Multiple endpoints in randomized controlled trials: a review and an illustration of the global test

A randomized controlled trial is often used to provide high quality evidence regarding treatment interventions. Due to the complex nature of many diseases, trials usually select multiple primary outcomes to capture the efficacy of the interventions. In this thesis, we conducted a literature search to determine the prevalence of the different types of multiple outcomes that have been used in randomized controlled trials. We also reviewed the corresponding statistical methods used to deal with such outcomes. In addition, we described the benefits of using global tests as a statistical method when there are multiple primary outcomes in order to answer the global question of whether the intervention is effective. As an illustration for the global test, we used data from a previously published trial in ulcerative colitis. The global tests included O’Brien’s OLS, Lauter’s test and O’Brien’s rank-sum test, and all of the tests used produced statistically significant results with p-values less than 0.05. Global tests should be considered when using multiple outcomes as well as additional guidelines surrounding how multiple primary outcomes should be managed

The early use of botulinum toxin in post stroke spasticity: developing a new approach to contracture management

Introduction Patients surviving a severe stroke are at risk of developing contractures. Evidence suggests that spasticity may be a cause of contractures, particularly in patients who have not recovered functional movement. The relationship and the time course of spasticity and contractures remain unclear. This thesis aims to identify when spasticity can be identified and investigate whether treating spasticity at onset using botulinum-toxin, might slow contracture development. Methods A double blind randomised placebo-controlled trial with an initial six-week screening phase was conducted in an acute NHS hospital. Patients with no arm function (Action Research Arm Test grasp-score<2) within six-weeks of stroke were eligible for screening. Screening for spasticity was carried out using a neurophysiological method. Patients who developed spasticity were randomly assigned to receive intra-muscular injections of 0.9%sodium chloride solution or onabotulinumtoxinA. Measures of spasticity and contracture development (reduced passive range of motion (PROM) and increased stiffness) were taken at the wrist and elbow at baseline, weeks-two, four, six and twelve post injection and six-months post stroke. Results Over a 23-month period, 1143 patients were admitted with stroke and 120 consented to study participation. Of these, 100 developed spasticity without functional recovery 84%(95% confidence interval(95%CI):76%-89%). Mean time of spasticity onset was 13.5-days(SD:8.5). Of the 100 eligible for randomisation 93 were included in intention to treat analysis. At six-weeks, treatment results in a reduction in wrist spasticity (mean difference(MD):4.8μV;95%CI:1.2to8.4;p=0.009), stiffness (MD=4.2mN/deg;95%CI:0.7to7.7;p=0.02) and PROM (MD=13.8o;95%CI:6.1to21.6;p=0.01). At the elbow; four-weeks spasticity (MD=9.8μV;95%CI:4.3to15.4;p=0.001), four-week stiffness (MD=4.8mN/deg;95%CI:-0.1to9.6;p=0.056) and twelve-weeks PROM–(MD=6.5o;95%CI:0.6to12.3;p=0.03). These changes were not maintained at the six-month follow-up assessment. Conclusion Spasticity occurs earlier and is more common than previously reported. Treating spasticity early with onabotulinumtoxinA can reduce the rate of contracture formation. Further work is required to elucidate who is at greatest risk of contractures and to explore if these treatment effects can be sustained with adjunct therapies

Encoding Featherweight Java with Assignment and Immutability using The Coq Proof Assistant

We develop a mechanized proof of Featherweight Java with Assignment and Immutability in the Coq proof assistant. This is a step towards more machine-checked proofs of a non-trivial type system. We used object immutability close to that of IGJ [8]. We describe the challenges of the mechanization and the encoding we used inside of Coq. prover. Our Coq sources are publically available 1. Example. We define a parametrized class Cell, where the mutable instantiation can get and set the interned object, whereas the immutable instantiation can only get the interned object, provided initially in the constructor. We chose to use transitive mutability in this example. 1

