User talk:Penlite/sandbox

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Iron Lung edit discussion - Research difficulty & topic coverage

In reviewing, over the past several days, everything I had time to search for regarding Wikipedia standards (generally, and for medical-related articles), and searching for medical literature available online regarding "iron lung" and "negative-pressure ventilation/ventilator", I've come to the conclusion that there are simply not enough studies out there that fully satisfy the ideals of WP:MEDRS.

For instance, I have searched the databases most highly recommended in WP:MEDRS, including National Institutes of Health, in both PMC and PubMed, and, following guidance from the medical library at Cambridge University, the U.K.'s National Health Service "NHS Evidence" database, and the Cochrane Library's Database of Systematic Studies -- generally casting my searches broadly, only constraining them to the last three or four decades.

To my astonishment, whenever I found any review even mentioning the topic, they essentially reported "there's too little research," or simply "we could find no studies that compared negative-pressure ventilation to positive-pressure ventilation" in their specific topic area, nor even generally -- not even in a systematic review about ventilation for "neuromuscular and chest wall disorders" (which include polio, for which the iron lung was created). In other research, if evaluators did find any such comparative study, they generally asserted that it wasn't adequate in size or sufficiently randomized[1] (and even some study authors admitted that in their reports[2]).

In a search of the NHS Evidence database, under "Guidance" and "Secondary Evidence" documents (the preferred source types, according to WP:MEDRS), out of their 193,406 such documents, only one mentioned "iron lung" (largely in passing). Searching those sources for "Negative-pressure ventilation" gave similar results.

In a search of Cohrane's database, in the section "Lungs and airways", out of its 828 systematic reviews, I only found three that made any reference to either "iron lung" or "negative-pressure ventilator," or "negative-pressure ventilation" (with or without the hyphen), within their titles, or in their lengthy, detailed abstracts. And those reviews, while focusing on a related topic, generally conflated the research on positive- and negative-pressure systems, rather than comparing them.[3][4] This is quite similar to the experience I was having previously while attempting to build up the essentially-vacant Wikipedia articles on these two topics.

While trying to find the reasons that the iron lung was replaced by today's positive-pressure ventilators, I found (of course) scattered mentions of the various medical issues listed in the "disadvantages" that I listed in the now-reverted versions of the two articles I've edited.

But, surprisingly, by far the most common basic reason cited in the literature, for the iron lung's replacement, was inconvenience -- not therapeutic outcomes. The most common specific criticism in the literature was about the iron lung's physical size, and that it was "uncomfortable" for patients and "cumbersome" for staff [5] -- in short, inconvenient. By comparison, such pro-and-con, life-and-death therapeutic issues -- such as superior or inferior rates of "oxygenation," "aspiration," "survival" -- were far less frequently cited as reasons for the change.

It appears that, once it became more convenient for clinicians to replace the iron lung with positive-pressure ventilators, medical outcomes became a secondary concern, at least as reflected in the focus of the literature. (Forgive the grim cynicsm; but that's what the historic medical literature rather blatantly reflects. For examples, see the broad-topic journal articles on ventilation history -- and ventilation, generally -- that I'd cited in the articles previously).

And, as the iron lung became scarce, by the 1980s, the literature on the topic largely evaporated. Some of the remarks in the subsequent literature seem to indicate that it was just too inconvenient to do the comparative research with the big, strange, old machines -- or the now-scarce machines were too hard to obtain "on short notice" for the research. The contemporary literature on negative-pressure ventilators seems focused on the more-compact cuirass and "poncho" or "jacket" ventilators, but even this is sparse.[6]

When studying ventilation options, then, the iron lung is simply not a common topic of thorough, current research -- despite several anecdotal case reports and low-grade studies raising substantial questions about its possible contemporary advantages and viability. It's as if the medical community has decided (like the proverbial drunk looking for his keys under a lamplight) to keep their focus where the light is, on current technology, and do so without looking back into the dark -- at scarce, forgotten, "awkward" equipment -- regardless of medical merit.

This, then, leaves a Wikipedia editor with two choices:

• Do not put up information about the iron lung, and leave a largely useless page (at a time when ventilation options are an urgent and essential focus of global inquiry); or
• Put up substandard information (and clearly identify it as such).

So I propose to rephrase the opening sentences of the "Advantanges-and-Disadvantages lists with language to that effect (supplemented by supporting reference citations), to read:

"Since the widespread conversion of the medical industry from negative-pressure ventilation to positive-pressure ventilation, during the 1970s and 1980s, there have been very few studies of the iron lung (and negative-pressure ventilators, generally), in comparison to positive-pressure ventilators. However, limited medical research has suggested possible comparative advantages and disadvantages of the iron lung:..."

