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Using the GRADE approach, at least two review authors (KH, SG) will independently rate the overall quality of evidence using the GDT tool ( ) for the main comparison pairs listed in the Types of interventions section. The quality of evidence reflects the extent to which we are confident that an estimate of effect is correct and we will apply this in the interpretation of results. There are four possible ratings: high, moderate, low and very low. A rating of high quality of evidence implies that we are confident in our estimate of effect and that further research is very unlikely to change our confidence in the estimate of effect. A rating of very low quality implies that any estimate of effect obtained is very uncertain.

The GRADE approach rates evidence from RCTs that do not have serious limitations as high quality. However, several factors can lead to the downgrading of the evidence to moderate, low or very low. The degree of downgrading is determined by the seriousness of these factors:

study limitations (risk of bias);


indirectness of evidence;

imprecision; and

publication bias.

We will include a 'Summary of findings' table, constructed according to the recommendations described in Chapter 10 of the Cochrane Handbook for Systematic Reviews of Interventions ( Handbook 2011 ). We will include the following outcomes in the 'Summary of findings' table: patient-reported disease severity score, individual symptom scores, significant adverse events (epistaxis), disease-specific health-related quality of life and other adverse events (local irritation/discomfort).

We would like to acknowledge Sam Faulkner for her input into the Search methods for identification of studies section and Jenny Bellorini for her help with copy editing the protocol.

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure, Cochrane Programme Grant or Cochrane Incentive funding to Cochrane ENT. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

Karen Head drafted and revised the protocol. Simon Glew, Claire Hopkins, Carl Philpott, Glenis Scadding, Anne Schilder and Kornkiat Snidvongs reviewed and edited the protocol.

Karen Head: none known.

Kornkiat Snidvongs: none known.

Simon Glew: none known.

Glenis Scadding: none known.

Carl Philpott: Carl Philpott has previously received consultancy fees from the companies Acclarent, Navigant, Aerin Medical and Entellus.

Claire Hopkins: Claire Hopkins has received financial support from several companies involved in producing instruments for sinus surgery.

Anne GM Schilder: Anne Schilder is joint Co-ordinating Editor of Cochrane ENT, but had no role in the editorial sign-off process for this review. Her evidENT team at UCL is supported by her NIHR Research Professorship award with the remit to develop a UK infrastructure and programme of clinical research in ENT, Hearing and Balance. She is a co-investigator on the NIHR PGfAR grant 'Defining best Management for Adults with Chronic RhinOsinusitis: the MACRO Programme.'

a journal of software studies

Author Yuk Hui


Affiliation Centre for Cultural Studies, Goldsmiths


Publication Date November 2011

Publication Date
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Review of, Manual DeLanda, Philosophy and Simulation, the emergence of synthetic reason London, Continuum, 2011 ISBN 1441170286 240 Pages

Manual DeLanda has been best known as a significant figure in the introduction of the works of Gilles Deleuze to the English speaking world with numerous examples of scientific phenomenon. Such an approach presents Deleuze as a scientifically informed philosopher who also used science and technology as a pivot to carry out a revolution within the field of French philosophy, as well as extending the philosophy of Deleuze to a broader range of areas that exceed Deleuze’s own endeavours. Four years after the publication of A New Philosophy of Society , Manual DeLanda has returned with a new title, Philosophy and Simulation—The emergence of synthetic reason , in which the name Gilles Deleuze only appears in the bibliography of the appendix. Shall we expect a new philosophy on the way, one not shadowed by the name Deleuze? A name nevertheless adds power to the history of philosophy, in Deleuze’s own words, the name of the father.

