educação como processo de ressocialização. Realizamos estudos bibliográficos que embasam a Pedagogia Social, e análise histórica de documentos norteadores da legislação. O resultado da pesquisa demonstra que há possibilidades de reinserção social a partir da pedagogia social, amenizando os efeitos da marginalização constituída pelo sistema capitalista.

Introduction. Despite widespread and liberal use of oxygen supplementation, guidelines about rational use of oxygen are scarce. Recent data demonstrates that current protocols lead to hyperoxemia in the majority of the patients and most health care professionals are not aware of the negative effects of hyperoxemia. Method. To investigate the effects of hyperoxemia in acutely ill patients on clinically relevant outcomes, such as neurological and functional status as well as mortality, we performed a literature review using Medline (PubMed) and Embase. We used the following terms: hyperoxemia OR hyperoxemia OR [“oxygen inhalation therapy” AND (mortality OR death OR outcome OR survival)] OR [oxygen AND (mortality OR death OR outcome OR survival)]. Original studies about the clinical effects of hyperoxemia in adult patients suffering from acute or emergency illnesses were included. Results. 37 articles were included, of which 31 could be divided into four large groups: cardiac arrest, traumatic brain injury (TBI), stroke, and sepsis. Although a single study demonstrated a transient protective effect of hyperoxemia after TBI, other studies revealed higher mortality rates after cardiac arrest, stroke, and TBI treated with oxygen supplementation leading to hyperoxemia. Approximately half of the studies showed no association between hyperoxemia and clinically relevant outcomes. Conclusion. Liberal oxygen therapy leads to hyperoxemia in a majority of patients and hyperoxemia may negatively affect survival after acute illness. As a clinical consequence, aiming for normoxemia may limit negative effects of hyperoxemia in patients with acute illness.

SummaryRed cells play a key role in normal haemostasis in vitro but their importance clinically is less clear. The objective of this meta-analysis was to assess if correction of anaemia by transfusing red cells at a high haemoglobin threshold (liberal transfusion) is superior to transfusion at a lower haemoglobin threshold (restrictive transfusion) for reducing the risk of bleeding or thrombotic events. We searched for randomised controlled trials in any clinical setting that compared two red cell transfusion thresholds and investigated the risk of bleeding. We searched for studies published up to October 19, 2016 in The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, and the Transfusion Evidence Library and ISI Web of Science. Relative risks (RR) or Peto Odds Ratios (pOR) were pooled using a random-effect model. Nineteen randomised trials with 9852 participants were eligible for inclusion in this review. Overall there was no difference in the risk of any bleeding between transfusion strategies (RR 0.91, 95 % confidence interval [CI] 0.74 to 1.12). The risk of severe or life-threatening bleeding was lower with a restrictive strategy (RR 0.75, 95 % CI 0.57 to 0.99). There was no difference in the risk of thrombotic events (RR 0.83, 95 % CI 0.61 to 1.13). The risk of any bleeding was not reduced with liberal transfusion and there was no overall difference in the risk of thrombotic events. Data from the included trials do not support aiming for a high haemoglobin threshold to improve haemostasis. PROSPERO registration number CRD42016035519.Supplementary Material to this article is available online at www.thrombosis-online.com.

Introduction: Acute upper gastrointestinal bleeding is a potentially life-threatening medical emergency that frequently requires red blood cell (RBC) transfusions. However, the optimal hemoglobin thresholds for transfusion is controversial. The objective of this study was to establish the most efficacious transfusion threshold. Methods: A systematic review of the published literature was completed. MEDLINE, Health technology assessment database, Cochrane central register, Cochrane database of systematic reviews, and EMBASE were searched from inception to May 2015 using search terms including “blood transfusions”, “hemoglobin”, and “red blood cell”. Studies were included if they: reported original data, were peer-reviewed, studied adult populations, were randomized controlled clinical trials and primarily focused on clinical efficacy or effectiveness of liberal and restrictive pre-transfusion hemoglobin level thresholds. Quality was assessed using the Cochrane Risk of Bias tool. Data were extracted and meta-analysis was conducted using a random effects model to determine the risk ratio for: all-cause mortality, further bleeding and any adverse events. All steps were completed independently by two reviewers. Results: The literature search identified 4037 unique abstracts. Of these, 156 abstracts proceeded to full text review. 154 articles were excluded during full-text review resulting in 2 articles for final analysis. The total number of participants included was 701. The hemoglobin threshold to transfuse RBC varied between 70-80g/L versus 90-100g/L in restrictive and liberal policies, respectively. Both studies were at low risk of bias. Meta-analysis resulted in a pooled decreased risk of all-cause mortality (RR 0.65, 95% CI 0.44-0.96), re-bleeding (RR 0.63, 95% CI 0.46-0.85) and adverse events (RR 0.83, 95% CI 0.73-0.95) in the restrictive blood transfusion group versus the liberal blood transfusion group. Conclusion: While the evidence is limited, the risk of death is lower and there is no significant harm for a restrictive strategy. In this context, there is a decreased risk of transfusion associated adverse events among those receiving a restrictive strategy and should be considered for its impact on patient safety and health system resources.

IntroductionThere has been a significant increase in the number of systematic reviews and meta-analyses of randomised controlled trials investigating thresholds for red blood cell transfusion. To systematically collate, appraise and synthesise the results of these systematic reviews and meta-analyses, we will conduct an overview of systematic reviews.Methods and analysisThis is a protocol for an overview of systematic reviews. We will search five databases: MEDLINE, Embase, Web of Science Core Collection, PubMed (for prepublication, in process and non-Medline records) and Google Scholar. We will consider systematic reviews and meta-analyses of randomised controlled trials evaluating the effect of haemoglobin thresholds for red blood cell transfusion on mortality. Two authors will independently screen titles and abstracts retrieved in the literature search and select studies meeting the eligibility criteria for full-text review. We will extract data onto a predefined form designed to summarise the key characteristics of each review. We will assess the methodological quality of included reviews and the quality of evidence in included reviews.Ethics and disseminationFormal ethics approval is not required for this overview as we will only analyse published literature. The findings of this study will be presented at relevant conferences and submitted for peer-review publication. The results are likely to be used by clinicians, policy makers and developers of clinical guidelines and will inform suggestions for future systematic reviews and randomised controlled trials.PROSPERO registration numberCRD42019120503.

Abstract Introduction:Patients undergoing cardiac surgery are among the most common recipients of allogenic red blood cell (RBC) transfusions. However, whether restrictive RBC transfusion strategies for cardiac surgery achieve a similar clinical outcome in comparison with liberal strategies remains unclear. Methods:We searched PubMed, Embase, the Cochrane Collaboration Central Register of Controlled Trials, and conference proceedings from inception to December 2017 for all randomized trials (RCTs). The primary outcome was mortality. Secondary outcomes were stroke, respiratory morbidity, renal morbidity, infections, myocardial infarction (MI), cardiac arrhythmia, gut morbidity, reoperation, intensive care unit (ICU) length of stay (hours), and hospital length of stay (days). We calculated the risk ratios (RR) and weighted mean difference (MD) for the clinical outcomes using a random-effects model. Results:We included 9 RCTs with a total of 9,005 patients. There was no significant difference in mortality between groups (RR 1.03; 95% CI 0.74-1.45; P=0.86). In addition, there were no significant differences between groups in the clinical outcomes of infections (RR 1.09; 95% CI 0.94-1.26; P=0.26), stroke (RR 0.98; 95% CI 0.72-1.35; P=0.91), respiratory morbidity (RR 1.05; 95% CI 0.89-1.24; P=0.58), renal morbidity (RR 1.02; 95% CI 0.94-1.09; P=0.68), myocardial infarction (RR 1.00; 95% CI 0.80-1.24; P=0.99), cardiac arrhythmia (RR 1.05; 95% CI 0.88-1.26; P=0.56), gastrointestinal morbidity (RR 1.93; 95% CI 0.81-4.63; P=0.14), or reoperation (RR 0.90; 95% CI 0.67-1.20; P=0.46). There was a significant difference in the intensive care unit length of stay (hours) (MD 4.29; 95% CI: 2.19-6.39, P<0.01) favoring the liberal group. However, there was no significant difference in the hospital length of stay (days) (MD 0.15; 95% CI -0.18-0.48; P=0.38). Conclusion:This meta-analysis showed that restrictive strategies for RBC transfusion are as safe as liberal strategies in patients undergoing cardiac surgery. Key points: Restrictive strategies for red blood cell transfusion are as safe as liberal approaches in patients undergoing cardiac surgery. Longer duration of stay in the intensive care unit is more common in patients managed with a restrictive transfusion approach. However, the overall hospital length of stay appeared to be similar between both groups. Further studies are needed to ascertain threshold triggers for RBC transfusion. Figure. Figure. Disclosures Hassan: abott: Other: grant. Bhatt:American Heart Association Quality Oversight Committee: Other: chair; Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSof: Membership on an entity's Board of Directors or advisory committees; Medscape Cardiology: Consultancy; Regado Biosciences: Consultancy; Elsevier Practice Update Cardiology: Consultancy, trustee; cardax: Consultancy; Abbott, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Idorsia, Ironwood, Ischemix, Lilly, Medtronic, PhaseBio, Pfizer, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines: Research Funding; Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population: Other: Data monitoring committee; American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda.: Other: trustee; ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim), Belvoir Publications (Editor in Chief, Harvard Heart Letter),: Other: board member; American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org: Honoraria.

