Missing steps in a staircase: a qualitative study of the perspectives of key stakeholders on the use of adaptive designs in confirmatory trials

Background Despite the promising benefits of adaptive designs (ADs), their routine use, especially in confirmatory trials, is lagging behind the prominence given to them in the statistical literature. Much of the previous research to understand barriers and potential facilitators to the use of ADs has been driven from a pharmaceutical drug development perspective, with little focus on trials in the public sector. In this paper, we explore key stakeholders’ experiences, perceptions and views on barriers and facilitators to the use of ADs in publicly funded confirmatory trials. Methods Semi-structured, in-depth interviews of key stakeholders in clinical trials research (CTU directors, funding board and panel members, statisticians, regulators, chief investigators, data monitoring committee members and health economists) were conducted through telephone or face-to-face sessions, predominantly in the UK. We purposively selected participants sequentially to optimise maximum variation in views and experiences. We employed the framework approach to analyse the qualitative data. Results We interviewed 27 participants. We found some of the perceived barriers to be: lack of knowledge and experience coupled with paucity of case studies, lack of applied training, degree of reluctance to use ADs, lack of bridge funding and time to support design work, lack of statistical expertise, some anxiety about the impact of early trial stopping on researchers’ employment contracts, lack of understanding of acceptable scope of ADs and when ADs are appropriate, and statistical and practical complexities. Reluctance to use ADs seemed to be influenced by: therapeutic area, unfamiliarity, concerns about their robustness in decision-making and acceptability of findings to change practice, perceived complexities and proposed type of AD, among others. Conclusions There are still considerable multifaceted, individual and organisational obstacles to be addressed to improve uptake, and successful implementation of ADs when appropriate. Nevertheless, inferred positive change in attitudes and receptiveness towards the appropriate use of ADs by public funders are supportive and are a stepping stone for the future utilisation of ADs by researchers.

Age and firm growth: evidence from three European countries

This article provides new insights into the dependence of firm growth on age along the entire distribution of growth rates, and conditional on survival. Using data from the European firms in a global economy survey, and adopting a quantile regression approach, we uncover evidence for a sample of French, Italian and Spanish manufacturing firms with more than ten employees in the period from 2001 to 2008. We find that: (1) young firms grow faster than old firms, especially in the highest growth quantiles; (2) young firms face the same probability of declining as their older counterparts; (3) results are robust to the inclusion of other firms’ characteristics such as labor productivity, capital intensity and the financial structure; (4) high growth is associated with younger chief executive officers and other attributes that capture the attitude of the firm toward growth and change. The effect of age on firm growth is rather similar across countries.

Imagined Comrades and Imaginary Protections

This paper describes the recent development of identity and community among gay men in China. It focuses both on the ways emerging forms of gay identity relate to larger ideological and discursive shifts within society, and on the ways these new forms of identity and community affect situated social interaction among gay men themselves. In particular, it addresses the question of how these emerging forms of gay identity and gay community affect the ways gay men in China understand the threat of HIV and make concrete decisions about sexual risk and safety. Among the chief tactics used by gay men in China to forge identity and community involves appropriating and adapting elements from dominant discourses of the Party-State and the mass media. This strategy has opened up spaces within which gay men can claim “cultural citizenship” in a society in which they have been heretofore marginalized. At the same time, this strategy also implicated in the formation of attitudes and social practices that potentially increase the vunerability of Chinese gay men to HIV infection.

Opposite effects of fasting on TGF-beta 3 and T beta RI distribution in the gastric mucosa of suckling and early weanling rats

Objective: Our aim was to evaluate the effects of a dietary regimen (suckling or early weaning) and feeding status (fed or fasted) on the distribution of transforming growth factor-beta 3 (TGF-beta 3) and TGF receptor-I (T beta RI) in the gastric epithelium of pups Methods: Wistar rats were used At 15 d, half of the pups were separated from dams and fed with hydrated powered chow On day 17, suckling and early weanling rats were subjected to fasting (17 h). Four different conditions were established. suckling fed and fasted and early weanling fed and fasted At 18 d stomachs were collected under anesthesia and were fixed in 4% formaldehyde for immunohistochemistry The number of immunostained epithelial cells per microscopic field was determined for TGF-beta 3 and T beta RI in longitudinal sections from the gastric mucosa Results: We found that during suckling, fasting reduced the number of immunolabeled cells per field of both molecules when compared with the fed group (P < 0.05), whereas in early weaning, food restriction increased TGF-beta 3 and T beta RI distributions (P < 0.05) We also observed that TGF-beta 3 and T beta RI were more concentrated in parietal cells in the upper gland in suckling pups, whereas after early weaning these were displaced to parietal and chief cells at the bottom of the gland Conclusion: Suckling and early weaning directly influence TGF-beta 3 and T beta RI distributions in the gastric epithelium in response to fasting, such that early weaning anticipates the effects observed in adult rats. Furthermore, the differential concentrations of TGF-beta 3 and T beta RI indicate that they might be important for cell proliferation events in growth control (C) 2010 Elsevier Inc. All rights reserved

