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.

Fighting, anger, frustration and tears: Matthew's story of hegemonic masculinity

This paper draws on Matthew's story to illustrate the conflicting discourses of being a boy and being a student. Matthew is 12 years old and in Grade Six, his final year at Banrock Primary ( a K- 6 Australian State School). School is far from a happy place for Matthew - his tearful accounts of his combative relationships with his peers and his teacher highlight his emotional distress. The paper's analytic focus draws attention to some of the ways Matthew's harmful storylines of hegemonic masculinity are made possible through, in particular, his teacher's gendered philosophies and her strategies of individualism and control. In this regard, Matthew's story provides insight into the potentially counterproductive realities of teacher practice in relation to addressing issues of masculinity within the school environment. Against this backdrop, the paper stresses the importance of teachers drawing on a sound research-based framework of gender knowledges that can illuminate how masculinities are constructed, regulated and, indeed, transformed through the power relations of everyday social practice, including teacher practice.

Zinc and vitamin A supplementation in Indigenous Australian children hospitalised with lower respiratory tract infection: a randomised controlled trial

Objective: To evaluate the efficacy of supplementation with zinc and vitamin A in Indigenous children hospitalised with acute lower respiratory infection (ALRI). Design: Randomised controlled, 2-by-2 factorial trial of supplementation with zinc and vitamin A. Setting and participants: 187 Indigenous children aged < 11 years hospitalised with 215 ALRI episodes at Alice Springs Hospital (April 2001 to July 2002). Interventions: Vitamin A was administered on Days 1 and 5 of admission at a dose of 50 000 IU (infants under 12 months), or 100 000 IU; and zinc sulfate was administered daily for 5 days at a daily dose of 20 mg (infants under 12 months) or 40 mg. Main outcome measure: Time to clinical recovery from fever and tachypnoea, duration of hospitalisation, and readmission for ALRI within 120 days. Results: There was no clinical benefit of supplementation with vitamin A, zinc or the two combined, with no significant difference between zinc and no-zinc, vitamin A and no-vitamin A or zinc + vitamin A and placebo groups in time to resolution of fever or tachypnoea, or duration of hospitalisation. Instead, we found increased morbidity; children given zinc had increased risk of readmission for ALRI within 120 days (relative risk, 2.4; 95% CI, 1.003–6.1). Conclusion: This study does not support the use of vitamin A or zinc supplementation in the management of ALRI requiring hospitalisation in Indigenous children living in remote areas. Even in populations with high rates of ALRI and poor living conditions, vitamin A and zinc therapy may not be useful. The effect of supplementation may depend on the prevalence of deficiency of these micronutrients in the population.

From bush to bouquet: The relevance of market research

‘Adopt a consumer focus’ is the mantra that pervades the commercialisation strategies of horticultural products world-wide, but does this translate into practice in small and medium enterprises or is the process still production driven? Typically, new products in floriculture are modifications of existing products, which are introduced to existing markets, where consumers’ needs are well understood. Under these circumstances, the traditional role of market research is marginalised. In contrast, the commercialisation of ‘true’ new products into new markets involves a greater effort. Here, market research can identify market segments that are more receptive to innovation and experimentation. In this paper, the authors draw upon preliminary research and their initial experiences in the commercialisation of an Australian native flower to examine the inter-play of information flows and new product development.

Language, respect and the power of protest: Linguistic stereotyping and people with disabilities in Japan

Discriminatory language became an important social issue in the west in the late twentieth century, when debates on political correctness and minority rights focused largely on the issue of respect in language. Japan is often criticized for having made only token attempts to address this issue. This paper investigates how one marginalized group—people with disabilities—has dealt with discriminatory and disrespectful language. The debate has been played out in four public spaces: the media, the law, literature, and the Internet. The paper discusses the kind of language, which has generated protest, the empowering strategies of direct action employed to combat its use, and the response of the media, the bureaucracy, and the literati. Government policy has not kept pace with social change in this area; where it exists at all, it is often contradictory and far from clear. I argue that while the laws were rewritten primarily as a result of external international trends, disability support groups achieved domestic media compliance by exploiting the keen desire of media organizations to avoid public embarrassment. In the absence of language policy formulated at the government level, the media effectively instituted a policy of self-censorship through strict guidelines on language use, thereby becoming its own best watchdog. Disability support groups have recently enlisted the Internet as an agent of further empowerment in the ongoing discussion of the issue.

The arithmetic of receiver scheduling for electronic support

In Electronic Support, it is well known that periodic search strategies for swept-frequency superheterodyne receivers (SHRs) can cause synchronisation with the radar it seeks to detect. Synchronisation occurs when the periods governing the search strategies of the SHR and radar are commensurate. The result may be that the radar is never detected. This paper considers the synchronisation problem in depth. We find that there are usually a finite number of synchronisation ratios between the radar’s scan period and the SHR’s sweep period. We develop three geometric constructions by which these ratios can be found and we relate them to the Farey series. The ratios may be used to determine the intercept time for any combination of scan and sweep period. This theory can assist the operator of an SHR in selecting a sweep period that minimises the intercept time against a number of radars in a threat emitter list.