BackgroundBlunt thoracic aortic injury (BTAI) is an uncommon diagnosis, usually developing as a consequence of high-impact acceleration–deceleration mechanisms. Timely diagnosis may enable early resuscitation and reduction of shear forces, essential to prevent worsening of the injury prior to definitive management. Death is commonly due to haemorrhagic shock, but clinical features may be absent until sudden and massive haemorrhage.ObjectivesThe aim of this systematic review was to determine the proportion of patients with BTAI who present with unstable vital signs.MethodsManuscripts were identified through a search of MEDLINE, EMBASE and the Cochrane Library databases, focusing on subject headings and keywords related to the aorta and trauma. Mechanisms of injury, haemodynamic status and mortality from the included manuscripts were reviewed. Meta-analysis of presenting haemodynamic status among a select group of similar papers was conducted.ResultsNineteen studies were included, with five selected for meta-analysis. Most reported cases of BTAI (80.0%–100%) were caused by road traffic incidents, with mortality consistently higher among initially unstable patients. There was statistically significant heterogeneity among the included studies (P<0.01). The pooled proportion of patients with haemodynamic instability in the setting of BTAI was 48.8% (95% CI 8.3 to 89.4).ConclusionsNormal vital signs do not rule out aortic injury. A high degree of clinical suspicion and liberal use of imaging is necessary to prevent missed or delayed diagnoses.

IntroductionWith its legalisation and regulation in Canada in 2018, the proportion of Canadians reporting cannabis use in 2019 increased substantially over the previous year, with half of new users being aged 45+ years. While use in older adults has been low historically, as those born in the 1950s and 1960s continue to age, this demographic will progressively have more liberal attitudes, prior cannabis exposure and higher use rates. However, older adults experience slower metabolism, increased likelihood of polypharmacy, cognitive decline and chronic physical/mental health problems. There is a need to enhance knowledge of the effects of cannabis use in older adults. The following question will be addressed using a scoping review approach: what evidence exists regarding beneficial and harmful effects of medical and non-medical cannabis use in adults >50 years of age? Given that beneficial and harmful effects of cannabis may be mediated by patient-level (eg, age, sex and race) and cannabis-related factors (eg, natural vs synthetic, consumption method), subgroup effects related to these and additional factors will be explored.Methods and analysisMethods for scoping reviews outlined by Arksey & O’Malley and the Joanna Briggs Institute will be used. A librarian designed a systematic search of the literature from database inception to June 2019. Using the OVID platform, Ovid MEDLINE will be searched, including Epub Ahead of Print and In-Process and Other Non-Indexed Citations, Embase Classic+Embase, and PsycINFO for reviews, randomised trials, non-randomised trials and observational studies of cannabis use. The Cochrane Library on Wiley will also be searched. Eligibility criteria will be older adult participants, currently using cannabis (medical or non-medical), with studies required to report a cannabis-related health outcome to be eligible. Two reviewers will screen citations and full texts, with support from artificial intelligence. Two reviewers will chart data. Tables/graphics will be used to map evidence and identify evidence gaps.Ethics and disseminationThis research will enhance awareness of existing evidence addressing the health effects of medical and non-medical cannabis use in older adults. Findings will be disseminated through a peer-reviewed publication, conference presentations and a stakeholder meeting.Trial registration numberDOI 10.17605/OSF.IO/5JTAQ.

Background: Hepatitis C virus (HCV) infection is an important cause of liver disease worldwide. Identification of risk factors can guide screening and prevention. Sexual transmission in monogamous heterosexual relationships is rare but it is uncertain which sexual behaviours are linked to HCV transmission. This review aimed to determine risk factors for sexual HCV transmission in heterosexuals in low HCV prevalence countries (PROSPERO registration CRD42016051099). Methods: We searched Medline, Embase, Science Citation Index-Expanded, Social Sciences Citation index, Conference proceedings (Web of Science), CINAHL, Scopus, LILACS, PubMed, and grey literature (04/11/2016). We included studies published in/after the year 2000 that examined sexual risk factors for HCV infection, other than interspousal transmission, in heterosexual adults (≥18 years). We excluded prisoners, people who inject drugs (PWIDs), people co-infected with HIV or from high prevalence countries. Two reviewers completed study selection, data extraction, risk of bias and quality of evidence assessment (GRADE) independently. Meta-analysis could not be conducted. Results: Eight studies were included, examining seven factors (multiple sex partners, receiving/providing sex commercially, PWID partner, and unprotected vaginal, oral, anal sex). None were significant, except the evidence for the factor having a PWID partner was conflicting. Conclusions: We are uncertain about the results due to the very low quality of evidence (GRADE). A more liberal approach to review inclusion criteria might be useful in further identifying factors associated with an increased risk of sexual transmission of HCV infection in a heterosexual population. However, caution should be applied to avoid the impact of confounders on the findings.

AbstractIntroductionGastrointestinal dysfunction (GDF) is one of the primary causes of morbidity and mortality in critically ill patients. Intensive care interventions, such as intravenous fluids and enteral feeding, can exacerbate GDF. There exists a paucity of high-quality literature on the interaction between these two modalities (intravenous fluids and enteral feeding) as a combined therapy on its impact on GDF.AimTo review the impact of intravenous fluids and enteral nutrition individually on determinants of gut function and implications in clinical practice.MethodsRandomized controlled trials on intravenous fluids and enteral feeding on GDF were identified by a comprehensive database search of MEDLINE and EMBASE. Extraction of data was conducted for study characteristics, provision of fluids or feeding in both groups and quality of studies was assessed using the Cochrane criteria. A random-effects model was applied to estimate the impact of these interventions across the spectrum of GDF severity.ResultsRestricted/ goal-directed intravenous fluid therapy is likely to reduce ‘mild’ GDF such as vomiting (p = 0.03) compared to a standard/ liberal intravenous fluid regime. Enterally fed patients experienced increased episodes of vomiting (p = <0.01) but were less likely to develop an anastomotic leak (p = 0.03) and peritonitis (p = 0.03) compared to parenterally fed patients. Vomiting (p = <0.01) and anastomotic leak (p = 0.04) were significantly lower in the early enteral feeding group.ConclusionsThere is less emphasis on the combined approach of intravenous fluid resuscitation and enteral feeding in critically ill patients. Conservative fluid resuscitation and aggressive enteral feeding are presumably key factors contributing to severe life-threatening GDF. Future trials should evaluate the impact of cross-interaction between conservative and aggressive modes of these two interventions on the severity of GDF.