Universal trend for heavy-ion total reaction cross-sections at energies above the Coulomb barrier

Heavy-ion total reaction cross-section measurements for more than 1100 reaction cases covering 61 target nuclei in the range (6)Li-(238)U and 158 projectile nuclei from (2)H to (84)Kr (mostly exotic ones) have been analyzed in a systematic way by using an empirical, three-parameter formula that is applicable to the cases of projectile kinetic energies above the Coulomb barrier. The analysis has shown that the average total nuclear binding energy per nucleon of the interacting nuclei and their radii are the chief quantities that describe the cross-section patterns. A great amount of cross-section data (87%) has been quite satisfactorily reproduced by the proposed formula; therefore, the total reaction cross-section predictions for new, not yet experimentally investigated reaction cases can be obtained within 25% (or much less) uncertainty.

Werv Magazine : layout och koncept av ett nytt livsstilsmagasin för tjejer inom brädsporter.

Currently there is no Swedish boardsport magazine for women. In this degree project a prototype of a new lifestyle magazine for women in boardsports has been created. Through a magazine study and a targetgroup survey we have found a magazine concept and suggestions for the magazine content. A digital 96-page prototype has been created. The feedback from Anders Neuman-Östberg, the experienced editor in chief of the Swedish boardsport magazine Transistion gives the project report the needed credibility.The overall response from all the people involved in the making of this prototype has been positive. We can see a market demand for a magazine like Werv and hope that we can find a way to publish it in the future. In this degree project we haven't looked into the economic sustainability and therefore we can't say if it's feasible. Further investigations are needed before Werv can be published.

Al-Mahdi - Gestalt och budskap : En litteraturstudie jämförande sudanesisk Mahdi och indisk Mahdi inom islam

Followers of three world religions, Judaism, Christianity and Islam are waiting for the Messiah. Muslims are even waiting for aspiritual leader al-Mahdi. Two different persons claimed the title of al-Mahdi, at the end of the nineteenth century. Theyappeared almost at the same time, at the totally different places of the earth, with a completely different message and underthe rule of the British colonial power. The aim of the study is to compare the both religious figures, Mirza Ghulam Ahmadfrom India and Muhammad Ahmad from Sudan regarding their different messages, to illustrate the social, political andreligious factors that lead to the entirely different profile and image of these two men and how their organizations havedeveloped after their death up till today. The result shows that the Sudanese Mahdi Muhammad Ahmad claimed hisMahdiship in the year 1881. He became a political leader in a time when Sudan was under the rule of a colonial power. Hetook advantage of the religion for personal purposes and tried to liberate his native country Sudan. The contemporaryMuslim clergy criticized him for his claim because the content of the Hadith traditions did not support his claim ofMahdiship. He maintained his sole right for the interpretation of religion and of the laws of Sharia. He made changes even inthe chief pillars of Islam by asserting that Jehad with sword was more imperative than the pilgrimage journey to Mecca. Heasserted that the Prophet Muhammad himself had entrusted him to launch the holy war against the non-believers. He hadimmense ambitions which were never fulfilled since he suddenly died four years after his claim for Mahdiship, in June 1885.This day his followers are organized as a political party in Sudan with a modest roll in the Sudanese politics. The IndianMahdi Mirza Ghulam Ahmad claimed in 1889 to be Mahdi, Mujaddid, Muhaddas, Messiah and a Prophet at a time of socialand political peace, though Islam as a religion was firmly pushed by the Hindu and Christian missionaries. He had no politicalambitions at all and was utterly loyal to the British colonial power. His mission was to crush the Cross and to demonstrateIslam’s excellence over all the religions of the world through overwhelming arguments. He proclaimed that Jesus was humanand a Prophet and not the son of God. Jesus survived from the cross and died a natural death after he had lived for manyyears. Ahmad claimed that God had commanded him to put stop to the religious wars. The contemporary Muslim clergyblamed him for being an imposter, melancholic and hypochondriac who had self invented the divine revelations. He died year1908, nineteen years after his claim and the communion he found is established today in more than hundred countries of theworld. Reasons for the breakdown of mission of the Sudanese Mahdi were that his objectives were political and he challengedthe colonial power with the sword. Another decisive factor was his sudden death merely four years after the beginning of hismission. Reasons for the success of Indian Mahdi were that his objectives were purely religious and he was wholly loyal to theforeign government. He survived nineteen years after the beginning of his mission which made it possible for him to create acommunion based on solid grounds. His followers continued on the same path and never engaged in local politics where everthey lived. For further studies it will be of great interest to study the life of Mirza Ghulam Ahmad and objectively examine thearguments he presented in support of his divine appointment. Furthermore it is enriching to study the organization andactivities of the Ahmadiyya Muslim community to explore if they are in accordance with the basic principles of Ahmad.