The Convergence of British and American Methodism in the South Pacific

There have been several Methodist denominations in the South Pacific, two of which operated under the name "Wesleyan Methodist Church". The first was from Britain in the nineteenth century and the second from America in the twentieth and twenty-first centuries. The latter and numerically smaller of the two, the American Wesleyan Methodist Church, is ultimately the focus of this thesis, but an overview of British Methodism is necessary to provide a context for the emergence of the latter group. This thesis outlines the historic development of the American Wesleyan Methodist Church of Australia from the appointment of its founder, Rev. Dr Kingsley Ridgway, in November 1945 until its most recent National Conference, in September 2015. In addition to the domestic history of the denomination, the development of missions in Papua New Guinea, Bougainville, the Solomon Islands and New Zealand resulted in the formation of the South Pacific Regional Conference of the Wesleyan Methodist Church in 2012. A summary of the regional expansion and the structure of the Regional Conference is included. The motivation for the formation of a second Methodist Church in 1946 was a conviction by some evangelicals that Australian Methodism had ceased to genuinely reflect John Wesley's original priorities. This claim is evaluated by comparing South Pacific Methodism of the twentieth century against John Wesley's statements that Methodism must hold true to his original "doctrine, spirit and discipline" or become merely a "dead sect". The conclusion of this research is that British Methodism, as practised in Australia and New Zealand in the twentieth century, had largely ceased to be recognisable as Wesley's Methodism and that American Methodism, as practised by the Wesleyan Methodists in Australia in the twentieth and twenty-first centuries, also fails to reproduce much of Wesley's spirit and discipline

Physiology students can use a quality improvement approach to support a safe and efficient medication pathway in geriatric rehabilitation

Peer reviewedPublisher PD

Gender-based analyisis plus (GBA+) and Intersectionality: Overview, an enhanced framework, and B.C. Case Study

In this paper, we present an overview of GBA+ and its central components, as well as a case study application of the framework to the question of poverty in the British Columbia context. We begin by tracing the theoretical foundations and development of SWC’s GBA+ tool, touching on the relevance of the framework given broader government goals of diversity, inclusion, and inclusive growth. Next, we consider the limitations and potential of GBA+ as operationalized in Canada, and then build on this analysis to adjust the existing GBA+ tool, with the goals of better incorporating the concept of intersectionality and rendering the framework useful beyond governmental contexts. Finally, we apply relevant elements of the adapted framework in a case study, examining the issue of poverty in B.C. from a gendered and intersectional perspective. Our main finding is that exploring the nature and causes of poverty in B.C. results in a harrowing picture, both of need and oppression, and one that government systems have been complicit in constructing. As a result, the BC Government will need to implement GBA+ frameworks within a context that includes broader reconsiderations of government process, structures, institutions, and norms, with an aim to remove discrimination and bias (e.g., heteronormativity, colonialism, misogyny, ableism). Ultimately, an understanding of both the broad context of systemic pathologies and the barriers associated with intersecting identity factors and social positions that shape individual experiences will be integral for analysts hoping to advance agendas of diversity, inclusion, and poverty reduction, particularly through the development of public policy

Gender-Based Analysis Plus (GBA+) of Two Policy Alternatives: Basic Income and Basic Services

In this paper, we apply GBA+ to two potentially transformative policy approaches—basic income and basic services—to consider their promise in the context of B.C.’s poverty reduction strategy. The core of our analysis is centred on evaluating how each proposal might address poverty in B.C. along intersectional lines, and according to the key dimensions or principles of poverty mitigation and prevention outlined by the B.C. government in its poverty reduction strategy: affordability, opportunity, reconciliation, and social. We also draw on insights regarding the systemic barriers that contribute to greater risk and prevalence of poverty for people whose identities are situated at various axes of difference. We not only consider how the proposals may produce “tangible” outcomes, but also focus on the various ways in which they could transform experiences within and beyond the system of programs, or erect barriers that are not immediately obvious or that may not exist for a “neutral” subject. We demonstrate that the basic income and basic services approaches both have immediate practical value, as well as exhibiting transformative potential, though such impacts largely hinge on how the policies are envisioned and implemented. The most important takeaways from this work are that intersectional groups need access to high-quality public services and, relatedly, that any policy approach that “trades off” services for income will have potentially devastating impacts—particularly for already vulnerable groups