Background: Scars can cause pain, even without symptoms of underlying nerve damage. A lack of knowledge on intrinsic scar pain hampers effective treatment of these complaints. Objective: Aggregate current knowledge on the prevalence, etiology, and pathophysiology of intrinsic pain in dermal scars. Study Design: Systematic review. Setting: University Medical Center. Methods: We searched the Embase, Medline, Cochrane central, CINAHL, Web-of-Science, and Pubmed databases with search terms: scar, skin, pain, and etiology/pathology, adding all synonyms of these terms. Relevant papers were selected and analyzed by 3 reviewers. Results: Intrinsic pain in scars has a low prevalence. However, pathologic scars and burns regularly cause pain of high intensity. The etiology is multifactorial, the extent of trauma was an important predicting factor. Nerve fiber density did not explain the intrinsic pain when panneuronal markers were used, while a correlation with an increased number of C-fiber subtypes seems plausible. Nerve growth factor (that stimulate these C-fibers) plays an important role in wound healing. Thereby, it also sensitizes neurons and promotes inflammation, releasing even more neurotrophic factors. Central sensitization causes a long-lasting effect even after wounds are healed. Furthermore, the opioid-system, that influences inflammation and healing and possible systemic sensory alterations after injury, is discussed. Limitations: Liberal selection criteria challenged the systematic selection of papers. Conclusions: Burn and pathologic scars often lead to high intensity pain symptoms. This pain has many characteristics of neuropathic pain that could be caused by an imbalance of C-fibers subtypes. The scar tissue itself may alter the nerve fiber distribution; the imbalance results in ongoing neuro-inflammation and pain symptoms. Key words: Systematic review, scar, pain, epidermal innervation, prevalence, neuro inflammatory response, peptidergic fibers

Abstract Background: Susceptibility to invasive pneumococcal disease (IPD) is high in children with sickle cell disease (SCD). National guidelines in many countries recommend a combined schedule of 13-valent pneumococcal conjugate vaccine (PCV13) beginning after birth followed by the 23-valent polysaccharide vaccine (PPSV23) beginning at age 2 years. In Africa, where the burden of SCD is greatest, PPSV23 is generally unavailable and not routinely administered to children with SCD. To help inform optimal immunization regimens for children with SCD in West Africa, we sought to determine the prevalence and spatial distribution of IPD in the region. We focused specifically on the 24 combined pneumococcus strains covered by PCV13 (serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F) and PPSV23 (serotypes 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, and 33F). This analysis also explored the epidemiology of IPD-associated serotypes after the introduction of routine PCV13 immunization in countries in West Africa. Methods: We conducted a systematic review of published literature between 1990 and January 2017 using BIOSIS Previews, Embase, and Ovid MEDLINE. Inclusion criteria were all investigations that reported estimates of prevalence or incidence and the specific serotype distribution profile of invasive Streptococcus pneumoniae (including bacteremia, meningitis, osteomyelitis, or pneumonia) in children and adults in ECOWAS-defined West Africa: Benin, Burkina Faso, Cape Verde, Cote d'Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone, and Togo. The search strategy utilized various combinations of relevant keywords and MeSH headings. Timing of the introduction of routine PCV13 immunization into study countries was determined through WHO national immunization coverage surveillance data. We generated maps of the spatial distribution of pneumococcal serotypes in countries with available data using R (version 3.3.3). Results: The search yielded 540 unique studies. We excluded 395 papers based on title and abstract. The remaining 145 studies underwent full text review. Twenty papers (representing 20 datasets and 1980 isolates) met inclusion criteria. Gambia had the most datasets (5); no data were available from six countries (Benin, Cape Verde, Cote d'Ivoire, Guinea, Liberia, and Sierra Leone); and at least one dataset was available from each of the remaining 8 countries. The most frequent invasive serotypes reported across countries were 1, 5, 6A, 12F, 14, and 23F; together, these represented 79.7% of all serotypes identified in IPD in children and adults in West Africa. Most (89.2%) of the serotypes identified are included in PCV13. However, serotypes 2 and 12F, which are covered only by PPSV23, represented 3.3% and 4.8% of identified IPD serotypes, respectively, across the 9 countries studied. These serotypes also accounted for up to 10% of isolates found in individual countries. PCV13 was introduced into all countries with datasets analyzed between 2011 and 2015. Only 1 dataset identified in the literature search (Ghana) was obtained after the introduction of routine pneumococcal vaccination, which precluded analysis of the impact of vaccination on temporal trends in serotype incidence. Conclusions: To our knowledge this is the first attempt to aggregate IPD serotype data across West Africa. While the majority of serotypes identified are included in PCV13, two serotypes exclusive to PPSV23 (2 and 12F) together accounted for 8.1% of the total IPD burden. Moreover, in some countries, the proportion of strains included in PPSV23 and not PCV13 is higher. Immunizing persons with SCD in West Africa with PPSV23 therefore may be warranted to optimize protection from IPD. Furthermore, as PCV13 vaccination coverage increases, it is possible that the epidemiology of IPD may shift to more strains exclusively covered by PPSV23. This analysis is limited by its retrospective nature and the paucity of data available after introduction of routine pneumococcal vaccination. Further work, including dynamic IPD surveillance and disease modeling, is needed to better understand the epidemiology of pneumococcus in West Africa with the aim of keeping vulnerable populations, such as those with SCD, safe from IPD. Disclosures No relevant conflicts of interest to declare.

La recidiva e la persistenza del cancro della laringe dopo radioterapia rappresentano eventi insidiosi, i cui tassi di incidenza variano dal 13% al 36%. L’intervento di laringectomia sopracricoidea (LSC), con cricoioidopessia (CIP) o cricoioidoepiglottopessia (CIEP), è in grado di garantire risultati oncologici e funzionali affidabili per i pazienti selezionati affetti da carcinoma glottico o sopraglottico, sia in caso di neoplasia primitiva che di recidiva. La presente metanalisi ha lo scopo di valutare i parametri oncologici e funzionali nei pazienti trattati con LSC per recidiva di carcinoma squamocellulare della laringe dopo fallimento di radioterapia. La ricerca è stata effettuata sui databases MEDLINE, PubMed ed EMBASE (da gennaio 1990 a dicembre 2015, solo in lingua inglese). Per la metanalisi è stato impiegato il metodo DerSimonian e Laird con effetto “midex random”; l’eterogeneicità è stata misurata mediante I. Sono stati inclusi nella ricerca 276 articoli, tra i quali ne sono stati selezionati 14 per la metanalisi, per un totale di 291 pazienti. L’analisi statistica ha mostrato una sopravvivenza globale (OS) a 5 anni del 80,2% (IC 0,719-0,885; I= 62%; p = 0,003) e una sopravvivenza libera da malattia (DFS) a 5 anni del 89,5% (IC 0,838-0,952; I= 52%; p = 0,022). Le indicazioni chirurgiche per una LSC dopo fallimento di radioterapia non cambiano rispetto a quelle adottate per pazienti con tumore primitivo. Pertanto, è stato ipotizzato che l’attenta valutazione dell’estensione del tumore, in caso di recidiva, potrebbe essere responsabile dell’alto tasso di OS e DFS a 5 anni. Per quanto riguarda i parametri di valutazione funzionale precoce postoperatoria, il tempo medio di decannulazione è stato di 35,6 giorni (IC 24,3-46,9; I= 95%; p < 0,001), mentre il tempo medio di rimozione del sondino naso-gastrico (SNG) o della gastrostrostomia percutanea endoscopica (PEG) è stato di 28,3 giorni (IC 22,7-33,8; I= 86%; p <= 0.001). Questi dati sono in accordo con gli Autori che preferiscono la rimozione precoce del sondino nasogastrico. In tal modo si può riprendere l’alimentazione orale quando è ancora presente il tubo endotracheale a protezione delle vie aree e permettere l’aspirazione degli eventuali residui alimentari.

Background High rates of cannabis and illicit drug use are experienced by young people during the final stages of neurodevelopment (aged 15-24 years), a period characterized by high neuroplasticity. Frequent drug use during this time may interfere with neurophysiological and neuropsychological development pathways, potentially leading to ongoing unfavorable neuroadaptations. The dose-response relationship between illicit drug use, exposure, and individual neurodevelopmental variation is unknown but salient with global shifts in the legal landscape and increasingly liberal attitudes and perceptions of the harm caused by cannabis and illicit drugs. Objective This systematic review aims to synthesize longitudinal studies that investigate the effects of illicit drug use on structural, functional, and cognitive brain domains in individuals under the neural age of adulthood (25 years). This protocol outlines prospective methods that will facilitate an exhaustive review of the literature exploring pre- and post-drug use brain abnormalities arising during neurodevelopment. Methods Five electronic databases (Medline, Embase, PsycINFO, ProQuest Central, and Web of Science) will be systematically searched between 1990 and 2019. The search terms will be a combination of MeSH (Medical Subject Headings), with keywords adapted to each database. Study reporting will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and if relevant, study quality will be assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Eligible studies are those that sampled youth exposed to cannabis or illicit drugs and employed neurophysiological or neuropsychological assessment techniques. Studies will be excluded if participants had been clinically diagnosed with any psychiatric, neurological, or pharmacological condition. Results This is an ongoing review. As of February 2020, papers are in full-text screening, with results predicted to be complete by July 2020. Conclusions Integrating data collected on the three brain domains will enable an assessment of the links between structural, functional, and cognitive brain health across individuals and may support the early detection and prevention of neurodevelopmental harm. Trial Registration PROSPERO CRD42020151442; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=151442 International Registered Report Identifier (IRRID) PRR1-10.2196/18349

