IntroductionArteriovenous fistulae (AVF) are the ‘gold standard’ vascular access for haemodialysis. Universal usage is limited, however, by a high early failure rate. Several small, single-centre ...studies have demonstrated better early patency rates for AVF created under regional anaesthesia (RA) compared with local anaesthesia (LA). The mechanistic hypothesis is that the sympathetic blockade associated with RA causes vasodilatation and increased blood flow through the new AVF. Despite this, considerable variation in practice exists in the UK. A high-quality, adequately powered, multicentre randomised controlled trial (RCT) is required to definitively inform practice.Methods and analysisThe Anaesthesia Choice for Creation of Arteriovenous Fistula (ACCess) study is a multicentre, observer-blinded RCT comparing primary radiocephalic/brachiocephalic AVF created under regional versus LA. The primary outcome is primary unassisted AVF patency at 1 year. Access-specific (eg, stenosis/thrombosis), patient-specific (including health-related quality of life) and safety secondary outcomes will be evaluated. Health economic analysis will also be undertaken.Ethics and disseminationThe ACCess study has been approved by the West of Scotland Research and ethics committee number 3 (20/WS/0178). Results will be published in open-access peer-reviewed journals within 12 months of completion of the trial. We will also present our findings at key national and international renal and anaesthetic meetings, and support dissemination of trial outcomes via renal patient groups.Trial registration numberISRCTN14153938.SponsorNHS Greater Glasgow and Clyde GN19RE456, Protocol V.1.3 (8 May 2021), REC/IRAS ID: 290482.
Later Microsoft's problems got even bigger when Edward Snowden released documents showing quite how closely Redmond is working with the National Security Agency to slurp customer's data. Redmond has ...installed a backdoor into Outlook encryption for the Feds, Windows Sky drive is wide open to the NSA and Skype calls are increasingly under scrutiny. Office 365 isn't looking as attractive as it was.
In Time and Death: Heidegger's Analysis of Finitude, Carol White pursues a strange hermeneutic strategy, reading Heidegger backwards by reading the central ideas of his later work back into his early ...magnum opus, Being and Time. White follows some of Heidegger's own later directives in pursuing this hermeneutic strategy, and this paper critically explores these directives along with the original reading that emerges from following them. The conclusion reached is that White's creative book is not persuasive as a strict interpretation of Heidegger's early work, but remains extremely helpful for deepening our appreciation of Heidegger's thought as a whole. Most importantly, White helps us to understand the pivotal role that thinking about death played in the lifelong development of Heidegger's philosophy.
*. Carol J. White (2005) Time and Death: Heidegger's Analysis of Finitude Mark Ralkowski (Ed.) Foreword by Hubert L. Dreyfus (Aldershot: Ashgate) pp. xlvii + 179, $94.95. Unprefixed page references are to this work.
Abstract
Background
The presence of signet ring cells (SRC) is associated with poorer survival in multiple cancer types. Here we aimed to determine the predictive and prognostic value of SRC in ...oesophageal and junctional adenocarcinoma (OAC) for patients treated with neoadjuvant chemoradiotherapy (nCRT) or chemotherapy (nCT).
Methods
Patients who underwent nCRT and nCT followed by surgery for OAC between 2000 and 2016 were identified from two institutional prospective databases. Pre-treatment biopsy and surgical resection pathology reports were used to determine the presence of SRC morphology. The association between SRC histology and clinicopathological characteristics including pathological response was assessed. The prognostic impact of SRC on disease-free survival (DFS) and overall survival (OS) was determined. Survival was calculated with Kaplan Meier method and differences tested with log rank test.
Results
Of the 689 study patients, 129 had SRC (nCRT; n = 65, nCT; n = 64) and 560 patients had no evidence of SRC (nCRT; n = 326, nCT; n = 234). The SRC group had higher pT stage (P = 0.004) and median number of involved nodes (P = 0.004) following nCT compared with the non-SRC group. There were no significant differences between the two groups with respect to age, gender, tumour site, pN, R status or pathological complete response. For the 129 in the SRC group, nCT patients had significantly worse DFS (median IQR; 12 months 50–5) compared with nCRT patients (median IQR; 26 months 111–9, P = 0.021). Moreover, nCT had a worse loco-regional recurrence-free survival (P = 0.004), but not distant recurrence-free survival (P = 0.74), in the SRC group. In contrast, there were no differences in DFS (P = 0.245) or recurrence patterns between nCRT and nCT among the 560 non-SRC patients. However, there was no significant difference in OS according to SRC status following nCT (P = 0.076) or nCRT (P = 0.541).