Who Should do What to Whom? : Occupational Groups´Views on Special Needs

The overall aim of this thesis is to increase our knowledge of different occupational groups´ views on work with children in need of special support. This is explored in four separate studies. The first study investigates the views of occupational groups in preschools and schools in one municipality. A questionnaire was handed out to all personnel (N=1297) in the municipality in 2008 (72.5 % response rate). The second study explores the views of educational leaders (N=45) in the same municipality. Questionnaire # 2 was distributed in 2009. All the educational leaders responded to the questionnaire. The third study describes the views of different occupational groups concerning special educational needs coordinators´ (SENCOs) role and work. This was highlighted by comparing responses from questionnaire #1 and # 2. Responses concerning SENCOs´ work were also added using a third questionnaire. This questionnaire was handed out in 2006 to chief education officers (N=290) in all municipalities in Sweden. The response rate was 90.3%. Finally, the fourth study presents five head teachers´ descriptions of their work with special needs issues. Study four was a follow-up study of questionnaire # 2. These head teachers were selected because of their inclusive values and because they seemed to be effective according to certain criteria. They were interviewed in January 2012. The results reveal a number of interesting findings. For example, there are both similar and different views among the occupational groups concerning work with children in need of special support. A majority of the respondents in all groups state that children´s individual deficiencies is one common reason why children need special support in preschools/schools. Differences between the occupational groups become especially visible regarding their views of SENCOs‟ work. Critical pragmatism (Cherryholmes, 1988) is applied as a theoretical point of departure. Skrtic´s (1991) critical reading and analysis of special education relative to general education is specifically used to interpret and discuss the outcome of the studies. Additionally, Abbott´s (1988) reasoning concerning the “division of expert labor” is used to discuss the occupational groups´ replies concerning “who should do what to whom”. The findings in the studies are contextualized and theoretically interpreted in the separate articles. However in the first part of this thesis (in Swedish: Kappa), the theoretical interpretations of the empirical outcome are discussed in more detail and the results are further contextualized and synthesised. Inclusion and premises for inclusive education are also discussed in more depth in the first part of the present thesis.

Emergency department triage scales and their components : a systematic review of the scientific evidence

Emergency department (ED) triage is used to identify patients' level of urgency and treat them based on their triage level. The global advancement of triage scales in the past two decades has generated considerable research on the validity and reliability of these scales. This systematic review aims to investigate the scientific evidence for published ED triage scales. The following questions are addressed: 1. Does assessment of individual vital signs or chief complaints affect mortality during the hospital stay or within 30 days after arrival at the ED? 2. What is the level of agreement between clinicians' triage decisions compared to each other or to a gold standard for each scale (reliability)? 3. How valid is each triage scale in predicting hospitalization and hospital mortality? A systematic search of the international literature published from 1966 through March 31, 2009 explored the British Nursing Index, Business Source Premier, CINAHL, Cochrane Library, EMBASE, and PubMed. Inclusion was limited to controlled studies of adult patients (≥15 years) visiting EDs for somatic reasons. Outcome variables were death in ED or hospital and need for hospitalization (validity). Methodological quality and clinical relevance of each study were rated as high, medium, or low. The results from the studies that met the inclusion criteria and quality standards were synthesized applying the internationally developed GRADE system. Each conclusion was then assessed as having strong, moderately strong, limited, or insufficient scientific evidence. If studies were not available, this was also noted. We found ED triage scales to be supported, at best, by limited and often insufficient evidence. The ability of the individual vital signs included in the different scales to predict outcome is seldom, if at all, studied in the ED setting. The scientific evidence to assess interrater agreement (reliability) was limited for one triage scale and insufficient or lacking for all other scales. Two of the scales yielded limited scientific evidence, and one scale yielded insufficient evidence, on which to assess the risk of early death or hospitalization in patients assigned to the two lowest triage levels on a 5-level scale (validity).

