A Comparison of Methodologies from Two Longitudinal Community-Based Randomized Controlled Trials of Similar Interventions in Palliative Care: What Worked and What Did Not

Background: Methodological challenges such as recruitment problems and participant burden make clinical trials in palliative care difficult. In 2001-2004, two community-based randomized controlled trials (RCTs) of case conferences in palliative care settings were independently conducted in Australia-the Queensland Case Conferences trial (QCC) and the Palliative Care Trial (PCT). Design: A structured comparative study of the QCC and PCT was conducted, organized by known practical and organizational barriers to clinical trials in palliative care. Results: Differences in funding dictated study designs and recruitment success; PCT had 6 times the budget of QCC. Sample size attainment. Only PCT achieved the sample size goal. QCC focused on reducing attrition through gatekeeping while PCT maximized participation through detailed recruitment strategies and planned for significant attrition. Testing sustainable interventions. QCC achieved a higher percentage of planned case conferences; the QCC strategy required minimal extra work for clinicians while PCT superimposed conferences on normal work schedules. Minimizing participant burden. Differing strategies of data collection were implemented to reduce participant burden. QCC had short survey instruments. PCT incorporated all data collection into normal clinical nursing encounters. Other. Both studies had acceptable withdrawal rates. Intention-to-treat analyses are planned. Both studies included substudies to validate new outcome measures. Conclusions: Health service interventions in palliative care can be studied using RCTs. Detailed comparative information of strategies, successes and challenges can inform the design of future trials. Key lessons include adequate funding, recruitment focus, sustainable interventions, and mechanisms to minimize participant burden.

Perceptual speed does not cause intelligence, and intelligence does not cause perceptual speed

There is ongoing debate whether the efficiency of local cognitive processes leads to global cognitive ability or whether global ability feeds the efficiency of basic processes. A prominent example is the well-replicated association between inspection time (IT), a measure of perceptual discrimination speed, and intelligence (IQ), where it is not known whether increased speed is a cause or consequence of high IQ. We investigated the direction of causation between IT and IQ in 2012 genetically related subjects from Australia and The Netherlands. Models in which the reliable variance of each observed variable was specified as a latent trait showed IT correlations of -0.44 and -0.33 with respective Performance and Verbal IQ; heritabilities were 57% (IT), 83% (PIQ) and 77% (VIQ). Directional causation models provided poor fits to the data, with covariation best explained by pleiotropic genes (influencing variation in both IT and IQ). This finding of a common genetic factor provides a better target for identifying genes involved in cognition than genes which are unique to specific traits.

Degenerate dentition of the dugong (Dugong dugon), or why a grazer does not need teeth: morphology, occlusion and wear of mouthparts

The morphology and functional occlusion of the cheekteeth of 57 dugongs Dugong dugon of both sexes were examined using reflected light and scanning electron microscopy, radiography, hardness testing and skull manipulation. The functional morphology of the horny oral pads was also described. Mouthparts and body size allometry was examined for ontogenetic and gender-related trends. We found that the worn erupted cheekteeth of the dugong are simple flat pegs composed of soft degenerative dentine. During occlusion, the mandible moves in a mainly antero-lingual direction, with the possibility of mandibular retraction in some individuals. Anterior parts of the cheektooth row may become non-functional as a dugong ages. As a function of body size, dugong cheekteeth are extremely small compared with those of other mammalian herbivores, and with other hindgut fermenters in particular. The morphology, small size and occlusal variability of the cheekteeth suggest that there has not been strong selective pressure acting to maintain an effective dentition. In contrast, great development of the horny pads and associated skull parameters and their lower size variability suggest that the horny pads may have assumed the major role in food comminution.

Field observations of instantaneous water slopes and horizontal pressure gradients in the swash-zone

Field observations of instantaneous water surface slopes in the swash zone are presented. For free-surface flows with a hydrostatic pressure distribution the surface slope is equivalent to the horizontal pressure gradient. Observations were made using a novel technique which in its simplest form consists of a horizontal stringline extending seaward from the beach face. Visual observation, still photography or video photography is then sufficient to determine the surface slope where the free-surface cuts the line or between reference points in the image. The method resolves the mean surface gradient over a cross-shore distance of 5 m or more to within +/- 0.001, or 1/20th -1/100th of typical beach gradients. In addition, at selected points and at any instant in time during the swash cycle, the water surface slope can be determined exactly to be dipping either seaward or landward. Close to the location of bore collapse landward dipping water surface slopes of order 0.05-0.1 occur over a very small region (order 0.5 m) at the blunt or convex leading edge of the swash. In the middle and upper swash the water surface slope at this leading edge is usually very close to horizontal or slightly seaward. Behind the leading edge, the water surface slope was observed to be very close to horizontal or dipping seaward at all times throughout the swash uprush. During the backwash the water surface slope was observed to be always dipping seaward, approaching the beach slope, and remained seaward until a new uprush edge or incident bore passed any particular cross-shore location of interest. The observations strongly Suggest that the swash boundary layer is subject to an adverse pressure gradient during uprush and a favourable pressure gradient during the backwash. Furthermore, assuming Euler's equations are a good approximation in the swash, the observations also show that the total fluid acceleration is negative (offshore) for almost the whole of the uprush and for the entire backwash. The observations are contrary to recent work suggesting significant shoreward directed accelerations and pressure gradients occur in the swash (i.e., delta u/delta t > 0 similar to delta p/delta x < 0), but consistent with analytical and numerical solutions for swash uprush and backwash. The results have important implications for sediment transport modelling in the swash zone.