Gender-Based Violence, Economic Security, and the Potential of Basic Income: A Discussion Paper

In Canada, diverse people face violence and abuse at alarming rates as a result of their gender, perceived gender, or gender expression. This phenomenon is referred to as gender-based violence (GBV). Gender-based violence has many manifestations, including sexual assault, femicide, and intimate partner violence (IPV), as well as dowry-related violence, early or forced marriage and pregnancy, female genital mutilation, elder abuse, human trafficking, sexual harassment, cyber abuse, and many other forms, both visible and invisible. Crucially, GBV does not simply occur in the context of inter-personal relationships or as the result of perpetration by ‘bad men’; rather, GBV is a systemic issue that seizes upon and operates through longstanding pathologies and power dynamics—patriarchy, racism, colonialism, and transphobia to name few—rendering diverse people more vulnerable to victimization on the basis of their identity. Strategies, policies, and programs focused on ensuring victims and survivors can achieve economic security will form a vital component of any serious plan to address GBV. On this point there is notable consensus. Less agreement exists, however, when debate begins on the question of which strategies, policies, and programs ought to be implemented. In this discussion paper, we weigh in on this debate through an evaluation of an economic security tool over which there has been much fanfare in recent years: the basic income model. Two questions guide our analysis: (1) to what extent could a basic income disrupt the material conditions and forms of oppression which drive GBV, and thus reduce both risk and prevalence? and (2) to what extent would basic income be an effective support for those encountering/recovering from various forms of GBV? Our analysis is driven by two definitional assumptions about economic security and basic income. That is, we consider economic security to be a state in which criteria for financial security, stability, and continuity are fulfilled, and conceive of basic income as a class of policies that share principles of simplicity, respect, economic security, and social inclusion

La prévention des problèmes sociaux : réalité québécoise

Les modèles de prévention actuels et leurs stratégies d'action contribuent-ils à une diminution importante et durable des problèmes sociaux? La réponse à cette question suppose qu'on examine la représentation des problèmes sociaux, les cibles et les contextes de prévention, la dimension de précocité de l'action ainsi que les stratégies privilégiées. Les développements théoriques actuels permettent d'acquérir une vision liant la résolution de problèmes individuels et celle de problèmes sociaux. Les auteurs dégagent enfin une première esquisse de la prévention sociale. La conjoncture actuelle nous laisse croire à une évolution intéressante de ce secteur dans la prochaine décennie

Managing Airbnb: A Cross-Jurisdictional Review of Approaches for Regulating the Short-Term Rental Market

Canada’s short-term rental (STR) market has grown considerably in recent years, resulting in a heightened focus by local governments on adopting regulatory approaches to manage it. Indeed, since 2018, an increasing number of Canadian governments (largely cities) have introduced regulatory frameworks to both mitigate perceived negative impacts of the STR market, as well as reap some of its benefits. In light of the gap in Canada-focused research on STR regulation, this article analyzes in comparative perspective the regulatory approaches adopted in 11 Canadian jurisdictions in response to the rise of platform-mediated home sharing. We find that aspects of regulation, such as licensing and registration, are increasingly a question, not of “if,” but rather “how” and “to what extent,” with the most promising approaches being those that reflect sophisticated understandings of the range of activity that plays out in the market and the various actors, including platforms and property managers, involved. For jurisdictions looking to introduce or tweak approaches going forward, there is potential benefit in reframing market regulation as a governance issue, rather than a technical legal problem. From this standpoint, of particular promise are joint governance approaches which involve municipalities and other local jurisdictions implementing distinct rules within the context of an overarching provincial framework