An analysis of Samoan reaction to The Orator (O Le Tulafale)’s Fāgogo defining Samoan identity

The Orator (O Le Tulafale) was promoted as the first Samoan language film shot in Samoa with a Samoan cast and crew. Written and directed by Samoan filmmaker Tusi Tamasese, the film succeeded at several of the movie industry’s prestigious festivals. The Orator (O Le Tulafale) is about an outcast family of a dwarf (Saili), his wife and her teenage daughter. As the main protagonist, Saili battles to overcome his fears to become a chief to save his family and land. The film’s themes are courage, love, honour , as well as hypocrisy, violence, and discrimination. A backlash by Samoans was predicted ; however, the opposite occurred. This raised the following questions: first, what is it about the film causing this reaction? It is a 106 -minute film shot in Samoa about Samoans and the Samoan culture . D espite promotional claims about the film , there have been Samoan -produced films in Samoa . Secondly, to what are Samoans really responding? Is it 1) just to the film because it is about Samoa, or 2) are they responding to themselves , and how they reacted during the act of watching the film? This implies levels of reactions in the act of watching, and examining the dominant level of response is important. To explore this, t he Samoan story telling technique of Fāgogo was used to analyse the film’s narration and narrative techniques. R. Allen’s (1993, 1997) concept of projected illusion was employed to discuss the relationship between Samoans and the film developed during the act of watching. An examination of the term Samoan and a description of the framework of Fa’a Samoa (Samoan culture) were provided. Also included were discussions of memory and its impact on Samoan cultural identity. The analysis indicated that The Orator (O Le Tulafale) acted as a memory prompt through which Samoans recalled memories confirming and defining cultural bonds. These memories constituted the essence of being Samoan. These memories were awakened, and shared as oral histories as fāgogo. The receivers appeared to interpret the shared memories to create their own memories and stories to suit their contexts, according to Facebook postings. An interpretation is that the organic sharing of memories as fā gogo created a global definition of Samoan that Samoans internationally claimed.

"Att peka med hela handen" : En studie om omsorgspersonals upplevelser av makt och kommunikation.

In a report of the National Board of health and welfare they statethat the chief's role in the health care profession, plays a major role in, among other things, their psychosocial work environment and that communication is carrying for the prerequisite to achieve this. In this paper a qualitative study has been made of how protective services workers feel that their work environment is affected by the power situation in relation to the head. This data has been analyzed based on theories of power, communication and sense of context (SOC). The results show that informants feel that the manager's way of communicating is important partly for sense of context (SOC) of their work, but also that it is dependent on communication for power visible or not.

1985-1986 Yearbook

TOC: Life at LaGuardia…3/ LaGuardia At Work…11/College-Wide Activities…20/Mayor LaGuardia…26/Martin Luther King…28/Statue of Liberty…30/Activities and Trips…33/Recreation…52/Student Government and Clubs…56/Faculty and Staff…64/Letters to Graduates…83/Class ’85…87/Class ’86…115/Dedication to the Challenger…156/Boosters and Ads…158 Yearbook Committee: Project Director, VINCENT BANREY; Asst. Project Director, CATHY WHAN; Editor-in-Chief, MARGARET NEISS; Layout Editor, HORACIO OWENS; Asst. Layout Editor, MARICRUZ SAUNDERS; Copy Editor/Captain Editor, UMOJA KWANGUVU; Typesetter, EDWARD HOLLINS; Cover Artist, DAVID VAZQUEZ; End Sheets Photo, YOUNG BAEK CHOI; Finance Manager, GEORGE BERMUDEZ; Photographers: HORACIO OWENS, MARINA DIAZ, MARGARET NEISS, LORI GEORGE, RANDY FADER SMITH, UMOJA KWANGUVU, JUAN SEGARRA, PETER ABBATE, CLASSIC STUDIO; Production Staff: HORACIO OWENS, MARGARET NEISS, MARINA DIAZ, UMOJA KWANGUVU, MARICRUZ SAUNDERS, IRENE LEBRON, ARLENE BANREY, QUAALAN SAMUELS, MAYRA ALDONADO, CATHY WHAN, RAVI RAMDASS, GEORGE BERMUDEZ, BLANCA ARBITO, EDWARD HOLLINS, BRIDGET DAVIS; Feature Writers: YVONNE CANNON AND HARRIET ASCHOFF ("LaGuardia at Work"); GEORGE BERMUDEZ ("Mayor LaGuardia, A Civil Rights Political Leader"); SCOTT ENGEL ("Statue Of Liberty"); JEFFREY DAVIS ("Tribute to Ron Miller"); MARICRUZ SAUNDERS ("Challengers"); CASSANDRA WILLIAMS ("King: The Vision and the Fulfillment").

LaGuardia Insider Newsletter, Spring 1997

- Spring 1997: LaGuardia Community College/CUNY - Editorial Advisory Board for Insider Newsletter: Editor-in-Chief, Randy Fader-Smith: Institutional Advancement, Susan Blandi: Adult and Continuing Education, Stephanie Cooper: Academic Affairs, Bill Kelly:

LaGuardia Insider Newsletter, Spring 1998

- Spring 1998: LaGuardia Community College/CUNY - Editorial Advisory Board for Insider Newsletter: Editor-in-Chief, Randy Fader-Smith: Institutional Advancement, Designer, Dale Cohen, Institutional Advancement, Susan Blandi: Adult and Continuing Education