Abstract Background Postoperative complications impact on early and long-term patients’ outcome. Appropriate perioperative fluid management is pivotal in this context; however, the most effective perioperative fluid management is still unclear. The enhanced recovery after surgery pathways recommend a perioperative zero-balance, whereas recent findings suggest a more liberal approach could be beneficial. We conducted this trial to address the impact of restrictive vs. liberal fluid approaches on overall postoperative complications and mortality. Methods Systematic review and meta-analysis, including randomised controlled trials (RCTs). We performed a systematic literature search using MEDLINE (via Ovid), EMBASE (via Ovid) and the Cochrane Controlled Clinical trials register databases, published from 1 January 2000 to 31 December 2019. We included RCTs enrolling adult patients undergoing elective abdominal surgery and comparing the use of restrictive/liberal approaches enrolling at least 15 patients in each subgroup. Studies involving cardiac, non-elective surgery, paediatric or obstetric surgeries were excluded. Results After full-text examination, the metanalysis finally included 18 studies and 5567 patients randomised to restrictive (2786 patients; 50.0%) or liberal approaches (2780 patients; 50.0%). We found no difference in the occurrence of severe postoperative complications between restrictive and liberal subgroups [risk difference (95% CI) = 0.009 (− 0.02; 0.04); p value = 0.62; I2 (95% CI) = 38.6% (0–66.9%)]. This result was confirmed also in the subgroup of five studies having a low overall risk of bias. The liberal approach was associated with lower overall renal major events, as compared to the restrictive [risk difference (95% CI) = 0.06 (0.02–0.09); p value = 0.001]. We found no difference in either early (p value = 0.33) or late (p value = 0.22) postoperative mortality between restrictive and liberal subgroups Conclusions In major abdominal elective surgery perioperative, the choice between liberal or restrictive approach did not affect overall major postoperative complications or mortality. In a subgroup analysis, a liberal as compared to a restrictive perioperative fluid policy was associated with lower overall complication renal major events, as compared to the restrictive. Trial Registration CRD42020218059; Registration: February 2020, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=218059.

ObjectiveTo analyze association between different perioperative glycemic control strategies and postoperative outcomes in patients with diabetes undergoing cardiac surgery.MethodsMEDLINE, Cochrane Library, Web of Science, EMBASE, Wanfang Data, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases were searched from inception to January 31, 2019. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies, and consensus was reached by discussion with a third researcher.ResultsSix RCTs were included in the meta-analysis. We analyzed the effect of liberal (&gt;180 mg/dl or 10.0 mmol/L), moderate (140–180 mg/dl or 7.8–10.0 mmol/L) and strict (&lt;140 mg/dl or 7.8 mmol/L) glycemic control strategies in patients with diabetes undergoing cardiac surgery. The pooled results showed that strict glycemic control strategy was associated with a significant reduction in the risk of atrial fibrillation [OR = 0.48, 95%CI (0.32, 0.72), P &lt; 0.001] and sternal wound infection [OR = 0.28, 95%CI (0.14, 0.54), P &lt; 0.001], while there was no significant differences in postoperative mortality, stroke, and hypoglycemic episodes when compared with moderate control. In addition, there is no significant difference between moderate and liberal glycemic control strategies in postoperative mortality. However, moderate control was beneficial in reducing atrial fibrillation [OR = 0.28, 95%CI (0.13, 0.60), P = 0.001] compared with the liberal glycemic control strategy.ConclusionsThis meta-analysis showed when compared with moderate glycemic control strategy in patients with diabetes undergoing cardiac surgery, maintained strict glycemic control was associated with lower risk of atrial fibrillation and sternal wound infection. No benefit was found with liberal glycemic control strategy, so it could be a poor glycemic control strategy.

In 2014, Sweden’s Feminist Foreign Policy (FFP) was announced with a fanfare. This article critically interrogates how Sweden implements the FFP through digital diplomacy by investigating the extent of Sweden’s gender equality activities on Twitter since the introduction of the FFP and by tracing gendered online abuse in digital diplomacy. I focus on Swedish embassy tweets towards two countries where feminism is highly contested – Poland and Hungary. The theoretical inspiration comes from discursive approaches to the spoken and unspoken, enriched by feminist observations about the non-binary character of voice/silence. The method applied is gender-driven quantitative and qualitative content analysis. The findings demonstrate that the FFP has not set any significant mark on digital diplomacy in the analyzed cases. The launching of the FFP went completely unnoticed and posts related to gender equality have actually decreased since 2014. There are no traces of ambassadors being subjected to gendered online abuse, but heavily xenophobic and paternalistic language is directed at Sweden as a representative of liberal policies. The article contributes to the literature on digital diplomacy by highlighting the (lack of) links between foreign policy and digital diplomacy and it addresses a gap by focusing on gender in digital diplomacy.

Resumo Em O Futuro da Natureza Humana, Jürgen Habermas afirma que os avanços recentes no campo das biotecnologias constituem um desafio para a ética do discurso nas Ciências Sociais. Por trás de sua crítica aos defensores da eugenia liberal reside o reconhecimento de que o Diagnóstico Genético Pré-Implantação potencialmente põe em cheque o papel exercido pela razão comunicativa na constituição de uma ética individual de auto-compreensão. A ‘ética da espécie’ proposta por Habermas como contraposição a esse fenômeno se nos apresenta como moralmente reativa, na medida em que sua crítica não alcança abarcar os aspectos metafísicos que estão no núcleo do discurso da eugenia liberal. O artigo é dividido em dois momentos: perceber como a recente intervenção de Habermas ecoa o motivo da alegada colonização do mundo-da-vida pela razão tecnológica, e demonstrar como a concepção de técnica que embasa seu relato o impede de divisar a crítica dos aspectos metafísicos da cultura genética contemporânea.Palavras-chave Jürgen Habermas; cultura genética; sociedade da informação; ciência e mundo-da-vida; ética do discurso Abstract In The Future of Human Nature, Jürgen Habermas recognizes that current advances in biotechnology are challenging discourse ethics in Social Sciences. Behind his fear of the possibility of liberal eugenics, lies the recognition that pre-implanted genetic diagnosis potentially puts into question the role played by communicative reason in the constitution of the individual’s ethics of self-understanding. The ethics of species proposed by Habermas sounds morally reactive, insofar as his critique does not manage to encompass the metaphysical features which are at the core of liberal eugenics discourse. This paper is divided into two moments: the current echoing in Habermas’ work of the motif of the alleged colonization of the lifeworld by technological reason, and a demonstration of how his conception of technique which underlies such a perspective prevents him of envisaging the critique of the metaphysical aspects of contemporary genetic culture. Keywords Jürgen Habermas, genetic culture, paradigm information, science and lifeworld, discourse ethics

Abstract Background The acknowledgment that conservative oxygen therapy (COT) was related to better prognosis in the intensive care unit (ICU) was challenged recently. We conducted an updated meta-analysis aimed to determine whether liberal oxygen therapy (LOT) or COT is associated with better improve clinical outcomes. Methods We systematically searched the electronic databases (PubMed, Web of Science and Embase) up to May 2021 for randomized controlled trials (RCTs). The primary outcome was the mortality of the final follow-up time and secondary outcomes were ICU mortality, the ICU length of stay and the number of ventilator-free days. Results A total of 7 RCTs were included, with 2166 patients admitted to the ICU. There was no significant difference in the primary outcome between the LOT and COT. Additionally, LOT could not significantly increase ICU mortality and the ICU length of stay compared with COT. Conclusions The present study showed that COT was not significantly superior to LOT in clinical outcomes. Therefore, additional high-quality studies with novel designs are required to further elucidate this controversy.

Prolonged preoperative fasting times for children scheduled for general anesthesia and surgery continue to be reported despite a plethora of recent studies suggesting that fasting for clear fluids can be shortened without increasing the risk of pulmonary aspiration. The aim of this narrative review was to summarize knowledge about the known benefits and potential consequences of prolonged fasting in pediatric anesthesia and to discuss the difficult implementation of reduced fasting times in clinical practice. This narrative review is based on fifteen studies published in the databases PubMed, EMBASE and Cinahl from October 2009 to June 2020. Outcome measures assessed were divided into 4 overall domains: metabolism and hemodynamics (1), patient comfort and patient/parent satisfaction (2), gastric volume and/or emptying time (3) and risk of pulmonary aspiration (4). While incidences of pulmonary aspiration remain low after implementation of less restrictive recommendations, the duration of fasting times relates to negative outcomes (low post-induction blood pressure, increase of blood ketones, poor patient/parent satisfaction). Preoperative fasting times must balance the risk of aspiration during anesthesia against children’s wellbeing and metabolic homeostasis. Based on the current evidence on preoperative fasting in children, liberal fasting times with nil-per-mouth for solids and formulas, breast milk and clear fluids corresponding to 6, 4 and 1 hours respectively, are safe. However, a reduction in real fasting times is pending and requires a multifactorial approach.

