Free parking in St. Paul? For a day ... you betcha!
Who says you can't find free parking? For Saturday, at least, motorists can park at a meter in St. Paul without paying a dime. Or a dollar. Or anything.
The city is suspending parking meter enforcement on Saturday as it resets parking pay stations for new enforcement hours and prices. New rates and times go into effect on Monday.
Meters will be enforced from 8 a.m. to 10 p.m. Monday through Saturday. Sundays remain free.
• Standard parking — $2 an hour from 8 a.m. to 6 p.m. and $1 an hour from 6 p.m. to 10 p.m. Corridors with less parking demand will have reduced rates.
• Event parking — $3.75 an hour at Xcel Energy Event Parking Zone and $2.50 an hour at CHS Field Event Parking Zone.
For updates on St. Paul's metered parking policy visit https://www.stpaul.gov/departments/public-works/traffic-lighting/parking/metered-parking.


text:
Lockheed secures $4.6bn Nasa contract for Orion spacecraft
Srivani Venna 24 September 2019
Lockheed Martin has secured a $4.6bn contract from the National Aeronautics and Space Administration (Nasa) to build at least six Orion spacecraft that will take astronauts to the Moon.
The space agency's indefinite-delivery, indefinite-quantity (IDIQ) Orion production and operations contract (OPOC) includes a commitment to order a minimum of six and a maximum of 12 Orion spacecraft, with an ordering period through 30 September 2030.
The contract covers $2.7bn for the first three Orion spacecraft for Artemis missions III-V and an additional $1.9bn for another three in fiscal year 2022 for Artemis missions VI-VIII.
Artemis III will be the first spacecraft to be delivered on the contract and carry the first woman and the next man to the Moon in 2024.
Nasa administrator Jim Bridenstine said: "This contract secures Orion production through the next decade, demonstrating Nasa's commitment to establishing a sustainable presence at the Moon to bring back new knowledge and prepare for sending astronauts to Mars."
Orion is a critical part of the Nasa's Artemis programme to build a sustainable presence on the lunar surface and to prepare to move on to Mars.
Through the Artemis programme, Nasa seeks to use innovative new technologies and systems to explore more of the Moon than ever before.
The agency is collaborating with its commercial and international partners to establish sustainable missions by 2028.
Lockheed Martin Space Orion programme manager Mike Hawes said: "We have learned a lot about how to design and manufacture a better Orion such as designing for reusability, using augmented reality and additive manufacturing, and we're applying this to this next series of vehicles. Driving down cost and manufacturing them more efficiently and faster will be key to making the Artemis programme a success."
In July, Lockheed Martin completed Nasa's Orion spacecraft capsule for Artemis 1 uncrewed mission to the moon.
Work on the spacecraft for the Artemis II mission, the first crewed flight to the Moon, is underway at the Kennedy Space Center in Florida.
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redpajama_set_name: RedPajamaCommonCrawl


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text:
\section{Introduction}
\label{sec:intro}

Recently, seemingly ever other natural language processing paper introduces a new task and a new dataset.\footnote{%
  Not quite, but not very far. Looking at the 2018 long and short paper proceedings of ACL and EMNLP, we get 94 hits for ``introduce new dataset'', 20 hits for ``introduce new corpus'', and 101 hits for ``introduce new task''.
}
We join some other recent papers
\cite[e.g.][]{Yogatama2019} in asking whether there is any coherence to this research approach, under which conditions it can lead to progress, and towards what. What we do differently, however, is to look at the fundamental assumptions behind this approach. We try to define central notions, in order to be able to discuss the structure of the typically only implicit formulated approach more clearly.

In our argumentation, we distinguish between \emph{language tasks}, such as for example ``describe this image'', or ``translate this sentence''---that is, single-step tasks that involve in an essential way natural language material, but not necessarily \emph{only} language material---; \emph{micro worlds}, which are environments that produce disinterested responses to actions, thereby possibly simulating the behaviour of independently existing systems; and \emph{dialogue games} as repeated and connected language tasks, which these environments enable. We define these notions first and think about general ways of evaluating their relevance.
We close with some tentative recommendations for how to connect individual modelling contributions with the larger enterprise of modelling language processing.

\section{Tasks, Worlds, and Games}
\label{sec:defs}

\begin{figure*}[ht]
  \centering
  \includegraphics[width=.8\linewidth]{Figures/tasks_and_games.pdf}
  \vspace*{-1ex}
  \caption{The structure of relations between the research objects \emph{model}, \emph{dataset}, \emph{task}, \emph{game}, \emph{environment}, \emph{cognitive capability}.}
  \label{fig:tag}
  \vspace*{-2ex}
\end{figure*}

\subsection{Tasks}
\label{sec:tasks}

A \emph{language task} is a mapping between an \emph{input space} and an \emph{output} or \emph{action space}, at least one of which contains natural language expressions.\footnote{%
  A formal definition of this and the other notions is given in the Appendix.
}
The mapping has to conform to a \emph{task description}, which
is typically given only informally, making reference to theoretical or pre-theoretical constructs external to the definition, such as ``translation'' or ``is true of''. We call this an \emph{intensional description}. Often, a task is also specified \emph{extensionally} through the provision of a \emph{dataset} of examples of the mapping (that is, pairs of state and action), $\mathcal{X} = \{(x_1,y_1), \dots, (x_m, y_m)\}$, where the assumption is that $(x,y) \in \mathcal{X} \; \rightarrow \; y = \mathcal{L}(x)$ ($\mathcal{L}$ being the task mapping).

This very general definition essentially covers much, if not all of natural language processing. For example, translation can be seen as a language task where the state space consists of expressions in one language, the action space of expressions in another language, and the task description
is that in each pair in the mapping, the second element be a translation of the first. We can further distinguish \emph{understanding tasks}, where the mapping requires demonstration of sensitivity to language meaning (however that is to be further defined); \emph{interpretation tasks}, where the input space contains language expressions that are to be ``understood''; \emph{generation tasks}, where the output does (with a given task potentially being both an interpretation and a generation task); \emph{reference tasks}, where the understanding is shown by relating linguistic and non-linguistic material, and \emph{inference tasks}, where linguistic material is related.

\subsection{Worlds}
\label{sec:worlds}

The language competence of humans plays out in \emph{repeated} task,
not single-step ones as described in the previous section, and it plays out
in contexts where language use is embedded in a non-linguistic context. To study such repeated, situated games, much recent work has made use of environment simulators that compute reactions to actions performed within them, in accordance to the assumed (or actual) rules of the domain they represent.\footnote{%
  See for example \cite{Savva2019,Adams2012,Johnson2016:malmo,Urbanek2019,Baroni2017:commai,Xia2018,Yan2018,Misra2018,Cote2018,Bennett2018,Anderson2018,Savva2017,Gordon2017,Brodeur2017,Chang2017a,Janarthanam2011,Baroni2017,Byron2007,Yamauchi2013}.
  }
Such environments can again be described as mappings, in this case from an action to an environmental response (a state), where again the mapping conforms to a description of which real-world counterpart it is intended to model, and how.\footnote{%
  In this desire to model the relevant aspects of a domain, and in the assumption that from dealing with a simulated environment transferable knowledge about dealing with the original enviroment can be achieved, this approach is reminiscent of the AI microworlds of the 1970s---``we see solving a problem often as getting to know one's way around a `micro-world' in which the problem exists.'' \cite{MinskyPapert1972}---and perhaps
  susceptible to similar kinds of critiques as these attempts \cite{Dreyfus1981,marr:vision}.

}

\subsection{Games}
\label{sec:games}

An \emph{interaction game} is a setting where \emph{players} can produce \emph{actions} (a special kind of which can be \emph{messages}), possibly regulated by some regime on when they can do this and who can observe them. A priviledged, but disinterested player \emph{Nature} can respond to those actions, by providing game-relevant information (and interfacing with the environment in which the game is embedded). Again, we assume that there is an informal \emph{game description} which specifies which, if any, otherwise existing activity the game is meant to model. A \emph{language game} is an interaction game that embeds language tasks which govern the actions of the players. For example, one player asking and the other player answering questions would be a language game that poses repeated language tasks to the players.

