Ascertainment of cause-specific mortality in COPD - operations of the TORCH clinical endpoint Committee

Background: TORCH (Towards a Revolution in COPD Health) is an international multicentre, randomised, placebo-controlled clinical trial of inhaled fluticasone propionate/salmeterol combination treatment and its monotherapy components for maintenance treatment of moderately to severely impaired patients with chronic obstructive pulmonary disease (COPD). The primary outcome is all-cause mortality. Cause-specific mortality and deaths related to COPD are additional outcome measures, but systematic methods for ascertainment of these outcomes have not previously been described. Methods: A Clinical Endpoint Committee (CEC) was tasked with categorising the cause of death and the relationship of deaths to COPD in a systematic, unbiased and independent manner. The key elements of the operation of the committee were the use of predefined principles of operation and definitions of cause of death and COPD-relatedness; the independent review of cases by all members with development of a consensus opinion; and a substantial infrastructure to collect medical information. Results: 911 deaths were reviewed and consensus was reached in all. Cause-specific mortality was: cardiovascular 27%, respiratory 35%, cancer 21%, other 10% and unknown 8%. 40% of deaths were definitely or probably related to COPD. Adjudications were identical in 83% of blindly re-adjudicated cases ( = 0.80). COPD-relatedness was reproduced 84% of the time ( = 0.73). The CEC adjudication was equivalent to the primary cause of death recorded by the site investigator in 52% of cases. Conclusion: A CEC can provide standardised, reliable and informative adjudication of COPD mortality that provides information which frequently differs from data collected from assessment by site investigators.

Nitrogen budget for the Oldman River Basin, southern Alberta, Canada

The Oldman River Basin (OMRB), located in southern Alberta (Canada), with an area of 28,200 km2, is mainly forested in its western part and is used for intensive agriculture in its eastern part. The objective of this paper is to estimate the nitrogen (N) budget for the Oldman River Basin as a whole and its sub-basins, and to discuss differences in the N budget between various sub-basins. Better knowledge of the N budget in this watershed may be also utilized for understanding N dynamics in similar watersheds within semi-arid climatic regions. The model used is a mass balance spreadsheet model that takes into account N inputs and N export through surface water. During the last 120 years, anthropogenic N inputs to the OMRB have increased circa 40 fold. By the end of the 20th century, the OMRB received an annualN input of about 5174 kg N km-2 yr-1, whereas only about 25 kg N km-2 yr-1 were exported via riverine flow. For the sub-basins, annual N inputs ranged from 2516 to 19011 kg N km-2 yr-1, and annual N export via riverine flows varied between 6 and 277 kg N km-2 yr-1. Over 85% of total N inputs to the OMRB are due to anthropogenic activities, including manure (55%), synthetic fertilizer (27%), and N fixation on agricultural lands (4%). Sewage accounted for less than 1%, and N inputs from atmospheric deposition and fixation in forests represented 6 and 8% respectively. Despite increasing anthropogenic N inputs, N export with riverine flow currently accounts for only 1% of the inputs, indicating thatmost of theNinputs are currently retained in the OMRB or are re-emitted into the atmosphere.

Application of Heuristic Evaluation Method by Universal Design Experts

This study highlights how heuristic evaluation as a usability evaluation method can feed into current building design practice to conform to universal design principles. It provides a definition of universal usability that is applicable to an architectural design context. It takes the seven universal design principles as a set of heuristics and applies an iterative sequence of heuristic evaluation in a shopping mall, aiming to achieve a cost-effective evaluation process. The evaluation was composed of three consecutive sessions. First, five evaluators from different professions were interviewed regarding the construction drawings in terms of universal design principles. Then, each evaluator was asked to perform the predefined task scenarios. In subsequent interviews, the evaluators were asked to re-analyze the construction drawings. The results showed that heuristic evaluation could successfully integrate universal usability into current building design practice in two ways: (i) it promoted an iterative evaluation process combined with multi-sessions rather than relying on one evaluator and on one evaluation session to find the maximum number of usability problems, and (ii) it highlighted the necessity of an interdisciplinary ad hoc committee regarding the heuristic abilities of each profession. A multi-session and interdisciplinary heuristic evaluation method can save both the project budget and the required time, while ensuring a reduced error rate for the universal usage of the built environments.

The Responses of States to the Comments of the CEDAW Committee on Domestic Violence

This article examines the question of how states have responded to the comments of the United Nations Committee on the Elimination of Discrimination against Women (CEDAW Committee) on the issue of domestic violence, through an analysis of 11 Western European States. It is argued that the majority of the states surveyed are complying with only some of the recommendations of the Committee in relation to domestic violence. This finding serves to highlight the fact that there are certainly major difficulties regarding the implementation of human rights law. This article focuses on the Concluding Observations made by the CEDAW Committee on the reports submitted by the Member States, and problems surrounding these Concluding Observations and the work of the Committee are also examined.

Integrating Human Rights? Socio-Economic Rights and Budget Analysis

This article explores an opportunity for mutual learning between the fields of human rights law and economic analysis. Specifically it considers how economic techniques might be used to appraise public expenditure in line with international obligations arising from the International Covenant on Economic, Social and Cultural Rights 1966 (ICESCR). Our argument is that such tools do have the potential to contribute to this aim, but that embedding them within government budget processes through “human rights mainstreaming” may prove problematic in practice. We therefore suggest, as part of a broader strategy which includes judicial enforcement, that mainstreaming initiatives and budget analysis can be useful as complementary tools for the full realisation of all human rights.

How Effective is the United Nations Committee Against Torture?

This article examines the question of how states have responded to the comments of the United Nations Committee against Torture through an analysis of eight Western European states. It concludes that the Committee’s recommendations have had a substantial impact in four of the states surveyed, however only a limited effect in two other states and little or no impact in the two remaining states. These findings lead to concerns as regards the effectiveness of the Committee against Torture. The article focuses on the Concluding Observations made by the Committee on the reports submitted by the states in question.