Gittins indices and constrained allocation in clinical trials

We explore the use of Gittins indices to search for near optimality in sequential clinical trials. Some adaptive allocation rules are proposed to achieve the following two objectives as far as possible: (i) to reduce the expected successes lost, (ii) to minimize the error probability at the end. Simulation results indicate the merits of the rules based on Gittins indices for small trial sizes. The rules are generalized to the case when neither of the response densities is known. Asymptotic optimality is derived for the constrained rules. A simple allocation rule is recommended for one-stage models. The simulation results indicate that it works better than both equal allocation and Bather's randomized allocation. We conclude with a discussion of possible further developments.

Evolution in design of integral leg prosthesis leads to improved outcomes

Developments of surgical attachments for bone-anchored prostheses are slowly but surely winning over the initial disbelief in the orthopedic community. Clearly, this option is becoming accessible to a wide range of individuals with limb loss. Seminal studies have demonstrated that the pioneering procedure relying on screw-type fixation engenders major clinical benefits and acceptable safety. The surgical procedure for press-fit implants, such as the Integral-Leg-Prosthesis (ILP) has been described Dr Aschoff and his team. Some clinical benefits of press-fit implants have been also established. Here, his team is once again taking a leading role by sharing the progression over 15 years of the rate of deep infections for 69 individuals with transfemoral amputation fitted with three successive refined versions of the ILP. By definition, a double-blind randomized clinical trial to test the effect of different fixation’s design is difficult. Alternatively, Juhnke and colleagues are reporting the outcomes of action-research study for a cohort of participants. The first and foremost important outcome of this study is the confirmation that the current design of the IPL and rehabilitation program are altogether leading to an acceptable rate of deep infection and other adverse events (e.g., structural failure of implant, periprosthetic factures). This study is also providing a strong insight onto the effect of major phases in redesign of an implant on the risk of infection. This is an important reminder that the development of a successful osseointegrated implant is unlikely to be immediate but the results of a learning curve made of empirical and sequential changes led by a reflective clinical practice. Clearly, this study provided better understanding of the safety of the ILP surgical and rehabilitation procedure while establishing standards and benchmark data for future studies focusing on design and infection of press-fit implants. Complementary observations of relationship between infection and cofounders such as loading of the prosthesis and prosthetic components used would be beneficial.Further definitive evidences of the clinical benefits with the latest design would be valuable, although an increase in health related quality of life and functional outcomes are likely to be confirmed. Altogether, the authors are providing compelling evidence that bone-anchored attachments particularly those relying on press-fit implants are an established alternative to socket prostheses.

Low-frequency electrical stimulation combined with a cooling vest improves recovery of elite kayakers following a simulated 1000-m race in a hot environment

This study compared the effects of a low-frequency electrical stimulation (LFES; Veinoplus® Sport, Ad Rem Technology, Paris, France), a low-frequency electrical stimulation combined with a cooling vest (LFESCR) and an active recovery combined with a cooling vest (ACTCR) as recovery strategies on performance (racing time and pacing strategies), physiologic and perceptual responses between two sprint kayak simulated races, in a hot environment (∼32 wet-bulb-globe temperature). Eight elite male kayakers performed two successive 1000-m kayak time trials (TT1 and TT2), separated by a short-term recovery period, including a 30-min of the respective recovery intervention protocol, in a randomized crossover design. Racing time, power output, and stroke rate were recorded for each time trial. Blood lactate concentration, pH, core, skin and body temperatures were measured before and after both TT1 and TT2 and at mid- and post-recovery intervention. Perceptual ratings of thermal sensation were also collected. LFESCR was associated with a very likely effect in performance restoration compared with ACTCR (99/0/1%) and LFES conditions (98/0/2%). LFESCR induced a significant decrease in body temperature and thermal sensation at post-recovery intervention, which is not observed in ACTCR condition. In conclusion, the combination of LFES and wearing a cooling vest (LFESCR) improves performance restoration between two 1000-m kayak time trials achieved by elite athletes, in the heat.

Phase accumulated carrier pulse width modulation

An alternative approach to digital PWM generation uses an accumulator rather than a counter to generate the carrier. This offers several advantages. The resolution and gain of the pulse width modulator remain constant regardless of the module clock frequency and PWM output frequency. The PWM resolution also becomes fixed at the register width. Even at high PWM frequencies, the resolution remains high when averaged over a number of PWM cycles. An inherent dithering of the PWM waveform introduced over successive cycles blurs the switching spectra without distorting the modulating waveform. The technique also lends itself to easily generating several phase shifted PWM waveforms suitable for multilevel converter modulation. Several example waveforms generated using both simulation and FPGA hardware are presented.

Inventing the Future: Intellectual Property and 3D Printing

A new technology – 3D printing – has the potential to make radical changes to aspects of the way in which we live. Put simply, it allows people to download designs and turn them into physical objects by laying down successive layers of material. Replacements or parts for household objects such as toys, utensils and gadgets could become available at the press of a button. With this innovation, however, comes the need to consider impacts on a wide range of forms of intellectual property, as Dr Matthew Rimmer explains. 3D Printing is the latest in a long line of disruptive technologies – including photocopiers, cassette recorders, MP3 players, personal computers, peer to peer networks, and wikis – which have challenged intellectual property laws, policies, practices, and norms. As The Economist has observed, ‘Tinkerers with machines that turn binary digits into molecules are pioneering a whole new way of making things—one that could well rewrite the rules of manufacturing in much the same way as the PC trashed the traditional world of computing.’