\ \\
Summarising this section, Figure~\ref{fig:tag} shows the structure of relations between the notions introduced here: Models relate to Tasks, via Datasets, Games are realised in Environments. \emph{Capabilities} will be discussed below.

\section{What makes a good task, world, game?}
\label{sec:eval}

Let's now assume we encounter a paper that proposes a new dataset, language task, microworld, or language game. How can we evaluate the contribution that is made?

\subsection{Tasks}
\label{sec:taskeval}

\paragraph{... and datasets}

As mentioned, tasks are often exemplified by the provision of a dataset of examples of the task being executed by agents that are assumed to be capable of doing so---typically, human participants in experiments or data collection efforts. Evaluating such datasets in itself is relatively straightforward. First, it should be \emph{verified}, which is to check whether the provided input/output pairs can indeed be judged correct relative to the task (in its intensional description). If the examples are collected specifically for the purpose of exemplifying the task, this is the process of controlling annotation, and standard methodologies exists \cite{ArtPoesio:kappa}.

\emph{Validating} a dataset is a less formalised process. It comprises arguing that the dataset indeed exemplifies the task intension well. For example, pairs only of images of giraffes and sentences describing them would arguably not exemplify the general task of \emph{image description} very well (even if the descriptions are accurate), while perhaps exemplifying the task of \emph{giraffe image description}.

Another way to evaluate datasets is by providing a model of the task learned on parts of it, and testing it on the remaining part (for which a comparison, or \emph{loss}, function on input/output pairs must be provided as well). If a model can ``solve'' the dataset even when not given information that for theoretical or pre-theoretical reasons is seen to be crucial, the dataset can be considered an unsatisfactory exemplification of the task. E.g., in a \emph{visual (polar) question answering} setting \cite{VQA2015}, if in a dataset all and only the expressions that mention giraffes are true, a model would not need to take the images into account at all to perform well (as it would just need to detect the presence of giraffe-related words), which would be evidence that the dataset is deficient relative to the task description.

\paragraph{... in themselves}

How can a task in itself be motivated and evaluated? This is easy, if it has a direct value to a consumer (such as translation presumably has), which can be measured. If the consumer is a computer system that processes the output of the task further, the burden of evaluation is simply shifted to the system as a whole. If the interest is in replicating with a theoretically motivated model performance characteristics of humans attempting the task, the task can be evaluated for its power helping distinguish between different modelling choices.

A recent trend, however, has been to motivate tasks in a different way, neither via their inherent practical use, nor as answering questions about language processing as implemented in humans. The argument roughly goes as follows (even if typically only made implicitly): To be good at task $T$, an agent must possess a set $C_T$ of capabilities (of representational or computational nature). If the $c \in C_T$ are capabilities that competent language users
can be shown or argued to possess and make use of in using language---let's call the set of these capabilities of a competent language user $C_L$, so that $C_T \subseteq C_L$--- then being able to model these capabilities (via modelling the task) results in progress towards the ultimate goal, which is to model competent language use. And hence, any task $T$ that comes with an interesting set $C_T$ is a good task.\footnote{%
  To give some examples of informal versions of this argument, and chosing papers more or less randomly, here are some quotes (typically from the introduction sections of their respective papers):

  From the paper that introduced the \emph{visual question answering} task \cite{VQA2015}: ``What makes for a compelling "AI-complete" task? We believe that in order to spawn the next generation of AI algorithms, an ideal task should (i) require multi-modal knowledge beyond a single sub-domain (such as CV) and (ii) have a well-defined quantitative evaluation metric to track progress. [\dots] Open-ended questions require a potentially vast set of AI capabilities to answer -- fine-grained recognition (e.g., "What kind of cheese is on the pizza?"), object detection (e.g., "How many bikes are there?"), activity recognition (e.g., "Is this man crying?"), knowledge based reasoning (e.g., "Is this a vegetarian pizza?"), and commonsense reasoning (e.g., "Does this person have 20/20 vision?", "Is this person expecting company?").''

  About the \emph{natural language inference} problem, and attempting at least an implicit structuring of the space of capabilities, \citet{Condoravdi2003} write: ``The ability to recognize such semantic relations is clearly not a \emph{sufficient} criterion for language understanding: there is more to language understanding than just being able to tell that one sentence follows from another. But we would argue that it is a minimal, \emph{necessary} criterion.''

  \citet{Williams2018}, on the modern version of this task: ``The task of natural language inference (NLI)
is well positioned to serve as a benchmark task for research on NLU. [\dots] In particular, a model must handle phenomena like lexical entailment, quantification, coreference, tense, belief, modality, and lexical and syntactic ambiguity.''

}

Under what conditions does this argument work? First of all, the assumed connection to the set of capability must indeed be there. We have already seen a way to \emph{challenge} a claimed connection, namely through providing a model that can ``solve'' a given task (via a dataset) while not having access to information that should be involved in the capability. (Although this challenge in the first instance only targets the dataset and not the task itself.)
Secondly, following usual scientific methodology \cite{popper:logik}, we can rank the worth of an instantiation of this argument by how precisely the capability is specified, from the trivially correct ``task T involves the capability to do task T'' to a statement that could be wrong (and hence involves other theoretical constructs), e.g.\ ``task T involves the capability to compute the syntactic structure of a natural language sentence''.

Furthermore, we can rank the motivation given for a task by how explicit it is in delineating the set of capabilities it involves, along two dimensions. In the one dimension (\emph{separability}), in the most extreme form, the claim would be that the set of capabilities $C_T$ is fully separated from $C_L \setminus C_T$, and hence there is no danger of overfitting solutions to $C_T$ in such a way as would be detrimental for the remaining capabilities.\footnote{%
  That is, unless the claim is that $C_T = C_L$; the use of ``AI-complete'' in the quote above from \citet{VQA2015} suggest that is something that not everyone shies away from.
} In the other dimension (\emph{exhaustivity}), the strongest claim would be that $T$ brings out all there is to $c \in C_T$, and that another task $T'$, insofar as it requires $c$ as well, could be handled by a model of $c$ built with only $T$ in mind. In the other extreme, we only have ``$c$ as required by $T$'', which does less to indicate progress beyond $T$.

As this discussion suggests, it seems difficult to properly motivate a task without relying, at least implicitly, on assumptions about how $C_L$ decomposes.

\subsection{Worlds}
\label{sec:worldeval}

We have introduced ``worlds'' (or environments, or simulators) above as the settings that enable repeated tasks (\emph{games}), and in parts their evaluation is connected to those. However, as the providers of \emph{inputs} to a task in reaction to its \emph{outputs}, where this mapping must also confirm to a description, we can also evaluate them qua environment.

First, the notions of \emph{validation} and \emph{verification} apply as well: An environment should match, as well as possible, its stated description of its relation to a real-world counterpart, and should be verified to be correct according to its specification. Environments like those needed for games like Chess and Go \cite[e.g.][]{Silver2017}, or Settlers of Catan \cite[e.g.][]{afentenos:etal:2012}, can fully model their intended real-world counterpart, whereas others can only be modelled aproximately
(e.g., ``the interior of a house, through which an agent moves, from the perspective of that agent'' --- as the body of the agent and the agent's awareness of it, arguably, is a part of the environment, this would entail modelling this as well).

A detailed list of desiderata for such ``artificial general intelligence'' environments is given by \citet{Adams2012} (see also \citet{Baroni2017}): ``C1. The environment is complex, with diverse, interacting and richly structured objects. C2. The environment is dynamic and open. C3. Task-relevant regularities exist at multiple time scales. C4. Other agents impact performance. C5. Tasks can be complex, diverse and novel. C6. Interactions between agent, environment and tasks are complex and limited.
C7. Computational resources of the agent are limited. C8. Agent existence is long-term and continual.'' While this list mixes what we separate as demands on environments and on games set in them, it should be useful to evaluate proposed environments.

In analogy to what we observed for tasks, it seems that
trying to make progress through modelling tasks in simulated worlds entails making another separability hypothesis, which assumes that the natural
competence of handling the world as a whole is separable into handling various parts of it, which can be ``knit'' together to form the whole.\footnote{%
  ``[W]e feel [the micro-worlds] are so important that we plan to assign a large portion of our effort to developing a collection of these micro-worlds and finding how to embed their suggestive and predictive powers in larger systems without being misled by their incompatibility with literal truth.