In this new title, DeLanda proposes a philosophy of emergence by defending what he calls synthetic reason, one that cannot be reduced to deduction and its principles, one that exceeds both the linear, simple mechanisms and the logical operation of the human brain, one that can better be thought by computation and mathematical models. The book, in its modest words, according to DeLanda, is to study the various mechanisms of emergence and its ontological status through computer simulations. Yet the ‘and’ in the title also gives an ambiguous position to ‘simulation’ in a philosophical text such as this. The book consists of eleven chapters on different phenomenon of emergence including chemistry, genetic algorithms, neural networks, economies, language, society, accompanied with examples of computer simulation. It finishes with an appendix to associate this ambitious work with what he has developed elsewhere: the theory of assemblage. The philosophical goal is to unfold an “emergent materialist world view that finally does justice to the creative powers of matter and energy”, but, interestingly, through computer simulations.

The first question that must be justified is what is the relation between emergence and simulation? That question is immediately followed with another one: what is the position of philosophy in such an assemblage? DeLanda recognizes that simulation cannot be fully responsible for ensuring the legitimacy of the concept of emergence; in fact, simulation is always a reproduction of an epistemological understanding. Simulation for DeLanda is a tool that opens up a philosophy that can be visualized and imagined through the topological figures and the constant reconfiguration of data within the simulated environment. Simulation demonstrates and confirms DeLanda’s early writings on the creative force of matter, which formed what one might call a scientifically informed transcendental empiricism. In this respect, DeLanda remains loyal to his Deleuzian method of philosophy, as stated in Qu’est que la Philosophie by Deleuze and Guattari: ‘Philosophy is a constructivism, and the construction has two complementary aspects that are different in nature: to create the concepts and to trace a plane” [1] . Philosophers establish a plane according to their contemporary situation and project the image of thought to the diagrammatic infinity. In this book, DeLanda creates the concepts of synthetic reasons and further develops that of the abstract structure of the assemblage, it also seems to me that he was trying to extend a plane that goes beyond the previous conception of transcendental empiricism, but this yet remains obscure in this ambitious work.

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At least two of the three review authors independently extracted data from the included studies using standardised forms. We resolved disagreements by discussion.

We also noted possible variations in the definition of outcomes between studies, and where possible, standardised these across studies before meta-analysis. See Included studies and Appendix 3 for more details.

At least two review authors independently assessed the methodological quality of the included trials. We resolved any disagreements by discussion. We took the following taken into consideration, as guided by the Cochrane Handbook for Systematic Reviews of Interventions ( Moa7 dress White Talbot Runhof MHIpzIL

sequence generation;

allocation concealment;


selective outcome reporting;

incomplete outcome data;

other sources of bias.

We used the Cochrane 'Risk of bias' tool in Review Manager 5 ( RevMan 2014 ), which involves describing each of these domains as reported in the trial and then assigning a judgement about the adequacy of each entry: 'low', 'high' or 'unclear' risk of bias.

Results of the 'Risk of bias' assessment are presented in a 'Risk of bias' summary and a 'Risk of bias' graph.

We analysed data according to the intention-to-treat principle, whereby all participants are analysed in the groups to which they were randomised. Where data were missing or there was loss to follow-up, we conducted an available case analysis.

We expressed the pooled measures of treatment effect for number and severity of episodes of tonsillitis or sore throat and number of days with sore throat as mean differences with 95% confidence intervals (CIs).

We identified no studies with non-standard designs, such as cross-over and cluster-randomised trials.

We planned to seek key unpublished information missing from reports of included studies, if necessary, by contacting the authors of the included trials. No imputations for missing data were pre-planned, apart from standard calculations to obtain SD values for continuous data as detailed in the Cochrane Handbook for Systematic Reviews of Interventions ( Handbook 2011 ).

We assessed clinical heterogeneity (which may be present even in the absence of statistical heterogeneity). We reviewed the included trials for potential differences between studies in terms of the types of participants recruited, interventions or control used and how outcomes were measured and/or reported.

We assessed statistical heterogeneity by visual inspection of the forest plots and statistical tests for heterogeneity. We assessed heterogeneity using the Chi 2 test (with a significance level set at P value < 0.10) and the I 2 statistic, which calculates the percentage of variability which is due to heterogeneity rather than chance, with I 2 values over 50% suggesting substantial heterogeneity ( Handbook 2011 ).

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