And then re-title the sub-sections as: "Possible advantages" and "Possible disadvantages", or "Reported advantages[/disadvantages]" or "Alleged advantages [/disadvantages]" or "Suspected..." or "Claimed..." or "Suggested possible..." -- and, on each of the specific claims, begin the item with "May..." or "May possibly...", and end each list item with ref cites to peer-reviewed medical studies, reviews or guidelines, or substantial medical historic literature (e.g.: major medical journals), making those assertions.

Alternatively, of course, we could broaden the research for this article to include reference to older documents, when the iron lung was still a "current" item in the literature, yielding a much richer crop of information (probably including direct comparisons of iron lungs, and their NPV kin, to the then-emerging positive-pressure systems). But, of course, studies comparing the iron lung to positive-pressure ventilators of that era may be rather irrelevant, given that there have probably been substantial advancements in positive-pressure ventilation over the several intervening decades. And, in any case, documents from that era are likely to be scarce on the internet, regardless of whether or not they've been indexed by the principal sources noted above.

Any thoughts? ~ Penlite (talk) 15:30, 29 April 2020 (UTC)

CHINA notes

To add my 2 cents' worth: "China" and "People's Republic of China" are the same, and different, depending upon topic, context, and communicator.

• Geographically, "China" is a physical region, which can easily be taken to include current "Mainland China" -- including land now held as the common provinces of the "People's Republic of China" (PRC), along with "Hong Kong" and "Macao", but arguably not (either historically or geophysically, or both) Tibet, northeastern Kashmir, Taiwan, or even Xinjiang Province.
• Politically "China" is a politically defined region of discrete political entities, and that definition varys in the minds of those living within those spaces, as well as in the minds of those outside them.
  • The central government of the People's Republic of China, of course, claims all of geophysical "China" and many adjacent regions -- some acquired by the Chinese Communist revolution and subsequent conquest -- including
    • Xinjiang
    • Northeastern Kashmir
    • Tibet
    • Taiwan
    • Qemoy and Matsu
    • The Spratly Islands
    • The South China Sea (most of it)
    • ...and who knows what, next?

...notwithstanding (for decades) the rejection of many of these claims of PRC sovereignty over these areas, as expressed by many of these places' natives (some by popular vote) and cultural descendants and diaspora thereof, and much of the global community of nations (most notably: the United States of America, India, Pakistan, and much of Southeast Asia and Europe).

• • Many Taiwanese (including its current president) view Taiwan -- officially: "the Republic of China" (ROC) -- as a sovereign entity, independent of the PRC. These echo the claims of the remnants of "China"'s former nationalist government, which, when routed by the Communists, took refuge in Taiwan (and became Taiwan's governing force for decades, as the Kuomintang). Likewise, some culturally indigenous Taiwanese have viewed the Nationalist Chinese (mostly ethnic Han Chinese from the mainland) as invading conquerors.
  • Many Hong Kong citizens appear to view their country as an entity entitled to sovereignty, independent of the PRC.
  • Many nations -- probably most, including all those around the South China Sea -- dispute the PRC's claim of territorial sovereignty over the Spratly Islands, other archipeligoes and coral reefs in the region, and most of the South China Sea
  • Most of South Asia and Europe, along with the United States, renounce the PRC's claim of its claimed "Chinese" sovereignty over conquered Tibet and PRC-occupied northeastern Kashmir, as have native Tibetans.
• Culturally -- "China" can be referred to as a cultural organism, consisting primarily of Han Chinese, but also other historically "Chinese" ethnicities, as well, throughout the PRC, and in a vast diaspora throughout surrounding regions, and extending as far as Siberia, South Africa, Europe and the United States -- and many countries in-between. In many cases, the Chinese ethnic communities of those nations constitute a significant (even, in some cases, largely pivotal) subculture of those countries (e.g.: Indonesia, Malaysia, South Africa, etc.).

China -- like many other expansionist nations, over the years (ranging from Nazi Germany, to India and Pakistan, to Russia, to Israel, and more) -- has implied that the presence of some of the global diaspora of its people, in a place, gives the PRC some theoretical argument of sovereignty or other international legal claims.

At present, for instance, the PRC has begun rapidly repopulating Tibet with Han Chinese (indigenous to traditional "China" -- and not to "Tibet"), allegedly in an attempt to more firmly establish its claim of sovereignty, among other motives (including, allegedly, to subdue the Tibetans resisting PRC occupation).

So, then, it becomes a significant question as to what is meant by the word "China." Is it a geographic, political, or cultural term, and entity? If so, by whose definition are its boundaries defined? What exactly is, and -- just as importantly -- is not "China"?

And on what Wikipedia protocols are these definitions being made, and applied?

Are these protocols being applied uniformly, across all nations, or uniquely in the complex and very challenging case, at present, of so-called "China."?