  [\dots] In order to study such problems, we would like to have collections of knowledge for several `micro-worlds', ultimately to learn how to knit them together.'' \cite{MinskyPapert1972}.
}

\subsection{Games}
\label{sec:gameeval}

What makes for an interesting language game? First we note that games seem to be less well exemplified by datasets than (non-game) tasks are, as for them the relation between an input and an output is much less constrained, and the output can be a sequence of actions rather than a simple one. To give an example, in the language-navigation task \cite[e.g.][]{Anderson2018,Ma2019}, while the input is a single datum (a verbal description of a goal location), the output is a sequence of navigation actions.\footnote{%
  On the role of environments/games vis-\`a-vis datasets, \citet{Savva2019} state their belief that ``simulators will assume the role played previously by datasets''; no further argumentation is given to support this belief, however.
}

As the site for repeated and connected language tasks, we can evaluate a game again for how it connects to language capabilities, and for how the game setting improves over a (non-repeated) task setting. For example, some previous work has shown that language production under (interactive) task constraints is different from null-context language production \cite{ilinykh:inlg18,DaSilvaRocha2016}.

Finally, it seems that for language games there is a natural supremum, which would be ``unrestricted situated language interaction''. We can then also evaluate proposed tasks for how close they come to this ultimate form, for some definition of ``closeness''.

\begin{figure*}[ht]
  \centering
  \includegraphics[width=.9\linewidth]{Figures/making_progress.pdf}
  \caption{Three ways of making progress: improving models, improving datasets, improving tasks. (Not shown: devising models that handle more than one dataset.)}
  \label{fig:prog}
\end{figure*}

\section{Making Progress}
\label{sec:prog}

\begin{quote}
  \emph{{\"U}berhaupt hat der Fortschritt das an sich, da{\ss} er viel gr\"o{\ss}er ausschaut als er wirklich ist.} (It is in the nature of progress that it appears much greater than it actually is.) \textsc{Nestroy}, via \citet{Witt:PU}
\end{quote}

\noindent
Research is an incremental enterprise, and new tasks, datasets, models, environments, and games are introduced in a context of existing ones. We can now distinguish several modes of making progress in the general project, by relating new proposals to existing ones.

\subsection{Better Models}
\label{sec:mod}

This is the mode of progress for most of the current work in NLP / AI, and it is also the one that needs the least argumentative support: If a model trained on a given dataset performs better, in terms of the same pre-defined metrics, than a previous model, then progress has been made. Or would that it were so simple: Even in this setting, considerations of computing power spent should arguably also factor, and how to account for use of larger datasets (for example in pre-training), when judging models that achieve better results.\footnote{%
  See e.g.\ the recent discussion on \url{https://hackingsemantics.xyz/2019/leaderboards/}.
}
And ultimately, the worth of progress in modelling a particular task rests only on the worth of the task itself.

A different way in which models can improve over others is in how well they are suited for transfer to other tasks (see \citet{Ruder2019} for a recent overview of such transfer-learning).

\subsection{Better Datasets}
\label{sec:data}

We have discussed the relation between tasks and datasets above. If a dataset can be shown to be successfully modelled even in the absence of information that is deemed criticially involved in the capability of interest, it can be considered invalid relative to the task description, and, if the interest in the task is kept, a new dataset must be found.

The task of visual question answering provides an interesting example case of such a development. After \citet{VQA2015} introduced the first large scale dataset for this task, it quickly became clear that this dataset could be handled competitively by models that were deprived of visual input \cite[``language bias'', as noted e.g.\ by][]{Jabri2016}. This problem was then addressed by \citet{Goyal2017} with the construction of a less biased (and hence more valid) corpus. Targetting the set of capabilities involved in the task, \citet{Andreas2016a} noted that ``questions in most existing natural image datasets are quite simple, for the most part requiring that only one or two pieces of information be extracted from an image in order to answer it successfully'', which makes it not challenging enough in terms of ``[c]ompositionality, and the corresponding ability to answer questions with arbitrarily complex structure''. To improve on that, they introduced the  \textsc{shapes} dataset which pairs synthetic images with synthetic, programmatically generated sentences that contain spatial relations. Two more datasets explored this direction \cite{Johnson2016,Suhr2017},
until another dataset \cite{Suhr2018} progressed beyond the use of synthetic images, in effect claiming that natural images are more valid for the task described as ``visual question answering''.

\subsection{Better Tasks and Games}
\label{sec:tasks}

We see a movement towards involvement of \emph{capabilities} already in the previous two sections. Where a model can be judged to be better than another one (trained on the same data) simply by the linear order imposed by the evaluation metric, a dataset must be argued to be more representative of a task by taking recourse to the capabilities of interest (e.g., in the example discussed just above, that of handling \emph{compositionality}).

As shown in Figure~\ref{fig:tag}, tasks are only grounded (to their left in the diagram) by capabilities (and games by tasks), and hence an argumentation for a task $T'$ in relation to a previous task $T$ should ideally make mention of how $C_{T'}$ and $C_T$ relate. (Similarly for games.)

\ \\
Figure~\ref{fig:prog} again summarises this discussion in a diagramm.

\subsection{From Models to Capabilities}
\label{sec:modcap}

An interesting additional avenue of research has been explored in recent years \cite[see for example the paper by][and references therein]{Hewitt2019}, where models trained on datasets (representing tasks or games) are explored for how they decomposed their (representational) task. For example, the question might be, as in the cited paper, whether a particular model trained on a particular task creates ``internally'' something akin to syntax trees. Again, why this might be interesting is typically not spelled out in these papers, but one can assume that the intended underlying argument goes something like this: ``If the theoretical construct is to be found, this shows that postulating it is empirically validated (and it can be learned simply through exposure to data); if it is not there, then the task can be done without it, to the extent that the model can do it, and it need not be postulated''.

\section{Conclusions: Making it Explicit}
\label{sec:conc}

The discussion above has mixed  normative (how it could, or should be) and descriptive (how it is) aspects. I will close by commenting more directly on what I think could be improved.

As discussed above, the most frequent way of contributing to the project is by improving models, for which established methods of evaluation exist. Next frequent is providing new or improved datasets. Here already we find a much larger variety of how the contribution is motivated and framed, and often it is taken as self-evident that a new dataset will drive progress. Here, more explicitness about the assumed advantages, and how they connect to the goal of modelling language competence, would be helpful.\footnote{%
  The recent initiative of formulating ``Data Sheets'' \cite{gebru:datasheets}, although developed for different purposes, would be a good step also in this direction.
}

This holds even more when introducing new tasks or games. As the discussion above hopefully has made plausible, motivating those in themselves, and relating them to existing ones, requires making claims about language capabilities. To make these in a convincing way, it seems advantageous to strive for a renewed, stronger connection to the sciences that study them: linguistics and cognitive psychology. Those fields provide the theoretical terms and constructs that would allow us to make the, as discussed above, typically  implicit arguments more explicit (and hence contestable).