The PerCues framework and its application for sustainable mobility

This paper presents a framework, design and study of an ambient persuasive interface. We introduce a novel framework of persua sive Cues in Ambient Intelligence (perCues). Based on this framework we designed an application for mobile devices. The application aims to persuade people to abstain from using their cars and to use public mass transportation instead in order to reduce emissions. It contains a bus schedule and information about the pollution status. We evaluated the application in two successive studies regarding user acceptance, oppor tune moments of use and persuasive effects. The perCues received a high acceptance due to its benefit for the users. The results confirm the im portance of opportune moment and user acceptance for persuasion. The findings also indicate the persuasive potential of perCues.

Popper or Kuhn: Truth and the progress of science

The questions of whether science pursues truth as correspondence to reality and whether science in fact progresses towards attaining a truthful understanding of physical reality are fundamental and contested in the philosophy of science. On one side of the debate stands Popper, who argues that science is objective, necessarily assumes a correspondence theory of truth, and inevitably progresses toward truth as physical theories develop, gaining a more truthful understanding of reality through progressively more sophisticated empirical analysis. Conversely Kuhn, influenced by postmodern philosophy, argues that ultimate truth cannot be attained since no objective metaphysical reality exists and it cannot be known, and consequently the notion of scientific objectivity and "progress" is a myth, marred by philosophical and ideological value judgments. Ultimately, Kuhn reduces so-called scientific progress through the adoption of successive paradigms to leaps of "faith". This paper seeks a reconciliation of the two extremes, arguing that Popper is correct in the sense that science assumes a correspondence theory of truth and may progress toward truth as physical theories develop, while simultaneously acknowledging with Kuhn that science is not purely objective and free of value judgments. The notion of faith is also critical, for it was the acknowledgement of God's existence as the creator and instituter of observable natural laws which allowed the development of science and the scientific method in the first place. Therefore, accepting and synthesising the contentions that science is to some extent founded on faith, assumes and progresses toward truth, and is subject to value judgments is necessary for the progress of science.

Efficient probabilistic contingency analysis through a stability measure considering wind perturbation

The integration of stochastic wind power has accentuated a challenge for power system stability assessment. Since the power system is a time-variant system under wind generation fluctuations, pure time-domain simulations are difficult to provide real-time stability assessment. As a result, the worst-case scenario is simulated to give a very conservative assessment of system transient stability. In this study, a probabilistic contingency analysis through a stability measure method is proposed to provide a less conservative contingency analysis which covers 5-min wind fluctuations and a successive fault. This probabilistic approach would estimate the transfer limit of a critical line for a given fault with stochastic wind generation and active control devices in a multi-machine system. This approach achieves a lower computation cost and improved accuracy using a new stability measure and polynomial interpolation, and is feasible for online contingency analysis.

The association between student characteristics and the development of clinical reasoning in a graduate-entry, PBL medical programme

This study sought to assess the extent to which the entry characteristics of students in a graduate-entry medical programme predict the subsequent development of clinical reasoning ability. Subjects comprised 290 students voluntarily recruited from three successive cohorts of the University of Queensland's MBBS Programme. Clinical reasoning was measured once a year over a period of three years using two methods, a set of 10 Clinical Reasoning Problems (CRPs) and the Diagnostic Thinking Inventory (DTI). Data on gender, age at entry into the programme, nature of primary degree, scores on selection criteria (written examination plus interview) and academic performance in the first two years of the programme were recorded for each student, and their association with clinical reasoning skill analysed using univariate and multivariate analysis. Univariate analysis indicated significant associations between CRP score, gender and primary degree with a significant but small association between DTI and interview score. Stage of progression through the programme was also an important predictor of performance on both indicators. Subsequent multivariate analysis suggested that female gender is a positive predictor of CRP score independently of the nature of a subject's primary degree and stage of progression through the programme, although these latter two variables are interdependent. Positive predictors of clinical reasoning skill are stage of progression through the MBBS programme, female gender and interview score. Although the nature of a student's primary degree is important in the early years of the programme, evidence suggests that by graduation differences between students' clinical reasoning skill due to this factor have been resolved.

The hype cycle model: A review and future directions

The hype cycle model traces the evolution of technological innovations as they pass through successive stages pronounced by the peak, disappointment, and recovery of expectations. Since its introduction by Gartner nearly two decades ago, the model has received growing interest from practitioners, and more recently from scholars. Given the model's proclaimed capacity to forecast technological development, an important consideration for organizations in formulating marketing strategies, this paper provides a critical review of the hype cycle model by seeking evidence from Gartner's own technology databases for the manifestation of hype cycles. The results of our empirical work show incongruences connected with the reports of Gartner, which motivates us to consider possible future directions, whereby the notion of hype or hyped dynamics (though not necessarily the hype cycle model itself) can be captured in existing life cycle models through the identification of peak, disappointment, and recovery patterns.