Atualmente a reflexão sobre as práxis e as qualificações pedagógicas do professor na docência do ensino superior tem mostrado a necessidade de estabelecer a relação da identidade do professor dentro do âmbito do ensino e analisar sua relevância no processo de formação dos futuros profissionais. Nesse sentido a universidade precisa ser entendida como um lugar de aquisição de conhecimento e de formação profissional, onde a práxis pedagógica é um fator determinante para a emancipação dos indivíduos nos processos formativos da aprendizagem. Esta pesquisa objetivou investigar a atuação do corpo docente do curso de Educação Física da Universidade Paranaense/UNIPAR unidade de Umuarama/Pr., e de que forma a práxis pedagógica e a formação continuada interferem na formação dos futuros profissionais. Este estudo se embasou na análise e interpretação de diversos dados obtidos em uma pesquisa de campo, onde se pretendeu buscar informações diretamente com a população pesquisada, por meio de um questionário, exigindo que o pesquisador reunisse diversas informações a serem documentadas a fim de compreender e explicar o problema pesquisado, e fundamentou-se em revisão de literatura através de livros e artigos científicos acerca da temática. Pode-se concluir que os professores universitários têm consciência em relação a sua formação, priorizam as aprendizagens significativas, embasadas em práticas liberais e éticas e buscam como ferramentas de trabalho diversos métodos a fim de enriquecer e aprimorar o conhecimento dos alunos, objetivando formar profissionais capacitados a enfrentar o mercado de trabalho e as situações adversas que podem surgir na sua atuação profissional.

Abstract While restrictive abortion laws still prevail in most low- and middle-income countries (LMICs), many countries have reformed their abortion laws, expanding the grounds on which abortion can be performed legally. However, the implications of these reforms on women’s access to and use of health services, as well as their health outcomes, are uncertain. This systematic review aimed to evaluate and synthesize empirical research evidence concerning the effects of abortion law reforms on women’s health services and health outcomes in LMICs. We searched Medline, Embase, CINAHL and Web of Science databases, as well as grey literature and reference lists of included studies. We included pre–post and quasi-experimental studies that aimed to estimate the causal effect of a change in abortion law on at least one of four outcomes: (1) use of and access to abortion services, (2) fertility rates, (3) maternal and/or neonatal morbidity and mortality and (4) contraceptive use. We assessed the quality of studies using the quasi-experimental study design series checklist and synthesized evidence through a narrative description. Of the 2796 records identified by our search, we included 13 studies in the review, which covered reforms occurring in Uruguay, Ethiopia, Mexico, Nepal, Chile, Romania, India and Ghana. Studies employed pre–post, interrupted time series, difference-in-differences and synthetic control designs. Legislative reforms from highly restrictive to relatively liberal were associated with reductions in fertility, particularly among women from 20 to 34 years of age, as well as lower maternal mortality. Evidence regarding the impact of abortion reforms on other outcomes, as well as whether effects vary by socioeconomic status, is limited. Further research is required to strengthen the evidence base for informing abortion legislation in LMICs. This review explicitly points to the need for rigorous quasi-experimental studies with sensitivity analyses to assess underlying assumptions. The systematic review was registered in PROSPERO database CRD42019126927.

Abstract Background Major depressive disorder is common, debilitating, and affects feelings, thoughts, mood, and behaviors. Childhood and adolescence are critical periods for the development of depression and adolescence is marked by an increased incidence of mental health disorders. This protocol outlines the planned scope and methods for a systematic review update that will evaluate the benefits and harms of screening for depression in children and adolescents. Methods This review will update a previously published systematic review by Roseman and colleagues. Eligible studies are randomized controlled trials (RCTs) assessing formal screening in primary care to identify children or adolescents not already self-reporting symptoms of, diagnosed with, or treated for depression. If no or only a single RCT is available, we will consider controlled studies without random assignment. Studies of participants with characteristics associated with an elevated risk of depression will be analyzed separately. Outcomes of interest are symptoms of depression, classification of major depressive disorder based on a validated diagnostic interview, suicidality, health-related quality of life, social function, impact on lifestyle behavior (e.g., substance use, school performance, lost time at work, or school), false-positive results, overdiagnosis, overtreatment, labeling, and other harms such as those arising from treatment. We will search MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, and grey literature sources. Two reviewers will independently screen the titles and abstracts using the liberal accelerated method. Full-text screening will be performed independently by two reviewers using pre-specified eligibility criteria. Data extraction and risk of bias assessments will be performed independently by two reviewers. Pre-planned analyses, including subgroup and sensitivity analyses, are detailed within this protocol. Two independent reviewers will assess and finalize through consensus the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and prepare GRADE evidence profiles and summary of findings tables for each outcome of interest. Discussion The systematic review will provide a current state of the evidence of benefits and harms of depression screening in children and adolescents. These findings will be used by the Canadian Task Force on Preventive Health Care to inform the development of recommendations on depression screening. Systematic review registration PROSPERO CRD42020150373

Abstract Background Mental health (MH) problems are among the most important causes of morbidity and mortality for children and youth. Problems of lack of equity in child and youth MH services (CYMHS)—including, but not limited to, problems in inaccessibility and quality of services—are widespread. Characterizing the nature of equity in CYMHS is an ongoing challenge because the field lacks a consistent approach to conceptualizing equity. We will conduct a scoping review of how equity in MH services for children and youth has been defined, operationalized, and measured. Our objectives are to discover: (1) What conceptual definitions of equity are used by observational studies of CYMHS?; (2) What service characteristics of CYMHS care do indices of equity cover?; (3) What population dimensions have been used to operationalize equity?; (4) What statistical constructs have been used in indices that measure CYMHS equity?; and (5) What were the numerical values of those indices? Methods The following databases will be searched: Medline, Embase, PsycINFO, Cochrane Controlled Register of Trials, CINAHL, EconLit, and Sociological Abstracts. Searches will be conducted from the date of inception to the end of the last full calendar year (December 2019). Studies will be included if they include an evaluation of a mental health service for children or youth (defined as those under 19 years of age) and which quantify variation in some aspect of child or youth mental health services (e.g., accessibility, volume, duration, or quality) as a function of socio-demographic and/or geographic variables. Study selection will occur over two stages. Stage one will select articles based on title and abstract using the liberal-accelerated method. Stage two will review the full texts of selected titles. Two reviewers will work independently on full-text reviewing, with each study screened twice using pre-specified eligibility criteria. One reviewer will chart study characteristics and indices to be verified by a second reviewer. Reviewers will resolve full-text screening and data extraction disagreements through discussion. Synthesis of the collected data will focus on compiling and mapping the types and characteristics of the indices used to evaluate MH services equity. Discussion The planned, systematic scoping review will survey the literature regarding how equity in MH services for children and youth has been operationalized and help inform future studies of equity in CYMHS. Systematic review registration Open Science Foundation ID SYSR-D-19-00371, https://osf.io/58srv/.