\subsubsection*{Acknowledgements}
\label{acks}

{\small
I thank Raquel Fern\'andez, Manfred Stede, and Sina Zarrie{\ss} for interesting discussions about topics related to this paper, while reserving the exclusive right to be blamed for any misunderstandings it might betray. \par
}

\bibliographystyle{acl_natbib}

redpajama_set_name: RedPajamaArXiv


We start when Sahira from Incredible Edible Dunstable went along to give a talk about all things Incredible at Dunstable Gardening Club. And while enjoying a cuppa after the talk, Val, one of the club members, approached Sahira to let her know about a raised bed which wasn't been used in a local shopping centre. Val knew Nick who knew Justin (the landlord for the property) who knew Sharna who works with Autism Bedfordshire whose shop is next to the raised bed. And through these community networks an incredible new group started to grow!
Sahira knows about growing but hadn't run a course before or worked with people with autism, but that didn't stop her. Shahira worked with staff from Autism Bedfordshire to develop a five week course which local people with autism attended. The course included visiting the original Incredible Edible Dunstable site, planning out what to plant in the raised bed, clearing out the site and getting it ready for planting, getting the plants in and finally having an amazing launch supported by the Deputy Mayor.
The group who attended the course all really enjoyed the opportunity to get involved in something outside and which contributed to improving the appearance of their local community. They also enjoyed learning about plants (and weeds!) and are looking forward to eating and sharing the food as the crops come into season. Jason, who attended the course, works in the nearby Autism Bedfordshire shop and as part of his job he'll be out watering the plants in the bed every Saturday. Meantime another eager volunteer, Carley, will be encouraging the local community to get involved and to make Incredible Edible Oldhill a great new group.
The local Glider pub, has supported the activity by giving the upstairs room to the group for free so they could meet and plan – the incredible landlord, Rupert, even provided free tea and coffee. Sahira was keen to support local business too so she chose the local independent nursery, Eaton Bray Nurseries, to buy the plants from and the nursery returned the favour by delivering the plants for free. And Milehams Discount Car Care, a keen supporter of Incredible Edible Dunstable, provided the sign for the new bed, made from a car registration plate.
This story shows how incredible things happen – the power of community networks, the support of business and partners and the interest in learning about where our food comes from. We would like to give a big thanks to the businesses who have supported this work, to Autism Bedfordshire for their enthusiasm and of course to the group of people who have made the raised bed into something the local community can value and enjoy.
If you're in Dunstable, head along to the Incredible Edible Oldhill site and see the beautiful raised bed outside the Autism Anglia shop at Lowther Road, Dunstable.


The New Year is here, and our IT and Unified Communications experts are excited to present the trends and technologies that we believe will power The Smart Enterprise in 2014.
Part one of our series discussed the benefits and flexibility Advanced Mobility, Software Defined Tools, and High Availability can bring to the enterprise. In part two, we'll take a look at additional trends that are becoming increasingly popular in helping businesses reduce costs.
CIOs in the past have been very conservatively attached to their data centers. But the slow economic growth, reduction in IT budgets, and increase in cost of skilled IT workers has propelled a growing need for newer approaches to manage infrastructure assets. CIO's are more vulnerable, and are looking to align enterprise IT services and strategies with expanding business requirements.
Alignment can be a complex endeavor, particularly in deciding where and how to deploy new equipment to accommodate current and future increases in demand. Modularity allows you to invest only in what is needed today, which reflects well on the company's bottom line. It also allows for trimming up-front costs while leaving open the possibility of expanding or incorporating new technologies in the future.
Cloud-based services offer distinct cases for modularity. Modularity becomes more than just dividing physical space, but rather the allocation of specifc functions or workloads to an off-premises facility. Companies maintain the ability to deploy applications across the full range of today's alternatives (physical, virtual, private cloud, public cloud) but benefit from the OPEX savings, and thus remain cost-competitive in their markets.
In recent years, performance improvement and cost reduction of sensors and processing technologies has spurred data collection and information extraction across a wide range of industry sectors.
Authentication by biometric verification—which is completed based on biological attributes of the person accessing the technology—is becoming increasingly common in corporate and public security systems, consumer electronics, and point of sale (POS) applications.
Biometric technology has matured rapidly over recent years. It helps travelers who've passed background checks move quickly through expedited security lines at airports. It permits first responders to be given instant admittance to an incident scene—and to be routed to exactly where they're needed. It also protects our ports, federal buildings, and government resources by giving access to the individuals whose identities have been scrutinized and verified, while helping law enforcement secure those who have not.
Biometric software can composite fingerprint scans, retinal scans, geometric patterning (facial markers and body contours), and voice files and use them to recognize certain parties, enabling speedy and secure contextual interactions.
In addition to security, the driving force behind biometric verification has been convenience, as its use helps quickly make identifications within large numbers of people.
Buildings consume approximately 40 percent of the world's energy— far more than the transportation sector, according to The World Business Council for Sustainable Development (WBCSD). Regardless of age, nearly every building wastes energy. Buildings, the equipment used within, and tenants all represent a complex, interdependent system. Every structure runs differently, and energy consumption profiles and concerns differ across locations and structures, and seasons and occupancy levels. Advanced energy-saving solutions must cater to both time as well as place.
This is why Information and Communications Technology will play an increasingly vital role in an energy efficient society required to balance energy supply and demand.
Smart Buildings achieve enhanced environmental and economic performance by producing, storing, efficiently managing, and optimally controlling energy.
Energy waste can be minimized through systems that use individuals' location information to enable automatic control of air conditioning and lighting. These systems control energy usage and enhance security by providing the positioning data of the people inside the buildings.
Within enterprises and data centers there will be an important focus on energy efficient technologies that help save power. Advances in renewable energy technology will also allow for the collection of kinetic energy, which now is usually wasted.
Our experts know that evaluating your company's IT and Communications Solutions can be stressful. If you've been tasked with reducing costs and increasing efficiency, these are just a few of the solutions that you could consider to increase positive results. Since you have the option to choose the technology, solution, or strategy that makes the most sense for your business, be sure to read our first post in this series which covers other solutions that can help.
If you're ready to learn all 10 Enterprise IT & Communication Trends for 2014, you can skip forward and download our eBook now.


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Investigating'Every Witch Way' Cast: Where Are They Now?
Chris Pizzello/Invision/AP/Shutterstock
This may be hard to believe, but it's been over five years since the fan-favorite Nickelodeon show Every Witch Way came to an end, and time has seriously flown by. Yep, on July 30, 2015, fans said their goodbye to Iridium High, and it seriously seems like just yesterday!
For those who forgot, the show tells the story of normal teenager Emma whose life gets turned upside-down after finding out that she's actually a witch. The series starred Paola Andino, Paris Smith, Daniela Nieves, Nick Merico, Tyler Alvarez, Rahart Adams, Elizabeth Elias, Denisea Wilson and Zoey Burger.
Paola chatted with Just Jared Jr. in August 2014 about her working alongside her costars, and had nothing but amazing things to say! "After working with the same people for two seasons, my costars are definitely my second family," she said at the time. "We spend so much time together and are so comfortable around each other. I think that's the best thing about working with them. We can all be ourselves."
The actress also touched on the similarities and differences between her and her character. "Emma and I have a lot in common. She's honest, innocent, and always wants to fix problems when they come up, like me," Paola said of Emma at the time. "The main difference between Emma and I is the way she handles all of the power she has. She's the Chosen One which means she's the most powerful witch in her generation but she lets people distract her sometimes. I wouldn't have time for boys or mean girls if I were a witch."
What has Paola and the rest of the cast been up to since the show aired its final episode in 2015? Well, Daniela, for one, is set to star as Lissa Dragomir in the upcoming Vampire Academy series on Peacock!
"Been keeping this for almost 2 months, and I'm so happy its finally out !! A vampire!!!" the actress wrote on Instagram alongside the show's announcement in August 2021. "Pinch me. … I know you guys will love this story and Lissa as much as I do … hope you guys like the lil clues too."
These two talented ladies aren't the only ones still killing it! J-14 did some investigating and turns out they've all stayed in the spotlight, went on to have super successful acting careers and have grown up so much! Scroll through the gallery to see what the cast of Every Witch Way is up to now.
Richard Shotwell/Invision/AP/Shutterstock
Paola Andino played Emma Alonso
Scroll to see what she's up to now.
Broadimage/Shutterstock
Paola Andino Now
After Every Witch Way, Paola went on to reprise her role as Emma in the series' spinoff show, WITS Academy. She also appeared in the series Queen Of The South and Talia in the Kitchen. She is also set to star in the upcoming film, Sno Babies.
Nick Merico played Daniel Miller
Scroll to see what he's up to now.
Nick Merico Now
After he played the role of Daniel, Nick went on to nab roles in Trico Tri Happy Halloween and First Timers. In March 2019, he auditioned for American Idol with a cover of the Amy Winehouse song "Back to Black."
Rob Latour/Shutterstock
Paris Smith played Maddie Van Pelt
Paris Smith Now
Since her role as Maddie, Paris went on to appear in TV shows like Talia in the Kitchen, Nicky, Ricky, Dicky & Dawn, Speechless and Knight Squad. She's also starred in movies like A Stolen Life and My Stepfather's Secret.
Daniela Nieves played Andi Cruz
Daniela Nieves Now
Daniela went on to nab roles in many TV shows after starring as And in Every Witch Way. She's also appeared in Talia in the Kitchen, WITS Academy and Five Points.
Mediapunch/Shutterstock
Tyler Alvarez played Diego Rueda
Tyler Alvarez Now
Tyler has gone on to star in many TV shows after his role as Diego. He has appeared in Talia in the Kitchen, Orange Is The New Black, American Vandal, Fresh Off The Boat, The Fosters and Veronica Mars. He also starred in movies like High School Lover and The Pretenders.
Rahart Adams played Jax Novoa
Photo by Nina Prommer/EPA-EFE/Shutterstock
Rahart Adams Now
Since his role as Jax, Rahart went on to star in TV shows like House Husbands and Foursome. He also had roles in movies like Liar, Liar, Vampire, Nowhere Boys: The Book of Shadows, Emo The Musical, Pacific Rim: Uprising and Nancy. Rahart is also set to star in two upcoming films, Star Light and Shadows.
Elizabeth Elias played Mia Black
Elizabeth Elias Now
After playing Mia in Every Witch Way, Elizabeth went on to star in the television show Hialeah.
Denisea Wilson played Katie Rice
Denisea Wilson Now
Since playing Katie, Danisea has gone on to star in Trouble Man and the upcoming film Sid Is Dead.
Zoey Burger played Gigi Rueda
Zoey Burger Now
Since playing Gigi, Zoey has gone on to star in the movies Con and Runaway.
Major Throwback 'Dog With a Blog' Cast: Where Are They Now?
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Major Glo' Up 'Good Luck Charlie' Cast: Where Are They Now?
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Looking Back 'High School Musical' Stars: Where Are They Now?
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I receive the blessings that profoundly heal my heart, and I deeply love and accept myself and the Universe deeply loves and accepts me unconditionally.
An Amazing Candle to Go Higher! Set Your Highest Potential Intention!
Your Highest Potential is most heavenly in and around you today and everyday!