Why is economics not a complex systems science?

The article argues that economics will have to become a complex systems science before economists can comfortably incorporate institutionalist and evolutionary economics into mainstream theory. The article compares the complex adaptive system of John Foster with that of standard economic theory and illustrates the difference through an examination of familiar production function. The place of neoclassical, Keynesian economics in complex systems is considered. The article concludes that convincing, multiple models have been made possible by the increase in widely available computing power available.

Liberal Democracy and the Inferior 'Other'Other’: Could the peace liberal democracy promises to bring not extend to ‘Others’?

Advocates of liberal democracy argue that its principles and practices contribute directly to peace (at both inter-state and domestic levels). They rely on ideals such as the rule of law, institutional checks and balances on power, an ethos of tolerance, and free market economics to deliver the liberal peace. Liberals, however, overlook three important features embedded in the construction of liberal democracy which can serve to facilitate political violence: 1) the fixed and thus non-negotiable nature of liberal democracy’s core principles, 2) the inferior manner in which it conceives ‘Other’ social orders that do not share its core principles, and 3) the urge to proselytise Others. Together, these constitutive qualities can facilitate moves by leaders of Other groups to argue that liberal democracy threatens ‘their’ preferred identity, and thus its promised peaceful outcomes can be put in doubt.

Swash-aquifer interaction in the vicinity of the water table exit point on a sandy beach

The coupling of sandy beach aquifers with the swash zone in the vicinity of the water table exit point is investigated through simultaneous measurements of the instantaneous shoreline (swash front) location, pore pressures and the water table exit point. The field observations reveal new insights into swash-aquifer coupling not previously gleaned from measurements of pore pressure only. In particular, for the case where the exit point is seaward of the observation point, the pore pressure response is correlated with the distance between the exit point and the shoreline in that when the distance is large the rate of pressure drop is fast and when the distance is small the rate decreases. The observations expose limitations in a simple model describing exit point dynamics which is based only on the force balance on a particle of water at the sand surface and neglects subsurface pressures. A new modified form of the model is shown to significantly improve the model-data comparison through a parameterization of the effects of capillarity into the aquifer storage coefficient. The model enables sufficiently accurate predictions of the exit point to determine when the swash uprush propagates over a saturated or a partially saturated sand surface, potentially an important factor in the morphological evolution of the beach face. Observations of the shoreward propagation of the swash-induced pore pressure waves ahead of the runup limit shows that the magnitude of the pressure fluctuation decays exponentially and that there is a linear increase in time lags, behavior similar to that of tidally induced water table waves. The location of the exit point and the intermittency of wave runup events is also shown to be significant in terms of the shore-normal energy distribution. Seaward of the mean exit point location, peak energies are small because of the saturated sand surface within the seepage face acting as a "rigid lid'' and limiting pressure fluctuations. Landward of the mean exit point the peak energies grow before decreasing landward of the maximum shoreline position.

Effects of iron additions on filament growth and productivity of the cyanobacterium Lyngbya majuscula

The bioavailability of iron, in combination with essential macronutrients such as phosphorus, has been hypothesised to be linked to nuisance blooms of the toxic cyanobacterium Lyngbya majuscula. The present laboratory study used two biological assay techniques to test whether various concentrations of added iron (inorganic and organically chelated) enhanced L. majuscula filament growth and productivity (C-14-bicarbonate uptake rate). Organically chelated iron (FeEDTA) with adequate background concentrations of phosphorus and molybdenum caused the largest increases (up to 4.5 times the control) in L. majuscula productivity and filament growth. The addition of inorganic iron (without added phosphorus or molybdenum) also stimulated L. majuscula filament growth. However, overall the FeEDTA was substantially and significantly more effective in promoting L. majuscula growth than inorganic iron (FeCl3). The organic chelator (EDTA) alone and molybdenum alone also enhanced L. majuscula growth but to a lesser extent than the chelated iron. The results of the present laboratory study support the hypothesis that iron and chelating organic compounds may be important in promoting blooms of L. majuscula in coastal waters of Queensland, Australia.

Termination of real-time programs: Definitely, definitely not, or maybe

Real-time control programs are often used in contexts where (conceptually) they run forever. Repetitions within such programs (or their specifications) may either (i) be guaranteed to terminate, (ii) be guaranteed to never terminate (loop forever), or (iii) may possibly terminate. In dealing with real-time programs and their specifications, we need to be able to represent these possibilities, and define suitable refinement orderings. A refinement ordering based on Dijkstra's weakest precondition only copes with the first alternative. Weakest liberal preconditions allow one to constrain behaviour provided the program terminates, which copes with the third alternative to some extent. However, neither of these handles the case when a program does not terminate. To handle this case a refinement ordering based on relational semantics can be used. In this paper we explore these issues and the definition of loops for real-time programs as well as corresponding refinement laws.