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.

Accuracy of Death Certificates in COPD: Analysis from the TORCH Trial

The Towards a Revolution in COPD Health (TORCH) trial was an international clinical trial of chronic obstructive pulmonary disease (COPD) patients where cause of death was assigned by an independent committee. Comparison of death certificate data and adjudicated cause of death allows a unique opportunity to determine death certificate accuracy and frequency of COPD listing on death certificates of COPD patients. In this analysis, the authors determine the concordance between adjudicated cause of death and primary and secondary cause of death from death certificates. In 317 (80%) of informative deaths, the primary or secondary cause of death from certificates agreed with adjudicated cause of death. Only 229 (58%) of death certificates in these COPD patients listed COPD on the certificate. COPD was not listed on the death certificate in 21% of deaths adjudicated to be caused by COPD exacerbation. Compared with pulmonary causes, the listing of COPD on certificates occurred with less frequency than cardiovascular, cancer and other categories of death. The combined primary and secondary listing on death certificates has good concordance with actual cause of death. COPD is under-reported on death certificates, and this under-reporting is more frequent when the primary cause of death is not pulmonary.

Revolt and Revolution: the place of Islamism

The outbreak of revolt and revolution in the Middle East has given rise to a re-consideration of threat and security analyses as they pertain to the region and beyond. The resilience of some authoritarian regimes and the rapid collapse of others signal a significant transition within the region to which jihadi Islamist groups form one part of a powerful matrix. This article analyses the part and place of jihadi Islamism and Islamisms more generally in the revolts and revolutions. The article contends that events provide both opportunities and threats in strategies aimed at countering terrorism in the Middle East.

Right to War in the Islamic Tradition:Jihad and its Compatibility with Modern International Law (will be submitted to the publisher in April 2014)

In the last century, Islam drew the world’s attention though such phenomena as the Islamic revolution in Iran, the fierce Muslim resistance against the Soviet invasion of Afghanistan, and the assassination of Egypt’s President Sadat by a radical Islamic group. But it was when Osama Bin Laden and his organization Al Qaeda were established to have been behind the 11 September attacks in the US, the age-old images of Islam, the fanatical and belligerent religion threatening what the Western world stands for, were revitalized. The impact of 9/11 attacks was so great that even balanced portrayals of Islam were eclipsed by stereotypical images of a fundamental, anti-Western and warmongering religion that bore the hallmarks of medieval prejudices and rhetoric. The popular image tailored for the Western audience reflected Islam as monolithic, intrinsically aggressive, and determined to engage in religious wars against the interests and values of the Western civilisation.
This book intends to help reduce, at least to a reasonable degree, the impact of sweeping, and at times tendentious, generalisations about Islamic laws of warfare. The main purpose of this book is to place the legal, cultural and historical practices of Islamic wars in their broader socio-political contexts, thereby establishing that there has been no undisputed understanding of what defensive or aggressive warfare entails in Islam, whether in doctrine or in practice.

Heterogeneous error-resilient scheme for spectral analysis in ultra-low power wearable electrocardiogram devices

Wearable devices performing advanced bio-signal analysis algorithms are aimed to foster a revolution in healthcare provision of chronic cardiac diseases. In this context, energy efficiency is of paramount importance, as long-term monitoring must be ensured while relying on a tiny power source. Operating at a scaled supply voltage, just above the threshold voltage, effectively helps in saving substantial energy, but it makes circuits, and especially memories, more prone to errors, threatening the correct execution of algorithms. The use of error detection and correction codes may help to protect the entire memory content, however it incurs in large area and energy overheads which may not be compatible with the tight energy budgets of wearable systems. To cope with this challenge, in this paper we propose to limit the overhead of traditional schemes by selectively detecting and correcting errors only in data highly impacting the end-to-end quality of service of ultra-low power wearable electrocardiogram (ECG) devices. This partition adopts the protection of either significant words or significant bits of each data element, according to the application characteristics (statistical properties of the data in the application buffers), and its impact in determining the output. The proposed heterogeneous error protection scheme in real ECG signals allows substantial energy savings (11% in wearable devices) compared to state-of-the-art approaches, like ECC, in which the whole memory is protected against errors. At the same time, it also results in negligible output quality degradation in the evaluated power spectrum analysis application of ECG signals.

Scientific revolutions, progess and accounting research

Thomas Kuhn’s concept of a normal science paradigm has been utilised and criticised across a range of social science fields. However, Kuhn’s aim was to argue that science progresses not in an incremental manner but through a series of paradigms that need a revolution in thought to shift from one to the next. This paper addresses Kuhn’s work focusing on the totality of his model, but recognising the ambiguities concerning paradigm shifts that have led to charges of relativism. To address this weakness an argument is advanced for a political economy analysis of the publication process and the development of critical accounting research centred on human emancipation. The paper concludes with some suggested research agendas particularly relevant to the Irish context.

Overview on bio-based building material made with plant aggregate

Global warming, energy savings, and life cycle analysis issues are factors that have contributed to the rapid expansion of plant-based materials for buildings, which can be qualified as environmental-friendly, sustainable and efficient multifunctional materials. This review presents an overview on the several possibilities developed worldwide about the use of plant aggregate to design bio-based building materials. The use of crushed vegetal aggregates such as hemp (shiv), flax, coconut shells and other plants associated to mineral binder represents the most popular solution adopted in the beginning of this revolution in building materials. Vegetal aggregates are generally highly porous with a low apparent density and a complex architecture marked by a multi-scale porosity. These geometrical characteristics result in a high capacity to absorb sounds and have hygro-thermal transfer ability. This is one of the essential characteristics which differ of vegetal concrete compared to the tradition mineral-based concretes. In addition, the high flexibility of the aggregates leads to a non-fragile elasto-plastic behavior and a high deformability under stress, lack of fracturing and marked ductility with absorbance of the strains ever after having reached the maximum mechanical strength. Due to the sensitivity to moisture, the assessment of the durability of vegetal concrete constitutes one of the next scientific challenging of bio-based building materials.