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Friday 4th August 2017 the Cellar Bar Galway, Cranium Titanium Metal Show on Galway's Flirt FM 101.3 brings you a Metal Show to remember, accounting for all metal tastes from Alternative, to Thrash to Doom to Death To Folk.
Headliners, Na Cruithne, a six piece Folk Metal group from Galway City, well known for their exciting and intense performances, have become an unstoppable tour-de-force of late with not only securing a position on the new blood stage at this years Bloodstock Festival in the U.K but playing the main stage at this years world renowned Metal Days festival in Slovenia sharing the stage with metal superstars such as Amon Amarth, Opeth, Iced Earth and Marilyn Manson.
Playing main support to Na Cruithne are metal prodigies Snowblind.
They maybe be a relatively new band but Afterlife To Ashes pull no punches.
Since 2015 they've been lighting up the live metal scene up and down the country with incredible energetic and theatrical performances. Two strong singles under their belts with 'Dahlia' and more recently 'Insects' the stage quite literally is set for ATA. This August witness their first Galway show.
Starting off proceedings in the heaviest way possible are Stonecarver, a new three piece Ritual Drone Doom band from Galway City, who have been turning heads and gaining attention with their unique take on fuzzed out riffs.


Edifice was selected to provide construction services for the 99,977 square-foot addition to an existing multipurpose building on campus that serves both Carmel Baptist Church and Carmel Christian School. This two-story addition fits like a glove into the multi-angled existing structure and offers a contemporary change to the existing architecture. This project was challenging with eight (8) different occupied floor levels, 19 roof areas, 47 different corners of the exterior perimeter and a high ratio of exterior skin to floor area. The interior offers a variety of spaces including a 450+ seat auditorium, student community space, flexible classrooms, six (6) science labs, administration, and a 1000 seat gymnasium. The combination of exterior finishes include zinc metal panels, masonry, EIFS, and generous glass surfaces. Interior finishes are also abundant including polished concrete, maple wood flooring, laminate wall panels, tin ceilings, stick wood wall treatments, K-13 acoustical spray, and three (3) Skyfold partitions.


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Home » News » Andrew W. Mellon Foundation Increases Investment in Funding Prison Education and Re-entry Programs
Andrew W. Mellon Foundation Increases Investment in Funding Prison Education and Re-entry Programs
NEW YORK, June 13, 2019 – The Andrew W. Mellon Foundation today announced a series of grants totaling $3.3 million to support four prison education and re-entry programs across the country. The grants acknowledge the human costs and large-scale social and historical impact of criminal justice policies on individuals and society and seek to strengthen and expand degree-granting programs in the liberal arts for currently and formerly incarcerated students.
"Mass incarceration is linked to mass undereducation, but innovative, proven interventions can address both crises," said Mellon Foundation President Elizabeth Alexander. "The Mellon Foundation believes in each and every student's humanity and sees expanding access to higher education in prison as a public good."
"We know that higher-education-in-prison programs reduce violence inside prisons, improve incarcerated students' ties with family and community in advance of parole, reduce rates of recidivism, and interrupt the cycle of intergenerational poverty,"said Mellon Foundation Senior Program Officer Eugene M. Tobin. "Prison classrooms can and should also be sites of curricular innovation in the humanities and a pipeline for transfer and reintegration services in partnership with universities and philanthropic supporters. College-in-prison programs represent values that should be at the heart of a democratic society."
Grants will be awarded to support the following projects...
Bloomberg Harvard City Leadership Initiative Announces Third Class of Mayors to Go Back to School
Yearlong program provides 41 mayors from around the globe with world-class executive training to help deliver results for residents. Read @ Bloomberg Philanthropies
Alfred P. Sloan Foundation Grant Helps Launch AGU Ethics and Equity Antiharassment Initiative
AGU has been awarded a 3-year grant from the Alfred P. Sloan Foundation to launch the AGU Ethics and Equity Initiative: Catalyzing Cultural Change in... Read @ EOS
Children's Health Fund Launches New Mobile Clinic in NYC Made Possible by the Leona M. And Harry B. Helmsley Charitable Trust
The mobile clinic will enable the Children's Health Fund to provide healthcare to hundreds more children and families each year. Read @ The Bronx Chronicle
New York Life Foundation's Award-Winning Grief-Sensitive Schools Initiative Surpasses Milestone
he New York Life Foundation, the largest corporate sponsor of childhood bereavement support, today announced it has surpassed its goal of providing... Read @ PR Newswire
Doris Duke Charitable Foundation Names The 2019 Doris Duke Artists
Six performing artists in the fields of Jazz, Dance and Theater receive up to $275,000 each, totaling $1.65 Million in Doris Duke Artist Awards. Read @ Doris Duke Charitable Foundation


It's summer! The sun is out! Good times are to be had!
Today, we have Jeff Goldblum, Celebrity Nooz, and Bizarre July Holidays!
I'm excited and I know you are too! Let's end June with some good stuff...the BEST STUFF! Enjoy!
"The body is shaped, disciplined, honored, and in time, trusted."
It's true! It's all true! Jeff Goldblum is magical, exceptional, and amazing...like a unicorn...a handsome, angelic unicorn.


