Cautionary tales in the interpretation of systematic reviews of therapy trials

This is the second in a series of articles emphasizing the cautions in the interpretation of health-care studies. Systematic reviews are presented as comprehensive, unbiased summaries of evidence and are often referred to by clinicians, guideline developers and health policy-makers. Their strengths and limitations, and how their results can be subject to bias and misinterpretation, are discussed.

Student expectations of TESOL programs: Student and teacher perspectives

Most practitioners teaching English to speakers of other languages (TESOL) will agree that students come with some expectations about course content and teaching methodology and that these expectations play a vital role in student motivation and learning. However, the study of student expectations has been a surprising omission from Second Language Acquisition research. In the studies reported here, the authors develop a model of student expectations by adapting the Expectation Disconfirmation paradigm, widely used in consumer psychology. Student and teacher perspectives on student expectations were gathered by interviews. Responses shed light on the nature of expectations, factors causing expectations and effects of expectation fulfilment (or lack of it). The findings provide new avenues for research on affective factors as well as clarify some ambiguities in motivational research in second language acquisition. The model presented here can be used by teachers or institutions to conduct classroom-based research, thus optimising students' learning and performance, and enhancing student morale.

An experiment in the design of distributed programs

This paper describes an experiment in the design of distributed programs. It is based on the theory of Owicki and Gries extended with rules for reasoning about message passing. The experiment is designed to test the effectiveness of the extended theory for designing distributed programs.

Improving supportive care for women with breast cancer in Australia: The challenge of modifying health systems

Although the benefits of many psychosocial support strategies in improving well being in women with breast cancer have been demonstrated, few women receive these programs as part of routine care. This paper provides some recommendations, based on experience in Australia, about how access to evidence-based supportive care strategies might be improved through modification of health systems. It demonstrates the paucity of research about the costs and health service implications of psychosocial support strategies, which is vital to health planning and service delivery change. It outlines the systematic approach taken in Australia to improving psychosocial support nationally by: the development of research reviews; preparation of guidelines about supportive care, implementation of programs to foster the adoption of guidelines through modification of policy, health service delivery and clinician training; and monitoring programs. Coalitions of government, health care professionals and consumers are key to effective lobbying for change. If all women with breast cancer are to receive better supportive care, there is a need for approaches which: refocus the research effort in psycho-oncology; develop more strategic approaches to generating change in health systems and health policy and foster partnerships to advocate for improved resources. Copyright (C) 2003 John Wiley Sons, Ltd.

Distribution of major health risks: findings from the global burden of disease study

Background Most analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness. Methods and Findings For 26 selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%-61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1-3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median. Conclusions Many major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden.

High performance sport coaching: Institutes of sport as sites for learning

There has been a marked increase in the number of government-funded, high performance institutes and academies of sport within Australia. Given that these organisations employ significant numbers of full-time performance sport coaches, they may be accurately characterised as workplaces. Performance sport coaches have underscored the importance of experience in developing their coaching skill. However, despite wide acceptance of the view that learning occurs everywhere but to different extents and with different efficiency, and the acknowledgement of current national coach education programs as insufficient, no sport coaching research has focused specifically on sport workplaces as sites for learning. This paper will review the current nature of coach development with a view to examining the interaction between what the workplace (institute/academy) affords the individual and the personal agency of the individual (high performance sports coaches).

The effect of enacted capabilities on adoption of a government electronic procurement system by Malaysian SMEs

Prior studies have shown that innovative information systems (IS) adoption behaviour by small-and medium-sized enterprises (SMEs) is greatly dependent on organizational and environmental characteristics. Government influence (i.e., federal and local government agencies) was found to play an important role in the promotion or enforcement of innovative IS adoption by SMEs, and it is vital for ensuring adoption of nationwide innovative IS, particularly in developing economies. This study introduces the construct of enacted capabilities and examines the enacted capabilities that motivate SMEs to use innovative IS (i.e., a government's electronic procurement systems) to its full potential. A model of how enacted capabilities affect IS adoption behaviour through perceived net benefits and attitude is developed. A survey (and follow-up interviews) of CEOs/owners from Malaysian SMEs was conducted. Results indicate the enacted capabilities possessed by SMEs play a prominent role in determining the adoption of government electronic procurement systems by these enterprises.

Progress in deriving concurrent programs: Emphasizing the role of stable guards

We present some techniques to obtain smooth derivations of concurrent programs that address both safety and progress in a formal manner. Our techniques form an extension to the calculational method of Feijen and van Casteren using a UNITY style progress logic. We stress the role of stable guards, and we illustrate the derivation techniques on some examples in which progress plays an essential role.