The contemporary supermarket is a work of classification and cataloguing as marvellous as any museum. Barcodes are hallmarks by which its computer systems could know, in their own electronic language, every possible product of a certain kind afoot in the nation. It is a rather special institution in this respect -- a huge fund of contemporary synchronic cultural memory, a database and storehouse of collected human tastes to which individuals turn to seek out their own. However, this means that just as Wittgenstein demonstrated the impossibility of a purely private language, there can be no such thing as a purely private taste. Taste is demonstrated by choosing from a range of public items, that is, products. Therefore let's bracket the liberal concept of sovereign personal taste for now and beat a different track: the supermarket is the site of aggregation of multiple discourses by which the individual is sewn into and sews the fabric of collective life. Techniques used to sell food today, such as freebies (like plastic toys), free offers, forms of gambling, and images of healthiness, convenience, celebrity and enhanced relationships, appeal to -- must appeal to for commercial reasons -- shared values. It is inviting to view the supermarket as an emblem of a postmodern condition. The gaggle of images and words that line its aisles defy unity, play fast and loose with reality, create a simulacral space of copied quotes and sight bites that is coterminous with radically decentred selves. It conforms to the Jamesonian topography of a culture that has lost it -- that sense of real placed history that identity used to be tied up with. But my aim in this essay is to critique such a rhetoric of loss. Discourse remains the province of the self-imaginings of social groups in spite of the diversity of images in circulation. And although the media through which group solidarity is transmitted change with technological developments, the fact of such transmission does not. Hence, by looking at the imagery used on food packets, I will analyse the way that one rhetorical strategy used to sell the food we find on supermarket shelves -- nationalism -- is part of a longstanding cultural trajectory by which citizens of a nation imagine their relationship with their land. This, however, involves the equation of 'the nation' with the ethnic imagery of the group that dominates its political apparatus and territory, a process of circumscription that I shall ultimately suggest has political ramifications, especially in the context of nations like Australia which were formed by largely European settler colonisation of the land. Nationalism, then, is a strand of marketing rhetoric used most often, but not exclusively, for the promotion of products in the country of their origin. As such it grafts a tradition of art commemorating place and ethnic identity into the seemingly unlikely genre of the product label. Indeed, for Benedict Anderson the sociopolitical sentiment of nationalism requires forums and images through which to articulate itself, or more accurately, to imaginatively create its auratic object of adoration -- as nationalism is itself innovative (Anderson 15). It also depends upon technologies that can produce a sense of simultaneity between dispersed people who will never meet each other. The distribution of the packaged 'gifts' of a land to 'its people' provides one such opportunity for the transmission of sacralised images of land and the solidarity of its inhabitants. So the genre of the label that comes with a specific distribution and selling system provides the technical medium, and the land, its produce, its people and their relationships in ecosocial community, form the imagery. A limit case example of pride in the gifts of the land can be found on the label of New Zealand's Steinlager: "New Zealand's Finest ... World's Best Lager ... Brewed with the finest New Zealand Hops, Yeast, Barley and Pure Water ... Since 1854". It embodies a series of associations found in other examples: the products of the land are associated with firstly, high quality, and secondly, natural purity. New Zealand seems to be repeated with two slightly different senses. In its juxtaposition with "the world", the two places centre on the finished product of lager, which is presented as a literally world-beating national product. The last line of the label reads "Brewed and Bottled by New Zealand Breweries Limited", the company name both emphasising the agency of New Zealand people in processing ingredients taken from their land's soil, and the legally New Zealandian status of their enterprise. The second sense implies the physical basis for all this: the giftedness of the land which subtends an economy and a culture. "Since 1854" brings these components together on the axis of continuity, making the origination of national production temporal as well as spatial. In other words this benign relationship of production becomes part of national heritage. A certain double sense is in play. Land is both a nation comprising citizens and physical resource; the word that perfectly fuses the sense of the former's political proprietary relationship with the latter into a working unity. Accordingly many packets transfigure the legal requirement to mention the place of production into an attention-grabbing declaration of country of origin whilst also referring to the physical land. The latter may be parsed into two general categories: imagery of animals, plants, landscapes, the elements, etc, and rustic images of human management of the land. So Bulla ice cream advertises its Australianness to a pastoral backdrop; Saxa salt, which has been "Australia's own ... Since 1911", is being hauled by a hat-wearing Aussie man and loyal horse; Bundaberg caster sugar is both "pure Australian" and "Australian made" thanks to the blessing of the (Australian) sun. And other products, such as Australian Natural Foods Non Dairy Soy Mango Smoothie and Pureland Organic Tofu make links between nation and nature through 'land-based' company names similarly buttressed by images of Australian agricultural landscape and the Australian made hallmark respectively. The three conceptual categories often found in correlation with the concrete particulars of 'the land' -- healthiness, purity and naturalness -- are well represented in the packets analysed here. A series of metonymic implications is set up between the terms. They are all potential qualities of the land that are realised in the products it yields. Pureland and Australian Natural Foods juxtapose nation and healthiness closely and the pastoral visions of Bürgen and Dairy Vale have the approval of the National Heart Foundation. Bundaberg and Pureland make the most direct appeals to purity, but concepts such as Bulla's "Australian made real dairy" and Devondale's "choice grade" and "premium Australian" also convey a certain sense of uncorrupted pedigree in their products' provenance. Most products seem to evoke naturalness pictorially, with green rolling landscapes and cows feeding on the verdure featuring particularly highly. Thus at this point a critique of capitalist industrial culture is possible. The missing links are the contemporary factory and office: the places of the processing and assembly of the product physically and discursively; the places where the fruits of the land meet their packaging and are primed for the marketplace. The gifts of nature become commodities but are inscribed as the gifts of nature still, such that the point of sale obfuscates the point of production: profit. The whole enterprise seems to be based on a principle of distantiation. Because of urbanisation, the vast majority of people live away from farm land, and because most food is not consumed by the local communities that produce it, but is produced for larger markets, it is packed and written upon for transport to strangers who will buy it and perhaps also an idealisation of the land. Yet they aren't strangers. This mediation of group solidarity by food-as-commodity does not tear social bonds apart, it forms them. It forms ecosocial community just as it provides a projection of one. And the very invocation of group loyalty as the reason for buying means we should question, as John Frow has done, whether the commodity is always simply a token of abstraction in conceptual opposition to 'the gift' (Frow, "Gift and Commodity"). It is not simply the case that capitalists dupe consumers into thinking of commodities in gift-like terms. Indeed, the discourses of the land we find on supermarket shelves go back a long way in Western culture. As Raymond Williams says: "in English, 'country' is both a nation and a part of a 'land'; 'the country' can be the whole society or its rural area. In the long history of human settlements, this connection between the land from which directly or indirectly we all get our living and the achievements of human society has been deeply known" (1). The majority of the packets analysed extend the pastoral tradition of European art, a tradition which determines the "innate bounty" (33) of the land as the province of benign, 'total' social relations as reflected in the "timeless rhythm" of the authentic agrarian life (10). But the pastoral tradition is itself a media technical one. Williams points out that "a working country is hardly ever a landscape. The very idea of landscape implies separation and observation" (120). The same is true of pastoral in its nationalistic guise. It is transmitted by books, paintings and packets, is predicated on such a 'separation and observation'. The idealisation of the common land that subtends 'us' may be an attempt to bridge that distance, yet it is, ironically, transmitted through inscribed objects that create bonds between spatially and temporally dispersed people. It achieves what Anderson calls "unisonance", "a special kind of contemporaneous community which language alone suggests -- above all in the form of poetry and songs" (132). So, if the supermarket turns inner desire outward to the realm of public items that provides its possibilities, nationalistic desire moves in the same way, both inside and outside the supermarket context. There is no purely internal or purely external nation, just as there is no private language. Rather cultural memory, whether transmitted by a food packet or a poem is a thread transmitted through selves, language, technological milieux, and groups of people. Thus as Thongchai Winichakul succinctly states, "a nation is not a given reality. Rather it is the effect of imagining about it" (14). "We can know about it as long as we employ certain technologies to inscribe the possible sphere. In turn, such technologies create the knowledge of it, create a fact of it, and the entity comes into existence." (15). The contemporary food packet is one such media technology as certainly as a book or a song, and all media inscriptions of the possible sphere of 'the land' are lived ecosocial experience of the land. They make the land a unity by fusing its first physical sense with its second sociopolitical one. Invocation of the land as a prior given that subtends and provides the continuity of a sociopolitical group that has power over its resources, nests the historical contingency of that power relationship into a secure vision of the provenance of nation with the self-origination of 'its' land. That natural element, free, pure and healthy, is the one in which the group's ownership rights are rooted and legitimated. However, in fact, any nation is itself an historical innovation, an inherently unstable ideological product of strategy, technique, rhetorical and material. Nation-states are not naturally correlative with the land, nor are the ethnic groups that politically dominate the nation. They arise where other socio-economic political organisations existed before; they emerge. In The City and the Country Williams's main concern was to point out an alternative class-based history of the real and largely exploitative management of the land, a history that is actively occluded by idealised renderings of the countryside. Here in a parallel way but without room for explication, I want to suggest an alternative history of the management of the land that is indissociable from the emergence of the modern Australian nation -- a race-based history. Thus, here's the rub: the totems of pastoral that are equated with Australianness in the packets I have referred to, are European. The 'food packet' pastoral idealises group totems such as to transform historically contingent relationships of certain ethnic groups with the land into naturalised ones. The cows of Bulla and Devondale, the pastures of Dairy Vale, Bürgen's wheat, the agricultural infrastructure, the men imaged and their modes of management of the land, are European in lineage, and so is most of the food they sacralise as 'Australian'. These things are not natural to the land but were introduced, as was a related political and economic infrastructure that created 'Australia'. And there is a whole history to this appropriation of the land that is not active in the rhetorical force field of the European Australian pastoral, just as the living cultural memories of Aboriginal peoples disposed by the creation of the Australian nation-state are not. ... In "Australia Day at the Aboriginal Tent Embassy", Felicia Fletcher and John Leonard mention how representatives of Aboriginal countries in Australia assembled at Parliament House eat food to sustain themselves in their bid to right this dispossession: "vegetables are cooked in the coals, bread is toasted over the fire, endless cups of tea are poured, pots of three dozen eggs are boiled again and again to keep up the strengths and spirits of the people" (16). However, they add, quoting the group rather than a specific individual: "'It's nice, but at home we'd have a nice bit of kangaroo tail in the fire -- you've got to know how to do it properly -- and damper'": a different memory of and relationship with 'the land' (in both its senses). To conclude, the memories of the land create it at the time of commemoration. How we commemorate it is a present-day matter of great communal and political significance. Plates 1 Ducks Nuts 7 Bürgen High-Bake Heritage White bread 2 Steinlager Beer 8 Devondale Extra Soft margarine 3 Bulla Real Dairy Ice Cream 9 Bundaberg Caster Sugar 4 Saxa Table Salt 10 Dairy Vale Skim Milk 5 Pureland Organic Tofu 11 Devondale Cheese 6 So Natural Mango Smoothie 12 Edgell References Anderson, Benedict. Imagined Communities: Reflections on the Origin and Spread of Nationalism. London: Verso, 1983. Fletcher, Felicia, and John Leonard. "Australia Day at the Aboriginal Tent Embassy." Meanjin 58.1 (1999): 10-17. Frow, John. "Gift and Commodity." Time and Commodity Culture: Essays in Cultural Theory and Postmodernity. Oxford: Oxford UP, 1997. ---. "Toute la Mémoire du Monde: Repetition and Forgetting." Time and Commodity Culture: Essays in Cultural Theory and Postmodernity. Oxford: Oxford UP, 1997. Williams, Raymond. The Country and the City. London: Chatto & Windus, 1973. Winichakul, Thongchai. Siam Mapped: A History of the Geo-Body of a Nation. Chiang Mai: Silkworm Books, 1994. Citation reference for this article MLA style: Guy Redden. "Packaging the Gifts of Nation." M/C: A Journal of Media and Culture 2.7 (1999). [your date of access] <http://www.uq.edu.au/mc/9910/gifts.php>. Chicago style: Guy Redden, "Packaging the Gifts of Nation," M/C: A Journal of Media and Culture 2, no. 7 (1999), <http://www.uq.edu.au/mc/9910/gifts.php> ([your date of access]). APA style: Guy Redden. (1999) Packaging the gifts of nation. M/C: A Journal of Media and Culture 2(7). <http://www.uq.edu.au/mc/9910/gifts.php> ([your date of access]).