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Perioperative mortality in Colombia: perspectives of the fourth indicator in The Lancet Commission on Global Surgery – Colombian Surgical Outcomes Study (ColSOS) – a protocol for a multicentre prospective cohort study
Carlos J Pérez-Rivera1,
Nicolás Lozano-Suárez1,2,
http://orcid.org/0000-0001-6681-1883Alejandro Velandia-Sánchez1,3,
Camilo A Polanía-Sandoval2,3,
Juan P García-Méndez1,2,
Sharon V Idarraga-Ayala1,
Julián M Corso-Ramírez1,2,
Danny Conde-Monroy2,
Danna L Cruz-Reyes2,
Carlos F Durán-Torres2,
Juan G Barrera-Carvajal3,4,
Luisa Fernanda Rojas-Serrano2,
Laura Alejandra Garcia-Zambrano1,2,
http://orcid.org/0000-0002-7665-3724Silvia Valentina Agudelo-Mendoza1,2,
http://orcid.org/0000-0003-4452-3818Leonardo Briceno-Ayala5,
Paulo A Cabrera-Rivera2,4
ColombianSurg Collaborative
1General Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
2Escuela de Medicina y Ciencias de la Salud, Universidad Del Rosario, Bogotá, Colombia
3Vascular and Endovascular Surgery Research Group, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
4Surgery, Fundación Cardioinfantil Instituto de Cardiología, Bogotá, Colombia
5Public Health Research Group, Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
Correspondence to Dr Leonardo Briceno-Ayala; leonardo.briceno{at}urosario.edu.co
Introduction Death following surgical procedures is a global health problem, accounting for 4.2 million deaths annually within the first 30 postoperative days. The fourth indicator of The Lancet Commission on Global Surgery is essential as it seeks to standardise postoperative mortality. Consequently, it helps identify the strengths and weaknesses of each country's healthcare system. Accurate information on this indicator is not available in Colombia, limiting the possibility of interventions applied to our population. We aim to describe the in-hospital perioperative mortality of the surgical procedures performed in Colombia. The data obtained will help formulate public policies, improving the quality of the surgical departments.
Methods and analysis An observational, analytical, multicentre prospective cohort study will be conducted throughout Colombia. Patients over 18 years of age who have undergone a surgical procedure, excluding radiological/endoscopic procedures, will be included. A sample size of 1353 patients has been projected to achieve significance in our primary objective; however, convenience sampling will be used, as we aim to include all possible patients. Data collection will be carried out prospectively for 1 week. Follow-up will continue until hospital discharge, death or a maximum of 30 inpatient days. The primary outcome is perioperative mortality. A descriptive analysis of the data will be performed, along with a case mix analysis of mortality by procedure-related, patient-related and hospital-related conditions
Ethics and dissemination The Fundación Cardioinfantil-Instituto de Cardiología Ethics Committee approved this study (No. 41–2021). The results are planned to be disseminated in three scenarios: the submission of an article for publication in a high-impact scientific journal and presentations at the Colombian Surgical Forum and the Congress of the American College of Surgeons.
Colombia lacks accurate national registers of perioperative mortality; therefore, a prospective approach will provide a better quality of data than the available evidence.
A key strength of the study is the perioperative mortality analysis by assessing the case mix by procedur, patient and hospital related conditions.
One-week prospective collection could induce bias related to seasonal surgical variation, which will be partially reduced by using different collection weeks for different regions.
A convenience sample of participating institutions could provoke selection bias and decrease the generalisability of the results to the entire Colombian population.
Information quality will be improved by training in data collection and methodology for each participating centre and through data validation.
The Lancet Commission on Global Surgery created a movement that is currently the most crucial source of data and recommendations regarding surgical services globally, claiming that surgery is a fundamental pillar of public health.1 2 The Commission's main objective was to improve the quality of surgical services worldwide. They established six indicators encompassing comparison between countries and measurement standardisation.3 The fourth indicator, known as perioperative mortality, is defined as 'the number of in-hospital deaths from any cause in patients who have undergone a procedure done in an operating theatre, divided by the total number of procedures, presented as a percentage'.4 This indicator is essential, as it allows each nation to use this percentage to measure improvements in surgical care,5 and it is 'a global indicator of access to safe surgery and anaesthesia'.6 Therefore, multiple multicentre international collaborative studies on this indicator have emerged (table 1).
Summary of previous studies on national 30-day perioperative mortality16 21 24 28–31
Approximately 300 million surgical procedures are performed worldwide, with an estimated mortality rate of 1%–4% in the perioperative period.7 At least 4.2 million deaths occur annually within the first 30 postoperative days, half of which occur in low-income and middle-income countries.8 These represent 7.7% of the total deaths worldwide, making 'perioperative death' the third leading cause of death globally, exceeded only by coronary heart disease and strokes.4 8 Without proper care, the early postoperative period will continue to be a significant cause of preventable death and disability based on the absence of solid surgical care.2
In low-income and middle-income countries, accurate information continues to be scarce.3 Likewise, in Colombia, data for this indicator are limited. The study by Hanna et al9 is the first attempt to apply The Lancet Commission on Global Surgery indicators in Colombia, estimating early postoperative mortality in Colombia at 0.74%. Second stage analysis of the same dataset was recently published, establishing aggregate perioperative mortality at 0.87% and mortality attributable to emergency and elective surgery at 1.3% and 0.73%, respectively.10 Both studies were based on a retrospective review of data from the National Administrative Department of Statistics and the Individual Service Provision Registries. As stated by Hanna et al, this inclusion methodology poses several problems, including an information bias, as Colombian national databases do not report where and under what circumstances the death occurred, and thus do not correlate with the definition of perioperative mortality in The Lancet Commission on Global Surgery.4 9 Furthermore, it is crucial to understand Colombia's social context and healthcare system for data analysis and the interpretation of the results, as they have multiple factors that may impact the results (online supplemental appendix 1).
We aim to contribute to our country with the first research study reporting accurate and prospective information on perioperative mortality in Colombia and Latin America, by following the instructions created by The Lancet Commission on Global Surgery precisely. The data obtained will be the first step in formulating public policies in the surgical field, adjusted to our population. Moreover, it will help construct a healthcare system with available, affordable and high-quality surgical services by contributing to future interventions that will boost this vital area of healthcare, affecting Colombian patients' care and quality of life.
Objectives of the study:
The primary objective of this study is to describe the Lancet indicator of perioperative mortality in patients who have undergone surgical procedures in participating Colombian institutions.
The secondary objectives are to:
Characterise the sociodemographic and clinical variables of the patients who underwent surgical procedures in Colombia.
Determine the secondary postoperative clinical complications associated with surgical procedures in Colombia.
Describe the installed surgical capacity and infrastructure of the participating health centres.
Study design:
A multicentre, observational, analytical, prospective cohort multicenter study will be conducted (figure 1).
Colombian Surgical Outcomes Study (ColSOS) flow chart. Step-by-step work plan to carry out the study over a total of 12 months. *According to Resolution 8430 of the Colombian Ministry of Health, this is a no-risk study. Verbal or written informed consent requirements will be established by the ethics committee of each participating institution.
The study will be carried out throughout Colombia. As many institutions as possible that perform surgery will be included. We expect to have at least one institution per region. We currently have 60 confirmed participating institutions and are establishing preliminary contact with others (figure 2). The list of participating centres and researchers will be continuously updated, the final version of the list will be attached to the final report and we will compare their characteristics with official national registries from the Colombian Ministry of Health and Social Protection 'Datos abiertos' platform and Health Situation Analysis (ASIS) report.
Preliminary departmental distribution of participating institutions. Map showing the allocation of institutions selected for preliminary articulation, by department, in Colombia. The Colombian map was acquired from 'pixabay', which is free for commercial use, and no attributions are required (https://pixabay.com/vectors/colombia-map-geography-36572/). It was subsequently adapted in Adobe Illustrator (V.1.3.2 for iPad, https://www.adobe.com/la/products/illustrator.html).
Patient and public involvement statement
Patients were not included in the design of the research. Even so, the aim of the study is to understand the factors related to perioperative mortality with the objective of beginning a discussion around surgery in public health. Study participation will not entail any intervention or change in treatment for the patients; nonetheless, informed consent to participate will be obtained. Once the study has been published, patients all over Colombia will be invited to the discussion and presentation of the results; also, the results will be presented in a non-technical way to deliver the information to everyday citizens.
Characteristics of the participants
All patients over 18 years of age who undergo a surgical procedure during the collection period will be included. Patients who do not agree to participate in the study through informed consent or who undergo radiological/endoscopic procedures will be excluded.
