OMERACT-OARSI Initiative: Osteoarthritis Research Society International set of responder criteria for osteoarthritis clinical trials revisited.

Background: The OARSI Standing Committee for Clinical Trials Response Criteria Initiative had developed two sets of responder criteria to present the results of changes after treatment in three symptomatic domains (pain, function, and patient's global assessment) as a single variable for clinical trials (1). For each domain, a response was defined by both a relative and an absolute change, with different cut-offs with regard to the drug, the route of administration and the OA localization. Objective: To propose a simplified set of responder criteria with a similar cut-off, whatever the drug, the route or the OA localization. Methods: Data driven approach: (1) Two databases were considered The 'elaboration' database with which the formal OARSI sets of responder criteria were elaborated and The 'revisit' database. (2) Six different scenarios were evaluated: The two formal OARSI sets of criteria Four proposed scenarios of simplified sets of criteria Data from clinical randomized blinded placebo controlled trials were used to evaluate the performances of the two formal scenarios with two different databases ('elaboration' versus 'revisit') and those of the four proposed simplified scenarios within the 'revisit' database. The placebo effect, active effect, treatment effect, and the required sample arm size to obtain the placebo effect and the active treatment effect observed were the performances evaluated for each of the six scenarios. Experts' opinion approach: Results were discussed among the participants of the OMERACT VI meeting, who voted to select the definite OMERACT-OARSI set of criteria (one of the six evaluated scenarios). Results: Data driven approach: Fourteen trials totaling 1886 CA patients and fifteen studies involving 8164 CA patients were evaluated in the 'elaboration' and the 'revisit' databases respectively. The variability of the performances observed in the 'revisit' database when using the different simplified scenarios was similar to that observed between the two databases ('elaboration' versus 'revisit') when using the formal scenarios. The treatment effect and the required sample arm size were similar for each set of criteria. Experts' opinion approach: According to the experts, these two previous performances were the most important of an optimal set of responder criteria. They chose the set of criteria considering both pain and function as evaluation domain and requiring an absolute change and a relative change from baseline to define a response, with similar cut-offs whatever the drug, the route of administration or the CA localization. Conclusion: This data driven and experts' opinion approach is the basis for proposing an optimal simplified set of responder criteria for CA clinical trials. Other studies, using other sets of CA patients, are required in order to further validate this proposed OMERACT - OARSI set of criteria. (C) 2004 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Desperately seeking the global subject: international education, citizenship and cosmopolitanism

This article takes the case of international education and Australian state schools to argue that the economic, political and cultural changes associated with globalisation do not automatically give rise to globally oriented and supra-territorial forms of subjectivity. The tendency of educational institutions such as schools to privilege narrowly instrumental cultural capital perpetuates and sustains normative national, cultural and ethnic identities. In the absence of concerted efforts on the part of educational institutions to sponsor new forms of global subjectivity, flows and exchanges like those that constitute international education are more likely to produce a neo-liberal variant of global subjectivity.

Computerizing the welfare state: An international comparison of computerization in social security

Although computer technology is central to the operation of the modern welfare state, there has been little analysis of its role or of the factors shaping the way in which it is used. Using data generated by expert informants from 13 OECD countries, this paper provides an indicative comparison of the aims of computerization in national social security systems over a 15-year period from 1985 to 2000. The paper seeks to identify and explain patterns in the data and outlines and examines four hypotheses. Building on social constructivist accounts of technology, the first three hypotheses attribute variations in the aims of computerization to different welfare state regimes, forms of capitalism, and structures of public administration. The fourth hypothesis, which plays down the importance of social factors, assumes that computerization is adopted as a means of improving operational efficiency and generating expenditure savings. The findings suggest that, in all 13 countries, computerization was adopted in the expectation that it would lead to increased productivity and higher standards of performance, thus providing most support for the fourth hypothesis. However, variations between countries suggest that the sociopolitical values associated with different welfare state regimes have also had some effect in shaping the ways in which computer technology has been used in national social security systems.

Administering Welfare Reform: International Transformations in Welfare Governance

While reforms of welfare policies have been widely analyzed, the reform of welfare administration has received far less attention. Using empirical case studies, this book provides significant new insights into the way welfare administration is being internationally transformed. Particular attention is given to the effect on welfare clients, staff, and agencies. The book presents a critical analysis of governance practices in welfare administration, examining shifts in the participants, practices, and processes. Administering Welfare Reform provides a much-needed international and comparative perspective of changing welfare governance.

Leadership across international borders: A case study of an environmental leader

This paper focuses on the story of a well-respected leader known for his tireless work in promoting and preserving the environment both within Australia and internationally. It highlights the contextual factors that have influenced and continue to influence his thinking about leadership as well as the key values he embodies as a leader. The paper begins by considering some of the salient leadership literature in the field. The next part of the paper reviews the qualitative methodology that steered the research for this paper. Following on, the paper provides a snapshot of the life forces and context that played an important role in shaping the leader’s views and practices. Finally, the paper provides an analytical discussion of the leader’s practices in the light of two well-known leadership frameworks.

Critical reflections on international collaborative research

The excitement and challenge of undertaking research is an integral part of an academic staff member’s role. There are a multitude of reasons which encourage academics to undertake collaborative research. These range from the enthusiasm that arises from particular discipline interests, through to the pressure from tertiary contexts to be actively engaged in research and to produce research outputs. This paper uses the experiences of an international academic research team to explore the nature of the collaborative academic research process, including the perils and pitfalls, as well as the joys and enthusiasms. The three researchers are convinced that there are many positives to be gained from international collaboration. By critically reflecting on the dynamics of the research process employed by the tri-national team, (as against the research project itself), and identifying ‘lessons learned’ by the researchers themselves, suggestions for productive and enjoyable research relationships are offered.