In many ways, computers are becoming invisible and will continue to do so. When we reach into our pockets and pull out our cell phones to find a place to eat or message a friend on Facebook, we are no longer consciously aware that we are interacting with a user experience that has been consciously designed for our computer or device screen—but we are.— Andy Pratt and Jason Nunes, Interactive Design In theory, cell phones and other information and communication technologies (ICTs) are just a means for us to interact with people, businesses, and data sources. They have interfaces and, in a larger sense, are interfaces between their users and the networked world. Every day, people spend more time using them to perform more different tasks and find them more indispensable (Smith). As the epigraph above suggests, however, their omnipresence makes them practically invisible and has all but erased any feelings of awe or mystery that their power once generated. There is both a historical and functional dimension to this situation. In the historical advance of technology, it is part of what Kevin Kelly calls the “technium,” the ever-more complex interactions between advancing technology, our cognitive processes, and the cultural forces in which they are enmeshed; ICTs are measurably getting more powerful as time goes on and are, in this sense, worthy of our admiration (Kelly 11-17). In the functional dimension, on the other hand, many scholars and designers have observed how hard it is to hold on to this feeling of enchantment in our digital devices (Nye 185-226; McCarthy and Wright 192-97). As one study of human-computer interfaces observes “when people let the enchanting object [ICTs] do the emotional work of experience for them . . . what could be enchanting interactivity becomes a paradoxically detached interpassivity” (McCarthy et al. 377). ICTs can be ever more powerful, then, but this power will not necessarily be appreciated by their users. This paper analyzes recent narrative representations of ICT use in spy thrillers, with a particular focus on the canon of James Bond films (a sub-genre with a long-standing and overt fascination with advanced technology, especially ICTs), in order to explore how the banality of ICT technology has become the inescapable accompaniment of its power (Willis; Britton 99-123; 195-219). Among many possible recent examples: recall how Bond uses his ordinary cell phone camera to reveal the membership of the sinister Quantum group at an opera performance in Quantum of Solace; how world-wide video surveillance is depicted as inescapable (and amoral) in The Bourne Legacy; and how the anonymous protagonist of Roman Polanski’s Ghost Writer discovers the vital piece of top secret information that explains the entire film—by searching for it on his laptop via Google. In each of these cases, ICTs are represented as both incredibly powerful and tediously quotidian. More precisely, in each case human users are represented as interfaces between ICTs and their stored knowledge, rather than the reverse. Beginning with an account of how the naturalization of ICTs has changed the perceived relations between technology and its users, this essay argues that the promotional rhetoric of human empowerment and augmentation surrounding ICTs is opposed by a persistent cinematic theme of human subordination to technological needs. The question it seeks to open is why—why do the mainstream cinematic narratives of our culture depict the ICTs that enhance our capacities to know and communicate as something that diminishes rather than augments us? One answer (which can only be provisionally sketched here) is the loss of pleasure. It does not matter whether or not technology augments our capacities if it cannot sustain the fantasy of pleasure and/or enhancement at the same time. Without this fantasy, ICTs are represented as usurping position as the knowing subject and users, in turn, become the media connecting them– even when that user is James Bond. The Rhetoric of Augmentation Until the past five years or so, the technologization of the human mind was almost always represented in popular culture as a threat to humanity—whether it be Ira Levin’s robotic Stepford Wives as the debased expression of male wish-fulfillment (Levin), or Jonathan Demme’s brainwashed assassins with computer chip implants in his remake of The Manchurian Candidate. When Captain Picard, the leader and moral centre of the television series Star Trek: The Next Generation, is taken over by the Borg (an alien machine race that seeks to absorb other species into its technologized collective mind) in an episode from 1990, it is described as “assimilation” rather than an augmentation. The Borg version of Picard says to his former comrades that “we only wish to raise quality of life, for all species,” and it is a chilling, completely unemotional threat to the survival of our species (“Best of Both Worlds”). By 2012, on the other hand, the very same imagery is being used to sell smart phones by celebrating the technological enhancements that allegedly make us better human beings. In Verizon’s Droid DNA phone promotions, the product is depicted as an artificial heart for its user, one that enhances memory, “neural speed,” and “predictive intelligence” (thanks to Google Now). The tagline for the Verizon ad claims that “It’s not an upgrade to your phone; it’s an upgrade to yourself”, echoing Borg-Picard’s threat but this time as an aspirational promise (“Verizon Commercial”). The same technologization of the mind that was anathema just a few years ago, is now presented as both a desirable consumer goal and a professional necessity—the final close-up of the Verizon artificial heart shows that this 21st century cyborg has to be at his job in 26 minutes; the omnipresence of work in a networked world is here literally taken to heart. There is, notably, no promise of pleasure or liberation anywhere in this advertisement. We are meant to desire this product very much, but solely because it allows us to do more and better work. Not coincidentally, the period that witnessed this inversion in popular culture also saw an exponential increase in the quantity and variety of digitally networked devices in our lives (“Mobile Cellular”) and the emergence of serious cultural, scientific, and philosophical movements exploring the idea of “enhanced” human beings, whether through digital tool use, biomedical prostheses, drugs, or genetic modifications (Buchanan; Savulescu and Bostrom; “Humanity +”). As the material boundaries of the “human” have become more permeable and malleable, and as the technologies that make this possible become everyday objects, our resistance to this possibility has receded. The discourse of the transhuman and extropian is now firmly established as a philosophical possibility (Lilley). Personal augmentation with the promise of pleasure is still, of course, very much present in the presentation of ICTs. Launching the iPad 2 in 2011, the late Steve Jobs described his new product as a “magical and revolutionary device” with an “incredible magical user interface on a much larger canvas with more resources” and gushing that “it's technology married with liberal arts, married with the humanities, that yields us the result that makes our hearts sing” (“Apple Special Event”). This is the rhetoric of augmentation through technology and, as in the Verizon ad, it is very careful to position the consumer/user at the centre of the experience. The technology is described as wonderful not just in itself, but also precisely because it gives users “a larger canvas” with which to create. Likewise, the lifelogging movement (which encourages people to use small cameras to record every event of daily life) is at great pains to stress that “you, not your desktop’s hard drive, are the hub of your digital belongings” (Bell and Gemmell 10). But do users experience life with these devices as augmented? Is either the Verizon work cyborg or the iPad user’s singing heart representative of how these devices make us feel? It depends upon the context in which the question is asked. Extensive survey data on cell phone use shows that we are more attached than ever to our phones, that they allow us to be “productive” in otherwise dead times (such as while waiting in queues), and that only a minority of users worry about the negative effects of being “permanently connected” (Smith 9-10). Representations of technological augmentation in 21st century popular cinema, however, offer a very different perspective. Even in James Bond films, which (since Goldfinger in 1964) have been enraptured with technological devices as augmentations for its protagonists and as lures for audiences, digital devices have (in the three most recent films) lost their magic and become banal in the same way as they have in the lives of audience members (Nitins 2010; Nitins 2011; “List of James Bond Gadgets”). Rather than focusing on