Conclusion
For SRC OAC, nCRT is associated with better DFS and loco-regional control compared with nCT. However, the presence of SRC in OAC was not prognostic for OS following nCT or nCRT.
Disclosure
All authors have declared no conflicts of interest.
Martin Heidegger is, perhaps, the most controversial philosopher of the twentieth-century. Little has been written on him or about his work and its significance for educational thought. This unique ...collection by a group of international scholars reexamines Heidegger's work and its legacy for educational thought.
Heidegger presciently diagnosed the current crisis in higher education. Contemporary theorists like Bill Readings extend and update Heidegger's critique, documenting the increasing ...instrumentalization, professionalization, vocationalization, corporatization, and technologization of the modern university, the dissolution of its unifying and guiding ideals, and, consequently, the growing hyper-specialization and ruinous fragmentation of its departments. Unlike Heidegger, however, these critics do not recognize such disturbing trends as interlocking symptoms of an underlying ontological problem and so they provide no positive vision for the future of higher education. By understanding our educational crisis 'ontohistorically', Heidegger is able to develop an alternative, ontological conception of education which he hopes will help bring about a renaissance of the university. In a provocative reading of Plato's famous 'allegory of the cave', Heidegger excavates and appropriates the original Western educational ideal of Platonic paideia, outlining the pedagogy of an ontological education capable of directly challenging the 'technological understanding of being' he holds responsible for our contemporary educational crisis. This notion of ontological education can best be understood as a philosophical perfectionism, a re-essentialization of the currently empty ideal of educational 'excellence' by which Heidegger believes we can reconnect teaching to research and, ultimately, reunify and revitalize the university itself.
Issue Title: Special Section: Irigaray on Merleau-Ponty's "Eye and Mind" In Heidegger on Ontotheology: Technology and the Politics of Education, I argue that Heidegger's ontological thinking about ...education forms one of the deep thematic undercurrents of his entire career, but I focus mainly on Heidegger's later work in order to make this case. The current essay extends this view to Heidegger's early magnum opus, contending that Being and Time is profoundly informed - albeit at a subterranean level - by Heidegger's perfectionist thinking about education. Explaining this perfectionism in terms of its ontological and ethical components (and their linkage), I show that Being and Time's educational philosophy seeks to answer the paradoxical question: How do become what we are? Understanding Heidegger's strange but powerful answer to this original pedagogical question, I suggest, allows us to make sense of some of the most difficult and important issues at the heart of Being and Time, including what Heidegger really means by possibility, death, and authenticity.PUBLICATION ABSTRACT
Abstract
B
arrett's esophagus (
BE
), a common condition, is the only known precursor to esophageal adenocarcinoma (
EAC
). There is uncertainty about the best way to manage
BE
as most people with
BE
...never develop
EAC
and most patients diagnosed with
EAC
have no preceding diagnosis of
BE
. Moreover, there have been recent advances in knowledge and practice about the management of
BE
and early
EAC
. To aid clinical decision making in this rapidly moving field,
C
ancer
C
ouncil
A
ustralia convened an expert working party to identify pertinent clinical questions. The questions covered a wide range of topics including endoscopic and histological definitions of
BE
and early
EAC
; prevalence, incidence, natural history, and risk factors for
BE
; and methods for managing
BE
and early
EAC
. The latter considered modification of lifestyle factors; screening and surveillance strategies; and medical, endoscopic, and surgical interventions. To answer each question, the working party systematically reviewed the literature and developed a set of recommendations through consensus. Evidence underpinning each recommendation was rated according to quality and applicability.
Heidegger's Destruktion of the metaphysical tradition leads him to the view that all Western metaphysical systems make foundational claims best understood as 'ontotheological'. Metaphysics ...establishes the conceptual parameters of intelligibility by ontologically grounding and theologically legitimating our changing historical sense of what is. By first elucidating and then problematizing Heidegger's claim that all Western metaphysics shares this ontotheological structure, I reconstruct the most important components of the original and provocative account of the history of metaphysics that Heidegger gives in support of his idiosyncratic understanding of metaphysics. Arguing that this historical narrative generates the critical force of Heidegger's larger philosophical project (namely, his attempt to find a path beyond our own nihilistic Nietzschean age), I conclude by briefly showing how Heidegger's return to the inception of Western metaphysics allows him to uncover two important aspects of Being's pre-metaphysical phenomenological self-manifestation, aspects which have long been buried beneath the metaphysical tradition but which are crucial to Heidegger's attempt to move beyond our late-modern, Nietzschean impasse.
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