Only patients older than 18 years old will be considered as it is the national legal age and guarantee the direct process of informed consent with the participants. Also, a surgical procedure will be defined as any procedure conducted in the operating room regardless of the type of anaesthesia used. The excluded procedures are only intervention radiology and endoscopic procedures. Open, video-assisted, endovascular, robotic and mixed procedures that fulfil the eligibility criteria will be included.
The minimum number of patients needed to achieve significance in describing the national perioperative mortality ratio was calculated to be 1353. The estimate was made using the 0.74% postoperative mortality rate in Colombia obtained in Hanna et al's study.9 Bearing in mind this reduced mortality proportion, the sample for prevalence or proportion was calculated seeking an absolute precision of 0.5%, an alpha value of 0.05 and a design effect of 1.2, due to it being a non-randomised sample. The OpenEpi calculator11 was used to estimate the sample size for this proportion, using the following formula:
Where DEFF is the design effect (correction factor to adjust the sampling size), n is the sample size, N is the population size, p is the estimated proportion, q is one minus the estimated proportion, α is the alfa value and d is the desired absolute precision.12
Also, due to the nature of the study, randomisation is not possible. Nevertheless, convenience sampling is considered, as we aim to include all possible patients. Once the sample of patients is achieved, the study will continue until all participating institutions finish their collection week. When the collection is completed, a power analysis will be run to ensure the significance of the sample obtained.
The principal outcome of this study is to obtain primary and reliable information on the fourth indicator in The Lancet Commission on Global Surgery in Colombia. The specific definition of perioperative mortality that will be used in this study is 'all mortality secondary to any cause before leaving the hospital, or within a maximum of 30 days of hospital stay, in a patient who underwent a surgical procedure in an operating room'. This indicator will be represented through the perioperative mortality ratio4 and will be calculated as follows:
It is important to note that the crude national perioperative mortality and adjusted mortality will be calculated, addressing case mix by procedure, patient and hospital related conditions. The variables to be assessed as patient-related conditions will be age, affiliation with the Colombian healthcare system, medical history, illness severity by ASA (American Society of Anesthesiologists) score and preoperative patient status such as haemodynamic instability and preoperative cardiopulmonary arrest. In procedure-related conditions: cardiac risk for non-cardiac procedures, elective versus non-elective procedures and procedure category and type. In hospital-related conditions: hospital funding (public, private or mixed), location (rural vs urban) and level of complexity (I–IV).
The secondary outcomes measured are the installed surgical capacity and the postoperative clinical outcomes associated with surgical procedures in Colombia. The installed surgical capacity is going to be measured by the institutional level of complexity, number of surgical professionals (surgeons, orthopaedists, anaesthesiologists and obstetrician-gynaecologists), number of operating rooms and intensive care unit capacity. Further information on the clinical outcomes and installed surgical capacity is presented in the variables table (online supplemental appendix 2).
Identification and linking of research centres
Four strategies are proposed to attract interested researchers and institutions to participate in this study. Due to the support of the Colombian Surgical Association, a generalised invitation will be sent to all clinics and hospitals with surgical divisions throughout the country, using the ColombianSurg Collaborative organisation's official mail. This invitation will include general information on the research study to attract interest from these institutions. Additionally, the registration link will be published in the Colombian Surgical Association's journal and website so students, interns, doctors, residents and specialists interested in participating can register (https://fci-redcap.cardioinfantil.org/surveys/index.php?s=LE3KXAPXDE). Finally, word of mouth and mass dissemination through ColombianSurg Collaborative social networks (Instagram/Twitter/Facebook: @colombiansurg and the official website) cannot be ruled out.13
A hierarchical management organisation was set up to generate specific and personalised attention for each region and institution (figure 3). In addition, researchers will communicate with the ColombianSurg Collaborative team and vice versa through different platforms that will be made available to them, such as instant messaging groups, email and official websites.
Hierarchical management organisation. Route established intending to maintain active and accurate communication between the ColombianSurg Collaborative Team and the collection teams at each institution.
Data collection has not begun; it is planned to begin in May 2022. Data will be collected and stored online through a Research Electronic Data Capture (REDCap) web application server, allowing the collaborators to enter data and store it in a secure system; this protects patient data as it does not permit third-party access. Each hospital's designated collaborator will receive the login data in the REDCap system (login) so that the data are sent securely to the server. Only anonymous data will be uploaded to the database. No data will be collected to identify patients. All of this is in adherence to the Strengthening the Reporting of Observational Studies in Epidemiology statement.14 The Department of General Surgery at the Fundación Cardioinfantil-Instituto de Cardiología will serve as the coordinating centre.
Patient inclusion will be carried out prospectively for 1 week. All patients who meet the criteria between day 1 and day 7 will be included. All patients will be followed until one of the following endpoints is met: (1) the patient dies within the first 30 days of hospital stay, (2) the patient is discharged or (3) the patient completes 30 days of hospitalisation.
Data collection is predetermined to be carried out regionally, 1 week per region and another for the capital district. The order of collection will be randomly assigned, but there will be flexibility to postpone the collection week based on specific institutional needs.
As stated, all institutions and surgical specialties that wish to participate will be incorporated. Consequently, a collection team will be required for each institution. These teams consist of a leader and three to five collaborators. In cases where teams have more than 30 patients per collaborator, they may include more team members, maintaining the same rule of 30 patients per person, not including the team leader. There is no minimum number of patients to be collected or participants in a research team.
Information quality control
All data will be collected from the patients' electronic medical records. The database will comply with confidentiality rules, and the information analysis will not identify results by institution or researcher. Given the importance of data quality, validation will be done in three stages:
Stage 1: the collection tool will be designed to restrict answers clearly and concisely, using the correct symbology, without giving space for discussion. Also, it will contain a logical sequence in terms of information coherence, deploying a specific questionnaire depending on the information recorded previously.
Stage 2: the researchers at the participating centres will be trained in the use of REDCap and will be instructed on how to fill in the database. Likewise, a communication system will be enabled between the researchers at the participating centres and the leading researchers to answer questions, ensuring an adequate collection of data.
Stage 3: extreme results (outliers) will be validated through diagrams and corroborated with the collection centres, including patients, as needed. A member of the participating centre other than the leader or collaborators will be assigned to audit the data. A statistical sampling approach will be used to explicitly determine the percentage of data taken to validate the results.
Data analysis plan
A descriptive analysis of the data will be performed to address the primary and secondary objectives. The distribution of the variables will be assessed by graphical analysis and normality tests (Shapiro-Wilk or Kolmogorov-Smirnov). If the variables have a normal distribution, they will be expressed as means (a measure of central tendency) and SD (a measure of dispersion). Conversely, if the variables have a non-normal distribution, they will be expressed as medians (a measure of central tendency) and IQR (a measure of dispersion).
Continuous data with a normal distribution will be studied using parametric tests according to the number of comparators: Student's t-test or analysis of variance will be used if more than two groups of the variable are being compared. For continuous data with a non-normal distribution, non-parametric tests will be used: if two groups are compared, the Mann-Whitney test will be used, and if three groups are compared, the Kruskal Wallis test will be used. The p value shall be considered statistically significant at <0.05. Categorical variables shall be presented with absolute frequencies and proportions. Categorical data will be compared between two groups using the χ2 test or Fisher's exact test.
Perioperative mortality will be represented as a ratio or proportion of mortality in all patients who have undergone a surgical procedure within the collection period. To fully understand these phenomena, we will adjust mortality for procedure, patient and hospital related conditions, as previously described. Also, a mixed effect mode for geographical clustering and a multivariate logistic regression for perioperative mortality will be used to adjust for differences in confounding factors and assess possible associations. Possible risk factor variables will be assessed with lasso regression and a variance inflation factor to avoid collinearity. All analyses will be multilevel, carried out by city or municipality, department and country.
A multiple imputation method using the AMELIA algorithm in RStudio15 will be employed before any analysis. Model yields will be evaluated using model calibration and discrimination. A calibration analysis is proposed using the known data and finding the observed relationship between dependent and independent variables. Sensitivity analyses of the association between preoperative risk factors and inpatient mortality in those with complete data versus cases with multiple imputations of missing data will be performed to test the potential bias associated with missing variables.