technological empowerment, the post 2006 Bond films emphasize (1) that ICTs “know” things and that human agents are just the media that connect them together; and (2) that the reciprocal nature of networked ICTs means that we are always visible when we use them; like Verizon phone users, our on-screen heroes have to learn that the same technology that empowers them simultaneously empowers others to know and/or control them. Using examples from the James Bond franchise, the remainder of this paper discusses the simultaneous disenchantment and power of ICT technology in the films as a representative sample of the cultural status of ICTs as a whole. “We don’t go in for that sort of thing any more...” From Goldfinger until the end of Pierce Brosnan’s tenure in 2002, technological devices were an important part of the audience’s pleasure in a Bond film (Willis; Nitins 2011). James Bond’s jetpack in Thunderball, to give one of many examples, is a quasi-magical aid for the hero with literary precursors going back to Aeneas’s golden bough; it is utterly enchanting and, equally importantly, fun. In the most recent Bond film, Skyfall, however, Q, the character who has historically made Bond’s technology, reappears after a two-film hiatus, but in the guise of a computer nerd who openly disdains the pleasures and possibilities of technological augmentation. When Bond complains about receiving only a gun and a radio from him, Q replies: “What did you expect? An exploding pen? We don’t really go in for that sort of thing any more.” Technology is henceforth to be banal and invisible albeit (as the film’s computer hacker villain Silva demonstrates) still incredibly powerful. The film’s pleasures must come from elsewhere. The post-credit sequence in Casino Royale, which involves the pursuit and eventual death of a terrorist bomb-maker, perfectly embodies the diminished importance of human agents as bearers of knowledge. It is bracketed at the beginning by the bomber looking at a text message while under surveillance by Bond and a colleague and at the end by Bond looking at the same message after having killed him. Significantly, the camera angle and setup of both shots make it impossible to distinguish between Bond’s hand and the bomber’s as they see the same piece of information on the same phone. The ideological, legal, racial, and other differences between the two men are erased in pursuit of the data (the name “Ellipsis” and a phone number) that they both covet. As digitally-transmitted data, it is there for anyone, completely unaffected by the moral or legal value attached to its users. Cell phones in these films are, in many ways, better sources of information than their owners—after killing a phone’s owner, his or her network traces can show exactly where s/he has been and to whom s/he has been talking, and this is how Bond proceeds. The bomber’s phone contacts lead Bond to the Bahamas, to the next villain in the chain, whom Bond kills and from whom he obtains another cell phone, which allows the next narrative location to be established (Miami Airport) and the next villain to be located (by calling his cell phone in a crowded room and seeing who answers) (Demetrios). There are no conventional interrogations needed here, because it is the digital devices that are the locus of knowledge rather than people. Even Bond’s lover Vesper Lynd sends her most important message to him (the name and cell phone number of the film’s arch villain) in a posthumous text, rather than in an actual conversation. Cell phones do not enable communication between people; people connect the important information that cell phones hold together. The second manifestation of the disenchantment of ICT technology is the disempowering omnipresence of surveillance. Bond and his colleague are noticed by the bomber when the colleague touches his supposedly invisible communication earpiece. With the audience’s point of view conflated with that of the secret agent, the technology of concealment becomes precisely what reveals the secret agent’s identity in the midst of a chaotic scene in which staying anonymous should be the easiest thing in the world; other villains identify Bond by the same means in a hotel hallway later in the film. While chasing the bomber, Bond is recorded by a surveillance camera in the act of killing him on the grounds of a foreign embassy. The secret agent is, as a result, made into an object of knowledge for the international media, prompting M (Bond’s boss) to exclaim that their political masters “don’t care what we do, they care what we get photographed doing.” Bond is henceforth part of the mediascape, so well known as a spy that he refuses to use the alias that MI6 provides for his climactic encounter with the main villain LeChiffre on the grounds that any well-connected master criminal will know who he is anyway. This can, of course, go both ways: Bond uses the omnipresence of surveillance to find another of his targets by using the security cameras of a casino. This one image contains many layers of reference—Bond the character has found his man; he has also found an iconic image from his own cultural past (the Aston Martin DB V car that is the only clearly delineated object in the frame) that he cannot understand as such because Casino Royale is a “reboot” and he has only just become 007. But the audience knows what it means and can insert this incarnation of James Bond in its historical sequence and enjoy the allusion to a past of which Bond is oblivious. The point is that surveillance is omnipresent, anonymity is impossible, and we are always being watched and interpreted by someone. This is true in the film’s narrative and also in the cultural/historical contexts in which the Bond films operate. It may be better to be the watcher rather than the watched, but we are always already both. By the end of the film, Bond is literally being framed by technological devices and becomes the organic connection between different pieces of technology. The literal centrality of the human agent in these images is not, in this disenchanted landscape, an indication of his importance. The cell phones to which Bond listens in these images connect him (and us) to the past, the back story or context provided by his masters that permits the audience to understand the complex plot that is unfolding before them. The devices at which he looks represent the future, the next situation or person that he must contain. He does not fully understand what is happening, but he is not there to understand – he is there to join the information held in the various devices together, which (in this film) usually means to kill someone. The third image in this sequence is from the final scene of the film, and the assault rifle marks this end—the chain of cell phone messages (direct and indirect) that has driven Casino Royale from its outset has been stopped. The narrative stops with it. Bond’s centrality amid these ICTS and their messages is simultaneously what allows him to complete his mission and what subjects him to their needs. This kind of technological power can be so banal precisely because it has been stripped of pleasure and of any kind of mystique. The conclusion of Skyfall reinforces this by inverting all of the norms that Bond films have created about their climaxes: instead of the technologically-empowered villain’s lair being destroyed, it is Bond’s childhood home that is blown up. Rather than beating the computer hacker at his own game, Bond kills him with a knife in a medieval Scottish church. It could hardly be less hi-tech if it tried, which is precisely the point. What the Bond franchise and the other films mentioned above have shown us, is that we do not rely on ICTs for enchantment any more because they are so powerfully connected to the everyday reality of work and to the loss of privacy that our digital devices exact as the price of their use. The advertising materials that sell them to us have to rely on the rhetoric of augmentation, but these films are signs that we do not experience them as empowering devices any more. The deeper irony is that (for once) the ICT consumer products being advertised to us today really do what their promotional materials claim: they are faster, more powerful, and more widely applicable in our lives than ever before. Without the user fantasy of augmentation, however, this truth has very little power to move us. We depict ourselves as the medium, and it is our digital devices that bear the message.References“Apple Special Event. March 2, 2011.” Apple Events. 21 Sep. 2013 ‹http://events.apple.com.edgesuite.net/1103pijanbdvaaj/event/index.html›. Bell, Gordon, and Jim Gemmell. Total Recall: How the E-Memory Revolution Will Change Everything. New York: Dutton, 2009.“The Best of Both Worlds: Part Two.” Star Trek: The Next Generation. Dir. Cliff Bole. Paramount, 2013. The Bourne Legacy. Dir. 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