Statistical analyses will be performed using the R statistical software and the Statistical Package for the Social Sciences.
The Fundación Cardioinfantil-Instituto de Cardiología Institutional Ethics Committee approved this study in 2021 (Ref Number: No. 41–2021), and a copy of the official letter is attached.
The study will be conducted within the guidelines of the ethical principles for medical research on human subjects according to the Declaration of Helsinki – 59th General Assembly, Seoul, Korea, October 2008. The CIOMS Guidelines, Good Clinical Practice Guidelines of the International Conference on Harmonization and national ethical disclosures will also be taken into account. The investigators will be responsible for maintaining absolute confidentiality of the information contained in medical records and personal information, complying with the current regulations regarding the handling of this information. Absolute confidentiality will be maintained, and the proper professional, institutional name will be preserved. The confidentiality of the data will be guaranteed by masking with a code created by the researchers.
According to the Colombian Ministry of Health and Public Protection's Resolution 8430/1993, this is a no-risk study since no additional intervention or treatment modification is carried out on the participants, as all the information will be collected from the patients and will undergo anonymisation. However, as it is a multicentre study, institutions whose institutional ethics committees believe consent is necessary for participation (as is the case of the Fundación Cardioinfantil-Instituto de Cardiología) will be allowed to collect it. The participant consent form that will be used can be found in online supplemental appendix 3.
Dissemination is planned to occur in three different scenarios: via submission of an article to a high-impact scientific journal, at the Colombian Surgical Forum and at the Congress of the American College of Surgeons.
The principle of collaborative authorship will be used throughout this study. Collaborators from each institution will be acknowledged in the resulting publications as PubMed-citable coauthors. The criteria for authorship are the following:
Principal investigators: train collection teams, coordinate the study, analyse obtained data and write the manuscripts.
Departmental leaders: support recruitment and coordination of institutions in specific regional areas.
Hospital/research centre leaders: coordinate teams to complete data collection in the established period and attend meetings with the principal investigators.
The team from each hospital: collect data from all patients at each institution who meet the study criteria.
This study focuses on ascertaining postoperative in-hospital mortality in Colombia and its determinants, as a first step in developing the surgical field through public health. We consider that a prospective and multicentre approach can generate updated and more representative data than the currently available evidence. The few attempts to measure perioperative mortality have often involved different definitions than those proposed by The Lancet Commission on Global Surgery and study samples that are not representative of the Colombian national population or have reported data associated with a specific type of procedure.9 10 16 This indicator is convenient and of significant impact, as the possibility of a standardised measurement of perioperative mortality between countries, regardless of their income level, has been demonstrated in the literature.17
The specific methodology for the prospective data collection was chosen to decrease bias. Patients will be included if they are discharged prior to 30 days after surgery; alternatively, they will be followed until they complete 30 days of hospitalisation. The rationale for this is that patients who die during this lapse of time reach the primary outcome; patients who are discharged or who die after 30 days in the hospital may be influenced by external causes that are not always secondary to the surgical procedure; therefore, a censorship of the discharged patients will be conducted.
Previously, the 30 days after surgery have been considered to be part of the perioperative mortality interval, as the Thoracic Society of Surgeons defines operative mortality as 'death, that occurs before hospital discharge regardless of whether it occurred after 30 days, and all deaths that occur after hospital discharge in the first 30 days after surgery'.18 However, this is considered to limit the effectiveness and use of this measure and makes it impossible to make valid comparisons between jurisdictions or countries.4 19
The Lancet Commission for Global Surgery recommends that mortality be presented as the number of postoperative in-hospital deaths, overall, in patients undergoing surgical procedures.4 This is supported by a study that compared the different perioperative mortality rates in different care facilities in New Zealand, South Africa and Papua New Guinea. The authors determined that there are considerable differences between representatives of the high-income, medium-income and low-income countries, with one of the main differences being the lack of 30-day follow-up in the middle-income and low-income countries. Therefore, they recommended not considering deaths following hospital discharge.19
Additionally, multicentre studies using the proposed methodology in this study have shown tremendous impact, and country and region-specific data are necessary to make them truly useful, with several interventions that can be carried out to improve the surgical quality of each area.
Previous studies on postoperative mortality were conducted measuring mortality through the civil registry and vital statistics; by 2015, the specific postoperative mortality rate registered in low-income countries was only 1%.4 17 20 Nevertheless, the EuSOS study reported an in-hospital mortality rate of 4%, higher than expected, and described substantial differences between mortality in different countries, even after adjustment for all confounding variables.21 Meanwhile, ISOS (International Surgical Outcomes Study)main objective was not to describe postoperative mortality but in-hospital complications. However, they also reported in-hospital mortality at a rate of 0.5%, being significantly lower than that observed in the EuSOS study.16
The differences in perioperative mortality in similar populations was observed in EuSOS and in several other studies.5 16 21 This supports perioperative mortality ratio variability, which could be influenced by various factors even in safe and high-quality health systems.22 In fact, major changes can be triggered by risk stratification according to procedure and patient, age, preoperative clinical status and institutional factors such as location and funding (public vs private sector).6 22 23 Therefore, in order to succeed, a complete understanding of perioperative mortality is necessary to adjust mortality by the previous factors. In the Colombian population, it may also be important to adjust for type of affiliation to the healthcare system, because this defines access to timely, efficient and priority healthcare . Furthermore, other sociodemographic variables could play determinant roles, such as socioeconomic status, ethnicity and being migrants or communities displaced by violence.
Overcoming its limitations, the understanding of perioperative mortality identifies realistic figures and essential differences that impact the determinants and must be studied thoroughly. This can be seen in the ASOS study, which permitted African countries to obtain and understand the indicators associated with an investment in population-level research.24 These countries have developed public health programmes such as SURG-Africa or COST-Africa, supported by collaborators such as Harvard University and the Royal College of Surgeons.25 On an individual basis, the use of indicators and an understanding of how they help develop safe surgery have made countries like Ethiopia stand out among sub-Saharan and low-income countries for developing a national plan. This plan, called Saving Lives through Safe Surgery, aims to improve the access to and quality of surgical procedures for its population.4 26 27
Some preliminary interventions proposed include establishing public policies that improve these indicators and distribute resources properly and training doctors at primary care institutions to prepare patients and refer them correctly to ensure that the patients can have Bellwether procedures. Finally, there should be an awareness of the surgical capacity of the different institutional levels, consequently classifying each patient according to the complexity of the care required, and providing patients with fast, safe and effective care, avoiding the high volume of complicated surgical procedures in higher level institutions.4 9
Consent obtained directly from patient(s)
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CJP-R and NL-S are joint first authors.
Twitter @carlosperez_18, @dannacruz, @Leonard02017085
Collaborators ColombianSurg Collaborative: Gustavo-Adolfo Quintero-Hernandez, Lilian Torregrosa-Almonacid, Luis F Cabrera-Vargas, Felipe Casas-Jaramillo, Valeria Cormane-Alfaro, Laura N Buendía-Barrios, Laura C Arce-Polanía, Maria A Pineda-Castañeda, Juan D Saavedra-Henao, Daniela Lara-Espinosa, Santiago Garcés-Marulanda, Juliana Pinzón-Luna, Bayron R Guerra-Benedetti, María P Vargas-Cuéllar, Carlos E Rodriguez-Barbosa, Daniel A Buitrago-Medina, Sebastian Gallo-Bernal, Manuel S Mosquera-Paz, Akram Kadamani-Abiyomaa, Isabella Roa, Isabella Velandia-Sánchez, Julian A Garavito-González, Carlos F Román-Ortega, Maria I Camargo-Areyanes, Mariana Maksoud-García, María P Bohórquez-Tarazona, Vanessa Barreto and Fabien Mantilla-Sylvain.
Contributors PAC-R, LB-A, JGB-C, CJP-R, NL-S and AV-S: devised the study. DLC-R, DCM, NL-S, AV-S and SVI-A: planned the methodology and the statistical analysis. AV-S, CAP-S, CJP-R, JPG-M, JMC-R, LR-S, LAG-Z, SVA-M and CFD-T: designed and drafted the initial manuscript and prepared the final manuscript for submission for publication. PAC-R, LB-A and JGB-C: participated in critical review of the manuscript. All authors read and approved the final manuscript.
Funding This work was supported by Universidad del Rosario and the Fundación Cardioinfantil-Instituto de Cardiología grant number CTO 057-2021, project ID IV-FGV017, with US$375 000 each, for a total of US$750 000. The contact for the funding of this study is Melba Mercedes Mojica Amaya, Professional in Research Project Management, Universidad del Rosario, Bogotá, Colombia. Email: melba.mojica@urosario.edu.co.